Fracture Management for the Small Animal Practitioner

List of Contributors xv

Preface xvii

Section 1 General Information 1

1 Fracture Identification 3
Anne M. Sylvestre

1.1 Number of Fragments 3

1.2 Fracture Configuration 3

1.3 Location on the Bone 7

1.4 Salter– Harris Fractures 7

2 Open Fractures 9
Anne M. Sylvestre

2.1 First Degree 9

2.2 Second Degree 9

2.3 Third Degree 9

Reference 10

3 Patient Management 11
Anne M. Sylvestre

3.1 The Patient 11

3.1.1 Upon Admission 11

3.1.2 Immediate Postoperative Care 11

3.1.3 Upon Discharge From Hospital 11

3.1.4 Outside and Walks 12

3.1.5 Follow‐up Radiographs and Healing Times 13

3.1.6 Implant Removal 13

3.2 The Owner 14

3.2.1 Slippery Floors 14

3.2.2 Stairs 15

3.2.3 No Jumping 15

3.2.4 Common Stressors 15

3.2.5 Crates 15

3.2.6 Icing 15

3.2.7 Gentle Passive Range of Motion (PROM) 16

3.2.8 Urination and Bowel Movements 16

3.2.9 Food and Water 16

3.2.10 Cats 17

3.3 Managing Osteoarthritis (OA) 17

References 17

4 Bandages and Splints 19
Jennifer White and Anne M. Sylvestre

4.1 The Bandage 19

4.1.1 Layers of a Bandage 19

4.1.2 Creating the Bandage 19

4.2 Forelimb 27

4.2.1 Velpeau Sling 27

4.2.2 Spica Bandage 30

4.2.3 Antebrachial Bandages 31

4.2.4 Bandages for a Manus 37

4.2.5 Carpal Flexion Sling 37

4.3 Hind Limb 39

4.3.1 Ehmer Sling 39

4.3.2 Robert Jones Bandage 39

4.3.3 Crural and Tarsal Bandages 39

4.3.4 Bandages for a Pes 47

4.3.5 Robinson and 90‐90 Slings 47

4.4 Bandage Care 47

4.4.1 Home Care Instructions 47

4.4.2 Bandage Changes 50

4.4.3 Bandage/Splint Complications 50

Reference 60

Section 2 The Forequarter 61

5 Mandible and Maxilla 63
Teresa Jacobson

5.1 Mandibular Fractures 63

5.1.1 Mandibular Symphyseal Separation 63

5.1.2 Rostral Mandibular Fractures 63

5.1.3 Fracture at the Level of the Mandibular First Molar 64

5.1.4 Temporomandibular Luxation 65

5.1.5 Other Mandibular Fractures 68

5.2 Maxillary Fractures 68

5.2.1 Fracture and/or Avulsion of the Incisive Bone 68

5.2.2 Fractures of the Maxillary Bone 68

5.3 Managing Expectations 68

5.4 Alternatives When the Treatment of Choice is Not an Option 68

5.5 Potential Complications of Maxillofacial Fracture Repair 69

References 74

6 Scapula 75
Anne M. Sylvestre

6.1 Fractures 75

6.1.1 Fractures Through the Body and Spine of the Scapula 75

6.1.2 Acromion Fractures 76

6.1.3 Fractures of the Neck of the Scapula 76

6.2 Managing Expectations with Recommended Treatments 78

6.3 Alternatives When Treatment of Choice is Not an Option 78

References 79

7 Shoulder Joint 81
Anne M. Sylvestre

7.1 Fractures and Luxations 82

7.1.1 Avulsion of the Supraglenoid Tuberosity 82

7.1.2 T or Y Fractures of the Scapular Neck and Glenoid Rim 82

7.1.3 Other Fractures Involving the Shoulder Joint 82

7.1.4 Medial Luxations 82

7.1.5 Lateral Luxations 84

7.2 Managing Expectations with Recommended Treatments 84

7.3 Alternatives When Treatment of Choice is Not an Option 86

7.3.1 Fractures 86

7.3.2 Luxations 86

References 86

8 Humerus 87
Catherine Popovitch, Thomas W.G. Gibson, and Anne M. Sylvestre

8.1 Fractures 88

8.1.1 Physeal Fractures of the Proximal Humerus 88

8.1.2 Two‐Piece Humeral Shaft Fractures 88

8.1.3 Multifragmented Humeral Shaft and/or Supracondylar Fractures 89

8.2 Managing Expectations with Recommended Treatments 90

8.3 Alternatives When Treatment of Choice is Not an Option 90

References 91

9 Elbow Joint 93
Anne M. Sylvestre

9.1 Fractures and Luxations 94

9.1.1 Condylar Fractures 94

9.1.2 Bicondylar Fractures 94

9.1.3 Acute Luxations 94

9.1.4 Chronic Luxations 99

9.1.5 Proximal Ulnar Fractures 100

9.1.6 Monteggia Fractures 100

9.2 Managing Expectations with Recommended Treatments 101

9.3 Alternatives When Treatment of Choice is Not an Option 101

9.3.1 For Patients with a Fracture 101

9.3.2 For Patients with a Luxation 102

References 102

10 Radius and Ulna 105
Catherine Popovitch, Thomas W.G. Gibson, and Anne M. Sylvestre

10.1 Fractures 106

10.1.1 Fractures of the Proximal Ulna 106

10.1.2 Fractures of the Proximal Radius 106

10.1.3 Fractures of the Radius in Toy Breed Dogs 106

10.1.4 Fractures of the Radius and Ulna in Non‐Toy Breed Dogs and Cats 107

10.1.5 Isolated Fractures of the Shaft of the Ulna 112

10.1.6 Physeal Fractures of the Distal Radius 112

10.2 Managing Expectations with Recommended Treatments 114

10.3 Alternatives When Treatment of Choice is Not an Option 114

References 117

11 Carpal Joint 119
Anne M. Sylvestre

11.1 Fractures and Ligamentous Injuries 120

11.1.1 Fractures of the Styloid Process of the Radius or Distal Ulna 120

11.1.2 Fractures of the Radial Carpal Bone 120

11.1.3 Fractures of the Accessory Carpal Bone 122

11.1.4 Fractures of the Ulnar Carpal Bone 123

11.1.5 Collateral Ligament Injuries 123

11.1.6 Shearing Injuries 124

11.1.7 Hyperextension Injuries 125

11.1.8 Luxation of the Antebrachiaocarpal Joint 125

11.1.9 Luxation of the Accessory Carpal Bone 125

11.1.10 Luxation of the Radiocarpal Bone 126

11.2 Managing Expectations with Recommended Treatments 127

11.3 Alternatives When Treatment of Choice is Not an Option 127

11.3.1 For Patients with a Fracture 127

11.3.2 For Patients with Ligamentous Injuries 128

11.4 About Pancarpal Arthrodesis 128

11.5 About Partial Carpal Arthrodesis 128

References 129

Section 3 The Hindquarter 131

12 Pelvis 133
Anne M. Sylvestre

12.1 Co‐morbidities 134

12.2 Fractures 134

12.2.1 SI Luxations/Fractures 134

12.2.2 Fractures of the Ilial Shaft or Wing 134

12.2.3 Acetabular Fractures 137

12.2.4 Ischial Fractures 137

12.2.5 Fractures of the Pelvic Floor 137

12.2.6 Summary of Indications for Surgical Repair of Pelvic Fractures 138

12.3 Managing Expectations with Recommended Treatments 139

12.4 Alternatives When Treatment of Choice is Not an Option 139

References 140

13 Coxofemoral Joint 141
Thomas W.G. Gibson and Anne M. Sylvestre

13.1 Fractures and Luxations 141

13.1.1 Acetabular Fractures 141

13.1.2 Hip Luxations 142

13.1.3 Alternative Treatment of Choice: Open Reduction 146

13.1.4 Capital Physeal Fractures of the Proximal Femur 148

13.1.5 Fractures of the Femoral Neck 149

13.2 Managing Expectations with Recommended Treatments 150

13.3 Alternatives When Treatment of Choice is Not an Option 150

13.3.1 Acetabular Fractures 150

13.3.2 Luxations 150

13.3.3 Femoral Head and Neck Fractures 151

13.4 About the FHO 151

References 152

14 Femur 153
Thomas W.G. Gibson and Anne M. Sylvestre

14.1 Fractures 154

14.1.1 Avulsion Fractures of the Greater Trochanter 154

14.1.2 Fractures of the Femoral Shaft 154

14.1.3 Physeal Fractures of the Distal Femur 157

14.2 Managing Expectations with Recommended Treatments 159

14.3 Alternatives When Treatment of Choice is Not an Option 159

References 161

15 Stifle Joint 163
Anne M. Sylvestre

15.1 Fractures and Luxations 164

15.1.1 Articular Distal Femoral Fractures 164

15.1.2 Patellar Fractures 164

15.1.3 Traumatic Patellar Luxations 166

15.1.4 Collateral Ligament Damage 166

15.1.5 Luxation of the Stifle Joint 166

15.1.6 Articular Proximal Tibial Fractures 169

15.2 Managing Expectations with Recommended Treatments 170

15.3 Alternatives Treatment When Surgery is Not an Option 170

References 170

16 Tibia and Fibula 171
Thomas W.G. Gibson and Anne M. Sylvestre

16.1 Fractures 172

16.1.1 Tibial Tuberosity Avulsion Fractures 172

16.1.2 Tibial Plateau Physeal Fractures 172

16.1.3 Proximal Tibial Shaft Fractures 173

16.1.4 Fractures of the Mid‐ and Mid‐to‐Distal Portions of the Tibial Shaft 173

16.1.5 Fractures of the Distal Tibial Shaft 177

16.1.6 Physeal Fractures of the Distal Tibia/Fibula 177

16.1.7 Fractures of the Fibular Shaft Alone 177

16.2 Managing Expectations with Recommended Treatments 178

16.3 Alternatives When Treatment of Choice is Not an Option 178

References 181

17 Tarsal Joint 183
Anne M. Sylvestre

17.1 Fractures and Ligamentous Injuries 184

17.1.1 Articular Distal Tibial Fractures 184

17.1.2 Fractures of the Medial Malleolus or the Lateral Malleolus 184

17.1.3 Medial or Lateral Collateral Ligament Injuries 186

17.1.4 Luxations of the Tarsocrural Joint 186

17.1.5 Shearing Injuries 186

17.1.6 Fractures of the Calcaneus 188

17.1.7 Fractures/Luxations of the Talus 192

17.1.8 Fractures/Luxations of the Central Tarsal Bone 193

17.1.9 Fractures of the Numbered Tarsal Bones 193

17.1.10 Luxation of the Intertarsal and/or Tarsometatarsal Joints 194

17.2 Managing Expectations with Recommended Treatments 194

17.3 Alternatives When Treatment of Choice is Not an Option 195

17.4 About Pantarsal Arthrodesis 195

17.5 About Partial Tarsal Arthrodesis 195

References 197

18 Paw (Manus and Pes) 199
Anne M. Sylvestre

18.1 Fractures and Luxations 199

18.1.1 MC/MT Fractures 199

18.1.2 Phalangeal Fractures 202

18.1.3 Luxations of the Inter‐Phalangeal or MC/MT‐Phalangeal Joints 203

18.2 Managing Expectation with Recommended Treatments 204

18.3 Alternatives When Treatment of Choice is Not an Option 204

References 204

Section 4 Fracture Repair Techniques 205

19 Essential Information on Fracture Repair 207
Anne M. Sylvestre

19.1 Forces Applied to a Bone 208

19.2 Techniques for Reducing a Fracture 208

19.2.1 Distraction 209

19.2.2 Lever 209

19.2.3 Toggle 209

19.2.4 Oblique Fractures 210

19.2.5 Using the Plate 211

19.3 Instrumentation 211

19.3.1 Drills 211

19.3.2 Fracture Repair General Instruments 213

References 214

20 Pins and Wires 215
Catherine Popovitch

20.1 Case Selection 215

20.2 Instrumentation 215

20.3 Fundamentals of Application 215

20.3.1 Cerclage Wires 215

20.3.2 Pins 216

20.4 Pinning Techniques for Various Long Bones 218

20.4.1 Humerus 218

20.4.2 Radius 218

20.4.3 Femur 218

20.4.4 Tibia 220

References 221

21 Plating 223
Anne M. Sylvestre

21.1 Case Selection 223

21.2 Instrumentation 223

21.2.1 Bone Screws 223

21.2.2 Bone Plates 224

21.2.3 Plating‐specific Instruments 225

21.3 Fundamentals of Application 226

21.3.1 Selecting a Plate 226

21.3.2 At Surgery 227

21.3.3 Pin–Plate Combination 228

21.3.4 Stack Plating 230

21.4 Postoperative Care 230

21.5 Plating Techniques for Various Long Bones 230

21.5.1 Humerus 230

21.5.2 Radius 230

21.5.3 Femur 230

21.5.4 Tibia 232

References 233

22 External Fixators 235
Kathryn Wander

22.1 Case Selection 235

22.2 Basic Rules of External Fixation 235

22.2.1 Pins 235

22.2.2 Connecting Bars 236

22.2.3 Clamps 236

22.3 Fundamentals of Application 237

22.4 Fixators: Biomechanics/Constructs 237

22.4.1 Acrylic Splints/Constructs 238

22.4.2 Circular External Fixators 239

22.5 Postoperative Care 239

22.6 Complications 241

22.7 Preferred Technique for Various Long Bones 242

22.7.1 Tibial Fractures 242

22.7.2 Humeral Fractures 242

22.7.3 Femoral Fractures 242

22.7.4 Radial Fractures 242

References 243

23 Repair of Physeal Fractures 245
Thomas W.G. Gibson

23.1 Physeal Fractures 245

23.1.1 Crossed Pin Technique 246

23.2 Avulsion Type Physeal Fractures 247

23.2.1 Tension Band Wiring Technique 247

23.3 Repair Techniques for Various Physeal Fractures 247

23.3.1 Proximal Humerus 247

23.3.2 Proximal Ulna 247

23.3.3 Proximal Radius 247

23.3.4 Distal Radius 247

23.3.5 Greater Trochanter 248

23.3.6 Distal Femur 248

23.3.7 Tibial Tuberosity 248

23.3.8 Proximal Tibial Physis 248

23.3.9 Distal Tibial Physis 248

References 248

24 Fractures of the Jaw 251
Teresa Jacobson

24.1 Anatomical Considerations 251

24.2 Jaw Fracture Management 251

24.2.1 The Principles of Jaw Fracture Management 252

24.2.2 Intubation Considerations for the Fracture Repair 253

24.2.3 Feeding Plan Post Jaw Fracture Repair 253

24.3 Pain Management 254

24.4 Maxillofacial Fracture Repair 255

24.5 Methods of Maxillofacial Fracture Stabilization 257

24.5.1 Tape or Nylon Muzzles 257

24.5.2 Osseous Wiring Techniques for Maxillofacial Fracture Repair 257

24.5.3 Intra‐Dental Wiring Techniques with Acrylic Reinforcement 260

24.5.4 Bonding the Maxillary to the Mandibular Canines 265

24.6 Bone Grafts 266

24.7 Teeth in the Fracture Line 266

24.8 Antibiotic Therapy in Maxillofacial Fracture Repair 267

24.9 Irrigation of the Appliance 267

24.10 Recheck Examinations 267

References 267

25 Approaches to the Long Bones 269
Anne M. Sylvestre

25.1 Approach to the Diaphysis of the Humerus 269

25.1.1 Patient Position 269

25.1.2 The Surgical Approach 269

25.2 Approach to the Diaphysis of the Radius 271

25.2.1 Patient Position 271

25.2.2 Surgical Approach 271

25.3 Approach to the Femoral Diaphysis 271

25.3.1 Patient Position 271

25.3.2 The Surgical Approach 272

25.4 Approach to the Tibial Diaphysis 272

25.4.1 Patient Position 272

25.4.2 The Surgical Approach 272

Reference 274

26 Implants 275
Harold Wotton

26.1 Maneuvering Orthopedic Implants 275

26.2 Quality Implants: Essential Information on Quality Implants 276

26.3 Titanium vs Stainless Steel 276

Index 279