Bilateral Tibial Fracture Repair with External Skeletal Fixation in a Dog

Background

Teddy, a canine patient, with a history of falling from a height the previous day. Initial assessment revealed bilateral tibial fractures—an open fracture in the right hind limb and a closed fracture in the left hind limb. The pet had been given incomplete bandaging at an outside clinic, which Teddy subsequently removed, resulting in exposure of the injured areas.

Initial Presentation & Stabilization

On arrival, Teddy was inappetent, had not taken any fluids since the morning, and showed discomfort in both hind limbs. Physical examination confirmed bilateral distal tibial fractures, with intact deep pain sensation and withdrawal reflexes.

"MRI + CT + 3D planning for safer surgery."

Immediate management included:

• Intravenous fluid therapy for stabilization
• Pain management and anti-inflammatory medications.
• Robert Jones bandaging to immobilize the limbs.
• Owner counseling regarding prognosis, treatment options, and surgical requirements.

Diagnostic Workup

Over the next few days, Teddy underwent:

• CBC, LFT, and KFT blood panels to assess systemic health and anesthetic risk.
• X-rays confirming fracture configuration.
• AFAST and TFAST ultrasonography to evaluate internal organ health and rule out thoracic/abdominal trauma.

Findings revealed elevated liver enzymes and bilirubin, necessitating supportive hepatic therapy before proceeding with surgery.

Surgical Intervention

On once Teddy’s systemic parameters improved, external skeletal fixation (ex-fixation) was performed under general anesthesia.

• Two cross pins were placed from the tibia to the tarsals in each limb for stabilization.
• Muscles and subcutaneous tissues were closed with absorbable sutures, and skin with non-absorbable sutures.
• Postoperative recovery from anesthesia was smooth.

Postoperative Care & Rehabilitation

Teddy was managed with:

• Injectable antibiotics, analgesics, and anti-inflammatories for the first three days post-op.
• Oral medications for pain, joint support, and bone healing over the following weeks.
• Regular bandage changes every three days.
• E-collar application to prevent interference with surgical sites.
• Scheduled follow-ups for suture removal, pin site inspection, and physiotherapy guidance.

Follow-Up & Implant Removal

Over the next two months, Teddy attended regular reviews. Radiographic assessment confirmed satisfactory healing. On August 17 and 26, 2024, staged implant removal procedures were carried out successfully, with no complications noted.

Outcome

By the end of the treatment period, Teddy was active, bearing weight on all limbs, and showing a good range of motion. The fractures had healed satisfactorily, and the patient’s quality of life had returned to normal.

Discussion

This case highlights:

• The importance of timely stabilization in open fractures to prevent infection and further trauma.
• Preoperative optimization, especially in patients with concurrent systemic issues such as elevated liver enzymes.
• External skeletal fixation as an effective technique for stabilizing complex, bilateral hind limb fractures in small breed dogs.

The need for owner compliance in post-operative care for successful outcomes.