Management:
  To treat this case, we will first confirm that the valgas deformity is a
result of the
metacarpal non-union and has a potential to be straightened.  If the bone that
is not
fractured is bent and can not be straightened, we suggest sending calf to
slaughter.
If the bone can be straightened with fixation techniques, we suggest an external
fixation
procedure.  The bone does not need debridement, since it is viable.
Several reasons for our suggestion:
1- Less contamination of the fracture, especially for large animals and the
environment
in which they are kept.  An open reduction and fixation of the fracture will
greatly
increase the chance of introducing bacteria.
2- Little damage to the bone's blood supply, by a much less invasive procedure. 
There
is no need to dissect away fascia and muscles and collateral circulation that
comes
through these tissues.
3- This type of fixation can provide enough stability for healing to take place,
if the
appropriate technique is used with sufficient points of fixation to the bone. 
Partially
threaded pins with secure and strong side bars are essential.
4- Finally, they can be adjusted without more surgery, which is essential to the
management and growth stages of this young bull. The external side bars can be
cut,
bent or heated to realign the fracture if the post-op radiographs show a poor
progress.
The bone can also be moved daily to straighten or lengthen the leg.  To speed
healing,
the fixator can be partially removed to increase the stress carried by the bone.
5- Minimal postoperative care is required.

The disadvantages to the external fixation technique include mandatory stall
confinement
with large animals, and a high percentage may loosen before radiographic healing
has
taken place.  The pin tracts may cause scarring.

Fractures below the stifle and elbow are generally the most common sites for
external
fixation.  Frames with more than one sidebar should be used, however Type III
fixators
are not recommended for large animals due to their environment and potential to
injure
themselves.  The extremities below the elbow are exposed enough to give enough
room
to apply the necessary number of pins for an external fixator.  The further
apart the pins
on the fragment, the better the leverage on that particular fragment.  The
distal
extremities are also covered with less muscle, therefore making it easier to
place the pins
in positions that will not affect the movement of the limb.

Technique:
We suggest a closed reduction technique, because of its limited effects on the
local tissue
environment, rapid healing even without accurate reconstruction, lower cost and
comminution.  Young animals also have the advantage for rapid healing, which
also
makes this a good choice in this case.  Alignment and reduction are less
important,
however the external fixator must still provide adequate stability so the
fracture callus
can form and mature.
Threaded pins should be used, which hold better and loosen slower.  Raised or
rolled-on
threads are optimal for Type I fixators, centrally threaded pins for type II
fixators.  Each
major fragment should have 3 pins through it.  Bone length, rotation, alignment,
and
angulations are established with the end fragments.  The remaining fragments
will form
part of the callus, and large segments between the ends can be positioned to
reduce the
gap-filling required for bridging.  Place pins as far away as possible from each
other, but
not any closer than 1 cm from the fracture line.  Minimize injury to underlying
tissue
when placing pins.    Side bars are attached to the pins with clamps, which are
the
weakest link.  Acylic sidebars should be used as well as transfixation pinning
and casting.
With this technique, the transfixation pins are placed and then a fiberglass
cast is applied
which incorporates the pins.
Further, 2nd or 3rd cephalosporin antibiotics should be used for susceptible
bacterial
cultures, in addition to amoxicillin or gentamycin for E.coli or Strep, po.

Post-op care:
The pin tracts should be kept clean by hosing down, prevent the animal from
chewing or
rubbing at the side bars if possible.  Limit exercise to the stall until the
frame is removed.
Radiographic rechecks are recommended at 6 weeks and unloading of the frame can
be
started if a good callus has formed.  Complete removal when bony bridging is
visible
radiographically, then restrict exercise for another week or two.