Management Plan:

Fracture Repairs- 

Left Femur: Due to the nature of the fracture, the size of the dog, and the fact that both hind legs are fractured internal fixation to repair the femoral fracture using a bone plate and lag screws is the best option. The wedge fragment will be screwed back into the proper place and the smaller fragments if found should be removed. The ends of the femur will be plated together on the lateral side of the leg.  In addition, any gross injury to soft tissue structures should be repaired.

The second less desirable option would be to apply a Schroeder-Thomas splint to the tibia.  Intramedullary pinning may not be adequate due to the size of the dog and nature of the fracture.  

Right Tibia options:

The best option considering the size of this dog and the fact that both hind legs have been fractured is internal fixation using a bone plate. The plate should be fixed on the medial surface of the bone to ensure stability. Screws will be placed in the cortex of each segment of the bone.

A second option would be to apply an external fixator to the tibia in combination with an intramedullary pin.  This method would reduce the cost of the repair in addition to preserving the soft tissue surrounding the fracture thus causing less contamination of the fracture and maximizing healing.  

The third and cheapest  option would be to apply a Schroeder-Thomas splint to the tibia.  

Post operative plan:
Radiograph both affected limbs immediately following surgery to ensure proper alignment and fixation.  
The dog should be confined to a cage or a room for 1 week following surgery, and then exercise must be controlled on a leash for the next 4-6 weeks.  At this point,  the dog should be rechecked to re-radiograph the fractures and then depending on the progression of bone repair the decision can be made as to when the dog can return to normal physical activity.  In addition, if the external fixator was chosen for the tibial fracture then removal of the device can be accessed at this point.

Pain Management:
A Fentanyl patch will be applied for analgesia BEFORE surgery to ensure that the drug will be in effect by the time the animal recovers from surgery. The Fentanyl patch should last approximately 3 days. The client will need to return to the clinic in 3 days then for the patch to be removed since it contains a controlled substance.  Rimadyl or Etogesic should be used in this dog as an anti-inflammatory and analgesic. 


Prognosis:
If plating is used this dog has a good prognosis and should make a full recovery.  The prognosis is less certain with the more conservative methods of fixation.


Note:  If  we are a country mixed animal practice with limited capabilities the surgeries described above may need to be referred to a specialty practice.  Furthermore, if the clients are not financially capable of such procedures a conservative approach may need to be taken.  While this greatly reduces the chances for ideal repair, the femur and tibia could theorectically be stabilized with Schroeder-Thomas splints, Robert Jones bandages, or casts if no other options are acceptable.  However, since this dog has bilateral fractures client maintenance of the dog would be extremely high and may result in permanent limb deformities.