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1.
Femur fractures associated with canine total hip replacement   总被引：1，自引：0，他引：1  
OBJECTIVE: To report femur fracture as a complication of canine total hip replacement (THR) and to report the incidence, predisposing factors, treatment options, and outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Twenty-two client-owned dogs with 24 femoral fractures occurring during or after THR. METHODS: Cemented THR (BioMedtrix, Boonton, NJ) was performed. Medical records and radiographs were used to identify dogs that had femur fracture and to identify risk factors. Follow-up was obtained until dog death or study end. RESULTS: The overall incidence of femur fracture after THR was 2.9%. Femoral fractures occurred intraoperatively, immediately postoperatively, and up to 2196 days after THR. In 17 dogs, fractures resulted from a traumatic event. Osteopathy was present at THR in 5 dogs; all developed femoral fissures during reaming. Three dogs had fractures associated with cortical thinning secondary to aseptic loosening. Fracture treatment included euthanasia (1 dog), strict confinement (3 dogs), full cerclage wires on long oblique fractures (3 dogs), or plate and screw fixation (10 with, and 7 without, cerclage wires). All fractures extended near the distal tip of the femoral stem and all aggressively treated fractures healed. CONCLUSIONS: Predisposing risk factors for femur fracture after THR include osteopathy and iatrogenic fissures created during reaming. Trauma, excessive load concentration, and increased torque can lead to mid-diaphyseal fracture near the end of the femoral stem. Fracture did not disrupt THR implants. Cement fracture exposing the tip of the femoral stem did not affect fracture healing or rehabilitation. Immediate plate and screw fixation resulted in the most favorable outcome; healing occurred in 6-10 weeks. CLINICAL RELEVANCE: Femur fractures that occur after THR should be repaired using plate and screw fixation augmented with cerclage wire when needed. Forces on fissures should be neutralized to prevent propagation and fracture. Owners of high-risk patients (old dogs with osteopathies or previous hip surgery) should be counseled before THR. The prognosis is excellent when fractures are treated correctly.  相似文献   

2.
Multiple intramedullary wire fixation infrequently can be used as an alternative technique to plating, transfixation devices, single intramedullary pinning, or external coaptation for some radius and ulna fractures.
This report describes a comminuted fracture of the radius and ulna with fissures and comminution extending too far into the proximal radius for effective application of a bone plate or Kirschner-Ehmer apparatus. Resulting fracture instability and collapse prohibited effective use of external coaptation as a primary means of fixation. The radial fracture was repaired and stabilized with full cerclage wires and multiple intramedullary Kirschner wires. The dog was using the leg normally 12 months following surgery.  相似文献   

3.
OBJECTIVE: To evaluate the use of polyamide bands, manufactured for securing electrical cables, for repair of oblique femoral fractures in rabbits. STUDY DESIGN: Experimental study. ANIMALS: Twelve nulliparous, 21-25-week-old, California female rabbits. METHODS: Rabbits were divided into 3 groups (n=4) and studied for 14, 28, or 56 days. A Z-shaped mid-diaphyseal femoral osteotomy was repaired with a 2.5 mm intramedullary pin and a polyamide 6.6 cerclage band. Healing was evaluated at intervals by physical examination, limb use, femoral radiographs, and callus histology. RESULTS: Rabbits had early limb use with good wound healing. From the 1st day, movement of the hip and stifle joints was satisfactory. Radiographically, fractures were healed at 28 days. Histologically, there was no foreign body reaction and bone healing was normal. CONCLUSION: Nylon cerclage band application was accomplished easily, maintained reduction, and resulted in good healing and limb use. CLINICAL RELEVANCE: Sterilized nylon bands, manufactured for electrical use, can be used for cerclage in rabbits.  相似文献   

4.
OBJECTIVE: To compare the monotonic tensile and fatigue strength of 16-gauge stainless steel wire (SSW) to ultra-high-molecular weight polyethylene (UHMWPE) cable using a transfixed cerclage technique in an in vitro midbody sesamoid osteotomy model. Endoscopic modifications to Martins transfixed cerclage technique were developed. A new suture technique of fixation was compared with the transfixed cerclage technique by measuring gap formation after cyclic testing. STUDY DESIGN: An in vitro biomechanical paired equine cadaver limb study. SAMPLE POPULATION: Twenty-one paired cadaveric adult equine forelimbs. METHODS: Uniaxial medial midbody sesamoid osteotomies were created in paired adult equine forelimbs. Monotonic tensile strength was measured on 10 forelimbs repaired by a transfixed cerclage technique using wire or cable. Fatigue testing to failure was performed on 4 forelimbs repaired using the transfixed cerclage technique by cycling the limbs between 500 N and 2,000 N. The limbs were initially repaired with wire, cycled until the wire broke, then repaired with cable and cycled again to failure. Fatigue testing for gap displacement was performed on 8 limbs repaired with either the transfixed cerclage technique or the suture technique. Limbs were cycled between 500 N and 2,000 N for 10,000 cycles. The limbs were repaired with wire initially, tested, and then repaired with cable and tested again. Twenty-two limbs were used for mechanical testing. The remaining limbs (20) were used to develop and practice the endoscopic transfixed cerclage (10 limbs) and suture (10 limbs) techniques. RESULTS: Ultimate tensile strength (UTS) of UHMWPE cable constructs was 34% greater than the UTS of SSW constructs. Fatigue strength was 2 to 20 times greater for UHMWPE cable constructs than SSW constructs. Separation of fragments was 153% less for limbs repaired by the suture technique compared with those repaired by the transfixed cerclage technique. CONCLUSIONS: UHMWPE cable shows promise for this clinical application because of its greater tensile and fatigue strength. The newly described suture technique significantly reduced gap formation compared with the transfixed cerclage technique. Osteotomy gap formation occurred early in cycling, suggesting that rigid support in the form of a cast may be needed during the early postoperative period for wiring techniques. CLINICAL RELEVANCE: Clinical testing of UHMWPE cable should eliminate problems of wire breakage seen with SSW. The endoscopic transfixed cerclage technique can be used by surgeons familiar with arthroscopic surgery. However, the suture technique needs to be tested in vivo to determine whether there is a clinical advantage compared with the transfixed cerclage technique.  相似文献   

5.
Isobutyl 2-cyanoacrylate was used to reattach partial-thickness cortical bone fragments from the femur in rabbits. Stability, apposition, callus formation, and inflammation around the fragments were evaluated at 2, 4, 8, and 12 weeks.
All glued bone fragments were stable, compared with 85% of controls. Good apposition was achieved in 95% of the glued bone fragments, compared with 19% of the controls. Analysis of the mean scores for callus formation revealed a significant difference only in the 8 week survival group.
Bony union was noted in 20 of 21 of the glued fragments. No evidence of inflammation was seen around the glue, and viable bone was seen adjacent to the adhesive in many sections. In control legs, 13 fragments had healed by osseous union, two by fibrous union, and in six the chip had resorbed.  相似文献   

6.
OBJECTIVE: To determine bone healing at 20 weeks, after either static fixation (SG) or after dynamization (DG) at 4 weeks in osteotomized canine femurs repaired with an interlocking nail (ILN) secured with a type I external skeletal fixator (ESF). STUDY DESIGN: Experimental study. ANIMALS: Ten adult beagle dogs. METHODS: After mid-diaphyseal femoral osteotomy, femurs in 10 dogs were repaired with an ILN secured with 4 (2 proximal, 2 distal) threaded custom pins (TP; 2.7-mm-diameter cortical screw with a 2-mm shaft attached to the screw head) to which 2 parallel connecting bars were attached in a type I ESF configuration. In 5 dogs, dynamization was performed at 4 weeks by removing the connecting bars and 2 distal screws. Limb function, range of motion of the stifle joint (ROMSJ), radiographic evidence of bone healing, and complications were studied for 20 weeks. RESULTS: Full limb function was achieved between 8 and 10 weeks in SG dogs, but a decreased ROMSJ was observed from 5 to 8 weeks. In DG dogs, full limb function occurred between 5 and 6 weeks except in 1 dog, and ROMSJ was considered normal in all dogs. Bone healing was not affected by dynamization. Average healing time for SG was 12.8 weeks, and for DG it was 13.6 weeks. Periosteal reaction at TP insertion points, osteolysis around the thread and head of TPs were observed in both groups. A windshield-wiper effect was observed at the tip of 1 ILN. CONCLUSION: ILN locked with a type I ESF can be used for fixation of mid-shaft femoral fractures. Dynamization at 4 weeks did not affect bone healing but did prevent stifle ankylosis and promoted earlier limb function. CLINICAL RELEVANCE: ILN locked with a type I ESF is seemingly a feasible method for repair of mid-shaft femoral fractures and may decrease risk of nail failure.  相似文献   

7.
The stiffness, load to failure, and bending moments of adult intact equine humeri and humeri repaired with 3 fixation techniques were determined in vitro. Bones were tested in axial compression (30 pairs), mediolateral 3-point bending (15 pairs), and caudocranial 3-point bending (15 pairs). An oblique osteotomy of 1 humerus of each pair was performed to simulate the long spiral oblique fractures that occur clinically in horses. Bones were repaired in 3 ways: group 1--nylon band cerclage fixation (20 bones); group 2--multiple intramedullary pinning (20 bones); and group 3--nylon band cerclage fixation and multiple intramedullary pinning (20 bones). Intact bones were significantly (P less than 0.05) stronger than repaired bones in each testing mode. Bones repaired with bands only were significantly less stiff in bending than were bones repaired with pins only or with pins and bands. In compression, only specimens repaired with pins and bands were significantly stiffer than were bones repaired with bands only. Bones repaired with bands only required significantly less load to failure in compression and in caudocranial bending than did bones repaired with pins only or with pins and bands. Bones repaired with pins only deformed through the full displacement of the actuator (5 cm), and pins deformed plastically. Bones repaired with pins and bands were stiffer and had higher bending moments than did bones repaired with pins only, but the differences were not significant.  相似文献   

8.
OBJECTIVES: To evaluate healing of a radial osteotomy repaired by application of dynamic axial fixation devices (DAF) in large ruminants. STUDY DESIGN: In vivo study of bone healing after application of 2 DAF types. Model I had 2 sidebars, each with a central cylindrical cuff (internally threaded) with 2 detachable connecting rods telescoping within the cuff. Model II had 2 side bars with 2 moveable clamps with multiple holes. SAMPLE POPULATION: Bull calves (n=8; aged, 1.5-2.0 years; weighing, 175-250 kg). METHODS: A mid-diaphyseal radial osteotomy was repaired by use of a model I (n=4) or model II (n=4) DAF. Calves were monitored for weight bearing, stability of fixation, and radiographically for fracture reduction, alignment and healing at intervals for 6 months. Fixators were removed when there was radiographic evidence of healing. RESULTS: Both the fixators were well tolerated with free movement of adjacent joints. Fragment fixation was maintained until healing in all but 1 model I calf where failure occurred within 7 days. Model II DAF provided more rigid fixation as indicated by early full weight bearing and fracture healing with less callus formation. Functional recovery of repaired limbs occurred within 60 days in surviving calves. CONCLUSIONS: Both bilateral DAFs were easy to apply; however, the model II DAF provided better fixation. CLINICAL RELEVANCE: The model II DAF made of low carbon steel was economical and may be useful for treating long bone fractures in large ruminants.  相似文献   

9.
A yearling Arabian filly presented with a history of acute hindlimb lameness, marked tarsocrural effusion and associated soft tissue swelling and was diagnosed with fractures of both the lateral and medial malleoli of the distal aspect of the tibia. The fractures were repaired using a combination of cortical bone screws placed in lag fashion and a tension band wire. A full limb cast bandage was placed for recovery from general anaesthesia and the early post operative period. Despite radiographic development of osteoarthritis, 21 months after surgery the filly was clinically sound and racing successfully.  相似文献   

10.
The fixation of fractures in which one of the following primary devices is used: IM pins, bone plates, external skeletal fixators, can benefit from the additional application of any number of secondary devices. The secondary devices include cerclage, hemicerclage, or interfragmentary wires, skewer-pins, screws, and external skeletal fixators. These are indicated to facilitate the repair and eliminate the forces acting on the fracture site. A complete understanding of all the methods of fixation facilitates the selection of the proper implant or combination of implants. This information must be combined with the knowledge of how each device is most appropriately used depending on both the fracture type and fracture location. Taking into consideration all of these factors helps ensure that fracture healing occurs in the shortest possible time with the fewest complications. The ultimate goal of obtaining a full return to function may thereby be achieved.  相似文献   

11.
OBJECTIVE: To compare fracture locations, repair methods, complications, and outcomes of horses with fractures of the rostral portions of the mandible and maxilla. DESIGN: Retrospective study. ANIMALS: 89 horses with fractures of the rostral portions of the mandible and maxilla. PROCEDURE: Medical records and radiographs were reviewed. Fractures were categorized by fracture location and stability. Postoperative complications and long-term outcome were determined by clinical examination and telephone interviews with horse owners. RESULTS: 4 fracture types were recognized. Fractures involving just the alveolar plate (33%) and those involving the alveolar plate and the body of the bone (32%) were most common and were often repaired by interdental wiring. Unilateral fractures of the mandible (11%) were managed without surgery if stable. Unstable fractures were repaired with wires, a U-shaped bar (U-bar), or a bone plate. Bilateral fractures (24%) were often repaired with orthopedic wires in foals or with a U-bar, acrylic splint, wires, or bone plate in adult horses. In 2 horses, bilateral fractures were managed conservatively. Short-term complications developed in 24 of 89 (27%) horses. Soft tissue infections and wire loosening or failure were the most common short-term and long-term complications. Wire replacement was not required in any horses after release from hospital. Persistent draining tracts were most often associated with bone sequestration. Long-term functional and cosmetic outcomes were favorable for all fracture types and repair methods. CLINICAL IMPLICATIONS: Although complications in horses with fractures of the mandible and maxilla are common, long-term prognoses for functional and cosmetic outcome are favorable.  相似文献   

12.
Four long bone fractures with a short distal fragment were repaired with a cobra head bone plate alone (2 cattle) or in combination with a straight, broad dynamic compression plate (2 horses). Three fractures were of the distal femur (1 horse, 2 cattle) and one was of the distal radius (1 horse). The long-term outcome of the three femoral fractures was soundness in one case and mild lameness in two. Although satisfactory bone healing progressed in the horse with the radial fracture, laminitis in the contralateral forelimb necessitated euthanasia at week 6.  相似文献   

13.
OBJECTIVE: To evaluate 2 methods of midbody proximal sesamoid bone repair--fixation by a screw placed in lag fashion and circumferential wire fixation--by comparing yield load and the adjacent soft-tissue strain during monotonic loading. STUDY DESIGN: Experimental study. SAMPLE POPULATION: 10 paired equine cadaver forelimbs from race-trained horses. METHODS: A transverse midbody osteotomy of the medial proximal sesamoid bone (PSB) was created. The osteotomy was repaired with a 4.5-mm cortex bone screw placed in lag fashion or a 1.25-mm circumferential wire. The limbs were instrumented with differential variable reluctance transducers placed in the suspensory apparatus and distal sesamoidean ligaments. The limbs were tested in axial compression in a single cycle until failure. RESULTS: The cortex bone screw repairs had a mean yield load of 2,908.2 N; 1 limb did not fail when tested to 5,000 N. All circumferential wire repairs failed with a mean yield load of 3,406.3 N. There was no statistical difference in mean yield load between the 2 repair methods. The maximum strain generated in the soft tissues attached to the proximal sesamoid bones was not significantly different between repair groups. CONCLUSIONS: All repaired limbs were able to withstand loads equal to those reportedly applied to the suspensory apparatus in vivo during walking. CLINICAL RELEVANCE: Each repair technique should have adequate yield strength for repair of midbody fractures of the PSB immediately after surgery.  相似文献   

14.
Severely comminuted diaphyseal fractures in 11 dogs were repaired with standard bone plates that spanned a fracture gap filled with autogenous cancellous bone graft. Five dogs had closed injuries, 4 dogs had open fractures, and 2 dogs had infected nonunion fractures for which previous attempts at internal pin fixation had failed. A second autogenous cancellous bone graft was performed in 3 of the dogs during the healing period. The technique was successful in all dogs. The technique was considered a versatile and relatively simple alternative, compared with meticulous small fragment reconstruction and cortical bone allografts.  相似文献   

15.
YAN LU  MD    BRETT NEMKE  BS    DOUGLAS M. LORANG  PhD    ROEL TRIP  MD    HIROHITO KOBAYASHI  MS    MARK D. MARKEL  DVM  PhD  Diplomate ACVS 《Veterinary surgery : VS》2009,38(4):467-476
Objectives— To compare bone healing of tibial osteotomy repaired with Nitinol wire braid and hardened steel rods (Braid system) and polymethylmethacrylate bone cement with an interlocking intramedullary (IM) nail fixation in an ovine model.
Study Design— In vitro and in vivo experimental study.
Animals— Adult female sheep (n=22).
Methods— Using sheep tibia, a middiaphyseal transverse osteotomy was performed in the right tibia, which were then randomly assigned to the Braid system group or IM nail group (n=5). The left tibia were used as controls. The torsional properties of tibial constructs were compared. The study was repeated in vivo in 12 sheep and mechanical properties and bone healing were evaluated at 12 weeks.
Results— In vitro, there was no significant difference in torsional stiffness between the groups. In vivo, operative time for the Braid system group was significantly shorter than the IM nail group. At 12 weeks, there were no significant differences in maximum torque and torsional stiffness between IM nail and Braid system groups nor were there significant radiographic or histologic differences between the groups.
Conclusions— The Braid system might decrease operative time for repair of transverse middiaphyseal tibial fractures and result in similar bone healing at 12 weeks after surgery compared with an interlocking IM nail repair.
Clinical Relevance— A Nitinol Braid system may be a treatment option for transverse midshaft tibial fractures.  相似文献   

16.
Intramedullary fully-threaded pins were manufactured from an alloy of titanium, aluminium and vanadium in a fully-threaded style. Pins were produced in various diameters, ranging from 4 mm to 11 mm. Pin lengths varied from 5 cm to 22 cm. The proximal end of the pins was designed to fit into a hexagonal screwdriver, while the distal end was slightly tapered to allow for ease of entry into cancellous bone. Treatment using the fully-threaded intra- medullary pin was carried out in a total of 175 fractures of the humerus, femur, and tibia in 95 cats (bilateral femur in 1 case) and 77 dogs (bilateral femur in 2 cases). Radiographic follow-up for the cases was performed at monthly intervals. Non-union developed in one dog with a femoral fracture in which cerclage wire had also been used. Delayed healing and lameness were observed in two other dogs. Healing with excessive callus formation was observed in 16 dogs. However, there were not any problems noted in these dogs in regards to limb usage. Clinical and radiological results obtained for the remaining cases were found to be very good. Normal, complete fracture healing occurred between four to 14 weeks in dogs, and between four to 12 weeks in cats. Pins were removed upon observation of satisfactory functional and radiographic recovery. Pins could not be removed from 26 cats and 21 dogs as the owners had declined pin removal, or because the owners were lost to follow-up.  相似文献   

17.
PURPOSE: To examine and evaluate clinical indications and postoperative outcome in a series of small animal patients in which corneal disease was managed by the application of butyl 2-cyanoacrylate adhesive. MATERIALS AND METHODS: In this retrospective study all small animal patients were identified that presented to the Royal Veterinary College, University of London over a 2-year period, in which corneal disease was managed by the application of butyl 2-cyanoacrylate. Indications for application, complicating factors prior to gluing, glue retention time, postoperative comfort, and extent of subsequent corneal reaction and scarring were noted for each case. Long-term follow-up data concerning visual and cosmetic outcome were obtained from owners and referring veterinarians. RESULTS: Thirty-seven patients (28 dogs and 9 cats), in which 39 eyes were treated, were identified. Indications for corneal gluing in this series included stromal ulceration (26/39 eyes); descemetocele (4/39 eyes); corneal laceration/foreign body (5/39 eyes); lamellar keratectomy (3/39 eyes) and superficial ulceration (1/39 eyes). At least one factor responsible for initiation, persistence or progression of the ulcer was identified in 66.7% of eyes prior to corneal gluing. These included keratomalacia; confirmed bacterial keratitis; corneal edema related to endothelial disease and keratoconjunctivitis sicca. Cyanoacrylate was generally well tolerated by patients with only 8/34 eyes demonstrating transient blepharospasm and increased lacrimation postoperatively. Retention time of cyanoacrylate varied widely from < 1 week to approximately 6 months, but was < 2 months in the majority (89%) of eyes. Exaggerated corneal vascularization was an infrequent postoperative complication, noted in only six canine eyes, and did not appear to be related to initial corneal disease, glue retention time or breed. CONCLUSIONS: Butyl 2-cyanoacrylate offers a convenient, economical and effective alternative to other treatment modalities, such as conjunctival grafts, in the management of corneal defects in canine and feline patients.  相似文献   

18.
OBJECTIVE: To investigate the effectiveness of intramedullary xenograft cortical bone pins compared with stainless steel Kirschner wire for the repair of a standardized avian humeral fracture. STUDY DESIGN: Prospective randomized study. SAMPLE POPULATION: Thirty mature pigeons (Columba livia). METHODS: Birds were randomly assigned to 3 groups. Transverse mid-diaphyseal humeral fractures were created in 1 humerus in each bird. Fractures were stabilized with intramedullary ostrich or canine xenograft cortical bone pins or Kirschner wire. Radiographic, histological, and biomechanical assessments were used to compare fracture healing 6 weeks after fracture stabilization. The contralateral humerus of each bird was used as a control. RESULTS: All fractures healed regardless of intramedullary pin type. There were no statistically significant biomechanical differences among groups or within groups. Xenograft cortical bone pins induced a mononuclear inflammatory reaction that did not impair bone healing. Bones stabilized with intramedullary cortical bone pins had more periosteal callus and inflammation at the fracture site than bones stabilized with stainless steel Kirschner wires. CONCLUSIONS: Intramedullary xenograft cortical bone pins, derived from mammalian or avian sources, appear to represent an alternative for the repair of avian humeral fractures. CLINICAL RELEVANCE: Intramedullary xenograft cortical bone pins are biodegradable and may reduce the need for additional surgery to remove implants after fracture healing.  相似文献   

19.
Fifty-one calcaneus fractures associated with (41) or without (10) central tarsal bone (Tc) fractures in racing greyhounds were evaluated and categorized. All calcaneal fractures with no Tc fractures had a plantar proximal intertarsal subluxation. No subluxations were found in dogs with both calcaneal and central tarsal fractures. The calcaneal fractures were treated either with coaptation splints or surgical repair. Surgical techniques included a Steinmann pin with a figure eight tension band device or screw or plate fixation as primary techniques supplemented by Kirschner wires and cerclage wires. In all calcaneal fractures associated with plantar proximal intertarsal subluxation, an arthrodesis of the calcaneoquartal joint was performed. All 22 surgically repaired fractures in dogs available for physical and radiographic reexamination had healed within 1 to 6 months. Eight dogs with fractures of the calcaneus associated with fractures of Tc returned to a racing career. None of the dogs with plantar proximal intertarsal subluxation raced again. Based on the orientation of the fracture lines and on dissection of two tarsi with calcaneal fractures, a hypothesis on the pathogenesis of calcaneal fractures in racing greyhounds was formulated.  相似文献   

20.
Two sequential fractures in the left hind leg of a deer and their treatments are described. The first, a tibial fracture was treated using an intramedullary pin with full cerclage wires supported by a plaster cast. This fracture healed uneventfully. A subsequent second fracture involving the distal metatarsus was stabilized by external fixation. This fracture healed with the formation of a periosteal involucrumlike structure which encased the full length of the metatarsal bone. This involucrum was thought to be due to a sub-periosteal hematoma.  相似文献   

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