A broken bone in a dog needs one of three things: rest and confinement, external coaptation (splint or cast), or surgical repair. The decision depends on the bone affected, the fracture pattern, the dog's size and age, and the available equipment.

Getting this decision right the first time matters. Fusion Veterinary Orthopedics: "Attempting to use a splint or cast for several weeks with the hope of the fracture healing and doing surgery later is not advised. Chronic non-healing fractures are far more difficult to realign, are more costly, and have a lower likelihood of healing."

Quick answer: External coaptation suits minimally displaced fractures below the elbow or stifle in large adult dogs. Comminuted, articular, open, and upper-limb fractures require surgery. Small and toy breed distal radius fractures almost always need surgical repair.

Key takeaways

• Splints only work for fractures below the elbow or stifle: humeral and femoral fractures cannot be adequately immobilized externally
• Comminuted and articular fractures always require surgery: they are too unstable for external coaptation to maintain alignment
• Open fractures require emergency treatment within 8 hours: irrigation, debridement, and temporary stabilization precede definitive fixation
• 83% of distal radius/ulna fractures in small and toy breeds managed with external coaptation result in malalignment or nonunion
• Growth plate fractures should be surgically repaired within 24 to 48 hours of injury to minimize long-term joint damage
• Consult a board-certified surgeon for complex fractures including spinal, articular, and small-breed distal radial/ulnar

The three management options

1. Cage rest alone: reserved for very young dogs (puppies) with minimally displaced, inherently stable fractures for example, some rib fractures and stable pelvic fractures where the dog's own muscle mass provides sufficient immobilization.

2. External coaptation (splint or cast): for fractures below the elbow or stifle, minimally displaced, in stable large-breed adult dogs. Today's Veterinary Practice: "Ideal fractures for primary fixation using external coaptation include incomplete diaphyseal tibial fractures in young dogs, sometimes referred to as 'greenstick fractures.'"

3. Surgical repair: for the majority of fractures in adult dogs, all fractures in small and toy breeds, all comminuted and articular fractures, all open fractures, and all fractures above the elbow or stifle.

When external coaptation is appropriate

External coaptation requires that the joints above and below the fracture can both be immobilized. This is only achievable for fractures distal to (below) the elbow and stifle.

Clinical Brief: "External coaptation may be successful in fractures below the elbow or stifle, where the joints above and below the fracture can be fully immobilized."

Fractures that may be managed with splinting:

• Greenstick (incomplete) tibial fractures in young large-breed dogs
• Minimally displaced distal radius fractures in large-breed adult dogs
• Some metacarpal and metatarsal fractures
• Toe fractures

How splints are applied: Today's Veterinary Practice: "The splint should span the joint above and below the fracture, and be padded enough to prevent pressure sores and prevent movement of the limb." After placement, a radiograph confirms alignment.

Complications of splinting: ACVS: "Bandages and splints can cause very serious complications. They can be an effective treatment tool for fracture healing and pain control, but careful monitoring and appropriate follow-up must occur." Pressure sores, bandage slippage, and limb swelling are the most common complications; daily monitoring is essential.

When surgical repair is required

Fractures above the elbow or stifle

Animal Medical Center: "It is easy to temporarily immobilize bones below the elbow and knee, while the upper arm and thigh are more challenging to manage because the shoulder and hip are difficult to splint."

Today's Veterinary Practice: "Temporary stabilization of humeral and femoral fractures should not be attempted. In these cases, hospitalization with confinement to a crate along with analgesic relief is ideal while awaiting definitive fixation."

SustainableVet: "Trying to splint these upper limb fractures often leads to pain, delayed healing, and poor limb function. Immediate referral for surgical repair is recommended."

Comminuted fractures

A comminuted fracture means the bone is broken into multiple pieces. These are mechanically unstable fragments shift with any weight bearing. SustainableVet: "These are very unstable and cannot be held in place by a splint alone. The pieces move easily, and the risk of poor healing is high. In these cases, surgical fixation is needed to realign and stabilize the fragments."

Articular fractures (fractures entering a joint)

Any fracture that enters a joint surface requires anatomical reduction the fracture fragments must be restored to near-perfect anatomical position and rigid fixation to prevent joint surface step-off and subsequent arthritis. Fusion Veterinary Orthopedics: "Any growth plate fracture or joint fracture should be treated as quickly as possible within about 24 to 48 hours after injury."

Open (compound) fractures

Animal Medical Center: "Open fractures often require an initial surgery to clean the wound and bone within 8 hours of the injury." The management sequence is:

1. Immediate wound irrigation and debridement under anesthesia
2. Temporary stabilization (bandage)
3. Systemic antibiotics
4. Definitive fracture repair after soft tissue stabilization

Do not attempt definitive fixation of a contaminated open fracture at the initial presentation; this dramatically increases infection risk.

Small and toy breed radius and ulna fractures

Today's Veterinary Practice: "In small and toy breed dogs, 83% of distal radius and ulna fractures addressed with external coaptation alone result in malalignment or nonunion. Therefore, internal fixation is recommended for these fractures in small and toy breed dogs."

SustainableVet: "Toy breeds like Chihuahuas, Pomeranians, and Yorkies are at high risk of nonunion. Their small bones have less blood supply, which slows healing. Even simple fractures may not heal with splints alone."

Spinal fractures and luxations

Spinal fractures with cord involvement are neurosurgical emergencies requiring immediate specialist referral for stabilization and decompression. Clinical Brief: "For complex fractures including spinal, consider consultation with a boarded veterinary surgeon or referral to a specialty practice."

Surgical options for fracture repair

Vets4Pets provides a useful overview: "Two types of surgical fracture repair are normally used in pets. Internal fixation involves placing surgical screws, pins, or metal plates under the skin around the fracture site to stabilize the bone. External fixation involves attaching surgical scaffolding to the bone through small holes in the skin."

Specific implant systems used:

• Intramedullary (IM) pins: inserted down the bone canal; suitable for some long-bone fractures
• Bone plates and screws: the most common implant system; provides rigid fixation; locking plate systems are particularly stable
• External skeletal fixators (ESF): transcutaneous pins connected by an external frame; useful for open fractures, infected fractures, and certain metaphyseal fractures
• Interlocking nails: for femoral and tibial shaft fractures

Timing matters

Animal Medical Center: "You should treat a closed fracture within 2 to 4 days. Timely veterinary fracture repair can prevent complications like bone misalignment or long-term mobility issues."

Fusion Veterinary Orthopedics: "Chronic non-healing fractures are far more difficult to realign, are more costly, and have a lower likelihood of healing."

Delaying evaluation hoping the dog will be "better tomorrow" consistently leads to worse outcomes. Fractures should be radiographed and assessed by a veterinarian on the day they are suspected.

For recovery care after fracture surgery, see orthopedic surgery home care guide. For the referral decision framework across orthopedic conditions, see when to refer orthopedic cases. For the full specialist referral process, see what is veterinary referral surgery.

Frequently asked questions

My dog is walking on the leg a little. Does that mean it is not broken?

No. Weight bearing on a fractured limb is common many dogs do not display obvious non-weight-bearing lameness with incomplete or minimally displaced fractures. Any dog with pain, swelling, or abnormal limb conformation after trauma needs radiographs.

How do I transport a dog with a suspected broken leg to the vet?

Keep the dog calm and restrict movement. Do not splint at home; improper application can worsen the fracture. Carry small dogs; use a rigid surface for large dogs. Call ahead so the clinic can prepare.

Will my dog's fracture heal faster with rest than surgery?

For fractures that require surgery, no. Fusion Veterinary Orthopedics: "Surgery ensures optimal alignment and stabilization for less pain and faster healing." Splinting a fracture that needs surgery delays appropriate treatment and often results in malunion or nonunion.

What is a growth plate fracture and why is it urgent?

Growth plates are bone formation zones at long bone ends in immature dogs. Fractures disrupt blood supply to growth cells. Fusion Veterinary Orthopedics: "Growth plate fractures should be treated within 24 to 48 hours." Delay risks permanent deformity.

Can a dog live with an untreated fracture?

Some dogs survive without repair, particularly with stable pelvic fractures. However, untreated fractures often result in malunion, nonunion, chronic pain, and permanent functional loss. Any decision against surgery should be fully informed.

How often does a splint need to be checked when my dog is wearing one?

ACVS: splints require careful monitoring and appropriate follow-up. Checks every 3 to 5 days are standard initially. Watch for swelling above or below the splint, foul odor, cold or pale toes, or the dog chewing the bandage.

Resources

• SustainableVet. Fracture Management in Dogs: When to Splint or Refer? sustainablevet.org
• Today's Veterinary Practice. Definitive Treatment of Limb Fractures With Splints or Casts. todaysveterinarypractice.com
• ACVS. Fractured Limbs. acvs.org
• Clinical Brief. Fracture Management. cliniciansbrief.com
• Fusion Veterinary Orthopedics. Minimally Invasive or Open Fracture Repair. fusionvetortho.com

Elbow dysplasia is one of the most common causes of forelimb lameness in large and giant breed dogs.

It is not a single condition it is a group of developmental abnormalities that affect the elbow joint during skeletal growth.

Early diagnosis is important because cartilage damage is irreversible and osteoarthritis begins accumulating from the earliest stages of disease.

Quick answer: Elbow dysplasia encompasses FCP, OCD, UAP, and joint incongruity. It presents as forelimb lameness in large-breed puppies aged 4 to 12 months. Radiographs are first-line; CT is more sensitive for FCP. Refer when lameness persists beyond 2 to 4 weeks of conservative management.

Key takeaways

• Elbow dysplasia encompasses FCP, OCD, UAP, and joint incongruity most dogs have only one component, rarely all three
• Forelimb lameness in a large-breed puppy aged 4 to 12 months should prompt elbow radiographs as first-line imaging
• CT is significantly more sensitive than radiographs for FCP: medial coronoid lesions are frequently missed on plain films
• UAP is diagnosed when the anconeal process has not fused by 20 weeks in large breeds; visible on a flexed lateral radiograph
• Both elbows must always be imaged: bilateral disease is common and can mask the lameness asymmetry
• Arthroscopy provides definitive diagnosis and minimally invasive treatment in a single procedure; it is the gold standard

What is elbow dysplasia?

Canine elbow dysplasia is a condition involving multiple developmental abnormalities of the elbow joint. The elbow is a complex joint made up of 3 bones (radius, ulna, and humerus). If the 3 bones do not fit together perfectly due to growth abnormalities, abnormal weight distribution on areas of the joint occurs, causing pain, lameness, and the development of arthritis.

Elbow dysplasia is a multifactorial developmental condition that involves one or more of the following: ununited anconeal process (UAP), medial coronoid disease (MCD), osteochondrosis or osteochondritis dissecans of the medial humeral condyle, and joint incongruity. Clinical signs include forelimb lameness, joint pain, decreased range of motion, and joint effusion, typically noticed between 4 and 10 months of age.

The three main components

Fragmented medial coronoid process (FCP / MCD)

There are three common developmental problems often referred to as elbow dysplasia: a fragmented medial coronoid process (FMCP), an ununited anconeal process (UAP), and osteochondritis dissecans (OCD). Dogs with elbow dysplasia typically have only one of the three conditions.

FCP develops through abnormal wear and stress and micro-fracture through the coronoid, resulting in fragmentation. The resulting loose fragment causes irritation, inflammation, and osteoarthritis.

MCD is the most common form of elbow dysplasia. Affected breeds include Labrador Retrievers, Golden Retrievers, Bernese Mountain Dogs, and Rottweilers.

Radiographic findings: early MCD is often not visible on plain radiographs. Subtle signs include increased subchondral bone density, mild joint effusion, and early periarticular new bone. CT is required to confirm and characterize the lesion.

Ununited anconeal process (UAP)

UAP is failure of the anconeal process to unite with the proximal ulna during the first 5 months of skeletal maturation. The normal anconeal process should be fused with the ulna by 150 days of age; failure to ossify after this time is termed ununited and leads to joint instability and secondary degenerative joint disease.

UAP is usually readily confirmed on x-rays. A lateral radiograph of the elbow in a fully flexed position enables visualization of the ununited process.

UAP is most common in large breeds with a secondary ossification centre for the anconeal process: German Shepherd Dogs, Saint Bernards, and Basset Hounds.

Osteochondritis dissecans (OCD)

OCD is an abnormality in endochondral ossification resulting in a poor connection between cartilage and the underlying bone. The result of this weak connection is separation and peeling away of cartilage from the bone, leading to lameness, pain, and progressive osteoarthritis.

OCD of the medial humeral condyle can coexist with MCD. Arthroscopy confirms the extent of cartilage involvement and allows concurrent treatment.

Clinical presentation

Affected dogs develop a front limb lameness that typically worsens over a period of weeks to months. Lameness is usually worse after exercise and typically never completely resolves with rest. Often both fore legs are affected, which can make detection of lameness difficult, as the gait is symmetrically abnormal.

Classic presentation:

• Large or giant breed dog, aged 4 to 12 months
• Forelimb lameness, often worse after exercise and after rest
• Elbow pain on palpation and manipulation
• Reduced range of elbow flexion
• Joint effusion (swelling around the elbow)
• Possible external rotation of the affected limb

When both elbows are affected which is common the dog may appear to have a bilaterally stiff, stilted forelimb gait rather than a unilateral limp.

Diagnostic imaging

Radiographs (first-line)

Radiographs should include mediolateral and craniocaudal views. A flexed mediolateral view is essential to assess the anconeal process for UAP.

The primary radiographic finding of ununited anconeal process is a radiolucent line separating the anconeal process from the olecranon in dogs older than 5 months.

Both elbows must always be radiographed. Early MCD may show only subtle changes mild subchondral sclerosis, slight joint effusion or may appear radiographically normal despite significant disease.

CT scan (second-line, often essential)

The most reliable non-surgical test for FCP, OCD, and MCD is a CT scan. Ununited anconeal process is usually readily confirmed on x-rays, but the other conditions cannot always be distinguished on radiographs alone.

Early diagnosis of elbow dysplasia is based on radiographic evidence. Unfortunately, by the time lameness is persistent and not controlled by anti-inflammatory drugs, degenerative joint disease has already been established.

CT should be performed early before significant OA has developed to guide treatment decisions.

Arthroscopy

Arthroscopy provides direct visualization of the joint surfaces and cartilage, confirmation of the specific lesion, and the ability to treat (fragment removal, cartilage debridement) in the same procedure.

It is considered the gold standard for diagnosis and treatment of MCD and OCD.

When to refer

Refer to an orthopedic specialist when:

• Forelimb lameness in a large-breed puppy persists beyond 2 to 4 weeks despite rest and anti-inflammatory treatment
• Radiographs show elbow OA in a young dog without a confirmed diagnosis
• CT or arthroscopy is needed to characterize the lesion
• Surgical treatment is indicated

Early treatment of elbow dysplasia is indicated when radiographs show that the disease process has started and further development of OA may be expected. Early treatment of UAP consists of dynamic ulnar osteotomy to release the pressure on the anconeal process.

At-risk breeds that warrant a low threshold for elbow imaging: Labrador Retriever, Golden Retriever, Bernese Mountain Dog, Rottweiler, German Shepherd Dog, Newfoundland.

For the broader referral decision guide, see when to refer for orthopedic surgery: surgical vs non-surgical cases.

For imaging and diagnostics before referral, see imaging and diagnostics before referral: what's essential and when.

Frequently asked questions

At what age does elbow dysplasia typically show up?

Clinical signs most commonly appear between 4 and 12 months of age. Some dogs present later (12 to 18 months) when lameness becomes significant enough to prompt veterinary attention.

The underlying lesion, however, develops during the rapid bone growth phase in the first few months of life.

Can elbow dysplasia be managed without surgery?

Conservative management (activity modification, weight management, NSAIDs, physiotherapy) can reduce clinical signs but does not address the underlying lesion. OA progression continues regardless.

Surgery particularly arthroscopy for fragment removal is generally recommended for FCP and OCD to give the best chance of slowing arthritis development.

How accurate are radiographs for diagnosing FCP?

Radiographs have relatively poor sensitivity for early FCP many cases appear normal or show only subtle indirect signs. CT is significantly more sensitive.

If radiographs are inconclusive and clinical suspicion is high, CT should be performed rather than assuming the elbow is normal.

Is elbow dysplasia always in both elbows?

Not always, but bilateral disease is common. Both elbows should always be imaged, even if only one is clinically lame.

A dog with bilateral disease will often distribute weight more evenly, making the lameness appear milder or even absent on either side individually.

Can elbow dysplasia be prevented?

There is a strong hereditary component.

Breeding programs that screen for elbow dysplasia using radiographic or CT grading (IEWG grade 0 to 3) and exclude affected dogs from breeding reduce prevalence over time.

Weight management during growth to avoid over-nutrition may also reduce severity of expression in genetically susceptible dogs.

Resources

• ACVS. Canine Elbow Dysplasia. acvs.org
• Merck Veterinary Manual. Elbow Dysplasia in Dogs. merckvetmanual.com
• Davies Veterinary Specialists. Elbow Dysplasia Fact Sheet. vetspecialists.co.uk
• Today's Veterinary Practice. Radiographic Diagnosis of Developmental Orthopedic Disease of the Canine Elbow. todaysveterinarypractice.com
• VCA Animal Hospitals. Fragmented Coronoid Process in Dogs. vcahospitals.com

Surgical antimicrobial prophylaxis (SAP) is the use of antibiotics before or during surgery to reduce the risk of surgical site infection. It is not treatment there is no infection to treat.

The goal is to achieve adequate drug concentrations in the tissues at the time bacteria first enter the wound.

Done correctly, SAP is an evidence-based infection control tool. Done incorrectly (wrong timing, wrong drug, wrong duration), it provides no benefit and contributes to resistance.

Quick answer: Cefazolin 22 to 25 mg/kg IV is the first-choice SAP drug, given 30 minutes before incision and redosed every 2 hours. Stop within 24 hours for clean cases. Many clean procedures in healthy patients do not need SAP.

Key takeaways

• Cefazolin 22 to 25 mg/kg IV is the first-choice prophylactic drug for most clean and clean-contaminated procedures
• Give within 30 minutes before the first incision: ENOVAT 2025 specifies 30 to 60 minutes pre-incision
• Repeat every 2 hours intraoperatively: cefazolin has a short half-life and long procedures require redosing
• Stop within 24 hours: extending prophylaxis in clean cases provides no SSI benefit and selects for resistant organisms
• Many clean procedures under 90 minutes in healthy patients do not require SAP: widespread overuse is documented in veterinary surgery
• Fluoroquinolones and aminoglycosides should not be used for SAP: their resistance classification makes routine prophylactic use inappropriate

What SAP is and is not

SustainableVet: "SAP is not used to treat existing infections but to prevent new ones from developing. Using SAP properly reduces complications, speeds up healing, and improves surgical outcomes."

The fundamental concept: ENOVAT 2025: "The basic concept of SAP is that therapeutic levels should be present at the surgical site during the period of highest infection risk.

This starts at the time of the first incision and ends at an ill-defined point after final closure."

Worms and Germs Blog: "It's widely accepted that there is tremendous overuse of antimicrobials in this context in both human and veterinary medicine.

In a large percentage of cases, use of antimicrobials is actually unnecessary and is based more on habit or fear versus actually helping the patient."

When SAP is indicated

The decision is based on wound classification and patient risk factors:

WSAVA SAP Guidelines: "Are prophylactic antibiotics indicated for this surgery?" is the first step. Not all procedures require SAP.

Worms and Germs Blog: "Antimicrobial prophylaxis is indicated in some surgical patients to reduce the risk of SSI, but in a large percentage of cases use is actually unnecessary."

Acta Veterinaria Scandinavica (Helsinki study): "Even complete omission of antimicrobials was not associated with increased risk for SSI" in clean orthopedic and neurosurgeries in low-risk patients.

Drug selection

First-line: cefazolin

ENOVAT 2025: "Cefazolin, a first-generation cephalosporin, is the most widely recommended drug for SAP in human medicine and is a recommended option in dogs and cats where it is available."

SustainableVet: "The best antibiotics for prophylaxis target common skin and wound bacteria like Staphylococcus species. Amoxicillin-clavulanate and first-generation cephalosporins (e.g., cefazolin) are commonly used."

Why cefazolin:

• Excellent gram-positive coverage (Staphylococcus, Streptococcus) the dominant SSI pathogens
• Adequate gram-negative coverage
• Long enough half-life for practical intraoperative redosing intervals (every 2 hours)
• Extensive safety and pharmacokinetic data in dogs and cats
• Low cost, widely available

NCBi pharmacokinetic study: cefazolin at 25 mg/kg IV was effective against pathogens with MIC 2 mg/L or less across a wide range of canine patient populations.

Dose: 22 to 25 mg/kg IV (WSAVA, ENOVAT).

Alternatives when cefazolin is unavailable

ENOVAT 2025: "Ampicillin may be an effective option in regions where beta-lactamase producing staphylococci are uncommon. Other potential options include cefuroxime (second generation cephalosporin) and parenteral amoxicillin/clavulanic acid."

ENOVAT 2025: "Cefuroxime failed uniformly while ampicillin or amoxicillin may be effective, but only if readministered every 1.5 hours."

What not to use

ENOVAT 2025: "Concentration-dependent antimicrobials (fluoroquinolones or aminoglycosides) would not require redosing but should not be administered routinely for SAP considering their higher/more critical EMA classifications."

Fluoroquinolones (enrofloxacin, marbofloxacin) and aminoglycosides are reserve antibiotics for treatment of resistant infections. Using them for routine prophylaxis depletes their efficacy for the cases where they are genuinely needed.

Timing

Pre-incision administration

ENOVAT 2025: "To achieve therapeutic levels by the start of the procedure, the drug should be administered intravenously 30 to 60 minutes prior to the anticipated time of first incision."

Acta Veterinaria Scandinavica: "The antimicrobial was given intravenously 30 to 60 minutes before the estimated time of incision."

SustainableVet: "Antibiotics should be given 30 to 60 minutes before the surgical incision. This timing ensures effective tissue drug levels when bacteria may enter the wound."

University of Melbourne Companion Animal Guidelines: "Intravenous antimicrobials: administer 30 to 60 minutes prior to surgery."

The critical point: if the antibiotic is given after the incision, tissue concentrations are not achieved during the highest-risk period. Post-incision administration provides no meaningful SSI prophylaxis.

Intraoperative redosing

ENOVAT 2025: "Intraoperative dosing is necessary to maintain therapeutic levels for longer procedures or where there was a delay from antimicrobial administration to the start of the procedure.

Intraoperative dosing of any time-dependent antimicrobial such as beta-lactams should be considered every two half-lives of the drug."

WSAVA: cefazolin redosing interval: "2 hours or earlier (22 mg/kg) or 3 hours (25 mg/kg)."

For a TPLO lasting 3 hours, an initial pre-incision dose and one or two intraoperative redoses are typically required.

Duration

Stop within 24 hours for clean procedures

SustainableVet: "Clear guidelines suggest giving antibiotics within 60 minutes before the first incision and stopping them within 24 hours unless there are signs of infection."

NCBi (TPLO antibiotic comparison study): "Results showed no difference in SSI rates" between perioperative-only and extended postoperative antibiotic groups for clean TPLO cases.

"Eliminating postoperative antibiotic medication in a clean orthopedic procedure helps to reduce antibiotic resistance."

Extending prophylaxis beyond 24 hours in clean procedures selects for resistant organisms, does not reduce SSI rates, and increases costs.

Antimicrobial stewardship

Worms and Germs Blog: "Clinical guidelines are an advancement in care, and the field of antimicrobial guideline development has progressed significantly in recent years.

We've moved from primarily expert-opinion-based guidelines to evidence-based, structured guideline development."

SustainableVet: "Veterinary teams are encouraged to take proactive steps toward antimicrobial stewardship. This includes educating staff, using culture and sensitivity testing, and regularly reviewing protocols."

Stewardship checklist for SAP:

• Is SAP indicated for this wound class and patient?
• Is cefazolin available? If not, what is the evidence-based alternative?
• Has the drug been given within 30 to 60 minutes of incision?
• Has intraoperative redosing been planned for procedures over 2 hours?
• Is there a clear plan to stop antibiotics within 24 hours if no infection evidence?
• Will culture and sensitivity be obtained if infection develops, rather than empiric escalation?

For the SSI prevention context in which SAP operates, see how to prevent surgical site infections in dogs. For the antibiotic treatment guide when infection develops, see antibiotics for surgery wound infection.

For the scrub and aseptic technique guide, see veterinary surgical hand scrub protocol.

Frequently asked questions

My dog is having a routine spay or neuter. Does it need antibiotics?

Not necessarily. Clean, short procedures in healthy young patients are a lower-risk category. Many experienced surgeons perform routine spays and neuters without prophylactic antibiotics and achieve excellent outcomes.

Discuss with your vet whether SAP is indicated for your specific patient.

Why is cefazolin given by injection rather than as a pill?

For SAP, achieving tissue concentrations before incision requires IV administration to deliver the drug rapidly into circulation and tissues.

Oral antibiotics are absorbed more slowly and variably and cannot reliably achieve adequate tissue concentrations at the correct time.

Can the same antibiotic used for prophylaxis be used to treat infection if one develops?

Yes in principle, but culture and sensitivity should guide selection. The prophylactic agent may not cover the infecting organism; appropriate treatment requires culture results.

Why not use a broad-spectrum antibiotic like enrofloxacin for prophylaxis to cover more organisms?

ENOVAT 2025 advises against fluoroquinolones for routine SAP. Their resistance classification makes prophylactic use disproportionate; using them for prophylaxis depletes their effectiveness for resistant infections where they are needed.

My dog had a 4-hour TPLO. Should antibiotics continue for a week after?

No. Studies consistently show no SSI benefit from extending prophylaxis beyond 24 hours in clean orthopedic procedures. Intraoperative redosing maintains concentrations during the procedure. Postoperative continuation only adds resistance pressure.

What if cefazolin is not available at my clinic?

ENOVAT 2025 recommends parenteral amoxicillin/clavulanic acid or cefuroxime. Note cefuroxime failed uniformly in pharmacokinetic modeling for standard intervals. Amoxicillin/clavulanic acid requires redosing every 1.5 hours. Discuss available options with your distributor.

Resources

• ENOVAT. 2025 Guidelines for Surgical Antimicrobial Prophylaxis in Dogs and Cats. onlinelibrary.wiley.com
• WSAVA. Surgical Antimicrobial Prophylaxis in Dogs. wsava.org
• Acta Veterinaria Scandinavica. Antimicrobial Prophylaxis in Clean Orthopaedic and Neurosurgeries in Dogs. springer.com
• Worms and Germs Blog. Surgical Antimicrobial Prophylaxis Guidelines in Dogs and Cats. wormsandgermsblog.com
• University of Melbourne. Companion Animal Surgical Guidelines. science.unimelb.edu.au

Rehabilitation after orthopedic surgery is not optional it is a core component of recovery.

Dogs that receive structured rehabilitation after procedures such as TPLO, FHO, or fracture repair consistently return to function faster and more completely than those managed with rest alone.

Referring veterinarians are in a key position to set expectations, identify appropriate patients for formal rehabilitation referral, and guide owners through what they can do at home between specialist visits.

Quick answer: Rehabilitation after orthopedic surgery combines passive range-of-motion exercises, controlled leash walking, hydrotherapy, therapeutic laser, and progressive strengthening. Formal rehabilitation with a certified canine rehabilitation practitioner produces measurably better outcomes than rest alone.

Key takeaways

• Rehabilitation significantly improves post-surgical outcomes: dogs receiving post-TPLO rehab return to limb use faster than controls managed with rest alone
• Hydrotherapy is one of the most impactful modalities: water buoyancy reduces weight-bearing stress by up to 90% while building muscle
• Passive range-of-motion exercises begin within the first few days post-surgery to prevent joint stiffness and soft tissue adhesion
• Therapeutic laser can be initiated immediately after surgery to reduce inflammation and support tissue healing
• Rehabilitation referral should be considered for any orthopedic surgical patient, particularly large-breed dogs, bilateral cases, and slow-progressors
• Home exercises taught to owners at discharge sit-to-stands, controlled leash walking, passive ROM extend the benefit of formal sessions

Why rehabilitation matters after orthopedic surgery

Surgery creates a stable repair. Rehabilitation determines the quality of function that is achieved on top of that repair.

Physical rehabilitation is a specialty of veterinary medicine that focuses on strength, mobility, and comfort of pets. Rehabilitation therapy utilizes a combination of therapeutic exercises, physical modalities like laser, and hands-on techniques to alleviate pain and improve function.

Without proper rehabilitation, dogs may experience prolonged pain, stiffness, muscle atrophy, or even a decline in overall function. Physical therapy helps bridge the gap between surgery and a full return to normal activities by promoting safe and effective healing.

The referring vet's role after orthopedic surgery is threefold: enforce rest during early healing, manage pain so the dog can engage in rehab exercises, and identify patients who need formal rehabilitation referral.

Rehabilitation modalities

Passive range-of-motion exercises (PROM)

Range-of-motion and stretching exercises are vital activities to help improve joint motion and flexibility in pets after surgery. These exercises help prevent adhesions between soft tissues and bone, improve muscle extensibility, and prevent further injury to joints, ligaments, tendons, and muscles.

PROM begins within the first few days of surgery, before the dog can actively bear weight. Owners are typically taught how to perform these at discharge.

The technique involves gentle flexion and extension of the affected joint through its comfortable range, without forcing the endpoint.

Hydrotherapy (underwater treadmill)

The buoyancy effect reduces weight-bearing stress by up to 90%, allowing pets to exercise with minimal pain while still building muscle mass.

Most veterinarians recommend beginning hydrotherapy only after the surgical site is fully closed and inflammation has subsided, which usually occurs after two to four weeks but this timeline varies depending on the procedure and the individual pet.

The underwater treadmill is the most commonly used hydrotherapy tool in veterinary rehabilitation. Pool swimming is also used but provides less controlled, task-specific exercise.

Therapeutic laser (photobiomodulation)

Laser therapy can be initiated right after surgery to stimulate healing.

Therapeutic laser reduces inflammation, decreases pain, and promotes tissue repair at the cellular level. It is one of the few modalities that can begin immediately post-operatively at the surgical site.

Therapeutic exercises

Physiotherapy exercises for dogs can include things like balancing on three legs, walking on the front legs, sit-and-stand exercises, and side-hopping. These exercises can help with recovery.

Progressive land-based exercises are introduced as healing advances. Sit-to-stand exercises build hindlimb strength without high-impact loading. Balance boards, cavaletti poles, and incline walking are added as the dog progresses.

Heat and cold therapy

Cold therapy (cryotherapy) is used in the first 48 to 72 hours post-surgery to reduce inflammation and swelling. Heat is introduced later to relax muscles and increase local circulation before exercise sessions.

When to refer to a certified rehabilitation practitioner

Formal rehabilitation referral is appropriate for:

• Large and giant breed dogs after major orthopedic procedures (TPLO, THR, fracture repair)
• Any dog that is not bearing weight on the operated limb by the expected timepoint
• Bilateral cases where both limbs are affected
• Dogs with concurrent neurological signs
• Dogs with pre-existing muscle atrophy or poor baseline condition
• Cases where owners cannot reliably perform home exercises

A certified canine rehabilitation practitioner (CCRP) or diplomate of the American College of Veterinary Sports Medicine and Rehabilitation (DACVSMR) provides the most structured and evidence-based program.

Home exercises for owners

Most owners can learn and perform the following between formal sessions:

Short controlled leash walks: beginning as short as 5 minutes, three times daily, increasing progressively per the surgeon's protocol. No pulling, no running.

Passive range-of-motion: gentle flexion and extension of the surgical joint, 10 to 15 repetitions, two to three times daily. Stop at the point of resistance; never force.

Sit-to-stand exercises: asking the dog to sit and stand repeatedly encourages hindlimb muscle activation. Begin with 5 repetitions and increase over weeks.

Cold packing: 10 to 15 minutes of cold application to the surgical site after exercise sessions in the first two weeks reduces local inflammation.

For the pain management that supports engagement in rehabilitation, see orthopedic pain management in pets: multimodal approaches. For the nutrition and supplement context, see nutrition and supplements for orthopedic patients.

Frequently asked questions

How soon after orthopedic surgery can rehabilitation begin?

Passive range-of-motion and short controlled leash walks typically begin within the first few days. Hydrotherapy begins once the incision is closed and inflammation has subsided, usually at two to four weeks.

Therapeutic laser can begin immediately. The surgeon's discharge protocol sets the specific timeline for each patient.

My patient is not bearing weight at two weeks post-TPLO. Should I refer?

Yes. Persistent non-weight-bearing at two weeks warrants assessment either by the performing surgeon or a rehabilitation specialist. Causes include inadequate pain management, implant-related issues, or lack of physiotherapy engagement.

Formal rehabilitation evaluation is appropriate here.

Can owners do rehabilitation at home without formal sessions?

Home exercises taught at discharge are valuable and can significantly improve outcomes. However, formal sessions with a certified practitioner provide progression, monitoring, and modalities (laser, underwater treadmill) that owners cannot replicate.

Where resources allow, a combination is ideal.

What does a typical post-TPLO rehabilitation program look like?

Week 1 to 2: PROM, cold therapy, very short leash walks. Week 3 to 4: progressive leash walk duration, sit-to-stand exercises, hydrotherapy begins.

Week 5 to 8: increased land exercises, balance work, progressive incline walking. Month 3 to 4: gradual return to normal activity. Specific protocols vary by surgeon and practitioner.

Is rehabilitation covered by pet insurance?

Some comprehensive pet insurance plans cover rehabilitation therapy following surgery. Coverage varies significantly by policy and provider. Owners should check their policy before assuming coverage.

Resources

• AESC Parker. Physical Rehabilitation to Improve Surgical Recovery. aescparker.com
• DVM360. Physical Rehabilitation: Improving the Outcome in Dogs with Orthopedic Problems. dvm360.com
• AKC. Canine Rehabilitation Therapy: What to Know. akc.org
• PetMD. Dog Physical Therapy: Everything a Pet Parent Should Know. petmd.com
• VetGarofallo. Swimming and Physical Therapy After Surgery in Pets. vetgarofallo.com

When a dog breaks a bone, the surgical goal is to stabilize the fracture so it heals correctly. Two of the most common methods are external skeletal fixation and internal plate fixation.

Choosing between them depends on the fracture type, location, the dog's size and health, and the presence of any concurrent wounds or infection.

Quick answer: External fixators use pins through the skin connected to an external frame; internal plates fix directly to bone. External fixators suit open fractures and contaminated bone. Internal plating is preferred for most closed fractures and needs less daily home care.

Key takeaways

• External fixators use pins through the skin connected to external bars; preferred for open fractures and when internal implants would increase infection risk
• Internal plating fixes a plate directly to bone under the skin; it provides rigid fixation for most closed long-bone fractures
• Fracture type is the primary determinant: open or contaminated fractures favour external fixation; simple closed fractures favour internal plating
• External fixators need daily pin-site cleaning to prevent tract infections, the most common complication
• Internal plating is generally superior for most closed fractures; no direct head-to-head studies exist for all configurations
• Both methods can be combined (hybrid fixation) for complex fractures requiring biological and mechanical advantages

External skeletal fixation (ESF)

What it is

External fixation is completed using a device called an external fixator. This specialized device consists of multiple pins and external bars or rings, which hold a fractured bone in place during the healing process.

Pins are placed through the skin and bone on either side of the fracture. These pins connect to an external frame bars in linear fixators, rings in circular (Ilizarov-type) fixators.

The frame holds the fracture in alignment without directly contacting the fracture site.

Types

Type I (uniplanar, unilateral): pins exit one side of the limb only; the simplest and most commonly used type.

Type II (biplanar, bilateral): pins exit both sides of the limb; more rigid than Type I.

Circular fixators: ring-based frames that allow gradual correction of complex deformities and angular limb corrections. More technically demanding.

When external fixation is indicated

External fixation is an effective procedure to correct complex fractures and angular limb deformities in dogs.

Key indications:

• Open fractures with skin wounds communicating with the fracture site placing internal implants risks trapping contamination
• Infected or contaminated bone external fixation avoids implant-associated biofilm infection
• Soft tissue compromise severe bruising, degloving, or burn injury around the fracture
• Angular limb deformities gradual correction is possible with circular fixators
• Skeletally immature dogs where growth plates need to be protected
• Temporary stabilization before definitive repair (damage control orthopaedics)

Limitations and home care

External fixators require daily pin-site care by the owner cleaning around each pin to prevent tract infection. Pin-tract infection is the most common complication and can require early removal if severe.

The external frame can be bulky and requires the dog to avoid catching it on furniture or other dogs.

Internal plate fixation

What it is

Internal plating fixes a metal plate directly to the bone surface using cortical screws. The plate bridges the fracture and holds the bone in alignment during healing.

Everything is under the skin; no external components are visible once the wound is closed.

In all but the most minor fractures, internal fixation is superior to external fixation. Typically implants are made from inert metals such as stainless steel and take the forms of pins, plates, screws, or wires.

When internal plating is indicated

The advantages of addressing long bone fractures with internal fixation versus external coaptation include early return to function and maintenance of joint motion. Internal fixation is indicated for fractures that are subjected to compression, shearing, and/or tensile forces.

Key indications:

• Closed long-bone fractures in medium and large breeds radius/ulna, femur, tibia, humerus
• Articular fractures where precise anatomical reduction is essential
• Highly comminuted closed fractures where external fixation cannot achieve adequate stability
• Periprosthetic fractures around existing implants
• Fractures requiring early weight bearing plates provide more rigid fixation than most external frames

Plate types

Locking plates (LCP): the most commonly used system in modern veterinary orthopaedics. Screws lock into the plate, creating an angular-stable construct that does not rely on friction between the plate and bone.

Conventional dynamic compression plates (DCP): older design; still used in some straightforward fractures.

Specialty plates: T-shaped for proximal tibia, L-shaped for distal femur, curved for acetabular fractures.

Limitations

Internal plating requires open surgical access to the fracture, which temporarily disrupts the blood supply and soft tissue around the bone. In open or infected fractures, this approach increases infection risk.

Implant removal is sometimes required if pain or implant loosening develops, though many plates remain in place for life without issues.

Comparison summary

It is recommended that veterinarians base treatment choice on available orthopaedic equipment at their clinic and their personal experience with fracture stabilisation methods they are comfortable using. Both methods have potential risks and complications.

For the broader fracture management decision guide, see fracture management in dogs: when to splint or refer. For minimally invasive approaches to orthopedic repair, see minimally invasive orthopedic surgery for general practitioners.

Frequently asked questions

Which is better an external fixator or an internal plate?

Neither is universally better. The right choice depends on fracture type, whether the fracture is open or closed, the presence of contamination, the dog's size, and surgeon experience.

For most closed long-bone fractures in medium and large dogs, internal plating provides more reliable fixation. For open or infected fractures, external fixation is generally safer.

How long does a dog wear an external fixator?

Typically 6 to 10 weeks, until radiographic evidence of sufficient bone healing allows safe removal. The frame is removed under sedation or light anesthesia at the clinic.

Timeline varies by fracture severity, the dog's age, and healing rate.

Do internal plates need to be removed?

Not routinely. Most plates remain in place permanently without causing problems.

Removal is considered if the dog develops pain, implant loosening, or infection around the plate or occasionally in very young dogs where the plate may interfere with bone growth.

Can my dog bear weight with an external fixator?

Yes, often earlier than with splints or casts. One advantage of external fixation is that it allows some controlled weight bearing during healing, which promotes bone healing through mechanical stimulation.

Your vet will specify the allowed activity level.

What is hybrid fixation?

Hybrid fixation combines elements of both methods for example, a plate for primary stabilization with an external component for additional support.

It is used for very complex fractures where a single method cannot achieve adequate stability alone.

Resources

• WagWalking. External Fixation in Dogs. wagwalking.com
• WagWalking. Internal Fixation in Dogs. wagwalking.com
• Today's Veterinary Practice. A Practitioner's Guide to Fracture Management, Part 3: Selection of Internal Fixation Technique. todaysveterinarypractice.com
• PMC. Comparing Internal versus External Fixation for Diaphyseal Tibial and Fibular Fractures in Skeletally Immature Dogs. pmc.ncbi.nlm.nih.gov
• VIN / WSAVA 2016. External Skeletal Fixation: Options and Techniques. vin.com

Cats are exceptional at concealing pain. This is not stubbornness it is a deeply ingrained survival instinct. In the wild, a visibly lame or injured animal becomes prey.

Domestic cats retain this drive to mask weakness, which means orthopedic disease in cats is frequently underdiagnosed and undertreated.

Quick answer: Cats rarely limp overtly even with significant orthopedic pain. Reliable signs of hidden lameness include reduced jumping, reluctance to use stairs, grooming changes, and irritability when handled. OA affects 60 to 90% of older cats. Hip dysplasia affects up to 46.7% of some pedigree cat populations.

Key takeaways

• Cats rarely limp overtly even with significant joint pain; behavioral changes are the primary indicator of orthopedic disease
• 60 to 90% of older cats have radiographic OA but most owners do not recognize it as a clinical problem
• Hip dysplasia affects up to 46.7% of pedigree cats in some studies, with Maine Coons and Siamese most commonly affected
• Reduced jumping height or frequency is one of the earliest reliable signs of feline orthopedic pain
• Examining lame cats is challenging: they are often anxious and aggressive in the clinic; a calm, low-stress approach is essential
• CT is the most reliable non-invasive tool for subtle elbow and coronoid lesions that radiographs may miss

Why cats hide orthopedic pain

Cats can often much better compensate for pelvic limb lameness and hide their pain, and as a result, owners are less likely to notice this condition.

Osteoarthritis is common in cats but may not be noticed because cats often hide signs of pain. Approximately 60 to 90% of older cats have osteoarthritis.

Examination of the lame cat can be difficult. Owner history is often not helpful because most injuries are not witnessed. Cats can be highly anxious in a hospital setting and may be aggressive.

The clinical implication is clear: waiting for a cat to present with an obvious limp means waiting for a level of pain that most cats will never openly display.

Earlier detection requires recognizing the subtler behavioral signals.

Behavioral signs of hidden orthopedic pain in cats

Rather than an overt limp, cats with orthopedic disease typically show:

Changes in jumping behavior:

• Reduced jumping height landing lower than usual on furniture
• Reduced jumping frequency choosing not to jump when they previously would
• Hesitating before jumping, or looking for an alternative route up

Activity and movement changes:

• Reluctance to use stairs
• Slower, more deliberate movement
• Spending more time on lower surfaces
• Stiffness when rising after rest, particularly in the morning

Grooming changes:

• Reduced grooming of the hindquarters and tail base (hips or spine painful to flex toward)
• Matted coat in areas the cat cannot reach comfortably
• Overgrooming of a painful limb (licking at the joint or foot)

Litter box behavior:

• Difficulty squatting defecating outside the box, particularly in cats with hip pain
• Reluctance to step over a high-sided litter box

Behavioral and temperament changes:

• Increased irritability, especially when touched around the affected area
• Withdrawal from family interaction
• Reduced playfulness or hunting behavior
• Vocalizing when handled or picked up

The main clinical signs are decreased activity and reluctance to jump on higher places, reluctance to use stairs and to squat when defecating and defecation outside of the litter box; signs of pelvic limb lameness are rare.

Common feline orthopedic conditions

Osteoarthritis (OA)

The most prevalent orthopedic condition in cats, particularly in middle-aged and older animals.

The joint cartilage in freely moving joints may degenerate over time, leading to loss of joint movement and, in many cases, pain. Joint degeneration can be caused by trauma, infection, the body's immune system, or malformation during development.

The elbows and hips are most commonly affected, followed by the stifles and spine.

Management is multimodal: weight management, environmental modifications (ramps, low-sided litter boxes, raised food bowls), NSAIDs formulated for cats (meloxicam), and joint supplements.

Hip dysplasia

Hip OA is relatively common in cats but is often not recognised, either because cat owners do not appreciate the pelvic limb lameness or because cats are better able to compensate for the resulting functional impairment.

The prevalence of hip joint dysplasia in all pedigree cats was 46.7%, of which 78% of cats had bilateral dysplasia. Dysplasia was mainly mild to moderate; however, 6.1% of hip joints showed signs of severe hip dysplasia in Maine Coon and Siberian cats.

Fortunately, hip dysplasia is rarer in cats than in dogs, and many cats with hip dysplasia may never show symptoms. This may occur because cats are better at compensating for hind limb lameness and hiding their pain.

Most cats with hip dysplasia are managed conservatively. Surgical options exist for severe cases.

Patellar luxation

Patellar luxation was noted in 32.7% of pedigree cats, present bilaterally in 91.4%, and was grade 1 or 2 in most cats.

Most feline patellar luxations are low-grade and clinically silent. Higher-grade luxations causing intermittent lameness may require surgical correction.

Fractures

Feline fractures are a prevalent orthopedic issue in cats. Accidents often result in these injuries, with the shoulder, elbow, wrist, knee, and ankle joints being the most susceptible to fracture.

Cats sustaining high-rise falls (high-rise syndrome) often present with thoracic, facial, and forelimb injuries. A cat presented after a fall with any lameness or reluctance to bear weight requires radiographic assessment.

Cranial cruciate ligament (CCL) disease

Mediolateral and craniocaudal radiographs of a seven-year-old domestic shorthair cat showed cranial cruciate ligament rupture.

CCL rupture is less common in cats than dogs, but it does occur, particularly in middle-aged neutered cats. Unlike in dogs, some cats achieve functional stability through fibrosis without surgery.

Feline vs. canine orthopedic anatomy: key differences

The cat appendicular skeleton has numerous subtle differences compared to dogs. Cats tend to have a more shallow acetabular fossa and this must be taken into account when interpreting radiographs for hip dysplasia. Cats have a high degree of pronation and supination in their elbow joint, and about 40% will have a sesamoid in the supinator muscle that can be mistaken for a chip fracture.

These anatomical differences mean that normal feline radiographic findings can be misinterpreted as pathology, and vice versa. Feline orthopedic radiographs should be interpreted with species-specific reference ranges in mind.

Assessment approach

The feline orthopedic examination requires a low-stress approach. Allow the cat to settle in the room before beginning. Observe spontaneous movement first: how the cat rises, walks, and places each foot.

Palpation of joints should be systematic but gentle, noting pain responses, crepitus, reduced range of motion, and muscle atrophy.

The most commonly reported physical examination findings in cats with hip dysplasia are pain and crepitus upon extension of the hips, and muscle atrophy.

For subtle lesions, particularly of the elbow, CT provides better sensitivity than radiography alone.

For the referral decision framework, see when to refer for orthopedic surgery: surgical vs non-surgical cases. For post-surgical home care in cats, see post-op home care for pets after orthopedic surgery.

Frequently asked questions

How can I tell if my cat is in orthopedic pain if it isn't limping?

Watch for behavioral changes: reduced jumping, reluctance to use stairs, grooming changes, litter box avoidance, and increased irritability when touched.

These are often more reliable indicators of feline orthopedic pain than gait changes, which cats suppress effectively.

Is arthritis common in cats?

Yes. Radiographic evidence of OA affects 60 to 90% of older cats.

The condition is significantly underdiagnosed because cats compensate so well that owners rarely notice clinical signs until the disease is advanced.

My cat is a Maine Coon. Should I be concerned about hip dysplasia?

Maine Coons are one of the most commonly affected breeds, with hip dysplasia rates of 18 to 21% reported in some studies.

Annual veterinary checks including orthopedic assessment are worthwhile, even in the absence of obvious clinical signs.

Can cats have surgery for orthopedic conditions?

Yes. Fracture repair, patellar luxation correction, femoral head ostectomy for hip disease, and CCL repair are all performed in cats. Outcomes are generally good.

The decision to pursue surgery depends on severity, the cat's overall health, and owner circumstances.

How should I modify my home for a cat with arthritis?

Lower-sided litter boxes, ramps to reach favourite resting spots, raised food and water bowls, soft bedding in warm locations, and healthy weight management all significantly reduce the daily pain burden of OA.

Resources

• Merck Veterinary Manual. Joint Disorders in Cats. merckvetmanual.com
• VetTimes. Common Feline Orthopaedic Conditions Beyond OA Cases. vettimes.com
• MSPCA-Angell. Feline Orthopedic Disease. mspca.org
• PMC. Prevalence of Feline Hip Dysplasia, Patellar Luxation and Lumbosacral Transitional Vertebrae in Pedigree Cats. ncbi.nlm.nih.gov
• PetMD. Hip Dysplasia in Cats. petmd.com