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Transarticular external skeletal fixation (TESF) is repeatedly used for temporary stabilisation of tarsal joint in cats. Hence, this study aimed to evaluate the use of temporary modified type II TESF for management of talocrural instability (TCI) in cats without joint arthrodesis and to rate short-term outcomes and complications. Medical records of all cats treated for TCI between January 2012 and December 2021 were reviewed. Information was collected including signalment, degree of lameness, type of TCI, accompanying soft tissue and bone injuries, and post-operative follow-up assessment including time of frame removal, complications, degree of lameness, range of joint motion and ankylosis. Surgical management didn't involve debridement of the articular cartilage. Eighty-five percent of cats had satisfactory joint stability at the time of frame removal. Eighteen cats exhibited minor complications, six cats had major complications, and 8 cats showed persistent lameness. All cats showed reduction of joint motion range by 20°-30° directly after frame removal while returned to normal in 79% of cats 4 weeks later. Variable degrees of joint ankylosis were reported. In conclusion, this study supports the use of temporary modified type II TESF for management of TCI in cats without joint involvement as an excellent alternative to tarsal arthrodesis.

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OBJECTIVES: The aims of this study were to describe the type, presentation and prognostic factors of feline humeral fractures over a 10-year period and to compare three stabilisation systems for feline humeral diaphyseal fractures. METHODS: In total, 101 cats with humeral fractures presenting to seven UK referral centres between 2009 and 2020 were reviewed. Data collected included signalment, weight at the time of surgery, fracture aetiology, preoperative presentation, fixation method, surgical details, perioperative management and follow-up examinations. Of these cases, 57 cats with humeral diaphyseal fractures stabilised using three different fixation methods were compared, with outcome parameters including the time to radiographic healing, time to function and complication rate. RESULTS: The majority of the fractures were diaphyseal (71%), with only 10% condylar. Of the known causes of fracture, road traffic accidents (RTAs) were the most common. Neutered males were over-represented in having a fracture caused by an RTA (P = 0.001) and diaphyseal fractures were significantly more likely to result from an RTA (P = 0.01). Body weight had a positive correlation (r = 0.398) with time to radiographic healing and time to acceptable function (r = 0.315), and was significant (P = 0.014 and P = 0.037, respectively). Of the 57 humeral diaphyseal fractures; 16 (28%) were stabilised using a plate-rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only. Open diaphyseal fractures were associated with more minor complications (P = 0.048). There was a significant difference between fixation groups in terms of overall complication rate between groups (P = 0.012). There was no significant difference between fixation groups in time to radiographic union (P = 0.145) or time to acceptable function (P = 0.306). CONCLUSIONS AND RELEVANCE: All three fixation systems were successful in healing a wide variety of humeral diaphyseal fractures. There was a significantly higher overall complication rate with external skeletal fixators compared with bone plating; however, the clinical impact of these is likely low.

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AIM: To evaluate the clinical and radiographic outcome of pes varus deformity correction in dachshunds managed with acute medial opening wedge osteotomy of the distal tibia and stabilised with a mini hybrid external skeletal fixator (HESF). METHODS: Surgical correction involved a transverse osteotomy over the premeasured location at the distal tibia and application of a IMEX mini HESF. All corrections were evaluated using centre of rotation and angulation methodology. RESULTS: Medical records and radiographies of 20 dachshunds (28 pes varus corrections) were reviewed. All osteotomies healed and fixators were removed between 6 and 12 weeks. Lameness resolved in 18 dachshunds (90%) and significantly improved in two dachshunds (10%). Lateral patella luxation (LPL) was detected in 11/28 (39.2%) of the involved pelvic limbs, all of which resolved following pes varus correction. Mean frontal plane alignment (FPA) of the normal and abnormal tibiae were 12.3° valgus (range: 4°-18°) and 25° Varus (range: 16°-41°) respectively. Angular correction ranged between 30° and 50° (Mean: 39°) and the mean post-operative FPA was 13° valgus (range: 5°-21°). CLINICAL SIGNIFICANCE: Pes varus deformity in dachshunds can be corrected by medial opening wedge osteotomy of the distal tibia stabilised by HESF. Single-session bilateral pes varus corrections can also be performed with minimal morbidity. LPL was commonly detected in dogs with pes varus deformity and all resolved spontaneously following pes varus correction alone.

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BACKGROUND: Surgical correction of lower limb discrepancy in children poses a significant clinical problem. The aim of this paper is to present our experience with the PRECICE electromagnetic intramedullary nail. MATERIALS AND METHODS: The study group consisted of 5 patients (2 girls; 3 boys) aged 11.5 to 18 years (mean age 16.3) treated for lower limb discrepancy by femoral lengthening using the PRECICE nail intramedullary system. Average discrepancy was 63 mm (range: 45-74.5 mm). RESULTS: Femoral lengthening was successful in all patients. The femur was lengthened by a mean of 49 mm (range: 40-58 mm). A knee flexion contracture of about 10° occurred in one patient. CONCLUSIONS: 1. Femoral lengthening in children poses a therapeutic challenge. 2. The PRECICE intrame-dullary nail system helps reduce complications and increases patient comfort.

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Distraction osteogenesis was used in 2 wild raptor patients for the repair of tibiotarsal fractures. The first case was a hatching year female peregrine falcon (Falco peregrinus) admitted with an open oblique right distal tibiotarsal fracture. The fracture was surgically managed with the external skeletal fixator intramedullary pin tie-in technique (ESF-IM pin tie-in). Appropriate healing of the fracture site occurred with the ESF-IM pin tie-in. However, there was significant pelvic limb shortening of the affected leg, and the bird consequently developed pododermatitis on the contralateral foot. The second case was an adult female great horned owl (Bubo virginianus) that was admitted with a closed, partially healed, overriding right tibiotarsal fracture. Because of the advanced stage of this fracture, which presented with a fibrous callus, and the already apparent pelvic limb shortening, the ESF-IM pin tie-in was not used. Both patients were fitted with a circular external skeletal fixator (CESF), and distraction osteogenesis was performed until the length of the pelvic limb was deemed anatomically adequate. It is critical that rehabilitated raptors be released without any physical conditions that may reduce their ability to survive and reproduce in the wild. Pelvic limb shortening can potentially predispose a raptor patient to pododermatitis, even with fatal consequences, in both captive and wild environments. The orthopedic technique used here proved useful to repair the limb shortening in both raptor cases, and each bird fully recovered and was released.

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To compare the bending strength of a locking plate (LP), nonlocking plate (NLP), and an external skeletal fixator intramedullary pin (ESF-IM) tie-in fixation applied by a dorsal approach in an avian humerus fracture model, 5 left humeri obtained from pigeon (Columba livia) cadavers were randomly assigned to each repair technique (n = 15). The ESF-IM group was repaired with a 0.062-inch intramedullary pin tied-in with two 0.035-inch positive profile transfixation pins using acrylic filled plastic tubing. The LP group was repaired with a dorsally applied titanium 1.6-mm screw 7-hole locking plate (1 bicortical and 2 monocortical screws in each segment). The NLP group was repaired with a dorsally applied 6-hole stainless steel 1.5-mm dynamic compression plate (all bicortical screws). All constructs were applied before complete ostectomy to allow perfect reconstruction. Constructs were cyclically tested nondestructively for 1000 cycles in four-point bending before being tested to failure. Outcome measures included stiffness, strength, and strain energy. All specimens cycled without failure. The ESF-IM specimens were significantly stiffer and stronger than the plated repair groups. Plated constructs had significantly higher strain energies than ESF-IM. LP and NLP were of equal stiffness, strength, and strain energies. This study demonstrated that bending biomechanical properties of the ESF-IM configuration were superior to those of the dorsal plate fixation. Exact properties of fixation required to facilitate avian fracture healing are largely unknown. Further study, including assessments of optimal plate position and configuration, and torsional and in vivo studies in avian species are warranted.

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In treating avian species with fractures, the clinician must be prepared to think laterally and assess each case individually, taking into account the unique characteristics of the fracture, the temperament of the species and the individual, its lifestyle, and the desired outcome. All this should be considered during the decision making process, which should involve the owner or career of the patient. The clinician should aim for a result as close as possible to the original functional anatomy. The degree of perfection required for postoperative return to normal function is dictated by the species and the lifestyle of the patient.

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An adult, male snowy owl ( Bubo scandiacus) was found down and unable to fly in western New York State. Physical examination and radiographs revealed a subacute, open wound and fractured major and minor metacarpals of the right wing. A minimal type II external skeletal fixator (ESF) device was placed on the right major metacarpal bone and the open wound was allowed to granulate and close. After evidence of bone union, the ESF device was removed. The owl performed auto-physiotherapy throughout the process and was released with sustained flight 2 months postoperatively. It was recaptured 7 weeks later and underwent further rehabilitation to allow successful release 11 months after surgical stabilization. To our knowledge, this is the first case report describing use of a type II ESF device on the metacarpus of a bird.

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OBJECTIVE: To compare the Minimally Invasive Reduction Instrumentation System (MIRIS) to a two-ring circular fixator construct (CFC) for indirect reduction during minimally invasive plate osteosynthesis. STUDY DESIGN: Cadaveric antebrachial fracture model. ANIMALS: Ten skeletally mature dog cadavers. METHODS: Simulated bilateral antebrachial fractures were reduced and stabilized with the MIRIS on one limb, and a CFC on the contralateral limb, prior to placing a 10 hole Locking Compression Plate. Time to satisfactory reduction and implant placement were compared. Difficulty of fracture reduction and plate application was subjectively scored (1 to 5) for each procedure. Prefracture and postoperative orthogonal antebrachial radiographs were compared to assess restoration of radial length and angulation in sagittal and frontal planes. A paired t test (P ≤ .05) was used to compare parameters between the two reduction techniques. RESULTS: Reduction was faster (P = .0191) and plate application was subjectively easier (P = .047) when using the MIRIS compared to the CFC. There were no differences in subjective difficulty of reduction or plate application time between techniques. Mean postoperative radial length was reduced by approximately 4-mm, and procurvatum were decreased by approximately 7° compared to prefracture measurements, regardless of reduction technique. CONCLUSION: The MIRIS allowed for faster fracture reduction, and simplified plate placement compared to a temporary application of a CFC in our simulated antebrachial fracture model.

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OBJECTIVES: The purpose of this study was to determine the accuracy of a commonly used veterinary wire tensioner. METHODS: Wire tension was measured using a load cell after each of five tensioners were used to tension each of six wires to the 66, 84, and 118 mm ring settings in an adjustable custom testing fixture. Each tensioner then experienced simulated aging and testing was repeated. Percentage error was calculated for each ring size, before and after tensioner aging. Measured tension values were compared to manufacturer reported tension values for each ring size using a one-sample two-way t-test; p <0.05 was considered significant. RESULTS: Compared to the manufacturer reported values, measured wire tension values were significantly lower for 66 mm and 84 mm rings and significantly higher for 118 mm rings, before and after simulated aging. Mean wire tension values did not significantly differ between individual wire tensioners. CLINICAL SIGNIFICANCE: The tensioners tested achieved significantly different wire tension values than those reported by the manufacturer. This discrepancy could lead to under-tensioning and allowing excessive movement at a fracture site or over-tensioning, leading to wire breakage. We recommend tensioning wires at least to the recommended line on the device for 66 mm and 84 mm rings and at most to the recommended line for 118 mm rings. Further studies are needed to evaluate other veterinary wire tensioners and to develop a calibration method for these devices in practice.

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O objetivo do presente trabalho foi relatar os principais locais de fraturas em membros de 22 ruminantes e determinar a eficiência dos tratamentos utilizados. Foram incluídos no estudo oito caprinos, oito ovinos e seis bovinos Em casos de fraturas distais, o tratamento conservativo com imobilização foi o método de eleição. Em casos de fraturas proximais e fraturas expostas de metatarso ou metacarpo, os ruminantes foram tratados cirurgicamente. Observou-se maior frequência de fraturas envolvendo o metacarpo ou metatarso (54,5%), seguido por fraturas de tíbia (22,7%), fêmur (9%) e casos isolados de fraturas de falange medial, úmero, rádio e ulna (4,5% cada). O índice de recuperação total alcançou 95,4%. A imobilização com gesso associada à tala de Thomas, ou apenas com talas de madeira em animais jovens, foi eficiente na redução de fraturas de metacarpo, metatarso, tíbia, úmero e rádio nos ruminantes tratados. Enquanto no caso de fratura de falange medial, a imobilização com uso apenas de gesso foi suficiente para proporcionar reparação óssea adequada. A fixação esquelética externa ou interna deve ser considerada uma opção no tratamento de fraturas metacárpicas, metatársicas, tibiais e femorais em ruminantes, principalmente quando o animal for de baixo peso corporal.(AU)

The aim of the present study was to report the main locations of limb fractures in 22 ruminants and to determine the efficiency of the treatment choices. Eight goats, eight sheep and six cattle were included. In cases of distal fractures, the conservative treatment with immobilization was the method of choice. In cases of proximal, exposed metatarsal or metacarpal fractures, the ruminants were treated surgically. The higher frequency of fractures involved the metacarpal or metatarsal (54.5%) followed by fractures of the tibia (22.7%), femur (9%) and isolated cases of medial phalanx, humerus, radius and ulna fractures (4.5% each). Total recovery rate reached 95.4%. Immobilization with plaster associated with Thomas splint, or just with wooden splints in young animals, was efficient in reducing fractures of metacarpal, metatarsal, tibia, humerus, and radio in the treated ruminants. In the case of medial phalanx fracture, immobilization using only plaster was sufficient to provide adequate bone repair. The internal or external skeletal fixation should be considered an option in the treatment of metacarpal, metatarsal, tibial and femoral fractures in ruminants, especially in low body weight animals.(AU)

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A consensus of current surgical practice favors external skeletal fixation in the patients with open fractures, where it can be difficult to achieve a good position and fixation by the usual methods and ipsilateral multiple fractures where it is desirable to avoid prolonged immobilization of adjacent joints. From March, 1979 to December, 1981, 34 patients with lower limb fractures were treated by the method of external skeletal fixator. 22 patients had open comminuted fractures with extensive soft tissue injuries and 12 patients had multiple fractures which were difficult to reduce and maintain in alignment. In the 30 patients which could be assessed, the final result was excellent or good in 23 patients, acceptable in 5 patients, and poor in 2 patients.

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