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Today's VeTerinary PracTice | september/october 2015 | tvpjournal.com a PracTiTioner's Guide To FracTure ManaGeMenT Peer reviewed 24 Ideally, a middle ground for fxation should be identifed that: • Stabilizes the fracture site to allow bone healing, but is not so rigid that fixation delays bone healing • Preserves blood flow to the fracture, and does not disrupt the blood clot at the fracture site during surgery. EXTERNAL COAPTATION External coaptation is defned as the use of bandages, splints, casts, or other materials to aid in stability and support for soft and osseous tissues. Furthermore, external coaptation can help manage wounds and control edema. Indications External coaptation can be used as either: • Primary fixation for a fracture • Ancillary fixation to provide additional support (ie, after bone plating a radius/ulna fracture), or • Temporary fixation for an open fracture and/or until definitive surgical correction can take place. External coaptation should only be used in fractures distal to the elbow and stife, as correct application requires immobilization of the joints above and below the fracture. Certain splints, such as spica splints, can help immobilize more proximal injuries (humerus and femur); however, given the location of these fractures, external coaptation may create a fulcrum effect with the bandage. Fracture Alignment Fracture alignment is imperative to limb function. Once the bandage/splint has been applied, assess both reduction and rotational alignment with radiographs. Joint stiffness is common after immobilization; therefore, place and develop the bandage/splint to achieve maintenance of a neutral standing position. There are a number of different types of splints available, ranging from spoon splints to tongue depressors (as used with small puppies and kittens). We prefer to use fberglass, which allows a custom- made molded splint to be created. These can be placed either palmar or lateral in the forelimbs or lateral in the hindlimbs. Temporary Fixation Temporary fxation with external coaptation can help improve patient comfort, reduce swelling, and provide a protective covering for open fractures prior to defnitive fxation and/or surgical correction. If external coaptation is used: 1. Attempt to reduce the fracture prior to applying external coaptation. 2. If there is an open fracture, immediately fush the wound and debride dead tissue. 3. After appropriate wound care, cover the exposed Table 2. Factors to Consider When Choosing Fracture Fixation Method Patient Size, age, body condition, breed, activity level Client Finances, compliance, husbandry Fracture Confguration, location, forces, contamination Veterinarian Understanding of biomechanics and healing, knowledge of particular implants, experience and skill level, implant availability Table 3. Five Main Forces That Act on Bone The most common forces acting on bone, and those that MUST be counteracted with bone fxation, are: 1. Bending 2. Compression 3. Shearing 4. Tension 5. Torsion Choosing Between External & Internal Fixation Counteracting Forces External coaptation can effectively counteract bending and rotational forces, provided the joints above and below the fracture are immobilized. However, fractures subjected to compression, shearing, and/or tensile forces require internal fxation. Furthermore, comminuted and long oblique fractures are not ideal for external coaptation. Fracture Reduction When external coaptation is chosen, fracture reduction greatly increases the chances for primary fxation healing. The "50/50 rule" applies, and states that fracture ends should have at least 50% contact to expect fracture healing. Unfortunately, this rule also states that 50% reduction is the absolute minimum for bone healing to be possible, not probable. If the fracture cannot be reduced appropriately, then some type of internal fxation should be pursued instead.