Client education

       Ramon sustained two fractures when he was struck by the car three days 
ago.  He has a fracture of his left femur, and another of his right tibia. Both 
fractures are in the mid-shaft area, are complete across the bone, and involve 
several bone fragments.  Neither fracture penetrated the skin, which lessens 
the chance of infection.  Ramon had also had a few abnormalities on his 
blood work, probably due to trauma caused by the accident and the 
administration of drugs by the referring veterinarian.  It is nothing we are too 
concerned about, there doesnŐt seem to be any internal organ damage, but 
we will recheck his blood before he leaves the hospital and again a week 
after to see that he has stabilized and that the anemia is resolving.
       We think that the best way to fix the fractures is by internal fixation 
using pins and bone plates.  This is a more invasive procedure, requiring us 
to go inside and open up the wounds to possible infection and additional soft 
tissue damage, but we believe that it will provide the strongest support for 
the healing fractures.  Complications of the surgery are implant failure 
leading to improper healing, and infection.  We will take radiographs after 
the procedure to ensure that the fractures were lined up correctly, and also 
administer antibiotics while he is in the hospital to prevent infection.  In 
addition, external fixation is less bulky than external, requires less 
maintenance by you at home, and will leave fewer scars when healing is 
complete.  Ramon is a young, healthy animal and we feel that he has a good 
chance for a strong recovery and return to normal function.
       When Ramon gets home, he will need to be kept confined to a cage or a 
room for at least a week to minimize movement and stress placed on the 
healing fractures.  He will have a bandage on for a few days, which will 
reduce swelling.  After the bandage is removed, make sure he is not licking 
or chewing at the surgery sites or we may have to fit him for an e-collar.  We 
will take radiographs every two weeks to assess how his bones are healing.  
Until we see signs that healing has taken place, his exercise will be limited 
to leash walks only.  Physical therapy, consisting of gentle flexion and 
extension of the joints above and below the fracture sites and also gentle 
muscle massage, will benefit Ramon.  For pain, Ramon will be given 
oxymorphone, a morphine-like drug, while in the hospital, and will be sent 
home with a non-steroidal anti-inflammatory drug.