Small Animals Fracture Repair

Extremities

Fracture of the Scapula

Figure 21: Radiograph of a fractured body of the ilium treated with bone plate, a luxation of the sacroiliac articulation treated with a well-placed bone screw and an acetabular fracture treated with a reconstruction bone plate.

Figure 22: Radiograph of a triple pelvic osteoctomy showing transposition of the trochanteric osteoctomised fragment to tighten the head into the acetabulum. The screw placements are excellent. Radiograph of a bilateral triple pelvic osteoctomy. A period of about three months is allowed before the second surgery.

Fractures of the femur

The femur is the most commonly fractured long bone of the dog and cat. The femoral shaft is the most commonly injured area. A stable, uncomplicated fracture may do well with an intramedullary pin, while a more severe fracture with tendency to rotate or collapse on a pin might need an external fixator. sever multiple and badly comminuted fractures are more successfully treated with bone plates.

Figure 23: Multiple pin placement in a single K/E bar that is treating a severely comminuted fracture (not a femur).(A) Transverse proximal femoral fracture. (B) A transverse proximal femoral fracture treated with a bone plate. Note the long screw in the femoral neck that provides greated holding power and stability.

Figure 24: (A) Proximal short oblique femoral fracture. (B) Lateral view of short oblique femoral fracture treated with bone plate. Cerclag and lag screw were used. A small defect in the distal shaft was treated with a K-wire and a loop of orthopedic wire.

Figure 25: Oblique proximal femoral fracture with small communuted fragments. (B) Short oblique proximal femoral fracture plated. A lag and a long screw into the femoral neck ensure interfragmentary compression and good proximal stability.

Figure 26: (A) AP Radiograph of a proximal femoral fracture treated with an IM pin. The pin has penetrated the knee joint and the fracture site is unstable. (B) In the same case, the pin has been removed and the plate applied. The long proximal screw were directed into the shaft because of the weakening of the femoral neck from the previous pinning. The cancellous screw has increased holding power in the weakened bone. (C) AP radiograph shows good healing.

Figure 27: Medshaft femoral fracture. (B) Severe midshaft femoral fracture, plated, Lag screw were used for interfragmentary compression to form a stable fracture. A neutral fixation plate was applied. (C) Radiograph of (B) showing healing and bony overgrowth over the plate.

Figure 28: (A) Radiograph of a severely comminuted midshaft femoral fracture. (B) Severely comminuted midshaft femoral fracture with the fragments packed in place. Some fragments are missing. A buttress plate has been applied. The screws could only be placed in the most proximal and distal fragments. (C) Very severely comminuted midshaft femoral fracture after the bone has healed. Cancellous screws were used to obtain a firm hold on the distal fragment. Note the large callus and bone mass as compared to where the fragments are repositioned with lag screws, cerclage wires, and K-wires.

Figure 29: (A) In this midshaft femoral fracture, the plate was too light for the dog's activity and it broke. (B) A broken plate was replaced with a heavier one in this midshaft femoral fracture. Centrally, cancellous bone screws were used by by greater holding power in soft bone. The rest of the screws are finer, threaded cortical screws. Healing eventually resulted.

Figure 30: (A) A fresh, fractured transverse distal femur. Note the outward rotation of the proximal fragment. (B) A transverse distal femoral fracture that was treated with bone plate.

Figure 31: (A) Radiograph of a distal femoral epiphyseal fracture. (B) A distal femoral epiphyseal fracture treated with crossed pins.

Figure 32: Distal femoral epiphyseal fracture, Salter II type. (B) This radiograph of a distal femoral epiphyseal fracture shows placement of double IM pins. (C) Lateral radiograph of a distal femoral epiphyseal fracture show healing of the fracture and the heavy periosteal overgrowth common in immature patient. (D) AP radiograph of a distal femoral epiphyseal fracture shows healing. The pins will be withdrawn from the trochantric fossa.

Figure 33: (A) Distal femoral epiphyseal fracture. (B) Lateral view of a distal femoral epiphyseal fracture treated with modified Rush pin technique. Note the K-wires used to stabilize the distal fragment prior to insertion of the pins.

Figure 34: (A) Medial femoral condylar fracture. (B) Medial femoral condylar fracture treated with bone mscrews.

Fractures of the tibia and fibula

Tibial fractures are very common. They vary from a simple greenstick which can adequately treated with cast to severely comminuted, contaminated and infected fractures that require pins, external fixators and bone plate. Proximally and distally the joint must be preserved to prevent degenerative joint diseases.

Figure 35: This fractured proximal tibial epiphysis was treated with two crossed pins.

Figure 36: (A) Gunshot fracture of the proximal tibia. (B). Radiograph of same patient, treated with a T-plate used as a buttress. (C) Healed fracture after plate removal.

Figure 37: (A) Proximal tibial fracture. (B). The same fracture treated with a compression bone plate.

Figure 38: (A) Proximal oblique fracture of a tibia. Note the hairline crack in the distal portion.(B) |Same patient, treated with a bone plate. It does not protect the crack in the distal tibia. (C) The completely healed fracture. Note use of cerclage wires and K-wire.

Figure 39: (A) Radiograph of a midshaft tibial fracture. The slender fibula has remained intact. (B) Treatment consisted of a full K/E external factor with two pins in the proximal and two pins in the distal fragments. The pin pass completely through the leg. (C) Note the periosteal stimulation around the top pins on the medial side.

Figure 40: (A) Short oblique midshaft tibial fracture. Radioapaque threads are from a sterile sponge. (B) Above treated with a full K/E external fixation. The two proximal pins do not penetrate the leg completely. (C) Completely healed fracture. The dark holes are where the pins were seated. Some bone erosion around the pins is seen.