1. Fracture Management in Small Animal Practice
Dr. B. Justin William

2. Patients present for elective as well as non elective (fractures) and emergency treatment
Patients < 2yrs require CBC and urine analysis
Patients > 2yrs require serum biochemistry as well

3. Preoperative Coaptation
Robert Jones Bandage
Splints (metallic)
Spica Splint
POP Cast

4. Anesthetic Protocol

5. Intramedullary Pinning
Indications
Realign long bone fragments in simple or complex fractures
Advantages
Easy to place and remove Stabilizes the fracutre against bending forces
Disadvantages
Variation in bone size and shape

6. Pins Double pointed trochar Steinmann pins and Krischner wires
Rush pins
Pin chuck is used to insert the pin
Pin cutters are to trim the wires

7. Application Open or Closed approach
Pins should fill 75% of the diaphyseal medullary cavity
Intramedullary are usually removed after 1-3 months

8. Bone Plating Indications Advantages Disadvantages
Simple or communited long bone or flat bone fractures
Advantages
Quick return of limb function
Counteracts all distractive forces
Disadvantages
Specialized training and equipment
Extensive soft tissue dissection
Second surgeries to remove broken plates

9. Equipment Plates-Various shapes Screws
Straight, T-shaped, L-shaped, Reconstructive
Screws
Used to anchor plates and occasionally used alone to stabilize physeal fractures of long bones
Cortical and cancellous threads available

10. Application Extensive open apprroach to isolate the fracture
The plate is usually applied on the tension side (concave or distracted side)
Contouring of plates is doone using a bending iron
Screws are then applied to stabilize the fracture

11. Wiring Indications Advantages Disadvantage
Used to encircle (cerclage) or penetrate (henicerclage) the bone and provide fragmentary apposition
Advantages
Affordable and easy to apply
Disadvantage
Require ancillary fixation

12. Equipment Orthopedic wire available in different gauges
Wire tighteners used to secure the wire to the bone
Wire cutters used to trim the excess

13. Application Open approach
Wires are placed across the fracture line directly on the bone to minimize soft tissue cmpromise
Simple interrupted figure of eight configurations are often used
Two cerclage wires are required per fracture to provide stability
In tension band fixation two Krischner wires and a figure of eight flexible wires are required

14. External Skeletal Fixation
Indications
Stabilizing long bone fractures (simple, comminuted, open or closed) in all ages and sizes of animals
Advantage
Affordable, Reusable and adaptable
Preserves bone and soft tissue vascularity
Limits the incidence of surgical infection
Disadvantage
Extensive post operative patient care
May be functionally and cosmetically unappealing to the pet owner

15. Equipment Percutaneous pins Smooth or threaded
Pin clamps t cnnect the pins
Connecting bars or acrylic compounds or Epoxy putty
Hand chucks and low speed drills
Pin cutters

16. Application Closed or limited open approach
Functional anatomic realignment to preserve parallelism of joints proximal and distal to the fracutre is the goal
Pins are placed percutaneously avoiding majr muscle groups
External clamps are tightened to the connceting bar or acrylic materials are allwe dt harden by drying

17. Bone grafts
Cancellous and cortical bone grafts are used to enhance healing during fracture repair
Fresh cancellous autogenous bone grafts are used most frequently to prvide osteoblasts for osteogenesis
Cortical grafts are used primarily to provide strength and mechanical support

18. Scapular fracutres Infrequent
Brachial plexus nerve function, thoracic wall integrity and cardio pulmonary status should be assessed pre op
Minimally displaced fratcure- Spica splint
Severly displaced- Wire and plate fixation

20. Humeral fractures Proximal, Shaft and Distal
Proximal- Kirschner wires or small pins and partially threaded screw
Shaft-
Intramedullary pins seated in the greater tubercle
Bone plate and screws
External fixation
Distal Supracondylar and condylar
Supracondylar stabilzed with pins, double rush pins or bone plates applied to the caudomedial aspect
Unicondylar Lag screw
Intercndylar ( T or Y fracture) Lag screw and Krischner wire

21. Intramedullary Pinning Shaft Fractures
Management of Proximal and Distal segmental fractures

22. Radius and Ulna Proximal Shaft Olecranon
Krischner wires and figure of eight tension band wiring
Monteggia (Dislocation of radial head and fracture of proximal ulna)
Suture the annular ligament between R/U
Plates and Screws for the ulnar fracture
Trans-fixation of the radius and ulna by bone screws and hemi-cerclage wires
Shaft

23. Shaft Fracture of R/U
Greenstick fractures or complete stable fractures treated best with POP casts
Closed or Open contaminated fracutres (Comminuted, transverse, or oblique) stabilized with external fixators
Closed unstable fractures bone plate and screws along cranio medial aspect of Radius/ Ulna with cancellous bone graft indicated

24. Other Fractures in Forelimb
Metacarpal
Requires internal support with palmar splints. Internal repair with wires or small plates if > 2 bones are involved
Phalangeal
External support with splints
Digit amputation in non healing fractures

25. Fractures of Femur Proximal Fractures Capital or Physeal fractures
Retrograde placement of Krishcner wires and bone screw
Femoral neck fractures
Avulsion fractures
Krischner wires and figure of eight tension band wiring
Subtrochanteric fractures
Bone screws and plate

27. Shaft of femur External Fixators Intramedullary pinning
Bone plating with screws
Autogenous cancellous bone grafting

28. Shaft Fracture Normograde Vs Retrgrade Pinning

29. Methods of Stabilizing Femur Shaft Fractures

30. Distal fractures Supracondylar Physeal fractures
Cross and Intremedullary pinning
Physeal fractures
Pinning, wiring and transcondylar screws

31. Fractures of Tibia and Fibula
Proximal Avulsion fractures
Krischner wires and figure of eight tensin band wiring
Physeal injuries Multiple krischner wires place peripherally
Shaft fractures
Stable minimally displaced and incomplete fractures
Cast
Closed oblique
Intramedullary pinning and wiring
Transverse
Intramedullary pinning with unilateral external fixator
Highly unstable
Bone plating and cancellous bone grafting
Distal Fractures
Physeal injuries
External support
Malleolar fractures
Pinning and tension band wiring