You should seek the advice of your veterinarian if your pet is ill as only he or she can correctly advise on the diagnosis and recommend the treatment that is most appropriate for your pet.

A Patient Fracture Assessment Score is a scheme to assist clinicians to evaluate the likely success of fracture management. 

Most veterinary clinicians record a minimal amount of clinical information in their case recording system whether they use paper records or a computerised system. A PFAS is a recording system for the information that a clinician should be evaluating during the management of a fracture case.

The advantages of using a PFAS in a practice are :

• The attending clinician will not forget to consider an important factor in determining management protocols and the likely prognosis for the case
• Retrospectively, the actual outcome of cases can be compared with the PFAS - and so it can be used as a method for clinical audit within your practice. Clinicians should expect to get excellent results in patients with a high PFAS, whereas complications with bone healing can be expected in patients with a low PFAS.

The PFAS is obtained by considering three types of factors which might affect bone healing :

1. Biological Factors

• Age - bone healing is more rapid in young animals, may be delayed in old animals
• Likelihood of infection. Higher in open fractures compared to closed fractures
• Low energy versus high energy trauma. Type of trauma - a fall, a road traffic accident. The distance of a fall, the speed of a vehicle. The type of ballistic in gun shot wounds. High energy trauma increases the risk of post-operative complications 
• Has blood supply to the region been compromised ? Concurrent damage to major blood vessels and surrounding soft tissue. Stripping of periosteum from the bone.
• Are there any other disorders present which might indirectly influence bone healing -eg cancer, hypothyroidism, renal failure, hypoproteinaemia 

2. Mechanical Factors

• What are the loads on the bone likely to be during the repair period. Will the bone be expected to bear it's full share of loading - less, or more ? Excess load will be borne by the bone if the animal has lost the contralateral limb.
• Body weight - is the patient obese ? If so this increases load bearing on the fracture.
• Body size - giant breeds of dog often have trouble getting up and move around clumsily when they have a fractured limb. This increases the likelihood of abnormal stresses and forces being put on the fracture site during the healing period.
• Is more than one limb injured. If the other 3 limbs are normal they can take some of the load off the fractured limb.

3. Clinical Compliance Factors

• How experience is the surgeon at performing the chosen fracture repair procedure ? The more familiar and experienced a clinician is with a procedure the greater the chance of an excellent outcome without complications.
• Will the owner comply with recommendations during the post-operative period ?
• Will the animal comply with recommendations during the post-operative period ?

Usually a 10-point scoring system is used for each of the above 3 groups of Factor with :

1 - Worst possible case scenario

5 - Average case scenario

10 - Best possible case scenario

So, the maximum score is 30, the minimum score is 3. Average score is 15.

Practical Use of PFAS :

• Patients with a high PFAS  have the best prognosis
• Complications should be anticipated in patients with a low PFAS 
• For patients with a low PFAS the practice should develop protocols to minimise the likelihood of complications occurring, for example :
  • Rational use of antibiotics and surgical drains (when appropriate) to counteract infection at the wound site
  • Restrict movement of patients to avoid excessive load bearing early in the fracture repair period
  • Use of sedatives to calm down  boisterous animals during the early post-operative period
  • Use of elizabethan collars and other methods to stop self-trauma to the wound site.
• Owners of patients with a low PFAS should be warned about the possible problems that might occur and they should be given an appropriate prognosis.
• If clinicians are achieving poor post-operative results in patients given a high PFAS :
  • They should re-evaluate their method for determining the PFAS - in case they are forgetting to consider some important factors.
  • Their surgical technique should be evaluated for
    • Choice of technique - are they choosing the correct procedure for the type of fractures that they are seeing
    • Surgical competence - if the best procedure is being used for the type of fracture - is it being carried out competently or is further training/experience needed.

Feedback Request

The use of a PFAS scheme is not widespread in the veterinary profession . If you are using such a scheme please share your experiences with Provet. Send details of the scheme you are using with comments about the benefits and problems you have running it in your practice to feedback@provet.co.uk 

Updated October 2013