Avulsion of the tibial tuberosity with separation of the proximal tibial physis in seven dogs

Seven dogs developed avulsions of the tibial tuberosity apophysis in combination with a fracture of the proximal tibial physis. Six of them were small terrier breeds, treated by internal fixation using two Kirschner wires and a tension band in five cases, and crossed Kirschner wires alone in the other. The seventh case was managed conservatively. The tension band repair was simple, provided adeqate fixation and avoided the placement of implants across the proximal tibial physis.     

Nonunion

The recognition and treatment of delayed union or nonunion of a fracture is an orthopedic salvage procedure that all veterinary surgeons eventually experience. The major factor in determining whether a fracture becomes a nonunion or goes on to unite is the degree of stabilization of the fracture site. Infection (osteomyelitis) also contributes significantly to the formation of a nonunion. Nonunions can usually be classified clinically and radiographically as either vascular (capable of biologic activity) or avascular (incapable of biologic activity). Once this determination has been made, treatment regimens include application of rigid internal fixation (vascular nonunions) and installation of autogenous cancellous bone grafts after decortication (avascular nonunions). With the complication of osteomyelitis, microbiologic evaluation and antibiotic therapy should be considered even though a fracture will heal in the presence of infection if it is stable.     

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.     

The use of a biodegradable implant in fracture fixation: a review of the literature and a report of two clinical cases

A method of internal fracture fixation using rod-shaped biodegradable implants made of self-reinforced polyglycolic acid (PGA) is described. These biodegradable implants were employed in the fixation of fractures in a metaphysis and diaphysis. The fractures healed clinically and radiolo-gically in six weeks without complicatons. The patients started to use the operated limbs during the first postoperative week and lameness disappeared within six weeks. Biodegradable fixation devices will be a useful tool in the treatment of fractures in veterinary surgery.     

Basic avian bone growth and healing.

There have been few studies on the process of fracture repair in avian species. Most of the information shows similarities between avian and mammalian bone growth and fracture repair, but there are differences. The main finding confirms that fractures must be reduced properly, stabilized, and immobilized with an adequate blood supply to the bone fragments for optimal healing. The return to function of extremities, particularly the legs and wings, is an important consideration when internal fixation methods are used. Causing little or no collateral damage to soft tissue and joint when implanting internal hardware is ideal and reduces the likelihood of impaired function. Whether internal or external fixation methods are used for fracture reduction, the knowledge of avian bone growth and fracture repair is essential for veterinarian understanding and when discussing the healing process with clients.     

Tibial fractures

Tibial fractures are common in small animal practice. As with other appendicular fractures, the patient's age, fracture location, and fracture type must be considered thoroughly. While methods for tibial fracture repair are similar to those used for appendicular fractures elsewhere, there are some unique considerations, both anatomically and functionally, that must be contemplated before repair. The following article will review the incidence of tibial fractures, tibial fracture types, and options for tibial fracture management and treatment. The use of external fixators, orthopedic bone plates, open reduction with internal fixation (ORIF), and external coaptation will be discussed. An emphasis will be placed on the most common types of tibial fractures, as well as those best suited for repair by general practitioners of veterinary medicine. Three case based examples will follow the overview.     

Results of plate fixation of type 5 olecranon fractures in 20 horses

REASONS FOR PERFORMING STUDY: Previous olecranon fracture reports contain a small proportion of type 5 fractures, mostly treated with conservative therapy. OBJECTIVES: To evaluate the clinical details and outcome of type 5 olecranon fractures in a large group of horses treated by tension band plate fixation and to compare results with other treatment methods. METHODS: Medical records of 97 cases, including 32 (33%) classified as type 5, were reviewed. Subject details, history, radiographic findings, treatment and follow-up results (2-146 months post operatively) were recorded. RESULTS: Treatment included open reduction and internal fixation using a narrow or broad dynamic compression plate (n = 20), conservative therapy (n = 7) and euthanasia (n = 5). Long-term follow-up was available in 15 cases treated surgically, of which 2 were sound and in training, 11 sound and performing athletically and 2 unsound. Distal semilunar notch involvement, comminution or open status did not appear to affect prognosis. CONCLUSIONS: Internal plate fixation provides an excellent prognosis for an animal to be capable of athletic performance. POTENTIAL RELEVANCE: Describing tension band plate fixation and results offers a method of fracture repair that should improve treatment and prognosis for type 5 olecranon fractures.     

Surgical Repair of a Pelvic Fracture in a Ferret (Mustela putorius furo)

A 9-month-old, chemically spayed female ferret (Mustela putorius furo) presented after a fall (5.5 m) from the first floor of an apartment building. The animal was nonambulatory, with pain localized in the pelvic region. Radiographic examination revealed a bilateral fracture of the iliac body with medial displacement of the left hemipelvis and narrowing of the pelvic canal. Rib fractures, pulmonary contusions, and pleural effusion were also present on thoracic radiographic images. After emergency stabilization of the patient, the fracture of the left iliac body was successfully repaired using a composite internal fixation system with K-wires and polymethylmethacrylate. The implants allowed fracture healing despite loosening of one of the K-wires. Bony healing was achieved within 25 days, including the restoration of pelvic rigidity and maintenance of the diameter of the pelvic canal. Orthopedic examination was unremarkable 4 months following the surgical procedure. To the authors’ knowledge, this is the first described open reduction of a pelvic fracture in a ferret.     

Management of fractures in small animals.

Fracture repair in small animals has arrived at a crossroads because of advances in fracture repair and client demands. Research into bone healing and repair techniques, collective professional experience,economics, and client demands are obligating veterinarians to greater expertise in the actual act of repairing fractures. The influx of surgery specialists into burgeoning private practices has improved access to specialty service beyond what the limited number of academic practices could previously provide and has raised the local standard of practice for orthopedic surgery at the same time. The necessity to deal with the preoperative and postoperative management of traumatized small animals by the general practitioner has not changed, however.Treatment of the small animal patient with a fractured bone does involve accurate definition of the fracture, selection of an appropriate method of fracture fixation from the variety of devices available, and correct application of the fixation. Far more than these, however, it involves assessment and treatment of the traumatized patient as a whole,including preanesthetic evaluation of critical body systems, preoperative preparation of the patient and client, and postoperative management of the repaired fracture and patient.     

Treatment of long bone fractures in South American camelids: 5 cases

An adult llama and four alpacas were referred with long bone fractures. The llama presented with a closed, comminuted fracture of the right metatarsal bones. Two of the alpacas presented with comminuted fractures of the proximal radius. One fracture was closed and one was open. One alpaca had a closed, comminuted fracture of the distal radius, and the final alpaca had a closed, oblique fracture of the metatarsus. A diagnosis was made in each animal on the basis of clinical examination and radiographs. All fractures were managed by open reduction and internal fixation using selective placement of lag screws and dynamic compression plates. Four animals made uneventful recoveries and no long-term complications were encountered. One alpaca was re-admitted for plate failure and non-union of the fracture 5 weeks after surgery. The plate and screws were removed and a transfixation cast was applied. The fracture healed, however the alpaca showed signs of radial nerve paralysis after the cast was removed. With confinement in a small yard, full function gradually returned to the leg over the ensuing 4 months. Using techniques recommended in other species, South American camelids are suitable candidates for long bone fracture repair using open reduction and internal fixation.     

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.     

Surgical repair of femoral fractures in New World camelids: five cases (1996-2003)

Five New World camelids were admitted to the Western College of Veterinary Medicine between 1996 and 2003 for evaluation of femoral fractures. There were three alpacas and two llamas. Four of the animals were female and three were less than 3 months of age. Fracture configurations consisted of distal physeal fractures (three), a comminuted diaphyseal/metaphyseal fracture, and a transverse diaphyseal fracture. Fractures were diagnosed with a combination of physical examination and radiographs in all cases. All five fractures were repaired with internal fixation and three animals were discharged from the hospital with fractures that healed. One cria underwent successful internal fixation but died from pulmonary oedema during recovery from anaesthesia. Postoperative complications were rare and limited to inadequate fracture stability in one alpaca and prolonged recovery to weight bearing in another. One llama with a comminuted metaphyseal fracture, repaired with a 4.5 mm dynamic compression plate, subsequently had catastrophic failure of the bone 17 days after surgery. Overall the clients were pleased with the outcome of discharged animals. Although femoral fractures are considered rare, they pose a unique opportunity for the large animal veterinarian to successfully achieve fracture union with the aid of internal fixation.     

Femoral Head and Neck Fractures in the Dog and Cat: A Review of 115 Cases

Case histories of 115 dogs and cats with fractures of the femoral head or neck, were reviewed; these animals had been presented to the Ohio State University Veterinary Hospital between 1969 and 1976. Signalment, fracture type by anatomic location, fracture to fixation interval, surgical approaches used, methods of surgical repair, surgical complications, and final results of surgical repair were examined. Avascular necrosis of the femoral head was not a clinically significant problem following internal fixation in this study. Most animals had very good to excellent limb function following fracture repair.     

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.     

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.     

Fractures and luxations of the vertebral column.

External fixation of the vertebral column is indicated to treat fractures of the caudal lumbar spine, open fractures where vertebral osteomyelitis is present or likely to occur, and vertebral fractures not easily stabilized by internal fixation alone (e.g., compression fractures, fractures including spinous processes, and articular facets). Advantages of external fixation of caudal lumbar fractures, especially in combination with dorsal fixation devices, include the following: Fracture fixation does not preclude dorsal decompression; fixation devices need not be applied directly to the fractured vertebrae; and the combined technique provides dorsal and ventral vertebral fixation, which is more stable than dorsal fixation alone. Although external fixation is not applicable to all vertebral fracture/luxations in small animals, it provides additional points of fixation for rigid stability. Animals with vertebral fracture/luxations treated with an external fixation device have tolerated the external portion well. Development of additional applications for this method of vertebral fracture repair seems warranted.     

Complications of fractures repaired with plates and screws

The complications associated with bone plates and screws often are related to undersized or oversized implant selection, improper number of implants, inadequate or improper screw fixation, malpositioned plates or screws, poor plate contouring, and failure to use cancellous bone grafts when a gap is present at the fracture site. A thorough understanding of the principles of plate and screw application helps to avoid most problems. The surgeon must use an implant that will stabilize the fracture adequately during the healing process. The patient's activity levels must not exceed the mechanical limits of the implant. Methods to promote bone healing, such as using cancellous bone grafts when a deficit is present, help to protect the implant from fatiguing before the fracture is healed. Proper positioning and contouring of the implants are important to the successful application of plates and screws. It must be realized that even if all of these things are done, some complications still will occur. When that happens, the complication should be dealt within a manner that will allow the objectives of fracture treatment (a healed bone and normal limb function) to be achieved.     

犬股骨远端髁间T型骨折内固定实验模型的建立

为创建犬股骨远端髁间T型骨折并同期行内固定术的实验动物模型,观察这种内固定术后的愈合情况。对8条成年犬通过截骨的方法制作动物模型,并分别于术后1d、1周、2周、4周、8周、12周对实验犬进行X线检查。除一条实验犬创口感染形成假关节外,其余的犬对手术耐受良好,X线检查显示,随着固定时间延长,骨折间隙逐渐变窄,骨痂从无到有,骨折线从开始模糊到消失。本实验模型中采用的内固定方法能很好的治愈犬股骨远端髁间T型骨折。     

Type 1B external fixation of a metacarpal fracture in an alpaca

External skeletal fixation can be used in small ruminants as a successful, economic, alternative to internal fixation. In this case report, a type 1B frame was used on an alpaca to salvage a comminuted metacarpal fracture after failed internal fixation. Positioning the frame on the caudal aspect of the limb allowed full carpal flexion for kneeling and hence normal use of the limb throughout the recovery period. Complete healing occurred without further complications.