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External Fixators and Internal Plating: When Are These Indicated?

External Fixators and Internal Plating: When Are These Indicated?

Best Practices

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When do dogs need external fixators vs. internal plating? Learn key indications, pros, and real case examples in veterinary fracture repair

By 

Sustainable Vet Group

Updated on

April 21, 2025

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Understanding Fixation Methods in Dogs

When a dog breaks a bone, the goal of veterinary orthopedics is to stabilize the fracture so it can heal properly. This is done using fixation methods that hold the bone in place during recovery.

Two common methods are external fixators and internal plating.

  • External fixators are metal rods or pins placed outside the body and connected to the bone through the skin.
  • Internal plates are metal plates and screws that are attached directly to the bone during surgery, under the skin and muscle.

Choosing the right method is important. It affects how fast the bone heals, how much pain your dog feels, and how likely complications are. The location and type of fracture, your dog’s size, activity level, and overall health all play a role in deciding which method offers the best outcome.

When Are External Fixators Indicated?

External fixators are useful in many orthopedic cases where internal plating may not be the safest or most effective choice. They allow stabilization without disturbing nearby tissues and can be adjusted or removed more easily during healing.

1. Open and Comminuted Fractures

External fixators are commonly used for open fractures, where the bone is exposed due to skin damage, and comminuted fractures, where the bone is broken into multiple pieces. In these cases, placing plates inside the wound increases the risk of infection or poor healing.

External fixators stabilize the bone from outside, keeping the area open for cleaning and monitoring. They are especially helpful when the soft tissue around the bone is torn or swollen, as they avoid further trauma and support gradual healing without adding pressure to already damaged areas.

2. Soft Tissue Compromise

When soft tissue around the fracture is severely bruised, torn, or at risk of poor blood flow, external fixators are often the safest choice. They allow the bone to heal without cutting into or lifting the soft tissue.

This protects important structures like muscles, nerves, and blood vessels. Because the fixator stays outside the body, it avoids additional injury to tissue that’s already struggling to heal. This method is especially important in dogs with injuries to the lower legs, where blood supply is limited.

3. Infection or Osteomyelitis

In cases where the bone or surrounding tissue is already infected, such as with osteomyelitis, external fixators are preferred. Internal implants can trap bacteria and make infections worse. External fixators, on the other hand, stay outside the skin, allowing easier cleaning and drainage of infection.

Antibiotics can reach the area more effectively, and the wound can be monitored closely. This method also avoids further surgery in infected areas, which reduces complications and gives the dog a better chance at full recovery.

4. Distal Limb Fractures

Fractures in the lower parts of the limbs, like the radius, ulna, metacarpals, or metatarsals, are often treated with external fixators. These bones are small and close to the skin, so there’s not much muscle or soft tissue to protect internal plates.

Using an external frame avoids the need for deep dissection and gives the bone support from the outside. It also makes post-op care easier and avoids pressure on thin skin. This approach is especially helpful in small or toy breeds where space is limited.

5. Temporary Fixation in Polytrauma

In dogs with multiple injuries (polytrauma), external fixators are often used as a temporary solution to stabilize bones until the patient is strong enough for full surgery. This staged approach allows the vet to focus first on life-saving care, such as treating internal injuries or stabilizing vital signs.

Once the dog is stable, a more permanent surgical plan can be made. External fixators keep the bones in place during this critical period without needing long or complex anesthesia times.

6. Limb Deformity Corrections and Lengthening

External fixators are useful in correcting limb deformities or gradually lengthening bones. Special fixator systems allow small adjustments to be made over time, guiding the bone into the correct position as it heals.

This method is often used in cases of angular limb deformities, bone defects, or after trauma that caused uneven growth. Because the fixator can be adjusted daily, it offers great precision without needing multiple surgeries.

7. Pediatric and Growth Plate Protection

In young dogs with open growth plates, internal plating may damage growing bone or affect normal development. External fixators avoid this risk by stabilizing the fracture from the outside without interfering with growth.

They also allow flexibility for adjusting the frame if the bone grows during healing. This makes them a safer choice for puppies or growing dogs with fractures near the growth plates, especially in the lower limbs.

8. When Post-Op Access is Needed

In some cases, ongoing access to the surgical site is needed for wound care or monitoring, especially when there’s infection, open wounds, or skin grafts. External fixators keep the bone stable while leaving the area open for cleaning, bandaging, or visual checks.

This is very helpful when wounds need frequent dressing changes or when skin healing is part of the treatment plan. It also allows for better drainage, which is essential in complex trauma cases.

When Are Internal Plates Indicated?

Internal plating is a popular method for stabilizing bone fractures in dogs. Plates and screws are placed directly onto the bone under the skin to hold the fracture tightly together. This method offers rigid support and helps promote fast, clean healing in the right cases.

1. Simple, Closed Fractures

Internal plates are ideal for simple, closed fractures, where the skin remains intact and the soft tissues are healthy. These fractures have clean, straight lines and are easier to align. With no open wounds or infection risk, plates can be safely placed beneath the skin.

This method offers strong, stable fixation and encourages quick healing. It also reduces the need for bandaging or frequent wound checks, making it easier for both the pet and the owner during recovery.

2. Midshaft Long Bone Fractures

Plates are often used for midshaft fractures in long bones like the femur, humerus, and tibia. These areas have enough muscle and soft tissue to support internal fixation and protect the implant. The plate helps hold the bone firmly in place and allows for strong healing.

It’s especially useful when the bone breaks cleanly in the middle, away from joints. With proper healing, most dogs regain normal limb use within a few months.

3. Intra-Articular or Precise Reductions

When a fracture extends into a joint, precise alignment is critical to avoid arthritis or long-term stiffness. Internal plating is ideal in these cases because it allows the surgeon to reposition the bone pieces with exact accuracy.

By securing the joint surface with a rigid plate, the vet can restore normal joint shape and function. This is especially important in the elbow, hock, or stifle joints, where perfect alignment is needed for smooth movement and long-term comfort.

4. Cases Requiring Rigid Stability

Some fractures need very firm support to heal properly, especially in active dogs or weight-bearing limbs. Internal plates offer rigid fixation, reducing micromovement at the fracture site. This helps the bone heal more quickly and evenly.

The strong support also allows for earlier use of the leg, which helps prevent muscle loss and joint stiffness. This approach is ideal for dogs that need to return to function quickly, such as working or service animals.

5. Low-Maintenance Recovery

One major benefit of internal plates is that they’re buried under the skin, which means there are no external parts to clean or protect. This makes recovery easier for both the dog and the owner. There’s no risk of pin tract infection or the need for daily cleaning, as with external fixators.

Once the wound heals, the plate stays in place quietly while the bone repairs itself. This lower-maintenance option can be ideal for busy households or anxious pets.

6. When Infection Risk is Low

Internal plates are best used when the risk of infection is low. In clean, closed fractures without skin wounds or swelling, buried implants are safe and reliable. If there is no contamination and the surgical field is sterile, plates can stay in the body long-term without causing problems.

However, in cases of open wounds or previous infection, external fixation may be a safer option to avoid trapping bacteria around the implant.

How Surgeons Choose Between Fixators and Plates

Veterinary surgeons choose between external fixators and internal plates based on several key factors. The goal is always to select the method that ensures safe healing, minimal complications, and a return to function.

Here’s what guides the decision:

  • Fracture type - Comminuted or open fractures are usually treated with external fixators. Simple, clean breaks are better suited for internal plates.
  • Tissue health - If the soft tissue around the fracture is damaged, swollen, or has poor blood flow, external fixation avoids further disruption. Plates are preferred when tissue is healthy and strong.
  • Infection risk - In cases with infection or open wounds, external fixators are safer. Plates are ideal for sterile, closed injuries.
  • Dog’s size and age - Young dogs with growth plates often benefit from fixators to protect developing bones. Larger adult dogs may need the rigid support of internal plates for better long-term stability.

Pros of external fixators: Less invasive, adjustable, ideal for infection or soft tissue concerns.
Cons: Requires more cleaning and regular monitoring at home.

Pros of internal plates: Strong, stable support with hidden hardware and low daily care.
Cons: Not suitable for infected or heavily damaged tissue.

Common Case Examples in Dogs

Understanding how fixators and plates are used in real cases helps show why surgeons choose one method over the other. Each dog’s size, fracture location, and health status plays a key role in the decision.

Toy breed with radius/ulna fracture → external fixator

Small dogs, especially toy breeds, have thin bones in the forelimbs with little soft tissue coverage. When the radius or ulna breaks, an internal plate can be too large or risky.

An external fixator provides support without putting stress on the bone or nearby tissues, and it avoids complications like implant pressure or delayed healing.

Large dog with diaphyseal femur fracture → internal plate

In large breeds with a clean break in the middle of the femur (diaphysis), an internal plate offers rigid stability and excellent alignment. The strong muscle coverage in this area protects the implant, and the dog can often start light movement sooner due to the plate’s solid support.

Tibial comminution with wound → external frame

For a shattered tibia with an open wound, an external frame is the safest option. It avoids placing metal inside an infected or damaged area, allows the wound to stay open for cleaning, and holds multiple bone fragments in place while they heal gradually.

Puppy with limb deformity → fixator for correction

Growing dogs with angular limb deformities benefit from external fixators, especially adjustable ones. They allow the bone to be slowly realigned over time without damaging the growth plate, guiding proper bone development while preserving future joint function.

These examples show how the right method supports faster healing and fewer risks based on the dog’s unique condition.

Final Thoughts

When it comes to fracture repair in dogs, there is no one-size-fits-all solution. Each case needs an individualized approach based on the type of break, soft tissue condition, infection risk, and the dog’s age and size. The choice between external fixators and internal plates plays a big role in how well the bone heals and how quickly your dog returns to normal activity.

The surgeon’s experience is key in selecting the right method and performing the procedure safely. Post-operative care, including rest, follow-ups, and sometimes physical therapy, is just as important for long-term success.

As a pet owner, don’t hesitate to ask your veterinarian about all available options. Understanding the pros and cons of each method can help you make informed decisions and give your dog the best chance at a full, healthy recovery.

FAQs About Fracture Repair in Dogs

Which fractures need surgery in dogs?

Surgery is usually needed when a fracture is unstable, displaced, or involves a joint. Open fractures, comminuted breaks, or those that won’t heal well with a cast often require surgical repair using plates or fixators. The goal is to restore alignment, allow proper healing, and prevent long-term pain or poor limb function.

Are external fixators painful for dogs?

External fixators may look uncomfortable, but most dogs tolerate them well. Pain is usually managed with medications, especially in the first few days after surgery. Once the fixator is in place and the initial swelling goes down, most dogs adjust quickly and can walk comfortably with limited activity during healing.

How long does it take for a fracture to heal?

Most fractures take 6 to 12 weeks to heal, depending on the dog’s age, the type of break, and the chosen repair method. Puppies tend to heal faster, while older dogs or those with complex fractures may take longer. Regular X-rays help monitor healing progress during recovery.

Can internal plates stay in forever?

Yes, internal plates are designed to stay in the body long-term. In most cases, they do not need to be removed unless there’s an infection, irritation, or implant-related problem. Many dogs live full, active lives with plates still in place after their bones have fully healed.

What’s the success rate of each method?

Both internal plates and external fixators have high success rates when used appropriately. Success depends on fracture type, surgeon skill, and post-op care. Most dogs heal well, with success rates above 90%. Complications are rare but possible, so regular follow-ups are important to ensure smooth healing.

Is one method cheaper or safer than the other?

Costs and risks vary by case. External fixators may cost less up front but need more follow-up care. Internal plates are more expensive initially but often need fewer home-care steps. Safety depends on the dog’s condition, infection risk, and the complexity of the fracture. Your vet will recommend the best option based on all these factors.

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