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DOI: 10.3415/VCOT-14-08-0120
Impact of fixation method on postoperative complication rates following surgical stabilization of diaphyseal tibial fractures in cats
Financial Support The authors declare that no financial support or funding was received.Publication History
Received:08 August 2014
Accepted:16 February 2014
Publication Date:
26 December 2017 (online)
Summary
Objectives: To compare the complication rate between open reduction and internal fixation (ORIF) and external skeletal fixation (ESF) for feline diaphyseal tibial fractures.
Methods: In a retrospective study spanning a 10 year period, 57 feline tibial fractures stabilized via ESF or ORIF were included for analysis and complication rates were compared between the two methods.
Results: In the overall study population, 23 (40.4%) cases suffered complications (9 major, 20 minor, 6 with both major and minor). All of the major complications occurred in the ESF group. Complications were more common in cats with ESF (50.0%) while only one (7.7%) of the ORIF cases suffered complications (OR 12.0 [CI: 2.09; 228.10], p = 0.02). Use of postoperative antibiotic medications was identified as a confounder. After adjusting for confounding, stabilization using ESF remained associated with a higher risk of complications (OR = 13.71 [CI: 2.18; 274.25], p = 0.02). Cats with ESF had a longer duration of follow-up (15.6 weeks; 95% CI: 13.0; 18.3) compared to ORIF (9.5 weeks; 95% CI: 6.4; 12.7) (p = 0.003), and a higher number of revisits (mean 3.0; 95% CI: 2.4; 3.6) than the ORIF group (mean 1.6; 95% CI: 0.9; 2.3) (p = 0.002).
Clinical significance: This study demonstrates a significant difference in complication rates between the methods of stabilization, with ESF resulting in a significantly higher complication rate compared to ORIF. Based on these results, it may be prudent to select ORIF for stabilization of feline tibial fractures wherever practical.
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References
- 1 Harari J. Treatments for feline long bone fractures. Vet Clin Small Anim 2002; 32: 927-947.
- 2 Nolte DM, Fusco JV, Peterson ME. Incidence of and predisposing factors for non-union of fractures involving the appendicular skeleton in cats: 18 cases (1998-2002). J Am Vet Med Assoc 2005; 226: 77-82.
- 3 Hill FWG. A survey of bone fractures in the cat. J Small Anim Pract 1977; 18: 457-463.
- 4 Knecht CD. Fractures in cats: A survey of 100 cases. Feline Practice 1978; 8: 43-46.
- 5 Boone EG, Johnson AL, Montavon P. et al. Fractures of the tibial diaphysis in dogs and cats. J Am Vet Med Assoc 1986; 188: 41-45.
- 6 Richardson EF, Thacher CW. Tibial fractures in cats. Compend Cont Educ 1993; 15: 383-393.
- 7 DeAngelis MP. Causes of delayed and non-union of fractures. Vet Clin North Am 1975; 5: 251-258.
- 8 Lu C, Miclau T, Hu D. et al. Ischaemia leads to delayed union during fracture healing: A mouse model. J Orthop Res 2007; 25: 51-61.
- 9 Schrader SC. Orthopaedic surgery. In Sherding RG. editor The Cat: Clinical Diseases and Clinical Management. 2nd edition. New York: Churchill Livingstone; 1994: 1649-1710.
- 10 Johnson AL, Kneller SK, Weigel RM. Radial and tibial fracture repair with external skeletal fixation: Effects of fracture type, reduction and complications on healing. Vet Surg 1989; 18: 367-372.
- 11 Gemmill TJ, Cave TA, Clements DN. et al. Treatment of canine and feline diaphyseal radial and tibial fractures with low-stiffness external skeletal fixation. J Small Anim Pract 2004; 45: 85-91.
- 12 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.
- 13 Guiot L, Dejardin LM. Prospective evaluation of minimally invasive plate osteosynthesis in 36 nonarticular tibial fractures in dogs and cats. Vet Surg 2011; 40: 171-182.
- 14 Schmokel HG, Stein S, Radke H. et al. Treatment of tibial fractures with plates using minimally invasive percutaneous osteosynthesis in dogs and cats. J Small Anim Pract 2007; 48: 157-160.
- 15 Dudley M, Johnson AL, Olmstead M. et al. Open reduction and bone plate stabilisation, compared with closed reduction and external fixation for treatment of comminuted tibial fractures: 47 cases (1980-1995) in dogs. J Am Vet Med Assoc 1997; 211: 1008-1012.
- 16 Reems MR, Beale BS, Hulse DA. Use of a plate-rod construct and principles of biological osteosynthesis for repair of diaphyseal fractures in dogs and cats: 47 cases (1994-2001). J Am Vet Med Assoc 2003; 223: 330-335.
- 17 Sarrau S, Meige F, Autefage A. Treatment of femoral and tibial fractures in puppies by elastic plate osteosynthesis. A review of 17 cases. Vet Comp Orthop Traumatol 2007; 20: 51-58.
- 18 Gerber C, Mast JW, Ganz R. Biological internal fixation of fractures. Arch Orthop Trauma Surg 1990; 109: 295-303.
- 19 Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002; 84: 1093-1110.
- 20 Farouk O, Krettek C, Miclau T. et al. Effects of percutaneous and conventional plating techniques on the blood supply to the femur. Arch Orthop Trauma Surg 1998; 117: 438-441.
- 21 Brinker WO, Flo GL. Principles and application of external skeletal fixation. Vet Clin North Am 1975; 5: 197-208.
- 22 Bradley RL, Rouse GP. External skeletal fixation using the through and through Kirschner-Ehmer splint. J Am Anim Hosp Assoc 1980; 16: 523-530.
- 23 Roe SC, Johnson AL, Harari J. Placement of multiple full pins for external skeletal fixation: technique and results in four dogs. Vet Surg 1985; 14: 247-251.
- 24 Egger EL, Rigg DL, Blass CE. et al. Type I biplanar configuration of external skeletal fixation: application technique in nine dogs and one cat. J Am Vet Med Assoc 1985; 187: 262-267.
- 25 Egger EL, Runyon CL, Rigg DL. Use of Type I double-connecting bar configuration of external skeletal fixation on long bone fractures in dogs: a review of 10 cases. J Am Anim Hosp Assoc 1986; 22: 57-64.
- 26 Aron DN, Toombs JP, Hollingsworth SC. Primary treatment of severe fractures by external skeletal fixation: threaded pins compared with smooth pins. J Am Anim Hosp Assoc 1986; 22: 659-670.
- 27 Johnson AL, Seitz SE, Smith CW. et al. Closed reduction and type II external skeletal fixation of comminuted fractures of the radius and tibia in dogs: 23 cases (1990-1994). J Am Vet Med Assoc 1996; 209: 1445-1448.
- 28 Foland MA, Egger EL. Application of type 3 external fixators: a review of 23 clinical fractures in 20 dogs and 2 cats. J Am Anim Hosp Assoc 1991; 27: 193-202.
- 29 Palmer RH, Hulse DA, Hyman WA. et al. Principles of bone healing and biomechanics of external skeletal fixation. Vet Clin N Am 1992; 22: 45-68.
- 30 Bouvy BM, Markel MD, Chelikani S. et al. Ex vivo biomechanics of Kirschner-Ehmer external skeletal fixation applied to canine tibiae. Vet Surg 1993; 22: 194-207.
- 31 Piermattei DL, Flo GL. Fractures, classification, diagnosis and treatment. In Piermattei DL, Flo GL. editors Handbook of Small Animal Orthopaedics and Fracture Repair. 3rd ed. Philadelphia: WB Saunders Co; 1997: 51-52.
- 32 Weese JS. A Review of post-operative infections in veterinary orthopaedic surgery. Vet Comp Orthop Traumatol 2008; 21: 99-100.
- 33 Fitzpatrick N, Solano MA. Predictive variables for complications after TPLO with stifle inspection by arthrotomy in 1000 consecutive dogs. Vet Surg 2010; 39: 460-474.
- 34 Sauerbrei W, Meier-Hirmer A, Benner C. et al. Multivariable regression model building by using fractional polynomials: Description of SAS, STATA and R programs. Computational Statistics & Data Analysis 2006; 50: 3464-3485.
- 35 Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol 1993; 138: 923-936.
- 36 Phillips IR. A survey of bone fractures in the dog and cat. J Small Anim Pract 1979; 20: 661-674.
- 37 Egger EL, Histand MB, Norrdin RW. et al. Canine Osteotomy healing when stabilised with decreasingly rigid fixation compared to constantly rigid fixation. Vet Comp Orthop Traumatol 1993; 6: 182-187.
- 38 Classen DC, Evans RS, Pestotnik SL. et al. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med 1992; 326: 281-286.