Lapis ISSN 2398-2969

Limb fracture repair: internal fixation

Contributor(s): David Perpinan, Anna Meredith

Introduction

  • Used to repair fractured limbs.
  • It can be used in combination with external fixation or external coaptation.

Print off the Owner factsheetCaring for your rabbit before and after surgery    Caring for your rabbit before and after surgery  to give to your clients.

Uses

  • Fractured limb   Limb fracture  , particularly femur   Femur: fracture 02 - lateral radiograph   and humerus, and sometimes metatarsal and metacarpal bones.
  • Metacarpal/metatarsal bones are usually fractured after the rabbit is stepped on. Stepping on a rabbit causes closed fractures.
  • Interna fixation is used for metacarpal/metatarsal bones when multiple bones are fractured   Metacarpal: fracture repair internal fixation - DV radiograph  . If only one or two bones are fractured, conservative treatment or external coaptation may be more indicated. 
  • Intramedullary pin fixationis best used for simple femoral and humeral fractures, although it is commonly combined with external fixation to avoid rotation.
  • Platescan be a useful alternative technique to external fixation for grade 2 or 3 fractures of the humerus and femur - but needs a very experienced surgeon.

Advantages

Intramedullary pin fixation
  • This technique is available to most practices and works very well in the rabbit.
  • Most veterinary surgeons are familiar with this method, and it is relatively quick and economical.
  • The rapid healing time of rabbits means that early pin loosening is not normally a problem.

Plates

  • Useful method for complex fractures, particularly in the femur   Femur: fracture 03 - AP radiograph    Femur: fracture repair 02 internal fixation - AP radiograph  .

Disadvantages

  • It generally needs combination with external fixation to avoid rotation.

Plates

  • Needs very experienced surgeon and specialized equipment; therefore, not commonly used in general practice.
  • Expensive.
  • Increases anesthetic time.
  • The wider surgical exposure also increases the risk of osteomyelitis and non-union.
  • Early plate removal is recommended to avoid over protection of the fracture site necessitating a second anesthetic and further cost to the owner.
  • The comminuted nature of most rabbit fractures and the thin cortices makes screw placement difficult.
  • The placement of multiple screws increases the risk of fissures, particularly in giant breeds.

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

  • Varies from good to poor, depending on the type of fracture.
  • Open and severe comminuted fractures, and pathological fractures, carry a grave prognosis.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Pead M J & Carmichael S (1999) Treatment of a severely comminuted fracture in a rabbit using a Kirshner-Ehmer apparatus. JSAP 30 (10), 579-591 Wiley Online Library.
  • Terjesen T (1984) Bone healing after metal plate fixation and external fixation of the osteotomised rabbit tibia. Acta Orthop Scand 55 (1), 69-77 PubMed.

Other sources of information

  • Bojrab M J, Waldron D R & Toombs J P (2013) Eds Current techniques in Small Animal Surgery. Teton NewMedia.
  • Harcourt-Brown F & Chitty J (2013) Eds BSAVA Manual of Rabbit Surgery, Dentistry and Imaging.BSAVA. pp 440
  • Slatter D (1993) Textbook of Small Animal Surgery. Volume 2. W B Saunders.
  • Brinker W O, Piermattei D L & Flo G L (1990) Handbook of Small Animal Orthopaedics and Fracture Treatment. 2nd edn. W B Saunders.


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