Little Details

A Fact-Checking Community for Writers

Previous Entry Share Next Entry
Veterinary care for dog with fractured leg
Writing sucks.
j_guda wrote in little_details
Setting: Present day (2006, if it matters), American small town animal hospital

In searching "veterinary care for dog with fractured leg" "procedure for leg fracture in dog" "veterinary anesthesia procedure" "veterinary x-ray practices" and a thousand variations and related topics, I've collected every possible bit of information I'd ever need regarding what first aid to perform on the dog before taking it to the vet, how to take care of it once the cast is on and you take it home, and how much it would all cost.

What I need to know is what exactly happens at the veterinary hospital itself while a dog with a broken leg is receiving care.

The details of my scenario: Main Character's four month old Australian Shepherd mix puppy (probably weighs about 25 lbs.) is hit by a car (the car isn't going fast, sees the dog and tries to swerve, but clips it anyway). MC rushes Dog to nearby animal hospital.

The lower part of the dog's left hind leg is broken. It's a simple fracture that won't require surgery. No other injuries beyond a few scrapes and bruises.

This is a pretty small town so the vet, though it's a modern practice and the vet is good at his job, probably wouldn't have the latest, fanciest equipment.

(I personally haven't had a dog since I was a kid, and my cat has never had a veterinary procedure more serious than a check up and shots with me present.)

Specific questions I'd like answered:

1) If the dog becomes agitated when separated from its owner, will they let the owner stay in the room for the whole procedure?

2) As the leg is obviously broken and they will want to make sure the dog doesn't have internal injuries, the first thing they'll do is X-ray, right?
a)What does this involve? Do they put the dog on the exam table and move the machine over it? Or is the machine in separate room by itself?
b)How big is the machine? Does it make noise?
c)How long does it take?
d)How do they keep the dog still during the X-ray?
e)How long does it take for the X-ray(s) to come back?

3) If his master's present he's relatively calm, if in a lot of pain, so how likely is it that they would put the dog under?
a)If they don't put him under would they give him drugs?
-What kind?
-How are they administered? A shot? If so, where?
-How long until they take effect, and what will the dog be like afterwards?
b)Is there any possibility they *wouldn't* give him drugs at all?
-Why or why not?

4)How many people will be in the room? Just the vet? The vet and his assistant?
a)If the owner is present and the dog is calm, does he need an assistant?
b)Who performs each step of the procedure if there is an assistant?
-Would the assistant be the one to administer the X-ray? The anesthesia? Who puts the cast on?

5) What actual steps are involved in casting the leg? (the biggest thing I've broken is a finger, but that only involved a splint, so telling me how it does or doesn't relate to human cast procedures tells me very little.)
a)How do they make sure the bone is properly aligned?
b)Do they shave the fur off before they put the cast on?
c)It's the white plaster part first, followed by the colored wrap, right?
-How long does it take for the white plaster to set up? The wrap?
-As a small animal hospital are they likely to have different colors? If only one or a few, what is/are the most likely color/s? (As the dog is going to be wearing the cast for several weeks/a few chapters in the story, I sort of need to know what he'd have on. ;D)
d)When they've finished, to make sure it's not too tight, they'll test his circulation based on the color and capillary refill in the pads on his paw, right?

6) Once the cast is on, how long until they can go home?
a)This would obviously change based on the drugs given, right?

7) I've seen the plastic cone collar referred to as a "space collar" and an "Elizabethan collar". What is the vet likely to call it?
a)Besides the collar, would the vet send anything else (besides maybe "Taking Care of Your Injured Dog" literature and paperwork) home with them?
b)As there was no surgery or other injuries, the dog wouldn't need antibiotics, right?
c)Would he get a prescription for any kind of painkillers, especially considering how it's a minor fracture?

8) How long, in total, would the whole thing - from the time they walk in the door of the clinic to the time they walk out of it - take?

I know that's a lot of questions. Thanks for any help you can give!

At my vet's, the x-ray is in a different room and owners aren't allowed in there, but are allowed to stay for everything else that's not surgery. Was the same at my last vet.

As for the rest of your questions, you might try asking here:
http://forums.about.com/n/pfx/forum.aspx?nav=messages&webtag=ab-vetmedicine


1) Generally owners are not allowed into procedure rooms. Exam, yes. Procedure, no.

2)Yes! You're right.
a) It depends on how big the practice is. Where I worked, the machine was in a nook in one of the procedure rooms. You put the dog on a specific table, usually attached to the machine, move the actual machine component in place, and go for it.
b) Not huge - it fits above on a standard-size veterinary exam table. There are some noises involved, kind of a clanking. Also, anyone not 100% necessary will be asked to step outside the room. Anyone staying will be given a heavy lead apron to wear that covers about chin to thighs.
c) Just a few seconds.
d) Sedation, usually. I don't think I've ever x-rayed a conscious dog. If you really want the dog conscious, I'd suggest having someone gently but firmly hold it down maybe at the hip and shoulder and speak soothingly, but really that's not your best bet.
e) Honestly I don't remember.

3) I'd still say it's fairly likely they'd sedate the puppy. It's *possible* that they wouldn't but not likely.
a)Probably an anti-inflammatory and something for pain. The method would depend on the drug - if it's an injection, it's either going to be intravenous or subcutaneous (under the skin). For intravenous, you lock the dog's front leg outward with one hand above its elbow and clamp down to get the vein to rise. When you find it you just slip the needle in and inject it. For subcutaneous, you pull up a fold of skin above a muscle, like on the shoulder, and run the needle into the fold, injecting under the skin. Again, though, that depends very much on the drug, as does how long until it would kick in.
b) Not likely. There would also probably be pills sent home with the owner for follow-up pain management - prednisolone would be a good option, or phenylbutazone. Tramadol *might* be if it's really severe pain.

4) Depends. One vet could handle this, but I'd guess probably the vet and one or two techs.
a) Yes. Owners do not help with this kind of thing, usually, that'd be really odd.
b) That depends, too - in some offices the vet does most of the work, in others the techs (usually not called assistants, btw, in my experience) do a lot of it after a point. A vet would do the initial exam, a tech could do the x-ray, and a vet would probably set the bone. The tech would also probably administer anesthesia.

5) a) I'm actually not 100% on this one, sorry!
b) Actually I've never seen plaster on a dog, just a splint and the wrap - that was how we did it but that doesn't mean every vet does it that way, so I can't vouch for plaster. The wrap is called "vet wrap" and yes, a small animal hospital would probably have a couple of different colors - we had purple and green. Also the wrap doesn't need to set. It's very similar to the stretchy, self-sticking wrap you can get at drug stores if you want to see for yourself - it's not adhesive, but there's some degree of stick because of how it's designed.
c) I never did that, but the guy I worked with was very old-school, so I don't know. Sounds good?

6) You're right, this depends on whether the dog was sedated. Anywhere from immediately (if it wasn't) to most of the day (if it was) - policy varies from vet to vet.

7) Probably a cone.
a) Nope!
b) No antibiotics.
c) Yes - see above, but the prescription would be filled in-house and would probably only be for about a week, ish.

8) You can play with this a lot. It depends on how many vets are in the practice, how busy it is, how difficult the dog is to work with, etc. If all goes well I'd say a couple of hours, ish, but again that's very relative.


Another note - if you do choose to have the dog be sedated, that's going to be via gas. There are two options that the vet/techs would call "sevo" or "iso". "Sevo" is not preferred - it knocks them out very quickly but when they come out of it they can have rather violent reactions. I had a kitten literally launch itself out of my hands and into mid-air, when it'd been unconscious about two seconds before. "Iso" lets them wake up a lot more slowly. In either case they'll be intubated, which involves a special kind of tubing with a little bulb that'll be inflated once the tube is inserted into the trachea. That's then hooked to what basically looks an oxygen tank on wheels, there's some knobs that get turned depending on the size of the animal, etc. There are also little face masks that can be used, if you'd rather go that way, but intubation is more common. There'll be a vet tech monitoring the dog's breathing the whole time it's under - at a low-tech office this probably means just watching the ribcage to be sure it's still rising and falling normally. Creepy trick: if it stops for a few seconds (this is totally normal and not cause for panic), if you lightly smack the animal's side it'll generally breathe in again.

Hope that helps - it's nice being able to apply two years of working in a low-tech small-town clinic to something, I miss it!

I would think they'd only do gas sedation if they were going to do surgery. Most quick/down for an x-tray type stuff we did a quick shot of ketamine.

Yeah, see, most of what I worked with were more serious traumas and surgeries, so that's where I was coming from with this. Thanks for pointing that out!

Was Tramadol in use in 2006? I don't recall any of our reps even talking about it, and I know we didn't use it. I last worked at a clinic in 2007.

This answered so many of my questions. Thanks!

I was a vet tech some years ago so …

They will not be able to allow the owner to stay during the entire procedure, if nothing else, it is illegal to have bystanders present during the x-ray. If the dog gets too agitated and can't be held still enough for the x-ray by a couple of hefty techs, they'll sedate it.

X-Ray machines don’t make much noise. The movement of the big lens/camera section may grind when moving along it's track but the photographing itself doesn't.

A concious animal is held still by a tech or two. An unconcioius animal has a tech in there to move it around as needed. If an animal is violent, leather gloves, muzzles, towels and pet bags (sturdy nylong bags that most of the animal is stuffed into) may be used. If the animal is too violent for that, they would be sedated with a light does of ketamine or similar.

If the x-ray maching is not digital, it can take an hour or so (it would be developed like film, in chemical baths and timing depends at least a little on the business of the office).

If they actually have to reset the leg (as opposed to simply bandage it up), they will sedate the animal (ketamine, often). If there is no open fracture, a simple break, the owner may be there for everything except the x-ray. Surgury, etc, no – they would have to leave the dog and return when it's done (among oather things, the dog would have to be fit into an existing surgical schedule and a closed break is not such a crisis that they'd dump everyone else).

With any medim sized dog, there will be the vet and at least one assistant – the tech is the one whose going to be doing the heavy lifting (literally and otherwise): taking temp, lifting and moving the dog, holding its head, weighing, taking notes for the vet. The vet will do the actual exam (heart/breathing, looking at the leg, checking for shock or other injuries). The owner may 'assist' in restraining the animal but few vets depend solely on an owner to do that.

The techs do the x-rays, often, they do not inject the sedatives but, if the dog needs surgury a surgical tech may monitor the gas sedation if needed. The vet puts on the cast, does any IV or IM injections (they are beyond the scope of techs), confirms there are no hidden injuries etc.

For the cast, unless the break is complex or compound, they may not use a plaster cast. If they do the fur is shaved. If not, they often leave the fur on underneath a soft cast. The soft wrap generally comes in beige, blue, pink and green. Animals heal quicker than humans.

Nowadays, they'd probably send some mild painkillers home with the dog, at least for the first day. The collar would be called an elizabeathen collar.

If the vet is not busy the entire process could happen in as little as … 2 hours but is more likely to be 4.

Exactly what I needed to know, thank you.

1) No. Only employees (and often just tech(s) and the vet) are allowed in the room when x-raying, for liability and safety purposes.

2) Yep, x-ray first.
a) The machine is very large and does not get moved. It had a long surface that the dog would be on, and then the x-ray part (can't remember specific names; it's been a few years since I was a tech) slides so it can be placed over the specific part being x-rayed.
b) The machine is very large. It weighs several hundred pounds. I'd say the table part is about a foot and a half to two feet wide and four feet long.
c) Taking the actual x-ray takes seconds. It takes a lot longer to get the dog positioned, possibly sedated, muzzled, and measured to properly set the machine for the x-ray being taken. Overall, I'd say a good 15-20 minutes.
d) In this case, because it's a break and a fresh, not healed or healing, injury, they'd sedate him to keep him still.
e) There's generally a darkroom in the clinic where the tech can develop the x-rays. It'd be about 5-10 minutes.

3) They wouldn't put him under (that's general anesthesia), but they would sedate him. They'd have to handle the broken leg, and even the calmest of dogs will snap when they're in that much pain.
a) They would give him a sedative such as acepromazine intravenously. It really doesn't take long to take effect, just ten to fifteen minutes. He would also get an intramuscular injection of a painkiller like Rimadyl.
b) No responsible vet would handle a major injury like a broken leg without drugs. It's cruel to the dog, and it's dangerous for the owner, the tech(s), and the vet.

4) The vet and a vet tech would be in the room.
a) Yes, because someone needs to hold/restrain the dog, and that's the tech's job.
b) The tech positions the dog for x-rays. If there's more than one tech, or a tech and an assistant, a tech might take the x-rays. It depends on the size of the clinic. If there's only one tech, or it's a finicky machine that isn't properly calibrated and the vet knows how to adjust the settings, then the vet would take the x-ray while the tech holds the dog in position. The vet puts the cast on, with the tech holding the leg in position to properly set it. Either the tech or the vet could administer the anesthesia; it depends on the size of the clinic (larger clinic, the tech would probably do it with another tech or assistant restraining) and how good the vet and tech are at hitting veins. The last clinic I worked at, the vet was pretty bad, so she'd hold while I drew blood or gave IV medications.

5) The bonesetting I've been present for have all been surgically. The casting for that is wrapping it, no cast. If I remember correctly, at my first clinic, there was a dog who'd fractured her leg by running (yes, really). Hers was splinted with cotton padding and then tightly wrapped with vet wrap.
a) They take another x-ray after setting and splinting the leg.
b) Usually not; there's no need to with a splint like the one I described.
c) I've never seen a dog with a plaster cast. I think it's more likely to be like I described. Even post-surgical wrapping wasn't a plaster cast. The colored wrap is called vet wrap (at least, among employees), and it comes in just about any color you'd like. They'd have different colors, most likely, even if it's just for different widths of the wrap.
d) Correct.

6) Until the dog is sufficiently recovered from the sedative.
a) It would. Acepromazine is most likely, like I said; it lasts about four hours. They might send him home after three or so, as long as he's waking up well from it and doesn't seem to have any negative effects like vomiting or low heart rate.

7) E-collar.
a) Just painkillers.
b) Some vets would give antibiotics for a break, others wouldn't.
c) Yes, he would. He'd at least get Rimadyl, which is used post-surgically, for arthritis pain, and so on.

(cont'd)

Re: Long comment is long

subluxate

2010-10-04 05:17 pm (UTC)

8) I would guess they'd be there about four hours, maybe more.

What would generally happen is this: The owner rushes in, carrying the dog, and tells the person who greets him (receptionist, tech, vet--whomever) that his dog was hit by a car. They get him into a room or the back right away, since that can mean major injuries. Physical exam for any signs of shock, internal bleeding, or broken bones. The break is discovered, and the vet prints an estimate of everything that needs to be done and the cost. The owner then signs the estimate and a release for sedatives, x-rays, and splinting. The owner is asked to either come back in a few hours or wait in the front room. The dog is given IV acepromazine and intramuscular Rimadyl. Once that takes effect (10-15 minutes), the vet and tech get the dog on the x-ray table, position the leg, and x-ray is. The minor fracture is discovered. The vet realigns the bone and has the tech hold the leg in place while the vet splints it. Then they take another x-ray to make sure it's properly aligned. The dog is then put in a cage to be observed as he's waking up. Once he's sufficiently awake, the owner is called and brought back into an exam room. The vet or tech goes over the care of the dog (keep him confined, have him on a leash when you take him outside, don't let him jump, etc.), the medication, and when he should come back in, as well as what he should watch for in case the injury worsens. Then the owner pays, gets the Rimadyl and his dog, and is sent on his way.

Re: Long comment is long

j_guda

2010-10-04 06:10 pm (UTC)

What would generally happen is this...

This is so perfect, it's like a check list of exactly the answers I wanted. Thank you so much!

Re: Long comment is long

subluxate

2010-10-04 06:22 pm (UTC)

You're very welcome.

I work for a veterinary teaching hospital so here's my two cents worth.

It depends on how badly broken the leg is. As you have indicated no surgery, they would probably radiograph the leg to see how bad the break is and the thorax and abdomen to check for internal injuries. Owners will not be present during radiographs. Everyone present has to have a rad badge that monitors their exposure over time. No badge/not in the room. We use tape to pull the legs out of the area of interest (thorax or abdomen) and sandbags to keep them lying on the table without anyone having to hold them. The leg can be carefully positioned with foam pads, wedges and troughs, depending on what views are taken. Standard views are a lateral (coming from the side)and a cranial-caudal (from front to back). If the dog is very good no sedation will be required, but if they are newly broken, they are usually very painful and sedation is a mercy to the animal. If they are otherwise healthy, most places (us included) use a drug called dexdomitor. It's a quick knockdown, the pet is usually very relaxed and pain free and it has a reversing agent, so if the animal's condidtion degrades, the reversal can be given to wake them up. The usual route for dexdomitor is intravenous, with the reversal atipamezole, given intramuscular. It can be given IV if the dog is in trouble, but I understand it is a less-traumatic recovery if it is given IM and allowed to wake up gradually.

A non surgical broken leg repair on a forelimb would probably get a spoon splint or hard plastic with foam padding on the inside. The leg is not clipped unless it is dirty and/or there is a wound. An open fracture would require surgery. A couple of pieces of tape are applied to the paw to help with traction,then the leg is wrapped with roll cotton, splinted, more cotton, then roll gauze, then tape, then VetWrap (the stretchy, only-sticks-to-itself stuff). All this is done while the dog is still sedated and maybe another couple of images are obtained to check the alignment. The dog goes home with some kind of animal-specific pain control. Human NSAIDS are NOT good to give pets. Aspirin is worse on their stomachs than it is on ours and isn't something you want to give in the case of an injury, due to the possibility of bleeding. Aftercare usually consists of keeping them quiet and comfortable with instructions to return if there is any problems or for a recheck in a few days to a week. The bandage has to be monitored to make sure it doesn't cause sore and may have to be changed as healing progresses.

The collar is often known simply as an E-collar, as well as jokingly referred to as lampshades, satellite dishes, or bucketheads.

Here's a link to a client brochure for pain control. http://www.fda.gov/downloads/AnimalVeterinary/ResourcesforYou/AnimalHealthLiteracy/UCM117773.pdf

Hope this helps!
Debi

Edited at 2010-10-04 05:24 pm (UTC)

WOW. Such great information. Thanks!

5) What actual steps are involved in casting the leg? (the biggest thing I've broken is a finger, but that only involved a splint, so telling me how it does or doesn't relate to human cast procedures tells me very little.)

At this point the animal must definitely be sedated, or at least I have never seen a cast put on on an awake animal. It seems to me it'd be too painful to do so anyway. To make sure the bone is properly aligned, the leg is pulled straight as far as it will go, though I'm not sure if the vet could tell from other cues. It seemed very intuitive to me, but hey, it always worked, so obviously she knew what she was doing. At the clinic I worked at, the most common type of cast was a fiberglass bandage that hardened as it dried.

There were several steps to applying the cast. This is the way my vet did it:
- I never saw the leg be shaved for this.
- 2 strips of tape stuck at either side of the foot and stuck together to make a sort of handle, so that the tech could hold the leg in its stretched position without actually having to grab the foot and getting in the way of the working vet.
- First a soft, cottony bandage was applied for padding and comfort.
- Then came a layer of regular gauze bandage to make the padding firmer and prep it for the fiberglass.
- The fiberglass bandage comes next. As it hits air it begins to dry so while it shouldn't be applied carelessly, you can't take your sweet time with it! It should be all set after only a few minutes, by the time the following step is done it's almost all set.
- Then comes the colored wrap. (we favored hot pink, lime green, electric blue or orange, haha)
- The colored wrap is secured with tape around the edges, and the tapes from the handle from the beginning are unstuck from each other, twisted and stuck to the cast.
- Usually most of the casts I have seen put on covered the foot as well, I never really saw the vet check for circulation afterward in that way. She was just very careful not to make the bandages too tight as she applied the cast. I assume she's perfected the art with all her years of experience so she knows how to do this very intuitively!

6) Once the cast is on, how long until they can go home?
Usually they can go home as soon as they're fully awake from any sedative and have been observed for a while to make sure everything's all right.

7) I've seen the plastic cone collar referred to as a "space collar" and an "Elizabethan collar". What is the vet likely to call it?
I live in Puerto Rico and we speak Spanish here so I don't think what we call it would be useful to you ;) But I can say that a collar may not really be necessary for your dog's case, unless there are other wounds that the dog could aggravate by chewing/licking/etc. In the case of broken bones and casts I never ever saw one of those collars put on just for that. This is just my experience at this clinic, of course, so a collar might be protocol elsewhere.
Usually no pamphlets or anything of that sort were given, just detailed instructions from the vet. Any medications were sold right at the clinic.

8) How long, in total, would the whole thing - from the time they walk in the door of the clinic to the time they walk out of it - take?
This would vary a lot... it'd depend on how many people there are at the clinic, how many vets are working, how many rooms there are to work in... Since you say it's a small town clinic, I think it can be compared with the clinic I worked at: only one vet at any given time, 2 exam rooms, one treatment room, one surgery room and the x-ray room. If there are many clients in, the whole process might take several hours, but if it's a calm day and there isn't much wait time, maybe a couple hours.

Hope this helped some :)

This is the way my vet did it

So concise. Tells me everything I need, thank you!

I never really saw the vet check for circulation afterward in that way.

Got that from a couple of books I read. Thanks so much for point out they (or more probably I) got it wrong. :)