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2014 - 20172
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Author: PHANEENDRA, M.S.S.V. × Start date: 1981 ×
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    EVALUATION OF ANTIBIOTIC IMPREGNATED IMPLANTS AND BEADS FOR STABILIZATION OF LONG BONE DIAPHYSEAL COMPOUND FRACTURES IN DOGS
    (SRI VENKATESWARA VETERINARY UNIVERSITY TIRUPATI - 517 502. (A.P.) INDIA, 2017-11) PHANEENDRA, M.S.S.V.; DHANA LAKSHMI, N(MAJOR); RAGHUNATH, M; RAJU, N.K.B.; ADILAXMAMMA, K
    ABSTRACT: The study was undertaken in 30 dogs with compound long bone diaphyseal fractures presented to Veterinary Clinical complex, Department of Veterinary Surgery and Radiology, Tirupati. The detailed history and signalment including sex, breed, age, weight, time since injury and limb involved were collected from the owner and incidence was analyzed. The cases were divided into two groups, in which 24 dogs with various compound long bone diaphyseal fractures were stabilized by Locking compression plates or intramedullary pins along with local antibiotic (gentamicin) + biodegradable bone cement (hydroxyapatite or Poly D,L lactide) (Group I) and 6 dogs with various compound long bone diaphyseal fractures were stabilized by Locking Compression Plates or intramedullary pins without local antibiotic therapy as control group (Group II). The outcome was evaluated by clinical, radiographical and biochemical analysis in both the groups. In Group I, 18 dogs out of 24 cases were stabilized by using antibiotic bone cement impregnated Locking Compression Plates and 6 dogs of humerus and femur fractures were stabilized using intramedullary pinning with local application of antibiotic bone cement beads. Post-operatively, the operated limb was supported by Robert- jones bandaging and systemic antibiotics were given in both the groups. Clinical evaluation was routinely carried out at periodical intervals for the signs of swelling, exudation, weight bearing and stability of the fixation in all the dogs. Post-operative swelling was not much in Group I compared to Group II. The degree of lameness was graded from I to V on 1st, 7th, 14th, 28th, 45th and 60th day of the surgery in all the cases and thereafter every two weeks until implant removal in case of plating. All the dogs showed grade V lameness preoperatively. In Group I, all dogs with radius-ulna and tibia compound fractures stabilized by antibiotic impregnated Locking Compression Plating (LCP) technique showed grade I lameness by 14th post-operative day except for two cases in which grade I lameness was seen by 19th and 21st post-operative day whereas all dogs in control group (Group II) stabilized with LCP showed complete weight bearing only after 45th post-operative day. In case of humerus and femur compound fractures in Group I, which were stabilized with intramedullary pinning with placement of a local antibiotic bead, full weight bearing with paw touching on the ground associated with normal gait was observed on 25th postoperative day. On 45th day, all the cases showed no lameness (grade I) whereas all dogs in control group (Group II) showed grade I lameness by 60th post-operative day. Medio-lateral and anterio-posterior radiographs of the operated bones were obtained immediately after surgery and on 3rd, 5th, 7th and 9th week postoperatively and whenever needed on later dates in all the cases for assessing alignment of fragments and implant position to assess the progress of bone healing. Radiographs showed progressive healing of the fractures. In case of plating in Group I, obliteration of the fracture line with the bony callus bridging the fracture area was observed on 7th post-operative week and by 11th post-operative week in all cases of Group II. In case of Intramedullary Pinning in Group I, on 6th post-operative week remodeling of the callus with obliteration of the fracture line was observed in all the cases whereas in the same Intramedullary Pinning cases of Group II postoperative healing was observed by 9th postoperative week. Physiotherapy of the limb was advised after two weeks of surgery for 10-15 minutes thrice a day to retain normal joint movement for 6- 8 weeks. Haematological studies showed neutrophilia, leucocytosis and high erythrocyte sedimentation rates persisted for upto 14th post-operative day and 28th post-operative day in Group I and Group II (control group) respectively. Blood biochemistry showed serum alkaline phosphatase values significantly increased from preoperative day to 14th day and there after the levels decreased reaching normal by 60thday in both the groups. CRP values in Group II were higher compared to Group I, owing to prolonged post-operative inflammation in Group II. Swab samples were taken from the wound at fracture site on the preoperative day and on 12th postoperative day, which were assessed for microbial load. The microbial load values in Group I on 12th day was in the range of 3.73±0.84×102 to 3.92±1.27×103 CFU/ml and in Group II was ranging from 4.97±0.97×106 to 3.52±0.86×107 CFU/ml. The use of poly-(D,L)-lactide bone cement was limited to three cases as it turned about to be less cost effective, which was replaced by the use of another high efficiency biodegradable hydroxyapatite bone cement. The implants were well tolerated in all the cases except in one case of intramedullary pinning in Group II, which showed slight pin migration resulting in seroma formation. In the present clinical study, the technique of improvised use of antibiotic impregnated implants and beads along with biodegradable bone cement for stabilization of long bone diaphyseal compound fractures in dogs resulted in favorable functional limb outcome and bone healing. The infection was controlled by adding gentamicin and the bone healing was facilitated by the use of biodegradable bone cements like hydroxyapatite and poly-(D,L)-lactide. Unnecessary long term systemic antibiotic usage for open and infected fractures in dogs may be avoided by using antibiotic biodegradable impregnated implants in future.
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    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.