MANAGEMENT OF LONG BONE DIAPHYSEAL FRACTURES WITH MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS TECHNIQUE USING LOCKING COMPRESSION PLATES IN DOGS
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Date
2016-08
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SRI VENKATESWARA VETERINARY UNIVERSITY TIRUPATI - 517 502. (A.P.) INDIA
Abstract
ABSTRACT:
Twenty four dogs presented to the college hospital (SVVU/KVAFSU) with
unstable long bone diaphyseal fractures which were diagnosed by clinical signs,
orthopaedic examination and survey radiography were taken as clinical material for
the study. The breed, age, sex wise incidence, etiology and type of fracture were
studied. The dogs were equally divided into four groups viz; Group I (humerus),
Group II (radius and ulna), Group III (femur) and Group IV (tibia and fibula) and the
fractures were stabilized with minimally innasive plate osteosynthesis (MIPO) using
locking compression plate following standard AO/ASIF procedures. Preoperative plan
was prepared using Fracture Patient Assessment Score (FPAS) and following the
AO/ASIF procedures. The minimally invasive surgical approach for long bones was
successfully implemented in radial and tibial diaphyseal fractures. MIPO was not
successful in humeral and femoral diaphyseal fractures and hence alternate Open
reduction and internal fixation (ORIF) was used for fracture repair.
The outcome of fracture stabilization and healing was evaluated with
postoperative lameness grading, radiography, ultrasonography and biochemical
analysis. All the animals showed grade V lameness i.e. no weight bearing on limb at
rest or while walking before surgery. Animals in group II (Radius Ulna) & group IV
(Tibia) which underwent MIPO exhibited early limb usage (grade II lameness by 7th
day and grade I lameness by 45th day) as compared to group I (Humerus) and group
III (Femur) in which MIPO was unsuccessful (grade III lameness by 28th day and
grade II lameness by 60th day). Radiographic healing (grade 1) was noticed in all the cases treated by MIPO of group II (Radius Ulna) and IV (Tibia) with obliterated fracture line and
homogenous bone structure (callus) within 7 weeks, where as, group I (Humerus) and
group III (Femur) where MIPO was unsuccessful showed grade 2 radiographic
healing with barely discernible fracture line and massive bone trabeculae crossing
fracture line (callus) by 7th week indicating slower fracture repair than MIPO.
Ultrasonographic healing (grade 4 – Increasingly homogeneous, hyperechoic image of
the tissue at the fracture site (acoustic shadow returns) was noticed in all the cases
treated by MIPO of group II (Radius Ulna) and IV (Tibia) ,where as, group I
(Humerus) and group III (Femur) where MIPO was unsuccessful showed (grade 3 -
Evidence of bridging of the fracture gap with inhomogeneous tissue (mix of
hypoechoic and hyperechoic areas) by 5th week. Vascularization was not detectable
by use of power Doppler ultrasonography by 9th week in all the group. No major
intraoperative complications like implant instability or loosening of screws were seen
in MIPO group (Radius Ulna and Tibia), however, Dog no 1(Radius Ulna) and Dog
no 3 (Tibia) showed lateral angulation of distal limb.
Statistical analysis revealed increase (P<0.05) in the serum alkaline
phosphatase values significantly from 0 day to 7th day in all the groups and there after
the levels decreased reaching normal at 45th day. Serum Calcium values were also
increased significantly from 0 day to 14th day in all the groups. Serum phosphorus
level showed significant difference on the day 0, 7, 14 and 28 days in all the groups.
Based on present study, it was concluded that successful MIPO technique for
long bone fracture repair can be done clinically for faster healing in radial and tibial
fractures, whereas for Femoral and Humeral long bone fractures, it was difficult due
to more instability and unsuccessful alignment due to strong musculature and bone
configuration. As the MIPO technique has a “learning curve”, it can be successful
once the surgeon gains dexterity in MIPO and can be attempted for complex fracture
where alignment may be possible due to loss of bone.
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