ISSN 2398-2950      

Fracture: internal fixation

ffelis

Synonym(s): Wire, Pin, Plate, Lag screw


Introduction

  • The aim of fracture management is early return to function and the provision of an optimal environment for fracture healing Fracture: healing. This can be achieved through the basic AO principles of fracture management, ie:
    • Fracture reduction and fixation to restore anatomical relationships.
    • Stability by fixation or splintage, as the nature of the fracture and injury require.
    • Preservation of blood supply to soft tissues and bone by careful handling and gentle reduction techinques.
    • Early and safe mobilization of the affected part of the patient.
  • Internal fixation can be performed with open, closed or minimally invasvie techinques depending on the location and type of fracture.
  • Types of implants used include:
  • Implants chosen should adequately resist the disruptive forces at the fracture site, ie axial compression, bending, rotation, shear and distraction/tension. Implant constructs can function in:
    • Load sharing:
      • Anatomic reduction of fracture.
      • Fractures are more likely to heal by direct healing.
    • Buttress:
      • Implants span fracture gap with no load sharing with bone.
      • Fracture heals though callus formation.

Uses

  • Diaphyseal fractures Fracture: overview:
    • Comminuted fractures that cannot be anatomically reduced appropriately are managed using implants in buttress.
    • Simple fracture that can be appropriately anatomically reduced are managed using load sharing constructs.
  • Metaphyseal fractures.
  • Joint fractures require anatomic reduction and rigid fixation.
  • Vertebral and pelvic fractures.
  • Certain open fractures:
    • Fractures can heal in the presence of infection if rigidly stabilized.

Advantages

  • Early return to function.
  • Good reduction and limb alignment possible.
  • Implants can remain in place provided no complications.

Disadvantages

  • Can be technically challenging.
  • Complications can occur which require additional medical or surgical treatment.
  • Equipment can be expensive.

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 when correctly applied.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Scott H (2005) Repair of long bone fractures in cats. In Practice 27 (8), 390-397 VetMedResource.
  • Basinger R R & Suber J T (2004) Two techniques for supplentating interlocking nail repair of fractures of the humerus, femur, and tibia: results in 12 dogs and cat. Vet Surg 33 (6), 673-680 PubMed.
  • Duhautois B (2003) Use of veterinary interlocking nails for diaphyseal fractures in dogs and cats: 121 cases. Vet Surg 32 (1), 8-20 PubMed.
  • Larin A, Eich C S, Parker R B et al (2001) Repair of disphyseal femoral fractures in cats using interlocking intramedullary nails: 12 cases (1996-2000). JAVMA 219 (8), 1098-104 PubMed.

Other sources of information

  • Piermattei D L, Flo G L, DeCamp C E (2006) Handbook of Small Animal Orthopaedics and Fracture Repair. Fourth edition. Saunders Elsevier, Missouri.
  • Johnson A L, Houlton J E F, Vannini R (2005) AO principles of fracture managment in the dog and cat. AP Publishing.

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