Management Plan

Preoperative Management:

The PCV is below the threshold for surgery, so the surgery should be delayed for 1-2 days to allow the bone marrow to replace the lost RBC's or a whole blood transfusion should be considered.


Fracture Repairs:

Right Tibia: We will use internal fixation for the fracture repair.   We are going to plate the bone on the medial side of the bone, so the bone is stable and osteo-synthesis can repair the gap in bone continuity.  Compression will be applied to the bone while plating to add stability to allow normal osteogenesis.  3-4 screws are placed in the cortex of each major segment of bone.  A bone graft may be needed on the lateral cortex if non-reducible fragments are present.  

Left Femur: We are going to use internal fixation to repair the fracture using a bone plate and lag screws.  The wedge fragment will be scewed back into place and all the other smaller fragments will be removed.  The two end of the femur will then be plated together on the lateral side.

After Care:  
The patient is allowed early limited active use of the limbs.  The dog should be confined and exercise restricted for 4-6weeks.  At 8-12 weeks a gradual return to activity will be allowed.  Follow-up radiographs will be performed at 8 weeks to assess healing and need for bone grafts prior to increasing activity level.


Pain Management:  

A Fentanyl patch can be applied for pain management post surgery, which should last approximately three days.  The dog will also be placed on Etogesic prior to surgery for anti-inflammatory activity top reduce swelling of the limbs.  The patient will be given torbugesic for pain management immediately following surgery until the fentanyl has time to take effect.

Prognosis:

The prognosis for the patient is good for a full recovery to pet status.  Prognosis would be decreased if bone healing does not progress as expected or the bone fragments do not fuse together.