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20141
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Subject: Veterinary Surgery and Radiology × Author: PHANEENDRA, M.S.S.V. × Start date: 2014 × Type: Thesis × Thesis Type: M.V.Sc. ×
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    ThesisItemOpen Access
    MANAGEMENT OF TIBIAL DIAPHYSEAL FRACTURES WITH LINEAR EXTERNAL SKELETAL FIXATORS USING CARBON CONNECTING RODS IN DOGS
    (SRI VENKATESWARA VETERINARY UNIVERSITY TIRUPATI - 517 502. (A.P.) INDIA, 2014-10) PHANEENDRA, M.S.S.V.; DHANA LAKSHMI, N(MAJOR); DEVI PRASAD, V; RAJU, N.K.B.
    ABSTRACT: Dogs with fractures of tibia presented to College Hospital were diagnosed by clinical signs, orthopaedic examination and survey radiography. The breed, age and sex wise incidence of these fractures was studied. Twelve selected cases of diaphyseal tibial fractures (9-22 months old with body weight ranging from 8-25 kg) were stabilized with indigenously designed Type II linear external skeletal fixator using maximal frame construction of various sizes of centrally threaded transfixation full pins, clamps and carbon fiber connecting rods as per the fracture patient assessment following AO principles. The linear fixator was applied either with open reduction or closed reduction under isoflurane maintenance anaesthesia. Selection of appropriate size of transfixation pins ( 2.5 and 3.5 mm), carbon fiber connecting rods (4 mm for dogs weighing less than 12 kg and 6.3 mm between 12-25 kg) and clamps according to age, body weight and type of fracture provided good fracture stability. In all the cases, no technical difficulties were observed while application of transfixation pins. Predrilling a pilot hole prior to insertion of the centrally threaded full pins facilitated easy insertion of pins and provided good stability. Two or three Pins were placed in each fractured bone fragment and were interconnected with carbon fiber connecting rod with clamps. No bending or breakage of carbon fiber bars was noticed. The fixator frame was rigid and strong in all the 12 cases throughout the fixation period. The outcome of fracture stabilization and healing was evaluated with lameness grading, pain score, radiography and biochemical analysis. All animals, which were diagnosed with unstable diaphyseal tibial fractures showed grade V lameness before surgical management. Postoperatively, all cases showed early functional limb usage with full weight bearing in an average 4-7 weeks except case No.8 which showed Grade IV lameness after 14 days due to pin tract infection. After proper antibiotic treatment in this case, weight bearing lameness Grade I was observed by 9th week. No migration or pin loosening of the centrally threaded pins was observed except for few complications such as pin tract infection, wound at suture site, wound at pin-skin interface in case No.8, 10 and 11 respectively. These complications did not show any interference in clinical weight bearing and healing of the fractures except for delayed healing in case No.8. Functional limb outcome was excellent in 5 cases, good in 7 cases. The mean values of University of Melbourne Pain Score were significantly higher in all the cases 0 day and 14th postoperative day and lesser values were recorded on 60th postoperative day in all 12 cases. The fractures showed radiographically excellent postoperative healing of cortical union, absence of fracture line with endosteal bridging callus except case No.8 in which healing with periosteal callus. The overall average healing time in all the cases was 4-10 weeks. Statistical analysis revealed a highly significant difference (P<0.01) in serum alkaline phosphatase and C-reactive protein values in different stages of postoperative intervals. The serum alkaline phosphatase values significantly increased from 0 day to 14th day and thereafter reached to normal values by 21st postoperative day. Lower C-reactive protein values were observed in cases stabilized by closed reduction than in fractures that subjects to open reduction and the values decreased by 3 weeks. Fixator complete removal was done on an average 4-7weeks. Based on present study, it was concluded that linear external skeletal fixation with various sizes of centrally threaded transfixation full pins, clamps and carbon fiber connecting rods according to fracture patient assessment was good for stabilization of unstable tibial diaphyseal fractures for early ambulance and excellent healing. More over the carbon fiber connecting rods had following advantages such as rigid stabilization capacity, light weight for early weight bearing and X-ray transparency, which enabled better visualization of the fracture site to assess bone healing mainly when the fractured bone radiographed in medio-lateral view by preventing overlapping of the rods. Even though carbon fiber is an expensive orthopaedic material, the above stated advantages along with its durability and the ability to reuse the rods reduce the cost, making it amicable to use in Veterinary practice.