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When faced with a fracture there are many different factors to consider when it comes to which method of repair to use.

The goal of repair is to stabilize the broken bone for long enough to allow healing to occur. With every fracture there is a race between bone healing and implant failure!

Things to consider in fracture management include

- the age of patient (and thereby the rate of healing to be expected)

- the patient’s activity levels (and thereby chance of implant loosening or breaking)

             - degree of displacement of the bone fragments

- any concurrent diseases (complicating anaesthesia and recovery)

- possible infection in an open fracture where bone has pierced through the skin

             - other injuries caused by the traumatic incident

With many road traffic accidents or falls, more immediate life-threatening injuries such as blood or air in the chest need to be addressed first. Once the patient is stabilized (which may take days) fractures can be fixed.

With open infected fractures implants ideally need to be kept away from the site of injury as bacteria will grow on them protected from antibiotics.

Commonly used methods of repair are:

-      Splinting and bandaging. This is commonly used in young dogs with non-displaced fractures that should heal quickly, and is the least invasive method.

-      Intramedullary pins placed down the centre of the bone. These are also common and best used in fractures in the middle of the long bones such as the femur, where the pin can take good hold in the bottom section.

-      External fixators, with pins drilled at right angles through the bone and held in position with one or more bars outside the skin. Despite looking scary, these are actually quite non-invasive and have the advantage of staying away from the actual site of fracture. As a result they are often used in injuries that may have been infected.

-      Plates and screws. These provide maximum security but require the most surgical exposure to place. They are frequently used in older animals that have slower healing rates, often in conjunction with bone grafts to stimulate healing, and in very unstable injuries. They are also often used in very active or big dogs that may place a lot of strain on the implants.

Sometimes more than one method will be used in conjunction for extra stability, such as an intramedullary pin and external fixator pins, or an intramedullary pin and plate.

It is normal procedure to recommend cage rest for up to 2 months after surgery, depending on the fracture and mode of fixation.

Generally we will recommend follow-up visits to check on progress 3 days and 2 weeks post surgery, and will usually re X-ray the injury at 6 to 8 weeks to check the bones are healing and the implants are in place.

Some implants will always need removal after the bones have healed, whilst others (such as plates) may be left in, and only removed if causing a problem later in life.