Treatment of distal diaphyseal fractures using hybrid external skeletal fixation in three dogs

Stabilisation of distal diaphyseal/metaphyseal fractures or osteotomies of the tibia and the radius is challenging due to the small fragment size, with innovative implants and external skeletal fixation systems described for their management. Hybrid external skeletal fixation is a novel external fixation system for use in small animals. This case series describes the management of distal diaphyseal fractures with IMEX-SK hybrid external skeletal fixation in three canine patients. Fracture healing was achieved in all cases, with frame removal after 5 to 10 weeks. Minimal complications were encountered in two cases. IMEX-SK hybrid external skeletal fixation constructs provide the veterinary surgeon with another option in the management of distal diaphyseal/metaphyseal fractures.     

Evolution of the treatment of canine radial and tibial fractures with external fixators

OBJECTIVES: To determine if indications for external fixator treatment of radial and tibial fractures, management of the fractures, or outcomes have changed over three decades. METHODS: Three groups of dogs were identified from discrete time spans within three decades and the medical records and radiographs were evaluated. The groups were compared in order to determine whether indications (signalment, etiology, fracture type and configuration), reduction method, equipment and implants, frame types and pin numbers, numbers of radiographic reevaluations, use of destabilization, frequency of pin track osteolysis, frame removal times and percentage of complications remained the same over the decades. RESULTS: The indications for external fixator treatment of radial and tibial fractures remained consistent over three decades. The equipment and implants changed over the decades. Frame construction changed from the predominately Type II frames constructed in the 1980's and 1990's to a variety of modified Type II, Type Ia, Type Ib and hybrid frames constructed in the 2000's. The frequency of pin track osteolysis decreased significantly over the decades. Frame removal times have not changed significantly over the past three decades. Complications (nonunion, delayed union, osteomyelitis, implant failure and premature frame loss) have decreased over this time. CLINICAL SIGNIFICANCE: Improvements in techniques and equipment have led to decreased complications with external fixators.     

Type I external skeletal fixation of radial fractures in microchiropterans.

An adult male big brown bat (Eptesicus fuscus) and an adult female hoary bat (Lasiurus cinereus) were presented with open transverse middiaphyseal left radial fractures. Initial repair was attempted by intramedullary pinning. When the fractures did not heal, intramedullary pins were removed and type I external skeletal fixators were placed. The fractures healed, and the big brown bat regained normal flight but the hoary bat did not.     

Use of intramedullary fully-threaded pins in the fixation of feline and canine humeral, femoral and tibial fractures

Intramedullary fully-threaded pins were manufactured from an alloy of titanium, aluminium and vanadium in a fully-threaded style. Pins were produced in various diameters, ranging from 4 mm to 11 mm. Pin lengths varied from 5 cm to 22 cm. The proximal end of the pins was designed to fit into a hexagonal screwdriver, while the distal end was slightly tapered to allow for ease of entry into cancellous bone. Treatment using the fully-threaded intra- medullary pin was carried out in a total of 175 fractures of the humerus, femur, and tibia in 95 cats (bilateral femur in 1 case) and 77 dogs (bilateral femur in 2 cases). Radiographic follow-up for the cases was performed at monthly intervals. Non-union developed in one dog with a femoral fracture in which cerclage wire had also been used. Delayed healing and lameness were observed in two other dogs. Healing with excessive callus formation was observed in 16 dogs. However, there were not any problems noted in these dogs in regards to limb usage. Clinical and radiological results obtained for the remaining cases were found to be very good. Normal, complete fracture healing occurred between four to 14 weeks in dogs, and between four to 12 weeks in cats. Pins were removed upon observation of satisfactory functional and radiographic recovery. Pins could not be removed from 26 cats and 21 dogs as the owners had declined pin removal, or because the owners were lost to follow-up.     

Treatment of open, delayed union, and nonunion fractures with external skeletal fixation.

ESF is useful in treatment of open fractures and delayed union and nonunion fractures. The fixation pins can be placed away from the fracture site to avoid disruption of blood supply. The appliance is well tolerated and inexpensive, and many of the parts can be reused. Adjustment of the splint is possible to permit correction of stabilization for optimal results. Gradual reduction of frame rigidity improves the quality of healing by increasing the stress on the bone. As stiffness of the healing fracture increases, return of limb function occurs. Early fixator removal reduces patient morbidity and permits a return to normal activity.     

Treatment of growth deformities with external skeletal fixation.

Growth deformities of the long bones are usually caused by premature closure of the physis. The most commonly affected bones are the radius, ulna, and tibia. Premature closure of the physis can result in shortened, angular, and rotational bone deformities, especially when one bone of a paired bone system like the radius and ulna is affected. Adjacent joints may develop osteoarthritis. Corrective osteotomy to realign in joint surfaces is indicated in mature animals. Bilateral or type II external fixation frames are used to stabilize the osteotomies. The advantages of ESF are: (1) The transfixation pins can be used as guide pins to realign joints. (2) The fixation allows rigid stabilization of the osteotomy site. (3) Postoperative correction of alignment can be achieved. (4) Implant removal after bone union is simple.     

Treatment of inherently unstable open or infected fractures by open wound management and external skeletal fixation

OBJECTIVES: To assess the use of external skeletal fixation with open wound management for the treatment of inherently unstable open or infected fractures in dogs. METHODS: A retrospective review of 10 cases. RESULTS: Fracture stabilisation and wound management required only a single anaesthetic, and despite the challenging nature of these injuries, the final outcome was acceptable or good in every case. However, minor complications associated with the fixator pins were quite common, and two dogs developed complications which required additional surgery. CLINICAL SIGNIFICANCE: Open management of wounds, even when bone was exposed, proved to be an effective technique, and external skeletal fixators were usually effective at maintaining stability throughout an inevitably extended fracture healing period.     

Circular external skeletal fixation stabilization of antebrachial and crural fractures in 25 dogs

Fracture stabilization using circular external skeletal fixation was evaluated in 14 dogs with antebrachial fractures and 11 dogs with crural fractures. Most dogs were consistently weight bearing on the stabilized limb by 3 days following surgery. Although all dogs developed minor wire/pin tract inflammation and eight dogs developed major wire/pin tract inflammation, postoperative lameness was not consistently associated with wire/pin tract complications. Fractures in 23 dogs achieved radiographic union (mean +/- standard deviation [SD], 61 +/- 21 days; median, 57 days) without additional surgery; two dogs required restabilization of their fractures with linear fixators. Twenty of the 21 owners that could be contacted felt their dog had no (n=15) or only a mild (n=5) intermittent lameness at the time of final, long-term (mean +/- SD, 37 +/- 17 months; median, 42 months) assessment.     

Treatment of radius-ulna and tibia fractures with circular external skeletal fixator in 19 dogs

This study was carried out on 19 dogs of different breed, age and sex. 10 different types of radius-ulna and 9 tibia fractures were treated by circular external skeletal fixator. The cases were followed by clinical and radiological controls in the postoperative period. It was observed that the cases tolerated the apparatus well. There was no looseness of fixator stability and configuration during the 15-day interval examination. Complications like pin track, serous drainage and pin loosening were observed postoperatively. It was concluded that radiographic, clinical and anatomical data together with good preoperative planning, the Ilizarov Method and circular external skeletal fixator was successful for the treatment of open or closed fragmented radius-ulna and tibia fractures in dogs.     

History of external skeletal fixation.

The concept of external skeletal fixation was introduced by Malgaigne in 1840, with a spike driven into the human tibia that was held by a strap encircling the limb. The first readily available external fixator, the Parkhill clamp, appeared in 1897. By the 1920s, a number of adaptations of pins or screws inserted into bone fragments for external control of reduction and fixation had been published. Important developments in that era were triangular half-pin units and anchoring bone pins in both cortices. The Stader splint, which was the first half-pin splint to provide reduction as well as fixation, was used by surgeons in the U.S. Navy during World War II. The Kirschner-Ehmer splint, a veterinary modification of the Anderson splint for humans, was introduced in 1947. Popularity of external skeletal fixation declined in the 1950s because of poor results that may have been caused by errors of application. Improvements in fixator configurations and the skill and judgment of surgeons led to the current acceptance of the method.     

Complications of external skeletal fixation.

Complications associated with ESF can deleteriously affect soft tissue and bone healing. Adherence to proper surgical techniques and guidelines will minimize development of ESF-related complications. The most common problems associated with ESF are pin tract infections, fixator problems, and soft tissue impalement. These complications can be avoided by using proper pin insertion techniques that reduce skin tension; pin-bone, pin-skin motion; and soft tissue trauma. In addition, proper selection of pins (size, threaded or smooth), fixator configuration, ancillary implants, and a cancellous bone graft further reduce the risk of complications and inadequate healing.     

The use of circular and hybrid external skeletal fixation systems to repair open tibial fractures in large ruminants: a report of six clinical cases

Veterinary Research Communications - A prospective clinical study consisting of six bovines (200–300 kg body weight) undergoing open tibial fractures was carried out, to evaluate the...     

Transarticular application of external skeletal fixation.

External skeletal fixators provide a useful alternative to external coaptation techniques for immobilization of joints in selected patients. This is especially true when the orthopedic injury involves an open wound requiring daily treatment. Devices such as the K-E splint, the Rudy external fixator boot, and acrylic frame fixators are economical and effective for transarticular fixation in small animal patients. Clinical indications for these techniques have included fixation of tibial or radial fractures with a short distal fragment; arthrodesis of the elbow, carpus, stifle, or tarsus; protection of Achilles tendon repairs; protection of collateral ligament repairs of the tarsocrural joint; and protection when multiple ligaments of the stifle joint have been reconstructed. Use of contoured rods has facilitated transarticular application of type II Kirschner-Ehmer splints. Use of acrylic frames and the Rudy boot technique have extended safe use of transarticular external fixation to extremely small patients not accommodated by the Kirschner system alone. An understanding of the advantages and disadvantages inherent in each of these techniques is critical to proper selection of the best method for a given patient. Attention to the basic principles of pin selection, pin insertion, and frame design are needed for successful execution of the chosen technique.