The specialty exams we expected to see were radiographs of the pelvis and both hind limbs plus 
chest radiographs and abdominal radiographs.  We also expected to see bloodwork (CBC and 
chemistries) along with a urinalysis.  (There was no WBC total count given and the rest of the WBC values were in percentages which are all relative and of little use without the means to change them to actual values.)  Other exams we thought would have proven useful were 
ultrasound of the abdomen to look for internal damage of organs and an ECG of the heart.  

Not seeing the ultrasound and ECG was not unexpected.  These exams could be decided upon 
after reviewing the radiographs, bloodwork, and urinalysis and may prove unnecessary.  
However, chest radiographs (to look for pneumothorax, pneumomediastinum, hemothorax, 
atelectasis, diaphragmatic hernia, etc) should have been taken along with abdominal 
radiographs.

We expected the urinalysis would help establish whether or not Ramon had a functional bladder.  
Also, many substances can be filtered or spilled into the urine that would help clue us in to certain 
areas to be concerned about.  On the radiographs of the pelvis and hindlimbs we expected to see a 
fracture of the right tibia and left femur.  This was based on the orthopedic exam.  We also 
believed the pelvis may have been involved with either a fracture or luxation of the femur.  

Interpretation of specialty exams:

Radiographs: 

The radiographs revealed a mid shaft fracture of the left femur and a fracture of the right tibia and 
fibula just distal of midshaft.  Free bone fragments were visible in all 3 fractures.  All 3 fractures 
were comminuted fractures.  It was hard to evaluate soft tissue swelling from the internet pictures, but 
there appeared to be some significant soft tissue swelling of the right hind limb along the length 
of the tibia.  I really couldn't tell about the soft tissue swelling on the left limb from the pictures, but 
from the physical we knew there should be soft tissue swelling of the entire limb.  There was no 
visible joint involvement in any of the fractures.  There was no radiograph of the pelvis so it 
could not be determined whether or not there was any damage to it.  In the lateral view of the 
femur we could see a little of the pelvis and what we could see of the pelvis looked normal.

Bloodwork:  CBC and Chemistries

The only values outside of normal limits were an increase in glucose, neutrophils, and ALP, and a 
decrease in sodium and chloride and hematocrit.  

The increase in glucose and neutrophils was expected due to a stress leukogram from the 
traumatic hit by car, the corticosteroids that were administered could also be adding to the stress leukogram findings.  An increase in ALP is most likely due to the large dose of corticosteroids 
the dog was given.  In dogs, corticosteroids can induce ALP.  A decrease in both chloride and 
sodium can occur with bladder rupture (however, there we no other lab findings to support this such as hyperkalemia or azotemia), it can also occur with GI losses or wound losses but you 
won't see hyponatremias unless the animal is rehydrated with a sodium poor solution.  The 
decrease in hematocrit would be explained by the hemorrhage from the HBC 3 days ago. 

Urinalysis:

The urine was normal except for a small amount of blood probably due to trauma to the 
urogenital tract from the impact of the vehicle There were a few bilirubin crystals and amorphous 
crystals which are clinically insignificant findings.  A small amount of bilirubin in a dog's urine 
can be normal as can be a few amorphous crystals.