Management Plan/Prognosis

	For treatment of the fracture, we recommend that the femoral fracture be 
Stabilized using internal fixation, while the tibial/fibular fractures are stabilized using 
external fixation.  The internal fixation method we recommend for the femoral fracture is 
a neutralization plate with interfragmentary screws.  The neutralization plate attaches the 
solid ends of each bone piece which allows the transfer of the weight-bearing forces past 
the communitive fracture.   The interfragmentary screws reduce the fracture.   The 
external fixation method we recommend is a Kirschner Splint with the addition of an 
intramedullary pin for extra stability.  The Kirschner Splint involves transcutaneous 
placement of two half pins in the proximal and distal ends of the tibia.  These two pins 
are connected by an external bar.  The intramedullary pin is simply a pin placed in the 
medullary cavity of the bone.  Also, the bone fragments need to be removed due to 
possible necrosis, and autogenic cancellous bone grafts should be done if there are any 
transcortex gaps.
	During the hospitalization for the surgery, we will continue to monitor the 
patient's status by blood and urine analyses.  Proper fluid and nutritional support will be 
provided also.

	Post-surgery, oral antibiotics need to be administered to prevent bacterial 
infection.  Also, the patient needs to be cagebound for one week followed by five weeks 
of controlled leash walks.  At that time, radiographs to assess the extent of healing should 
be done.  If the healing is not complete, the patient will have to continue with the leash 
walks until healing is complete.  Three to six months post-healing, the plates from the 
internal fixation should be removed if problems develop.  The pins should be removed 
once healing is complete.

	The prognosis is good if no complicating infections or further damage occur.  Complete recovery probably will not be evident for approximately six months.