Pedal bone fractures

Fractures of the pedal bone are usually the result of direct trauma, and are relatively commonly encountered in equine practice. Either front or hind feet may be affected. Seven distinct fracture types are recognised. Type I fractures involve the palmar/plantar process and do not enter the distal interphalangeal (DIP) joint. Type II fractures are oblique or parasagittal fractures that are articular but are not on the midline. Type III fractures are midline articular fractures that bisect the pedal bone into 2 equal halves. Type IV fractures involve the extensor (pyramidal) process of the pedal bone. Type V fractures are comminuted and split the pedal bone into multiple fragments. Type VI fractures are solar margin fractures. Type VII fractures are exclusive to foals and are also fractures of the solar margin. In most cases the onset of clinical signs is acute. The diagnosis is usually achieved by radiography, although computed tomography or magnetic resonance imaging can be helpful in some cases. Treatment options include surgical and nonsurgical therapies. The prognosis for articular fractures (Types II and III) is worse than for nonarticular fractures (Types I, IV, VI and VII) because of the likelihood of osteoarthritis within the DIP joint. Nonarticular fractures carry a good prognosis if a long enough convalescence is undertaken. Comminuted fractures (Type V) carry a poor, but not hopeless, prognosis.     

Risk factors for humeral condylar fractures in the dog: A retrospective study

Humeral condylar fractures have fracture lines that extend through the joint surface and through one or both epicondyles. One hundred and eighty-nine dogs with humeral condylar fractures are presented in this study. Lateral condylar fractures were the most frequent (67 per cent), occurring nearly 10 times as often as the medial condylar fracture. Intercondylar fractures represented about 35 per cent of these. Condylar fractures occur as a result of moderate trauma and only rarely due to traffic accidents. The histories and circumstances of the three fracture types are not essentially different. Dogs, three and four months old, were strongly over-represented among the lateral and medial condylar fractures, compared with the age distribution of other types of fractures in the extremities of the dogs. Humeral condylar fractures were recorded in 58 breeds. All dogs are vulnerable to humeral condylar fractures. All sizes and both sexes are equally at risk. Some breeds seem to be more vulnerable to lateral condylar fractures: English and French bulldogs, Yorkshire terriers, miniature schnauzers, Gordon setters and German short-haired pointers. The St Bernard seems to be more vulnerable to medial and intercondylar fractures and the German shepherd dog and beagle to intercondylar fractures. A retrospective case control study does not provide wholly reliable statistical information on risk factors, and the statistics concerning breed and breed size must be judged accordingly. The method was considered to be the best statistical model available for this study.     

Bilateral iatrogenic [corrected] maxillary fractures after dental treatment in two aged horses

This clinical report describes two horses with bilateral maxillary fractures following dental treatment. The fractures occurred during dental treatment by a veterinarian, and both had rostral, transverse, and complete bilateral maxillary fractures with instability and minimal displacement. The fractures were repaired using bilateral intraoral wiring with the patients under general anesthesia. The postoperative period was without complications and the fractures healed as expected. Maxillary fractures during or after routine dental treatment are rare, but can occur, especially in older horses. Appropriate sedation and, if necessary, regional nerve blocks might reduce the risk of iatrogenic fractures of the maxilla. General anesthesia must be considered for tooth extraction in horses that are difficult to restrain.     

Radius fractures in the horse: a retrospective study of 47 cases

The case records, radiographs and treatment results of 47 consecutive equine radius fractures presented to The Ohio State University Veterinary Hospital from 1975 to 1985 were examined retrospectively. Chip fractures and incomplete fractures were not considered. Both diaphyseal fractures and fractures involving the physes were included. Diaphyseal fractures were placed into three major categories: comminuted, oblique and transverse; and subclassified as proximal, mid-diaphyseal, or distal. Fractures involving a physis were classified using the Salter-Harris classification system. The horses ranged in age from one day to 19 years old. Nineteen of the patients were destroyed humanely on presentation, and 28 were treated. Twenty-four of the 28 fractures treated were repaired by open reduction and internal fixation. Success rate was related to the age of the horse and the type of fracture. Adult radius fractures have a poor prognosis. Most fractures in foals are either physeal fractures or transverse or oblique diaphyseal fractures and have an excellent to good prognosis when repaired adequately.     

Management of fractures and exostosis of the metacarpals and metatarsals II and IV in 25 horses

Twenty-five cases of fractures of the second and fourth metacarpal and metatarsal (splint) bones were reviewed. Fourteen fractures involved a thoracic limb and 11 involved a pelvic limb. Fractures of the proximal one-third of splint bones are reported in one of two forms: fractures that are closed, or fractures with a permanent or intermittent draining sinus. Thirteen of the fractures presented were closed fractures and the remaining 12 were open. All of the closed fractures were managed by surgical excision of the distal fragment and the exostosis at the fracture site, followed by primary surgical wound closure. Lag screw fixation of the proximal fragment was used in three cases. All of the open fractures were managed surgically by excision of the distal splint fragment and debridement of the contaminated fracture site. Primary wound closure was used in 11 of the 12 cases. All closed fractures healed by primary intention, and 10 of 13 were free from lameness at one year follow-up. The 11 open wounds which were operated and subsequently closed under suture healed by primary intention. The wound left open healed by granulation, scar contraction, and epithelialisation. Eight of these horses were sound one year later. The remainder of the open fractures were lost to follow-up.     

Arthroscopically assisted repair of articular fractures

Arthroscopic assistance in the management of articular fractures should be the standard of treatment because of the numerous advantages afforded by the technique. Arthroscopic evaluation of the entire joint as well as fracture reduction are superior to that obtained by radiography, fluoroscopy, or direct observation. Condylar fractures and third carpal slab fractures are the most commonly performed procedures with the technique but simple phalangeal fractures, mid-body sesamoid fractures, and other injuries can be managed similarly. The arthroscopic evaluation should be combined with intraoperative radiographic/fluoroscopic imaging of the internal fixation.     

Clinical application of an external fixator in the repair of bone fractures in 28 birds

The repair of seven tibiotarsal fractures, three humeral fractures, three tarsometatarsal fractures, two femoral fractures and 13 radial and ulnar fractures with a tubular external fixator system was evaluated prospectively in 10 common pigeons (Columba livia), 11 psittacine birds, six birds of prey and one Bali starling (Leucopsar rothschildii). The fixations included type 1, type 2 and intramedullary tie-in methods, and the fractures healed in all but three cases. A comparison of the weight of different connecting bars showed that the external fixation system and polymethylmethacrylate are the lightest available systems and that there was no clinically relevant difference between them.     

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.     

Femoral neck fractures and capital epiphyseal separations in cats

In a retrospective study, 47 fractures of the femoral neck and 17 capital epiphyseal separations were recorded in a total of 62 animals over a 12-year period. It was found that cats sustain femoral neck fractures more often than capital epiphyseal separations. Until cats are six months old the vast majority of lesions in the proximal femur are fractures of the neck. Between the ages of six and 12 months both lesions are equally represented. After 12 months of age no capital epiphyseal separations occur and the incidence of femoral neck fractures diminishes appreciably. If left untreated, an acceptable clinical result can be obtained in both femoral neck fractures and capital epiphyseal separations, although the best functional result is achieved in femoral neck fractures. In the present study, spontaneous healing was seen only in femoral neck fractures in cats younger than three months. All cats with capital epiphyseal separations developed hypertrophic pseudoarthrosis.     

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.     

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.     

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.     

Bilateral calcaneal stress fractures in two cats

Two cats that developed bilateral calcaneal stress fractures are reported. One cat developed lameness associated with incomplete fractures at the base of both calcanei, both of which progressed to acute, complete fractures 2 months later. The second cat presented with acute complete calcaneal fracture, with evidence of remodelling of the contralateral calcaneus, which subsequently fractured two years later. The calcaneal fractures were successfully stabilised with lateral bone plates in each case. Stress fractures were suspected because of the bilateral nature, the simple and similar configuration, the consistent location of the fractures, the absence of other signs of trauma in both cases and the suspected insidious onset of the lameness. The feline calcaneus is susceptible to stress fracture, and cats presenting with calcaneal fractures without evidence of trauma should be evaluated for concurrent skeletal pathology.     

Condylar fracture of the cannon bone with axial sesamoid fracture in three horses

The case histories of three young thoroughbred racehorses with displaced lateral condylar fractures combined with an axial fracture of the lateral sesamoid bone are described. In two cases the condylar fracture was repaired surgically but both horses developed severe degenerative joint disease and remained lame. The third horse was destroyed humanely. It is important that axial fractures of the sesamoid bone are recognised so that a poorer prognosis can be given for treatment of condylar fractures in racing thoroughbreds.     

Emergency management of open fractures and luxations.

This article discusses the emergency management of open fractures and traumatic joint luxations. The emergency management of open fractures can be challenging. The proper initial evaluation and treatment of open fractures can have a positive impact on their successful outcome. The clinical signs and diagnosis of traumatic joint luxations are reviewed. Emphasis is placed on the management of these injuries in the emergency situation.     

Emergency treatment of limb fractures in large and small ruminants

Limb fractures in cattle have to be treated as emergencies. The success or failure of treatment depends on a careful examination and adequate emergency treatment by the veterinarian. The most important rules in an emergency treatment are the evaluation of the general systemic conditions and the initiation of whatever supportive care is required. Further attention should be paid to thoroughly rinsing and disinfecting open wounds and to immobilizing fractures for transport purposes. In 39 cases the localisation and the type of fracture were determined and the clinical relevance of a careful examination and emergency treatment was evaluated. Metacarpal fractures were the most common type of fracture. Open fractures were more likely to occur in cases of insufficient immobilisation than with properly attended patients (p less than 0,01). Open fractures have a poorer prognosis than closed fractures (p less than 0.002).     

Conservative and surgical treatment of canine acetabular fractures: A review of 34 cases

The case histories of 34 dogs with acetabular fractures are reviewed. Twenty-one were treated surgically and 13 conservatively. A classification system for acetabular fractures is presented and the results of treatment in each group are described and discussed.     

Diagnosis and management of proximal sesamoid bone fractures in the horse

Fractures of the proximal sesamoid bones (PSBs) range in severity from simple to complex and comminuted and can be articular or nonarticular. The majority of PSB fractures are diagnosed in racehorses, but PSB fractures, especially simple ones, do occur in sport horses undertaking various disciplines. For simple apical, basilar and abaxial articular PSB fractures, surgical removal via arthroscopy carries the best prognosis for return to athletic performance. Removal of apical and abaxial PSB fractures generally result in a favourable prognosis for return to racing but are dependent on the amount of suspensory ligament injury. Removal of basilar PSB fracture fragments results in a less favourable or fair prognosis for return to racing. Mid‐body PSB fractures typically require (lag screw) surgical fixation preferably with arthroscopic guidance and carry a fair to guarded prognosis for return to racing.     

Gunshot Fractures of Extremities: Classification, Management, and Complications

Fifteen clinical cases of gunshot fractures were studied. A radiographic classification of the fractures was developed to aid in fracture evaluation. Type I fractures involved a simple transverse or oblique fracture with minimal soft tissue damage. Type II fractures were severely comminuted with no cortical bone defect and minimal soft tissue damage. Type III fractures were "shatter" fractures, characterized by severe comminution, cortical bone defects, and extensive soft tissue damage. Type I and Type II fractures (combined 26.7%) healed in 8 weeks or less. Eleven of the 15 cases evaluated (73.3%) were found to be Type III fractures, requiring more than 14 weeks for complete cortical healing. Osteomyelitis was associated with 3 cases of Type III tibial fractures, 2 of which developed after a second surgical intervention. Management, complications, and prognosis of gunshot fractures are discussed.     

Sixteen fractures of the shoulder region in the horse

The clinical and radiological features of fractures of the shoulder region in 16 horses are described. High quality radiographic views were essential for an accurate diagnosis. This sometimes necessitated general anaesthesia. The limitations of radiography are discussed. Nine horses had articular fractures of the supraglenoid tuberosity and eight of these were destroyed because of persistent lameness. The possibility of surgical removal of the fracture fragment(s) is discussed and the importance of early diagnosis emphasised. Seven other fractures of the shoulder region are described. The clinical outcome depended upon the location and nature of the fracture.