Today's Veterinary Practice

SEP-OCT 2015

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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tvpjournal.com | September/October 2015 | TOday'S VeTerinary PracTice a PracTiTiOner'S Guide TO FracTure ManaGeMenT Peer reviewed 27 With direct bone healing, formation of an external callus and resorption of the fracture ends should not be present; however, the cutting cones across the fracture gap may create a loss of radiopacity in the area. With indirect bone healing (as seen with external coaptation or unstable fracture fxation): • Initial resorption of the fracture ends is noted radiographically by loss of radiopacity and widening of the fracture gap; this process can be noted around 5 to 7 days after the injury. • Callus formation is not noted radiographically until it becomes mineralized; however, there is typically some phase of tissue healing present in the fracture site, such as a hematoma, granulation tissue, and connective tissue, which are all components of indirect bone healing. • The callus is noted first as a collar around the fracture site (the periosteal component), which may be seen as early as 10 to 12 days after repair (Figure 2). • As healing progresses, the callus becomes more identifiable, the fracture ends become more radiopaque, and the fracture line begins to disappear (Figure 3 ). COMPLICATIONS Numerous complications can occur with bone healing and fracture repair. Infection With open fractures or surgical site contamination, infection is a potential risk that can lead to implant infection, osteomyelitis, and potential sequestrum formation. 6 Wolff's law —a theory developed by German anatomist and surgeon Julius Wolff—states that bone in a healthy person or animal will adapt to the loads under which it is placed or, more simply, bone adapts to pressure, or a lack of it. FIGURE 3. A right radius/ulna fracture in a 10-month-old boxer puppy that was treated by external coaptation (note that primary fxation is indicated in this case), showing secondary bone healing at 4 weeks (A), 8 weeks (B), and 12 weeks (C) after injury. Note that over time the ulnar fracture develops a slight callus formation. As the tissues in the fracture gap are slowly transitioning into bone, the fracture line begins to slowly disappear. Due to using external coaptation, there is thinning of the cortical diaphysis of the ulna resulting from immobilization. A B C FIGURE 2. Example of indirect bone healing in an experimentally created fracture in a research study: Note the initial sharply marginated fracture ends (A); over time there is slight resorption, with the beginning of callus formation (periosteal component) (B), and between the fracture ends there would be some phase of tissue healing. As the fracture continues to heal, the callus formation becomes larger (C). Courtesy Journal of Bone & Joint Surgery A B C

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