Exotis ISSN 2398-2985

Reptiles

Limb fracture repair: internal fixation

Contributor(s): Agata Witkowska, David Perpinan

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.
  • Often used for fractures of the humerus and femur. Occasionally used for fixation of mandibular fractures with combination of suture material or plates and screws.
  • Intramedullary pins most used.
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.
  • 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.
    • Preferred fracture fixation technique in aquatic species, where external fixation will prohibit normal activity.
    • 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.
    • Although the use of bone plates has been described in reptiles, they can be particularly difficult to fit in Chelonia due to the presence of the shell.

Disadvantages

  • Intramedullary pin:
    • Do not counteract rotational forces:
      • Only bending forces are neutralized.
      • If placed through the joint, can predispose to arthritis.
      • Higher risk of pin migration compared to mammals due to slower fracture healing.
    • Need to be removed.
  • Bone plates:
    • Require an experienced surgeon.
    • Longer anesthetic time compared to other methods.
    • Can be difficult to place in reptiles as the bone surface is sometimes more irregular compared to mammals. May need special contouring.
    • 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.
  • Di Geronimo P M (2019) Orthopedics in reptiles and amphibians. Vet Clin North Am Exot Anim Pract 22 (2), 285-300 PubMed.
  • Castro J L C, Santalucia S, Pachaly J R et al (2014) Mandibular osteosynthesis in a Boa constrictor snake. Semina: Cienc Agrar 35 (2), 911-918 VetMedResource.
  • Di Giuseppe M, Faraci L & Luparello M (2013) Use of intramedullary pin for humeral fracture repair in a Chamaeleo chamaeleon. Natura Rerum 3, 63-69. 
  • Raftery A (2011) Reptile orthopedic medicine and surgery. J Exot Pet Med 20 (2), 107-116 VetMedResource.
  • Scheelings T F (2008) Surgical management of maxillary and mandibular fractures in an eastern Bluetongue Skink, Tiliqua scincoides scincoides. J Herpetological Med Surg 7 (4),136-140 VetMedResource.
  • Matičić D, Stejskal M, Vnuk D et al (2007) Internal fixation of a femoral fracture in a green iguana developing metabolic bone disease – a case report. Veterinarki Arhiv 77 (1), 81-86 VetMedResource.
  • Pollock C (2002) Postoperative management of the exotic animal patient. Vet Clin North Am Exot Anim Pract 5 (1),183-212 PubMed.
  • Mitchell M A (2002) Diagnosis and Management of Reptile Orthopedic Injuries. Vet Clin North Am Exot Anim Pract 5 (1), 97-108 PubMed.
  • Williams M S (2002) Orthopedic radiography in exotic animal practice. Vet Clin North Am Exot Anim Pract 5 (1), 1-22 PubMed.
  • Crane S W & Jacobsen M C (1980) Neutralization bone-plating repair of a fractured humerus in an aldabra tortoise. JAVMA 177 (9), 945-948 PubMed.
  • Pritchard J & Ruzicka A (1950) Comparison of fracture repair in the frog, lizards and rat. J Anat 84, 236-261 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 604-605.


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