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1.
BACKGROUND: Bone healing is monitored mainly by physical and serial radiologic examinations of the fracture site. However, it is sometimes difficult to distinguish a delayed union from a nonunion, and advanced imaging techniques may not be available. Serum biochemical markers of bone formation, such as alkaline phosphatase (ALP) activity, may be clinically useful in evaluating the progress of healing. OBJECTIVE: The purpose of this study was to correlate serial values of serum ALP activity with the process of fracture healing in dogs and to assess its potential as a postsurgical prognostic indicator. METHODS: Changes in serum ALP activity were studied in 83 dogs with closed long bone diaphyseal fractures treated surgically. Physical and radiologic examinations of the fracture site and determination of serum ALP activity and calcium (Ca) and phosphate (P) concentrations were performed on admission (day 0); postoperatively on days 10, 20, and 30; and subsequently on a monthly basis until bone union was completed or signs of nonunion were evident. The dogs were allocated into 3 groups with respect to the fracture healing progress as documented by physical and serial radiologic examination. RESULTS: Group A dogs (n=35) developed a medium-sized callus that led to bone union within 2 months. Group B dogs (n=36) had a hypertrophic callus and delayed union, within 3-5 months. Group C dogs (n=12) had slow progress in fracture healing, with minimal callus formation during a 2-month period. Changes in mean serum ALP activity followed the same pattern in groups A and B, reaching a maximum level on day 10. Group A values returned to normal within 2 months, at which point bone union was complete, whereas group B values remained increased and returned to normal within 3-5 months, thus correlating with delayed union. In Group C, mean serum ALP activities showed no significant changes during the 2-month follow-up period, consistent with failure of bone union (nonunion). Serum P and Ca changes followed a proportional and inverse pattern to ALP changes, respectively. CONCLUSION: Serial determination of serum ALP activity during fracture healing could be an additional tool in predicting fractures at risk of developing a nonunion, helping the clinician to choose the appropriate intervention.  相似文献   

2.
OBJECTIVES: To evaluate the use of ultrasonography (US) to detect bone healing in uncomplicated diaphyseal fractures of dogs and cats, and to compare these observations with detection of healing by radiography (RG). STUDY DESIGN: Clinical study. ANIMALS: Dogs (33) and cats (11). METHODS: RG and brightness mode US were used to follow uncomplicated secondary fracture healing. Fractures were examined at admission and then every 2-4 weeks until healed or implant removal. Temporal differences in definitive detection of healed fracture by imaging technique were examined by species, patient age, bone, and fracture type. RESULTS: US images obtained during uncomplicated secondary fracture healing were consistent with images of fracture healing described in humans. Mean time to US diagnosis of a healed fracture (mean 46 days) was significantly shorter than by RG (mean 66 days). Mean time until diagnosis of a healed fracture (US and RG) did not differ significantly between open and closed treatment. Patients 36 months (n=11), but there was no significant difference between the latter 2 groups. Diagnosis of a healed simple fracture by US was significantly quicker than for a comminuted fracture (P<.05), but no difference was noted when using RG. CONCLUSIONS: US can be used to evaluate secondary fracture healing in biologically treated fractures in dogs and cats. US permits detection of a healed fracture earlier than RG. CLINICAL RELEVANCE: Earlier diagnosis of a healed fracture by US can prevent unnecessarily long limb immobilization and allow earlier dynamization.  相似文献   

3.
Deep-Frozen Allogeneic Cancellous Bone Grafts in 10 Dogs: A Case Series   总被引：1，自引：0，他引：1  
Deep-frozen, aseptically collected and processed allogeneic cancellous bone was implanted in eight dogs during the surgical repair of diaphyseal long bone fractures and in two dogs during arthrodeses. A combined allogeneic and autogeneic cancellous bone graft was used in two fractures with a segmental bone loss of more than 5 cm. Bone union occurred in five fractures and in both arthrodeses. Failure of fixation occurred in two dogs with nonunion fractures and in a third dog with an open, infected fracture. Biopsies from the fracture sites were obtained from these dogs following failure of their fracture fixation. The cancellous bone graft appeared to be in the process of normal incorporation in each case. Failure of fixation was attributed to technical or case management errors or both, in each of the three fractures that failed to achieve bony union. Frozen allogeneic cancellous bone grafts were effectively incorporated when used in the primary repair of fractures and arthrodeses. Combined autogenous and allogeneic cancellous bone grafts may be particularly useful in the repair of fractures with large segmental diaphyseal bone defects. The use of allogeneic cancellous bone grafts in nonunion fractures requires further investigation before it can be recommended.  相似文献   

4.
A technique using a third bar and guide clamp was developed to permit reduction and stabilization of distal limb fractures with full pins and two connecting bars, one on each side of the bone. The system uses only single Kirschner clamps. Four distal limb fractures were stabilized using this technique. Closed reduction was used in three dogs to avoid devitalization of fragments and avoid contamination of a closed fracture. The fracture site stability achieved with this configuration allowed early return to weight bearing and rapid bone healing.  相似文献   

5.
OBJECTIVE: To report the prevalence of third metacarpal bone fractures after dorsal plating for pancarpal arthrodeses in dogs and to identify predisposing factors. STUDY DESIGN: Retrospective clinical study. ANIMALS: Fifty-four client-owned dogs. METHODS: Pancarpal arthrodesis was performed using dorsally applied 2.7- or 3.5-mm bone plates. Medical records and radiographs were retrospectively evaluated to identify those dogs with metacarpal bone fractures after pancarpal arthrodesis and to determine the angle of arthrodesis, the percentage of the third metacarpal bone covered by the bone plate, and the percentage width of the bone occupied by the screw. Radiological evidence of arthrodesis at follow-up examination 6 weeks postoperatively was recorded. Long-term results were obtained by telephone follow-up with the owners. All lame dogs were evaluated clinically and radiographically. RESULTS: Metacarpal fractures occurred in 6 of 54 dogs. One of these dogs had a stress fracture of the third metacarpal 10 months after implant removal and was not included in the statistical analysis. Fractures occurred through the distal screw hole in four dogs and involved two metacarpal bones (III and IV) in two dogs. The median ratio of bone screw diameter-to-metacarpal bone diameter was the same for dogs with metacarpal bone fractures and those with no fractures (44%), and the median angles of arthrodesis were 8 degrees and 7 degrees. These values were not statistically significant. The percentage length of the metacarpal bone covered by the plate was 53% (no fracture) compared with 46% (fracture), and this difference was statistically significant (P = .035). CONCLUSIONS: Screw diameter was not implicated as a predisposing factor for metacarpal bone fracture in dogs undergoing pancarpal arthrodesis using a dorsally applied dynamic compression plate. The length of the metacarpal bone covered by the bone plate did affect the frequency of metacarpal fracture, with fewer fractures occurring when greater than 53% of the bone length was covered by the dynamic compression plate. CLINICAL RELEVANCE: When performing pancarpal arthrodesis with a dorsally applied bone plate, it is recommended that at least 50% of the length of the third metacarpal bone should be covered by the plate.  相似文献   

6.
Dual-energy x-ray absorptiometry was used to measure bone mineral density of four regions in healed femora of nine dogs after fracture fixation with a leg-lengthening plate. Six to 85 months (mean, 46 months) after surgery, the bone mineral density of healed femora was not significantly different from the contralateral uninjured femora ( P >.05; power = 0.8 at Δ= 15%). Radio-lucencies around the proximal screws, apparently associated with screw loosening, were seen on radiographic views of the healed femora of three dogs. In one of these dogs, one screw in the proximal metaphysis had broken. Force-plate analysis of gait was also performed on dogs at the time of bone mineral density measurement. Peak vertical force was decreased in the pelvic limb with the healed fracture compared with the contralateral unoperated limb ( P < 0.05). Clinically apparent lameness in three dogs did not appear to be associated with altered bone mineral density and may have been caused by hip osteoarthritis, a nondisplaced hairline diaphyseal fracture, and screw loosening in conjunction with extensive post-traumatic soft tissue injury.  相似文献   

7.
OBJECTIVE: To report clinical outcome after use of an interlocking nail (veterinary interlocking nail [VIN]) for stabilization of diaphyseal fractures in dogs and cats. STUDY DESIGN: Retrospective study. Animals: Seventy-eight dogs and 43 cats with diaphyseal fractures of the femur (n = 96), tibia (n = 14), or humerus (n = 11). METHODS: Interlocking nails (4 mm diameter [n = 72], 6 mm [n = 25] or 8 mm [n = 24]), were used in static (n = 106) or dynamic (n = 15) fixation mode. Cerclage wires also were used in 63 (52%) cases. Data about the patient (species, breed, weight, age), characteristics of the fracture, and details of the surgery and perioperative complications were recorded. The surgeon evaluated functional outcome, and fracture healing was quantified 6 weeks (W6) and 3 months (M3) after surgery with a radiographic index. RESULTS: Twelve cases had been unsuccessfully treated by another technique. Of 106 comminuted fractures, 60 were classified as unstable. Only 112 animals were evaluated at W6; 86 (77%) healed without complication and had a functional outcome considered excellent (n = 80, 93%), good (n = 5, 4%), or fair (n = 1). Twenty-six complications were noted: 16 (14%) patients did not require additional surgery and had a good or excellent outcome, whereas 10 (8%) patients needed surgical intervention to CONCLUSIONS: VINs can be used to repair diaphyseal fractures of the femur, tibia, and humerus in dogs and cats provided the implants are appropriately sized for the fractured bone. The high healing rate (even with unstable fractures), associated with a functional outcome, and low complication rate support the use of VINs for these fracture types. However, a period of training and the application of basic principles are necessary to ensure successful results. CLINICAL RELEVANCE: VINs should be considered as alternative technique for management of selected diaphyseal fractures of the femur, tibia, and humerus in dogs and cats.  相似文献   

8.
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   

9.
In fracture treatment, several adverse effects of metal, especially its excessive rigidity, often require the removal of the implants after a fracture has healed. Recent research with biodegradable polymers has contributed to the development of totally biodegradable polylactic acid implants with very high initial bending and shear strengths, but a modulus of elasticity comparable to that of bone. These implants were originally intended for use in fractures involving cancellous bone. Encouraging results from treating experimentally produced diaphyseal fractures led the authors to use these implants in a clinical trial on shaft fractures in dogs and cats. In this study, a total of 11 dogs and 14 cats had 28 diaphyseal fractures treated with one or several intramedullary pins of self-reinforced left isomeric polylactic acid. Of the 25 treated cases, 23 healed. Four of these had an unsatisfactory end result attributed to the implants used and one developed an osteomyelitis. Thus, out of 25 fractures, 23 united (92 per cent] and 18 [72 per cent) had a good or excellent outcome.  相似文献   

10.
A retrospective study was undertaken to record the occurrence and pattern of long bone fractures, and the efficacy of Intramedullary (IM) Steinmann pin fixing in growing dogs. All the records of growing dogs during a 10-year-period were screened to record the cause of trauma, the age and sex of the animal, the bone involved, the type and location of the fracture, the status of fixation, alignment, maintenance of fixation and fracture healing. The results were analysed and comparisons were made between growing dogs with normal and osteopenic bones. Among the 310 cases of fractures recorded, the bones were osteopenic in 91 cases (29%). Minor trauma was the principal cause of fracture in dogs with osteopenia (25%), and indigenous breeds were most commonly affected (38%). Fractures in dogs with osteopenic bones were most commonly recorded in the age group of 2-4 months (53%), whereas fractures in normal dogs were almost equally distributed between 2 and 8 months of age. Male dogs were affected significantly more often in both groups. In osteopenic bones, most fractures were recorded in the femur (56%), and they were distributed equally along the length of the bone. Whereas in normal bones, fractures were almost equally distributed in radius/ulna, femur and tibia, and were more often recorded at the middle and distal third of long bones. Oblique fractures were most common in both groups; however, comminuted fractures were more frequent in normal bones, whereas incomplete fractures were more common in osteopenic bones. Ninety-nine fracture cases treated with IM pinning (66 normal, 33 osteopenic) were evaluated for the status of fracture reduction and healing. In a majority of the cases (61%) with osteopenic bones, the diameter of the pin was relatively smaller than the diameter of the medullary cavity (<70-75%), whereas in 68% of the cases in normal bones the pin diameter was optimum. The status of fracture fixing was satisfactory to good in significantly more osteonormal (59%) than osteopenic dogs (42%). Fracture healing, however, was satisfactory in significantly more cases with osteopenic than normal bones. The appearance of callus was relatively early and the amount of bridging callus was relatively large in greater number of osteopenic bone fractures. Mal-union and non-union were recorded more often in osteopenic cases than in normal cases. However, the incidence of bone shortening and osteomyelitis was significantly higher in normal bones than in osteopenic bones.  相似文献   

11.
OBJECTIVE: To compare the efficacy of 2 doses of recombinant human bone morphogenetic protein-2 (rhBMP-2) on tibial osteotomy healing in dogs. STUDY DESIGN: Experimental, randomized complete block (n=7). ANIMALS: Adult female dogs (n=21). METHODS: Right midshaft tibial osteotomies were created and stabilized with a 1-mm gap using type I external fixators. Seven dogs were untreated controls and 14 with osteotomies were treated with either 0.05 or 0.2 mg/mL rhBMP-2 delivered in an absorbable collagen sponge (ACS). At 8 weeks, dogs were euthanatized and bones were mechanically tested and examined by microscopy. RESULTS: Bone healing based on radiographic scoring, was significantly improved in dogs treated with 0.2 mg/mL of rhBMP-2 compared with the other groups; these tibiae were also significantly stronger and stiffer than 0.05 mg/mL rhBMP-2 and control osteotomized tibiae. Histologic scores were significantly better for 0.2 mg/mL rhBMP-2 group than 0.05 mg/mL rhBMP-2 group, but neither was significantly different from control. CONCLUSIONS: rhBMP-2 in ACS at a concentration of 0.2 mg/mL improves healing of tibial osteotomies in dogs compared with untreated controls and 0.05 mg/mL rhBMP-2 based on force plate analysis and radiographic evaluation. This was not confirmed histologically but treated bones had improved mechanical properties at 8 weeks. CLINICAL RELEVANCE: After a long bone fracture, dogs may face a long recovery period before full return of limb function. rhBMP-2, in association with good fracture fixation principles, may enhance bone healing in dogs with diaphyseal fractures.  相似文献   

12.
OBJECTIVES: To determine if there was histological correlation with ultrasonographic images of healed fractures and implant-associated tissue after fracture treatment by plate osteotomy. METHODS: Eight adult dogs were included in this retrospective study. Ultrasonography (B-mode and power Doppler) and radiography were performed before plate removal. Surgical biopsies were taken of the fracture site and the tissue adjacent to the plate. These were stained with haematoxylin and eosin to assess histomorphology and bone content and immunolabelled with CD31 to assess vascularity. RESULTS: Ultrasound and radiographic diagnoses of a healed fracture correlated with histological finding of bone healing. Ultrasonography and histology findings of vascularity were also highly correlated. The tissue surrounding the surgical implants was significantly more vascularised on both ultrasonography and histology than that at the fracture site itself. CLINICAL RELEVANCE: Ultrasonography can be used to diagnose fracture healing in plated fractures. Power Doppler ultrasonography examination of fracture healing should be performed away from surgical implants to avoid false-positive results of vascularisation.  相似文献   

13.
A system already described by Unger and others was used to classify long bone fractures in dogs. The present paper reports experiences using the fracture classification system regarding its ease of use and the ability to analyse the data generated. Three hundred and eighty-six canine long bone fractures were classified from radiographs. Results were assessed by reviewing the medical records or by sending questionnaires to referring veterinarians. There were a few inconsistencies, particularly in classifying proximal ulnar fractures, but the system was easy to use and data retrieval was readily accomplished. Data from the system were used to compare the results of repairs of diaphyseal fractures of the radius/ulna, femur and tibia/fibula. A chi square analysis was used to determine significant differences between the outcome scores of the three fracture types. Fractures of the femoral diaphysis had a statistically poorer outcome than did diaphyseal fractures of the radius/ulna or tibia/fibula.  相似文献   

14.
Twenty-eight consecutive fractures of the canine radius and tibia were treated with external skeletal fixation as the primary method of stabilization. The time of fixation removal (T1) and the time to unsupported weight-bearing (T2) were correlated with: (1) bone involved; (2) communication of the fracture with the external environment; (3) severity of the fracture; (4) proximity of the fracture to the nutrient artery; (5) method of reduction; (6) diaphyseal displacement after reduction; and (7) gap between cortical fragments after reduction. The Kruskal-Wallis one-way analysis of variance was used to test the correlation with p less than .05 set as the criterion for significance. The median T1 was 10 weeks and the median T2 was 11 weeks. None of the variables correlated significantly with either of the healing times; however, there was a strong trend toward longer healing times associated with open fractures and shorter healing times associated with closed reduction. Periosteal and endosteal callus uniting the fragments were observed radiographically in comminuted fractures, with primary bone union observed in six fractures in which anatomic reduction was achieved. Complications observed in the treatment of these fractures included: bone lysis around pins (27 fractures), pin track drainage (27 fractures), pin track hemorrhage (1 fracture), periosteal reaction around pins (27 fractures), radiographic signs consistent with osteomyelitis (12 fractures), degenerative joint disease (2 dogs), and nonunion (1 fracture). Valgus or rotational malalignment resulted in 16 malunions of fractures. One external fixation device was replaced and four loose pins were removed before the fractures healed. One dog was treated with antibiotics during the postoperative period because clinical signs of osteomyelitis appeared.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

15.
Medical records of 38 horses less than 1 year of age and diagnosed as having a fracture of the femoral diaphysis, metaphysis or distal physis were evaluated. Twenty-six foals had fractures of the femoral diaphysis or metaphysis with the most common fracture configuration being comminuted. Twelve foals had distal physeal fractures with the most common fracture configuration being a Salter-Harris type II. Twenty-one foals with fractures of the capital femoral physis, neck or greater trochanter during the same time period were excluded from this study. Surgical repair was attempted in 16 diaphyseal and 2 distal physeal fractures. Most of the diaphyseal fractures were repaired by placing plates on the lateral and cranial surfaces of the bone. Dynamic condylar screw plates or angle blade plates were used for increased bone purchase in 4 foals with short distal fragments. Five foals with distal physeal fractures were treated; 2 were surgically treated by placing an angle blade plate on the lateral cortex, and 3 foals with minimally displaced distal physeal fractures were managed with stall confinement. Eight of the 16 surgically repaired diaphyseal fractures healed. Fracture location and configuration was not a determinant of outcome, but the mean age of foals with successfully repaired diaphyseal fractures was 2 months compared with 4 months for the unsuccessful cases, indicating that the age and size of the foal was important. Long-term follow up revealed that 6 of the 8 successfully repaired diaphyseal fractures had no residual effects of the fracture observed during performance of the horse for its intended use. Only 1 of the 2 surgically repaired distal physeal fractures healed, but this horse was eventually killed because of unthriftiness related to a malabsorption syndrome. Some form of complication developed in 13 of the 18 surgically repaired fractures. Infection was the primary cause of failure. The greatest determinant associated with infection was the inability to control post-surgical seroma formation.  相似文献   

16.
Objectives: To compare fracture healing in diaphyseal tibial fractures stabilized using either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF). Methods: Dogs in each group were matched for type of fracture, age and body weight. Stage of healing was measured blindly every four weeks postoperatively until complete healing. Outcome variables including fracture length, plate length, plate bridging ratio, plate working length, healing grading, and fracture reduction were compared between groups using the Mann-Whitney test. Significant difference was set at p <0.05. Results: Based on the definition of clinical union, at 30 days five out of eight dogs managed with MIPO had healed, while two of the eight of dogs managed with ORIF had healed. We did not find any significant differences in the other outcome measures. No complications were reported in the MIPO group whereas one major complication was reported in the ORIF group. Clinical significance: All dogs treated by MIPO healed rapidly without any complications, nevertheless the difference in radiographic healing between the two groups was not significant.  相似文献   

17.
A 7-month-old, 180-kg, female foal was presented with open diaphyseal fracture of the left third metacarpal bone. The fractured limb was stabilized preoperatively with external coaptation. Open reduction and internal fixation were done using 4.5-mm broad dynamic compression plate, which was applied in a neutralization manner. Postoperatively, external support with padded bandage reinforced with gutter splint made of fiber glass was provided. The incisional infection and the contaminated wound on medial aspect of the metacarpal were managed with regular dressing. Complete radiographic union and functional recovery were noticed by 4 months postoperatively. Open diaphyseal fractures can be managed by proper preoperative fracture stabilization, wound management, and fixation methods using bone plate and external coaptation.  相似文献   

18.
Five New World camelids were admitted to the Western College of Veterinary Medicine between 1996 and 2003 for evaluation of femoral fractures. There were three alpacas and two llamas. Four of the animals were female and three were less than 3 months of age. Fracture configurations consisted of distal physeal fractures (three), a comminuted diaphyseal/metaphyseal fracture, and a transverse diaphyseal fracture. Fractures were diagnosed with a combination of physical examination and radiographs in all cases. All five fractures were repaired with internal fixation and three animals were discharged from the hospital with fractures that healed. One cria underwent successful internal fixation but died from pulmonary oedema during recovery from anaesthesia. Postoperative complications were rare and limited to inadequate fracture stability in one alpaca and prolonged recovery to weight bearing in another. One llama with a comminuted metaphyseal fracture, repaired with a 4.5 mm dynamic compression plate, subsequently had catastrophic failure of the bone 17 days after surgery. Overall the clients were pleased with the outcome of discharged animals. Although femoral fractures are considered rare, they pose a unique opportunity for the large animal veterinarian to successfully achieve fracture union with the aid of internal fixation.  相似文献   

19.
Objective-To evaluate fracture healing after minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF) of coexisting radius and ulna fractures in dogs via ultrasonography and radiography. Design-Prospective cohort study. Animals-16 dogs with radius-ulna fractures that underwent MIPO (n = 9; 2 dogs were subsequently not included in the analyses because of incomplete follow-up information) or ORIF (7). Procedures-Dogs in the 2 treatment groups were matched by age, body weight, and configuration of the fractures. Fracture healing was evaluated with ultrasonography, power Doppler ultrasonography, and radiography every 3 to 4 weeks until healing was complete; a semiquantitative score based on the number of Doppler signals was used to characterize neovascularization, and subjective B-mode ultrasonographic and radiographic scores were assigned to classify healing. Results-Fractures in dogs that underwent MIPO healed in significantly less time than did fractures in dogs that underwent ORIF (mean ± SD; 30 ± 10.5 days and 64 ± 10.1 days, respectively). Radiography revealed that fractures in dogs that underwent MIPO healed with significantly more callus formation than did fractures in dogs that underwent ORIF. Although Doppler ultrasonography revealed abundant vascularization in fractures that were healing following MIPO, no significant difference in neovascularization scores was found between groups. Conclusions and Clinical Relevance-For dogs with radius-ulna fractures, data indicated that bridging osteosynthesis combined with a minimally invasive approach contributed to rapid healing after MIPO. The MIPO technique may offer some clinical advantage over ORIF, given that complete radius-ulna fracture healing was achieved in a shorter time with MIPO.  相似文献   

20.
Bilateral midshaft femoral osteotomies were fixed with a 3-mm fracture gap in 6 dogs. In each dog, one femur was fixed with a porous titanium-surfaced bone plate and screws, whereas the opposite femur was fixed with a standard smooth-surfaced bone plate and screws. The mean removal torque for porous titanium-surfaced screws (32.3 kg X cm) was significantly (P less than 0.01) greater than the mean removal torque for standard screws (4.4 kg X cm). Osseous tissue ingrowth into the surface of porous titanium-surfaced screws was verified by histologic examination of the bone-screw interface. Radiographic and histologic examinations of the osteotomy gaps showed accelerated primary gap healing in osteotomies fixed with porous titanium-coated implants, compared with slower callus healing seen in osteotomies fixed with standard smooth-surfaced implants.  相似文献   

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