ISSN 2398-2985      

Limb fracture repair: internal fixation

4ferrets

Introduction

  • Technique of fracture fixation.
  • Often used in combination with external coaptation as well as external fixation.
  • Principles of fracture fixation follow the same principles as in dogs and cats.

Uses

  • Surgical fixation of fractures most used for long bones.
  • Internal fixation is often used for fractures of the humerus, radius and femur.
  • One reports of internal fixation for proximal ulna (olecranon) fracture exists.
  • Fractures of the metacarpal and metatarsal are uncommon and are suitable for external coaptation.
  • Internal fixation has been described for bilateral fracture fixation of the iliac body with the use of multiple K-wires and polymethylmethacrylate.
  • Different techniques used:
    • Intramedullary pin.
    • Kirschner wire.
    • Bone plate.

Advantages

  • Intramedullary pin:
    • Easy to place.
    • Require basic orthopedic experience.
    • Low cost: hypodermic needles can be adapted as an intramedullary pin for very small patients.
    • Decreased bone exposure.
    • Can be combined with other devices such as cerclage wires.
    • Preferred method of fixation in animals that would not tolerate an external fixator.
    • Early return to function possible.
  • Kirschner wire:
    • Occasionally used on its own for simple fractures, eg olecranon.
    • Do not require removal unless causing lameness.
  • Bone plates:
    • More control over forces acting on the bone.
    • Good fragment apposition.
    • Do not require removal unless causing discomfort.

Disadvantages

  • Intramedullary pin:
    • Do not counteract rotational forces:
      • Only bending forces are neutralized.
      • If placed through the joint, can predispose to arthritis.
    • Need to be removed.
  • Bone plates:
    • Require an experienced surgeon.
    • Longer anesthetic time compared to other methods.
    • More expensive to place.
    • Thin bone cortex of many patients prohibits the use of plates and screws.
    • Possible loss of bone strength post-operatively.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Good to guarded depending on complexity of procedure.
  • Open fractures carry a guarded prognosis due to possibility of post-operative osteomyelitis.
  • Patients suffering with metabolic bone disease carry a poor prognosis.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Schmidt L, Blake C, Dugat D et al (2019) Femoral type 2 Salter-Harris fracture repair in a domestic ferret (Mustela putorius furo). Vet Comp Ortho Traumatology 32 (4), A13-A24.
  • Pignon C, Vallefuoco R, Krumeich N et al (2014) Surgical repair of a pelvic fracture in a ferret (Mustela putorius furo). J Exot Pet Med 23 (1), 96-100 VetMedResource.
  • Ritzman T K (2002) Ferret orthopedics. Vet Clin North Am Exot Anim Pract 5 (1), 129-155 PubMed.
  • Pollock C (2002) Postoperative management of the exotic animal patient. Vet Clin North Am Exot Anim Pract 5 (1), 183-212 PubMed.
  • Williams M S (2002) Orthopedic radiography in exotic animal practice. Vet Clin North Am Exot Anim Pract 5 (1), 1-22 PubMed.

Other sources of information

  • Chitty J R & Johnson-Delaney C A (2016) Common Surgical Procedures. In: Ferret Medicine and Surgery. Ed: Johnson-Delaney C A. CRC Press, USA. pp 413-414.
  • Mehler S J (2014) Surgery. In: Biology and Diseases of the Ferret. 3rd edn. Eds: Fox J G & Marini R P. Wiley, Blackwell, USA. pp 304-305.

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