12/07/2026
Meet Rhe, 16 weeks old female entire Border collie. She presented to Cedar Mountain Vet Referral for the right forelimb digit fracture (4th middle phalanx). The owner wanted her to be an agility competitor. She had a protective bandage at the time of presentation. Underneath skin was already compromised by pressure due to protective bandage. The fracture was mid diaphyseal oblique in nature, could not maintain the length of the digit appropriately due to sliding and shortening as the result. The fracture would surely heal eventually if she was rested, because she is a young puppy. However, the fracture could not be maintained in the appropriate position by closed reduction due to oblique nature. It would heal with malunion (heal with shortening and bending), affecting her performance in the future.
The challenge was the bone stock availability. She was small, the bone was small, physes were still open. No effective internal fixation method could be applied. The decision was made to use an intramedullary/dowel pinning (reported by Kornmayer and Lindenberg Vet Record Case report 2022). Intramedullary pin has an advantage of mechanical force against bending, while rotational and compressive forces cannot be neutralized. The neighboring 3rd and 5th digits could act as splint for the fractured 4th digit, while a dowel pin prevent sliding off and bending, and maintain the length of the fractured middle digit. A 0.8mm pin was used. After 4 weeks of postoperative bandaging, fracture has been healing but complete union was not achieved yet. Pressure sores from bandaging started to be a concern. At this stage, the bandage was discontinued. 8 weeks postoperatively, repeated radiographs showed complete union of the fracture. If there was no intramedullary pin in the bone, bandage needed to be continued despite pressure sores. Moreover, the fracture would not heal in physiologic position but malunion (shortening, angled). The benefit of internal fixation is reducing duration of external coaptation (bandage) skin complications, and earlier functional recovery. In fact, Rhe has walked well without bandage since 4 weeks postoperatively. We canโt wait to see Rhe get into agility.