Modified transfixation pinning of compound radius and ulna fracture in a heifer

A 405-kg heifer sustained a compound fracture of the distal portion of the radius and ulna after being hit by a car. The fracture was thoroughly debrided, lavaged, and reduced with the heifer under general anesthesia. The fracture was immobilized with a modified walking cast, using 2 fully threaded 6.4-mm (outside diameter) Steinmann pins placed through the proximal portion of the radius. The pins were incorporated into a full-limb fiberglass cast, and a 0.5-cm X 2.25-cm aluminum walking bar was positioned medially and laterally on the limb. The modified walking cast was removed after 7 weeks, and the fracture healed without complication. The transfixation pins and aluminum walking bar helped reduce the strong compressive and rotational forces at the fracture site. The modified walking cast can potentially be used for fixation of a variety of fractures in large animals.     

Transfixation pinning and casting of radial-ulnar fractures in calves: A review of three cases

We reviewed the medical records of three calves with radial-ulnar fractures which were reduced and stabilized by transfixation pinning and casting. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material was placed from proximal to distal radius and served as an external frame to maintain pin position and fracture reduction.

At the time of injury, the calves ranged in age from one day to two months and weighed from 37-102 kg. Two fractures were comminuted and one was transverse. All fractures were closed. After surgery, all calves could walk within 24 hours. Radiographic and clinical evidence of fracture healing was present five to seven weeks (mean 6) after surgery. At that time, the pins and cast material were removed. Return to normal function was rapid and judged to be excellent at follow-up evaluation five to nine months later.

Advantages of transfixation pinning and casting in management of radial-ulnar fractures include flexibility in pin positioning, adequate maintenance of reduction, early return to weight-bearing status, preservation of joint mobility, and ease of ambulation. The inability to adjust fixation and alignment after cast application is a disadvantage of this technique compared with other external fixators. We concluded that transfixation pinning is a useful means of stabilizing radial-ulnar fractures in pediatric bovine patients.

     

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.     

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.     

Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results

Reasons for performing study: Fractured ribs are encountered quite frequently in newborn Thoroughbred foals, often with fatal outcome. Surgical repair of fractures therefore requires consideration as a means of reducing mortality. Objectives: To evaluate the repair of rib fractures using internal fixation techniques in foals at 2 different equine hospitals following similar diagnostics and case selection. Methods: The records of 14 foals that underwent internal fixation of fracture ribs were reviewed. Subject details, clinical presentation, diagnosis, surgical technique, post operative care and complications were recorded. Follow-up information was obtained in 7 foals. Results: The fractured ribs were reduced and stabilised using reconstruction plate(s), self-tapping cortical screws and cerclage wire in 12 cases, Steinmann pins and cerclage wires in 1 case and both techniques in 1 case. Not every rib was reduced on each case. Surgical reduction was performed on an average of 2 ribs, range 1-3 ribs in each foal. At the time of writing, 4 foals had been sold, one age 2 years was in training and 2 others died from unrelated causes. Conclusions: Our data support the use of surgical stabilisation utilising reconstruction plates, self-tapping cortical screws and cerclage wire for selected cases of thoracic trauma in neonatal foals. The use of Steinmann pins may be suboptimal due to cyclic failure, implant migration and the potential for iatrogenic internal thoracic trauma. Potential relevance: Foals with existing extensive internal thoracic trauma resulting from rib fracture(s), or the potential for such trauma, previously considered to have a guarded to poor prognosis for survival, may be successfully managed with internal fixation of selected fracture sites.     

Use of a hybrid external skeletal fixator for repair of a periarticular tibial fracture in a Patagonian cavy

An 8-week-old female Patagonian cavy was examined because of acute right hind limb lameness; radiography revealed a moderately displaced, comminuted fracture of the proximal third of the tibia. The fracture was stabilized with a hybrid external skeletal fixator. Two Kirschner wires were placed in the main proximal fragment, parallel to the tibial plateau and at right angles to each other. These wires were connected to a partial circular external fixator ring. Three half pins were placed in the distal fragment, and a straight connecting rod positioned on the medial side of the limb was connected to these pins and the fixator ring. A second connecting rod was positioned on the craniomedial side of the limb and was connected to the fixator ring and a fourth half pin in the distal fragment. The fracture healed without complications, and the fixator was removed 3 weeks after surgery. Hybrid external skeletal fixators combine the benefits of circular and linear external skeletal fixation methods, enabling rigid fixation of periarticular long bone fractures without adversely affecting mobility of the adjacent joint.     

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)     

Transfixation pinning and casting of tibial fractures in calves: five cases (1985-1989)

Medical records of 5 calves with tibial fractures that were reduced and stabilized by transfixation pinning and casting were reviewed. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments, and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material serves as an external frame to maintain pin position and fracture reduction. Calves were between 2 weeks and 6 months old and weighed between 40 and 180 kg. Three fractures were spiral in configuration and 2 were comminuted. One tibial fracture was open. After surgery, all calves were ambulatory within 24 hours. To improve tarsal flexion and achieve normal stance in 3 calves, cast revision was required on the caudal aspect of the limb. Good radiographic and clinical evidence of stability was observed in 5 to 10 weeks (mean 8 weeks), at which time the pis and cast were removed. Return to normal function was rapid and judged to be excellent at follow-up evaluation 3 to 12 months later. Advantages of transfixation pinning and casting in management of tibial fractures include flexibility in pin positioning, adequate maintenance of reduction, early return to weight-bearing status, joint mobility, and ease of ambulation. The inability to adjust fixation and alignment after cast application is a disadvantage of this technique compared with other external fixators.     

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.     

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.     

Closed reduction and blind cross-pinning for repair of a proximal tibial fracture in a foal

A 4-day-old foal underwent repair of a proximal metaphyseal fracture of the tibia. After closed reduction, fixation was achieved by use of blind cross-pinning. Thirty-five days after surgery, radiography demonstrated complete healing. The foal was mildly lame 4 months after repair of the fracture. Blind cross-pinning may be considered as a method of repair for certain long bone fractures in small foals.     

Surgical salvage from comminuted metatarsal fracture using a weight-bearing pin-putty apparatus in a dog

Comminuted metatarsal fractures in a dog were treated using intramedullary pins externally connected and stabilized by epoxy resin putty and application of a fibreglass cast. Two weeks later the cast was removed. After further 2 weeks application of a Robert-Jones bandage the dog could stand and walk with the pin-putty apparatus in position. The pin-putty apparatus was removed 3 months postoperatively, and the dog resumed normal activity. This fixation method could be an easy, economical and effective alternative treatment for managing comminuted fractures of the metatarsal and possibly metacarpal bones in selected cases.     

Placement of Multiple Full Pins for External Fixation Technique and Results in Four Dogs

A technique using a third bar and guide clamp was developed to permit reduction and stabilization of distal limb fractures with full pins and two connecting bars, one on each side of the bone. The system uses only single Kirschner clamps. Four distal limb fractures were stabilized using this technique. Closed reduction was used in three dogs to avoid devitalization of fragments and avoid contamination of a closed fracture. The fracture site stability achieved with this configuration allowed early return to weight bearing and rapid bone healing.     

Racing prognosis of horses following surgically repaired olecranon fractures

Olecranon fracture is a common orthopedic problem in juvenile horses. Prognosis for complete fracture healing when various methods of internal fixation are used is good; however, the impact of olecranon fracture stabilization on the likelihood that foals will start on a racecourse is unknown. Medical records of foals undergoing internal fixation for an olecranon fracture were reviewed. The dam's foaling records were obtained and lifetime racing records were then retrieved for both the affected foals and 1 of their siblings. Twenty-two of 24 repaired fractures healed completely, subsequently, 16 of the foals started in at least 1 race. Statistical calculations suggest that when compared with their siblings, the occurrence of olecranon factures requiring internal fixation in juvenile racehorses will not significantly reduce the likelihood that they will race; however, the siblings had significantly more lifetime race starts and higher career earnings.     

Internal Skeletal Fixation Using a Kirschner Apparatus for Stabilization of Fracture/Luxations of the Lumbosacral Joint in Six Dogs: A Modification of the Transilial Pin Technique

A technique using a modification of the transilial pin technique for stabilization of fracture/ luxations of the lumbosacral joint was performed in six dogs. This technique used an internal skeletal fixator composed of two transilial pins secured with two double fixator clamps. Collapse (shortening) of the seventh lumbar vertebra (L7) was observed in five dogs without compromise of the vertebral canal. Kirschner wires placed across the articular facets as supplemental fixation devices migrated to the subcutaneous tissues in two dogs and were easily removed. Migration of the internal fixators was not observed during healing; vertebral canal dimensions were maintained in all cases, and the internal fixators were not removed after resolution of fracture healing. All fractures were healed within 6 to 12 weeks of surgery without evidence of pain, neurologic impairment, or long-term complications.     

Radiologic and gross anatomic evaluation of bone healing in the dog.

Bone healing associated with 3 techniques of midshaft femoral fracture fixation in 36 young adult Beagle-type dogs was evaluated in radiographic and gross pathoanatomic studies. A serrated transverse fracture was surgically and aseptically created on the midshaft of either the left or the right femur of each dog. The fixation devices used were intramedullary (IM) pin, IM pin and 1/2 Kirschner device, and tension bone plates. The radiographic evaluation was done in series. The first radiographs were taken during surgery. Radiographs were then taken immediately after surgery, to record the status of reduction, alignment, and fixation. Radiographs were taken at the 4th and 10th postoperative weeks, to monitor healing. All dogs were euthanatized at the 10th week. Both the normal femur and the healing femur were removed from all dogs, all soft tissue was removed from the bone, and each femur was examined grossly. Each type of fixation was associated with a distinct mode of osteogenesis. Bony union and clinical union (that stage in the healing process when fixation can be removed) were defined as a successful conclusion to each case. Malunion and nonunion were defined as unsuccessful conclusions. Delayed union was defined as neither successful nor unsuccessful. The IM pin cases had a 64.2% success rate and a 14.2% failure rate. The IM pin and 1/2 Kirschner cases had a 100% success rate. The bone plate cases were 91% successful, with 0% failure. A problem identified with IM pinning was axial rotation (6 of 14 or 42% of the cases). It was concluded that IM pins should not be used alone for the fixation of femoral fractures in adult dogs.     

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.     

Treatment of a Periarticular Tibial Fracture in a Foal with a Hybrid External Fixator

Objective— To report repair of a right proximal tibial Salter-Harris type II fracture in a foal with a hybrid external fixator (HEF).
Study Design— Case report.
Animals— A 5-month-old male foal.
Methods— After open surgical reduction, an HEF built with wires, 2 half-rings, 3 half-threaded connecting rods, and Schanz pins was used to stabilize the fracture.
Results— Immediately after surgery, the foal had relatively good weight bearing. The HEF was removed at 60 days after radiographic confirmation of healing.
Conclusions— HEF can be used to stabilize a proximal tibial Salter-Harris type II fracture in a 5-month-old foal.
Clinical Relevance— HEF should be considered as another option for repair of proximal tibial Salter-Harris type II fractures in foals.     

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.     

Crosspin Fixation of Fractures of the Proximal Tibia in Three Foals

Three foals, each less than 1 month of age, were presented with Salter Type II fractures of the proximal tibial physis. Reduction of the fractures was accomplished manually and maintained by crosspin fixation. Fracture healing in two of the foals was uncomplicated. The third foal developed an infection around the implants, which responded to periodic local antiseptic flushing and administration of penicillin and gentamicin. Follow-up information ranging from 11 to 22 months after surgery revealed satisfactory results in two of three foals; premature closure of the proximal tibial physis was found in the other foal, resulting in the development of an angular limb deformity.