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Department of Veterinary Surgery & Radiology
College of Veterinary Science and Animal Husbandry
Anand Agricultural University, Anand - 388 001 (Gujarat)
: Edited by :
Dr. P. V. Parikh
A Monogram on A Monogram on
Management of InjuredManagement of Injured
BirdsBirds
A Monogram on
Management of Injured
Birds
"Karuna Abhiyan""Karuna Abhiyan""Karuna Abhiyan"
ii
A Monogram on Management of Injured Birds
Editor : Dr. P. V. Parikh
ISBN No. :
Publication Series & Year : RES - 1 : 14 : 2019 : 500
Copies : 500
Price : Free of cost
Publisher : Department of Veterinary Surgery & Radiology
College of Veterinary Science and Animal Husbandry
Anand Agricultural University, Anand - 388 001 (Gujarat)
Copyright @ All rights reserved by Anand Agricultural University, Anand
Jurisdiction : All disputes with respect to this publication shall be subject to the
jurisdiction of the court, tribunals and forums of Anand, Gujarat
only.
Place of Publication : Anand
Printer : Asian Printary,
Opp. Talati Hall
Raipur, Ahmedabad
Ph. : (079) 22148826
42
CHAPTER – 10
FRACTURE MANAGEMENT IN BIRDS
Dr. D. N. Kelawala, J. K. Mahla & Dr. H. M. Barot
Orthopedic problems in birds may occur as a result of trauma (ceiling fan injuries, ying into a
window or mirror, kite string injury or getting stepped on), others occur from nutritional imbalances, and
others may occur as a result of genetic or developmental problems. Avian fractures are often open and
comminuted. Many times the bones are small and the patient is fractious and prone to self-trauma.
Over the past few years, great advances have been made in techniques for repairing fractures in
birds. Earlier external coaptation was the only method of fracture stabilization routinely recommended for
avian patients. Fractures can be repaired either through non-invasive methods like gure-of-eight bandage
or invasive surgical approaches. The right choice of fracture repair method helps to achieve the best possible
bone healing.
The tie-in xator (TIF), a combination of an intramedullary pin (IM) linked to external skeletal
xator pins (ESF), has been adapted and found extremely useful in managing avian fractures. Compared
to standard methods used from the early 1970’s through the mid-90’s, a clear improvement in results was
realized with overall success rate, as measured by full return to function, going from 40% to over 65%.
The goals of avian fracture management are to stabilize the fracture, allow load sharing, and limit activity
during healing. Exact anatomical reduction may not be necessary in all cases but the orthopedic device
should offer rigid support and be lightweight. Limiting activity will benet lower limb fractures but be
detrimental for wing injuries and return to ight.
Important Facts
• Maintenance and protection of soft tissues is the single most important aspect of successful surgery
• The degree and type of soft tissue damage more critical in determining the potential for postsurgical
return to function than specic osseous injuries.
• Orthopedic problems in birds may occur mostly as a result of trauma
• Many times the bones are small and the patient is fractious and prone to self-trauma.
• Bird bones tend to fragment or shatter upon impact, and many of the bones of the distal extremities have
little soft tissue support and are covered only by tendons and skin.
• Thin cortex offers less holding power for pins and other hardware when applying orthopedic devices
• Limited soft tissue exists over the long bones, which adversely affects fracture repair
• Fracture fragments are often unstable, and the blood supply can be compromised
• Thin and the lack of signicant subdermal tissue is also a problem associated with orthopaedic injuries.
These factors contribute to a high incidence of open, comminuted fractures and make iatrogenic fracture
during repair attempts a signicant concern.
• Open fractures further complicate healing and can lead to generalized bacterial infections
• Over the past few years, great advances have been made in techniques for repairing fractures in birds.
43
• After proper examination of the affected wing/ limb, radiography must be performed.
• Radiography provides a clear diagnosis and gives valuable information about possible surgical approach.
• Radiography is an essential diagnostic tool in judging the fracture healing and proper alignment of the
fractures.
• Postoperative radiographs should be taken at two- to four-week intervals to assess bone healing.
• The radiographic changes associated with bone healing can appear similar to those that occur with
osteomyelitis including periosteal reaction, sclerosis and increased radiodensities in the medullary
canal.
• Most avian patients are under severe stress after a fracture occurs both because of initial trauma and the
additional stress of restraint and handling.
• Fracture assessment and repair should be postponed until the patient is stable and out of danger
• Haemostasis, shock therapy, and temporary support for any fractures should be rst line of treatment
• Most important goal: Rigid stabilization for rapid bone healing in orthopaedic surgery.
• Rotational alignment is critical, restoration of bone length is of concern and acquisition of partial load-
sharing between the bone and the xator is desirable.
• Exact anatomical alignment of loose fragments is of lesser importance.
• “Biological” management of fractures, stressing restoration of length and rotation with as little
manipulation of bone fragments and soft tissues as possible and relying on bridging osteosynthesis to
ll areas of bone defects is of great importance in avian orthopedics.
Regardless of techniques employed in fracture repair, it is important to:
• treat contaminated and infected wounds,
• preserve soft tissue structures,
• appose, align and control rotation of fractures,
• reduce luxations,
• rigidly immobilize the fracture site,
• maintain range of motion in all joints affected by the fracture or xation technique and
• return the affected wing/limb to normal function as soon as possible.
• After the initial diagnosis it is important to rst stabilise the fracture site to prevent contraction of the
soft tissue before any procedure is carried out.
• Do not irrigate any exposed medullary cavities
• Remove any protruding bone
• When the wound is clean the surgeon can proceed with the necessary orthopaedic surgery
• Post-operatively polymethylmethacrylate (PMMA) antibiotic beads can be used around the operation
site.
44
WHAT CAN BE DONE FOR A BIRD WITH A FRACTURE IS DEPENDENT ON MANY
FACTORS:
1.
Availability of veterinary assistance
2.
Type of fracture
3.
Duration of the fracture
4.
Location of the fracture
1.
Availability of veterinary assistance
This is essential to treat fractures effectively. If you do not have access to this, then nd it. There
will be situations where due to a lack of resources, the bird is euthanized – that is better for the animal than
6 weeks of pain and suffering and the same outcome. Not pleasant, but a fact of life.
Radiographs are required to diagnose a fracture. Often a second x-ray view is required.
Where possible, to reduce pain and further damage, x-rays should be done under anaesthesia by a
veterinarian.
It is a surgical procedure to place implants into bones. Ideally, surgery is performed to reduce the need
for bandaging and permitting the immediate return to function of the affected limb.
Antibiotics such as Clavulox are required for a minimum of two weeks.
Pain relief should be provided for the rst 3 to 5 days. Metacam or carprofen is suitable for birds.
Follow up is required. Birds with strapped wings should be anaesthetized every 3 days for physiotherapy
on the wing and bandage change. Repeat x-rays are taken at 10 days, 21 days and further if required.
Physiotherapy involves stretching the pytagial tendon and performing supported full range of motion
starting at the hand and working back to the broken joint. This is performed under anaesthesia to
prevent further damage to fracture site.
2.
Types of Fractures
We can describe fractures in different ways
Has it broken the skin ?
Open fractures are where the skin has been broken. They carry a poorer prognosis due to
contamination of the wound and ascending bacterial infection.
Closed fractures are where the skin has not broken. They carry a better prognosis.
Is one bone or more affected ?
If one bone is affected, the prognosis is better.
If two bones are affected such as the radius and ulna of a wing, then surgical intervention is a
necessity and a poor prognosis results.
If two discreet bones are broken say humerus and femur, then euthanasia is preferred as the bird
cannot use its wing to balance its leg or vice versa.
Is the bone in one or more pieces ?
45
If the bone has a simple fracture, it is in two pieces and the prognosis is good.
If the bone has a comminuted fracture, then there are many pieces of bone. With loss of the length of
bone, prognosis is poor as it is difcult to put several pieces back together as bird bone is more thin
and brittle than mammalian bone.
3.
Duration of the fracture
In the perfect world, fractures that are repaired within 24 hours of their occurrence have the best
outcome and prognosis.
Fractures that are open (and thus infected) for longer than 24 hours have a much poorer prognosis.
The longer the fracture spends broken, the more muscle contraction, drying of tissues, and progression of
infection that occurs. The ends of the bone have begun to heal over by 48 hours.
Age fractures by looking at the colour of the bruising:
1. Red : < 24 hours,
2. Blue-purple : Older than 24 hours but less than 5 days
3. Green : 5 – 7 days
4. Yellow : Greater than 8 days,
5. No colour : Older than 2 weeks.
4.
Location of the fracture
Where the fracture is found has a great bearing on whether the bird will be successfully released
and also what method to x the fracture is used.
Fractures that can be bandaged
Shoulder fractures of coracoid, scapula and furcula if less than 400g and not in a high performance
ier (raptor, migratory bird).
Radius : Closed fractures from middle of bone to distal end.
Ulna : Closed fractures along length.
Hand : Closed fractures (rare occurrence).
Tibiotarsus : Upper two thirds of bone (common in young magpies).
Metatarsus (foot) : Simple fractures (ball bandage required).
NOTE
Bandages are changed on the wing every 3 days, and every 5 - 7 days for leg fractures.
The frequency of bandage changes is dependent on the presence of open wounds – daily changes for
rst 3 days with saline dressings, reduced to changes every 3 – 5 days depend on the wound. Check
bandages daily for swelling, pain or lack of use on limb.
Use Vetrap (Coplus, etc) or Micropore only as bandage material – NO ELASTOPLAST as it damages
the feathers.
46
Fracture repair
• Earlier external coaptation was the only recommended method of fracture stabilization
• Fractures now can be repaired either through non-invasive methods like gure-of-eight bandage or
invasive surgical approaches.
• The right choice of fracture repair method helps to achieve the best possible bone healing.
• Avian bones seems to heal faster than mammalian bones with well aligned, stable fractures
• Prolonged immobilization may result in ankylosis of the involving joints, contraction of soft tissues and
muscle atrophy
• Aviary birds rarely require full mobility following fracture repair, and the post-fracture prognosis for
return to function with these birds is generally excellent.
• By comparison, free-ranging birds (particularly raptors), which can be viewed as nely tuned athletes,
must have near perfect wing function in order to survive in the wild. A slight rotation in the wing
(particularly in the distal wing) can alter ight.
Fracture correction technique
EXTERNAL COAPTATION
Bandaging Basics
The goals of bandaging include preventing contamination, maintain an environment that promotes
wound healing, preventing mutilation by the patient, and reduction of dead space. Splinting is the addition
of materials to stabilize broken bones or damaged joints. These things must always be checked for when
applying bandages or splints:
1.
Wing gure - eight bandage Indication
Used with fractures beyond the midshaft humerus, with
dislocations of the elbow or carpus, and with wounds of the wing
proximal to the carpus.
Application
• Use Vetrap self-adhesive bandaging. Restrain the wing in a semi-
folded position.
• Figure illustrates the route of wrapping. Starting at the wrist, wrap
inward around the carpus, across the dorsal surface of the wing,
around the medial surface of the humerus, across the ventral surface
of the wing, and around the leading edge of the phalanxes to the
starting point. Repeat the same path at least three times. Finish off
by wrapping at least once around the body at mid-sternum. Tape the
exposed end of the Vetwrap.
• The following tips will help you apply a good
47
Place limbs in a functional position so that joints are arranged at natural angles.
Keep the crossing at the humerus as high as possible into the pit of the wing.
Keep the crossing at the phalanxes at about midway down the phalanxes.
Avoid crossing too low (results in feather breakage and restricted wrist circulation) or crossing too
high (results in looser bandage).
Do not stretch the Vetrap as it is applied. Unwrap the roll several feet and reroll loosely. Apply only
slight tension to the material while wrapping.
2.
Wing Body Wrap
Indication
Fractures or luxations involving the humerus, coracoid, furcula or
scapula The legs should be extended.
Application
The wing should be folded in a normal exed position and held to
th e body using a selfadherent bandage or adhesive tape that does not harm feathers.
3.
Foot gure - eight
Indication
Brief treatment of small minor wounds on the foot pad. Seldom used.
Alternatives include ball and doughnut bandages.
Application
Tape that is very sticky and waterproof is preferred. Telfa and gauze
sponges are placed over the lesion on the sole of the foot. Figure illustrates
the route of wrapping. Starting at the cranial face of the distal tarsometatarsus
(TMT), wrap around the TMT, over the hallux, and down across the pad.
Continue up around the opposite side of the hallux and around the TMT to
the starting point. Repeat at least two times or until the dressing on the pad is
covered and secure. About three wrappings are usually sufcient.
4.
Ball Bandage
Indication
Bumblefoot or wounds of the foot pads, temporary foot restraint (as
during surgery) and to supplement splints or external skeletal xators during
fracture healing.
Application
Place a wad of gauze sponges in the foot and close the toes around it
uniformly. If a wound is involved, place a non-stick pad (e.g. Telfa) against the
wound with an appropriate antimicrobial ointment. Wrap with self-adhering
elastic wrap. Simply progress around and around the foot and ankle as though
48
forming a ball. Once sufciently wrapped (three layers at least) then tear off the wrapping material and
adhere it to itself. For birds that tend to shake the bandage off or pick at it, add a piece of medical tape to
the ankle portion and perhaps a sacricial tab or two on the ball itself.
5.
Tape splint
Indication : Immobilizing tarsometatarsal or distal tibiotarsal fractures on small birds.
Application
Pluck the feather if possible. If the fracture is open, the site must be cleaned and ushed thoroughly.
Reduce the fragments to their approximately normal conguration. Apply a small amount of antimicrobial
ointment (e.g. Silvidine) and a piece of non-stick dressing. Apply strips of tape from front to back all along
the inside length of the leg, keeping it in a slightly bent position to resemble the stance while standing.
Repeat along the outside of the leg so that the leg is sandwiched between tape strips. Leave the foot exposed
unless the fracture is very distal on the tarsometatarsus. Apply cyanoacrylate glue to the seems and trim
away the excess. In larger small birds (100 grams and higher), you may want to add a paperclip or other
stiffener to the sandwich. Make sure that you place it outside of the initial wrap so that it does not dig into
the skin.
6.
Paddle Bandage
Indication
To immobilize a broken toe or foot in small and medium-sized birds or to cover minor wounds on
the toes or feet. This bandage is easier to apply on small feet than wrappings, provides stiffness, and reduces
the risk of strangulating toes.
Application
Make a platform out of strips of waterproof tape. Apply prescribed antimicrobial ointment and
dressing to the wound. Apply the tape platform to the bottom of the foot so that it extends beyond the
whole foot at least one inch. Apply strips of tape across the top of the toes and so that they sandwich the
foot in between. Apply one strip of tape around the ankle and cross it over itself on the bandage. Finally,
49
apply cyanoacrylate glue to the edges of the bandage to stiffen it and prevent delamination. Trim away the
excess from the sides. Try to leave the tips of the toes protruding to aid in removal and to allow inspection
for tightness. When removing this bandage from small birds, great care must be taken not to cut toes off!
Usually a pair of suture scissors can be worked from the ankle down using small bites to gradually ay the
whole bandage open.
INTERNAL FIXATION
A variety of K-wires and Steinman pins may be passed into the bones, and a variety of connecting
bars and acrylic cements can be used for stabilizing the pins.
Intramedullary pins, external skeletal xators in various congurations and combinations of the
two, along with coaptation have proven utility in managing forelimb fractures where the objective is full
ight.
Advantages in order to reduce patient morbidity and optimize the outcome:
• technically not difcult to apply,
• devices are inexpensive,
• light weight,
• easy to remove and
• are well tolerated by many avian
• when properly used provide rigid stabilization and preserve joint and periarticular structure, while
neutralizing rotational, bending and shear forces.
• use of a smaller diameter IM pin than would otherwise be used, which causes less damage to the
intramedullary blood supply, an increase in resistance to bending forces compared to either ESF or IM
pin alone
Humerus fracture
• The diameter of the IM pin should ll 50 to 60% of the medullary cavity
• Intra-medullary pinning - under the C-arm guidance
• At the pin’s exit at proximal side, pin is to bent at 90°. One threaded K-wire of very small size (1.2-1.5
mm) are to transversely inserted into the proximal fragment and in distal segment.
50
• A plastic straw can be placed over the interface pin and the two K- wires and the intramedullary pin
which is bent through 90° and the two transverse pins are rigidly connected using liquid dental acrylic.
• Threaded pins have superior bone-holding strength in avian cortices. Positive prole pins have a higher
locking strength at the pin-bone interface and may be considered advantageous in larger bones.
• The tie-in xator (TIF), a combination of an intramedullary pin
(IM) linked to external skeletal xator pins (ESF), has been
adapted and found extremely useful in managing avian fractures.
• Overall success rate, improved as measured by full return to
function, going from 40% to over 65%.
Points to be considered:
• Use of partially threaded, positive prole pins
• Use of xator bars constructed from acrylics or thermally activated casting tapes
• Normograde placement of intramedullary pins
• Favored locations for external skeletal xation (ESF) wire placement
• Application of constructs whose geometries eliminate the need for extended coaptation
• Type II (through-and-through) xators are more stable and stronger than Type I xators, which tend to
loosen rapidly.
51
• The use of positive-prole threaded pins in a Type I xator conguration is particularly useful in
repairing fractures of the proximal humerus and femur, where interference with the body wall makes it
difcult or impossible to place a Type II xator.
Radius-Ulna fracture
• External splinting
• Figure-of-eight bandage combined with
cage rest
• Rush pinning of a fractured ulna using
a suitable K wire bent into shape can be
done.
• In case of the simple fractures involving radius-ulna, C- arm guided normograde intra-medullary
pinning is done in Ulna using small sized pin or K-wire as per the size of the bone.
Limb injury
o In case of the dislocations involving the tibiotarsus
bone, major metatarsal bone external cooptation
can be provided using light weight cast bandage.
o In case of fracture of tibiotarsus the tie-in external
skeletal xator is the treatment of choice
o In case of fracture of long tibiotarsus bone,
intra-medullary pinning can be performed.
52
Bone healing
• True bony union takes 22 days and complete remodelling takes six weeks.
• The rate of healing is dependent on displacement of bone fragments, damage to blood supply,
presence of infection and movement at the fracture site.
• In case of external coaptation, healing takes about 5-8 weeks, whereas, in internal xation union
occurs at two weeks and by third week remodeling begins.
• Primary bone healing occurs with rigid xation and does not occur if there is a gap or motion at the
fracture site
• Secondary bone healing is characterized by maximum callus formation occurs
Post-opperative Management
• Orthopedic patients are at risk for fracture disease, which results from disuse of a limb. To improve
vascular supply to damaged tissue and to speed up the bone healing process, active and passive
rehabilitative techniques should be instigated as soon as possible after an orthopaedic surgery. Initial
physical therapy may involve only a bird’s daily activities of perching and prehending food.
• The use of physical therapy, specically passive range of motion (PROM) techniques, is critical to
successful rehabilitation of raptors with wing injuries. Physiotherapy begins immediately after surgery
or injury and is continued until maximum performance is achieved. Benets from physiotherapy
includes increased blood and lymph ow, improved resolution of inammation, decreased muscle
atrophy, increased strength and endurance, and preservation of joint range of motion.
• Post-operatively, in case of birds the lesions should be ushed with chlorhexidine or povidone-iodine
solution. The use of intraoperative, broad-spectrum antibiotics with good tissue penetration such as
cephalosporin, chloramphenicol, and tetracycline is satisfactory in orthopaedic surgery. Regardless of
the severity of disease, analgesia should always be considered in any critically ill patient; especially if
the illness is related to trauma. In clinical avian practice, meloxicam is commonly used for its analgesic
anti–inammatory effects.
• The birds should be classied and provided with separate shelters according to their family and feeding
habits till the complete recovery. Feeding is another important factor for the success of the fracture
management. If the bird is not eating at all, forced feeding is necessary. Birds can be nutritionally
supplemented in many ways: by hand, syringe/tube feeding, IV parenteral nutrition or surgically placed
feeding tubes.
• The rate at which the bone heals is probably a little faster than in mammals. True bony union takes 22
days and complete remodelling takes six weeks. The rate of healing is dependent on displacement of
bone fragments, damage to blood supply, presence of infection and movement at the fracture site. Stable,
well aligned fractures heal faster in birds than in mammals. Clinical stability of a fracture (2–3 weeks)
may precede radiographic evidence that bone is healed (3–6 weeks). In case of external coaptation,
healing takes about 5-8 weeks, whereas, in internal xation union occurs at two weeks and by third
week remodeling begins.
• Primary bone healing (bone growth through the Haversian system with minimal callus formation)
occurs with rigid xation and does not occur if there is a gap or motion at the fracture site. In these
53
cases, secondary bone healing characterized by maximum callus formation occurs. In birds, where
fractures were repaired with bone plates (maximum stabilization), callus formation was found to be
minimal, suggesting that primary bone healing had occurred.
• Complications associated with fracture repair included wound at the point of pin entry, pin migration,
osteomyelitis and non-union. In cases of non-union, mal-union as well as old and irreparable fractures,
amputation is recommended.
• Flying acuity should be assessed by allowing the bird to y in a large closed area. Complete return of
ight can be observed between 45-60 days.
• Incidence of fracture is more in wings as compared to limbs. Intramedullary pinning in combination with
external coaptation provides rigid immobilization. Fracture repair in small birds was more challenging
than medium/large sized birds. Prognosis is poor in cases of delayed presentation, fracture near joint
and comminuted fracture.
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