Treatment of antebrachial and crural septic nonunion fractures in dogs using circular external skeletal fixation: a retrospective study

Objective: To evaluate the outcome of treatment of antebrachial and crural septic nonunion fractures in dogs using circular external skeletal fixation (CESF), and to document the type and frequency of complications associated with this technique.

Methods: The medical records of all dogs with infected antebrachial and crural nonunion fractures treated using the methods of Ilizarov at the Department of Animal Pathology of the University of Turin between 2006 and 2011 were retrospectively reviewed. Only dogs in which radiographic and clinical assessment were available at the time of CESF removal were included in the study.

Results: Twenty-three dogs met the inclusion criteria. Twenty nonunion fractures treated with CESF healed and three did not. The latter three cases underwent amputation of the affected limb. In the 20 dogs that achieved bone union, six had minor complications and five had major complications. The midterm outcome was judged to be excellent (n = 11), good (n = 6), fair (n = 2), or poor (n = 4).

Conclusions: The results of this study support the use of CESF for the management of antebrachial and crural septic nonunion fractures in dogs. Union was achieved in the majority of dogs and the complication rate was acceptable, considering the severity of the nonunion fractures that were managed in this fashion.

Keywords

Radius - tibia - nonunion fracture - circular external skeletal fixation - dog

• References

• 1 Blaeser LL, Gallagher JG, Boudrieau RJ. Treatment of biologically inactive nonunions by a limited en bloc ostectomy and compression plate fixation: a review of 17 cases. Vet Surg 2003; 32: 91-100.
• 2 Brinker MR. Nonunions: evaluation and treatment. In: Browner BD, Levine AM, Jupiter JB. et al. editors Skeletal Trauma: Basic Science, Management, and Reconstruction. Philadelphia: W.B. Saunders; 2003. pg. 2003-507.
• 3 Kaderly RE. Delayed union, nonunion and malunion. In Slatter D. editor Textbook of Small Animal Surgery. Philadelphia, PA: Saunders; 1993. pg. 1993-1676.
• 4 Meister K, Segal D, Whitelaw GP. The role of bone grafting in the treatment of delayed unions and nonunions of the tibia. Orthop Rev 1990; 19: 260-271.
• 5 Sumner-Smith G. Delayed unions and nonunions: Diagnosis, pathophysiology and treatment. Vet Clin North Am 1991; 21: 745-760.
• 6 Frost H. The biology of fracture healing: an overview for clinicians. Part II. Clin Orthop Rel Res 1989; 248: 294-308.
• 7 Ting D, Petersen SW, Déjardin LM. Bone transport osteogenesis for treatment of canine osteomyelitis. A report of two cases. Vet Comp Orthop Traumatol 2010; 23: 134-140.
• 8 Rahal SC, Volpi RS, Vulcano LC. et al. Large segmental radius and ulna defect treated by bone transportation with the Ilizarov technique. Aust Vet J 2003; 81: 677-680.
• 9 Rahal SC, Volpi RS, Vulcano LC. et al. Acute shortening and subsequent lengthening of the radius and ulna for the treatment of an infected nonunion in a dog. Can Vet J 2001; 42: 724-726.
• 10 Lesser AS. Segmental bone transport for the treatment of bone deficits. J Am Anim Hosp Assoc 1994; 30: 322-330.
• 11 Owen MA. Use of the Ilizarov method to manage a septic tibial fracture nonunion with a large cortical defect. J Small Anim Pract 2000; 41: 124-127.
• 12 Lenehan TM, Smith GK. Management of infected tibial nonunions with sequestration in the dog. Vet Surg 1984; 13: 115-121.
• 13 Rahal SC, Volpi RS, Vulcano LC. Treatment of segmental tibial defects using acute bone shortening followed by gradual lengthening with circular external fixator. J Vet Med 2005; 52: 180-185.
• 14 Ramoutar DN, Rodrigues J, Quah C. et al. Judet decortication and compression plate fixation of long bone non-union: is bone graft necessary?. Injury 2011; 42: 1430-1434.
• 15 Biasibetti A, Aloj D, Di Gregorio G. et al. Mechanical and biological treatment of long bone nonunions. Injury 2005; 36 Suppl 4 S45-S50.
• 16 Wu CC. Single-stage surgical treatment of infected nonunion of the distal tibia. J Orthop Trauma 2011; 25: 156-161.
• 17 Kenwright J, Richardson JB, Cunningham JL. et al. Axial movement and tibial fractures. A controlled randomised trial of treatment. J Bone Joint Surg Br 1991; 73: 654-659.
• 18 Wolf Jr JW, White III AA, Panjabi MM. et al. Comparison of cyclic loading versus constant compression in the treatment of long-bone fractures in rabbits. Bone Joint Surg Am 1981; 63: 805-810.
• 19 Ilizarov GA. The tension–stress effect on the genesis and growth of tissues. Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res 1989; 239: 263-285.
• 20 Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty five open fractures of long bones. J Bone Joint Surg 1976; 58-A: 453-458.
• 21 Anderson GM, Lewis DD, Radasch RM. et al. Circular external skeletal fixation stabilization of antebrachial and crural fractures in 25 dogs. J Am Anim Hosp Assoc 2002; 39: 479-498.
• 22 Weber BG, Cech O. Pseudoarthrosis, Pathophysiology, Biomechanics, Therapy, Results. New York-San Francisco-London: Grune and Stratton, Jovanovich Publishers; 1976
• 23 Lewis DD, Bronson DG, Samchukov ML. et al. Biomechanics of circular external skeletal fixation. Vet Surg 1998; 27: 454-464.
• 24 Anderson MA, Aron DN, Palmer RH. Improving pin selection and insertion techniques for external skeletal fixation. Compendium Cont Ed 1997; 19: 485-494.
• 25 Ferretti A. The application of the Ilizarov technique to veterinary medicine. In: Maiocchi AB, Aronson J. editors. Operative Principles of Ilizarov. Baltimore, MD: Williams & Wilkins; 1991. pg. 1991-551.
• 26 Catagni M. Classification and treatment of nonunion. In: Maiocchi BA, Aronson J. editors. Operative Principles of Ilizarov. Milan: Medi Surgical Video; 1991. pg. 1991-190.
• 27 Whelan DB, Bhandari M, McKee MD. et al. Interobserver and intraobserver variation in the assessment of the healing of tibial fractures after intramedullary fixation. J Bone Joint Surg 2001; 84-B: 15-18.
• 28 Fox DB, Tomlinson JL, Cook JL. et al. Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs. Vet Surg 2006; 35: 67-77.
• 29 Dismukes DI, Tomlinson JL, Fox DB. et al. Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia. Vet Surg 2007; 36: 699-704.
• 30 Dismukes DI, Tomlinson JL, Fox DB. et al. Radiographic measurement of canine tibial angles in the sagittal plane. Vet Surg 2008; 37: 300-305.
• 31 Song HR, Cho SH, Koo KH. et al. Tibial bone defects treated by internal bone transport using the Ilizarov method. International Orthopaedics (SICOT) 1998; 22: 293-297.
• 32 Cierny G, Mader JT. Adult chronic osteomyelitis. Orthopaedics 1984; 7: 1557-1564.
• 33 Franczuski D, Chalman JA, Butler HC. et al. Postoperative effects of experimental femoral shortening in the mature dog. J Am Anim Hosp Assoc 1987; 23: 429-437.
• 34 Welch RD, Lewis DD. Distraction osteogenesis. Vet Clin North Am Small Anim Pract 1999; 29: 1187-1205.
• 35 Latte Y. Applications du fixateur externe circulaire [Applications of circular external fixation]. In Latte Y, Meynard JA. editors Manuel de fixation externe: applications au chien et au chat [Manual of External Fixation : Applications in Dogs and Cats]. Paris: PMCAC; 1997. pg. 1997-425.
• 36 Green SA, Jackson JM, Wall DM. et al. Management of segmental defects by the Ilizarov intercalary bone transport method. Clin Orthop Relat Res 1992; 280: 136-142.
• 37 Maini L, Chadha M, Vishwanath J. et al. The Ilizarov method in infected nonunion of fractures. Injury 2000; 31: 509-517.
• 38 Gugenheim Jr. JJ. The Ilizarov method. Orthopedics and soft tissue applications. Clin Plast Surg 1998; 25: 567-578.
• 39 Magadum MP, Basavaraj Yadav CM, Phaneesha MS. et al. Acute compression and lengthening by the Ilizarov technique for infected nonunion of the tibia with large bone defects. J Orth Surg 2006; 14: 273-279.
• 40 McCartney WT. Limb lengthening in three dogs using distraction rates without a latency period. Radius/ulna, tibia, femur. Vet Comp Orthop Traumatol 2008; 21: 446-450.
• 41 Aida T, Yoshioka I, Tominaga K. et al. Effects of latency period in a rabbit mandibular distraction osteogenesis. Int J Oral Maxillofacial Surg 2003; 32: 54-62.
• 42 Rovesti GL, Bosio A, Marcellin-Little DJ. Management of 49 antebrachial and crural fractures in dogs using circular external fixators. J Small Anim Pract 2007; 48: 194-200.
• 43 Piras LA, Cappellari F, Peirone B. et al. Treatment of fractures of the distal radius and ulna in toy breed dogs with circular external fixation: a retrospective study. Vet Comp Orthop Traumatol 2011; 24: 228-235.
• 44 Welch JA, Boudrieau RJ, DeJardin LM. et al. The intraosseous blood supply of the canine radius: implications for healing of distal fractures in small dogs. Vet Surg 1997; 26: 57-61.
• 45 Gauthier CM, Kowaleski MP, Gerard PD. et al. Comparison of the axial stiffness of carbon composite and aluminium alloy circular external skeletal fixator rings. Vet Comp Orthop Traumatol 2013; 26: 1-5.