It was a member of the public who rushed Max in on a drizzly Saturday afternoon. Max, a small scruffy dog of indeterminate breed, had run straight out in front of their car, chasing a squirrel. Although they’d stood hard on the brakes, the car had clipped his leg and knocked him over. The member of the public was apologetic and distraught, but had done absolutely the right thing bringing him straight to the vets.
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Urgent first aid and stabilisation
Max was rushed through to be examined by the duty vet as the support staff took down some details. He was scanned for a microchip, and whilst the vet gave him a thorough examination, the support staff set about tracing his owner. Luckily, Max’s owners, Sarah and Kate, had made sure his microchip details had been kept up to date. They answered the phone immediately. They were still out walking, calling for Max, and were both horrified and relieved to find out that he’d been found, but had been in an accident.
When Sarah and Kate arrived at the surgery a short time later, the vet was waiting with the results of her initial examination. The vet highly suspected he’d broken his right back leg, where the car had clipped him. Other than that, he had some minor grazes to his face from the road, but otherwise seemed stable. He’d had some pain relief and was on fluids to counteract the effects of shock and was comfortable, but feeling sorry for himself.
Once they’d seen Max and given him some much-needed cuddles, the vet had a chat about the plan going forward. She recommended a quick ultrasound scan to check for internal trauma, and x-rays to assess the suspected fracture. She explained that although Max seemed fine apart from the leg, some internal injuries can be difficult to spot just on examination; an ultrasound would help rule out underlying problems before sedating Max for x-rays.
FAST scanning
TFAST and AFAST (thoracic and abdominal focused assessment with sonography for trauma) is a swift diagnostic technique used by vets when an animal is presented after a traumatic incident, such as a road traffic accident. It focuses on using ultrasound to spot any unusual fluid in the abdominal and chest cavities which shouldn’t be present. Problems such as bladder rupture, internal bleeding and fluid in the lungs can be found using this method. This valuable diagnostic test provides immediate information for the vet in an emergency situation, with minimal time and risk to the patient.
Next steps
With the scans clear, and the vet happy that Max’s vital signs were all stable, he was sedated to allow x-rays to be taken of his hindlimbs. The x-rays confirmed that his right back leg was broken. The vet explained that the fracture was a serious one; as it was a complete oblique fracture of the femur, with minimal displacement.
Fractures in dogs
Bones can break in multiple different ways. Vets use special terminology when discussing fractures, to convey the severity and to allow for treatment planning.
- Which bone is broken? In this case, Max has broken his femur: the thigh bone.
- Complete vs incomplete: an incomplete fracture is more like a crack, the bone is only partially broken, whereas in a complete fracture the bone is completely broken across the full circumference, creating two or more separate pieces.
- The shape of the break: complete fractures are further classified into their pattern. Oblique fractures go at a diagonal across the bone, whereas transverse fractures are breaks straight across the bone at a right angle to the length of the bone. Spiral fractures are oblique fractures with a twist. Comminuted fractures are those with multiple pieces.
- Displacement: this tells you if the bones are still in alignment, or have been knocked out of their usual orientation
- Open vs closed: an open fracture is where the bone has pierced the skin, or when an object has created a wound and broken the bone. In a closed fracture, the damage is more internal with no outside access to the bone.
Sarah and Kate listened as the vet explained some options for fixing Max’s leg
As the break was in the femur, a main load-bearing bone for dogs; it was important that the fix was strong enough to cope with future exercise and general life. The type of fixation depends on many things; patient factors, such as size and age, the type and location of fracture, the equipment and expertise of the vet (or the possibility of referral to a specialist) and financial considerations.
Max’s vet discussed that for this type of fracture, a bone pin and encircling wire would be a good option, and could be done in their own practice. However, she also gave them some other options for fixing Max’s leg; and discussed amputation as a further option if fixative surgery wasn’t possible.
Fracture fixation in dogs
There are multiple methods of repairing broken limbs in dogs.
- Casts – these are not often used in animals, but some very simple fractures, especially in young puppies, may respond to a cast and strict rest
- Pin and wire: a strong metal pin is placed down the centre of the bone (the marrow) and holds the broken pieces of bone together. Often, wire is used to stabilise the fracture and help the bone to resist twisting forces.
- Plate and screws: the bone is placed in position and a thin metal plate is screwed to the pieces to hold them together
- External fixator: several short metal pins are pushed through the skin into the fragments of bone, and are connected on the outside of the leg by bars and clamps.
If fixation using these methods is not possible, there is a further option of amputation. Some dogs, especially smaller ones, can do well on three legs. And the cost and recovery time are both smaller than with fixation.
Max was comfortable and stable, so Sarah and Kate didn’t have to rush a decision
The vet gave them some estimates, and some advice on the recovery time and after-care that would be needed. The vet advised that even after the cost of surgery, Max would likely need multiple vet visits and follow-up x-rays to check his leg was healing well.
Max was insured, which took the financial pressure off the situation.
Sarah and Kate were keen to go ahead with the surgery. Max’s leg was pinned back together after the weekend, and all went well. After the operation, he stayed at the vets for a couple of days so the vets could monitor his wound, and ensure adequate pain relief. Max, Sarah and Kate were all very relieved when he finally came home. Although Max wasn’t impressed with his new temporary home of a dog crate!
Fracture recovery usually takes multiple weeks, and poor Max didn’t enjoy his confinement. However, his postoperative x-rays a few weeks later were looking very good. And his owners were allowed to start a very gentle exercise regime. The vet recommended hydrotherapy, to help maintain muscle tone and strength in the leg without putting too much pressure on the recently-healed bone. Kate and Sarah were delighted to realise that their comprehensive, bells-and-whistles insurance plan covered some of these sessions too!
Max is now back to chasing squirrels; although his owners are trying hard to work on his recall so he doesn’t have another incident with a car! His extensive treatment was all covered by his insurance, including his initial emergency treatment and stabilisation, the surgery, his post-operative hospitalisation, all of his pain killers and other medications, his x-rays pre- and post-surgery and even his hydrotherapy (note – not all insurance policies cover hydro!). Sarah and Kate are very happy that they decided on such a comprehensive insurance policy for their beloved Max; as they would have been hard pressed to pay such a large and unexpected bill at short-notice.
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Note – details have been changed to protect the identity of Max’s owners.
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