Today's Veterinary Practice

JUL-AUG 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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Today's VeTerinary PracTice | July/august 2015 | tvpjournal.com a PracTiTioner's Guide To FracTure ManaGeMenT Peer reviewed 22 • Fracture factors: Configuration, location, forces, contamination • Veterinarian factors: Understanding of biomechanics and healing, knowledge of particular implants, implant availability. The goal is to select the appropriate fxation method for each individual fracture based on these described factors. For example, even though an intramedullary pin set and cerclage wires are available, this does not mean that every fracture should receive this fxation. In addition, when we approach fxation selection, we always evaluate the list of fxation methods (Table 3), pros and cons of each method, and previously described factors. In addition, we determine whether all the opposing forces (Table 1) can be counteracted with a particular fxation method. WHEN TO REFER An important concern when addressing fractures is to understand when to refer the patient to an orthopedic surgeon, based on consideration of the type of fracture, patient comorbidities, availability of appropriate fxation techniques, client resources, and the practitioner's experience. SH = Salter Harris Reference 1. Cross AR. Chapter 41: Fracture biology and biomechanics. In Tobias KM, Johnston SA (eds): Veterinary Surgery: Small Animal , 1st ed. Philadelphia: Elsevier, 2012. Table 3. Fracture Fixation Methods INVASIVENESS & STABILITY PRIMARY FIXATION ANCILLARY FIXATION Least invasive Most unstable Most invasive Most stable External coaptation (cast or splint) Lag screws IM pin and/or k-wires Full cerclage External skeletal fxator Hemi cerclage Interlocking nail Bone plate and screws M EREDITH K APLER Meredith Kapler, DVM, is a small animal sur- gical resident at North Carolina State Uni- versity. She has presented at the Veterinary Orthopedic Society Conference, instructs veterinary students, and contributed to re - search articles and a book chapter. She re- ceived her DVM from University of Tennes- see, completed a small animal internship at Virginia–Maryland Regional College of Vet - erinary Medicine, and completed an ortho- pedic research fellowship at University of Tennessee. Upon completing her residency, she will work as a staff surgeon at Veterinary Specialty Hospital of the Carolinas. D AVID D YC u S David Dycus, DVM, MS, Diplomate ACVS (Small Animal), is a staff orthopedic sur- geon at the Veterinary Orthopedic & Sports Medicine Group (VOSM) just out- side Washington, D.C. He has presented at national meetings and has lectured second- through fourth-year veterinary students. He has published an array of research articles and a book chapter. Dr. Dycus received his DVM from Mississippi State University, completed a rotating in - ternship at Auburn University, and com- pleted an MS and small animal surgical residency at Mississippi State University. FIGURe 7. Example of a right closed mid- diaphyseal comminuted femoral fracture, with caudoproximal and medial displacement. This fracture is considered comminuted because there is only one fracture location with more than 2 pieces. If there were 2 fractures in the bone—both proximally and distally (ie, more than one fracture in the bone)—then it would be considered segmental.

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