Section: Veterinary Care In-depth
Diagnosis
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. No laboratory tests are required to make the diagnosis, but 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 radial nerve is extremely important in allowing the animal to use the leg properly. The nerve courses alongside of the humerus and can easily become damaged during the original trauma or during surgical repair. In most cases the damage is only temporary, but permanent damage can occur leaving the leg non-functional or requiring more operations to help the animal use the leg. The thorough orthopedic examination is especially important for an animal that is unable or unwilling to get up and move on the other three legs. Specific palpation of the upper arm and finding swelling, bruising, and crepitation (abnormal "crunchy" feeling with motion) can be highly suggestive of fracture of the humerus.
Radiographs of the leg. Two radiographic view of the animal's upper arm are used to confirm the diagnosis of humeral fracture. Based on the location and severity of the fracture, a more informed discussion can occur regarding potential treatments, prognosis and costs.
Treatment
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. After stabilization, 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 humeral 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. A broken humerus is very difficult to immobilize and the animal is often simply sedated and left alone to rest until surgery can be performed.
Depending on the specific fracture type, location, and age of the animal, humeral fractures may be repaired in many different ways. Pins alone, pins and wires, bone plates and screws, and external fixators (pins holding the bone fragments stable through holes in the skin, like scaffolding) are used separately or in combinations to provide stability to the bone fragments while they heal.
Humeral fractures are not adequately stabilized with a cast or splint.
Humeral 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.
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