Fracture Estimate Worksheet

In order to give you and your client an accurate estimate to repair a fractured bone, there are several requirements. Cutting corners can lead to unseen fissure lines, additional fractures, unseen comminution, and joint involvement that can alter the pre-surgical planning and adversely affect the cost to the client.

  1. Orthogonal Views: I will not be able to quote or plan any fracture without two views of the fracture. Sedate if the patient is painful.
  2. Good Technique: Under or overexposed radiographs are difficult to read and interpret. The background should be black enough to barely see your finger behind the radiograph; if not, increase the MaS. If the background is black but the bone is too light, increase the KvP. Please take TABLE TOP radiographs of all limbs that are 10cm or less. Table top is far superior to Bucky. I can help you create a table top technique chart if you do not have one. Measure both views separately on the limb. Do not assume the technique will be the same for a lateral and AP of any limb. Adjust the technique accordingly.
  3. Good Positioning: Please sedate your patient and get good positioning of the fractured limb. Center the limb on the plate. Waiting until they are under anesthesia for surgery to take good films eliminates the possibility for doing good pre-surgical planning on my part. Sitting the patient up on their haunches to get a good AP of the femur is sometimes necessary to get good radiographs of a fractures femur. Take DV, LAT, and Obliques of all pelvic and acetabular fractures.
  4. Good Collimation: Please collimate to the affected limb only. Taking a hip radiograph and including the stifles is not considered a stifle radiograph. There should be visible collimation around the limb as this will reduce scatter and make the radiograph more detailed.
  5. Label the radiograph with date, left or right, and write down the technique used so we can adjust for post-operative or retake films if necessary.
  6. 1+1 is not equal to 2. If a patient has more than one injury, look for more. 37% of all pelvic fractures have neurological or urinary trauma. A urinating patient does not mean the bladder is not ruptured! Unless money is a serious issue, all trauma patients should have a chest and abdominal radiograph, an ECG, and pelvic fractures should have a cystogram with Renograffin diluted 50% with saline. Document all recommendations and owner’s response. This is not necessary in those cases where an owner can confirm the fracture occurred from playing, jumping, or other non-blunt force trauma.
  7. Read my handout on digital pictures of radiographs and email me a picture of the radiographs as well as a tracing in cases of bone plating. The tracing allows me to confirm that I have the correct size plate in stock and do not need to order one for FedEx shipment.
  8. Have the answer to a few questions including how this happened (low force or high force), when this happened, age and condition of pet, home environment (apartment, house, farm, single pet, multiple pet, kids, pool, lake, river,….), owner compliance, palpation of fracture (stiff or loose), additional wounds on leg, additional injuries on pet, open fracture or closed, how stoic is pet, and is the fracture configuration going to share load.

Any questions, please feel free to call me. We become a team once I accept a surgical case and these recommendations are a good way for us to make sure nothing is missed that could lead to angry or upset clients. Surgeons are taught to think “worst case scenario” and be pro-active in averting as many complications as possible.