Leave, splint or re-operate.

RE: Leave, splint or re-operate.

James Dunne — Tue, 04 Jan 2022 21:12:19 GMT

Apologies for the delayed reply - just seeing this now. There appears to be mild rotational malalignment in this repair; your carpus and elbow are not in the same plane on your craniocaudal or mediolateral views. This may of course be a consequence of radiographic positioning. There is a tiny gap present at the fracture edges. This is a high-strain fracture and will take ages to heal. I would not expect extensive callus formation. The apparatus seems appropriate. However, contouring to prestress the plate over the fracture does not appear to have been performed, which may have helped to compress the trans cortex gap. Adding a splint or cast will not increase stability associated with the repair, so other than immobilising the limb, it has limited use. As others have mentioned, complications with external coaptation can be high and more so in sight hounds. They have fragile skin. I wouldn't do any invasive intervention unless the dog is not weight bearing. If they are weight-bearing, then controlled progressive lead exercise and re-radiograph after 4 weeks.

RE: Leave, splint or re-operate.

Beats — Mon, 20 Dec 2021 21:11:26 GMT

Thanks for the replies.

I applied a splint with a view to changing it weekly for 3 weeks. The dog in question is lovable but pure mad (as they often are when they break a leg) - any level of restriction will be a nightmare.

I don't see a reason to re-operate now either (personally I'd have quite a high bar of poor fracture fixation on post-op xrays before I'd consider that), but it doesn't mean another more experienced vet mightn't consider it. I don't like to presume, and I guess if a better vet thinks that the fixation stands too high a chance of failure for any reason then they might wish to re-operate straight away for a higher chance of initial success rather than wait and see if fails? That's why included the option - it wasn't meant to be a trick question, was genuinely interested in different approaches.

RE: Leave, splint or re-operate.

Jill Butterworth — Sat, 18 Dec 2021 20:50:55 GMT

Just as an aside, no known trauma isn't that common, was the other one a possible spontaneous fracture also? Should we be looking for zebras?!

RE: Leave, splint or re-operate.

serena holmes — Sat, 18 Dec 2021 07:57:09 GMT

I think the plate could be longer proximally, to give more stability. As a result I would splint for a few weeks to provide a little extra stability.

RE: Leave, splint or re-operate.

Tafara Mapuvire — Sat, 18 Dec 2021 04:55:06 GMT

Hi there,

Apposition, alignment and apparatus seem satisfactory. Not convinced re-operating is indicated here. Is there a specific reason why you would consider it an option? Would place a post op dressing for 3 or so days to control swelling. Personally if I can get away with it, I avoid long term splinting or dressings as they are associated with their own set of morbidities - in up to 60% of cases in some studies.

RE: Leave, splint or re-operate.

Michael Woodhouse — Fri, 17 Dec 2021 22:46:00 GMT

Also confused. Would plate as you have done. Perhaps bandage for a few days post op to control swelling but nothing external long before sutures out.

RE: Leave, splint or re-operate.

David Mills — Fri, 17 Dec 2021 22:23:40 GMT

Why would you re-operate?