Dowel pinning for feline metacarpal and metatarsal fractures.

The goal of this retrospective study was to describe dowel pinning, and to compare the results of osteosynthesis and external coaptation of metacarpal and metatarsal fractures in cats. Evaluation of the medical records of 351 cats yielded 63 cats treated with dowel pinning, 35 cats treated with external coaptation and 14 cats treated with both methods within the same limb. All of the cats had been re-evaluated at an average of 2.8 years (six months - 15 years) postoperatively. Dowel pinning was superior to external coaptation when all fractured bones of a limb could be pinned. When internal fixation of multiple fractures was not feasible in all fractured bones due to comminution or fragments that were too short to pin, the outcome was not significantly different from cases treated with external coaptation alone. Malunion was seen in 16% of fractured bones in cats treated with external coaptation and occurred secondary to implant bending in 3% of fractured bones treated with dowel pinning. The latter refers to one operated cat, which had four metacarpal fractures in the same limb. Radiographs taken at re-evaluation showed implant migration within the medullary canal in two cats, although neither showed any signs of non-union or lameness. Non-union was seen in one operated cat, in which the fracture (MC IV) could not be completely reduced with a K-wire. Osteomyelitis did not occur. Dowel pinning is an easy, inexpensive and effective technique for repair of metacarpal and metatarsal fractures in cats.     

Traumatic tarsal luxation repaired without internal fixation in three horses and three ponies

Three horses and three ponies were treated for traumatic luxation of the proximal intertarsal or tarsometatarsal joint. In each case, there were fractures of one or more tarsal bones. Three of the animals had disruption of one of the collateral ligaments. Five animals were treated by closed reduction and external coaptation. One pony was treated by open curettage, a cancellous bone graft, and cast immobilization. No internal fixation was used in any of these animals. From this series of cases, it would appear that closed reduction and external coaption alone is adequate treatment for most cases of tarsal luxation.     

Retrospective study of 99 cases of bone fractures in cattle treated by external coaptation or confinement

Between 2000 and 2003, 99 cattle with limb fractures were treated. Over 50 per cent were tibial fractures, with the femur and os calcis being the second and third most frequently affected bones. Eight of the cattle were slaughtered because of their poor prognosis, 10 were treated by stall confinement, 76 were treated by external coaptation with a Thomas splint-cast combination and three were treated with a simple or reinforced half limb cast; these 79 cattle were usually discharged immediately. One calf was treated with internal fixation, and another by amputation. Follow-up information was obtained by telephone, and the treatments were classified as either completely successful (return to previous production level), partially successful (return to lower production level) or failure. Forty (52.6 per cent) of the cattle treated with the Thomas splint-cast combination were classified as a complete success and 14 (18.4 per cent) as a partial success; the treatment failed in 19 of the cattle and three were lost to follow-up. The animals' bodyweight, age and sex, and whether the fracture was open or closed, had no significant influence on the outcome. Among the 10 cattle treated for proximal fractures by stall confinement, there were five survivors, four non-survivors and one was lost to follow-up.     

Use of Bone Plate for Treatment of an Open Third Metacarpal Fracture in a Foal

A 7-month-old, 180-kg, female foal was presented with open diaphyseal fracture of the left third metacarpal bone. The fractured limb was stabilized preoperatively with external coaptation. Open reduction and internal fixation were done using 4.5-mm broad dynamic compression plate, which was applied in a neutralization manner. Postoperatively, external support with padded bandage reinforced with gutter splint made of fiber glass was provided. The incisional infection and the contaminated wound on medial aspect of the metacarpal were managed with regular dressing. Complete radiographic union and functional recovery were noticed by 4 months postoperatively. Open diaphyseal fractures can be managed by proper preoperative fracture stabilization, wound management, and fixation methods using bone plate and external coaptation.     

Comparison of fixation methods for treatment of long bone fractures in llamas and alpacas

Objective: To determine outcome after repair of long bone fractures in llamas and alpacas. Study Design: Case series. Animals: Llamas (n=11) and alpacas (8). Methods: Medical records (1998–2008) of camelids with long bone fractures were reviewed for history, repair method, and complications. Outcome was also assessed by owner telephone questionnaire. Results: Mean age at repair was 39 months. There were 8 males and 11 females. Fracture distribution was tibia (n=6), metatarsus (5), metacarpus (4), radius and ulna (2), humerus (1), and femur (1), with 13 closed and 6 open fractures. Fracture repair was by internal fixation (n=11), external fixation with a transfixation pin cast (5), external coaptation (2), and cross‐pinning (1). In 1 llama, the limb was amputated to revise a failed external fixation repair. Seventeen animals (89%) were discharged, and 2 were euthanatized. Outcome was available for 13 animals: 9 were used for breeding and 4 as pets. Fewer major complications occurred with internal fixation than with external fixation with a transfixation pin cast (P<.005); however, there were no significant differences in minor complications between groups. Conclusions: Internal fixation with bone plates was associated with fewer major complications than external fixation with a transfixation pin cast.     

External coaptation of rostral mandibular fractures in calves

Six cases of rostral mandibular fracture with considerable displacement were treated successfully by external coaptation. Four cases were simple and two were compound fractures. After xylazine sedation and manual reduction of the fractures, the casting tape was laminated to make a rigid splint below the mandibles and then the splint was secured using the casting tape passing the nasal bridge and cranial and/or caudal to the ears as it encircled the head. During application of the tape, a PVC pipe 25 mm in diameter was held in its jaws to keep the mouth open so that the calf could suckle. Simple rostral mandibular fractures were cured after two weeks of cast immobilisation and compound fractures after about three weeks. This method is easy and non-stressful and provided a good prognosis in the present cases.     

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.     

Comminuted First Phalanx Fractures in 30 Horses: Surgical vs. Nonsurgical Treatments

Comminuted first phalanx fractures were diagnosed in 30 horses. One leg was involved in each horse. Five horses were presented with open fractures. Nine horses had a portion of intact cortex (strut) extending from the proximal to distal joint. Ten horses were euthanized, including one with an open fracture, without treatment. The remaining 20 horses were treated by open reduction with a neutralization plate (8 horses, including one with an open fracture), open reduction with lag screw fixation (3 horses), lag screw fixation through stab incisions (2 horses), external coaptation with a cast (3 horses), and external skeletal fixation using a weight supporting shoe (4 horses, including 3 with open fractures).
Thirteen horses were euthanized following treatment because of persistent infection (9), chronic lameness (2), and third metacarpal bone fractures (2). Seven horses survived longer than 1 year after treatment. Six were lame and used as breeding animals, and one horse went on to race successfully. All four horses with open fractures that were treated were subsequently euthanized.
Significantly more horses with an intact strut of bone survived after treatment (4 of 7 [57%]) when compared to horses without an intact strut of bone that were treated (3 of 13 [23%]) (p < 0.05).
Invasive surgical approaches used for the repair of comminuted first phalanx fractures in this study were associated with an unacceptable infection rate (55%). Techniques involving less trauma to the compromised soft tissue around the fracture should afford a better chance for a successful outcome.     

Pinless External Fixation of Mandible Fractures in Cattle

Objective — This report describes our experience with a new technique for stabilization of mandibular fractures in cattle using a pinless external fixator.
Study Design — Mandibular fractures were stabilized with a pinless external fixator, which is a modification of a unilateral AO/ASIF (Association for the Study of Internal Fixation)-fixator in which pins are replaced with bone clamps.
Animals — Seven dairy cattle between 1 and 5 years of age.
Methods — Fracture stabilization was achieved by using the pinless external fixator. Postoperative management included intravenous administration of sodium chloride-glucose and antibiotics. A suspension of ruminal contents from a normal cow together with linseed and grass pellets was administered with a gastric tube.
Results — Three to 10 days after surgery six of seven cows masticated comfortably. The only failure was a yearling with a 10-day-old open infected fracture. This animal was slaughtered 9 days after surgery because of additional problems. In six cases there was enough callus formation 33 to 54 days after surgery to stabilize the fracture. The fixation devices were removed under heavy sedation. The major complication was bone sequestration at the fracture site, which required additional treatment.
Conclusion — The pinless fixator has proven satisfactory for external stabilization of unilateral horizontal ramus fractures of the mandible in cattle.
Clinical Relevance — The technique provides good stability without penetration of the medullary cavity and damage to the tooth roots. Other advantages of the technique include ease of application, minimal surgical trauma, and the short surgical time for application.     

Conservative Management of a Distal Epiphyseal Metacarpal Fracture in a Skyros Pony

Epiphyseal fracture, also known as epiphysiolysis, is the loosening or separation, either partial or complete, of an epiphysis from the shaft of a long bone. Distal epiphyseal fractures in foals pose a substantial challenge due to their guarded prognosis. This report describes the clinical signs, diagnosis, successful conservative treatment of an 1-month-old, male Skyros pony with an epiphyseal fracture of the right third metacarpal bone (type II Salter-Harris). The owner declined surgical treatment because of financial considerations along with the unfavorable prognosis. Conservative fracture treatment was pursued through external reduction and coaptation. The total duration of the conservative treatment was eighteen weeks and the foal returned to complete health.     

A retrospective clinical study of the fractures and luxations of the mandible in the cat

Twenty-six cases of mandibular fractures and luxations are reviewed. Mandibular trauma was due to car accidents (46%) and falls from great heights (23%). Cardiovascular shocks (40%), thoracic injuries (23%), epistaxis (30%), cleft palates (19%), subconjunctival hemorrhages (15%), broken canines (15%), concussions (15%), maxillary fractures (12%) were the most frequently encountered associated problems. Of the 26 cats, 22 had symphyseal fractures, 6 mandibular body fractures, 4 ramus fractures (3 of which were articular) and 6 had temporo-mandibular luxations. Open reduction and internal fixation was performed in 21 cases, surgery being indicated for unstable symphyseal and body fractures, the rostral body fractures being the most challenging to repair. Conservative therapy and ancillary treatment methods such as external coaptation and pharyngostomy were used for the fractures of the ramus. Six temporo-mandibular luxations associated with mandibular fractures in 5 cases were reduced under anesthesia. Good dental occlusion and mandibular function was obtained in the 24 treated cases.     

Long Bone Fractures in Large Animals A Retrospective Study

Two hundred and thirteen bovine and 115 equine long bone fractures presented for treatment to the Western College of Veterinary Medicine were reviewed. Based on the number of patients presented, cattle had a significantly (p < 0.01) higher survival rate than horses. In horses, the third metatarsal bone was most frequently presented for fracture treatment, but in cattle, the femur was most commonly affected. There was no significant difference (p > 0.05) in the treatment success rates when comparing the bones affected, methods of treatment used, duration between the fracture occurrence and presentation for repair, distance traveled prior to hospitalization, type of limb support during transportation, or medication given prior to hospitalization. Horses between 3 months and 2 years of age had a significantly (p < 0.05) lower survival rate than those in other age groups. Compared to open and comminuted fractures, a significantly (p < 0.01) greater number of simple fractures were selected for treatment in horses. Based on the cases presented, the survival rate of the horses with simple fractures is higher (p < 0.05). However, there was no significant difference between the survival rates of horses or cattle when simple, open, comminuted, and open plus comminuted fractures were treated. There were significantly (p < 0.001) more open fractures in horses than in cattle. Postoperative complications occurred in 49% of the horses treated, and the enthanasia rate was significantly (p < 0.01) higher in horses with complications.     

Radius/Ulna fracture repair

Fractures of the radius and ulna are commonly encountered in the small animal population. Diaphyseal fractures are the most common location and are often repaired with the use of external fixators or a bone plate. Select patients, such as young large breed dogs, may be managed with external coaptation. Extremely proximal and distal fractures require special consideration, especially if articular involvement is present.     

CARPAL ARTHRODESIS IN DOGS

SUMMARY Nine dogs, each with a severe carpal sprain injury, were treated by arthrodesis (2 bilateral). The same surgical technique with articular cartilage curettage, autologous bone grafting and compression plate fixation was used for each carpus. Initial treatment with external coaptation had been unsuccessful, but arthrodesis always resulted in resolution of the lameness. Complications included fracture of the compression plate (1 case) and loosening of the implants (2 cases).     

Use of the Cobra Head Bone Plate for Distal Long Bone Fractures in Large Animals A Report of Four Cases

Four long bone fractures with a short distal fragment were repaired with a cobra head bone plate alone (2 cattle) or in combination with a straight, broad dynamic compression plate (2 horses). Three fractures were of the distal femur (1 horse, 2 cattle) and one was of the distal radius (1 horse). The long-term outcome of the three femoral fractures was soundness in one case and mild lameness in two. Although satisfactory bone healing progressed in the horse with the radial fracture, laminitis in the contralateral forelimb necessitated euthanasia at week 6.     

Metacarpal and metatarsal fractures in dairy cattle: 33 cases (1979-1985)

Metacarpal (22) and metatarsal (11) fractures in 33 dairy cattle were treated by application of short or full limb casts. Twelve fractures involved the distal physis (6 closed, 6 open) and 21 fractures were nonphyseal (17 closed, 4 open). All physeal fractures were noncomminuted and 11/12 were classified as Salter-Harris type II. Eleven (52%) of nonphyseal fractures were comminuted. Closed fractures were reduced and a cast was applied after manual restraint, sedation with xylazine (along with use of ropes), or general anesthesia. Open fractures were best treated with the cow under general anesthesia. These fractures were carefully debrided, lavaged, and reduced, and a cast was applied. Antibiotics and analgesics were given parenterally. All cattle were restricted to a box stall during fracture healing. Fracture healing generally was rapid and uncomplicated. No closed fracture perforated the skin. Fracture healing was characterized radiographically by extensive circumferential periosteal new bone growth, closure of the distal physis, and preservation of articulations adjacent to the fracture site. Follow-up ranged from 6 to 78 months (mean, 32 months). Thirty of 33 (91%) cattle survived for a long period. All cows with closed (23) and 7 of 10 (70%) with open fractures survived. Three cows were euthanatized; 2 developed severe osteomyelitis and one fractured her metatarsus above a short cast. All 30 surviving cattle were considered by their owners not lame on the previously injured limb, with no noticeable angulation, bowing, or shortening. No deleterious effects on milk production were detected.     

Treatment of radial-ulnar and tibial fractures in cattle, using a modified Thomas splint-cast combination

In a retrospective study involving 15 cattle, radial-ulnar or tibial fractures were repaired with a modified Thomas splint combined with plaster cast. The cattle ranged in age from 1 day to 5 years and weighed from 46 to 775 kg. Eight cattle had radial-ulnar fractures and 7 had tibial fractures. The fractures healed in 14 cattle. The most frequent long-term complication was deviation of the involved long bones after healing. The degree of deviation decreased over several months' time in most cases. Thirteen of the 14 cattle with healed fractures were used for breeding or milking and their capacity for those functions was not diminished.     

Treatment of fractures in avian species.

External fixation, with coaptation or Kirschner-Ehmer splints, is a viable treatment for many fractures in captive and wild birds. Important considerations in selecting a device are the weight and size of the device, location of the fracture relative to joints, and prognosis associated with location of the fracture(s). A variety of materials, not limited to traditional medical materials, may be used in coaptation splinting. Straws, plastic spoons, and rubber balls can serve as effective splints. Type I and II Kirschner splints are typically used in birds, although large birds may require a type III splint on leg fractures. The most useful configuration for wing fractures is the type Ia single bar splint using epoxy or acrylic for the connecting bar. This splint is lightweight, positioned close to the patient, and stable for most fractures. The type II splint is an excellent choice for leg fractures at the level of the tibiotarsus and below. The destructive character of psittacines requires all splints be protected from the beak of the bird. Clavicular-furcular and coracoid fractures in small birds may be effectively managed with coaptation splinting. In birds over 400 g body weight, open reduction is needed for best results. Since fractures of the foramen triosseum are usually not surgically repairable, they can be stabilized with coaptation splints. Although humeral fractures may be managed with coaptation in some circumstances, firm stabilization with a type I Kirschner-Ehmer splint or internal fixation is best. Single bone fracture(s) of the radius or ulna can usually be managed with minimal treatment, brailling, or figure-of-eight wraps. Fractures of both the radius and the ulna require a type I Kirschner-Ehmer splint for internal fixation. Coaptation splinting alone is usually indicated for carpal or carpometacarpal injuries. Femoral fractures in small birds may be managed with coaptation splinting, although fractures in large birds or unstable fractures require internal fixation or a type I Kirschner-Ehmer splint. Tibiotarsal fractures, in many species, may be managed with internal fixation or a type II Kirschner-Ehmer splint. Tarsometatarsal fractures can be cast or stabilized with a type II Kirschner-Ehmer splint. Phalangeal fractures are best managed with coaptation splinting.     

Bite wounds involving the spine: characteristics, therapy and outcome in seven cases

Medical records of five dogs and two cats with bite wounds to the spine were reviewed. All dogs were bitten in the cervical spine and presented as quadriparetic. Both cats were bitten at the lumbar spine; one was paraparetic and the other paraplegic. Concomitant injuries to structures other than the spine were seen in two cases. Radiographic findings included vertebral fractures in all cases. Medical therapy included antibiotics (7/7), methylprednisolone sodium succinate (4/7) and analgesia (7/7). Five cases underwent minor (4/5) or extensive (1/5) surgical debridement. All cervical fractures were stabilized with fiberglass casts and animals with lumbar injury were cage rested for a month. Six of the cases survived, five of which regained good to excellent ambulatory ability within the first month. Although, the numbers of reported cases are limited, this study shows that adequate surgical debridement and wound drainage combined with external coaptation can be sufficient to manage bite wounds that involve the spine.