Comminuted Fractures in Dogs

Typically occurring due to high-energy trauma (the most common cause is a car accident), comminuted fractures are common fractures in animals. These fractures are challenging to fix due to having no intrinsic stability. The majority of comminuted fractures are considered to be a severe injury; unless the fracture is treated it can lead to your dog losing the function in his limb. In addition, an infection can spread which could ultimately lead to death. Often, those experiencing a comminuted fracture are also experiencing other life-threatening injuries. Young, intact male dogs are the most likely to experience a comminuted fracture, as they are the ones more likely to be hit by a car.

A comminuted fracture is when the bone is splintered or fragmented, with a minimum of three fracture fragments (fragments may be small or large), where the fracture lines interconnect.

As comminuted fractures often occur during car accidents, you will want to pay close attention to your dog during a return home from being missing. Should your dog have a comminuted fracture, you may notice a great deal of swelling in the limb that is fractured. Other signs include your dog not using a limb, as well as the limb dangling in a position that seems awkward and abnormal.

• Swelling of the limb
• Unable to use limb or bear weight
• Limb is in an awkward position

Types 

A comminuted fracture can be open or closed. The individual fracture lines that form the comminuted fracture may be transverse, oblique, or spiral.

A comminuted fracture in your dog is typically due to a high-energy trauma, for example being hit by a car or shot by a gun. Significant force and energy are necessary for a bone to fragment and the large amount of energy will also impact the soft tissues that surround your dog’s bone. A good number of comminuted fractures will be considered “open”. This is where a piece of the bone that has been shattered pokes through your dog’s skin which can lead to a contaminated or infected wound.

In most cases it will be obvious that your dog has experienced trauma in the case of a comminuted fracture. As your dog has likely been through major trauma, the veterinarian will want to check vital systems and stabilize him first. Once your dog is stabilized, your veterinarian will conduct a physical examination of him and ask you questions regarding your dog’s health before his injury. He will also inquire as to any other things that you have noticed in your dog since he was injured. An x-ray will then be conducted to diagnose the fracture (chest x-rays may be done as well to ensure it will be safe to use anesthesia). In addition, a blood test may be conducted prior to anesthesia being given.

As it is likely that your dog will have sustained other life-threatening injuries along with the comminuted fracture, your veterinarian will bandage the injured limb temporarily while addressing any other issues. As your dog is stabilized, the following treatment may be administered:       

• Your veterinarian will apply dressing to any areas of your dog’s skin, muscle or other tissue trauma and cover the area
• A sample may be taken from the location of the fracture for a bacterial culture
• Antibiotics may be started

In order to repair a comminuted fracture, the bone must be returned as closely as possible to its continuity. In many instances, open fixation is necessary as there is likely significant damage to the bone. Open fixation requires that the bones be exposed; possibly by dividing and cutting through muscle. This will allow the veterinarian to see the fracture and repair it. General anesthesia will be necessary.                    

In most cases, splints and cast will not be sufficient as they will not help to reestablish normalcy and would also hinder the treatment of any trauma to your dog’s soft tissue.

With external fixation, pins will be used. The pins will be put through the outside of the leg, through the skin of your dog and into the bones. Three pins above and below the fracture are ideal. The pins can then be connected to each other by bars, rods, plates, cement or rings. These will offer stability and help to squeeze or compress the fragments of bone together. Your dog will likely be given pain medication while undergoing treatment at the hospital and pain medication may be continued once he is discharged.

Comminuted fractures will require significant management and care for your dog at home. Should your dog have external fixators, the area where the pins meet your dog’s skin must be cleaned every day. While you can expect to see crusting and discharge, any significant swelling or excess discharge should be discussed with your veterinarian. The stitches will require removal within 14 days.

Rest will be necessary for your dog; in younger animals this will be around 2-4 weeks and in older animals 6-12 weeks. These fractures can be hard to repair as your dog has experienced damage to the blood supply to the bone and will be at risk of infection in the site of the fracture.

Follow-up with your veterinarian will be required; x-rays will be taken to confirm that the fracture is healing and that there are not issues with the implants.