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Abstract Femoral fracture of dogs is common in daily life. This paper introduced the diagnosis and treatment of a case of femoral fracture in dog， providing reference for clinical practice.
Key words Femoral fracture; Diagnosis; Treatment; Postoperative care
Femoral fracture is a surgical disease that is likely to occur in the daily life of dogs. In the treatment of dog fracture， a definite diagnosis could be made according to the specific location and clinical symptoms of the fracture combined with the specific results of clinical and laboratory examinations， and then， treatment could be performed according to the basic conditions of the dog by one or more fixation methods. This paper mainly introduced the diagnosis and treatment of femoral fracture in dog.
Introduction of the Case
Taotao， a teddy dog， 2 years old， male， had a body weight of 8 kg. Chief complaint： The dog accidentally fell from a high place， and then， it cannot move normally with a limped hind limb.
Basic Clinical Examination
The dogюs mental state was not good. The right hind limb limped obviously， and the dog was unwilling to move. It suffered from strong pain during palpation and had a body temperature within the normal range， and Xray examination was recommended. The result of the Xray examination is shown in Fig. 1.
Laboratory Examination
Blood Routine Examination
The results of blood routine examination are shown in Table 1. It could be seen that the number of lymphocytes in the dog increased， which was inflammation caused by the fracture. Other results were normal.
Biochemical examination
The results of the biochemical examination are shown in Table 2.
It could be seen that alanine transferase in the dog was slightly higher， but did not exceed the normal range， which was due to transient liver discomfort caused by the fracture. Other values were not abnormal.
Treatment
Based on the diagnosis， the owner of the dog decided to adopt a treatment plan of internal fixation using a bone plate.
Preoperative preparation
Before operation， venous access was prepared by supplementing fluid and administrating analgesic and hemostatic[1].
Anesthesia
First， atropine sulfate injection was injected according to 0.04 mg/kg， and about 15min later， propofol was administrated at 4 mg/kg to induce anesthesia. After the dog was anesthetized， a properlysized endotracheal tube was inserted and connected to a respiratory anesthesia machine filled with isoflurane[2-4]. Fixation
The dog was allowed to lie on the side， and was fixed by an assistant on the operating table. The right hind limb was not fixed and was in a pullable state. The hair on the right hind limb of the dog was shaved in a wide range， and the surgical site was disinfected with ethanol and iodine， isolated with a towel， and fixed with a towel clamp， to fully expose the surgical site.
Surgical procedure
The lateral surgical pathway was adopted[5-6]. A skin incision was made at the anterolateral thigh from the greater trochanter to the lateral femoral condyle， and the incision line was in line with the natural curvature of the femur， parallel to the edge of the biceps femoris and in front of the biceps femoris. The subcutaneous tissue was cut along the skin incision line （Fig. 2）. The fascia lata was cut at 2-3 mm in front of the biceps femoris， exposing the lateral femoral muscle （Fig. 3）， and the incision line extended from the greater trochanter to the lateral femoral condyle. The tensor fasciae lata and vastus lateralis were pulled forward， and the biceps femoris was pulled backwards to expose the femoral shaft （Fig. 4）. If more proximal femur is to be exposed， the initial part of the vastus lateralis can be exposed. The separation and pulling of the vastus lateralis and the biceps femoris were continued to expose the distal femur. The muscular branch of femoral artery passing through these muscles should be ligated. The vastus intermedius and adductor muscle were pulled forward and back ward， respectively， to enlarge the exposure range of the fracture （Fig. 5） and facilitate the reduction of the fracture ends. The bone plate was shaped according to the contour of the outer side of the femur， and then the bone screw was screwed into the bone through the bone plate， which was temporarily fixed with a rongeur.
Saline was used to clean the wound. The muscles were interruptedly sutured with muscleabsorbable sutures; the fascia and the subcutaneous tissue were simply sutured; and the skin was interruptedly sutured， and the surface of local skin was coated with silver ion gel. The wound was bandaged for 2-3 d after the operation. Xrays were used to determine whether the screw had penetrated the contralateral cortical end （Fig. 6）.
Postoperative care
After the operation， attention should be paid to the condition of the dog. The dog was given a small amount of water 6 h later， and was fasted for 12 h. It was subjected to transfusion for 5 d， with the addition of the antibiotic cefazolin sodium （20 mg/kg）. An Elizabethan collar was wore on the dog， which was checked regularly to see whether the sutured part bled. The dog was fed with nutritious food， and supplemented vitamin D and vitamin A twice daily. It was kept in a dog cage for more than 2 weeks， and was not allowed to jump and run freely. Xray examination was performed on schedule， which showed that the growth status of the femoral shaft was not abnormal. A rehabilitation training program was formulated to allow the dog to exercise properly.
References
[1]DING MX. Veterinary surgery[M]. Beijing： Science Press， 2009： 419. （in Chinese）
[2]HUANG HX， JIANG XL， ZHOU YT， et al. Internal fixation treatment of a case of femoral fracture in dog[J]. Guizhou Journal of Animal Husbandry & Veterinary Medicine， 2017， 41（4）： 42-43. （in Chinese）
[3]YU WL， WU XG， LIANG B， et al. Operative treatment of a case of femoral fracture in dog[J]. Guangdong Journal of Animal and Veterinary Science， 2016， 41（3）： 15-17. （in Chinese）
[4]WANG BJ， CAI LF， CAO L， et al. Experimental study on intramedullary needle fixation of femoral fracture in dogs[J]. Shangdong Journal of Animal Science and Veterinary Medicine， 2013， 5： 11-12. （in Chinese）
[5]LI JJ， LIU Y. Starter edition of veterinary surgery and operative surgery[M]. Beijing： China Agriculture Press， 2014： 2. （in Chinese）
[6]DONG HJ， PENG GN. Atlas of small animal orthopedic surgery[M]. Beijing： China Agriculture Press， 2011. （in Chinese）
Key words Femoral fracture; Diagnosis; Treatment; Postoperative care
Femoral fracture is a surgical disease that is likely to occur in the daily life of dogs. In the treatment of dog fracture， a definite diagnosis could be made according to the specific location and clinical symptoms of the fracture combined with the specific results of clinical and laboratory examinations， and then， treatment could be performed according to the basic conditions of the dog by one or more fixation methods. This paper mainly introduced the diagnosis and treatment of femoral fracture in dog.
Introduction of the Case
Taotao， a teddy dog， 2 years old， male， had a body weight of 8 kg. Chief complaint： The dog accidentally fell from a high place， and then， it cannot move normally with a limped hind limb.
Basic Clinical Examination
The dogюs mental state was not good. The right hind limb limped obviously， and the dog was unwilling to move. It suffered from strong pain during palpation and had a body temperature within the normal range， and Xray examination was recommended. The result of the Xray examination is shown in Fig. 1.
Laboratory Examination
Blood Routine Examination
The results of blood routine examination are shown in Table 1. It could be seen that the number of lymphocytes in the dog increased， which was inflammation caused by the fracture. Other results were normal.
Biochemical examination
The results of the biochemical examination are shown in Table 2.
It could be seen that alanine transferase in the dog was slightly higher， but did not exceed the normal range， which was due to transient liver discomfort caused by the fracture. Other values were not abnormal.
Treatment
Based on the diagnosis， the owner of the dog decided to adopt a treatment plan of internal fixation using a bone plate.
Preoperative preparation
Before operation， venous access was prepared by supplementing fluid and administrating analgesic and hemostatic[1].
Anesthesia
First， atropine sulfate injection was injected according to 0.04 mg/kg， and about 15min later， propofol was administrated at 4 mg/kg to induce anesthesia. After the dog was anesthetized， a properlysized endotracheal tube was inserted and connected to a respiratory anesthesia machine filled with isoflurane[2-4]. Fixation
The dog was allowed to lie on the side， and was fixed by an assistant on the operating table. The right hind limb was not fixed and was in a pullable state. The hair on the right hind limb of the dog was shaved in a wide range， and the surgical site was disinfected with ethanol and iodine， isolated with a towel， and fixed with a towel clamp， to fully expose the surgical site.
Surgical procedure
The lateral surgical pathway was adopted[5-6]. A skin incision was made at the anterolateral thigh from the greater trochanter to the lateral femoral condyle， and the incision line was in line with the natural curvature of the femur， parallel to the edge of the biceps femoris and in front of the biceps femoris. The subcutaneous tissue was cut along the skin incision line （Fig. 2）. The fascia lata was cut at 2-3 mm in front of the biceps femoris， exposing the lateral femoral muscle （Fig. 3）， and the incision line extended from the greater trochanter to the lateral femoral condyle. The tensor fasciae lata and vastus lateralis were pulled forward， and the biceps femoris was pulled backwards to expose the femoral shaft （Fig. 4）. If more proximal femur is to be exposed， the initial part of the vastus lateralis can be exposed. The separation and pulling of the vastus lateralis and the biceps femoris were continued to expose the distal femur. The muscular branch of femoral artery passing through these muscles should be ligated. The vastus intermedius and adductor muscle were pulled forward and back ward， respectively， to enlarge the exposure range of the fracture （Fig. 5） and facilitate the reduction of the fracture ends. The bone plate was shaped according to the contour of the outer side of the femur， and then the bone screw was screwed into the bone through the bone plate， which was temporarily fixed with a rongeur.
Saline was used to clean the wound. The muscles were interruptedly sutured with muscleabsorbable sutures; the fascia and the subcutaneous tissue were simply sutured; and the skin was interruptedly sutured， and the surface of local skin was coated with silver ion gel. The wound was bandaged for 2-3 d after the operation. Xrays were used to determine whether the screw had penetrated the contralateral cortical end （Fig. 6）.
Postoperative care
After the operation， attention should be paid to the condition of the dog. The dog was given a small amount of water 6 h later， and was fasted for 12 h. It was subjected to transfusion for 5 d， with the addition of the antibiotic cefazolin sodium （20 mg/kg）. An Elizabethan collar was wore on the dog， which was checked regularly to see whether the sutured part bled. The dog was fed with nutritious food， and supplemented vitamin D and vitamin A twice daily. It was kept in a dog cage for more than 2 weeks， and was not allowed to jump and run freely. Xray examination was performed on schedule， which showed that the growth status of the femoral shaft was not abnormal. A rehabilitation training program was formulated to allow the dog to exercise properly.
References
[1]DING MX. Veterinary surgery[M]. Beijing： Science Press， 2009： 419. （in Chinese）
[2]HUANG HX， JIANG XL， ZHOU YT， et al. Internal fixation treatment of a case of femoral fracture in dog[J]. Guizhou Journal of Animal Husbandry & Veterinary Medicine， 2017， 41（4）： 42-43. （in Chinese）
[3]YU WL， WU XG， LIANG B， et al. Operative treatment of a case of femoral fracture in dog[J]. Guangdong Journal of Animal and Veterinary Science， 2016， 41（3）： 15-17. （in Chinese）
[4]WANG BJ， CAI LF， CAO L， et al. Experimental study on intramedullary needle fixation of femoral fracture in dogs[J]. Shangdong Journal of Animal Science and Veterinary Medicine， 2013， 5： 11-12. （in Chinese）
[5]LI JJ， LIU Y. Starter edition of veterinary surgery and operative surgery[M]. Beijing： China Agriculture Press， 2014： 2. （in Chinese）
[6]DONG HJ， PENG GN. Atlas of small animal orthopedic surgery[M]. Beijing： China Agriculture Press， 2011. （in Chinese）