╨╧рб▒с>■  ')■   &                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴ ┐jbjbjкjк ╚╚       ]╘╘╘╘╘╘╘  Гъ((((((((@BBBBBB,mЇa |n╘(((((n└╘╘(((└└└(v╘(╘(@шЎ╘╘╘╘(@└t└4╘╘4  $Вэ╢Ю"4Management plan Surgical Repair of Tibia/Fibula: Begin internal fixation with a buttressing plate to span the gap in the bone due to the multiple fragments, which will not allow complete reconstruction of the bone cortices. Surgical approach: Expose bone from metaphysis to metaphysis. Reduce fracture and reconstruct bone cortex. Any bone fragments which cannot be reattached to the main cortex of the bone should be removed. Aluminum template applied to tension surface of bone which has been contoured to fit the bone surface. Plate should be clamped into place. Drill holes in area of intact bone when screws will be placed and secure plate. Do not leave any holes empty in bone. After routine closure the dog should be kept confined to a cage for 1 week. Controlled exercise (leash walking) for 5 weeks on until healing seen on radiograph. Once these signs are seen the dog can be returned to normal exercise. Plate removal recommended 3-6 months after healing only when problems are seen, although since this is a growing dog we should monitor more closely. Plate removal may be indicated in this case. Surgical Repair of Femur: Internal fixation of the fracture using screws and a neutralization plate. The screws will reattach the bone fragment to the main shaft of the femur. The neutralization plate will provide the major stabilization of the fracture. The neutralization plate will transfer the major weight from the fracture site to the intact stabile potion of the bone. Surgical approach: Expose bone from metaphysis to metaphysis. Reduce fracture and reconstruct bone cortex. Any bone fragments which cannot be reattached to the main cortex of the bone should be removed. Attach fragment to the intact surface of the bone using screws. Aluminum template applied to tension surface of bone which has been contoured to fit the bone surface. Plate should be clamped into place. Drill holes in area of intact bone when screws will be placed and secure plate. Do not leave any holes empty in bone. After routine closure the dog should be kept confined to a cage for 1 week. Controlled exercise (leash walking) for 5 weeks on until healing seen on radiograph. Once these signs are seen the dog can be returned to normal exercise. Plate removal recommended 3-6 months after healing only when problems are seen, although since this is a growing dog we should monitor more closely. Plate removal may be indicated in this case. Medical Management: Apply a Fentanyl patch after surgery (will provide 3 days of pain control). Then begin Rimadyl PRN for pain. Continue with Cephazoline. Prognosis: Good prognosis warranting any complications including non-union of fracture sites, tissue rejection., plate erosion, tissue irritation, and thermal conduction of plates. 2hВн ┴ MX¤¤¤¤>* 2фghВш м н ┴ LMX¤√√√√√√√ў√√√√√√Д╨2фghВш м н ┴ LMXYmrТУисх№············░╨/ ░р=!░"░#Ра$Ра%░ [4@ё 4NormalCJOJPJQJmH 2@2 Heading 1$@&5Б>*<A@Є б<Default Paragraph Font            ╪р ! $╩ ╥  ! ? 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