Management

	Because this patient is a large animal and because of the severity of the fracture, repair options are limited.  

1.  Euthanasia   This bull may never heal correctly or at all because of possible existence of a sequestrum, possible osteomyelitis, compromised vascular supply common to this type of fracture disruption of the physis and the length of time that it was left untreated.  If it does heal, the possibility of him becoming a sound pasture breeding bull seems unlikely.  

2.  Splinted Bandage   Because this fracture is classified as a hypertrophic delayed union it does not need to be rebroken before being rebandanged.  Simple bone alignment with a splinted bandage which prevents instability will allow the growing bone callus to reconnect the two fracture sites.  A splinted support bandage distal to the elbow permits weight bearing on the walking bar and allows moderate stability.  Putting on a bandage instead of a cast will allow daily changes that are necessary due to the draining tracts.  This should be a half limb bandage extends up to the middle or proximal 1/3 of the radius.  Only the claws of digits 3 and 4 should protrude distally.  The metal rod-walking bar should extend to the ground in order to distribute the animal's weight to the splint instead of the broken bone.  

3.  External Fixation   External fixator stabilization of open fractures allows easy access to the wounds to allow for topical debridement and drainage while holding the fracture stable.  We would not want to use internal fixation as this will spread the existing contamination to the rest of the leg.  In addition, external fixation spares local tissues, bone fragments and vascular supply which is often compromised with this type of wound.  The loss of skin also discourages the use of internal fixator devices.  In this patient we would use transfixation pins with an acrylic sidebar support.  Ideally, we would like to place three pins above and below the fracture site on the metacarpal bones.  This may be difficult because of the small amount of bone below the fracture site.  We need to assure proper alignment of the bone fragments and need proper spacing to spare tendons, arteries, veins and nerves.  The clamps, which attach the pins to the sidebar, are the weakest link.  Acrylic sidebars are preferred over metal sidebars because they allow flexibility in pin placement.  This method is preferred in large animals due to its minimal post operative care.  


In situations 2 and 3 this calf needs to be administered antibiotics to treat the infection.  The best antibiotic for this calf is Naxcel which is a second generation cephalosporin.  This should be given IM BID for 4-6 weeks.  Minimal pain management should be given so that the calf stays non-weight bearing on the injured limb.