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Limb fracture repair: external coaptation

ISSN 2398-2985


Introduction

  • Immobilization of the limb can be used to repair simple fractures with minimal displacement.
  • Allows for stabilization of fractures before and after surgical repair.
  • Can also be used to treat luxation and subluxation.

Uses

  • Simple limb fractures.
  • Where the fracture has minimal fragment displacement and there is >50% cortical contact after reduction.
  • Luxation of the distal limb.
  • Surgery is of a high risk to the patient.
  • Surgical repair is cost prohibited.
  • Size of the patient and bone thickness prohibits surgical fixation.
  • Underlying pathology is present making the animal a poor candidate, eg metabolic bone disease.
  • External coaptation may also be possible in fractures and trauma of some of the long bones.
    • Radius or ulna:
      • Ideally only one of the bones would be fractured.
    • Distal femoral fractures.
    • Carpal and metatarsal injuries:
      • These are rarely reported in ferrets.
      • Ligament trauma is a concern in these injuries as it may lead to medial and lateral instability of the joint.
    • Elbow luxation:
      • This is a common injury in ferrets.
      • Open reduction and internal stabilization are often needed.

Advantages

  • Inexpensive.
  • Quick procedure.
  • Easy to perform in most cases.
  • Little materials needed; basic bandages will be suitable for most cases.
  • Can sometimes be performed anesthesia free: analgesia should always be provided.

Disadvantages

  • Bandages and splints can be difficult to apply on small patients:
    • Slip easily.
    • Can be traumatized by the animal.
    • Can become easily contaminated.
    • Frequent changes may be needed.
    • If applied incorrectly ischemic necrosis may occur.
  • Limb may not regain full function.
  • The affected leg may require further treatment or amputation if the fracture does not heal.
  • Immobilization of limbs in skeletally immature animals can lead to joint deformities.

Technical problems

  • Full limb immobilization may be difficult to achieve.
  • Dressings and splints may need frequent changing.
  • Due to short limb length, splints and bandages are difficult to apply and slip off easily.

Alternative techniques

  • Rest and analgesia with anti-inflammatory treatment for distal limb fractures, eg carpal or digit.
  • Husbandry adjustment:
    • Avoidance of climbing and jumping
    • Change of substrate to non-slippery to prevent further trauma
  • Internal fixation.
  • External fixation.
  • Digit/limb amputation.

Time required

Preparation

  • Minimal.
  • Fur does not need to be clipped.
  • Any visible contamination needs to be thoroughly cleaned.
  • In fractious animals consider the use of sedation; perform a full clinical exam before induction of anesthesia.
  • 10-20 min.

Procedure

  • 5-20 min.
  • Diagnostic imaging should always be undertaken before limb immobilization is performed.
  • A minimum of two radiographic views should be obtained for full fracture assessment.
Obtaining radiographs of the opposite limb can help to determine normal versus abnormal anatomy. 

Decision taking

Criteria for choosing test

  • Budgetary concerns for the owner.
  • Animals with uncomplicated, simple fractures with no underlying conditions are best candidates.

Risk assessment

  • If underlying conditions such as metabolic bone disease are present, risk assessment and prognosis need to be fully discussed with the owner as further costs will be involved in husbandry correction.

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.
  • Ritzman T K (2002) Ferret orthopedics. Vet Clin North Am Exot Anim Pract 5 (1), 129-155 PubMed.  
  • Dunning D (2002) Basic mammalian bone anatomy and healing. Vet Clin North Am Exot Anim Pract 5 (1), 15-128 PubMed.
  • Helmer P J & Lightfoot T L (2002) Small exotic mammal orthopedics. Veterinary Clinics of North America: Exotic Animal Practice. 5 (1), 169-182 PubMed.
  • Pollock C (2002) Postoperative management of the exotic animal patient. Vet Clin North Am Exot Anim Pract 5 (1), 183-212 PubMed.
  • Williams M S (2002) Orthopedic radiography in exotic animal practice. Vet Clin North Am Exot Anim Pract 5 (1), 1-22 PubMed.

Other sources of information

  • Zehnder A & Kapatkin A S (2012) Orthopedics in Small Mammals. In: Ferrets, Rabbits and Rodents. 3rd edn. Quesenberry K & Carpenter J. Saunders, USA. pp 473-474.