Multiple Fractures in Dog: A Case Study

Abstract

A twelve years old non-descript dog weighing 25 kg was presented to

Teaching Veterinary Clinical Complex, with the history of an automobile
accident one day back and non weight bearing lameness in right hind-limb.
Physical examination revealed fracture of femur, tibia. Radio-graphic
examination confirmed multiple fractures on both femur and
tibia.Hematological examination showed anaemia and thrombocytopenia.
The case was resorted for surgical correction by bilateral reconstruction
plating. After premedication with atropine @ 0.045 mg/kg body weight
xylazine @ 1 mg/kg body weight, meloxicam @ 0.2 mg/kg body weight as
intramuscular injections and vetplasma-400ml iv infusion, the animal was
prepared for aseptic surgery. General anaesthesia was induced with
thiopental sodium @ 6 mg/kg body weight intravenously followed by
endotracheal intubation and was maintained with 1-2%isoflurane. A skin
incision was made from the cranio-lateral aspect of the thigh and cranio-
medial approach of tibia,the fracture site was exposed by muscle dissection.
Reconstruction plating was done after proper reduction of fragments. The
incised muscles and skin were sutured in routine manner. Post operatively,
the hindlimbs were immobilised with a bandage and animal was treated
with antibiotics[Intamox-d -10mg\kg] and NSAIDs for two days. After two
days, the same surgical procedure of bandaging by sanitary pads and
drainage of pus. The hindlimbs were immobilised with U-SPLINTS and post-
operative therapy was continued for seven more days.

Keywords: Dog, femur fracture, tibia fracture,metatarsals

fracture,reconstruction plate, bilateral plating.

Introduction

Bone is a multi-factorial connective tissue of the animal body, providing

skeletal support and motion. It acts as a protective cage for visceral organs,
fulcrum for the muscles, store house of calcium and phosphorous and is a
site for formation of haematopoietic and immune cells. Bone is considered
to be the hardest tissue in the body. It is flexible, yielding and remouldable.
In the embryonic stage, development of a bone takes place from the
mesenchyma, a diffuse loose connective tissue lying between ectoderm and
endoderm of the embryo.
Fracture is a highly complex injury.In animals, fractures are mainly caused
by the trauma and mechanical forces such as compression, bending and
twisting that can cause long bone fractures.
Fracture healing is a complex physiological process caused by interaction of
various cellular elements that are activated and controlled by an array of
activated and signalling proteins. This process is both temporal and spatial
in nature and usually results in the formation of new bone, which is
structurally and mechanically similar to pre-fracture state.
Fractured bone can be immobilised either by external immobilisation using
bandages and splints, using various external fixation devices and internal
fixation techniques using different types of pins and plates. The primary
reason to choose internal fixation for treatment of fracture is to hold the
fragments until they are healed, which allows the patient to move the limb
and to bear weight. For this the technique which neutralises all the forces
acting on the bone to get neutralised should be used. Bone plating provides
the most stable form of fracture fixation with neutralising all the forces that
commonly act on the fracture like compression, tension, shear, torsion and
rotation.
The closeness of the abdominal wall to the proximal femur and surrounding
heavy muscles limits the use of external skeletal fixation for femoral
fractures.
reconstructive plate is lighter in weight and has notches in between the
locking holes and helpful in contouring the plate in three planes and the
plates are fixed by the headed screws to the bone.

Case history and observations.

A 12-year-old [lingi] non-descript dog weighing 25 kg was presented to the
Unit of surgery Veterinary College gadag with non-weight bearing lameness
of right hind limb after an automobile accident. On clinical examination the
animal was apparently healthy and all the vital parameters were within the
normal ranges.animal was recumbent, inactive multiple open wounds at
pelvic region.cyanosis below right tibia.pain reflex and tail reflex were
present.
T. D- MULTIPLE LONG BONE FRACTURE.

Radiographic examination.
medio-lateral and carino-caudal radiographs of the affected femur,tibia
and metatarsals were performed for each case using X-ray machine with
exposure factors (48 KV and 6 MAs) according to the size and weight of the
affected animal. Lumbar and pelvis normal,right femur and tibia mid
diaphysial fracture, bilateral metatarsal fracture .The radiography were
assessed for the type of the fracture and the method of treatment.

TREATMENT.

Pre-operative preparation.

Animal preparation-Dogs were kept off feed for a period of 8 hours and off
water for 6 hours. Prior to surgery, dog were administered with Inj.
Amoxicillin +cloxacillin [intamox-d] @ 10 mg per and Inj. meloxicam @ 0.5
mg per kg intramuscularly and NS-400ml, vetplasm- 10ml per kg is
administered by IV.

Surgical site preparation-An extensive area over the limb was scrubbed in
centrifugal direction with soap water. The limbs were shaved in the
direction of hair follicle. The site was smeared with surgical spirit. Then
tincture Iodine solution was applied on the site prior to surger.

Sterilisation of surgical instruments-All the required surgical instruments

and orthopaedic instruments were sterilised by autoclaving.

Anaesthetic technique-
 Pre anaesthetic- atropine sulphate - 0.05mg per kg.
- after 10min xylazine- 1mg per kg.
Anaesthetic- surgical procedures were performed under general
anaesthesia were induced with combination of
thiopental sodium -1gm intravenously. Maintenance
of anaesthesia was done by 1- 2 % Isoflurane as
inhalant anaesthetic.

Implants
Reconstructive plates were used for stabilisation of fractures. The implants
are available in 2.7 mm, 3.5mm and 4.5mm hole
dimensions. In this study, 3.5mm reconstructive
plate was accommodated 26mm diameter cortical
headed screws of various length were used. These
reconstructive plates of 8 to 10 holes.the distance
between each holes was 10 mm. Hexagonal headed
cortical screws were used to fix the plate.

Anatomical approach to the shaft of fractured long bone tibia- tibia was
approached through a cranio-medial approach. An
incision was made extending from the stifle
proximally close to the hock distally. The skin and
fascia were separated by alies forceps and the
bellies of tibialis anterior and flexor digitorum
profundus were retracted to expose the fracture a
fragments
Anatomical approach to the shaft of fractured long bone femur- dog was
restrained in lateral recumbancy. An incision was
made on cranio-lateral aspect of the thigh
extending from greater trochanter to the stifle
joint. Skin and fascia were incised to expose the
bellies of vastus lateralis, biceps femoris, and
semimembranous muscles to expose the fractured
 bone.Soft tissues were removed from the fractured
fragments and these fragments were brought into
opposition.
Reduction and stabilisation technique-After apposition of fragments, the
plate was held in position with hands and holes
were drilled using hand hold drill using 2 mm drill
bit. While drilling, it was kept in mind to make a
hole near to the fracture site. After drilling of hole,
depth gauge was used to measure the length of the
screw needed. The plates were fixed in position
with non-self-tapping screws of appropriate size
using hexagonal head screw driver and by circling
wire.
In both the fractures,after stabilization of fractures, suturing of muscle was
done by using vicryl No. 2-0 using lock stitch
pattern. The skin was closed by polypropylene size
1-0 by simple interpreted suture pattern.

External fixation of metatarsals of both limb.- u-splint was made by plastic

pipes according to the size of limb and boric acid is
applied to cyanosis part of limb for better
healing.at last the bandage is applied.

Post-operative care and management.

Oxygen supply till the respiration through thoraic, and antibiotic-intamox-d

-10 mg per kg and meloxicam- 0.5 mg per kg.
Amoxicillin+cloxacillin [intamox-d] @ 10mg/kg body weight bid for ten days
was given prenatally.
The cynosis of limbs are treated with turmeric and boric acid powder and
coverd with sanitary pads for better abosption.
Homeopathy medication- calendulla q -
Staphysaggria-
 Symphytum 6-
Cal phos 6-

For 7days the wound is cleaned with povidine iodine solution and two
sutures are removed to pus drainage.Owners were
advised to restrict the activity of the dog

Post operatative complication of this case.-- there were lots of internal

damage to right hind limb,blood vessels and
nerves,muscles[vastus lateralis and biceps femories]
are damaged which leads to necrosis and pain reflex
were absent even pinched with the aretery forceps

Discussion
Bone fractures constitute a major problem in the practice of dog Fractures
of the tibia are the second in their incidence
between long-bone fracture first is femur. In the
present study, the tibia was reported with higher
percentage of fracture than the femur one with the
percentages of 54% and 47% respectively.
A possible explanation for the cause of oblique fracture might be, when a
force which is less than optimal breaking force of
the bone, acts tangentially on any object , it gets
distributed un-proportionately with more force on
the near cortex and less force on the far cortex
which is away, thus creating a oblique fracture.
Similarly when the bending force acts on the bone,
due to abnormal landings of the limb in pits or hole,
the cortex opposite to the forces breaks obliquely
Fracture healing was a process of bone regeneration and divided into well
documented stages: inflammatory, connective
tissue and fibro-cartilage formation.
For fracture healing the important 4 A are-
'4 As' - apposition,
alignment,
angulation and
apparatus by Langley-Hobbs
After post radiography examination confirmed proper placement of the
plate and screws, good apposition and alignment of
the fracture
Open reduction and internal fixation were performed using bone plate and
screws with cerclage wire.Bone plating resists the
rotational, tension and compression forces in
addition to resistance of bending forces.

References
01-Evaluation of Locking Reconstructive Plate for Long Bone Fracture Repair
in Dogs article by- G. N. Beerappa, D. Dilipkmar*, P.
T. Vinay, B. V. Shivaprakash, Shrikant Kulkarni and
S. M. Usturge.
02.essential orthopedics- Maheshwari and Mhaskar
03.veterinary orthopedics and lameness- anil kumar gangwar