Fracture fixation: casts in Dogs (Canis) | Vetlexicon
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Fracture fixation: casts

ISSN 2398-2942

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Synonym(s): Cast, Splint, External fixation

Introduction

  • To stabilize a fracture using a rigid cast until healing is complete.

Uses

  • Simple, transverse fractures of the bone(s) of an extremity (especially in young animals), with little distraction, which are easy to reduce, are relatively stable on reduction and where the joints both proximal and distal to the fracture can be immobilized in the cast Fracture: overview.
  • Greenstick fractures.
  • Open fractures where access to skin wounds is necessary ('Half' casts, acrylic cast).
  • Highly comminuted, minimally displaced fractures in pets belonging to owners who decline operative treatment.

Advantages

  • Relatively cheap.
  • Maintains 'closed' nature of injury.
  • Relatively short general anesthesia.
  • Acrylic casts are lightweight but strong.
  • 'Half' casts allow for wound treatment.

Disadvantages

  • Casts prevent normal limb movement.
  • Plaster casts are heavy and restrict general activity.
  • Plaster casts are not water proof.
  • Casts do not allow for compression of fracture site - healing may be slow with large callus formation.
  • Management can be difficult.
  • There is a fine balance between maintaining rigid stability, a close fit and avoiding pressure sores/abrasions from too tight a fit.
  • Only suitable for extremities where the joints both distal and proximal to the fracture can be immobilized by the cast - ie distal to elbow and stifle.

Technical problems

  • Insufficient padding between the cast and the limb will result in pressure sores/abrasions.
  • Too tight a fit can impinge on circulation.
  • Too loose a fit will result in insufficient stability and complications, eg non-union Fracture: healing.
  • Failure to stabilize joints proximal and distal to fracture will lead to complications of healing, eg non-union Fracture: healing.

Alternative techniques

  • External skeletal fixator Fracture fixation: external skeletal fixator - fractures where there is extensive tissue damage requiring continuing treatment, eg shearing injuries Carpus: shearing Injury , mandibular fractures, epiphyseal fractures causing limb deformity (distraction techniques) - ESF can also be used on simple closed fractures.
  • Internal fixation Fracture: internal fixation - closed fractures, complicated fractures, fractures where return to early function is imperative, fractures where immobilizing the joints on either side of the fracture is not possible.

Time required

Preparation

  • 20 min.

Procedure

  • 30 min.

Decision taking

Criteria for choosing test

  • Position of fracture must be such that the joints proximal and distal can be immobilized within the cast.
  • Radiographical evidence of type, nature and position of fracture isessential.
  • Extent of skin wounds must be assessed and accessibility for treatment - removable 'half' casts may be preferable to whole cast.
  • Size of cast needed relative to patient should determine choice of casting material - acrylic casts are lighter than plaster.
  • Assessment of subsequent exposure to moisture will determine whether a 'waterproof' acrylic cast is necessary, eg hindlimb cast may be exposed to urine soiling.
  • Better in younger patient where fracture healing is quicker.
  • Age and nature of animal (if unlikely to tolerate the device internal fixation may be a better option).
  • Ability of the owner to confine and care for.

Risk assessment

  • General anesthesia is essential for both radiography and subsequent reduction of fracture and casting - patient should be stabilized and other injuries assessed/treated prior to treating fractures.

Requirements

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Preparation

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Technique

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Sequin B & Harari J (1995) External coaptation devices for small animal surgical patients. Vet Tech 16, 107-119.
  • Wilson D G & Vanderby R (1995) An evaluation of six synthetic casting materials: strength of cylinders in bending. Vet Surg 24 (1), 55-59 PubMed.