Management Of Metaphyseal, Physeal And Epiphyseal Fractures Of Long Bones In Dogs
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Date
2007
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Tamil Nadu Veterinary and Animal Sciences University
Abstract
Dogs presented to the Madras Veterinary College Teaching Hospital with 159
metaphyseal, physeal, and epiphyseal fractures of long bones which were diagnosed
by clinical signs, orthopaedic examination and survey radiography were considered
for the study. The breed, age, sex wise incidence, cause and type of fracture were
studied. The fractures were broadly divided into four groups based on the
involvement of long bone. Viz; Group I (humerus), Group II (radius and ulna), Group
III (femur) and Group IV (tibia and fibula). Each group was further divided into two
subgroups based on the management techniques with external coaptation or internal
fixation. In external coaptation, the application methods like spica bandages, tubular
casts and gutter splints made up of Plaster of Paris and fiberglass were used for
stabilizing fractures in Groups I A, II A, III A and IVA. In internal fixation, the
techniques like K-wire with or without lag screw fixation, tension band wiring,
indigenously developed mini T-plate fixation, cross pinning, intramedullary pin along
with cross pinning and dynamic pinning were used for stabilizing fractures in Groups
I B, II B, III B and IV B based on the configuration of fracture and fracture patient
assessment score.
The fractures with stable metaphyseal, physeal fractures in group IV A
showed good outcome. In distal fractures of Group I A, III A there was excess
periosteal callus and malunion noticed in 30% cases. Distal radius and ulna fractureswere not healed in small breed dogs in Group II A and showed severe valgus
deformity with premature growth plate closure due long term stabilization of physis
with cast or splints. Premature growth plate closure was not evident in the fractures
surgically treated with small K-wires and pins except in S-H type IV cases. In
skeletally immature and body weight less than 6 kg dogs only cross pinning technique
was applied and more than 6 kg and in some mature dogs dynamic pinning and
intramedullary pin reinforcement techniques were applied in distal femur cases with
good functional out come. The techniques like lag screw fixation in distal humerus,
tension band wiring in epiphyseal fractures, cross pinning with K-wires for femur and
tibia fibula metaphyseal, and physeal fractures, mini T-plate fixation for distal radius
and ulna fractures provided healing of fractures by 4 weeks. The fracture patient
assessment score for preoperative decision making in selection of implants and repair
of these fractures was very useful in this study. The animals showed excellent to good
weight bearing of limb and functional range of motion without any joint stiffness in
IV A, IV B (90%), followed by III B (85%), II B and I B (80%). The animals showed
fair to poor functional limb outcome more in distal femur and humerus groups treated
with external coaptation method followed by distal radius and ulna group. The
implants were removed in skeletally immature animals to prevent the premature
physeal closure. There was significant elevation of serum alkaline phosphatase and
serum calcium in different stages of fracture healing in postoperative period when
compared to other groups whereas no significant changes in phosphorus levels in all
the groups were noticed.
Based on the present study it is concluded that the factors like breed, age and
size of the animal, fracture patient assessment scoring for appropriate selection of
management technique and time expected for biological union are important for the
successful management of metaphyseal, physeal and epiphyseal fractures. Stable
incomplete metaphyseal and physeal fractures without articular involvement can be
managed with external coaptation. Unstable fractures with or without involvement of
articular area should be stabilized with good anatomical reduction and internal
fixation with specific implants for achieving excellent functional limb outcome.