April 4, 2019

Orthopedic Emergency Treatments

Orthopedic Emergencies…is there really such a thing?  Ya, ya, you betcha!  How can you be a joint or a bone’s best friend?  Read on…

Part 1.  Joint luxation

The longer a joint is luxated, the poorer the prognosis for two general reasons.  First, hyaline cartilage is very picky when it comes to its environs.  It wants joint fluid and only joint fluid.  No serum, no blood, no PMNs, and certainly no fresh air.  And second, the longer (time) the support structures are discombobulated, the longer (length) the joint structures end up being.  Say goodbye to a nice tight joint.

So, when that patient comes in with a luxated hip or elbow or hock, put it back in its happy place that same day (if anesthesia can be tolerated.)  Most luxations need a high dose of an analgesic and a low dose of an anesthetic to get the work done.  Remember that narcotics/opioids are one of the safest drugs we have on several important fronts– cardiovascular, renal, hepatic.  Once that is on-board, a little bump with propofol  (followed with intubation/gas anesthesia as needed to lengthen the time interval to work), is all that is needed.

Hip Tips:  Learn The Triangle for your routine exams– very simple, VERY rewarding.  Hip luxations (both kinds) are a physical exam diagnosis…long before xrays are needed.  Most/all surgery textbooks will have a diagram, but briefly…

There is a triangle (“obtuse triangle”?) formed by lines between the following:  1) craniodorsal iliac spine and ischial tuberosity; 2) craniodorsal iliac spine and greater trochanter; 3) ischial tuberosity and greater trochanter.  Have the dog lying in lateral (but, I suppose you could do this standing too…)  With one hand, I put a digit on the craniodorsal iliac spine (most prominent palpable portion of wing of ilium) and one digit on the ischial tuberosity (most prominent palpable portion of ischium); with the other hand put a digit on the greater trochanter.  Imagine the triangle you create with those landmarks.

Now, in a normal pelvis and hip joint, the trochanter is below the long dorsal line imagined between the ilium and ischium, and at the 2/3rds caudal aspect of that line.  An obtuse triangle.

In a craniodorsal hip luxation (most common kind, but not exclusively so…know the other!), the triangle will be imagined differently when you put your digits on your landmarks.  The trochanter will be ON the long dorsal line imagined between the ilium and ischium, and at the 50% mark smack dab in the middle.

In a ventral hip luxation (common in older dogs, low-level traction trauma, “did the splits” or caught leg in leash), the triangle will be hard to imaging.  The trochanter is nowhere to be found!  If you push deep, you may feel it dimpled in, well below the dorsal line between ilium and ischium.

In a pelvic fracture, well, all bets are off!  Usually you will have a shorter line between the ilium and the ischium (when compared to opposite side; unless bilateral crunch); acetabular fractures make the trochanter disappear too, but usually are accompanied by shorter/asymmetric ilium to ischium line.

 Hip Tips:  (CranioDorsal Luxation)

  • Sling a leash/strap thru the groin and have an assistant put counter traction while you pull on the leg. Pulling is relative; big dog, big pull and I mean big.  Hang on to it a few minutes.  Cat, well, not so much, but still playing tug-o-war a bit.
  • Disengage the luxated head with strong, steady traction with the legs together (adducted) and the knee pointed skyward (external rotation). I hang onto hock and stifle to pull.
  • Reduce in one sweeping motion maintaining traction, rolling the head in (internal rotation) and spreading the legs apart (abduction).
  • Keep one hand or an assistant’s hand on the trochanter to “feel” your way thru that sweeping motion. They need to participate and not get all squeamish and silly.
  • Once it is reduced (CHECK YOUR TRIANGLE), apply pressure on the trochanter and spend a good five minutes “grinding” the hip into the socket thru range of motion (this pushes the torn joint capsule, blood clots, etc. out of the acetabulum.) **Don’t do this if it is not “in”.
  • Don’t just drop the leg and walk away; full adduction will pop it right back out. Keep it held slightly abducted or prop it on a rolled towel while you get sling supplies ready.
  • A sling is an option if the head has a tendency to want to stay in…this is an art, so you’ll just have to play with a few and see. Remember, you can always reluxate it when testing  The question is, does it “want” to stay in?
  • Sling it and then send it for internal surgical reduction/stabilization, as indicated.
  • Even small dogs and cats do better with their own hip (versus an FHO). Let’s save some hips!

 Hip Tips:  (Ventral Luxation)

  • Their leg is very straight, sometimes the patella is luxated laterally because the leg is so rotated.
  • Your technicians will screech and say “something popped when we took the VD.” (Congratulate them, cuz they just reduced the luxation!)
  • Indeed, reducing these just requires caudal traction, like you are taking an OFA film. (Give the poor dog/cat some pain meds/narcotic first!)  Extend hip and push the upper femur where you would check for a pulse.
  • Stabilization requires hobbles not a sling. Hobble the hocks hip-width apart.

 Elbow Advice:

  • These hurt. Get them done quickly and use the narcotics to allow enough relaxation.
  • The elbow is the most unforgiving joint of all; reduce it!
  • Open the book and follow the instructions; seems highly technical, but it really is simple.
  • This is a finesse one…no brute force.
  • Splint it in extension and send it for surgical evaluation of collateral ligament.

Hock Hints:

  • Hocks are usually open luxations. Clip and clean well with copious saline/LRS lavage (use a bag or two).  Mask and gloves and clean work area; we don’t want hospital bugs in there.
  • Reducing is pretty easy; nothing technical, no force needed.
  • These will need surgical stabilization.
  • Splint and manage the wounds actively so they are a good surgical candidate.

A note on custom splints vs. off-the-shelf splints:

There are a plethora of splints of various shapes and sizes you can buy and stock, or you can buy one product that “fits all” and actually works much better with fewer bandage complications.  All too often, the stuff you have in stock is the wrong size, wrong shape, and difficult to trim (so you don’t); and your stock probably takes over 10yrs to cycle thru.  So, I’d like to propose an easier option.  Buy 3″ casting tape from 3M (buy local!).  You can make a custom-fit splint in less than 3 minutes with some exam gloves and a dogbowl of warm water.  No cast cutter needed, no special supplies, minimal learning curve.

Most splints are either lateral or caudal…well, now that I think about it, 100% fall in those two locations.  You’ll be right at least 50% of the time– so, no stress!

  • Foot– caudal
  • Carpus/antebrachium– caudal
  • Elbow– lateral
  • Hock/stifle– lateral
  • Spica– lateral

To make a casting tape, custom splint, you will need the product, a bowl of tepid (i.e. lightly warm) water deep enough to submerge the roll, exam gloves to keep the goo off of your fingers and your assistant’s fingers, scissors and roll gauze/kling.

Start with a snug cast padding and roll gauze/kling bandage bridging the offending site.  Make sure you have read thru this and have the plan in your head and explained to your assistant; time is important here…no futzing around.

Don your gloves.  Open the casting tape, hold it in one hand and dunk it into the bowl of water.  Give it a gentle pinch/squeeze to burp some air out and let the water penetrate– 5 seconds.  Remove it and give a gentle squeeze and shake to remove some water.  Get moving.

The easiest way to make the splint is NOT on the animal.  Use the bandaged leg only to get the length you need…unroll the casting tape to appropriate length, then hold it up and start unrolling and folding the tape– stacking the folds on themselves to the thickness of layers you desire.  (More about this below.)  Cut off the excess if appropriate.

Now, simply lay it on the bandage (laterally,or caudally with some fingers gently holding it in place for you).  Do NOT poke fingers in the casting tape or make impressions of any kind; these translate as bumps on the inside and pressure sore potentials.  Immediately start to apply the roll gauze/kling to custom form the splint to the bandaged leg before it hardens.  Remember, NO finger marks/indents.  Support the casting tape broadly with a cupped hand as needed.  Snug the roll gauze to conform the soft casting tape as you go.

Once you finish the gauze at the top of the bandage, shape the leg appropriately before it hardens (flex the toes/foot a bit, extend the carpus a little to a standing angle, extend the elbow, flex the hock a tad).  Remember, NO finger marks; just use the broad surface of your hands to shape and hold while it hardens.

Once it is hard (just tap on it over the next 2-3minutes until it is hard), allow it to air dry a 2-3 minutes, then apply your vetwrap.  I also add a patch or two of elasticon to the walking surface of the foot area to reduce premature wear.

A short commentary on splint rigidity–

Most splints are overkill…inappropriately so.  This is especially true in small breeds.  The 3# yorkie does NOT need a splint bigger than its leg that weighs more than it body!  I hesitate to give a body weight cut off because the rigidity issue is more related to the size of the bones/leg and less concerned with the body weight.  So, roughly speaking, dogs/cats weighing less than 10# will be supported sufficiently for joint and fracture issues with a custom tongue depressor splint.

Yes, tongue depressors.  You have them in your clinic, they cost next to nothing, and they do not result in overkill complications (stress protection, impaired mobility, pressure sores, etc.)  To make a custom tongue depressor splint, you will need one or two tongue depressors (depending on leg size) and 1″ white tape.  See https://directvetsurg.com/ortho-tips-tricks-sept-2018/

Caudal splint:  For tiny dogs/cats/puppies/kittens, split the tongue depressor in half lengthwise.  (Just break it with your fingers; it will split roughly in half.)  For regular sized small breeds/large cats, use two whole tongue depressors.  In either scenario, tape the two items together (back together, if split) using 1″ white tape applied in a smooth spiral with overlapping edges down the length of the tongue depressor(s).  Trim the length appropriately with scissors (yes, regular bandage scissors will cut tongue depressors.)  Gently bend the splint into a V-shape to accommodate a caudal limb application; apply over a prepared bandage of cast padding/roll gauze using another layer of gauze, then vetwrap.

Lateral splint:  Cut lengths of tongue depressor to mimic the length of each segment of the leg (i.e. for rearlimb/hock, cut a length matching the foot, then another matching the crus/shin.)  Tape these two together in the shape/angle you want…roughly standing angle.  Do not make it a big bulky wad o’ tape; do like the hockey players do with their hockey stick tape…nice and tight and smooth.

When making a casting tape splint, do NOT feel compelled to use the entire role of casting tape.  Stop when it is thick “enough”.  Sorry, can’t help too much from afar on that one.  Start making them and feel how stiff/flexible they are.  Adjust and learn from there.  The only ones I have had problems with being too wimpy are large/giant breed dogs (approaching/exceeding 100#) when they have had to wear them for extended periods for nasty things like complete carpal hyperextension injury, and the owners have not been compliant with activity restriction.  These start to bend at the carpus.   Reinforcing with a “rebar” of aluminum rod buried in between casting tape layers works well for these.

Good luck, have fun, and let’s go SAVE SOME JOINTS, TEAM!!

Orthopedic Emergencies…take two.  In the previous section, we took a look at (and pity on) joint luxations.  Take away message, “Get those things reduced ASAP and use lots of narcotics to get there”.  Now we turn to our most common ortho emergencies, the fracture.  With a standard bandage supply stock and a little attention to detail, we can give all of our broken patients a bit of relief.   Read on…

Part 2.  Long Bone Fractures

The longer a bone is fractured without proper immobilization and stabilization, the longer an animal suffers the consequences.

Consequence #1:  A flopping fracture is painful (and it makes a lot of PEOPLE nauseated to watch!); an immobilized fracture is comfortable, for everyone.

Consequence #2:  A fracture dancing around in soft tissue is like the head chef at the local teppanyaki restaurant preparing your meal–have you seen what those chefs can do with a couple of cleavers?

Consequence #3:  Take pity not only on the patient, sure;  but how about the sorry cuss who has to repair that fracture?  The longer the leg remains foreshortened with overlapping fragments, the tighter those muscles surrounding the fracture get.  This early contracture– hours to days– brings lots of lactic acid to the muscles of the surgeon attempting open reduction and stabilization!  Never mind the over-stretching and trauma that can result in the muscles being re-lengthened during surgery.

And, consequence #4:  When a fracture is allowed time to go it on its own, with improper immobilization or markedly delayed rigid stabilization, a malunion will result.  This typically manifests as two joints, those above and below, being at odd angles relative to each other.  This alignment problem renders the leg useless and/or chronically painful.

So, when that patient comes in with a fractured femur, tibia, humerus or radius, throw some bandaging supplies and skill at it that same day (if anesthesia can be tolerated.)  The pain of an acute fracture can be ameliorated well with a stiff dose of an analgesic to get the work done.  Remember that narcotics/opioids are one of the safest drugs we have on several important fronts– cardiovascular, renal, hepatic.  Once that is on-board, immobilization can proceed, with maybe just a little bump with propofol to get past the most painful, initial stage.

Common message for all long bone fractures:  Immobilize the joint directly above and below the fracture.  Point to each of these when you are done, and make sure each is well covered by your immobilization masterpiece!

And another strong take-away message from this communiqué is to forget about the off-the-shelf splint options out there (waste of money and space), and go with 3M casting tape (3″).  You will be well served, need only keep 2-3 rolls in-stock, and will have more fun splinting patients.

Tibia Tips: 

  • A tibia splint is applied laterally.
  • Use more padding around the bony parts and less around the muscle-y parts. No need for a gargantuan splint…2-3 layers of cast padding, snugly applied, will do.
  • When immobilizing joint above and below the tibia, the hock is easy. Stifles, on the other hand, are tough (especially in brachycephalic and highly muscled breeds; the thighs get in the way.)  Your goal should be to create a bandage that is closer to the shape of a sausage than a funnel; you will see less sliding down if there is NOT a narrow zone below the stifle.
  • The off-the-shelf rearlimb splints (clear plastic, sorta shaped like a rearlimb) are badly designed, hard/impossible to trim to proper size, commonly lead to pressure sores around the foot and hock, and promote sliding of the whole apparatus below the stifle. The result is a big bandage hinged at the tibia fracture side and swinging like a pendulum.     They look pretty on the shelf, but not worth the money.  **IF you are using them, please have someone figure out how to trim them to size properly.

 Radius Rumors: 

  • Probably the easiest; a radius splint is applied either laterally (for a midshaft or higher) or caudally (for a distal 1/3 fracture). A very distal radius fracture probably does not need the elbow included as “the joint above”; I’m a rule breaker and lovin’ it!
  • The most common overkill site! In a toy breed, the splint should not weigh more than the dog!  To do this properly in a toy breed, you will need to cut your supplies down to 1″ (cast padding and vetwrap; its quick, see below) and make your own splint (modified tongue depressor; see below)
  • Zone of pressure sore: cranial elbow.  Do not tape with elasticon around the elbow (elasticon is the devil…in most applications).  Take the bandage well above the elbow (and advise owners to monitor site for slip and pressure) or stay below elbow (and pre-test for pressure by flexing elbow fully when splint first applied).
  • Zone of pressure sore: caudal point of elbow (olecranon).  Do not carry your splint up/over the point of the elbow.  Stop just short for caudal splints.  No amount of padding will prevent a decubitus ulcer on the olecranon that hurts and takes forever to heal.
  • Immobilizing the elbow is hard. It just is.  Not much room up the upper arm, high motion site.  So, accept this, work hard to get the bandage as high as possible, and then monitor, monitor, monitor!  Explicitly point to site (maybe even make a cute little vetwrap “sign” to label it!) and tell owners to watch the location for slippage.  Return if slipping.


Femur Factoids: 

  • Hips are hard; the proximal joints do not cotton to immobilization (intentional pun there!) To prevent the femur from dancing around the femoral artery, you have two immobilization choices.  There are risks and benefits to each, just like there are risk and benefits to letting it swing.
  • A spica splint incorporates the body, thus reducing movement of the upper joints (hip and shoulder). It also takes lots of bandaging supplies to make it right.  The best analogy is a candy cane…hook the cane over the back and incorporate it in wraps around the trunk.  The “cane” can be a creative undertaking.  I’ve used rolled up office paper from the recycle bin, aluminum rod, 3M casting tape, wire hangers.  If it is stiff (relative to the dog size) and can be shaped into a “cane”, off ya go.
  • A non-weight bearing sling will bring the entire leg up close to the body to minimize flopping of the fracture. It is similar to an Ehmer sling (anyone out there like that technique?  Ha!), but no need here to abduct and internally rotate (again, ha!).  The goal is to flex the naked limb up to the haunch and wrap it there like a little package.  Over-flexing of the knee and hock will itself hurt, so allow a little give to those joints as you strap up the leg.
  • The Male Dog Problem: Next time you see me, ask me about my “foot in mouth” episode standing over a GDV surgery in a male dog with two male students in my residency!   Nutshell, the prepuce/scrotum get in the way…in this case, of immobilizing the femur using either technique.  Just a pain in the neck.  Either you can work around them, or you can’t.  Each dog size and shape are different, so devise our fracture plan accordingly.
  • The location of the fracture and its character help with decision-making. A distal Salter I of the femur (for example) is an absolutely great fracture to reduce and immobilize with a splint right after it happens.  Often these will correct/reduce themselves (close(er) to perfect) in the splint, or at the very least will not turn into an articular fracture while swinging freely.   Another example for immobilization preference, sharp oblique main fragments do more soft tissue damage than transverse fragments.
  • Choosing between a spica and a sling and nothing/cage rest pending surgery is a balancing act. There is no right answer.  Variables to consider while making your plan are:
  1. time lag between injury and surgical repair;
  2. size of dog (can they be crated, carried, etc);
  3. male vs. female dog (see above rant);
  4. location and shape of the fracture;
  5. cost (I consider immobilization “pain management” and talk about it under this label)
  6. mobility of the patient (spicas can get in the way of less mobile/agile patients)
  7. cat vs. dog (some cats and splints; whew! Stand back!)


Humerus Helpers: 

  • Thankfully, the humerus is probably the least common longbone fracture. Shoulders are another hard joint to immobilize, but actually easier than the hip (see The Male Dog Problem above).  A spica works well, but a non-weight bearing sling can be quite effective too using the chest wall as your immobilization device.
  • Along those lines, here is a little tip that I discovered in my shelter/rescue work with broken animals (mind you, this is not a scientific study with loads of followup, so proceed eyes-open.) For kittens and puppies less than 12wks of age only (my current cut off), I do rely on the chest wall as my immobilization device for a definitive method of repair, i.e. no surgery, no anesthesia risk.  It is not for every animal; some will not tolerate the restrictions they feel, but it is only needed for 2-3wks, so drugs can bump up the percentage of patients who will be accepting.  Technique is as follows:
  • Narcotics on board.
  • One person holds the pet in a standing position (under their own steam, or “hang” from grip on dorsal neck and dorsal lumbar…easy to do on these little guys with just thumb and pointer “pinching” around neck base and lumbar muscled just in front of pelvis).
  • Second person pinches the elbow and pulls straight back, so the humerus is parallel to the table and snug to the chest wall. Forearm hangs down, foot pointed to table.  Traction here is helpful, so no squeamish elbow tractioners.
  • Third person applies the bandage. Start with 2 or 3″ cast padding.  Wrap around the body and upper arm.  Leave the forearm out, but go as far back as you can to just cover the elbow that is being pinched/tractioned.
  • Next apply 2 or 3″ vetwrap in same manner.
  • The goal of this is to have the humerus flat to the chest wall and straight, and the cranial aspect of the elbow “hooked” on the back edge of your bandage to maintain traction, and the pet can breathe. Make sure you have all of those achieved.
  • Change bandage as needed or every 1wk.
  • Total wear time is 2-3wks.


Bandage technique

I have seen 101+ bandage techniques in my day, some without any technique I could describe!  If your technique works, stick with it.  If not, or if the thought of bandaging something gives you the willies and you always hand it off to someone else, read on (or pass this on to that person too!)

Goals:  To cover and/or immobilize a limb such that the patient will be as or more comfortable than when you started, underlying tissues will remain healthy or get healthier, and the device will remain intact until planned removal.

  1. Apply stirrups: Don’t use.  Or, white tape.  Usually no more than ½” strips (ripped lengthwise for toy, small, medium breeds) or 1″ strips (large breed).  Length = 2-3x paw length.  Apply cranial only or cranial and caudal.  (side note:  medial and lateral is fine too, but if you have someone helping you by tractioning the stirrups, this will squeeze the toes together while you are applying the bandage; the toes will remain uncomfortably squished.)  When changing bandages, especially in cats and small dogs, don’t yank the stirrups off.  Just cut them flush with the foot and apply the new ones on top.  When the bandages come off for the last time, only one tape yank to do.  The skin will thank you!!!
  2. Apply cast padding from foot up, 50% overlap. This CANNOT be applied too tight, literally.  But it can be applied too loose.  Snug this as you apply each wrap from side to side.  No wrinkles allowed; “dart” when you change directions or go wide to narrow.  (Sewing reference, look it up.)  Number of layers depends…see comments above/throughout.
  3. Apply roll gauze from foot up, one layer w/ 50% overlap. This can be applied too tight.  In areas with lots of muscle or lots of cast padding, it’s ok to give it a snug tug.  The goal is even distribution of snugness.  Be consistent as you apply.
  4. Install splint device (if using), lateral or caudal.
  5. Apply 2nd roll of gauze, one layer w/ 50% overlap.
  6. Rotate stirrups up and tape to gauze. Stick your finger in between toes and tape and loosen the hairs that are caught in the tape!!!!  Great “he was chewing the bandage down there” prevention.
  7. Apply vetwrap, one layer w/ 50% overlap.


Note:  When using a splint, always finish off by making sure the leg is bent slightly in the right places to facilitate walking with the splint on.  An uber-straight leg is aaawk-ward!  For custom 3M splints, this has to happen immediately after applying the 2nd roll gauze before the casting tape hardens.

Note:  Don’t twist the foot around when applying the bandage.  Easy to do in a fractured limb.  An xray with the foot on backward is aaawk-ward!

Note:  Modified tongue depressor splint– See https://directvetsurg.com/ortho-tips-tricks-sept-2018/

Note:  Custom 3M casting tape splint; very, very worth it.– See https://directvetsurg.com/ortho-tips-tricks-sept-2018/

Bandage supply list

Cast padding:  The only stuff worth stocking, in my humble opinion, is Specialist Cast Padding by BSN Medical.  Easy to get.  It will go on without wrinkles, it can be conformed snuggly with gentle traction, and the corrugations are built in “how tight” indicators as you apply (just stretch enough to flatten those out.)  Recommend minimum stock: 3″ size.  If you will stock two sizes, 2″ and 4″.  For toy breeds and cats, I always cut down to 1″.  Just unroll slightly and start cutting, then re-roll.

Roll gauze:  The only stuff worth stocking, yada yada, is brown utility gauzeIt is cheap.  It is easy to get.  It has just enough “give” to it.  It stays flat when you apply; often the stretch gauze products will have a band of tight across the middle of the width depending on how you hold it.  The end result with brown gauze is a smooth/even compression; the other, not so much.  Recommended minimum stock:  3″ size.  If you will stock two sizes, 3″ and 6″.  The larger is great for body wraps, spica splints, and more.

3M Casting Tape:  Great stuff, easy to use, easy to source,  one-size-fits-mostRecommended minimum stock:  3″ size.

Vetwrap (or equivalent):  Recommended minimum stock:  4″.  If you will stock two sizes, 2″ and 4″.

Elasticon:  Love-hate relationship with this stuff.  Let’s just start with, it’s expensive.  Next, please do NOT apply this as an outer wrap to bandages (like Vetwrap is commonly used).  It is heavy (adds unnessary weight to your bandage), and you need Arnold Schwarzenegger and a chainsaw to cut it off.   Also, please, please, please do NOT tape directly to the patient.  It is nasty to get off.  Now, I understand that is why folks like to tape it to the patient, so bandages don’t go anywhere.  I can empathize with that, certainly.  But I can also empathize with the dog or cat that has tape pulling on their hair the entire time the bandage is on.  And I can empathize with the skin of the groin or armpit when trying to peel this industrial stick-um off that tender skin.  If you absolutely must tape to the patient, use that uber-stick-um to your advantage and minimize the pet morbidity during multiple bandage changes.  Put on a layer or ring of Elasticon on the pet.  Use that as your “base plate” that you tape “to”.  During each bandage change, untape “from” that base plate and then reapply to it.  Don’t remove the base plate until the last bandage removal…then treat the skin with some spa products to make up for it.  The only places I use Elasticon are:  1)  square patches pasted on the bottom of the foot to prevent premature wear of the bandage, and 2) Ehmer slings with roll gauze underneath majority of the bandage preventing excess skin-hair removal when sling time is over.  Whew, ok, enough about Elasticon.


White tape, 1″

Tongue depressors

Used IV bags (cut end off, poke holes, thread with roll gauze for tie-on, waterproof foot protection.

Which bones need surgery

There are a lot of ways to get something to heal.  Which is the best way depends on the pet owner’s goals.  I know it is often easier and faster to just say, “this is what you need to do to fix this fracture”.  It just isn’t accurate and puts ALL of the liability directly on your shoulders.  Most owners don’t want the discussion either, I KNOW.  But it does not stop me from having the discussion of choices given all of the risks and benefits.  They choose, they assume some of the responsibility.

With just the question of surgery vs. no surgery to heal a fracture, here is a nutshell answer:

Needs surgery: 

Femur, all ages, 99% of the time

Humerus, >12wks age, 99% of the time

Tibia, >16wks, 90% of the time, majority do better with surgery

Radius, >16wks, distal radius, toy/small breed,99% of the time

Radius, >16wks, displaced/not transverse, non-toy breed, majority do better with surgery

Open fractures any bone.

Pathologic fractures any bone.

Articular fractures any bone.

Non-surgical, is a viable option:

Humerus, <12wks age

Tibia, <16wks, intact fibula, green stick, 50% overlap fragments (all variables support no surgery)

Radius, <16wks, medium/large breed, intact ulna, green stick, 50% overlap fragments (all variables support non-surgical option)

Non-surgical treatment assumes the wonderful risks and headaches of external coaptation, so emphasize THAT in your discussions.  Sometimes big headaches.

Naming a fracture

One last note…”clean break“.  What is that?  Ya’ll navigated the same challenging vet school entrance requirements I did, went to the same classes I did in school, paid the same large sum of money for the privilege.  And now many of you want to describe a fracture to me using the phrase “clean break”?  Just don’t do it; means nothing.  Where are your $20 and $100 words?  You earned them!  Flex your knowledge, wow me with your creative descriptions!  And make my life oh-so-much-easier with a fracture description that paints an accurate picture.  Just like a standard signalment (those are appreciated too!), there are standard descriptive components to a fracture (“F”ive for “F”racture):

  1. Bone
  2. Location
    1. Proximal 1/3
      1. Articular
      2. Non-articular
    2. Midshaft
    3. Distal 1/3
      1. Articular
      2. Non-articular
    4. Architecture
      1. Transverse
      2. Short oblique (width of the end of the fragment is 1-2x diameter of cortex; just a little angle)
      3. Long oblique (width of end of fragment is >2x diameter of cortex; a good lookin’ spike!)
      4. Spiral (wraps around a bit)
      5. Comminuted (more than just the 2 proximal and distal main fragments)
      6. Avulsion
      7. Pathologic
        1. Lytic
        2. Proliferative
  • Combination
  1. Open vs. closed
    1. Wound overlying only
    2. Bone exposed
    3. High velocity projectile penetration
  2. Duration
    1. Known
    2. Estimate

Example:  “I’ve got a 2yr old male neutered Brittany with a 3 day old (5) distal 1/3 articular (2) comminuted (3), closed(4)  femur (1)) fracture that needs probable surgical repair.”

Ok, so off you go.  I have been yammering on long enough here.   Put out a sign, “Fractures R Us” and get those suckers splinted.  The patients will love you.  The clients will thank you.  And the receiving surgery team (when applicable) will sing your praises to the fracture goddess!!

Lara Marie Rasmussen, DVM, MS

Diplomate, American College of Veterinary Surgeons

Direct Veterinary Surgery, LLC


651 829-1111 (phone/text)