Solution: "What's Your Diagnosis?"
ANSWER TO QUESTION #1: Distal radius/ulna fractures are very common in the toy breed dogs. These fractures can be sustained after minimal trauma.
PHYSICAL EXAM:
General appearance: normal, BCS III/V
EENT: normal
Cardiovascular system: normal, no heart murmur, clear lung sounds
Neurologic exam: normal
Integument: normal
Orthopedic exam: non-weight bearing on the right forelimb; abnormal angulation to the distal antebrachium
QUESTION #2:: Based on the findings of the physical exam, what diagnostics tests, if any, would you perform?
ANSWER TO QUESTION #2: Radiographs of the antebrachium are indicated under sedation for analgesia.
Pre-Op Film
Radiographs (Pre-op): Lateral and cranial/caudal views of the right forelimb were taken to confirm a fracture. Distal, transverse radial, and ulna fractures are present with caudolateral displacement of the distal fragments.
Diagnosis: Distal radial and ulna fractures.
Treatment: When considering radius and ulna fractures, breed and signalment become important factors. When compared to large breed dogs, small breed dogs have been shown to have decreased blood supply to the distal one-third of the radius and ulna. Therefore, external coaptation is a risky stabilization technique and is prone to failure and non-union. The preferred treatment methods include either bone plates and screws, or external skeletal fixators. The technique chosen is often based on surgeon preference. External skeletal fixators have an advantage in that they are removed completely once the fracture is healed eliminating the possibility of implant complications in the coming months and years. Bone plates and screws tend to be more client-friendly immediately post-op as they require no at-home care. In the small breeds, stress protection from the bone plate is a possibility and follow-up radiographs may be indicated every six months for the next year.
Post-Op Film
Follow-up: After six weeks of rest, Breagha returned for recheck radiographs and the fracture was healed. She was allowed to return to all normal activities.
6-Week Recheck Film