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

ISSN 2398-2942


Synonym(s): Wire, Pin, Plate, Lagscrew

Introduction

  • The aim of fracture management is early return to function and the provision of an optimal environment for fracture healing. This can be achieved through the basic AO principles of fracture management, ie:
    • Fracture reduction and fixation to restore anatomical relationships.
    • Stability by fixation or splintage, as the nature of the fracture and injury require.
    • Preservation of blood supply to soft tissues and bone by careful handling and gentle reduction techniques.
    • Early and safe mobilization of the affected part of the patient.
  • Internal fixation can be performed with open, closed or minimally invasive techinques depending on the location and type of fracture.
  • Types of implants used include:
  • Implants chosen should adequately resist the disruptive forces at the fracture site, ie axial compression, bending, rotation, shear and distraction/tension. Implant constructs can function in:
    • Load sharing:
      • Anatomic reduction of fracture.
      • Fractures are more likely to heal by direct healing.
    • Buttress:
      • Implants span fracture gap with no load sharing with bone.
      • Fracture heals though callus formation.

Uses

  • Diaphyseal fractures:
    • Comminuted fractures that cannot be anatomically reduced appropriately are managed using implants in buttress.
    • Simple fractures that can be appropriately anatomically reduced are managed using load sharing constructs.
  • Metaphyseal fractures.
  • Joint fractures require anatomic reduction and rigid fixation.
  • Vertebral and pelvic fractures.
  • Certain open fractures:
    • Fractures can heal in the presence of infection if rigidly stabilized.

Advantages

  • Early return to function.
  • Good reduction and limb alignment possible.
  • Implants can remain in place provided no complications.

Disadvantages

  • Can be technically challenging.
  • Complications can occur which require additional medical or surgical treatment.
  • Equipment can be expensive.

Alternative techniques

  • External skeletal fixator Fracture fixation: external skeletal fixator - for fractures where there is extensive tissue damage requiring continuing treatment, eg shearing injuries Carpus: shearing Injury , mandibular fractures, correction of angular limb deformity (requiring distraction techniques).
  • External coaptation Fracture fixation: casts - only for fractures below the stifle or elbow - simple transverse fractures, greenstick fractures, fractures with little displacement or instability.

Decision taking

Criteria for choosing test

 

 

Risk assessment

  • Patient should be stabilized and other injuries assessed/treated prior to treating fractures.

Assessment of the traumatized patient

  • ABCD principle, ie:
    • Airway, Breathing, Circulation, Disability.
  • Full history and physical examination.
  • In trauma cases assessment for common concurrent injuries Trauma: overview :

Assessment of the injury

  • Neurological examination Neurological examination :
    • Assessment of sensory fields and segmental spinal reflexes.
  • Concurrent soft tissue trauma:
    • Exposure of fracture, ie open fractures.
    • Vascular competence - nail bed bleeding, palpation of or Doppler probe of pulse.
  • Preoperative imaging (radiography or CT) is essential to understand the fracture and plan its treatment:
    • When using radiographs orthogonal images focused on the area of interest should be taken.
    • Images of the contralateral (non-fractured) bone can be useful for templating of implants.
    • Heavy sedation or general anesthesia is often required to obtain satisfactory images.

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 .
  • Guiot L P, Déjardin L M (2011) Prospective evaluation of minimally invasive plate osteosynthesis in 36 nonarticular tibial fractures in dogs and cats. Vet Surg 40 (2), 171-182 PubMed.
  • Perren S M (2002) Evolution of the internal fixation of long bone fractures. The scientific basis if biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg (Br) 84 (8), 1093-1110 PubMed.
  • Johnson A L, Smith C W & Schaeffer D J (1998) Fragment reconstruction and bone plate fixation versus bridging plate fixation for treating highly comminuted femoral fractures in dogs: 35 cases (1987-1997). JAVMA 213 (8), 1157-1161 PubMed.
  • Avon D N, Johnson A L & Palmer R H (1995) Biologic strategies and a balanced concept for repair of highly comminuted long bone fractures. Comp Contin Educ Pract Vet 17 (1), 35-49 VetMedResource.
  • Hulse D A & Avon D N (1994) Advances in small animal orthopedics. Comp Contin Educ Pract Vet 16 (7), 831-832 VetMedResource.
  • Braden T D & Brinker W O (1973) Effect of certain internal fixation devices on functional limb usage in dogs. J Am Vet Med 162 (8), 642-646 PubMed.

Other sources of information

  • Piermattei D L, Flo G L, DeCamp C E (2006)Handbook of Small Animal Orthopaedics and Fracture Repair.4th edn. Saunders Elsevier, Missouri.
  • Johnson A L, Houlton J E F, Vannini R (2005)AO Principles of Fracture Management in the Dog and Cat.AO Publishing.