Oral and maxillofacial reconstruction in a cat using wire and acrylic

A 15-month-old DSH cat was presented with facial deformity secondary to multiple oral and maxillofacial fractures after being struck by an automobile. Multiple wires and dental acrylics were used for fracture repair.     

Fractures of the mandible and maxilla.

External fixation is an effective method for stabilization of many mandibular fractures. Thorough physical examination and patient stabilization should be instituted before attending to the fractures and associated soft tissue trauma. Normal occlusion rather than perfect reduction is the goal of oral fracture repair. Loose teeth or teeth in the fracture should be removed, as should any avascular bone fragments. Soft tissue wounds should be treated as for any contaminated wound. Mucosal wounds are allowed to heal by second intention. Although prophylactic perioperative antibiotics are indicated, they are usually not needed postoperatively. The three basic types of external fixators described include the Kirschner-Ehmer splint, pins or screws and acrylic, and the biphase splint. All three types are relatively easy to apply, and the principles of their application are similar. A minimum of two pins or screws are placed percutaneously in each fragment, avoiding the mandibular canal. The Kirschner-Ehmer splint is more easily adjustable than the biphase splint or the pin-acrylic splint, which use acrylic connecting bars. The advantages of fixators that use acrylic bars are that the pins or screws need not all be in the same plane and that they are more lightweight than the Kirschner-Ehmer splint. The disadvantages of the biphase splint are its increased expense and its use being limited to larger dogs. External fixators are well tolerated by the animals, and postoperative care is minimal. Mandibular fractures are usually healed in 3 to 5 weeks, and the fixators can be removed with the animal under sedation.     

Orthopedic clinical techniques femur fracture repair

Femur fractures occur commonly in cats and dogs following substantial trauma. Fractures of the femur may be categorized as capital physeal, femoral neck, trochanteric, subtrochanteric, diaphyseal, supracondylar or condylar or distal physeal. Most femur fractures are closed due to the heavy overlying muscle, unless due to a penetrating injury such as a gunshot wound. Femur fractures are generally not amenable to conservative repair, and some kind of internal fixation is generally required. Implant systems suitable for repair of femur fractures include bone plates, interlocking nails, plate-rod construct, lag screws, pins and wires and external fixators. Fractures may be repaired using anatomic reduction and rigid fixation or using the principles of biologic osteosynthesis. Biologic osteosynthesis is particularly effective for highly comminuted fractures because vascular supply and soft tissue attachments to bone fragments are preserved, speeding the formation of bone callus. Articular fractures should be anatomically reduced and rigidly stabilized to reduce the chance of progressive osteoarthritis.     

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.     

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.     

Cervical vertebral fracture in a Thoroughbred filly with minimal neurological dysfunction

Vertebral fractures in horses are relatively common and often occur due to trauma. Clinical signs may range from neck pain and mild neurological dysfunction to tetraplegia and death. Severity of signs and prognosis depends on extent of damage to the spinal cord. In this Case Report, serial radiographs, which track the bony changes associated with fracture healing, were performed over one year. Although surgical techniques have been described to repair fractures to the vertebrae, patients with minimal neurological deficit may have a favourable outcome with conservative medical management, as in this case.     

Maxillofacial and mandibular fractures.

Any traumatic event that produces maxillofacial and/or mandibular fractures generally results in gross and usually severe patient disfigurement and often results in the patient's inability to eat and drink. These fractures are exceptionally rewarding cases as simple techniques may be performed resulting in a successful functional outcome (ability to eat and drink) within a very short period of time (24 hours) after fracture stabilization. A markedly improved cosmetic appearance follows shortly thereafter once inflammation and edema resolve. The primary principle of fracture treatment, ie, providing stable fixation to the bone fragments, may be successfully used with wiring techniques only through an appreciation and proper application of biomechanical principles. Knowledge that bending forces (divided into their tensile and compressive components) are the primary forces to be neutralized dictates the use of the wiring techniques outlined as the "standard" to which all other methods of fixation for maxillofacial and mandibular fractures are compared. The location of the tension-band surface of the bone, the alveolar (oral) surface, dictates the most appropriate position for wire placement. Successful treatment is predicted on obtaining a cosmetically acceptable and functional result (Fig 29). Anatomic reduction and rigid fixation of fractures that can be reconstructed piece-by-piece creates optimal conditions for uncomplicated healing. Fractures in which bone loss or severe comminution exists, and which cannot be anatomically reconstructed, must be reduced using dental occlusion as the template for fracture fixation, thereby avoiding malocclusion. Excessive leverage on the bone fragments may occur secondary to malocclusion, resulting in an increased risk of complications (fragment motion, loosening of implants, infection). Some fractures with comminution or bone loss may not be suitable for wire fixation and must be treated by alternate methods (eg, external skeletal fixators, plates).     

Stress Fractures of the Acetabulum in 26 Racing Greyhounds

Acetabular fractures in 26 racing Greyhounds were reviewed. All fractures occurred during racing or training and were unrelated to any external trauma. All fractures had similar configurations, were minimally displaced, and involved only the acetabulum. Affected dogs were young (16-36 months). Fractures occurred unilaterally (22 dogs) and bilaterally (4 dogs). There was no sex predilection, and both right and left sides were equally represented. Bilateral fractures were associated with retraining between the occurrence of the first and second fractures. Radiographically, a fracture line was consistently visible in the caudal third of the acetabulum. Fractures in gross specimens resembled an inverted "Y." Results of histologic evaluation of two fractured acetabula showed changes characteristic of a nonunion fracture. Microfractures were evident in the grossly normal acetabulum opposite the fractured side. Evidence obtained from this study suggests a common pathogenesis of the fractures related to tremendous repetitive stresses produced during running. Greyhounds with unilateral acetabular fractures may provide a reproducible model for future studies of stress fractures in animals and humans because of the high incidence of bilateral fractures that develop during retraining. Surgical repair of the acetabular stress fracture was more successful than conservative management in returning the dogs to competitive racing.     

Management of limb fractures in wapiti (Cervus elaphus): 22 cases (1993-1997).

OBJECTIVE: To determine treatment and outcome of a series of wapiti (elk) with fractures of the limbs. DESIGN: Retrospective study. ANIMALS: 22 wapiti. PROCEDURE: Medical records were reviewed to determine affected limb and bone, fracture configuration, method of treatment, outcome, and complications. RESULTS: 2 animals had fractures of the humerus; 8 had fractures of the radius, ulna, or both; 5 had fractures of the third metacarpal bone; 3 had fractures of the tibia; 2 had fractures of the femur; and 2 had fractures of the tarsal bones. Most fractures (n = 11) were closed, displaced, nonarticular fractures; 6 fractures were open. Four animals died or were euthanatized prior to fracture treatment, 2 were not treated because fractures had already healed, and 14 underwent fracture repair. In the remaining 2 animals, the affected limb was amputated. Five animals developed nonfatal complications (wound dehiscence, osteomyelitis [2 animals], delayed union, and malunion) and 2 developed fatal complications (gastrocnemius rupture and femoral fracture during recovery). Overall, 16 animals were discharged from the hospital, and all were doing well at follow-up, 2 months to 4 years after discharge. CLINICAL IMPLICATIONS: In wapiti, limb fractures can be successfully treated by means of internal or external fixation. The high rate of fracture healing, even among wapiti with open fractures, should encourage veterinarians to repair limb fractures in wapiti.     

Modified intramedullary pin technique for repair of distal femoral physeal fractures in the dog and cat

A modified intramedullary pin technique for surgical repair of distal femoral physeal fractures in dogs and cats provided stability at the fracture site and allowed early range of motion. The fixation and stability of this technique was compared with that achieved with a multiple pin technique. Fixation failure did not occur in 11 animals treated by the modified intramedullary pin technique, whereas there were 2 failures in 13 patients treated by a multiple pin technique.     

Repair of diaphyseal femoral fractures in cats using interlocking intramedullary nails: 12 cases (1996-2000).

OBJECTIVE: To determine the outcome of femoral fractures repaired with 4.0- and 4.7-mm interlocking intramedullary nails in cats. DESIGN: Retrospective study. ANIMALS: 12 cats with diaphyseal femoral fractures. PROCEDURE: Records of all cats in which the 4.0- and 4.7-mm interlocking nail system was used for repair of diaphyseal femoral fractures at the Animal Medical Center and Florida Veterinary Specialists between 1996 and 2000 were reviewed. Information included signalment, type of fracture, size of the implant, details of the surgery, intra- and postoperative complications, fracture healing, and clinical outcome. RESULTS: Femoral fractures in 12 cats were repaired. Eleven of the fractures were comminuted, with 2 of these being open. Clinical outcome was excellent in 7 cats, good in 3, and fair in 1. One resulted in a nonunion. Complications included screw breakage (1 cat) and fracture distal to the nail (1). Fracture distal to the nail occurred from a second trauma. CONCLUSION AND CLINICAL RELEVANCE: Use of the interlocking nail has been limited in cats because of the small diameter of the medullary canal. Use of the 4.0-mm nail will allow for greater application of this implant in small patients. Results of this study indicate that the 4.0- and 4.7-mm interlocking nails can be used to repair simple or comminuted diaphyseal femoral fractures in cats.     

Fractures of the humerus

Humeral fractures are the least common long bone fracture in small animals. The low incidence of these fractures combined with the unique anatomy of the humerus makes repair of humeral fractures challenging. This chapter provides a review of humeral fracture management.     

Central tarsal bone fractures in the racing Greyhound: a review of 114 cases

A total of 114 central tarsal bone (Tc) fractures, including associated secondary fractures, were identified in 114 racing Greyhounds. The fractures were classified according to a previously described scheme. The type IV Tc fracture, dorsal and medial slab fractures, was most common. A Tc fracture alone, or a Tc fracture with associated fractures of the 4th tarsal bone (T4), calcaneus, or T4 and lateral base of the 5th metatarsal bone were the most commonly observed. The prevalence of secondary fractures increased with the severity of the Tc fracture. Management of Tc fractures involved 3 methods: coaptation, single-screw fixation, and 2-screw fixation. Additional repair was performed as indicated by the presence of concurrent secondary fractures. A total of 71% of the dogs returned to competitive racing.     

Complications after orthopedic surgery in alpacas and llamas: 24 cases (2000-2006)

Objective— To report complications associated with orthopedic surgery in alpacas and llamas.
Study Design— Retrospective study.
Animals— Alpacas (n=18) and llamas (n=6) that orthopedic surgery using internal or external fixation.
Methods— Medical records (January 2000–December 2006) and radiographs were reviewed and owners contacted for follow-up information for alpacas and llamas that had orthopedic surgery involving internal or external fixation. Fourteen camelids had internal fixation, 7 had external fixation, and 3 had a combination of internal and external fixation.
Results— Twenty-two animals (92%) were discharged after surgery (mean hospitalization, 15 days). Of 20 animals with ≥1 year follow-up information, 18 were alive (82%). Postoperative complications related to fracture healing, infection, soft tissue structures, or joints occurred in 21 camelids (87%). Thirteen animals returned to their intended use, 4 animals returned to breeding but not their intended use, 4 were euthanatized, and 3 were only able to be used as pets.
Conclusions— Fixation type (internal, external) did not have any significant effect on complications involving fracture healing, infection, soft tissue structures, or chronic lameness. Camelids with open fractures were more likely to have complications associated with fracture healing, repair, and infection than closed fractures.
Clinical Relevance— Complications after orthopedic surgery in alpacas and llamas are more common than previously reported and may result in chronic lameness or prevent return to their intended use.     

Lateral fabellar fractures in the dog: A review of eight cases

Fractures of the lateral fabella were recorded in seven medium or large breed dogs. Six dogs had unilateral fractures and one had bilateral fractures. The fractures appeared to occur spontaneously, without external trauma. Four fractures were managed conservatively and four were treated by surgical removal of the fracture fragments. Both treatments were successful in resolving the lameness.     

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.     

Management of fractures near the carpal joint of two calves by transarticular fixation with a circular external fixator

A four-ring circular external skeletal fixation device was evaluated for transcarpal fixation of compound fractures in two calves. Case 1 was an eight-month-old female Holstein-Friesian x indigenous breed calf weighing 72 kg, which had a Salter-Harris type II fracture at the distal metaphysis of the right radius/ulna with an open contaminated wound on the medial aspect of the carpus. Case 2 was an 18-month-old crossbred Haryana heifer weighing 105 kg, which had a comminuted fracture at the proximal end of its left metacarpus with severe soft tissue trauma and an open wound on the medial aspect. In both cases, the fractures were repaired with four-ring circular fixators by fixing the proximal two rings in the distal radius/ulna and the distal two rings in the metacarpus. Postoperatively, both calves were treated with analgesic and anti-inflammatory drugs and antibiotic, and the pin-bone interfaces and the open wound were cleaned regularly with povidone-iodine solution. In both animals weight bearing was good to excellent in the immediate postoperative period. The fixator was well maintained and tolerated by the animals until the fractures healed after 45 to 60 days. The movement of the carpal joint was slightly affected when the fixator was removed on day 60, but a follow-up examination after one year showed that both calves had normal functional usage of the limbs.     

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.     

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.     

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.