1. Advanced Avian Orthopedics
Doha, Qatar Jan 26-28, 2016

2. Qatar 2nd International Falcons Veterinary Conference
Goals
Proper triage
Prognosis and repair options for various fractures
Post-op care and protocols
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Why bother?
We are generally dealing with healthy birds
Prognosis can be quite good
Recovery can be very dramatic
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4. Factors affecting prognosis
Bone exposure
Proximity to a joint
Chronicity – is the patient emaciated?
Our patients have to be close to perfect for a successful outcome.
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5. Immediate needs/goals
Stabilize the bird
Immobilize bones
Prevent desiccation
Prevent further stress and injury
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Stabilization
Most fractures are not immediately fatal, but shock and stress are.
Warm fluids SQ BID/TID
Pain control with meloxicam and butorphanol
Start antibiotics if open fracture or if surgery will be needed
Enrofloxacin +/- clindamycin
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Wound care
Use anesthesia
Warm NaCl or LRS is always best
Wear gloves!
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Bone exposure
Must prevent desiccation by covering with skin, if possible. THIS IS AN EMERGENCY
Can use temporary sutures if necessary
Can also use collagen/gel dressings
Use Duoderm – saline-soaked Telfa does NOT work!
Start systemic antibiotics (enrofloxacin + clindamycin)
Surgery ASAP
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Stabilization
Figure 8 bandage for ulna/radius/metacarpal fractures
Figure 8 + body wrap for humerus and coracoid fractures
Padded splint +/- ball wrap for fractures distal to the knee
Not much can be done for femur fractures. Surgery indicated ASAP.
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Orthopedic supplies
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Orthopedic supplies
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A few more points
Examine entire bird including eyes.
Don’t want to put a bird thru surgery if it is blind.
If surgery is necessary, do it quickly.
Ideally within 2-3 days of admission
Goal is within 24 hours
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Ulna fracture
Probably most common fracture
Usually a closed fracture
If alignment ok, figure-8 bandage and PT may be enough
IM pin +/- ESF
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14. Ulna fracture – post-op
Goal is to
Prevent callus from bridging to the radius
Provide reasonable alignment
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15. Ulna fracture – bad pin placement
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Ulna fracture
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Ulna fracture – IM-ESF
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18. Ulna/radius combo fracture
Almost always open with massive soft tissue trauma
Very difficult to splint. Needs surgery immediately.
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19. Ulna/radius combo fracture
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20. Ulna/radius combo fracture
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21. Ulna/radius combo fracture
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22. Ulna/radius combo – post-op
Staged removal of implants
IM pin in ulna
IM pin placed in radius but this can interfere with the wrist joint
Remove it early (2-3 weeks)
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Extremely comminuted
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5 weeks later
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25. Don’t rush into surgery
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4 days later…
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No surgery required
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Humerus fractures
Very variable.
Midshaft, distal, proximal
Transverse, oblique
Comminuted or simple
Can have severe soft tissue trauma.
Severe muscle contracture common.
Bone exposure VERY common
Immediate stabilization requires a figure-8 wrap + body wrap.
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Anatomy – radial nerve
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Long oblique, midshaft
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31. IM-ESF + cerclage wires
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32. External fixator configurations
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Highly comminuted
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Highly comminuted
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35. External fixator tie-in
Disadvantages
Technically more challenging. Placing pins can cause damage.
Increased surgical time
More pin tracts to take care of
Very difficult/impossible in small birds?
Advantages
Fixation is MUCH more rigid
Can remove wrap sooner ( 2 days vs 3 weeks).
Definitely the treatment of choice
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36. Distal humerus fracture
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37. Distal humeral fracture
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Metacarpal fracture
Figure-8 wrap can work.
IM pin for proximal or unstable fractures.
IM-ESF in larger birds?
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Metacarpal fracture
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Coracoid fracture
Window strikes
Very difficult to palpate
Surgery is NOT indicated
Treat with figure-8 + body wrap for 3 weeks with intermittent PT OR just cage rest.
Prognosis is very good
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Coracoid fracture
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Coracoid fracture
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Femur fracture
Large muscle mass. Can be missed on physical exam.
Usually midshaft
Bumblefoot can result in opposite foot if not adequately stabilized.
Splints/wraps are not effective
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Femur fracture
IM pin will migrate/fall out. THIS DOES NOT WORK WELL.
External fixator tie-in MUCH more rigid.
Should blunt the pin at the stifle
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45. Femur fracture – tie-in fixator
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46. Femur fracture – tie-in fixator
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47. Femur fracture – tie-in fixator
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Femur fracture
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49. Femur fracture – IM-ESF
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Tibiotarsus
IM pin + ESF is usually best choice
IM-pin + shuttle pin is also an option
ESF alone does not work well
Pin placement can be difficult
Severe swelling – large soft tissue mass
Tibiotarsus has odd cross-section
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51. Tibiotarsus – Turkey vulture
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52. Tibiotarsus – Red-shouldered hawk
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53. Tibiotarsus - Red-shouldered hawk
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Tarsometatarsus
Very little soft tissue covering. Tissue distal to fracture can become necrotic if blood supply is compromised.
Toe swelling is bad prognostic indicator.
Temporary padded splint +/- ball wrap +/- coat-hanger side bars can be effective temporarily or in very young birds.
Bumblefoot can result in opposite foot if not adequately stabilized.
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Tarsometatarsus
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Tarsometatarsus
TM has a C-shaped cross-section. Must be very careful when placing pins.
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Tarsometatarsus
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Implant removal
Pull pin when
fracture is stable on palpation and
there is radiographic evidence of a mature callus.
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59. Typical protocol - part 1
Day 0 – Admission and stabilization.
Day 0-2 – Butorphanol 2 mg/kg IM BID.
Day 2-10 – Tramadol mg/kg BID.
Day 0-10 – Meloxicam 0.5 mg/kg BID.
Day 1 – Surgery.
Day 2-7 – Pins are cleaned daily and triple antibiotic ointment applied.
Day 3 – Begin physical therapy under ANE.
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60. Typical protocol- part 2
Day 3-21 – Physical therapy continues 3 x weekly. Anesthesia required for most of it.
Day 10 – Radiograph and every days thereafter.
Day 21 – Wrap can likely be removed, if present.
Week 3-6 – Physical therapy as needed without anesthesia.
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61. Typical protocol - part 3
Week 5 – Remove fixation and move to small (10x10 ft) outdoor cage to allow limited exercise.
Week 6 to10 – Move to large ( ft) flight cage with gradually increased forced exercise
Week 12 – Release!
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Physical therapy
Importance of PT cannot be overstated.
If you are not prepared to do PT frequently and humanely (i.e. with anesthesia) then patient should be euthanized or transferred to another facility.
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Physical therapy
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Flight training
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The release
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66. Surgical field preparation
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67. Surgical field preparation
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68. Surgical field preparation
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Driving cross pins
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Driving cross pins
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VTP material
X-Lite Classic cast rolls
allardin.com
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Thank you
Dave Scott, DVM Carolina Raptor Center P.O. Box Charlotte, NC x105
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