Fractures
Fracture Repair
The aim of a fracture repair is to provide rigid stability for the bone and allow the bone union to occur. This stability can be achieved with internal or external fixation implants.
Internal fixation is when a metallic implant is placed underneath the skin. Most commonly, these are pins, plates and screws. However, a huge variety of implants are available in the market and the choice of the implant is based on surgeon preference and the type of fracture.
External fixation is achieved with a device penetrating the skin and firmly holding the bone. These are most likely to be pins connected to an external metallic bar or circular implants.
Fracture healing can be obtained with external bandages and splints as well. However, this may require frequent bandage changes and may lead to a delay union or a non-union of the bone due to poor limb immobilization. Moreover, sedation may be required each time a bandage is changed.
Fracture Planning and Owner Compliance
Once the patient is stabilised, preoperative data must be analysed. These are summarised in fracture assessment score: mechanical, biological and clinical factors (Fossum, 2013).
Mechanical factors indicate how strong must be the implant according to the type of fracture. Biological factors indicate the rate of bone healing according to the age and clinical condition of a patient. Clinical factors include the owner and patient compliance.
A low fracture assessment score affects bone healing and may lead to a non-union fracture, which is a failure of the repair. To reduce the risk of failing, we require full blood tests prior to the surgery, selection of the correct implant according to the type of fracture, and strong client compliance in the post-operative care at home. Leaflets with detailed instructions will be dispensed at discharge.
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Type of implant
Most of the time, internal implants stay inside and do not require another surgery to be removed; however, in rare cases, these can cause skin irritation. In this case, quick surgery is required to remove the implant.
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The intraarticular fracture involved the trochlear notch of the ulna. Moreover, a transverse fracture is detected a few centimetres distally the intraarticular fracture.
The two fractures were fixed with VCP pate and 4 lag screws.
External implants are removed after bone healing (between 4-8 weeks). Extra care and attention should be taken with these implants.
Craniocaudal view of humeral fracture 4 weeks after the repair; the external implant was removed.
Mediolateral view of humeral fracture 4 weeks after the repair; the external implant was removed.
Early implant removal may be required in very young animals as their bones heal faster than adult patients.
In general, the rate of complication is low. The main complication is infections, which is treated with antibiotics. However, sometimes implant removal after bone healing may be required.
Another complication can be a rupture of the internal implant, especially in comminuted fractures. A sudden jump, a sprint or a fast movement may lead in the bending or rupture of the implant. In this case, a review surgery may be necessary. Based on this data, we always strongly recommend strict rest until the bone is completely healed.
Reference
Fossum.T (2013) Small Animal Surgery, Elsevier Mosby: ST Luis, MO
Case studies
Excellent range of motion was detected 6 weeks after the surgery.
Fracture
Patient: Dog, (Puppy)
Typology: Intracondylar Y fracture
Repairing Method: The fracture was repaired with an intercondylar screw in lag fashion and two plates on both condyles
The intraarticular fracture involved the medial and lateral condyle extending the articular intercondylar surface
The three fractures were fixed with two plates on both condyles and a lag screw between the two condyles.
