Specialty Exam Results

Clinical Pathology:

Hematology- all results are deemed as being within normal limits.  This means that there 
is probably no evidence of systemic bacterial infection (no leukocytosis).  There is a 
slight decrease in PCV (normal is 35), which is probably due to depletion/loss of RBC at 
fracture site due to the leaky blood vessels.  

Urinalysis- slight hypersthenuria, which shows that the kidneys are functioning normally.  
There is no evidence of muscle damage (myoglobinuria or hyperkalemia) or tubular 
necrosis (small amount of cells seen per hpf).  Bladder appears to be functioning 
normally as well.

Culture of fracture site- mixed culture with E.Coli and Staph which indicates an open 
fracture.  This is because Staph is part of the normal flora of the skin and E.Coli is a gram 
negative aerobe of the intestines which is found in the feces.  Either of these are likely to 
be found in an open fracture due to external contamination.

Radiographs- DP view indicates multiple fissure lines in the distal diaphyseal region of 
the metacarpals and no bone fragments (possible bone fragment in the muscle, but it is 
not near the fracture site and does not show up on the lateral view _ artifact or 
sequestrum? Ð though not surronded by an involucrum here?).  Lateral view shows an 
oblique fracture line extended from craniodorsal Ð caudalpalmar border.  There is 
extensive bony callous formation on both views, which indicates the presence of good 
blood supply and osteoprogenitor cells.  This may lead to the sclerosis (radioopaque 
region) of the distal bone.  

Prior history indicated the presence of a draining tract.  The culture of the fracture site 
revealed bacterial infiltrates, which leads us to believe that there is osteomyelitis 
contributing to the delayed union of the bone.  A cast was inappropriately applied, 
leading to a valgus deformity and the fracture should have initially been reduced with 
surgery because of the huge gap.  There is periosteal proliferation around the fracture, 
which is also indicative of osteomyelitis.

There is no physeal involvement, which is a good prognosis because it does not affect the 
growth plate = area of rapidly growing bone.