Can bone marrow aspirate improve mandibular fracture repair in camels (Camelus dromedarius)? A preliminary study

BackgroundMandibular fractures are common in camels, leading to considerable economic losses. This study explored methods of improving mandibular fractures repair, adjuvant with interdental wire, or bone plate fixation. Autologous bone marrow (BM) injection enhances osteogenesis and rapid healing.ObjectivesTo investigate the effect of autologous BM aspirate as an adjuvant treatment for repairing mandibular fractures in camels with interdental wire, or bone plate fixation.MethodsThirty dromedary camels aged 5–8 years and of both sexes were randomly divided into 4 treatment groups: group 1 (n = 10) treated with stainless steel wire fixation and BM injection at the fracture line, group 2 (n = 10) treated with plate fixation and BM injection at the fracture line, group 3 (n = 5) treated with stainless steel bone wire fixation and placebo saline injection at the fracture line, and group 4 (n = 5) treated with plate fixation and placebo injection at the fracture line. The mandibular fractures were followed weekly for 12 weeks postoperatively to assess improvement and healing based on clinical evaluation, radiographic union scale, and bone turnover markers (i.e., bone alkaline phosphatase, osteocalcin, pyridinoline, and deoxypyridinoline).ResultsCompared to other groups, elevated bone turnover markers in group 1 were demonstrated (p < 0.05) on the seventh postoperative day. Likewise, compared to other groups, both clinical findings and radiographic union scale significantly improved (p < 0.05) in group 1 on the 56th postoperative day.ConclusionsBM aspirate has a promising beneficial osteogenic effect on mandibular fracture repair in camels, most notably when combined with interdental wire fixation.     

Miniplate Fixation for Repair of Mandibular and Maxillary Fractures in 15 Dogs and 3 Cats

Maxillofacial miniplates and screws were used for skeletal fixation in 15 dogs and 3 cats that sustained a variety of mandibular and maxillary fractures. These implants were used as neutralization or buttress fixation in 11 caudal (junction of the ramus with the mandibular body) and 2 rostral mandibular fractures, 4 maxillary fractures, and 2 zygomatic arch fractures. All but one of the fractures healed with appropriate occlusion and excellent function. In one case of a rostral mandibular fracture, soft tissue dehiscence occurred accompanied by a loss of the fixation and subsequent distraction of the bone fragments; reasonable function was obtained by performing a rostral mandibulectomy. Plate contouring and application of the miniplates along the appropriate biomechanical lines of stress was easily performed and permitted the biomechanical principles of tension band fixation to be applied in most cases. Miniplate fixation, either used alone or in combination with other fracture fixation techniques, achieved sufficiently rigid skeletal fixation to provide uncomplicated healing and good to excellent functional and cosmetic results in 14 dogs and 3 cats.     

Lingual arch bar application for treatment of rostral mandibular body fractures in cats

Objective: To describe a lingual arch bar technique for fixation of rostral mandibular body fractures and report outcome in 16 cats. Study Design: Original study. Animals: Cats (n=16) with rostral mandibular body fracture (10 bilateral, 6 unilateral) just caudal to the canine teeth. Methods: Orthodontic wire (Dentaurum^®; 0.9 mm) was used as a lingual arch bar by contouring it to the shape of the lingual side of the alveolar margin, and secured by circum‐mandibular wires passed interproximal to teeth. Stability of fixation, occlusion, tolerance to the lingual arch bar, degree of secondary gingivitis/periodontitis, and ability to eat were evaluated clinically, and fracture union was assessed radiographically. Results: The lingual arch bar was well tolerated. Eleven cats without a feeding tube were able to eat within 24 hours. Time to fracture union and appliance removal ranged from 28 to 64 days (mean, 42.5 days). Malocclusion of the rostral part of the fracture occurred in 5 cats; however only 1 required correction. Conclusions: Intraoral stabilization of rostral mandibular fractures using a lingual arch bar is a simple and effective method for the treatment of rostral mandibular fractures just caudal to the canine teeth.     

Conservative management of fractures of the mandibular condyloid process in three cats and one dog

Three cats and 1 dog with fracture of the mandibular condyloid process and concomitant fracture(s) of the rostral portion of the mandible were treated successfully by wire fixation of the rostral mandibular fracture(s) and by conservative management of the mandibular condylar fracture. All animals regained satisfactory dental occlusion and normal, pain-free motion of the jaw. Fracture of the mandibular condyloid process is an infrequently diagnosed injury that usually occurs with other mandibular fractures. If satisfactory dental occlusion can be achieved by surgical stabilization of the noncondylar fractures, surgical repair of the mandibular condyloid fracture may not be necessary.     

Multiple Intramedullary Wire Fixation of a Radial Fracture in a Dog

Multiple intramedullary wire fixation infrequently can be used as an alternative technique to plating, transfixation devices, single intramedullary pinning, or external coaptation for some radius and ulna fractures.
This report describes a comminuted fracture of the radius and ulna with fissures and comminution extending too far into the proximal radius for effective application of a bone plate or Kirschner-Ehmer apparatus. Resulting fracture instability and collapse prohibited effective use of external coaptation as a primary means of fixation. The radial fracture was repaired and stabilized with full cerclage wires and multiple intramedullary Kirschner wires. The dog was using the leg normally 12 months following surgery.     

Fractures of the femur.

The most common indications for the use of ESF in femoral fractures are closed transverse, short oblique, and minimally comminuted fractures in the central one third of the bone. External skeletal fixation is usually used in combination with IM pins and wiring techniques. During the process of open reduction and internal fixation, the surgeon should strive for accurate anatomic alignment and stability at the fracture site. The fixator is applied after the internal fixation is in place and the surgical wound is closed. The number of fixation pins placed in each fracture fragment depends on the type of fracture and the stability gained by internal fixation. Partially threaded fixation pins are recommended. They are inserted through skin stab incisions with low-speed power equipment. Recent modifications of the Type Ia fixator may increase fixator rigidity. Important postoperative concerns include exercise restriction, pin tract care, and protection of the fixator from the environment. Complications associated with ESF can be minimized by realizing its indications and limitations.     

Computed tomographic documentation of a comminuted fourth carpal bone fracture associated with carpal instability treated by partial carpal arthrodesis in an Arabian filly

OBJECTIVE: To report treatment of a unilateral comminuted fourth carpal bone (C4) fracture associated with carpal instability by partial carpal arthrodesis (PCA) of the middle carpal joint (MCJ) and carpometacarpal joint (CMCJ). STUDY DESIGN: Case Report. ANIMALS: An 8-month-old Arabian filly. METHODS: A C4 slab fracture was diagnosed radiographically; however, fracture comminution was conclusively diagnosed after computed tomographic (CT) imaging. PCA of the MCJ and CMCJ was performed with 2 narrow dynamic compression plates. RESULTS: PCA provided appropriate carpal stability and correct limb alignment immediately after surgery. Complete bony fusion with substantial carpal flexion and no lameness at walk or light trot was observed 8 months after surgery. CONCLUSIONS: Carpal CT was successfully used to define fracture configuration after standard radiographic examination failed to delineate comminution. PCA was selected because of joint instability and lateral carpal collapse of MCJ and CMCJ and can be successfully used to treat comminuted C4 slab fractures associated with carpal instability. Moderate MCJ osteoarthritis without radiocarpal joint involvement allows pain-free, substantial carpal flexion and thus, return to low-level pleasure riding may be possible. CLINICAL RELEVANCE: CT imaging may more adequately characterize traumatic carpal bone injury, particularly, when carpal bone fracture configuration cannot be determined on standard radiographs. Early PCA of the MCJ and CMCJ is an useful alternative to treat comminuted C4 slab fractures that cannot be reconstructed.     

Reduction and temporary stabilization of acetabular fractures using ASIF mandibular reduction forceps: technique and results using plate fixation in 25 dogs

OBJECTIVE: To report the results of acetabular fracture fixation in 25 dogs in which a specialized forceps (ASIF mandibular reduction forceps, Synthes USA, Paoli, PA) was used to obtain fracture reduction and stabilization. STUDY DESIGN: A retrospective clinical study. ANIMAL POPULATION: Twenty-five client-owned dogs with traumatic acetabular fractures. METHODS: The mandibular reduction forceps (MRF) use a screw on each side of the fracture to attach the clamp directly to the bone and permit direct manipulation of the fragments. Medical records from 25 dogs with acetabular fractures were reviewed to determine the effectiveness of this technique in obtaining, and then maintaining, fracture reduction while a plate was being applied. RESULTS: Clinical results were considered successful in 24 of 25 dogs; the small size of 1 dog prevented application of the MRF. The final reduction and fixation of the fractures was evaluated as anatomic in 17 dogs, near-anatomic in 6 dogs, and nonanatomic in 1 dog. CONCLUSIONS AND CLINICAL RELEVANCE: Application of the MRF is an effective technique for aiding the reduction of acetabular fractures in dogs. It maintains reduction while simultaneously permitting unimpeded access to the dorsal acetabular rim, thus facilitating accurate contouring of a plate. Accurate reduction and rigid fixation of articular fractures is essential to prevent secondary osteoarthritis.     

Composite fixation of comminuted ilial wing fractures in cats: three cases

CLINICAL SUMMARY: The surgical repair of comminuted ilial wing fractures (comprising a long oblique fracture with ventral multiple fragmentation) in three cats using composite internal fixation is reported. The technique comprised the use of pins, screws, wire and polymethylmethacrylate. All cases had an excellent outcome with uneventful bone healing. One case had a very mild reduction in pelvic canal diameter postoperatively. There was no evidence of implant loosening or migration in any cat on follow-up radiographs. PRACTICAL RELEVANCE: This technique provided a quick and highly adaptable means of stabilising this fracture configuration, as well as restoring pelvic symmetry, when limited buttressing support and bone stock were available cranial and ventral to the acetabulum. This method of fixation may have biomechanical advantages over lateral or dorsal plating techniques for this particular type of fracture configuration.     

Maxillomandibular external skeletal fixation in five cats with caudal jaw trauma

Five cats with caudal jaw injuries including mandibular ramus fractures, temporomandibular luxation/subluxation and temporal bone fractures were managed with external skeletal fixation to provide open-mouth maxillomandibular fixation. Three of five cats were able to eat orally during the period of fixation, whereas two cats with jaws fixed in a suboptimal position were dependent on oesophagostomy tube nutrition. Fixation was well tolerated and was maintained for 21 to 42 days. All cats were eating normally and had good jaw function at follow-up (mean 39 months, range 7 to 71 months).     

Bilateral fixation of Y-T humeral condyle fractures via medial and lateral approaches in 29 dogs

OBJECTIVES: To describe bilateral fixation of Y-T fractures of the humeral condyle via combined medial and lateral approaches, and to determine the technique's clinical and radiographic short-term outcomes. METHODS: Details of 30 consecutive fractures in 29 dogs were reviewed. These included signalment, method of fixation, complications, and follow-up limb function and range of elbow joint motion. RESULTS: The age of the dogs ranged from three months to nine years, and bodyweight ranged from 1.9 to 48 kg. The humeral condyle was reattached to the shaft using medial and lateral bone plates in 18 fractures, a medial plate and lateral Kirschner wire(s) in six fractures, and medial and lateral Kirschner wire(s) in six fractures. Major complications were recorded in four fractures and minor complications in two fractures. Limb function at follow-up was graded as excellent in 12, good in 15 and fair in three fractures. The range of elbow flexion was normal in seven, mildly reduced in 18, moderately reduced in four and severely reduced in one fracture. CLINICAL SIGNIFICANCE: In contrast to the caudal approach, combined medial and lateral approaches decrease the extent of periarticular soft tissue dissection, avoid complications associated with olecranon osteotomy and enable exposure of the entire humeral diaphysis for fixation. Bilateral fixation is likely to be better at counteracting bending and torsional forces compared with unilateral fixation.     

Distal tibial fractures in dogs and cats

A total of 43 fractures of the distal tibia in dogs and cats were evaluated for fracture patterns, methods of stabilization, and time to bone union. Fractures of the metaphysis (9.3%), physis (30.9%), epiphysis (2.3%), and malleoli (58.2%) were classified. Open reduction and internal fixation, with combinations of Kirschner wire, orthopedic wire, and bone screws, were the methods of fixation used in the majority of fractures. These relatively simple methods of fixation were applied to all sizes of dogs and cats and resulted in an average bone healing time of 6 weeks.     

Fixation technique influences the monotonic properties of equine mandibular fracture constructs

OBJECTIVE: To determine the optimal fixation technique for equine interdental space fractures by evaluating the biomechanical characteristics of 4 fixation techniques. STUDY DESIGN: In vitro randomized block design. SAMPLE POPULATION: Twenty-seven adult equine mandibles. METHODS: Mandibles with interdental osteotomies were randomly divided into 4 fixation groups (n = 6/group). Fixation techniques were the following: (1) dynamic compression plates (DCP), (2) external fixator (EF), (3) external fixator with interdental wires (EFW), and (4) intraoral splint with interdental wires (ISW). Three intact (nonosteotomized) mandibles were tested as controls. Mandibles were subjected to monotonic cantilever bending until failure. Angular displacement data (radians) were derived from continuously recorded gap width measurements provided by extensometers placed across the osteotomy site. Osteotomy gap width data (mm) at 50 and 100 Nm were selected for standardized comparison of gap width before the yield point and failure point, respectively of all constructs tested. Stiffness (Nm/radian), yield strength (Nm), and failure strength (Nm) were determined from bending moment-angular displacement curves and were compared using ANOVA with appropriate post hoc testing when indicated. Radiographs were obtained prefixation, postfixation, and posttesting. RESULTS: Bending stiffness, yield, and ultimate failure loads were greatest for intact mandibles. Among osteotomized mandibles, stiffness was greatest for DCP constructs (P <.05) and was not significantly different among EF, EFW, and ISW constructs. Yield load was greatest for ISW constructs (P <.05) and was not significantly different among DCP and EFW constructs. Yield and ultimate failure loads were lowest (P <.05) and osteotomy gap width at 50 and 100 Nm were greatest for EF constructs (P =.09 and P <.05, respectively). There was no significant difference in failure loads and osteotomy gap widths among DCP, EFW, and ISW constructs (P <.05). Failure occurred through the screw-bone interface (DCP), acrylic splint (ISW), acrylic connecting bar and/or pin-bone interface (EF, EFW), and wire loosening (EFW). All 3 intact mandibles fractured through the vertical ramus at its attachment to the testing apparatus. CONCLUSIONS: Among osteotomized mandibles, DCP fixation had the greatest stiffness under monotonic bending to failure; however, the relatively low yield value may predispose it to earlier failure in fatigue testing without supplemental fixation. Techniques using tension-band wiring (EFW and ISW) were similar to DCP constructs in yield, failure, and osteotomy displacement, whereas EF constructs were biomechanically inferior to all other constructs. CLINICAL RELEVANCE: DCP fixation is most likely the most stable form of fixation for comminuted interdental space fractures. However, for simple interdental space fractures, ISW fixation may provide adequate stability with minimal invasiveness and decreased expense. Tension-band wiring significantly enhances the strength of type II external skeletal fixators and should be used to augment mandibular fracture repairs.     

Management of equine skull fractures using fixation with polydioxanone sutures

Ten horses presented with severe distortion of the facial contour, crepitus on palpation and mild to moderate epistaxis. Individual horses also showed ocular damage, ptosis, severe dyspnoea and movement of the facial bones concurrent with respiration. The fracture fragments were exposed using a large curvilinear incision and elevated using a retractor, periosteal elevator, chisel or Steinmann pin. The fracture fragments were unstable following reduction and fixation was necessary. Stabilisation was achieved with polydioxanone sutures placed through holes drilled in opposing sides of the fracture lines. Polydioxanone sutures provided good stability and had better handling properties than wire. There was good apposition of fracture edges and minimal complications. Use of polydioxanone sutures can also avoid the expense and complexity of plate fixation in selected cases, and should be considered as an alternative to fixation with stainless steel wire in any facial fracture that adjoins stable bone.     

Results of treatment of 145 fractures of the third metacarpal/metatarsal condyles in 135 horses (1986-1994).

The objectives of this study were to correlate condylar fracture characteristics and type of treatment with subsequent capacity for athletic ability, and to determine the characteristics of healing that affect prognosis after fracture fixation. Medical records, post operative radiographic studies and race records were examined for 135 horses sustaining 145 fractures. Sixty-five percent of horses overall started in a race post injury (SPI) in a mean time of 9.7 months with a mean of 13.7 races post injury. Having raced pre-injury did not confer an advantage to starting post injury, though nonstarters pre-injury tended to take longer to return. For horses starting pre- and post injury, 66% improved or maintained their race class level after injury, whereas 64.2% decreased their race earnings post injury. Eighty-five percent of the fractures received internal fixation, of which 70% were complete fractures. Eighty-seven percent of horses with incomplete-nondisplaced fractures treated conservatively raced post injury. The percent SPI for incomplete-nondisplaced, complete-nondisplaced and complete-displaced fractures treated with internal fixation were 74%, 58%, and 60%, respectively. Males (72%) raced post injury more frequently than fillies (53%), and may represent a truer probability of SPI. Spiral fractures tended to take longer until their first start (mean 13.3 months). Fifty-two percent of horses with articular fragments were able to race post injury. Horses were more likely to start if 2-4 month radiographic healing revealed no evidence of the fracture except the presence of lag screws. Based on this series of cases, the majority of horses, with proper treatment, were able to return to racing regardless of fracture characteristic. Prognosis appeared to be affected by the severity of the injury to the joint, the presence of articular comminution and the quality of surgical repair.     

Surgical Repair of Mid‐body Proximal Sesamoid Bone Fractures in 25 Horses

Objective— To describe the characteristics of unilateral mid‐body proximal sesamoid bone (PSB) fractures, to determine factors associated with the outcome of horses after surgical repair, and to describe a technique for arthroscopically assisted screw fixation in lag fashion. Study Design— Retrospective case series. Animals— Horses (n=25) with unilateral mid‐body PSB fracture. Methods— Medical records (1996–2006), radiographs, and arthroscopic videos of horses with surgically repaired unilateral mid‐body PSB fractures were reviewed. Retrieved data included signalment, affected limb and PSB, fracture characteristics, and surgical technique. Outcome was established by radiographic assessment of healing and race records; categorical data were analyzed using Fisher's Exact test. Results— Medial forelimb PSBs were most commonly affected (80%). Surgical technique and degree of reduction were significantly associated with outcome; 44% of horses with screw repair and none of the horses with wire fixation raced (P=.047). Factors that may have influenced this outcome were differences in fracture reduction (improved reduction in 22% wire repairs and 88% screw repairs, P=.002) and use of external coaptation (22% wire repair and 88% lag screw repair, P=.002). None of the horses with unimproved reduction raced after surgery. Conclusions— Only 28% of horses with mid‐body PSB fractures raced after surgery. Compared with wire fixation, screw fixation in lag fashion resulted in good reduction and is seemingly a superior repair technique. Clinical Relevance— For mid‐body PSB fractures, arthroscopically assisted screw fixation in lag fashion and external coaptation for anesthesia recovery and initial support provides the best likelihood of return to athletic use.     

Results of plate fixation of type 1b olecranon fractures in 24 horses

REASONS FOR PERFORMING STUDY: Previous olecranon fracture reports contain a small proportion of type 1b fractures, with only a few repaired by tension band plate fixation. OBJECTIVES: To evaluate subject details, history, clinical findings and outcome of type 1b olecranon fractures in a large group of horses treated by tension band plate fixation. METHODS: Medical records of 77 horses diagnosed with an olecranon fracture were reviewed. Twenty-four horses (31%) were classified as having type 1b olecranon fractures. Clinical details and follow-up results (4-128 months post operatively) were recorded. RESULTS: Treatment included open reduction and internal fixation using a narrow dynamic compression plate (n = 20), conservative therapy (n = 2) and euthanasia (n = 2). Long-term follow-up was available for 16 plated horses. Four were sound and in training and 9 were sound and performing athletically. Articular surface involvement, comminution, open status or removal of anconeal process fragments did not appear to affect prognosis or soundness. CONCLUSIONS: Internal plate fixation provides an excellent prognosis for an animal capable of athletic performance. POTENTIAL RELEVANCE: Describing tension band plate fixation and results offers a method of fracture repair that will improve the treatment and prognosis for type 1b olecranon fractures.     

Incidence of and predisposing factors for nonunion of fractures involving the appendicular skeleton in cats: 18 cases (1998-2002)

OBJECTIVE: To identify the most common sites of and possible predisposing factors for nonunions in cats with fractures of the appendicular skeleton. DESIGN: Retrospective study. ANIMALS: 344 cats treated for fractures between 1998 and 2002, 18 of which developed nonunions. PROCEDURES: Information collected from the medical records included signalment; type of trauma; fracture location, orientation, and type; degrees of displacement and comminution; treatment; and outcome. RESULTS: The tibia and proximal portion of the ulna were identified as the most common sites for nonunions. Factors significantly associated with development of a nonunion included age, body weight, affected bone, fracture type, degree of comminution, and fixation type, with older cats, heavier cats, cats with fractures of the tibia or proximal portion of the ulna, cats with open fractures, cats with comminuted fractures, and cats with fractures stabilized with a type II external skeletal fixator being significantly more likely to develop a nonunion. Eleven of the 18 cats with nonunions had a successful outcome following treatment of the nonunion. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in cats, fractures involving the tibia and proximal portion of the ulna are more likely to develop nonunions than are fractures involving other sites but that many factors may increase the risk of nonunion. Use of excessively large and rigid type II external skeletal fixators may be associated with development of nonunions; however, type II external skeletal fixators were commonly used to stabilize fractures in sites predisposed to nonunion.     

Radial and Tibial Fracture Repair with External Skeletal Fixation: Effects of Fracture Type, Reduction, and Complications on Healing

Twenty-eight consecutive fractures of the canine radius and tibia were treated with external skeletal fixation as the primary method of stabilization. The time of fixation removal (T1) and the time to unsupported weight-bearing (T2) were correlated with: (1) bone involved; (2) communication of the fracture with the external environment; (3) severity of the fracture; (4) proximity of the fracture to the nutrient artery; (5) method of reduction; (6) diaphyseal displacement after reduction; and (7) gap between cortical fragments after reduction. The Kruskal-Wallis one-way analysis of variance was used to test the correlation with p less than .05 set as the criterion for significance. The median T1 was 10 weeks and the median T2 was 11 weeks. None of the variables correlated significantly with either of the healing times; however, there was a strong trend toward longer healing times associated with open fractures and shorter healing times associated with closed reduction. Periosteal and endosteal callus uniting the fragments were observed radiographically in comminuted fractures, with primary bone union observed in six fractures in which anatomic reduction was achieved. Complications observed in the treatment of these fractures included: bone lysis around pins (27 fractures), pin track drainage (27 fractures), pin track hemorrhage (1 fracture), periosteal reaction around pins (27 fractures), radiographic signs consistent with osteomyelitis (12 fractures), degenerative joint disease (2 dogs), and nonunion (1 fracture). Valgus or rotational malalignment resulted in 16 malunions of fractures. One external fixation device was replaced and four loose pins were removed before the fractures healed. One dog was treated with antibiotics during the postoperative period because clinical signs of osteomyelitis appeared.(ABSTRACT TRUNCATED AT 250 WORDS)     

Intraoral acrylic splints for maxillofacial fracture repair

Maxillofacial fractures in dogs and cats occur secondary to vehicular trauma, falls, kicks, gunshots, and fights with other animals. Pathologic mandibular fracture may occur secondary to periodontal disease, neoplasia, and metabolic diseases. The primary objective for repair of maxillofacial fractures in small animals is return to normal function. Therefore, it is necessary to maintain occlusal alignment while providing adequate stability for bony union. Basic principles of maxillofacial fracture repair include anatomic reduction and restoration of occlusion, application of a stable fixation to neutralize negative forces on the fracture, gentle handling of soft tissues, avoidance of iatrogenic dental trauma, extraction of diseased teeth within the fracture line, and minimizing excessive soft tissue elevation. This review article will describe the application of intraoral acrylic splints for maxillofacial fracture repair.