Canis ISSN: 2398-2942

Biological fracture fixation

Synonym(s): If plate and screws used: Minimally invasive plate osteosynthesis MIPO

Contributor(s): Neil Burton, Prof Mark Rochat

Introduction

  • Surgical repair of comminuted long bone fractures in animals is shifting from the traditional, mechanical emphasis of anatomic reconstruction to a more functional, biological approach.
  • As with many other veterinary protocols, this trend in orthopedic surgery has been adapted from human studies performed in the late 1980s and early 1990s.
  • Successful clinical results using this method of biological fracture fixation (also termed bridging osteosynthesis) are now routinely appearing in the veterinary clinical journals and have become standard textbook inclusions.
    In both injured people and animals, faster healing and fewer complications have been reported with biological fixation methods compared to more invasive anatomic reconstruction.
  • Clinicians who perform orthopedic surgery should consider the biological approach for fracture fixation in lieuof attempts to anatomically reconstruct comminuted bone segments Femur: comminuted fracture 01 - radiograph Femur: comminuted fracture 02 (repair) - radiograph Femur: comminuted fracture 03 (repair) - radiograph.
  • Surgeons have several options including bone plates Fracture fixation: plate , interlocking nails Fracture fixation: interlocking nail , and external fixators Fracture: external fixation Fracture fixation: external skeletal fixator in treating these complex fractures. Preservation of hard and soft tissue integrity, maintenance of spacial alignment of joints above and below the fracture together with utilization of stable implants are the keys for reduction of patient morbidity and a prompt return to function.

Problems with fracture fixation

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Biological approach

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Indications for biological approach

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Post-operative care

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Further Reading

Publications

Refereed papers

  • Recent references from VetMed Resource and PubMed.
  • Horstman C L, Beale B S, Conzemius M G & Evans R R (2004) Biological osteosynthesis versus traditional anatomic reconstruction of 20 long-bone fractures using an interlocking nail: 1994-2001. Vet Surg 33 (3), 232-237 PubMed.
  • Reems M R, Beale B S & Hulse D A (2003) Use of a plate-rod construct and principles of biological osteosynthesis for repair of diaphyseal fractures in dogs and cats: 47 cases (1994-2001). JAVMA 223(3), 330-335 PubMed.
  • Johnson A L, Smith C W & Schaeffer D J (1998) Fragment reconstruction and bone plate fixation versus bridging plate fixation for treating highly comminuted femoral fractures in dogs. JAVMA 213,1157-1161 PubMed.
  • Hulse D, Human W & Nori M (1997) Reduction in plate strain by addition of an intramedullary pin. Vet Surg 26,451-459 PubMed.
  • Aron D N, Johnson & Palmer R H (1995) Biologic strategies and a balanced concept for repair of highly comminuted long bone fracturesComp Cont Educ Pract Vet 17, 35-49.

Other sources of information

  • Palmer R H (1999) Biological osteosynthesisVet Clin North Am Sm Anim Pract 29, 1171-1185 PubMed.


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