The Prognosis: Circular External Skeletal Fixator

After assessing Taj's radiographs, Dr. Rider determined that Taj had shattered his radius into several pieces (mostly mid-bone breaks); however, he also had hairline fractures along most of the bone. He had also fractured his ulna in half although this was a cleaner break. The radius is the stabilizing bone in this portion of the leg - so this was especially bad news for us.

Typically leg breaks can be treated through surgically installing: bone plates, pins, or external fixators. Bone plating involves surgically placing a metal break across the break site and securing it with tiny screws into the unbroken portions of the bone. Due to the severity of the splintering of the bone, this was not an option for poor Taj. He only had about a cm of intact (not shattered or fractured) bone at the top of his radius, which would make this procedure extremely tricky and potentially not successful and/or not as stable.

External fixators can be fairly simple or more complex devices; they are external devices used to hold the leg in the correct place to heal (in Taj's case aligning wrist and elbow joints). The fixators consist of an extracorporeal frame and fixation elements (e.g. small pins or small-diameter wires). The fixation elements (i.e. fixator pins) are drilled into healthy in-tact portions of bone to help stabilize the leg. Taj's fixator would help to transfer the weight from the in-tact bone immediately below the elbow, bypassing much weight on the broken portion of the radius and ulna, down through external braces to which the pins are attached to the in-tact bone right above the wrist joint. Below are some photos of types of fixators: 

Linear Fixator
Hybrid Fixator
Circular Fixator

Dr. Rider performs many complicated procedures such as fracture repair through bone plating, interlocking nails, and external fixation (as well as arthroscopic joint surgery, joint stabilization procedures like TPLO, TTA, and tightrope, neurosurgery procedures like spinal stabilization and intraverteral disk decompression, and Stem cell therapy). He is also a certified canine rehabilitation therapist. After inspecting the radiographs, Dr. Rider suggested that due to the nature of the break we contact the Veterinary Orthopedic Sports Medicine Group (VOSM) in Annapolis Junction, Maryland to assess what type of external fixator might be best for Taj's break.

VOSM confirmed that Taj had a severely comminuted fracture of the left radius (proximal to mid-diaphysis) and a transverse fracture of the ulna. Dr. Canapp at VOSM suggested that the best way to restore the leg would be through applying an circular external skeletal fixator. Did this sound a bit intimidating at first. Yes! Would I have Skeletor Saluki? Robo-leg? Franken-dog? However, more than any sci-fi canine creation my imagination could conjure, I wanted Taj to be able to walk, run, and play again - so circular external skeletal fixator it was.

Luckily, the staff at VOSM were fantastic and were able to get us on the surgery schedule very quickly. We loaded into a SUV for the long 3.5 hour drive down to Annapolis. The surgery was performed mid-day (successfully!) and Taj had to stay overnight until the next morning. The surgeons performed fluoroscopic-guided closed reduction (this is real-time x-ray imaging during surgery) to use as an anatomic guide for the external fixator installation process. The fixator stabilized the frontal left raduis and ulna using four fixator ring constructs connected by vertical braces. VOSM has a very informative page on external fixators that can be found here: External Fixator Article

These are the doctors that helped to save Taj's leg:

Dr. Rider at Metzger Animal Hospital
Dr. Canapp at VOSM
Dr. Kieves (Intern) at VOSM

I was able to drive Taj back home the next day. I decided to start this blog to help others who may have to go through similar procedures, since it was time-consuming for me to find resources when I started to look. Taj has all his re-check appointments and rehabilitation with Dr. Rider; although, we will go back down to VOSM to have the fixator removed.

Taj is not allowed to run, jump, or play for at least four months (that means no furniture!). He will have the fixator removed around 14 weeks (+/- 2 weeks). Initially, Taj is only allowed short leash walks for elimination purposes (for the first month+). He is only allowed in a crate, exercise pen, or on a leash.

Taj can NOT lick the fixator pins (we are starting with a plastic Elizabethan collar). The fixator pins (8 pins through the leg = 16 pin sites) must be cleaned daily with chlorhexadine solution and triple antibiotic ointment.

Taj is scheduled for weekly re-check appointments initially and monthly radiographs to confirm the healing progress until the fixator is removed.