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.

     

An expansion and compression technique for reducing and stabilizing proximal epiphyseal fractures of the tibia in foals.

Proximal tibial epiphyseal fractures in 2 foals were reduced and stabilized by expansion and compression between 2 transversely placed Steinman pins, one on each side of the fracture. A Charnley apparatus or turnbuckles placed between the pins on each side of the fracture provided the mechanical advantage for repositioning the fracture fragments and achieving rigid fixation during healing. A light cast was applied over the fixation apparatus, keeping the limb in an extended position. The cast and fixation apparatus were removed after 4 weeks. The technique allowed rapid healing and adequate ambulation. The foals had functional, straight hindlimbs 6 months after the fractures occurred.     

Cranial Approach to the Humerus for Repair of Fractures in Horses and Cattle

A cranial approach to the humerus was developed for application of a compression plate for repair of comminuted humeral fractures in a weanling foal, a calf, a heifer, and a mature cow. An incision was made from the cranial portion of the greater tubercle of the humerus to the radius. The cranial aspect of the humerus was exposed by retraction of the brachiocephalicus muscle and blunt dissection between the biceps brachii and brachialis muscles. A second plate was applied laterally in the heifer and cow by retraction of the brachialis muscle and elevation of the extensor carpi radialis muscle. Successful fracture reduction, alignment, and stabilization were achieved in all four animals.     

Large segmental radius and ulna defect treated by bone transportation with the Ilizarov technique

An 8-year-old male Boxer with a severely contaminated open fracture of the left radius and ulna fracture, produced by a helicopter propeller, was treated using bone transport by the Ilizarov method. Extensive diaphyseal bone loss and soft-tissue vascular damage were present. The radius and ulna were stabilised with an Ilizarov ring external fixator. The bone defect was partially shortened and restored by gradual transport of a bone segment created from proximal segments of the radius and ulna. The external fixator was removed 4 fi months after the beginning of the latency period, due to instability caused by osteolysis around the wires. A cast was placed for 3 weeks. Although the bone transport had resulted in formation of approximately 4 cm of bone, the antebrachium showed approximately 50% shortening when compared to the contralateral limb. The infection was eradicated, and the dog was able to bear weight on the operated limb when walking.     

The use of the walking cast to repair fractures in horses and ponies

The walking cast was used to repair 46 fractures of long bones (distal radius and tibia, metacarpus and metatarsus) and 10 fractures of first phalanx of 35 horses and 21 ponies. The walking cast proved to be highly effective. Even heavily comminuted and 'hopeless' fractures, which could not be treated with osteosynthesis, were treated successfully, because the weight of the animal, a common failure factor in large animal orthopaedics, was relieved from the injured leg. Immediate full weight bearing was possible post operatively. In five cases the walking cast was used in combination with osteosynthesis. Infection was the main complication that caused the walking cast to fail. Osteomyelitis may also be treated with a walking cast. Because of its success rate of 57 per cent, which is impressive, considering the type of fractures treated, we recommend the walking cast for international accreditation.     

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.     

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.     

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.     

External fixation repair of a displaced comminuted radial fracture in a juvenile camel

A young female camel had a complete comminuted midshaft fracture of the right radius. The fracture was repaired by external coaptation, which involved 2 full-limb fiberglass casts for 15 weeks. A Thomas splint was placed around the second cast for 12 weeks. The fracture healed in nonaligned configuration, and although lameness was substantial after the fracture had healed, the camel's breeding potential had been salvaged. This successful outcome is an indication that a high-limb fracture in a camel bone (in this case a radius) may be managed by external coaptation and repair by callus formation.     

Use of a Double Hook Plate for Treatment of a Distal Radial Fracture in a Dog

Attempted stabilization of open, distal radius and ulnar fractures in a 3-year-old German shepherd dog using intramedullary pins and a Schroeder-Thomas splint resulted in malalignment of the limb and osteomyelitis. A double hook plate was used to rigidly stabilize the distal radial fracture after anatomical realignment. An autogenous cancellous bone graft was used where a lateral architectural defect remained after reduction. Culture of the fracture site showed Staphylococcus sp., which responded to chloramphenicol therapy. Fracture union and resolution of osteomyelitis occurred by 9 weeks after surgery, and the dog had no lameness and a normal muscle mass 22 weeks after surgery. The double hook plate provided rigid internal fixation of the radial fracture, allowed a rapid return to function during osteosynthesis, and minimal interference of antebrachiocarpal joint function occurred.     

Splinting device for hindlimb fractures in horses

A Robert Jones bandage modified to include a steel walking bar frame and, in one case, side-supporting bars, was applied as a splinting device in 4 horses with hindlimb fractures (3 tarsal and 1 middle phalangeal). The modification was used as an adjunct to previous casting therapies or as a means for handling casting failures or soft tissue problems encountered during the casting period. This means of stabilization is easily adapted to replace a problematic cast in various clinical settings, is easily applied in the standing patient, is easily changed and adjusted on a regular basis, has minimal complications, is comfortable, and can be used for support for a long period.     

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.     

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)     

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.     

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.     

Repair of fracture of the proximal portion of the radius and ulna in a llama

Repair of a comminuted fracture of the proximal portion of the radius and ulna in a 4-month-old llama was achieved by use of internal fixation. An 8-hole narrow dynamic compression plate was applied to the lateral aspect of the radius and a 7-hole narrow dynamic compression plate was applied to the cranial aspect of the radius. One year after surgery, the llama had a normal gait and the cosmetic appearance of the limb was excellent.     

Tibiotarsal fracture and neurologic problems of a black-eared kite (Milvus migrans).

A wild-caught black-eared kite (Milvus migrans) was presented with a fracture of the right fibula and tibiotarsus that was repaired using combined crossed pins and a rigid cast technique. The fracture healed well; however, because the bird was not able to regain full use of its legs, radiographs were taken, which revealed a translucent structure involving the vertebral bodies of the notarium-synsacrum area. The condition of the bird deteriorated over the following days, and it was euthanized. Postmortem examination confirmed two bony intumescences involving the last vertebra of the notarium and the synsacrum. The vertebral canal, on a cut surface, was restricted, and the spinal cord was compressed.     

In vitro comparison of transfixation and standard full-limb casts for prevention of displacement of a mid-diaphyseal third metacarpal osteotomy site in horses

OBJECTIVE: To compare transfixation and standard full-limb casts for prevention of in vitro displacement of a mid-diaphyseal third metacarpal osteotomy site in horses. SAMPLE POPULATION: 6 forelimbs from 6 horses euthanatized for reasons not related to the musculoskeletal system. PROCEDURE: A 30 degrees osteotomy was performed in the mid-diaphysis of the third metacarpal bone. Two 4.5-mm cortical bone screws were placed across the osteotomy site to maintain alignment during casting. Two 6.35-mm Steinmann pins were placed from a lateral-to-medial direction in the distal aspect of the radius. A full-limb cast that incorporated the pins was applied. An extensometer was positioned in the osteotomy site through a window placed in the dorsal aspect of the cast, and after removal of the screws, displacement was recorded while the limb was axially loaded to 5,340 N (1,200 lb). Pins were removed, and the standard full-limb cast was tested in a similar fashion. RESULTS: The transfixation cast significantly reduced displacement across the osteotomy site at 445 N (100 lb), 1,112 N (250 lb), 2,224 N (500 lb), and 4,448 N (1,000 lb), compared with the standard cast. CONCLUSION AND CLINICAL RELEVANCE: A full-limb transfixation cast provides significantly greater resistance than a standard full-limb cast against axial collapse of a mid-diaphyseal third metacarpal osteotomy site when the bone is placed under axial compression. Placement of full-limb transfixation casts should be considered for the management of unstable fractures of the third metacarpal bone in horses.     

Influence of an interdental full pin on stability of an acrylic external fixator for rostral mandibular fractures in dogs

OBJECTIVE: To determine total stiffness and gap stiffness of an external fixation system in a canine mandibular fracture gap model incorporating a full interdental pin as the only point of rostral fixation in a bilateral type-I external fixator. SAMPLE POPULATION: 10 canine mandibles. PROCEDURE: Bilateral mandibular ostectomies were performed between premolars 3 and 4. A type-I external fixator incorporating a full interdental pin was placed to stabilize a 0.5-cm fracture gap. Four pin configurations (intact mandibular bodies with fixator; ostectomized mandibular bodies and complete fixator; ostectomized mandibular bodies with caudal pins of rostral fragment cut; ostectomized mandibular bodies with all pins of rostral fragment cut) were tested in dorsoventral bending 5 times on each mandible. The full interdental pin remained intact in all configurations. Total stiffness and gap stiffness were determined for each configuration on a materials testing machine. RESULTS: Total stiffness of intact mandibles was significantly greater than that of ostectomized mandibles, regardless of external fixator configuration. However, total stiffness and gap stiffness were not significantly different among different external fixator configurations applied to ostectomized mandibles. CONCLUSION AND CLINICAL RELEVANCE: External fixator configurations with only the full interdental pin engaging the rostral fragment were as stiff as configurations that had 2 or 4 additional pins in the rostral fragment for the applied loads. External fixators for rostral mandibular fractures may be rigidly secured with rostral fragment implants applied extracortically, avoiding iatrogenic trauma to teeth and tooth roots.     

Locking Compression Plates for Pancarpal Arthrodesis in a Thoroughbred Filly

Objective— To report treatment of a comminuted ulnar carpal (UC) bone fracture associated with carpal instability by pancarpal arthrodesis using 2 locking compression plates (LCP).
Study Design— Case report.
Animals— A 2-year-old Thoroughbred filly.
Methods— An UC fracture and luxation of the proximal row of carpal bones was diagnosed radiographically. Pancarpal arthrodesis was performed with 2 LCP positioned dorsolaterally and dorsomedially and centered over the carpus through a single skin incision. The filly was maintained in a full limb cast for 15 days, followed by a tube cast for 14 days, and subsequently a full limb bandage with caudal splint for 21 days.
Results— Two LCP provided appropriate carpal stability resulting in a pasture sound horse 6 months after surgery. The filly was discharged from the hospital 63 days after surgery, walking well with only a slight mechanical lameness.
Conclusion— Use of 2 LCP applied on the dorsomedial and dorsolateral aspect of the carpus can provide carpal stability for pancarpal arthrodesis.
Clinical Relevance— Excellent stability of the carpal joints can be achieved with 2 LCP.