Management Plan

1. Monitoring of patient's hematocrit and/or 
consideration of blood transfusion if hematocrit 
remains 
below 25%
2. Providing patient remains stable and no evidence 
of other internal injury impedes fracture fixation, 
surgical intervention is recommended immediately.  
An internal fixation technique is recommended for 
the mid-diaphyseal, oblique left femoral fracture.  
Following open anatomic reduction (to allow 
stabilization of the largest bony fragment) of the 
fracture, intramedullary pinning shall be applied 
using 
smooth IM pins to avoid stress concentration 
associated with threaded pins.  The fracture site 
will be 
further stabilized with hemicerclage wiring in a 
cruciate pattern to counteract any rotational 
forces 
while decreasing the interference with the bone's 
blood supply often encountered with cerclage 
wiring.  
Compression bone screw placement should be 
considered to secure the large bony fragment at the 
fracture site.  For the mid-distal diaphyseal, 
interdigitating break of the right tibia, external 
fixation is 
recommended to minimize further soft tissue trauma 
and discourage contamination.  Following closed 
anatomic fixation, six centrally threaded pins 
(three on each side of the fracture) shall be 
applied to the 
bone.  Pins will be placed beginning at least 1 cm 
from the fracture site at angles that best spare 
surrounding soft tissues structures.  The side bars 
employed will consist of an acrylic-filled,  
corrugated plastic tubing mold bilaterally.  The 
side bars will be placed at least 1 cm from the 
patient's 
skin.  Daily faucet/hose cleaning of the pin tracts 
associated with the external fixator will be 
required.
3. The patient will be restricted to cage rest for 
at least 3 days post-operative.  The client may 
then begin 
controlled leash walking which is slowly increased 
over 3 weeks.  Unsupervised exercise and play with 
other animals must be withheld until the pins are 
removed.  Radiographic examination of the fractured 
limbs should be conducted in 6 weeks.  Pin and wire 
removal can be done upon solid evidence of bone 
healing.       
4.  Adequate analgesia will be provided, pre-, intra-, post-operatively as well as during 
the recovery period when the animal returns home
5. Antibiotic therapy should be initiated to avoid infection associated with possible contamination during the open reduction and internal fixation procedures

Prognosis

Overall prognosis should be good.  There are several important considerations.  Open 
reduction/internal fixation of the femur allows for increased chance of contamination.  
There is also the possibility for the development of osteomyelitis associated with the 
fixation devices (pins, wire, screws) and pin tract infections occasionally.  Another risk is 
the possibility of secondary fractures associated with the insertion and stresses placed on 
the fixation devices or a compromise to the stability of the fixation.  The blood supply 
must be protected to facilitate new bone formation.  Provided the dog is well supervised, 
however, and its progress is monitored closely for any of these complications bony 
healing can occur smoothly allowing for a full recovery to soundness.