1. Fractures Special Topics

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3. General Overview A fracture is a break or crack in a bone. It is possible to fracture the skull, jaw, spine, ribs, pelvis and digits (fingers) as well as the long bones and small bones of the front and back limbs. Practically every bone in an animal’s body is susceptible to fracture, and some, like spinal fractures, have a higher priority to treat

4. The symptoms that arise with fractures are based on the body part injured and any organ damage. Fractures are usually caused by a traumatic event; however, pathologic fractures can occur from relatively low energy events when preexisting disease such as a tumor or a metabolic bone disease like rickets weakens the bone. Some breeds are also susceptible to particular fractures based on their anatomy, conformation and use (such as hunting or racing).

7. Because of the trauma involved with a fracture, it is imperative that the patient be checked for concurrent or parallel traumatic injuries. The pet should first be evaluated for shock, neurological problems and injury to internal organs.

8. Diagnosis of Fractures Complete medical history and physical examination Radiographs (X-rays) of the affected limb or area Chest and abdominal radiographs to rule out obvious organ injury especially for trauma patients Blood tests to evaluate for systemic organ trauma and diseases or consequences of shock

9. Treatment Depending on the physical status the pet, the veterinarian may temporarily stabilize the fracture by applying a splint, padded bandage or other device. After the patient is stable, definitive fracture repair can be instituted. In some cases, consultation with an orthopedic specialist is recommended.

10. Treatment continued The type of repair undertaken depends on a number of factors: The fracture type and duration The fracture location The presence of multiple bone fractures The intended activity of the patient The patient's age The owner's financial resources and commitment The surgeon's experience

11. Definitive fracture reduction and stabilization involves either closed reduction, in which a cast or splint is applied without surgery. A surgical method may also be an option using some type of metallic surgical implant such as a pin, wire, plate, screw, nail or fixator. The surgical technique often provides the best repair and chance for full return to function.

12. Frequently used implants include: Pin and wires Plates and screws Interlocking nails External skeletal fixators (ESF) ESF utilizes fixation pins that are placed through the skin and into the bone fragments. A series of clamps and bars or rings are used to stabilize the major fracture fragments.

14. Causes of Fractures Fractures are caused by a complex number of forces that exceed the bone's ability to absorb them. Twisting, shearing, bending, compression and torsion all play a role in the development of a fracture. The type of force applied to a bone during trauma in many respects determines the fracture pattern of the bone. Bones are generally stronger when they are compressed compared to when the force pulls (tension) on the bone.

15. Fractures can be classified as closed or open. Open fractures occur part of the bone has penetrated through the skin. Large bone pieces sticking through the skin are obvious indicators of an open fracture; however, frequently the bone will penetrate through the skin and then retract, leaving a hole in the skin. Although an open fracture can be dramatic and emotional, the prognosis is often similar to that of a closed fracture where the bone fragments have not penetrated the skin.

17. Certain breeds are susceptible to specific fractures. Toy breeds that jump from heights are susceptible to fractures in the lower part of the forearm (radius and ulna). Because of the poor blood supply to this area, these fractures tend to recover poorly with cast or splint treatment. A bone plate with screws is generally the recommended form of treatment. Spaniel breeds of dogs are also susceptible to particular fractures surrounding the elbow joint. The end of the humerus may not develop properly in these dogs and they may be at risk for fractures in this area. Because the elbow joint is involved, early treatment is warranted.

18. Performance dogs (greyhounds) are particularly susceptible to certain injuries associated with their role in life. Compression injuries occur in the lower extremities according to their direction raced on the track. Digit, hock and carpal injuries seem to predominate.

19. Types of Fractures There are four commonly seen fractures in the dog: Closed Compound Epiphyseal (growth plate) Greenstick (hairline). These first three types can be further characterized by whether they are simple fractures in which the bone breaks into only 2 or 3 pieces, or comminuted where the bone shatters into many pieces.

21. Closed Fractures: Closed fractures are those in which the skin is not broken. The bone is fractured, but the overlying skin is intact. Greenstick Fractures: Greenstick fractures are small cracks within the bone which leave the bone basically intact, but cracked. In other words, the bone is not completely broken.

24. Compound Fractures: Compound fractures are breaks in which the broken bone protrudes through the skin, and is exposed to the outside. Compound fractures are risky in that the bones can be contaminated with dirt and debris, resulting in an infection.

26. Epiphyseal Fractures: Epiphyseal fractures are commonly seen in young, growing dogs. In animals less than one year of age, there are soft areas near the ends of each long bone where growth takes place. These soft areas are referred to as growth plates or epiphyseal plates. Because these are areas of growth, they are rich in immature non-calcified cells that form a soft, spongy area of the bone. These growth plates are more easily fractured because they are the weakest part of the bone. The distal ends of the femur (thigh bone) and humerus (upper front leg) seem to be particularly susceptible to this fracture.

28. Fracture Management Just as in human medicine, splints, casts, pins, steel plates and screws can be used to realign the bone and allow healing. The treatment depends on the type of fracture, age of the dog, and which bone is broken. Compound fractures in which the risk of infection is high are treated differently than closed fractures. Growing puppies may heal in as little as five weeks, and because of their size they put less weight on the bone. Therefore, a fracture in a young puppy may be treated with a cast but the same fracture may need to be 'pinned' in a geriatric (senior) dog in which healing may take twelve weeks or more. Hairline fractures may only require rest, while surgical intervention will usually be needed in more severe fractures. Careful evaluation by a veterinarian will determine the proper treatment.