Thoracic trauma in newborn foals

In a report describing life ending fractures (255 horses) from the Livestock Disease Diagnostic Center, Kentucky (1993 and 1994), 32 foals had rib fractures. The purpose of our study was to examine the incidence of rib fractures in newborn foals on a Thoroughbred studfarm by physical and radiographic examination, to determine factors which may contribute to the problem and to document any clinical consequences. All foals (263) included were examined within 3 days of birth. The thoracic cage was palpated externally for abnormalities and all foals were placed in dorsal recumbency to evaluate thoracic cage symmetry. Radiographs were used to diagnose foals with thoracic cage asymmetry (TCA) and rib fracture (RF). A diagnosis of costochondral dislocation (CD) was made when no radiographic evidence of fracture was present but there was severe TCA. Fifty-five foals (20.1%) had TCA (9 RF). One to 5 ribs were fractured on 9 of 40 radiographic studies. No consequences of the thoracic trauma was detected clinically, radiographically or ultrasonographically in this group of foals or at a 2- and 4-week follow-up examination. The percentage of foals with a history of abnormal parturition was higher in the TCA foals (15%) compared to the normal foals (6.8%). There were more primiparous dams in the TCA group than in the normal foal group. Fillies (56.6%) had a higher incidence of birth trauma than colts (43.4%). This study demonstrates that thoracic trauma is often present in newborn foals and may not always be of clinical significance. Dystocia foals and foals from primiparous mares should be considered high risk for thoracic trauma.     

Detection of rib trauma in newborn foals in an equine critical care unit: a comparison of ultrasonography, radiography and physical examination

REASONS FOR PERFORMING STUDY: Previous studies have shown that in man ultrasonography is more accurate than radiography for detecting rib fractures. OBJECTIVES: To describe clinical, radiographic and ultrasonographic findings related with rib fractures in newborn foals in an equine critical care unit; and to compare diagnostic accuracy of ultrasonography to radiography. METHODS: A prospective ultrasonographic study was performed on 29 foals presented to the emergency unit. This study was performed at the Centre Hospitalier Universitaire Vétérinaire (CHUV), University of Montreal. Physical examination as well as radiographic and ultrasonographic examinations were performed. RESULTS: Thoracic radiographs revealed 10 rib fractures in 5 of 26 (19%) foals. Ultrasonography revealed 49 fractures in 19 of 29 (65%) foals of which fillies (n = 13; 68%) were significantly over represented as were fractures to the left thorax (n = 15; 78%). Seventeen of 19 foals (90%) had rib fractures located 3 cm or less from the costochondral junction, the distal part of the rib being displaced laterally in all cases. In 2 foals, where both thoracic radiographs and ultrasonography detected rib fractures, the site of fractures was located on the mid portion of the rib. Rib fractures were detected only by thoracic radiographs in one foal. Sixty-five percent (32/49) of fractured ribs had a moderate displacement (1-4 mm). CONCLUSIONS: Rib fractures are seen frequently in newborn foals in equine critical care units. Ultrasonography is more accurate than radiography and reveals fractures in most patients presented in emergency. The position (costochondral junction) of rib fractures and of the fragments suggest that most thoracic trauma probably occurs during parturition. POTENTIAL RELEVANCE: Ultrasound imaging increases awareness and improves the diagnosis of rib fractures in newborn foals.     

External skeletal fixation in the management of equine mandibular fractures: 16 cases (1988-1998)

Fifty-three cases of equine mandibular fractures were managed surgically from 1988-1998, of which 16 (30%) were repaired by external skeletal fixation (ESF). Three surgical methods were utilised: transmandibular 4.76 or 6.35 mm Steinmann pins incorporated into fibreglass casting material or nonsterile dental acrylic (methyl methacrylate - MMA) bars reinforced with steel; transmandibular 9.6 mm self-tapping threaded pins +/- 4.76 or 6.35 mm Steinmann pins incorporated into MMA bars reinforced with steel; and 4.5 mm or 5.5 mm ASIF cortical bone screws incorporated into MMA bars reinforced with steel or a ventral MMA splint. Fourteen horses were presented to the hospital for fixator removal at an average of 56.2 days. At removal, fractures were stable and occlusion of incisor and cheek teeth was considered adequate. Complications of the procedure occurred in 3 horses. Two horses with persistent drainage and ring sequestra from pin tracts required curettage 4 or 5 months after ESF removal. A third horse required replacement of the original fibreglass ESF with MMA bars to regain access to open, infected wounds. Another horse required removal of the second premolar at the time of fixator removal because the tooth root had been damaged in the original injury. ESF for the surgical management of mandibular fractures in horses has produced good results, with incisive and cheek tooth alignment reestablished in all horses. Horses that were managed via ESF had a rapid return to full feed and did not require any supplementation via nasogastric tube or oesophagostomy to maintain bodyweight or hydration status.     

INTRAMEDULLARY PINS IN FIXATION OF FRACTURES OF LONG BONES

The round Steinmann pin alone or in combinations with additional pins, orthopedic wire, Kirschner splint is a very versatile method of skeletal fixation which is applicable to tiny or large breeds and to the very young or mature animals. The objective of rigid skeletal fixation can be achieved if principles of auxiliary skeletal fixation are used in complicated fractures. For uniform success with each of the three types of intramedullary nailing described (Kuentscher, Rush, Steinmann) it is essential that the principles of accurate reduction and rigid fixation be followed. The method of Kuentscher is most limited in application to the dog. Rush pins are somewhat more versatile. The pins can be used singly or in pairs for shaft fractures but have a specific advantage for firm fixation of fractures in the cancellous bone near the ends of the shaft. The Steinmann (round) intramedullary pin is the most versatile, however it is frequently necessary to use auxiliary pins, orthopedic wire, or half Kirschner to achieve rigid fixation.     

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.     

Multiple Rib Fracture Repair in a Neonatal Holstein Calf

Objectives— To report rib fracture repair in a neonatal calf using the Securos^® Cranial Cruciate Ligament Repair System (SCCLRS).
Study Design— Case report.
Animals— A 2-day-old female Holstein calf with fracture of right ribs 4–10.
Methods— On the day of admission the calf was anesthetized and rib fractures were repaired using open reduction and the SCCLRS.
Results— Rib fractures were successfully stabilized and the calf discharged from the hospital 8 days postoperatively.
Conclusions— Modification of previously reported use of the SCCLRS to repair rib fractures in foals was required because of the different anatomy in the calf. This new technique was rapidly and easily performed for a large number of fractured ribs in this case.
Clinical Relevance— Effective rib fracture repair in calves can be readily performed using the SCCLRS with modification of the technique reported in foals.     

Internal fracture fixation

Over the past decade, many improvements to small animal internal fracture fixation have been developed, including improved fixation techniques and a more diverse selection of implants. The understanding that appropriate fixation selection is based on a plethora of biologic, mechanical, and clinical factors has also emerged. Classically, the methods of internal fracture fixation have used pins, wires, screws, and plates to rigidly stabilize fractures that have been anatomically reduced with significant disruption to the biologic fracture environment. Newer methods attempt to minimize trauma to the soft tissues surrounding a fracture and promote biologic osteosynthesis using such implants as interlocking nails and plate-rod fixations. This review provides an overview of both the traditional and current principles of small animal internal fracture fixation.     

Surgical treatment of tarsometatarsal joint luxation in a miniature horse foal

A 2-week-old Miniature Horse foal was referred for evaluation and treatment of a luxated right tarsometatarsal joint. Treatment consisted of closed reduction and internal fixation using two partially threaded Steinmann pins placed in normograde fashion through the tuber calcis into the proximal third metatarsus. Traumatic luxation has been reported to occur in the tarsocrural, proximal intertarsal and tarsometatarsal joints within the equine tarsus. Treatment for luxation of the distal intertarsal joint has not been documented. The treatment method most commonly suggested for tarsal luxation is closed reduction and cast immobilisation. Internal fixation using lag screws and plating has also been described. A combination of internal fixation and external coaptation is thought to achieve maximal stability and allow faster convalescence in cases of tarsal luxation. This case report describes for the first time a technique using two Steinmann pins to achieve successful internal fixation of a traumatic tarsometatarsal joint luxation in a 2-week-old Miniature Horse foal.     

Multiple rib fracture in a neonatal foal using a nylon strand suture repair technique

OBJECTIVES: To report rib fracture repair using the Securos Cranial Cruciate Ligament Repair System (SCCLRS; Securos Veterinary Orthopedics, Charlton, MA) in a neonatal foal. STUDY DESIGN: Case report. ANIMALS: A 1-day-old Standardbred foal with fracture of left ribs 2-9. METHODS: Four days after admission the foal was anesthetized and rib fractures were repaired using open reduction and the SCCLRS. RESULTS: Rib fractures were successfully stabilized and the foal was discharged 7 days postoperatively without further complications. CONCLUSIONS: The SCCLRS provided a straightforward, effective method of rib fracture repair in neonatal foals. CLINICAL RELEVANCE: Effective rib fracture repair in neonatal foals can be achieved with the SCCLRS.     

Evaluation of fixation devices for prevention of rotation in transverse fractures of the canine femoral shaft: an in vitro study

The effectiveness of various fixation techniques in preventing rotation of fracture segments in transverse fractures of the canine femoral diaphysis was evaluated under laboratory conditions. Single intramedullary Steinmann pins, single Küntscher nails, multiple intramedullary Steinmann pins, and an intramedullary Steinmann pin with a 1/2 Kirschner splint fixation sustained mean torque moments of 0.31, 0.61, 1.26, and 1.63 Newton meters, respectively, before rotation of the fracture segments occurred. Four-pin (full Kirschner) splints were more effective, sustaining a mean torque moment of 5.35 Newton meters before rotation occurred. The canine femoral medullary canal had an average isthmus length of 2.0 to 2.5 cm. The restricted area of implant-cortex contact limited the effectiveness of the intramedullary fixation devices in preventing fracture segment rotation.     

An expansion and compression technique for reducing and stabilizing proximal epiphyseal fractures of the tibia in foals.

Proximal tibial epiphyseal fractures in 2 foals were reduced and stabilized by expansion and compression between 2 transversely placed Steinman pins, one on each side of the fracture. A Charnley apparatus or turnbuckles placed between the pins on each side of the fracture provided the mechanical advantage for repositioning the fracture fragments and achieving rigid fixation during healing. A light cast was applied over the fixation apparatus, keeping the limb in an extended position. The cast and fixation apparatus were removed after 4 weeks. The technique allowed rapid healing and adequate ambulation. The foals had functional, straight hindlimbs 6 months after the fractures occurred.     

Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994-2004)

OBJECTIVE: To evaluate clinical findings, complications, and outcome of horses and foals with third metacarpal, third metatarsal, or phalangeal fractures that were treated with transfixation casting. DESIGN: Retrospective case series. Animals-29 adult horses and 8 foals with fractures of the third metacarpal or metatarsal bone or the proximal or middle phalanx. PROCEDURES: Medical records were reviewed, and follow-up information was obtained. Data were analyzed by use of logistic regression models for survival, fracture healing, return to intended use, pin loosening, pin hole lysis, and complications associated with pins. RESULTS: In 27 of 35 (77%) horses, the fracture healed and the horse survived, including 10 of 15 third metacarpal or metatarsal bone fractures, 11 of 12 proximal phalanx fractures, and 6 of 8 middle phalanx fractures. Four adult horses sustained a fracture through a pin hole. One horse sustained a pathologic unicortical fracture secondary to a pin hole infec-tion. Increasing body weight, fracture involving 2 joints, nondiaphyseal fracture location, and increasing duration until radiographic union were associated with horses not returning to their intended use. After adjusting for body weight, pin loosening was associated with di-aphyseal pin location, pin hole lysis was associated with number of days with a transfixation cast, and pin complications were associated with hand insertion of pins. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that transfixation casting can be successful in managing fractures distal to the carpus or tarsus in horses. This technique is most suitable for comminuted fractures of the proximal phalanx but can be used for third metacarpal, third metatarsal, or middle phalanx fractures, with or without internal fixation.     

Principles of long bone fracture management.

The fixation of fractures in which one of the following primary devices is used: IM pins, bone plates, external skeletal fixators, can benefit from the additional application of any number of secondary devices. The secondary devices include cerclage, hemicerclage, or interfragmentary wires, skewer-pins, screws, and external skeletal fixators. These are indicated to facilitate the repair and eliminate the forces acting on the fracture site. A complete understanding of all the methods of fixation facilitates the selection of the proper implant or combination of implants. This information must be combined with the knowledge of how each device is most appropriately used depending on both the fracture type and fracture location. Taking into consideration all of these factors helps ensure that fracture healing occurs in the shortest possible time with the fewest complications. The ultimate goal of obtaining a full return to function may thereby be achieved.     

Fracture healing after stabilization with intramedullary xenograft cortical bone pins: a study in pigeons

OBJECTIVE: To investigate the effectiveness of intramedullary xenograft cortical bone pins compared with stainless steel Kirschner wire for the repair of a standardized avian humeral fracture. STUDY DESIGN: Prospective randomized study. SAMPLE POPULATION: Thirty mature pigeons (Columba livia). METHODS: Birds were randomly assigned to 3 groups. Transverse mid-diaphyseal humeral fractures were created in 1 humerus in each bird. Fractures were stabilized with intramedullary ostrich or canine xenograft cortical bone pins or Kirschner wire. Radiographic, histological, and biomechanical assessments were used to compare fracture healing 6 weeks after fracture stabilization. The contralateral humerus of each bird was used as a control. RESULTS: All fractures healed regardless of intramedullary pin type. There were no statistically significant biomechanical differences among groups or within groups. Xenograft cortical bone pins induced a mononuclear inflammatory reaction that did not impair bone healing. Bones stabilized with intramedullary cortical bone pins had more periosteal callus and inflammation at the fracture site than bones stabilized with stainless steel Kirschner wires. CONCLUSIONS: Intramedullary xenograft cortical bone pins, derived from mammalian or avian sources, appear to represent an alternative for the repair of avian humeral fractures. CLINICAL RELEVANCE: Intramedullary xenograft cortical bone pins are biodegradable and may reduce the need for additional surgery to remove implants after fracture healing.     

The use of nylon cable ties to repair rib fractures in neonatal foals

Commercially available nylon cable ties were used as a method of internal fixation for displaced rib fractures in 8 equine neonates. The procedure was effective, well-tolerated, rapid, and inexpensive. The use of nylon cable ties as internal fixation for displaced rib fractures in foals is an effective surgical procedure.     

Fracture repair with transfixation pins and fiberglass cast in llamas and small ruminants

Transfixation pinning with fiberglass casting is an effective and adaptable method of longbone fracture fixation in llamas and small ruminants. Treatment of fractures in 7 limbs of 4 llamas and 2 small ruminants with this technique are described. Steinmann pins are placed transcortically proximal, and if necessary, distal to the fracture. The pin ends and limb are encased in fiberglass cast material. The cast is strong enough in animals of this size to eliminate the need for external frames or connecting bars. Severely comminuted fractures and fractures near joints are especially suited to fixation with this technique. Complications encountered in these cases included loosening of pins and one delayed union. All fractures healed to permit full use of the limb.     

Stabilisation with dorsal and ventral fixation of a traumatic cervical instability in a dog

This case study reports the outcome of dorsal and ventral stabilisation of a traumatic cervical instability in a dog. A 2-year-old, male Pointer was admitted following a motor vehicle accident. Clinical examination revealed non-ambulatory tetraparesis, severe neck pain and upper motor neuron changes in all limbs. Deep pain response was present. Subluxation of C2/3 and fractures of the dorsal spinous process and lamina of C2 were observed on radiographs. Ventral stabilisation was performed with screws and bone cement (polymethylmethacrylate). For dorsal fixation of the fractures, screws and cerclage wire were used. The dog stood up independently after 1 month, was able to walk 1.5 months postoperatively and had recovered completely at 1 year following surgery. We conclude that combined stabilisation techniques are effective for this type of cervical fracture in which the dorsal, middle and ventral structures of the vertebra are severely disrupted.     

Traumatic craniolateral shoulder luxation and fracture of the lesser tubercle of the humerus in a dog

A five-year old, spayed female, Bearded Collie was presented with a 24-hour history of non-weight-bearing lameness of the right thoracic limb after sustaining vehicular trauma. Radiographs revealed a craniolateral scapulohumeral luxation and a distally and medially displaced fracture of the lesser tubercle of the humerus. Open reduction and internal fixation of the fracture was achieved with lag screw fixation and an anti-rotational Kirschner wire. Surgical repair resulted in compression across the fracture line, anatomic reduction of the articular surface, and a stable scapulohumeral joint following reduction of the humeral head in the glenoid. Six weeks postoperatively, the patient exhibited no evidence of pain or lameness on the right thoracic limb and radiographs revealed complete healing of the fracture and normal articulation of the scapulohumeral joint. This is the first report of a lesser tubercle fracture associated with a craniolateral shoulder luxation. Surgical intervention resulted in the return of full shoulder joint function in this dog.     

Femoral Capital Physeal Fractures in 25 Foals

The medical records of 25 horses 1 year of age or younger affected with femoral head and neck fractures during an 18 year period were reviewed. Each fracture involved the capital physis. The foals were 11 days to 12 months of age (mean, 5 months). No femoral capital physeal fractures occurred in horses older than 1 year of age during the same period. The history in each case included acute onset of severe unilateral hindlimb lameness, 3 hours to 2 months (mean, 12 days) before presentation. Injuries observed were violent falls, struggles, and kicks. Crepitation, swelling, pain with manipulation or palpation or both, and apparent fracture fragment displacement were inconsistently noted. Tentative clinical diagnoses were confirmed by radiography in 24 foals and by necropsy alone in one foal. Twenty-one foals were euthanatized due to poor prognosis. One foal sent home for stall rest was lost to follow-up. Surgical repair was attempted in three foals. Two fractures were repaired with multiple intramedullary pins and the foals were euthanatized within 2 weeks due to surgical failure and, in one case, contralateral limb breakdown. The third fracture was repaired with a compressing screw and plate device; the animal was pasture sound at month 20.