Management Plan Mid-shaft femoral fracture Femoral fractures can be treated successfully with various methods of fixation. In general, multiple fractures respond best to bone plate and screw fixation; this is especially true of large dogs. The femoral diaphyseal fracture in this case can be classified as a Type B1 Reducible Wedge. Since the fracture is unstable, Steinmann pinning is less applicable. Reduction and stabilization of the wedge by means of cerclage wires or lag screws converts these fractures to Type A3 Transverse, which can be repaired with an intermedullary pin and a type 1A external fixator. An alternate means of surgical correction of this fracture, especially applicable to large breed dogs and therefore our first choice in this case, is plate fixation. The plate is usually applied to the lateral surface and contoured to fit that surface. The advantage of this technique is to provide more rigid fixation and bone compression, thereby making conditions more favorable for healing. Mid-shaft tibial fracture As with the femoral fracture, the surgeon also has a choice of repair methods for the tibial fracture--cerclage wire fixation with an intermedullary pin, or lag screw and neutralization plate fixation. The latter is typically considered to be the better option in large breed dogs. In this method, the tibial fracture is united with two lag screws, and then a neutralization plate is applied to the medial surface of the tibia. Since the fibular shaft is small and plays an insignificant role in support, for practical purposes it may be disregarded. If the tibial fracture is treated properly, the fibular fracture will respond with no special treatment. Pain Management Due to the extent of the injuries suffered by this dog and the need for substantial surgical correction, we elected to prescribe oxymorphone post-op. The dog was sent home on acetaminophen with codeine for 10-14 days. Prognosis Given the young age of this animal and its general health, the prognosis is excellent for return to normal function, especially if owner compliance is high.