Orthopedic Trauma

Dogs and cats have skeletons that are similar to ours.  The bones of their skeleton can break (fracture) for many of the same reasons that our bones break.  These can include sporting injuries, fights, falls, motor vehicle trauma, underlying bone diseases (pathologic fractures), and other unwitnessed trauma.  Also similar to people, dogs can experience strains, sprains, and tears of ligaments, tendons, and muscles.  These can be related to chronic overuse or sudden trauma and the initial signs of these injuries are often indistinguishable from the signs seen when a bone is broken. 

Signs of broken bones or injured tendons/ligaments can vary depending on the location of the injury, but may include severe lameness, holding up a leg, swelling, pain, or abnormal movement or angle of a limb.  However, some animals will  bear weight on a broken bone or damaged joint depending on the location or type of injury.  At the opposite extreme, major trauma (such as motor vehicle trauma) may lead to multiple orthopedic and soft tissue injuries, and these pets may be  unwilling (or unable) to get up or move around at all.  Major trauma that causes broken bones or torn ligaments/tendons may also damage internal organs (lung bruising/puncture, internal bleeding, bladder rupture) that may be more critical and require treatment or evaluation prior to treatment of the fracture.

Some diagnostic tests are needed prior to repair of a fracture or joint injury.  These can vary depending on the injuries of the individual pet, but generally include radiographs (x-rays) of the injured body part and blood work to evaluate organ function prior to sedation or anesthesia.  In pets with major trauma, additional diagnostics may be needed to more thoroughly evaluate for internal injury.  These tests may include chest radiographs, abdominal radiographs, or abdominal ultrasound.  In cases of spinal injuries or when more complex fractures are present, a CT scan or MRI is typically recommended.

Treatment of broken bones or joint injuries can be divided into four steps:  1) initial at home treatment, 2) temporary stabilization,3) definitive stabilization and 4) post-operative care.

1) At home treatment:  Dogs and cats with orthopedic trauma should be seen as soon as possible by your veterinarian or an emergency veterinarian in your area to evaluate the injuries and treat pain. While you are preparing to transport your pet, he or she should be confined to a small area (crate or very small room) to limit motion. Care should be taken during any movement of your pet, because he may bite or injure a family member due to being in significant pain. You should not give any medications or apply anything to the injury site without consulting your veterinarian because in some cases this can cause further injury.  It is important to remember that many over the counter human medications can be harmful or toxic to your pet.  If you are not able to bring your pet to a veterinarian immediately, please call for instruction.

Closed fractures (no skin wounds at the location of the broken bone) should ideally be treated within 2-4 days of the injury.  Open fractures (skin wound over location of the broken bone with or without exposure of bone) ideally need initial cleaning within 8 hours of the injury to prevent deep bone infections, but final treatment is often delayed for 1-2 days to allow wound management to start.  Tendon or ligament injuries may be stabilized externally for a period of time prior to definitive treatment.

2) Temporary treatment:  Temporary treatment usually involves immobilizing the injury site until definitive stabilization can be applied.  Injuries below the knee and elbow are often immobilized using a bandage with a splint inside it.  Injuries above the elbow and knee are best immobilized with slings to prevent weight bearing or just confinement to a small cage or kennel.  Pain management is also very important at this stage.  Depending on the injuries, some pets can be comfortable on oral medications and be discharged from the hospital while awaiting definitive treatment while other pets may require intravenous pain medications in the hospital to keep them comfortable.

3) Definitive treatment:  The goal of definitive fracture treatment is to reconstruct the bone and return it to its normal position (reduction of the fracture) and then hold the bones pieces in this position (stabilization) for 6-12 weeks while the bone heals.  Ultimately the method chosen to stabilize a fracture must be able to resist the forces that your pet would place on their normal bone during activity.  These include bending, twisting, compression, and pulling.  The final choice of the device(s) used to hold the fracture ends still will depend on many factors.  Things that we will take into consideration include the location and shape of the broken pieces, the age of your pet, the health status of your pet, the activity level and expected level of function of your pet, and the home environment.  Once we have considered these factors, several options may be available to you.  Your final choice may take into account your finances as well as your ability to adhere to the post-operative care and recheck schedules.  It is important that you discuss with your veterinarian any concerns you may have about the needed post-operative care and recheck schedule during the initial evaluation.  This will allow us to help you make the best decisions for your pet.  There are three main types of definitive treatment – external coaptation, external fixation, and internal fixation.  Sometimes more than one type of definitive treatment may be needed for a single fracture (condition). 

- External coaptation:  External coaptation is the use of a splint or cast inside of a bandage for definitive treatment of the fracture.

- External fixation: External fixation uses pins or wires that are placed through the skin and into the bone, but protrude outside of the skin.  The pins are connected by rigid bars or a hardened moldable putty outside of the skin to hold the bone pieces stable.  The pins and bars are removed when the bone is healed leaving no remaining implants.

- Internal fixation: Internal fixation uses traditional bone plates, interlocking nail, screws, pins, and orthopedic wire that are placed directly on or inside the bone.  If no complications develop, these implants are left in place under the skin after the bone is healed.

Similarly, the goal with treatment of joint injuries is to reconstruct or replace the supportive tissues to realign and stabilize this joint.  Alternatively, some joint injuries are treatment with temporary or permanent joint fusion (arthrodesis).

4) Post-operative care:

Bandage care – Some types of fractures need bandages, splints, or casts for final treatment or for support following a surgical repair.  These bandages are effective tools for fracture healing and pain control, but it is important to realize that they can also cause serious complications.  Approximately 60% of dogs placed into a splint can develop some sort of wound under the splint.  Careful monitoring and maintenance is required for safe bandage wear to help prevent and manage these complications.  To prevent problems, monitor the bandage daily and contact your veterinarian for a bandage change if any of the following are noted:

1. Swelling of the toes or of the leg above the bandage

2. Any soiling or wetness

3. Any change in position or shape of the bandage on limb

4. Any signs of excessive discomfort

5. Chewing of the leg/bandage

6. Any sores that develop at the top or bottom of the bandage

7. Any unusual or bad odors coming from the bandage

The bandage must be kept clean and dry.  A plastic covering (IV fluid bag, baggie, bootie, Medipaw) MUST be placed over the bandage every time your pet goes outside to protect the bandage.  Remove the plastic covering when your pet is inside.

You should not modify the bandage or splint in any way at home.  Adding tape or other wraps can seriously compromise the safety of the bandage.  If you notice problems at home, please return to your veterinarian for a bandage change.

Regular bandage changes will be scheduled during the splinting or casting period.  It is important that you follow this schedule and discuss any needed alterations to the schedule with your veterinarian in advance.

Activity restriction – Confine your pet as directed by your veterinarian.  This can be the hardest part of the recovery period and most pets will feel like fully using the leg long before the fracture has healed.  Dogs can be confined to a crate, a playpen, or a small room depending on the size of the dog.  Dogs should be on a leash at all times when outside of this confined area including when they are taken outdoors to use the restroom or to do physical therapy.  Cats are best confined in a large dog crate with enough room to place a litter box as well as food and water inside the crate.  Cats can also be confined to a small room, but they are more likely to jump onto surfaces so all furniture must be removed and there should be no ledges that the cat can reach. It is important that you continue to restrict your pet throughout the healing period as directed to prevent implant and bandage complications that can be severe and, in some cases, can lead to additional surgical procedures.

Physical therapy – Physical therapy may be helpful or needed for some fracture or ligament/tendon injuries and repair options.  Your veterinarian will talk with you about home or professional physical therapy options if they are indicated for your pet.