Fracture

Fracture Repair

The objective of fracture repair is to provide rigid stability for the bone and facilitate bone union. This stability can be achieved through internal or external fixation implants.

Internal fixation involves placing a metallic implant underneath the skin, commonly utilising pins, plates, and screws. However, a wide variety of implants are available in the market, and the choice depends on surgeon preference and the type of fracture.

External fixation is accomplished with a device penetrating the skin and firmly holding the bone. Typically, this involves pins connected to an external metallic bar or circular implants.

Fracture healing can also be achieved with external bandages and splints. However, this method may necessitate frequent bandage changes and could result in delayed union or non-union of the bone due to poor limb immobilisation. Additionally, 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, summarised in a fracture assessment score based on mechanical, biological, and clinical factors (Fossum, 2013).

Mechanical factors determine the strength required for the implant based on the type of fracture. Biological factors gauge the rate of bone healing considering the patient's age and clinical condition. Clinical factors encompass owner and patient compliance.

A low fracture assessment score negatively impacts bone healing and may result in non-union fractures, indicating a failure of the repair. To mitigate the risk of failure, comprehensive blood tests before surgery, selection of the appropriate implant based on the fracture type, and strong client compliance in post-operative care at home are essential. Leaflets with detailed instructions will be provided at discharge.

Type of Implant

Most of the time, internal implants remain in place and do not necessitate additional surgery for removal; however, in rare cases, they may cause skin irritation. In such instances, prompt surgery is necessary to remove the implant.

External Implants

External implants are removed after bone healing, typically between 4-8 weeks. Extra care and attention should be taken during the removal process of these implants.

Early Implant Removal and Complications

Early implant removal may be necessary in very young animals, as their bones tend to heal faster than those of adult patients.

Generally, the rate of complications is low. The primary complication is infections, which are treated with antibiotics. However, in some cases, implant removal after bone healing may become necessary.

Another potential complication is the rupture of internal implants, especially in comminuted fractures. Sudden jumps, sprints, or fast movements may result in the bending or rupture of the implant. In such cases, a review surgery may be required. Based on this data, we strongly recommend strict rest until the bone is completely healed.

Reference:

Fossum, T. (2013) Small Animal Surgery, Elsevier Mosby: St. Louis, MO.