Fracture of the Radius and Ulna in Dogs

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The radius and ulna are the two bones that comprise the forearm. Fractures of these bones are frequently encountered in veterinary medicine. Because of the conformation of the forearm, both bones, the radius and ulna, usually fracture at the same time.

These fractures are usually the result of trauma, but can be caused by disease of the bone itself. These fractures can occur in an immature bone (one that has not finished growing), or in a mature one, can be "open" or "closed" and can be "simple" or "comminuted." They can also involve either the carpus (wrist) or elbow joints.

Depending on the nature of the fracture and the age of the animal, different methods of repair may be indicated for each situation. Radius and ulna fractures can have serious complications if not repaired, or if the repair fails, and can result in developmental abnormalities of the leg if the animal is immature when the injury occurred.

What to Watch For

  • Lameness
  • Abnormally positioned leg
  • Pain or inability to move

    Diagnosis

    A thorough physical examination is important to determine if fractures are present and to determine if there are other injuries. No laboratory tests are required to make the diagnosis, but your veterinarian may recommend the following:

  • Complete orthopedic examination
  • Radiographs of the affected foot
  • Chest radiographs to determine other injuries

    Treatment

    Emergency care for concurrent problems caused by the trauma is the most important part of treatment. After stabilization, additional treatment may include:

  • Treatment of concurrent soft-tissue injuries

  • Cast or splint. Certain fractures of the forearm can be managed successfully with a cast or splint.

  • Surgery. Some radius and ulna fractures require anesthesia and surgical stabilization of the bone fragments for the best results

  • Pain medication. Injectable analgesics (pain medications) are given to the animal while being treated in the hospital and may be continued orally once discharged from the hospital.

    Home Care and Prevention

    Bring the animal to the veterinarian as soon as possible after any trauma for immediate attention. Try to prevent your pet from walking or moving too much. Prompt veterinary treatment is recommended. Do not attempt to place a splint or bandage on the leg unless there is profuse bleeding.

    After surgical repair of the fracture, the animal must be kept restricted from activity for several weeks and the skin incision should be monitored while healing. A recheck with your veterinarian will occur in several weeks to evaluate how the bones are healing (with new radiographs), to monitor the animal's progress, and to make sure it is safe to increase the animal's activity level.

    Many traumatic events are true accidents and thus unavoidable. Small dogs should be limited from jumping from heights. If these dogs are allowed on the furniture, ramps or stairs may allow these dogs to get up and down without risk of injury. Avoid the chance for motor vehicle trauma by not allowing your dog to roam.

    • X-ray of a fractured radius and ulna in a six month old Munsterlander before surgery.

    • X-ray following surgical repair using a metal plate and screws on the radius and a pin in the ulna.

    • X-ray taken four weeks following surgery to show that the fractured bones have healed.

    Radius and ulna fractures are common and motor vehicle trauma is the most frequent cause. These injured animals tend to be young, non-neutered males who roam away from home and get hit by a car. Animals of both sexes and of any age are susceptible to this type of trauma if not kept restrained. Small dogs (e.g. Italian greyhound) tend to be especially susceptible to these types of fractures with relatively minor trauma, like jumping off a bed

    Animals can develop non-traumatic fractures of the radius or ulna when certain disease conditions exist. These fractures, also known as "pathologic fractures,"can occur if the animal is malnourished, has a systemic illness such as kidney disease, has an endocrine disorder such as hyperparathyroidism, has a bone infection (osteomyelitis) or has cancer of the bone.

    Immature bones have growth plates (physes) that are still "open" and growing. These regions of the young bone are susceptible to damage caused by the trauma that can result in premature "closure." Due to the interrelationship between the two bones of the forearm during growth, premature closure of one growth plate before maturity can cause abnormal curvature of the bones and joint incongruities. This can result in future pain and lameness. The most common type of premature growth plate closure occurs in the distal physis of the ulna (the end of the bone near the wrist). This causes forward bowing of the forearm with lateral (outward) deviation of the carpus. Abnormalities can also occur in the elbow secondary to this type of growth plate injury.

    Depending on the location and amount of energy of each particular trauma, fractures can occur in various portions of the bone. Most fractures involve the proximal, midportion or distal diaphysis (shaft) of the bones. Sometimes fracture of the ulna can occur in combination with a luxation (dislocation) of the radius at the elbow instead of a fracture of that bone. Uncommonly, joint fractures occur involving the surfaces of the elbow joint or wrist.

    Fractures of the diaphysis of the radius and ulna can be classified as "open" or "closed" depending on whether the skin surface has been damaged during the injury. Open fractures have a greater chance of getting infected and may have more complications than closed fractures.

    As with all fractures, fractures of the radius and ulna can also be classified as "simple" if each bone breaks into two pieces or "comminuted" if there are multiple pieces.

    Each case of antebrachial fracture needs to be evaluated in its entirety (age of animal, severity of the fracture, experience of the surgeon and financial concerns of the owner) to determine the most appropriate and best form of treatment.

    Inappropriate case management, inadequate surgical stabilization or poor aftercare can lead to complications, such as non-unions (fractures that will not heal), malunions (fractures that heal in an abnormal direction or orientation), osteomyelitis (bone infection), arthritis or a non-functional leg.

    Diagnosis In-depth

    A thorough physical examination is very important to make sure your pet is not showing signs of hypovolemic shock secondary to the trauma or blood loss. It is also important to make certain that there are no other injuries present. Additional tests may include:

  • Thoracic radiographs (Chest X-rays). Chest trauma, in the form of pulmonary contusions (bruising) or pneumothorax (collapsed lung lobes secondary to free air within the chest cavity), must be ruled-out with chest radiographs prior to anesthesia to repair the leg.

  • Complete orthopedic examination. A complete orthopedic examination must be performed to look for the cause of the non-weight bearing lameness as well as possible injuries in other bones or joints. Examination involves palpation of all of the bones and joints of each leg for signs of pain or abnormal motion within a bone or joint as well as an assessment of the neurological status of each leg. The thorough orthopedic examination is especially important for an animal that is unable or unwilling to get up and move. Specific palpation of the forearm and finding swelling, bruising, and crepitation (abnormal "crunchy" feeling with motion) can be highly suggestive of a fracture of the radius and ulna.

  • Radiographs of the leg. Two radiographic view of the animal's forearm are used to confirm the diagnosis of a radius and ulna fracture. Based on the location and severity of the fracture, a more informed discussion with the owner can occur regarding potential treatments, prognosis and costs.

  • No laboratory tests are required to make the diagnosis.

    Treatment In-depth

    Emergency care for concurrent problems is paramount. Shock is a frequent result of major trauma and must be treated quickly. Treatment for shock involves intravenous fluid administration to maintain blood pressure and adequate oxygen delivery to the body. Injury to the lungs and chest cavity are also commonly seen after major trauma and may require supplemental oxygenation or removal of free air (pneumothorax) from around the lungs. Once stabilized, additional treatment may include:

  • Soft-tissue injuries must be addressed in order to minimize the chance for the development of wound infections. Lacerations and other open wounds or open fractures must be cleaned of debris and covered or closed to minimize infections.

  • In the interim between treating the emergency patient and surgical repair of the radius and ulna fracture, all of the orthopedic injuries that have been found should be addressed with splints and/or pain medications to keep the animal comfortable until the fracture can be properly addressed.

  • Depending on the specific fracture type, location, and age of the animal, radius and ulna fractures may be managed in one of two ways. Some of these fractures may not need surgical stabilization. Minimally displaced fractures that involve the middle or distal end of the bones might fit into this category.

  • Radius and ulna fractures may be surgically repaired in many different ways based upon the specific fracture type, location, and age of the animal. Surgical options include: bone plates and screws, pins and wires, and external fixators (pins holding the bone fragments stable through holes in the skin connected on the outside, like a scaffolding). These options can be used individually or in combinations to provide stability to the bone fragments while they heal.

  • Radius and ulna fractures, as well as any other traumatic injuries that the animal might have, are painful and the animal will be given analgesics before and after surgery.

  • If surgery is not required or not pursued, and a cast or splint is used to immobilize the leg instead, the animal must be strictly confined to allow the arm to heal and prevent excessive pain. Because the bone fragments are not as well stabilized when this course of treatment is followed (compared with surgical fixation), excessive motion or activity can prevent the fracture from healing at all or cause it to heal improperly.

    After discharge from the hospital, the animal must be restricted from activity to allow the fracture time to heal properly. Activity must be restricted for several weeks after surgery; the duration will vary depending on the severity of the injury and any concurrent injuries the animal may have. Restricted activity means that the animal should be kept confined to a carrier, crate, or small room whenever he cannot be supervised. Playing and rough-housing should be avoided, even if he appears to be feeling well. The use of stairs should be limited, and outdoor walks should be just long enough for the dog to relieve himself and then should be returned indoors for more rest.

    Animals whose fracture was repaired with an external fixation device will have pins exiting the skin. The "pin tracts" should be monitored daily for excessive swelling or discharge. Some discharge is normal and any crusty build-up that occurs at these sites can be gently cleaned with warm water.

    Analgesics (pain medications), such as butorphanol (Torbugesic®), or anti-inflammatories, such as deracoxib, aspirin or carprofen (Rimadyl®), should be given as directed by the veterinarian.

    The skin incision needs to be monitored daily for signs of excessive swelling or discharge. These can indicate problems with the incision or infection. If at any point prior to the recheck radiographs being taken the animal stops using the leg again after some improvement following surgery, there could be a problem.

    Several weeks after surgery, the arm will need to be radiographed again to make sure the bone is healing properly. If the healing has occurred as expected, the external fixator, if present, will be removed and the animal's activity level will be allowed to increase slowly back up to normal over the next few weeks.

    In general, any other implants that were used in the repair will be left in place unless they cause the animal a problem at some point in the future. Potential problems can include migration (movement) or infection of the implant.

    In younger animals, it's very important that the arm be monitored closely for signs of abnormal growth. Injuries to the growth plates cannot be completely determined at the time of the injury or surgery. Signs such as curving or bending of the leg or worsening lameness can occur very quickly after the injury and early intervention by the veterinarian may be able to prevent future problems.

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