Repair of femoral capital physeal fractures with 7.0 mm cannulated screws in cattle: 20 cases (1988-2002)

OBJECTIVE: To evaluate long-term outcome of repair of femoral capital physeal fractures with 70 mm cannulated screws in juvenile bulls that weighed >350 kg (770 lb). DESIGN: Retrospective study. ANIMALS: 20 bulls. PROCEDURE: Medical records of affected cattle were identified and reviewed. Follow-up information was obtained by means of a written questionnaire, 1 to 15 years after discharge, from the veterinarians who supervised the postoperative care at bull stud facilities. RESULTS: Mean age and body weight at time of repair were 19 months (range, 11 to 27 months) and 513 kg (1128.6 lb; range, 364 to 720 kg [800.8 to 1584 lb]), respectively. Surgical repair was performed with 70 mm cannulated screws. A second surgery to replace malpositioned implants was required in 1 bull. Fourteen of the 20 bulls were considered serviceable for semen collection after surgical repair, and persistent lameness was evident in 11 of the 14. Mean duration for bulls to become serviceable was 5.5 months (range, 2 to 11 months). Age, weight, duration of injury at the time of repair, and degree of reduction did not have a significant effect on whether surgical repair was successful. Six bulls remained severely lame and were euthanatized. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that surgical repair of femoral capital physeal fractures in adolescent bulls with 70 mm cannulated screws placed in lag fashion has a good prognosis for long-term function in a semen collection facility.     

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.     

Humerus fractures in llamas and alpacas: seven cases (1998-2004)

OBJECTIVE: To describe treatment and outcome of humerus fractures in llamas and alpacas. STUDY DESIGN: Retrospective study. ANIMALS: Llamas (n=4) and alpacas (3) with humerus fracture. METHODS: Medical records (January 1, 1998-August 1, 2004) were reviewed for small camelids with a humeral fracture. Retrieved data were signalment, history, physical examination and radiographic findings, surgical and medical treatment, and outcome. RESULTS: Humeral fracture occurred in 7 of 38 (18%) camelids admitted with fractures. Affected animals were aged from 1 month to 3 years old. Fracture configuration included long-oblique (n=4), short-oblique (2), and Salter-Harris Type II fracture of the proximal physis (1). One adult llama was managed by stall confinement and surgical repair was attempted in the other camelids: fixation by screws inserted in lag fashion (n=3), intramedullary pinning and fixation by screws inserted in lag fashion (1), rush pinning (1), and bone plating (1). A Velpeau sling was used for additional support in 3 animals. All fractures healed but temporary radial nerve paresis occurred in 3 animals. Limb shortening and permanent lameness occurred in the llama managed conservatively. CONCLUSIONS: Humerus fractures in small camelids are amenable to surgical repair which may offer better long-term outcome than medical treatment alone. CLINICAL RELEVANCE: Surgical treatment of humerus fractures should have a good prognosis in llamas and alpacas. In select cases, minimally invasive techniques, such as rush pinning or fixation by screws inserted in lag fashion are sufficient for fracture healing.     

Treatment of slipped capital femoral epiphysis in cattle: 11 cases (1974-1988)

A mixed population of 11 cattle (7 dairy, 4 beef; 9 male, 2 female) were examined because of acute onset of non-weightbearing hind limb lameness. Radiography revealed slipped capital femoral epiphyseal fracture in all cattle, with the exception of one large bull. Ten of the 11 cattle were treated with open reduction and internal fixation, using intramedullary pins. Cattle affected with slipped capital femoral epiphyseal fracture in previous reports typically have been calves that required forced extraction during dystocia. Cattle in this report were in the following 2 age groups in which trauma was the likely cause: 3 to 5 months and 1.5 to 2.3 years. Follow-up information was provided for 7 of the 10 cattle. Four of the 7 were functional and had no clinical signs of arthritis, abnormal gait, atrophy, scarring, contralateral compensation, breakdown, or other difficulty 6 months after surgical correction. If early diagnosis is achieved, it appears that reduction with intramedullary pinning can provide a good long-term prognosis in cattle when function as breeding animals is important to their future value.     

Femoral capital physeal fractures in dogs: 34 cases (1979-1989)

Complications associated with femoral capital physeal (CP) fractures in 34 dogs were evaluated. Fractures were surgically repaired, using divergent K-wires or lag screws; radiographic follow-up was available for 21 CP fractures. In all cases, radiographic abnormalities such as degenerative joint disease and resorption of the femoral neck and/or head were seen. Changes were more severe when fracture occurred at an early age. For 4 of 21 dogs (20%), femoral head and neck excision was performed because of complications associated with CP fracture repair. Prognosis for femoral CP fractures is guarded, although affected dogs should be able to function as pets.     

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.     

Internal fixation of femoral capital physeal injuries in dogs: 40 cases (1979-1987)

Fractures of the femoral capital physis were stabilized with small pins or a lag screw in 36 dogs (4 bilateral injuries). Radiography was used to monitor the development of osteoarthritis in affected joints and narrowing of the femoral neck. More radiographic signs of arthritis (P less than 0.05) developed in the coxofemoral joints of dogs that were less than or equal to 4 months old when injured, compared with those in dogs greater than 4 months old. Of 40 capital physeal injuries, 35% had concurrent ipsilateral coxofemoral joint injuries and developed more radiographic signs of arthritis (P less than 0.05) than did those that had no other coxofemoral injury. Narrowing of the femoral neck developed in 70% of the healing capital physeal repairs, but in most dogs, narrowing was not associated with segmental collapse of the femoral neck. Neither time interval from injury to surgical fixation nor surgical approach used had an effect (P greater than 0.05) on the development of narrowing of the femoral neck.     

Fixation of Femoral Capital Physeal Fractures with 7.0 mm Cannulated Screws in Five Bulls

Salter-Harris type I fractures of the femoral capital physis were repaired in five Holstein bulls with three 7.0 mm cannulated screws placed in lag fashion. Radiographically at months 7 to 10, the fractures were healed and there was periarticular bone production on the femoral necks and the dorsal acetabular rims. Four bulls had normal gaits, and one bull had muscle atrophy and barely detectable lameness.     

Spontaneous femoral capital physeal fractures in adult cats: 26 cases (1996-2001)

OBJECTIVE: To determine clinical, radiographic, and histologic abnormalities in adult cats > 1 year old with spontaneous (ie, nontraumatic) femoral capital physeal fractures. DESIGN: Retrospective study. ANIMALS: 26 cats. PROCEDURE: Medical records of cats > 1 year old with femoral capital physeal fractures and no history of trauma were examined. RESULTS: Mean +/- SD age of the cats was 22.5 +/- 6.5 months. Twenty-five cats were neutered males. Mean weight of the cats was significantly greater than mean weight of a group of age- and sex-matched control cats. Of 16 cats for which age at the time of neutering was known, 14 had been neutered before 6 months of age. Nine cats had bilateral fractures. Severity of femoral neck osteolysis and sclerosis increased with increased duration of clinical signs. The contralateral femoral capital physis, distal femoral physes, and proximal tibial physes were radiographically open in 13 of 18,19 of 24, and 24 of 24 cats, respectively. Histologically, the epiphysis contained normal articular cartilage and bone, but attached growth plate cartilage lacked the normal columnar arrangement of chondrocytes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that adult cats with spontaneous femoral capital physeal fractures were most likely to be heavier, neutered males with delayed physeal closure.     

Femoral Head Osteotomy in Horses and Cattle

Femoral head ostectomy was performed in six horses, three ponies, and four cattle for treatment of fractures of the femoral capital physis, coxofemoral luxation, fractured acetabulum, or severe degenerative joint disease. The procedures were performed via a cranial approach that did not involve osteotomy of the greater trochanter. A dorsal approach for femoral head ostectomy via osteotomy of the greater trochanter was evaluated in three healthy adult ponies. Three animals (2 ponies, 1 calf) were euthanatized within a month and one horse was euthanatized at year 2 due to postoperative complications. Nine animals were discharged to owners and six of them fulfilled their intended functions of breeding, milking, and being kept as companions. One horse was lost to follow-up and two horses died of causes unrelated to the surgery. All surviving animals had a residual lameness that was described by owners as mild to moderate. None of the horses were used as riding animals. The mean age and weight of 10 animals that regained weight-bearing locomotion was 3.1 months and 84 kg; for three unsuccessful cases it was 34 months and 174 kg. We concluded that femoral head ostectomy was a viable salvage procedure for large animals with capital femoral physeal fracture, chronic coxofemoral luxation, or acetabular fracture. Surgical prognosis appeared to be favorable in young cattle and fair in young horses or ponies weighing less than 100 kg. Osteotomy of the greater trochanter resulted in superior exposure of the intact coxofemoral joint and allowed easier, less traumatic surgical luxation of the joint to facilitate femoral head ostectomy.     

Femoral diaphysis fractures in cattle: 26 cases (1994–2005)

Objective   This retrospective study was conducted to evaluate the outcome for cattle with diaphyseal fractures of the femur, but not including capital physeal injuries.
Methods   Sources of information were medical records of cattle having a definitive diagnosis of diaphyseal femoral fractures and telephone survey of owners.
Results   Medical records for 26 cattle with femoral fracture were found; of the 20 aged less than 2 months, 15 were treated surgically, 4 conservatively (stall rest) and 1 was euthanased without treatment. The surgical treatment varied according to the configuration of the fracture and the surgeon's experience. Surgery for mid-diaphyseal fractures had a significantly better surgical outcome then distal diaphyseal fractures (P < 0.05), as there were significantly fewer postoperative complications. Of the 15 calves treated surgically, 10 were discharged from hospital and 5 were retained in the herd without noticeable lameness. Of the 4 calves treated conservatively, 3 were alive at follow-up, but 2 were still lame. Of the 6 older cattle, 3 were euthanased without treatment and 3 were treated conservatively, 2 of which were alive at follow-up but 1 was still lame.
Conclusion   Conservative treatment of femur fracture in cattle is possible but associated with complications during the convalescence. Continued research is needed to optimise distal diaphyseal fracture stabilisation in young cattle.     

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.     

Surgical reduction and stabilization for repair of femoral capital physeal fractures in cats: 13 cases (1998-2002)

OBJECTIVE: To evaluate anatomic reduction and surgical stabilization of femoral capital physeal fractures in cats. DESIGN: Retrospective study. ANIMALS: 13 cats. PROCEDURE: Medical records of cats with unilateral or bilateral femoral capital physeal fractures evaluated from 1998 to 2002 were reviewed. Age and weight of cats at the time of surgery; breed; sex; concurrent injuries; severity of lameness before and 1, 2, 4, 6, and 8 weeks after surgery; the amount of fracture reduction achieved and number of Kirschner wires (K-wires) used; degree of degenerative joint disease of the hip joint and lysis of the femoral neck and head observed after surgery; whether K-wires were removed after surgery; and complications after surgery were evaluated. RESULTS: Thirteen cats with 16 capital physeal fractures were identified. There was significant improvement in the severity of clinical lameness in all cats from weeks 1 through 4 after surgery. There was no correlation between the scores of the individuals who evaluated radiographs for fracture reduction and placement of K-wires. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that surgical stabilization and repair of femoral capital physeal fractures facilitate a short recovery period and a good prognosis for return to normal function in cats.     

Retrospective study of 38 cases of femur fractures in horses less than one year of age.

Medical records of 38 horses less than 1 year of age and diagnosed as having a fracture of the femoral diaphysis, metaphysis or distal physis were evaluated. Twenty-six foals had fractures of the femoral diaphysis or metaphysis with the most common fracture configuration being comminuted. Twelve foals had distal physeal fractures with the most common fracture configuration being a Salter-Harris type II. Twenty-one foals with fractures of the capital femoral physis, neck or greater trochanter during the same time period were excluded from this study. Surgical repair was attempted in 16 diaphyseal and 2 distal physeal fractures. Most of the diaphyseal fractures were repaired by placing plates on the lateral and cranial surfaces of the bone. Dynamic condylar screw plates or angle blade plates were used for increased bone purchase in 4 foals with short distal fragments. Five foals with distal physeal fractures were treated; 2 were surgically treated by placing an angle blade plate on the lateral cortex, and 3 foals with minimally displaced distal physeal fractures were managed with stall confinement. Eight of the 16 surgically repaired diaphyseal fractures healed. Fracture location and configuration was not a determinant of outcome, but the mean age of foals with successfully repaired diaphyseal fractures was 2 months compared with 4 months for the unsuccessful cases, indicating that the age and size of the foal was important. Long-term follow up revealed that 6 of the 8 successfully repaired diaphyseal fractures had no residual effects of the fracture observed during performance of the horse for its intended use. Only 1 of the 2 surgically repaired distal physeal fractures healed, but this horse was eventually killed because of unthriftiness related to a malabsorption syndrome. Some form of complication developed in 13 of the 18 surgically repaired fractures. Infection was the primary cause of failure. The greatest determinant associated with infection was the inability to control post-surgical seroma formation.     

Incomplete Oblique Sagittal Fractures of the Dorsal Cortex of the Third Metacarpal Bone in Six Horses

Objective —To describe incomplete oblique sagittal dorsal cortical fractures of the equine third metacarpal bone, their surgical repair, and subsequent performance of the horses.
Study Design —Retrospective examination of medical records and racing performance.
Animal Population —Six Thoroughbred race horses, 2 to 4 years of age.
Methods —Radiographic confirmation of all fractures preceded general anesthesia and surgical correction. Three fractures were treated by intracortical compression using screws placed in lag fashion, and five fractures were treated by osteostixis. Race records were reviewed for each horse to determine performance after surgery.
Results —Fractures were best observed on palmarodorsal radiographic projections. Three horses treated by intracortical compression returned to racing, but fracture recurred in one horse and was treated by osteostixis. This horse and the other three horses treated by osteostixis raced after surgery.
Conclusions —Horses with incomplete oblique sagittal fractures of the dorsal cortex of the third metacarpal bone can race after surgical management of the fracture by screws placed in lag fashion or osteostixis. The authors' preferred surgical procedure for managing this fracture is osteostixis.
Clinical Relevance —Palmarodorsal radiographic projections of the third metacarpal bone are recommended in young Thoroughbred race horses suspected of having dorsal metacarpal stress fractures.     

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.     

Rotational strength of double-pinning techniques in repair of transverse fractures in femurs of dogs

Transverse midshaft fractures of femurs from freshly euthanatized dogs were stabilized by means of 6 methods: (1) 3.5-mm bone plate and screws, (2) single intramedullary pin, (3) double intramedullary pins retrograded proximally and driven distally to the level of the femoral trochlea, (4) double intramedullary pins retrograded distally and driven proximally into the trochanteric region, (5) double intramedullary pinning in Rush pin fashion, and (6) multiple intramedullary pinning that filled the medullary cavity at the fracture site. All bones were subjected to torsional stress. The measured strain was converted to forces of torque and correlated with bone diameter to normalize the data. The forces of torque from each fixation technique were compared with each other and with the mean torque force necessary to fracture intact femurs. Torsional shear applied to plated femurs resulted in failure at a mean level of 33.8% of the calculated theoretic moment. Torsional forces were concentrated at one end of the plate and catastrophically failed at that point, whereas the fracture site remained rigidly fixed. There was no significant difference in the initial moment of torsional failure between the single intramedullary pin technique (0.05 Nm) and the double-pinning techniques (0.03 to 0.04 Nm). The multiple-pinning technique was 1.8 to 3 times as effective in resisting rotational forces, compared with the other pinning techniques, but not significantly so.     

Determination of Safe Depth of Pin Penetration for Repair of Distal Femoral Physeal Fractures in Immature Dogs: A Comparison of Normograde and Retrograde Pin Placement

Objective —The purpose of this study was to determine the depth that implants may be safely placed into the distal femoral epiphysis (DFE) for the repair of distal femoral physeal fractures.
Study Design —The depth of the DFE was related to the radiographic thickness of the patella in this experimental study.
Animals or Sample Population —Twenty immature canine cadavers.
Methods —Patella thicknesses were measured from lateral radiographs. Actual DFE depths were determined for pins driven in normograde fashion and for pins driven retrograde from the central depression between the metaphyseal pegs and from the cranial pegs. The association of DFE depth and patella thickness was evaluated using linear regression analysis. Using 95% confidence intervals, rules for estimating the safe depth of implant placement into the DFE were determined.
Results —DFE depth had significant correlation with patella thickness for pins placed in retrograde fashion from the central depression between the metaphyseal pegs (r²= .83) and from the cranial pegs (r²= .82) and for pins placed in normograde fashion (r²= .65).
Conclusions —Based on 95% confidence intervals, pins placed in retrograde fashion from the central depression between the metaphyseal pegs may be safely driven into the DFE a distance equal to 140% of patella thickness. Pins placed from the cranial metaphyseal pegs may be driven to a depth equal to 80% of patella thickness, and pins placed in normograde fashion may be driven to a depth equal to 30% of patella thickness.
Clinical Relevance —Measurement of patella thickness assists the surgeon in determining the approximate depth that pins may be driven into the DFE without penetrating the articular surface of the stifle joint.     

Complete biceps brachii tenotomy to facilitate internal fixation of supraglenoid tubercle fractures in three horses

OBJECTIVE: To describe a method for internal fixation of supraglenoid tubercle fractures in conjunction with complete tenotomy of the biceps brachii tendon. ANIMALS: Three horses, ranging in age from 8 months to 2 years and weighing from 300 to 400 kg. METHODS: Fractures were repaired by open reduction-internal fixation using bone screws placed in lag fashion and complete tenotomy of the biceps brachii tendon. OUTCOME: All three horses were sound for their intended use with a good cosmetic result 6 months after surgery. CONCLUSIONS: Complete transection of the biceps brachii tendon facilitates supraglenoid tubercle fracture repair by reducing tensile forces exerted on the supraglenoid tubercle. Complete tenotomy does not appear to preclude return to a successful athletic career.     

A technique for repair of femoral capital epiphyseal fractures in the dog

A new method for repair of femoral capital epiphyseal fractures in the immature dog is described. The technique employs two small AO/ASIF cortical screws inserted in lag fashion from the articular surface into the femoral neck. The screw heads are countersunk, so as not to project from the articular cartilage of the femoral epiphyseal fragment, While this is an early report it is hoped that it will prompt the use of the technique by others so that its long term assessment may be more rapidly determined than by one clinic working alone.