ISSN 2398-2950      

Fracture: external fixation

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Synonym(s): External coaptation - Casts, Splints, (Bandages, External skeletal fixation (ESF)


Introduction

Uses

External coaptation

  • Includes splints and casts. Proper immobilization is best achieved with a cast; splints and bandages (Robert Jones) are best used for temporary immobilization prior to definitive repair.
  • Simple, recent, transverse fractures in young animals with little displacement, which are easy to reduce and are relatively stable on reduction (casts).
  • Greenstick fractures (casts or splints).

External skeletal fixation (ESF)

  • Open fractures where access to skin wounds is necessary (ESF).
  • Correction of limb deformities following epiphyseal fractures Epiphyseal trauma (ESF - distraction techniques)
  • Mandibular/maxillary fractures (acrylic ESF).
  • Non-union and highly comminuted fractures (ESF).

Advantages

External coaptation

  • Widespread availability.
  • Avoidance of surgery and complications directly related to surgery.
  • Can produce rapid uncomplicated fracture healing when used in the appropriate situations.

External skeletal fixation (ESF)

  • No implants left in the bone.
  • Easy access for wound management for open fractuers.
  • Relatively rigid immobilization of fragments.
  • Equipment resusable (not the pins).

Disadvantages

External coaptation

  • Use is limited to the lower limbs (below elbow and stifle).
  • Joints above and below the affected bone must be immobilized increasing the likelihood of fracture disease.
  • Casts may be bulky and uncomfortable and become self-traumatized leading to a necessity for replacement.
  • Sores can develop under the cast.
  • Some fractures types are poorly immobilized.

External skeletal fixation (ESF)

  • Immobilization not as rigid as with internal fixation.
  • Not recommended where primary bone healing is optimal, eg for articular fractures.

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

  • Dependant on individual cases.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Johnson A L, DeCamp C E (1999) External skeletal fixators. Linear fixators. Vet Clin North Am Small Anim Pract 29 (5), 1135-1152 PubMed.
  • Oakley R E (1999) External coaptation. Vet Clin North Am Small Anim Pract 29 (5), 1083-1095 PubMed.
  • Langley-Hobbs S J, Carmichael S, McCartney W T (1997) External skeletal fixator for stabilisation of comminuted humeral fractures in cats. JSAP 38 (7), 280-285 PubMed.
  • Langley-Hobbs S J, Carmichael S, McCartney W T (1996) Use of the external fixator in the repair of femoral fractures in cats. JSAP 37 (3), 95-101 PubMed.

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