EVALUATION OF ANTIBIOTIC IMPREGNATED IMPLANTS AND BEADS FOR STABILIZATION OF LONG BONE DIAPHYSEAL COMPOUND FRACTURES IN DOGS
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Date
2017-11
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SRI VENKATESWARA VETERINARY UNIVERSITY TIRUPATI - 517 502. (A.P.) INDIA
Abstract
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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