Client education:

Your bull calf sustained a fracture of the left metacarpal bones.  It appears to 
be a clean fracture in the shaft region of the bone. The injury happened at the 
time of the delivery, and was never properly fixed.  This has lead to some 
secondary problems.  The leg appears deformed because the fracture ends 
were not aligned correctly. The fracture was not allowed to heal properly, 
and we have what we call a delayed union.  It appears that we do have a 
good blood supply to the fracture ends, which will be beneficial in treatment. 
The heavy bandage that was used caused some injury to the skin.  We now 
have a bacterial infection that has entered through the skin wounds and is 
invading the bone.  This lessens our prognosis somewhat.

Euthanasia is something to be considered, as treatment will be costly, 
involve much time, and may fail.  If you do decide to treat, prognosis for 
return to full function is guarded.  

There are two main goals of treatment for this calf, providing a rigid fixation 
for bone healing, and controlling the infection.  We will use antibiotics for 
the infection.  Culture and sensitivity tests indicated that the bacteria present 
are sensitive only to cephalosporins (second or third generation) or a 
combination of amoxicillin and gentamicin.  The combination therapy will 
be less expensive, although gentamicin does pose a risk of kidney toxicity, 
so it is important to keep the animal well hydrated.  We will keep him on 
antibiotics for six weeks, at which time we will reculture the site and take 
radiographs to make sure the infection has cleared.

Due to the extensive contamination of the fracture and the expense involved, 
we would like to use an external fixator.  This will allow for continued 
drainage of the infection.  Also, there is less chance of spreading the 
infection if we used a closed technique.  We will put pins through the 
metacarpal bones and secure the pins with sidebars.  This will require you to 
clean around the pins daily.  In addition, the calf must be kept confined in a 
clean, dry stall.  We will radiograph after applying the fixation device, to be 
sure that it was properly applied.  After six weeks of stall confinement, we 
will take radiographs to assess the degree of bone healing.  When sufficient 
healing has been achieved, we will remove the external fixation device.  
For pain management, we administer non-steroidal anti-inflammatory drugs.