Risk and Reward – Open Fracture Repair

Fiona, a 3 year old Greyhound, presented on emergency after a frightening encounter with a truck – this sweet girl was hit by a car.  While she was in shock from the event, this lucky dog did not have any major damage to her internal organs – her right front leg was another story.  Hanging limply from the middle of her forearm, radiographs confirmed a complete fracture of her radius and ulna. Adding another degree of concern, the leg had a significant bleed from either the fractured bone or an artery nearby, and her paw was cold to the touch.  After stabilizing her from the shock with fluids, pain medication, and some nursing care to cuts and scrapes, some big decisions needed to be made.

Fiona’s broken leg was an open fracture – meaning there were sores exposing the fracture site to the environment.  All the dirt and grime from the road had an opportunity to work its way in to the broken bone, and no matter how much we scrubbed and flushed, it provided a significant risk moving forward.  On top of the risk of infection, Fiona’s cold paw indicated circulation may have been damaged beyond repair.  We could attempt to repair the facture, but if her limb did not regain circulation, it could die off or become a chronic source of pain.  Not to mention, the hardware required to fix the broken bone could have infection trapped around it as a result of the sores, which could cause significant complications during healing – or even months down the road.

Unfortunately, the only other option was to amputate Fiona’s leg – with careful consideration of risks and benefits, Fiona’s family decided to take a chance and repair the fracture.  The bandage was removed and the clock was ticking – the fracture needed to be set and the bleed needed to be controlled as quickly as possible.  After locating the bleed from an artery, suturing up the larger lacerations, and plating the fracture, Fiona began her long road to recovery.

Fiona was on strict cage rest, had pain medication to keep her comfortable, and antibiotics to hold the infection at bay.  Unfortunately, Fiona did develop a resistant infection from her open fracture – a risk we knew had significant potential starting this repair.  A culture showed Fiona needed a hefty antibiotic called amikacin.  She would need regular injections, fluid therapy, and monitoring of her urine to make sure the treatment for the infection did not damage her kidney function.  With prescription ointments applied to the sores and injections carefully administered, Fiona was able to fight off the infection so her bone could heal.

It took 3 months and 19 days from surgery to our final radiograph check to confirm the infection was cleared and the bone was stable enough to start a slow return to activity, but this lucky dog and her loving family took a big risk and got a great reward – all four legs are doing well!