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PLATE-ROD TECHNIQUE FOR THE REPAIR OF COMMINUTED DIAPHYSEAL FEMORAL FRACTURES IN YOUNG DOGS

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Comminuted diaphyseal fractures of femur in eight young dogs of age ranging from 5 months to 14 months and weighing above 10kgs, repaired with plate-rod construct (PRC) using locking plates, were clinically evaluated for its efficacy. The diameter of the intramedullary rod (IMR) used was 40% of the diameter of medullary cavity. In all the cases, 2.7mm (6-8 holes) locking plates along with locking screws were used without engaging the epiphyseal growth plates. At least two bicortical screws were placed in each fracture fragment. Size and length of the bone plate and screws was determined based on preoperative orthogonal radiographs and body weight of the dog. All the dogs started bearing weight on the affected limb the immediate postoperative day which improved gradually. There was satisfactory visible callus formation radiographically during the 4 th postoperative week. Among the eight cases that underwent repair, one case developed major complication of pin migration. Minor complications like seroma formation and soft tissue irritation was seen in three cases. The results suggested that PRCs yield excellent results in diaphyseal femur fractures in young dogs with a range of severity if bone plates are placed away from the epiphyseal growth plates.
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IJABR, VOL.8 (4) 2018: 451-453 ISSN 2250 3579
451
PLATE-ROD TECHNIQUE FOR THE REPAIR OF COMMINUTED
DIAPHYSEAL FEMORAL FRACTURES IN YOUNG DOGS
Sherin B. Sarangom, *Kiranjeet Singh, Aswathy Gopinathan, K. Mohammed Arif Basha, D.S. Surendra,
C. Sowbharenya, Pallvi Sharma and Christina John
Division of Surgery, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, U. P., India - 243 122
*Corresponding author e-mail: ksuppli@yahoo.co.in, Ph: +91 8410757265
ABSTRACT
Comminuted diaphyseal fractures of femur in eight young dogs of age ranging from 5 months to 14 months and weighing
above 10kgs, repaired with plate-rod construct (PRC) using locking plates, were clinically evaluated for its efficacy. The
diameter of the intramedullary rod (IMR) used was 40% of the diameter of medullary cavity. In all the cases, 2.7mm (6-8
holes) locking plates along with locking screws were used without engaging the epiphyseal growth plates. At least two
bicortical screws were placed in each fracture fragment. Size and length of the bone plate and screws was determined
based on preoperative orthogonal radiographs and body weight of the dog. All the dogs started bearing weight on the
affected limb the immediate postoperative day which improved gradually. There was satisfactory visible callus formation
radiographically during the 4th postoperative week. Among the eight cases that underwent repair, one case developed major
complication of pin migration. Minor complications like seroma formation and soft tissue irritation was seen in three cases.
The results suggested that PRCs yield excellent results in diaphyseal femur fractures in young dogs with a range of severity
if bone plates are placed away from the epiphyseal growth plates.
KEYWORDS: plate-rod construct, locking plates, femur, young dogs.
INTRODUCTION
Femur fracture is the most common long bone fractures in
dogs accounting 37% (Kallianpur et al., 2018). The
surgical treatment of long bone diaphyseal fractures in
puppies has to take into account the particulars of growing
bone. In addition to anatomical alignment and apposition
of bone fragments, added care is a prerequisite to prevent
iatrogenic damage to the growth plates and periosteum.
Meticulous handling of implants, particularly screws is
imperative since the compact bone is less developed and
cortices are thin in puppies (Sarrau et al., 2007). Clinical
use of plate-rod combination (PRC) has been associated
with a high (98%) success rate (Reems et al., 2003). The
PRC has a greater versatility in fracture repair especially
its ability in providing adequate strength despite some
plate holes are left empty without adversely affecting the
potential for fracture healing (Reems et al., 2003). Also,
the intramedullary rod (IMR) in PRCs serves to replace
any transcortical defect in the bony column and act in
concert with the eccentrically positioned plate to resist
bending (Hulse et al., 1997).The objective of this study
was to evaluate the clinical outcome of PRCs in
comminuted diaphyseal fractures of femur in young dogs.
MATERIALS & METHODS
Eight young dogs, aged between 5 months to 14 months
weighing above 10kgs, presented with non-weight bearing
lameness of hind limbs and diagnosed to have
comminuted diaphyseal fractures were selected for the
study. All the dogs had the history of automobile accident.
The configuration and type of fracture along with the size
and dimension of the implants used for the repair were
determined by orthogonal radiographs. For application of
PRCs, the 2.7mm 6-8 hole locking plates (Nebula
surgicals, Ahmedabad, Gujarat, India) were used in all the
cases along with an IMR of 40% of diameter of medullary
cavity. Preoperatively, food was withheld for 12 hours and
water for 6 hours in all the dogs. Atropine sulphate at the
rate of 0.04mg/kg BW SC followed by diazepam at the
rate of 0.2mg/kg BW IV and butorphanol at the rate of
0.2mg/kg BW IV after 15 minutes were administered for
premedication. Anaesthesia was induced using propofol at
the rate of 4-6mg/kg BW IV and was maintained under
2% isoflurane in oxygen. A standard cranio-lateral
approach to femur was made through an incision along the
skin followed by subcutaneous tissue and fascia lata. The
biceps femoris muscle was caudally retracted and the
vastus lateralis muscle was cranially retracted to expose
the fractured bone. Axial realignment and length of the
fractured bone was re-established with a Steinmann pin
that was inserted in a normograde manner through the
inter-trochanteric fossa. Ancillary cerclage wiring was
done if required to proximate any widely displaced bone
fragments. The fractures was fixed using locking plates
placed on the craniolateral surface without engaging the
epiphyseal growth plates in all cases after contouring the
plate according to shape of the bone. Every effort was
made to preserve the periosteal attachments and fracture
hematoma by minimizing handling of fracture fragments.
At least two bicortical screws were placed in each fracture
fragment and at least four cortices were engaged without
damaging the epiphyseal growth plates. Once the plate
was fixed, the fascia lata and the subcutaneous tissue were
apposed separately using no 1-0 polyglycolic acid sutures
Plate-rod technique for the repair femoral fractures in young dogs
452
followed by the skin using polyamide in simple
interrupted pattern.
Postoperatively, ceftriaxone at the rate of 20mg/kg BW
was administered IV for 7 days along with meloxicam at
the rate of 0.2mg/kg BW orally and tramadol at the rate of
4mg/kg BW orally for two weeks. Regular bandage
dressing was done and the skin sutures were removed on
the 10th postoperative day. Movement restriction was
advised for four weeks followed by leash walking.
Postoperative grading was performed for lameness while
standing and walking, weight bearing while running,
functional outcome and radiographic outcome up to 12th
week. In all the cases, the IMR was removed on the 6th
postoperative week.
RESULTS & DISCUSSION
The radiographic evaluation during the 4th, 6th, 8th and 12th
postoperative week showed adequate alignment of fracture
fragments, good implant stability and satisfactory bone
healing (Fig. 1). Periosteal and endosteal callus was
observed during the 4th postoperative week. Extensive
inter-osteal bridging callus was observed during the 4th to
5th weeks. Also, the photographic and video-graphic gait
analysis and grades of weight bearing on these days
showed satisfactory results. All the dogs showed weight
bearing on the immediate postoperative day and complete
weight bearing by 5th postoperative week. Out of the eight
cases that underwent repair, one case developed pin
migration. Minor complications such as seroma formation
and soft tissue irritation due to the impingement of
proximal end of pin were seen in three cases. Similar
postoperative complications with PRCs were previously
observed by Sarangom et al. (2018).
FIGURE 1: Plate-rod technique employed for the repair of diaphyseal femoral fracture in a pup. A: Day 1; B: Immediate
postoperative; C: 6th week and D: 10th week
Plate rod technique has been used for the repair of
diaphyseal fractures in dogs (Reems et al., 2003 and Shiju
et al., 2010). In puppies, the simple femoral and tibial
fractures usually undergo repair by the principle of elastic
plate osteosynthesis (Casbassu, 2001 and Sarrau et al.,
2007). The elasticity was achieved by using longer thin
plates fixed by two screws each in proximal and distal
fragment. This was thought to induce micromotion of
fracture fragments and in turn early callus formation. But
in comminuted fractures where adequate implant-bone
stability is imperative, the strength of the repair can be
improved by the use of an IMR along with the plate. The
eccentrically placed bone plates prevent the axial collapse
and rotation of fracture fragments and the addition of IMR
along with the plate improve the bending strength. Also,
the IMR counteracts the susceptibility of plate to fail by
bending at the level of empty screw holes. Another
advantage of using PRC for the repair compared to plate
alone is the ability to create an intermittent stress on the
fracture site by removal of rod for stimulating fracture
healing once the callus forms (O’Sullivan, 1989).
Normograde placement of IMR was performed since
retrograde pinning of femur was more likely to induce
sciatic nerve injury (Palmer et al., 1988).
Functional and radiographic outcome of seven dogs was
excellent and one dog was good. The results suggests that
PRCs can be used for the repair of diaphyseal femoral
fractures of young dogs with wide range of severity by
placing bone plates away from the epiphyseal growth
plates.
ACKNOWLEDGEMENT
The authors are thankful to the Director, ICAR-Indian
Veterinary Research Institute, Bareilly, U.P., India for
providing necessary facilities for the study.
REFERENCES
Cabassu, J.P. (2001) Elastic plate osteosynthesis of
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S.B., John, C., Sowbharenya, C. and Sharma, P. (2018)
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O’Sullivan, M.E., Chao, Y.S. and Kelly, P.J. (1989) The
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Palmer, R.H., Aron, D.N. and Purinton, P.T. (1988)
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IJABR, VOL.8 (4) 2018: 451-453 ISSN 2250 3579
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nerve and gluteal muscles after retrograde and normograde
insertion. Vet. Surg. 17, 65-70.
Reems, M.R., Beale, B.S. and Hulse, D.A. (2003) Use of a
plate-rod construct and principles of biological
osteosynthesis for repair of diaphyseal fractures in dogs
and cats: 47 cases (19942001). J. Am. Vet. Med. Assoc.
223, 330-335.
Sarangom, S.B., Singh, K., Gopinathan, A., Surendra,
D.S., Sowbharenya, C., Sharma, P., John C. and
Kalaiselvan E. (2018) Long-term outcome of
complications associated with femur fracture repaired by
plate-rod construct using locking plates in nine dogs.
International J. Adv. Biol. Res. 8, 307-313.
Sarrau S., Meige F. and Autefage A. (2007) Treatment of
femoral and tibial fracture in puppies by elastic plate
osteosynthesis. Vet. Comp. Orthop. Traumatol. 20, 51-58.
Shiju, S.M., Ayyapan, S., Ganesh, T.N., and Suresh
Kumar (2010) Plate rod technique for the management of
diaphyseal femoral fractures in dogs. Indian J. Vet Surg.
31, 41-42.
... Body weight of the dogs is a mechanical factor that determines the amount of stress and strain acting on a bridging construct (Hulse et al. 1997). The dimensions of LCPs used in the present study were in agreement with the previous studies (Sarangom et al. 2018). ...
... Hindrance in placement of bicortical screws along the diaphysis was encountered in few cases of Groups B and D might be due to the inability of locking screws to comply with more than five degrees of angulations in order to achieve angle stable lock with the plate holes. Similar observation of hindrance in placement of screws for plate rod construct for femoral fracture repair has been reported (Sarangom et al. 2018). The mean screw densities used were 0.75±0.00, ...
... The minimum time taken for mobility, complete weight bearing and time taken for complete radiographic healing were comparable in all the Groups. Similar timings for radiographic healing in 10 to 28 weeks post-surgery using plate-rod technique for the repair of comminuted fractures in dogs are documented (Sarangom et al. 2018). The delay in radiographic healing in few cases can be mainly attributed to the age, degree of comminution, complications anticipated and encountered during post-operative period. ...
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Long-term outcome of complications associated with femur fracture repaired by plate-rod construct using locking plates in nine dogs
  • S B Sarangom
  • K Singh
  • A Gopinathan
  • D S Surendra
  • C Sowbharenya
  • P Sharma
  • C John
  • E Kalaiselvan
Sarangom, S.B., Singh, K., Gopinathan, A., Surendra, D.S., Sowbharenya, C., Sharma, P., John C. and Kalaiselvan E. (2018) Long-term outcome of complications associated with femur fracture repaired by plate-rod construct using locking plates in nine dogs. International J. Adv. Biol. Res. 8, 307-313.
Treatment of femoral and tibial fracture in puppies by elastic plate osteosynthesis
  • S Sarrau
  • F Meige
  • A Autefage
Sarrau S., Meige F. and Autefage A. (2007) Treatment of femoral and tibial fracture in puppies by elastic plate osteosynthesis. Vet. Comp. Orthop. Traumatol. 20, 51-58.
Plate rod technique for the management of diaphyseal femoral fractures in dogs
  • S M Shiju
  • S Ayyapan
  • T N Ganesh
  • Suresh Kumar
Shiju, S.M., Ayyapan, S., Ganesh, T.N., and Suresh Kumar (2010) Plate rod technique for the management of diaphyseal femoral fractures in dogs. Indian J. Vet Surg. 31, 41-42.