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P was anesthetized with Iso/O2 via mask and placed in sternal
recumbency.  The distal left radius/ulna area was prepped with
2% chlorhex.  A sterile drape was applied.  The previous incision
site was opened and bluntly disected to reach the bones. The
area where bone wax had been previously applied was debrided
and flushed copiously to remove all visible bone wax remnants.
 The skin was closed with 5-0 PDS in SC with a few additional
SI sutures. Applied thin layer of Mupirocin ointment and covered
with tegaderm+ telfa. Recovered without complications.

P was anesthetized (see GA record). The dorsal and ventral L
wing were plucked around the site of the synostosis at the distal
radius/ulna.  P was placed in sternal recumbency.  The area was
taped off and prepped with chlorhex.  Sterile drapes were applied
around the sx site.  A #15 blade was used to incise the dorsal
aspect of the wing directly over the area of synostosis.  Tenotomy
scissors were used to dissect down to the bone.  lempert rongeurs
and a periosteal elevator were used to break down the synostosis.
 Bone wax was applied between the radius and ulna at this site.
 The muscle was apposed with 5-0 PDS SI.  The skin was apposed
with 5-0 PDS SC.  TAO was applied to the incision, which was
then covered with tegaderm + telfa.  A left wing-to-body wrap
was applied with 1" silk tape. Coped beak with grinding cone
on Dremel.

Patient induced with Iso/O2 via mask.  HR and RR monitored throughout. No complications. Rads show cortical healing of both the radial and ulnar fractures.  There is diffuse, smooth, periosteal thickening that does not appear to be an active reaction at this time.  There is synostosis between the radius and ulna at the fracture site.  Plan to surgically excise this tissue and remove the ESF on 7/23.

Anesthetized with Iso/O2 via mask induction. No concerns under anesthesia.  Uneventful recovery.  
Radiographs showed progressive healing of the L ulnar fracture.  There is bridging at the medial and lateral aspect of the radial fracture, but there is still some lucency present along the fracture line medially. Synostosis is present. There is also multifocal expansion/thickening of the L radius both at the fracture site and proximally. Unknown etiology, cannot rule out infectious cause. Alignment is good. 

Upon observation of the radiographs, the ulna appears appropriate with no abnormalities noted. There is concern for thinning of the cortex around the radial fracture site, most apparent on the second extended left caudocranial view. This could be indicative of the beginning of a fracture site infection, or inadequate bone healing. No anesthesia complications.

To begin surgery, we incised the skin near the fracture site.
The skin around the site had granulated in and appeared healthy
and pink. We excised the fibrous callus until we could see both
egdes of the fractured bone.  We introduced a 5/64" IM pin into
the proximal ulna by entering the bone at an angle between the
second and third secondary feathers. Working the trocar back
and forth we manipulated the opening into the ulna so the pin
could be advanced in the center of the medullary cavity parallel
to the long axis of the bone. Once we had advanced an acceptable
distance and verified the location with the C-arm radiograph
machine, we introduced the 1.1mm ESF pins. The proximal ESF pin
was placed first at a 90 degree angle to the ulna. The distal
pin was placed next at a 90 degree angle, just proximal to the
olecranon. The intramedullary pin was then advanced until it
was in contact with the distal ESF pin. The IM pin that was exiting
the ulna proximally was then bent at a 90 degree angle as well.
The area of skin over the fracture site was closed with a simple
interrupted pattern using 4-0 PDS. External tubing, 6mm in diameter,
was placed over the two ESF pins and the bent end of the IM pin.
Once in place acrylic gel was pushed through the tubing. After
the gel had hardened, pin cutters were used to break the pins
to the level of the tubing. The exit sites of the pins were treated
with triple antibiotic and telfa pads were placed around them.
The bar was wrapped in cast padding and vet wrap was placed externally.
A wing to body wrap was applied. Recovery was smooth.

Patient 097 was anesthetized with isoflurane and placed in dorsal
recumbency on a heating pad. The patient was intubated with a
3 mm ET tube and it was secured with tape. The right stifle was
plucked and scrubbed with diluted betadine. A 20g IO catheter
with an extention line was placed in the right proximal tibotarsus
and connected to a hemo-nate 18 micron blood filter. The blood
tranfusion was started at 2.5 ml/kg/hr for 30 mins then later
increased to 5 ml/kg/hr. The distal wing was plucked, scrubbed
and isolated with drapes and tape on the surgical table. Surgical
scissors were used to extend the open wound on the dorsal aspect
of the wing. A small pair of hemostats were used to removed the
boney callus from the proximal fracture end of the radius. The
distal fracture piece was distracted prior to placement of IM
pin to help align the fracture. An IM pin was placed using a
retrograde technique into the distal fracture piece of the ulna
and then aligned with the proximal fracture piece. Radiographs
were taken of the left distal radius to ensure passing of the
IM pin through the distal and proximal fracture pieces and proper
alignment. The wound was flushed with sterile saline. The skin
was closed using 5-0 PDS in a simple interrupted pattern.The
end of the IM pin was bent dorsally and shortened using wire
cutters. Mupriocin ointment was placed around the IM pin and
sliver sulfadiazine was placed over the skin closure. Teraderm
and telfapad were placed around IM pin. Cast padding and silk
tape were used to wrap the wing in a wing to body bandage. The
remaining blood was transfused with an extension line and give
in the right jugular vein. During surgery the patient stop taking
breaths and breaths were manually taken every 10 seconds and
a second heating pad was placed on the patient to provide additional
heat. Flumazenil was given intranasal and the patient recovered
from anesthesia. The ending temperature was 97.6 F and the patient
was placed in an incubator at 90F post-op. 

Patient was anesthetiized with iso via facemask. Heart rate, respiratory rate, and temperature were monitored while the patient was under anesthesia. The patient recovered smoothly from anesthesia. The radiographic views include whole body VD, left lateral wing, right lateral body, and left caudal cranial wing. Fractures of the left radius and ulna were noted. The left wing has an open complete oblique distal diaphyseal fracture of the radius with lateral caudal displacement. The same wing contains an open comminuted distal diaphyseal fracture of the ulna with lateral caudal displacement. To provide better stability an IM pin will be placed through the radius. A blood transfusion will be administered via IVC while the patient is under anesthesia. Repair of the ulna will be attempted at a later time when the patient's condition is more stable for proper healing.