Exotis ISSN 2398-2985

Reptiles

Limb fracture repair: external coaptation

Contributor(s): Agata Witkowska, David Perpinan

Introduction

  • Immobilization of the limb can be used to repair simple fractures with minimal displacement.
  • Allows for stabilization of fractures before and after surgical repair.
  • Can also be used to treat luxation and subluxation.
  • External coaptation is commonly performed in reptiles, but full investigations need to be performed to determine fracture etiology:
    • Low impact trauma fractures are often simple and closed, eg diaphyseal femoral fractures:
      • Jumping out of the vivarium or enclosure.
      • Being dropped when handled.
    • Pathological fractures due to metabolic bone disease are often comminuted:
      •  The animal might not be a good candidate for fracture fixation if underlying disease is present.
    • Chelonians are often present for complicated, open fractures due to high-impact trauma:
      • Road traffic accidents after wandering off from the garden .
      • Domestic accidents such as during lawn mowing.
      • Fox or dog attacks

Uses

  • Simple limb fractures.
  • Where the fracture has minimal fragment displacement and there is >50% cortical contact after reduction.
  • Luxation of the distal limb.
  • Surgery is of a high risk to the patient.
  • Surgical repair is cost prohibited.
  • Size of the patient and bone thickness prohibits surgical fixation.
  • Underlying pathology is present making the animal a poor candidate, eg metabolic bone disease Metabolic bone disease.

Advantages

  • Inexpensive.
  • Quick procedure.
  • Easy to perform in most cases.
  • Little materials needed; basic bandages will be suitable for most cases.
  • Can sometimes be performed anesthesia free: analgesia should always be provided.

Disadvantages

  • Bandages and splints can be difficult to apply on small patients:
    • Slip easily.
    • Can be traumatized by the animal.
    • Can become easily contaminated.
    • Frequent changes may be needed.
    • If applied incorrectly ischemic necrosis may occur.
  • Limb may not regain full function.
  • The affected leg may require further treatment or amputation if the fracture does not heal.
  • Immobilization of limbs in skeletally immature animals can lead to joint deformities.

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

  • Dependent on site of the fracture.
  • Simple, noncomplicated fractures: good.
  • Long bones: guarded.
  • Fractures with joint involvement: guarded.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • DiGeronimo P M (2019) Orthopedics in reptiles and amphibians. Vet Clin North Am Exot Anim Pract 22 (2), 285-300 PubMed.
  • Alworth L, Hernandez S M & Divers S J (2011) Laboratory reptile surgery: principles and techniques. J Am Assoc Lab Anim Sci 50 (1), 13-14 PubMed.
  • Raftery A (2011) Reptile orthopedic medicine and surgery. J Exot Pet Med 20 (2), 107-116 VetMedResource.
  • Mitchell M A (2002) Diagnosis and management of reptile orthopedic injuries. Vet Clin North Am Exot Anim Pract 5 (1), 97-108 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

  • Mader D R & Bennett R A (2006) Surgery. In: Reptile Medicine and Surgery. 2nd edn. Ed: Mader D R. Saunders/Elsevier, USA. pp 599-604.


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