Plan of Action

Sedate the patient (if necessary Š the patient has already been heavily loaded on pain 
killers) so that a thorough orthopedic exam including neurological exam can be 
performed on the left leg to localize the lameness to a more defined area of the limb and 
identify any neurologic deficits.  While sedated, the patient should be positioned for 
radiographs of the right tibia, looking for fractures, and the left femur, provided the 
orthopedic/neurological exam doesnÕt eliminated the possibility of a second fracture in 
this area.  If sedation is via general anesthesia, fixation of the limb can be started 
immediately following radiographic evaluation.

WeÕd also be interested to see a CBC done on this patient to check that all parameters are 
stable (no systemic infection, no serious anemia, etc.), so that treatment can be pursued 
right away.

In addition to examining the musculoskeletal system and lameness, we should make sure 
that the thorax and abdomen have been considered in the injury.  Thoracic radiographs, if 
not already done, should be taken while other radiographs are being taken.  A ruptured 
bladder is unlikely at this point, but we should find out if urine has been passed since the 
injury, palpate the bladder, and check the bloodwork for signs of uremia.  Since the 
trauma was severe enough to break bones, a full physical exam should be done to ensure 
that no other damage resulted anywhere else in the body.