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 23 Fractures occur commonly in both dogs and cats and, therefore, are frequently seen in general practice. It is important for veterinarians to understand: • Fracture biomechanics, classification, and diagnosis • Selection of correct fixation method • Identification of bone healing and complications (if they occur). In Part 1 of this series, fracture biomechanics, fracture classifcation and diagnosis, and selection of proper fxation technique were addressed. In this article, selection of fxation technique is further discussed, along with the specifcs of external coaptation, identifcation of bone healing, and potential complications. The last article in this series will address several different internal fxation methods. SELECTION OF FIXATION METHOD Components to Consider When approaching fxation selection, the following components should be evaluated: 1. Potential fxation methods (Table 1) 2. Patient, client, fracture, and veterinarian factors (Table 2, page 24) 3. Pros and cons of each method 4. Whether opposing forces (Table 3, page 24) can be counteracted with a particular fxation method. Approaches to Fixation In the past, fracture fxation has been approached in 2 ways: 1. Anatomic reconstruction with rigid internal fxation ("the carpenter") 2. More recently, minimal reconstruction to preserve blood fow to the fracture site ("the gardener"). A PrActitioner's Guide to FrActure MAnAGeMent Part 2: Selection of Fixation Technique & External Coaptation Meredith Kapler, DVM North Carolina State University David Dycus, DVM, MS, Diplomate ACVS (Small Animal) Veterinary Orthopedic & Sports Medicine Group, Annapolis Junction, Maryland Table 1. Fracture Fixation Methods INVASIVENESS & STABILITY PRIMARY FIXATION ANCILLARY FIXATION Least invasive Most unstable External Fixation External coaptation (cast or splint) Internal Fixation Intramedullary (IM) pin and/or K-wires Lag screws Most invasive Most stable External skeletal fxator (ESF) Full cerclage Interlocking nail (ILN) Hemi cerclage Bone plate and screws Note: Even though ESF and ILN are listed above bone plates and screws, the last 3 primary fxation methods offer complete sta- bility depending on the fracture confguration; however, in general, ESF and ILN are less invasive than bone plates and screws. Peer Reviewed 23

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