Pooch fracture management
Like kids, naughty pooches are also prone to accidents. They need vigilance, all time; a small negligence can end up in a troublesome situation, viz bone fracture or sprain. God forbid! But if it occurs, one needs to have ample information and knowledge to handle the situation tactfully. Here’s a complete overview about the fracture management for pets. Pets have been an integral part of our society since time immemorial. Pets at home are wonderful companions, great stress busters and provide unsolicited love and affection. Keeping pets has gained immense popularity in the last decade. Hence, there has been an increased demand for advanced and specialized health care especially in the field of ‘Small Animal Orthopedics and Neurology.’
Numerous pets have been rendered lame or paraplegic for their entire lifetime either due to lack of expertise or facilities in this field. Compassionate pet owners are most eager to consult with specialists in this field to obtain the best possible treatment options for their ailing pets. Specialized small animal orthopedics and neurology services have now become a priority for pet owners.
Milestones… so far
Primary aim of fracture treatment is to restore anatomical shape of the fractured bone and to restore the function of the affected limb. Until the early fifties, treatment of fractures in pet animals was confined mainly to casts and splints, which did not prove successful in complex fractures, and resulted in fracture disease. Fracture disease is characterized by non-union/mal-union of fractures, osteoporosis, joint stiffness, limb deformity, arthritis and muscle wasting. In 1958, a study group of Swiss surgeons formed ‘The Association For The Study of Internal Fixation’ (AO/ASIF) and developed new techniques, devices and implants for treatment of fractures. The philosophy of the organization was “Life is movement-movement is life”. The aim of the AO technique is a rapid return to full function of the affected leg.
In the late sixties, veterinarians adapted the principles of the internal fixation group, made modifications better suited to the needs of animals, carried out research, developed new and versatile equipment and implants to produce maximal stability of fracture with minimal reaction to facilitate early and pain free return to full limb function and permitting full range of motion of the joints. The benefits of this technique include early return of normal limb function compared to conservative therapy; little or no pain at the fractured site compared to conservative therapy; and no limb deformity or lameness compared to conservative therapy.
The technique used for fracture management was based on the configuration of the fracture and the type of forces that needed to be counteracted to promote stability. The age temperament, health status of animal and owner compliance influence decisions on fracture management.
Medical boons for pooches
Dynamic compression plate (DCP): The dynamic compression plate developed by the association for the study of internal fixation probably represents one of the most innovative developments in orthopedic surgery in the last two decades (British Small Animal Veterinary Association). Combining the plate with an intra-medullary pin (placing a pin through the bone) increases the strength of the plate multifold. Specially devised ‘T’ plates are used to manage distal radial fractures (fractures of the end of radius bone), as they do not heal easily. External fixators (Ex-Fix) : Ex-Fix and intra-medullary pins are used in combination for management of open infected shaft fractures/comminuted fractures (broken into many pieces).
The ‘hanging limb method’ and the OBDNT (open but do not touch procedure) technique of external fixator application for fracture fixation fulfill the principles of minimally invasive orthopedic surgery and promotes biologic fracture healing. External fixators with stainless steel connecting rods and clamps (dogs weighing > 15 kg) or locally available epoxy (dogs weighing <15kg) as connecting column have been used with success. Healing times were reduced and complications were minimized.
A “tie-in” procedure combining the intramedullary pin and external fixator for management of complicated fractures of long bones.
The advantages of the External Fixators system include
- Closed or minimally invasive open application.
- Fracture alignment can be adjusted during or after surgery.
- Fixation can be removed without performing major surgery.
- Relatively affordable with many reusable components.
- Indicated for highly comminuted shaft fractures, open infected fractures mandibular fractures, bone deformities.
Other useful techniques include?:
- Tension band wiring technique for avulsion fractures of olecranon process of ulna, tibial tuberosity and calcaneus (fractures caused by pull of the muscles in the opposite direction).
- Combination of intramedullary pin and cerclage wiring (when the length of the fracture exceeded twice the diameter of bone) in fractures of long bones.
- Intramedullary pinning in combination with cross pinning for supra condylar (fractures occurring near the end) fractures of femur.
Curing common orthopedic disorders
- Femoral head and neck ostectomy (removal of the head and neck of femur bone) and placement of a muscle flap in the defect has been used successfully as a salvage procedure in the management of painful chronic osteoarthritis of the hip joints which occur in severe cases of hip dysplasia. Clinical studies indicate that this procedure provides early and pain free weight bearing on operated limb and improved quality of life of the animal.
- Nutritional bone disorders have been diagnosed early using biochemical and radiological evaluation and successfully managed. Imbalance in nutrition and overzealous supplementation with calcium, especially in rapidly growing giant breeds, is the primary reason.
- Growth deformities in dogs (bow legs) have been successfully managed with removing a portion of the ulna bone and using a fat graft or by performing corrective bone surgeries using a bone plate or an external fixator system.
- Correction of patellar luxation in dogs (knock knees) have been performed successfully.
(Dr Ayyappan with over 16 years of experience is a PhD and Associate Professor in veterinary surgery from Madras Veterinary College. He did a Clinical Postdoctoral fellowship at the Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, USA (2000-02). He specializes in small animal orthopedic surgery and neurology. He also completed the basic, advanced and special training in small animal orthopedic surgery at AO-International, Davos, Switzerland (1994,1995 and 1999). He can be contacted at: 9841249129/ 26475988; or email: email@example.com)