Exotis ISSN 2398-2985

Reptiles

Limb fracture repair: external fixation

Contributor(s): Agata Witkowska, David Perpinan

Introduction

  • An alternative technique for limb fracture repair that can be combined with internal fixation Limb fracture repair: internal fixation.
  • External fracture fixation incorporates the use of variety of materials for the frame in smaller patients.
  • Principles of fracture fixation follow the same principles as in dogs and cats.
  • Generally avoided in Chelonia due to the presence of the shell; may be suitable for some mandibular fractures.
  • Can also be used for joint luxations, eg elbow.

Uses

  • Preferred method of fixation for open and comminuted fractures.
A full clinical exam and blood work should be performed before fracture fixation is attempted in reptiles. This is because many patients will suffer with underlying disease such as metabolic bone disease Metabolic bone disease, which makes them unsuitable patients for surgical fracture fixation.
  • Used for fractures of the humerus, radius, femur, tibia and mandible.

Advantages

  • Avoids joint immobilization allowing faster return to function post-operatively.
  • Cheaper than bone plating.
  • Allows for stabilization of fracture against more forces: bending, rotational and shearing.
  • Offers better fracture fragment apposition.
  • A variety of materials can be adapted for use as pins and frame to suit the patient.

Disadvantages

  • Requires close monitoring and frequent cleaning.
  • Risk of pin tract infections.
  • Pin loosening is a possibility.
  • External fixators are prone to contamination and trauma in fractious animals.
  • Prone to patient interference and chewing.
  • If used in aquatic species, dry docking will be needed for longer than with internal fixation methods.
  • Need to be removed.

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 Osteomyelitis.
  • Patients suffering with metabolic bone disease Metabolic bone disease carry a poor prognosis.

Further Reading

Publications

Refereed Papers

  • Recent references from PubMed and VetMedResource.
  • Di Geronimo P M (2019) Orthopedics in reptiles and amphibians. Vet Clin North Am Exot Anim Pract 22 (2), 285-300 PubMed.
  • Nau M R & Eshar D (2018) Rostral mandibular fracture repair in a pet bearded dragon (Pogona vitticeps). JAVMA 252 (8), 982-988 PubMed.
  • Tuxbury K A, Clayton L A, Snakard E P et al (2010) Multiple skull fractures in a captive fly river turtle (Caretochelys insculpta): Diagnosis, Surgical repair, and Medical Management. J Herpetol Med Surg 20 (1), 11-19.
  • Mitchell M A (2002) Diagnosis and management of reptile orthopedic injuries. Vet Clin North Am Exot Anim Pract 5 (1), 97-108 PubMed.

Other sources of information

  • Divers S J (2019) Surgery: Principles and Techniques. In: BSAVA Manual of Reptiles. 3rd edn. BSAVA, UK. pp 210-212, 232-234.
  • Knafo S E & Karlin W M (2019) Fracture Fixation and Arthrodesis. In: Mader’s Reptile and Amphibian Medicine and Surgery. Elsevier, USA. pp 1104-1108.


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