Diagnostics and Lab Work:  pcDVM diagnostics CBC/Chm/Lytes - ALT 162 U/L. Thoracic radiographs - no obvious abnormalities. A-FAST on presentation was negative. Dr. Stallings reviewed the radiographs and confirmed a right comminuted tibia/fibular fracture. Dr. Stallings recommended open reduction/internal + external fixation. Amputation was also discussed as a salvage procedure due to the fact that there were fissure lines extending down to the hock/joint. 

Surgery: Femoral and sciatic nerve blocks were performed following anesthetic induction. A medial approach was made to the right mid/distal tibia. The main fracture fragments were exposed and gently debrided. The fracture fragments were reduced as anatomically as possible. Multiple small fragments were unable to be incorporated into the reduction. Four full, 18 ga. cerclage wires and four x .062" K-wires were applied to stabilize the fracture fragments. After thorough lavage and application of an autogenous cancellous bone graft (distal femur) mixed with cancellous osteoallograft, closure was accomplished routinely in multiple layers. Since there were multiple fissure lines proximally and distally to the level of the tarsocrural joint, hybrid circular external fixation was then applied in addition to cerclage and a k-wire distally. Tensioned stopper wires were used on either side of the fissure line to help maintain stable reduction. Threaded half pins were implemented proximally. Post operatively, the apparatus was wrapped with a bumper bandage.

Assessment: This case is another illustration of an exceptional cooperative effort between the primary care veterinary hospital, The COVE emergency/critical care service, and The COVE surgical service, all working together to provide excellent client service and state-of-the-art trauma management.