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.
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