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Fracture fixation: distal radius and ulna

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Synonym(s): Distal radial fractures are often referred to in human medicine as Colles fractures


Introduction

  • Fractures of the distal radius and ulna are not common in the cat.
  • The distal radius in the cat is relatively wide which may make it less likely to break.
  • When injuries occur they result from falls and road accidents.
  • Fracture nonunion at this level is not common.
  • Fracture complications are reduced if both the radius and ulna are stabilized in cats. The ulna is a relatively large bone particularly at the proximal aspect where it is larger than the radius.
  • Clinical signs:
    • Pain.
    • Acute onset forelimb lameness   Lameness: overview  .
    • Distal antebrachial pain and swelling.
  • Diagnostic investigation:
    • Radiography: 2 views should always be taken - craniocaudal and mediolateral Antebrachium: fracture 01 - radiograph lateral  Antebrachium: fracture 02 - radiograph CrCd .
    • Distal radial and ulna fracture - may be simple or comminuted.
  • Treatment:
    • No surgical treatment:
      • Stable fractures (transverse, dentate patterns) in young, medium sized cats that can be reduced in closed fashion are amenable to casting. The cast must extend from the toes to above the elbow to adequately control rotational forces and prevent distal limb swelling and edema.
      • External splint for 6 weeks.
    • Surgical treatment:
      • If closed reduction is not possible or cannot be maintained.
      • Internal fixation: cranial approach to the distal antebrachium
      • Ulna: intramedullary pin in the ulna using a 1.2 or 1.4 mm K wire placed in a retrograde fashion from the fracture site.
      • If the ulna fracture is very distal the fracture is known as a styloid fracture. These have significant distraction forces acting on them and can be repaired with parallel K-wires combined with wire tension bands to convert the distractive forces into compressive forces.
      • Radius: distal radial fracture stabilized with plate and screw fixation. A 1.5/2.0 mm veterinary cuttable place, 1.5/2.0 mm dynamic compression plate or a mini AO 1.5/2.0 mm T plate are implants that can be considered.
      • Crossed pins can also be employed for distal radial fractures but provide a less secure form of fixation and are not generally the first choice for fracture fixation, especially in comminuted or ortherwise unstable fracture configurations
    • All fractures repaired by open reduction should be considered for bone grafting Bone grafting. Either with autogenous cancellous bone graft obtained from the iliac crest or ipsilateral humeral head or allograft cancellous bone or demineralized bone powder obtained from a commercial source.
    • External skeletal fixation Fracture fixation: external skeletal fixator.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Generally excellent for closed fractures that are adequately stabilized.
  • The prognosis for open fractures depends on the extent of infection, soft tissue and vascular insult, and adequacy of the stabilization technique.
  • If a distal radial and ulna fracture occurs in a young cat then there is a possibility of premature growth plate closure.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Wallace A M, De La Puerta B, Trayhorn D et al (2009) Feline combined disphyseal radial and ulnar fractures - A retrospective study of 28 cases. Vet Comp Ortho Traumatol 22 (1), 38-46 PubMed.
  • Larsen L J, Roush J K & McLaughlin R M (1999) Bone plate fixation of distal radius and ulna fractures in small- and miniature-breed dogs. J Am Anim Hosp Assoc 35 (3), 243-250 PubMed.
  • Sardinas J C & Montavon P M (1997) Use of a medial bone plate for repair of radius and ulna fractures in dogs and cats: a report of 22 cases. Vet Surg 26 (2), 108-113 PubMed.

Other sources of information

  • Voss K, Langley-Hobbs S J, Montavon P M (2009) Radius and Ulna Fractures. In: Feline Orthopaedic Surgery and Musculoskeletal Disease. Montavon P M , Voss K (eds), Elsevier.
  • Johnson A L & Hulse D A (2002) Radial and ulnar fracturesSmall Animal Surgery 2nd ed., In, Fossum TW, ed. Mosby St. Louis Missouri, 938-962.
  • Piermattei D L & Flo G L (1997) Handbook of Small Animal Orthopedics and Fracture Repair. 3rd ed. WB Saunders, Philadelphia, 321-343.
  • Boudrieau R J (2003) Fractures of the radius and ulna. In: Slatter D ed.Textbook of Small Animal Surgery. 3rd ed., WB Saunders, Philadelphia, 1953-1973.

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