The surgeon closes the incision and hands the patient back. From that point, the referring vet carries the case.

Post-surgical care is not passive.

It requires active communication with the surgical team, structured recheck examinations, prompt complication recognition, and consistent owner support throughout a recovery that may last months.

Quick answer: Post-surgical follow-up for referred orthopedic patients includes reading the discharge summary before the first recheck, establishing a recheck schedule (suture removal at day 10 to 14, radiographs at week 6 to 8), recognizing complications early, and reinforcing owner compliance at every visit.

Key takeaways

• Read the discharge summary before the first recheck: skimming leads to medication errors, missed complications, and inconsistent owner instructions
• Standard orthopedic recheck schedule: suture removal at day 10 to 14; radiographs at week 6 to 8; final check at week 12 to 16
• Contact the surgical team for: implant complications, deep infection not resolving in 72 hours, wound dehiscence, or worsening lameness
• Owner compliance is the most modifiable variable: reinforce activity restrictions, E-collar use, and complication signs at every contact
• Refer back for: deep infection, implant-related concerns, wound dehiscence, or persistent non-weight-bearing beyond expected timepoints
• Document each visit clearly: both the referring vet and the surgical team need an accurate record to track patient progress

Reading the discharge summary

The role of a referring veterinarian does not end when the surgery is done. After the specialist performs the procedure, the referring veterinarian often monitors the patient's healing, manages medications, and supports the client with follow-up care. Without clear updates and guidance, this handoff can lead to confusion, missed issues, or delayed treatment.

The discharge summary is the primary communication from the surgical team.

It contains the diagnosis, the specific procedure performed, implant details, the prescribed medication list, the recheck schedule, and the complications to monitor.

Even when the specialist provides detailed discharge instructions, referring veterinarians often need to reinforce or adjust them during follow-up visits. Clients may forget or misunderstand what they were told at the surgical centre, especially if they were stressed or overwhelmed on discharge day.

What to extract from every discharge summary:

• Full medication list (drug, dose, frequency, duration)
• Recheck schedule and what assessment is required at each visit
• Specific complications the surgeon flagged for this case
• Activity restriction level and when it can be modified
• Criteria for contacting the surgical team directly

If anything is unclear, contact the specialist before the first recheck not after.

Recheck schedule

Soft tissue cases

• Day 10 to 14: incision assessment, suture removal, medication review
• Further rechecks: based on clinical signs and case complexity

Orthopedic cases

• Day 10 to 14: incision assessment, suture removal, gait assessment
• Week 6 to 8: radiographs to confirm bone healing and implant position
• Week 12 to 16: final assessment in complex cases; progressive activity increase if healing confirmed

If pain medications are still needed after a few weeks, it is best to follow up with your referring veterinarian.

Consistent scheduling helps track progress and catch complications early. Document each visit so both you and the specialist can follow the case.

What to assess at each recheck

At every visit:

• Incision appearance: closure status, discharge type and volume, redness, swelling
• Weight-bearing status on the affected limb
• Pain assessment using a standardized scale
• Muscle mass: compare bilaterally
• E-collar compliance
• Medication compliance and any adverse effects reported by the owner

At orthopedic rechecks:

• Joint stability (where applicable)
• Range of motion of the operated joint
• Radiographs at intervals specified in the discharge summary

Recognizing and triaging complications

Surgical site infection (SSI)

Signs: redness extending beyond the incision margins after day 3, purulent discharge, local heat, wound odor, systemic signs (fever, lethargy).

Management: culture and sensitivity before starting antibiotics. Surface infections can be managed locally. Deep infections, infections near implants, and infections not improving in 48 to 72 hours require surgical team contact.

Seroma

Soft, fluctuant non-painful swelling beneath the incision. Common after soft tissue and orthopedic surgery. Small seromas often resolve with strict rest. Larger seromas may need drainage under guidance from the surgical team.

Wound dehiscence

Partial or complete opening of the incision. Requires same-day assessment. Full dehiscence with tissue exposure is an emergency. Contact the surgical team before attempting local re-closure of complex wounds.

Persistent or worsening lameness

In orthopedic cases, persistent non-weight-bearing or worsening lameness beyond the expected timeline warrants radiographs and surgical team contact. Implant loosening, infection, or fracture propagation must be ruled out before managing locally.

Communicating with the surgical team

Smooth communication between the surgical team and the referring vet is crucial.

Contact the surgical team for:

• Any implant-related concern identified on radiograph
• Deep SSI not resolving with antibiotics in 48 to 72 hours
• Wound dehiscence of a complex closure
• Lameness or pain worsening rather than improving at expected timepoints
• Uncertainty about whether a finding requires re-referral

The GP's office should contact the orthopedic surgeon to get the discharge instructions, which include pin care and a schedule for pin removal. Call the specialty hospital on the day of surgery to get a briefing on the outcome and expected aftercare.

A proactive call immediately after surgery, confirming surgical findings and aftercare requirements, prevents the most common breakdown: managing a complication beyond scope while the problem worsens.

Supporting owners through recovery

Focus on key points like medication schedules, activity restrictions, wound care, and signs that need urgent attention. Avoid medical jargon clients appreciate straightforward, step-by-step guidance. You can provide these as printed handouts or digital summaries sent by email or text.

Follow-up communication needs to happen the day after the patient is discharged. Make sure you have updated contact information and the desired contact method. Encourage clients to call if they have any concerns once the pet is home.

Owner compliance particularly with activity restriction and E-collar use is the most controllable variable in post-surgical outcome. Non-compliance is the most common cause of wound complications and implant failure.

Reinforce it at every visit, not just at the first one.

For the complications guide covering specific scenarios and when to re-refer, see post-op home care for pets after orthopedic surgery.

For the communication framework between GP and specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

Frequently asked questions

When should I contact the surgical team vs. manage locally?

Manage locally: minor incision redness not progressing, small seromas under active rest restrictions, mild expected lameness on the expected timeline.

Contact the surgical team: any implant concern, deep infection, wound dehiscence of a complex closure, worsening rather than improving lameness, or any complication you are unsure how to manage.

What imaging is needed at the 6-week orthopedic recheck?

Radiographs of the operated region in the same views as the post-operative images from the discharge summary. Compare implant position, bone healing, and periimplant margins.

If the surgeon provided post-operative radiographs in the discharge summary, use these as the baseline for comparison.

My client says the dog is doing great but the incision looks concerning. Who is right?

Trust the physical examination over owner assessment. Owners naturally minimise signs when they want their pet to be well.

Document your findings, photograph the incision, and manage based on clinical evidence rather than owner report.

How do I handle the case if I cannot reach the surgical team?

Document the attempt and the clinical finding. For non-emergency complications, continue conservative local management while attempting to reach the team.

For emergencies (wound dehiscence with tissue exposure, signs of systemic sepsis), act appropriately and continue attempting specialist contact. Never delay emergency care while awaiting specialist guidance.

How long does the referring vet typically follow the case?

For straightforward soft tissue cases, typically until the 10 to 14 day recheck and discharge.

For orthopedic cases, the referring vet typically follows the patient through the 6 to 8 week radiographic recheck and the 12 to 16 week final assessment.

This represents a total follow-up period of 3 to 4 months.

Resources

• SustainableVet. Post-Surgical Follow-Up Guide for Referring Vets. sustainablevet.org
• Advanced Veterinary Care. Orthopedic Surgery Post-Operative Instructions. advancedvetcarenm.com
• Today's Veterinary Business. From Preop Through Postop. todaysveterinarybusiness.com
• ACVS. Postoperative Care After Surgery: What Animal Owners Should Expect. acvs.org

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

A well-prepared referral saves the specialist time, prevents duplicate testing at the owner's expense, and results in a more productive first consultation.

A poorly prepared referral missing radiographs, incorrect views, or no clinical summary forces the specialist to start from scratch and may delay diagnosis and treatment.

Quick answer: Before orthopedic referral, take minimum two orthogonal radiographic views under sedation, run baseline blood work for any patient likely to need surgery, and write a clear referral summary. CT and MRI are not routinely required before referral; most specialists prefer to perform these in-house to their own protocols.

Key takeaways

• Two orthogonal radiographic views are the minimum for any orthopedic referral: lateral and craniocaudal/mediolateral single views are inadequate
• Sedation improves radiograph quality: precise positioning detects subtle lesions; unsedated films are frequently non-diagnostic
• Send DICOM files, not printed films: digital files allow the specialist to adjust contrast and zoom; printed films are inferior
• CT and MRI are usually performed at the specialist centre: refer before CT/MRI unless the specialist specifically requests pre-referral imaging
• Baseline blood work is essential for any patient expected to need surgical anesthesia: CBC and biochemistry at minimum
• A clear written referral summary with gait findings, lameness duration, and prior treatment adds more value than extra imaging alone

Why pre-referral imaging matters

The most important part of the orthopedic exam and probably the most important part of the workup is attempting to localize the cause of lameness to a single joint or single bone.

Radiographs at the primary care practice serve several purposes: confirming the anatomical location, ruling out differentials, giving the specialist baseline images, and identifying concurrent findings the owner needs to know about.

Poor imaging quality, missing essential baseline tests, and unclear communication with specialists can cause delayed diagnoses and ineffective treatment plans.

Radiography: the essential pre-referral modality

Two orthogonal views minimum

Always take at least two orthogonal views (e.g., lateral and craniocaudal/mediolateral). Use stress or oblique views for joint instability (e.g., CCL rupture, elbow dysplasia). Ensure proper sedation for accurate positioning, especially for pelvic or spinal radiographs.

A single lateral view is not adequate for referral. Fractures, joint mice, and osteophyte patterns require two planes to characterize. Subtle findings visible on one view may be absent on another.

Sedation for positioning: unsedated radiographs in painful patients are often rotated, foreshortened, or underexposed. These films reduce diagnostic value and may force repeat imaging at the specialist centre a cost the owner bears twice. Sedation is appropriate and usually brief for orthopedic positioning.

Specific views by condition

Sending digital files

Send DICOM format where possible. Digital files allow the specialist to adjust window and level settings, zoom into areas of interest, and use measuring tools.

Printed films or JPEG photographs of films are significantly inferior and should be avoided.

When to perform CT before referral

CT is significantly more sensitive than radiography for:

• Medial coronoid process disease (elbow dysplasia)
• Complex periarticular fractures
• Spinal cord compression assessment
• Nasal cavity and dental pathology

Thoracic radiographs provide metastatic and pre-anesthetic screening. No additional radiographs are necessary if the patient will be referred for advanced imaging.

Most specialist centres prefer to perform CT in-house to their own protocols. Referring a patient with CT already done can be counterproductive if the protocol does not meet the specialist's requirements.

Unless the specialist has specifically requested pre-referral CT, radiographs alone are appropriate.

Exception: if CT is readily available at your practice, in good quality, and the specialist has confirmed they will accept your images, pre-referral CT for elbow dysplasia or complex fractures is valuable.

MRI before referral

MRI is superior to CT for soft tissue detail: spinal cord, brain, tendons, and ligaments. It is almost never required before referral.

MRI requires general anesthesia and significant scan time. Specialist centres perform it to their own protocols and prefer to interpret their own studies.

Referring a patient with MRI images from another centre creates interpretation challenges that can slow, not speed, diagnosis.

Laboratory diagnostics

Run basic lab tests (CBC, chemistry, joint fluid analysis if needed) before referring the case.

Pre-referral blood work:

• CBC: detects anaemia, leukocytosis (infection/inflammation), thrombocytopenia
• Biochemistry panel: kidney and liver function essential before any anesthetic
• Relevant for: any patient likely to need surgical anaesthesia at the specialist centre

When joint fluid analysis adds value:

• Suspected immune-mediated polyarthritis
• Joint effusion without clear traumatic or degenerative cause
• Suspected septic arthritis

In chronic orthopedic cases, laboratory diagnostics help differentiate degenerative diseases from immune-mediated or infectious conditions, providing a more complete clinical picture. C-reactive protein levels indicate active inflammation, commonly seen in immune-mediated arthritis. Synovial fluid analysis helps assess infection, immune-mediated polyarthritis, or degenerative joint disease.

The referral summary

A well-written referral letter adds value that no imaging can replace:

Include:

• Signalment and body weight
• Duration and progression of the lameness
• Which limb(s) and which joints on palpation examination
• Gait assessment findings (grade of lameness, pattern)
• Orthopaedic test results (cranial drawer, tibial compression, Ortolani)
• Differential diagnoses considered
• Previous treatments and response
• Reason for referral and what you are asking the specialist to do

Keep it concise. A one-page summary covering the above is far more useful than three pages of unformatted notes.

For the communication framework with the specialist, see how to optimize communication between general practitioners and orthopedic surgeons.

For what happens at the specialist consultation, see what to expect when your patient sees an orthopedic specialist.

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

Frequently asked questions

Do I need to sedate the dog for pre-referral radiographs?

Yes, for most orthopedic cases. Sedation improves positioning accuracy significantly. Unsedated films in painful patients are frequently rotated or foreshortened and may not provide diagnostic information.

Brief sedation for positioning is appropriate and is standard at most specialist centres for their own imaging.

The specialist centre is far away. Should I try to do a CT first?

Only if the specialist has specifically requested pre-referral CT and you can achieve the required protocol quality. Otherwise, radiographs are sufficient for referral.

CT performed without the specialist's protocol guidance may not meet their imaging requirements and could result in the owner paying for repeat CT at the specialist centre.

What format should I send radiographs in?

DICOM format wherever possible. If DICOM is not available, the highest-resolution uncompressed images you can export.

Avoid photographing films with a mobile phone these are not diagnostically useful and create a poor impression of the case preparation.

Is blood work always required before referral?

Not in an emergency. For elective or semi-urgent referrals where surgical anaesthesia is anticipated, blood work provides essential safety information.

It is best performed at the primary care practice to allow results interpretation by someone who knows the patient's history.

My radiographs show only mild changes. Should I still refer?

Yes, if the clinical signs warrant it. Radiographic severity does not always correlate with clinical severity. A dog with mild radiographic changes but significant lameness affecting quality of life merits specialist assessment.

Conversely, severe radiographic OA in a dog with good function may not need referral urgently.

Resources

• SustainableVet. Essential Imaging and Diagnostics Before Vet Referrals. sustainablevet.org
• MSPCA-Angell. Radiographic Approach to Bone Imaging. mspca.org
• Today's Veterinary Practice. Advanced Imaging: Its Place in General Practice. todaysveterinarypractice.com
• SustainableVet. When to Refer: Surgical vs Non-Surgical Orthopedic Cases. sustainablevet.org

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

Hip dysplasia is one of the most common orthopedic diagnoses in dogs, but it doesn't always mean surgery is coming.

Many dogs with hip dysplasia live comfortably for years on conservative management. Others reach a point where pain or mobility loss makes surgery the right path. Knowing which situation your dog is in, and which surgical option makes sense, is what this guide is for.

Quick answer: Surgery becomes the best option for hip dysplasia when conservative management no longer controls pain, when mobility is significantly impaired, or when a dog is young enough for preventive procedures. The two main surgical options are FHO (femoral head ostectomy) and THR (total hip replacement), each suited to different dogs.

Key takeaways

• Surgery isn't always necessary: many dogs manage well with medication, weight control, and physiotherapy.
• Two main surgical paths exist: FHO removes the femoral head; THR replaces the entire joint.
• FHO suits smaller dogs and tight budgets; THR delivers better function in large, active breeds.
• Early preventive surgery (DPO/TPO) is an option for puppies under 10 months with minimal joint damage.
• The trigger for surgery is quality of life, not the X-ray grade alone.
• Delaying surgery in severe cases worsens outcomes: arthritis accumulates and options narrow.

What hip dysplasia actually is

Hip dysplasia is a developmental condition in which the ball (femoral head) and socket (acetabulum) of the hip joint don't fit together correctly. Instead of a tight, smooth connection, the joint is loose, allowing abnormal movement that gradually wears down cartilage and produces bone-on-bone friction.

The result is pain, inflammation, and over time, progressive osteoarthritis.

Hip dysplasia is most common in large and giant breeds: German Shepherds, Labrador Retrievers, Golden Retrievers, Rottweilers, and Saint Bernards among the most frequently affected, but it occurs in any size dog.

The severity on X-ray does not always match the dog's visible symptoms. Some dogs with significant radiographic changes are relatively comfortable. Others with moderate findings are clearly in pain. Both the X-ray and the clinical picture matter.

When conservative management is enough

For many dogs with hip dysplasia, especially mild to moderate cases, non-surgical management controls symptoms well enough that quality of life is maintained without surgery.

Conservative management typically includes:

• Weight management: Reducing body weight is the single most impactful intervention. Every pound of excess weight adds direct mechanical load to an already unstable joint.
• Pain medication: NSAIDs (such as carprofen, meloxicam, or grapiprant) reduce inflammation and pain. Regular bloodwork monitoring is required for long-term NSAID use.
• Joint supplements: Glucosamine, chondroitin, and omega-3 fatty acids support cartilage health and reduce inflammation over time.
• Physical therapy and low-impact exercise: Controlled walking, swimming, and hydrotherapy build the muscle mass that stabilizes the joint and reduces the load on the hip.
• Environmental modifications: Ramps instead of stairs, non-slip flooring, orthopedic bedding.

Conservative management doesn't fix the underlying anatomy. It manages symptoms within the constraints of what the joint can do. When symptoms outgrow what this approach can control, surgery enters the conversation.

For non-surgical alternatives in more detail, see non-surgical alternatives to consider.

When surgery becomes the better path

According to Ask A Vet (2025), surgery is recommended when conservative management fails or when early intervention can prevent arthritis. The clinical signals include:

• Persistent limping or bunny-hopping that doesn't resolve with medication and rest
• Reluctance to stand, jump, or climb stairs that's significantly limiting daily life
• Muscle atrophy in the hindquarters from disuse
• Radiographic evidence of progressive joint damage alongside clinical decline
• Quality of life that is clearly impacted despite consistent conservative management

The decision to move to surgery is a quality-of-life decision, not purely a radiographic one. Two dogs with similar X-rays may need different approaches based on their clinical response to conservative care.

The surgical options for hip dysplasia

FHO (femoral head ostectomy)

FHO removes the head and neck of the femur: the "ball" of the ball-and-socket joint. The remaining femur is cushioned by a "false joint" of fibrous scar tissue that forms over the following weeks.

Best suited to:

• Small to medium dogs (typically under 50 lbs)
• Any size dog when THR isn't feasible (financial constraints, health contraindications)
• Cats

Limitations: The false joint doesn't provide the mechanical function of a real hip. Large breeds may have residual pain or gait abnormality. Function depends heavily on muscle mass and rehabilitation.

For a full explanation of what the procedure involves, see what FHO surgery is and how it helps.

THR (total hip replacement)

THR replaces the entire hip joint with a prosthetic implant. The femoral head and acetabulum are both replaced with precisely fitted components.

Best suited to:

• Medium to large dogs (typically over 40 to 50 lbs) who want full athletic function restored
• Skeletally mature dogs (typically over 9 to 12 months)
• Dogs in otherwise good health without significant comorbidities

Advantage over FHO: THR restores near-normal hip anatomy and function. Success rates of 80 to 98% are reported across published studies. Large active breeds return to full exercise capacity more reliably than with FHO.

For a full overview of the THR procedure, see total hip replacement as an alternative.

DPO/TPO (double or triple pelvic osteotomy)

This is a preventive surgery performed only in young dogs (typically under 10 months old) with hip laxity but minimal joint damage. The surgeon cuts and rotates the pelvic bones to improve how the socket holds the femoral head, reducing abnormal motion before cartilage damage accumulates.

Candidates: puppies with confirmed hip laxity on radiograph, little or no arthritis, and growing bones.

This window closes as the dog matures and joint damage develops.

How to know which surgical option applies to your dog

The right surgical option depends on the intersection of several variables:

For the direct comparison of FHO versus THR across all major factors, see FHO vs total hip replacement for hip dysplasia.

For the specific indications that guide the FHO recommendation, see when FHO is recommended.

The cost of waiting

For dogs with mild disease and adequate pain control, watchful waiting is entirely appropriate.

For dogs with moderate to severe disease where quality of life is declining, delay carries real costs:

• Progressive arthritis: The damaged joint continues to deteriorate. Every month of delay means more cartilage loss and more established arthritis.
• Muscle atrophy: Disuse of the painful leg causes the supporting muscle to waste away, making recovery from eventual surgery harder and longer.
• Narrowing options: As joint damage progresses, some surgical options become less appropriate. DPO/TPO is only available during a brief window in puppyhood.

Early action, when indicated, typically means simpler surgery, cleaner recovery, and better long-term outcomes.

For guidance on whether your dog is a candidate for THR specifically, see how to know if your dog is a THR candidate.

Frequently asked questions

My dog has hip dysplasia but doesn't seem to be in pain. Do they need surgery?

Not necessarily. Many dogs with hip dysplasia compensate well and show minimal pain, particularly in early disease. Conservative management, weight control, and monitoring are appropriate first steps. Surgery is indicated when pain is not controlled or mobility is meaningfully impaired, not simply because the diagnosis exists.

How old does a dog need to be for hip replacement surgery?

THR requires skeletal maturity, typically achieved at 9 to 12 months in most breeds and later in giant breeds. FHO can be performed at any age. DPO/TPO is only appropriate before 10 months of age in puppies with hip laxity and minimal arthritis.

Can hip dysplasia go away without surgery?

The underlying anatomic abnormality doesn't resolve. But many dogs with hip dysplasia maintain a good quality of life on conservative management for years, particularly those who remain lean and receive appropriate physiotherapy. "Going away" isn't the goal; managing symptoms within the joint's limits is.

Hip dysplasia doesn't come with a single right answer. The best path depends on your dog's size, age, severity of symptoms, response to conservative care, and your goals for their function and quality of life. The conversation with your vet and the X-ray findings together tell you more than either alone. Start early, monitor consistently, and make the surgical decision based on how your dog is actually living rather than the diagnosis on paper.

Resources

• PetMD. FHO Surgery in Dogs and Cats. petmd.com
• Ask A Vet. Vet-Approved 2025 Guide: Hip Dysplasia Surgery in Dogs. askavet.com
• Simon Vet Surgical. Hip Dysplasia Surgery in Dogs. simonvetsurgical.com

When a dog tears its cranial cruciate ligament (CCL), three osteotomy-based surgeries are currently in widespread use: TPLO (tibial plateau leveling osteotomy), TTA (tibial tuberosity advancement), and CBLO (CORA-based leveling osteotomy).

All three aim to change the biomechanics of the stifle to eliminate the need for the damaged CCL.

They differ in the specific bone cut, the mechanism of stabilization, the implants used, and the evidence base supporting their outcomes.

Quick answer: TPLO, TTA, and CBLO all stabilize the stifle by changing tibial geometry. TPLO has the most evidence, is the ACVS gold standard for large dogs, and achieves 93% limb function at 1 year. TTA produces similar long-term outcomes. CBLO is used mainly for immature dogs and revision surgery.

Key takeaways

• TPLO is the most evidence-supported procedure: a 2013 study confirmed 93% limb function restoration at 1 year; it is the ACVS-preferred procedure for most large, active dogs
• TTA produces similar long-term outcomes to TPLO: a PMC systematic review of 72 studies found both are successful; TTA may have slightly faster early recovery
• CBLO is a newer TPLO variant: the osteotomy is made at the CORA rather than proximally; fewer long-term studies exist; mainly used for immature dogs and revision cases
• All three require 8 to 12 weeks of activity restriction: post-operative management is essentially identical; radiographic healing confirmation before activity return is required for all
• TPLO has a lower SSI rate than TTA per the PMC systematic review; this is clinically meaningful given TPLO's already-elevated SSI risk vs other orthopedic procedures
• The choice between TPLO and TTA is often surgeon preference and facility capability: no clear clinical superiority exists for appropriately selected patients; CBLO is less universally available

How each surgery works

TPLO: tibial plateau leveling osteotomy

TPLO makes a curved osteotomy through the proximal tibia and rotates the tibial plateau segment to approximately 5 degrees.

This rotation eliminates the cranial shear force that drives tibial thrust when the CCL is absent. A plate and locking screws hold the rotated segment while the osteotomy heals.

The result: the stifle is mechanically stable during weight bearing regardless of CCL integrity, because the geometry of the tibial plateau no longer creates the shear force that was causing instability.

TTA: tibial tuberosity advancement

TTA moves the tibial tuberosity (the bony prominence at the front of the tibia where the patellar tendon attaches) forward, changing the angle between the patellar tendon and the tibial plateau.

When this angle reaches approximately 90 degrees, the patellar tendon acts as an active stabilizer of the stifle during weight bearing, neutralizing the cranial shear force.

TTA uses a cage (typically titanium or porous polyethylene) to maintain the advanced position of the tuberosity during healing.

B Braun Vet Care confirms: TTA was quicker with a smaller incision; patients weight bore faster with fewer direct post-operative complications. However, longer-term studies show similar outcomes for each procedure.

CBLO: CORA-based leveling osteotomy

CBLO is a variant of the leveling osteotomy concept.

TPLO makes its circular cut proximally near the tibial plateau. CBLO makes its osteotomy at the CORA (center of rotation of angulation), which is lower on the bone.

The goal is to correct the tibial deformity at the site where it actually originates geometrically, which may produce a more anatomically accurate correction in some dogs.

Southern Animal Health confirms: CBLO benefits appear limited to immature dogs or revision surgery where cuts have already been made higher on the bone.

Outcome comparison

TPLO outcomes

A 2013 study comparing TPLO and TTA found TPLO patients achieved 93% restoration of limb function at 1 year.

A randomized blinded clinical trial comparing lateral fabellar suture stabilization with TPLO in 80 dogs confirmed TPLO produced higher peak vertical force and higher owner satisfaction at 1 year.

TPLO has the most extensive published evidence base of any cruciate repair technique in dogs.

Vetamac confirms: a 2013 study found TPLO patients averaged 93% limb function return at 1 year, and a higher percentage achieved full return compared to TTA.

TTA outcomes

The PMC systematic review of 72 studies (PMC9748159) found both TPLO and TTA are successful management options, with no lameness at long-term evaluation for most patients.

It also found TTA showed better OA scores up to 6 months postoperatively, while TPLO had lower SSI rates.

B Braun Vet Care confirms: many longer-term studies show similar outcomes for TPLO and TTA; one study suggests TPLO had a marginally better outcome than MMP.

Southern Animal Health confirms: a study of long-term results 3 years after surgery clearly shows that TTA and MMP candidates show more arthritis and more discomfort than dogs repaired with TPLO.

CBLO outcomes

CBLO has fewer published long-term studies than TPLO or TTA. Early results are promising.

The SustainableVet.org CBLO article confirms that CBLO produces good outcomes and is particularly used for dogs with steep tibial slopes or early arthritis.

Longer-term comparative data against TPLO in equivalent patient populations remains limited.

Patient selection

When TPLO is the preferred choice

• Dogs over 35 to 40 pounds (medium to large breeds)
• Young, athletic, or working dogs of any size
• Dogs with steep tibial plateau angles (TPA above 25 to 30 degrees)
• Cases where maximum long-term joint stability and arthritis control are priorities

When TTA may be considered

• Dogs with low to moderate TPA (the mechanical advantage of TTA is greatest when the existing TPA is near 90 degrees)
• Cases where a shorter surgical time is beneficial (older dogs with anesthetic risk)
• Some surgeons prefer TTA for dogs with high-velocity tibial thrust where TTA's mechanism may provide faster active stabilization

When CBLO may be considered

• Skeletally immature dogs where TPLO would cut across the growth plate
• Revision cases where a proximal osteotomy has already been performed
• Dogs with unusual tibial geometry where the CORA is positioned lower than average

SustainableVet.org confirms: CBLO is a newer, flexible option that fits many situations, especially for dogs with steep tibial slopes or early arthritis.

Recovery comparison

All three procedures require essentially the same post-operative management:

• Strict activity restriction for 8 to 12 weeks
• Leash walks only during the restriction period
• Radiographic assessment of bone healing at 6 to 8 weeks and 12 weeks
• Progressive return to activity after radiographic confirmation

The one consistent early difference: TTA dogs may weight bear more readily in the first 1 to 2 weeks.

B Braun Vet Care confirms: TTA patients were quick to weight bear with fewer direct post-operative complications compared to TPLO.

This early advantage does not produce meaningfully different long-term outcomes in most studies.

Cost comparison

All three osteotomy procedures are similarly priced at referral centers -- typically $3,000 to $6,000 per stifle. The specific cost depends on the facility, surgeon, dog size, and geographic region.

Cost differences between TPLO, TTA, and CBLO at the same facility are typically not substantial.

For the full TPLO overview, see TPLO surgery pros and cons for dogs. For CBLO specifically, see CBLO surgery in dogs. For alternatives, see alternatives to TPLO surgery for dogs.

For lateral suture comparison, see lateral suture vs TPLO for dogs.

Frequently asked questions

Is TPLO better than TTA?

For most large, active dogs, the balance of evidence slightly favors TPLO for long-term outcomes and lower arthritis progression.

However, multiple studies show no significant difference in objective gait analysis at long-term follow-up. The choice is often surgeon experience and facility capability rather than an absolute clinical superiority.

What is CBLO and is it better than TPLO?

CBLO is a variant of the leveling osteotomy that makes its bone cut at a different anatomical location. It is not established as better than TPLO for routine adult dog CCL repair.

Its main current applications are in immature dogs and revision surgery cases where TPLO would be anatomically difficult.

Which surgery has the lowest complication rate?

TTA generally has a lower SSI rate in some studies and was associated with fewer immediate post-operative complications in others.

However, TPLO and TTA have broadly comparable overall complication profiles at experienced facilities. CBLO data is more limited.

Can my regular vet perform any of these surgeries?

TPLO and TTA require specialized training and equipment (oscillating saw, specific implants, fluoroscopy for osteotomy confirmation). Both are typically performed by board-certified surgeons or general practitioners with specific TPLO or TTA training.

CBLO is similarly specialized. None of these are routine general practice procedures.

My dog had a failed TTA. Can TPLO be done as a revision?

Yes -- TPLO can be performed as a revision after a failed TTA in appropriate cases. The surgical planning differs from primary TPLO because the proximal tibial anatomy has already been altered.

CBLO may be used in these cases for similar reasons. This is a specialist procedure requiring careful pre-operative radiographic planning.

Resources

• PMC. Systematic Review of TPLO vs TTA for CCL Rupture in Dogs. ncbi.nlm.nih.gov
• Vetamac. TPLO Surgery in Dogs: Success Rates and Alternatives. vetamac.com
• Southern Animal Health. Cruciate Repair Technique Comparison. southernanimalhealth.com.au
• ACVS. Cranial Cruciate Ligament Disease. acvs.org