Comparison of Two Bandage Splint Constructs in an Ex Vivo Equine Metacarpal Fracture Model.

OBJECTIVES: The aim of this study was to compare the deflection distance, deflection angle and pre-loading sub-bandage pressure of a transverse, mid-metacarpal fracture in an equine cadaver limb when loaded in bending while stabilized with either a Robert Jones Bandage (RJB) or a single-stack bandage (SS), each containing two orthogonal splints. STUDY DESIGN: In an ex vivo experimental study, forelimb pairs from eight horses were collected, and one forelimb from each pair was assigned to either the SS or RJB groups. A transverse osteotomy was performed at the midpoint of the metacarpus. After bandaging, the limbs were loaded in bending. Pre-loading sub-bandage pressure, pre- and post-loading radiographs and post-loading deflection distance measurements were taken. Dorsopalmar radiographs were used to measure the loaded deflection angle. RESULTS: There was no significant difference between RJB and SS constructs in change in deflection angle (10.7 ± 3.0 degrees vs. 9.8 ± 2.6 degrees; p = 0.5) or deflection distance (13.1 ± 2.6 cm vs. 11.4 ± 3.1 cm; p = 0.2). Sub-bandage pressures were significantly greater for the SS than the RJB both dorsally and laterally. CONCLUSION: The SS splint construct resists bending forces similarly to the RJB splint construct in an ex vivo transverse, metacarpal fracture model. The SS splint construct may be a useful alternative to the RJB splint construct in field situations for metacarpal fracture stabilization.

Pectus excavatum ­ Correção cirúrgica utilizando tala externa de poliuretano fabricada com tecnologia de impressão 3D / Pectus excavatum ­ Surgical correction, using polyurethane external splint made with 3D printing technology

Objetivou-se relatar o emprego de uma tala externa confeccionada com material de poliuretano e cobertura interna de neopreme na reparação cirúrgica do pectus excavatum em um felino jovem. O felino apresentava deformidade anatômica congênita na região do externo e sinais clínicos respiratórios. Imagens avançadas de tomografia foram utilizadas para moldar a tala impressa com tecnologia tridimensional. Esta alternativa possibilitou melhor planejamento cirúrgico e, com isso, conforto para o paciente, além da qualidade própria do material de poliuretano que é levemente maleável, o que permitiu melhor moldagem e expansão torácica durante a respiração. A tala se provou resistente o suficiente para suportar a tração ocasionada pelos fios de sutura e possibilitou o reposicionamento adequado do osso esterno ao mesmo tempo que se mostrou confortável e acarretou mínimas lesões ao paciente.

The aim of this paper was to report the use of an external splint made of polyurethane material and internal neopreme covering in the surgical repair of a pectus excavatum in a young feline. The feline exhibited a congenital anatomical deformity in the external region and clinical respiratory signs. Advanced CT images were used to shape the 3D-printed splint. This alternative allowed better surgical planning and, therefore, comfort for the patient, this because to the quality of the polyurethane material, which is slightly malleable, and allowed for better molding and chest expansion during breathing. The splint proved to be strong enough to withstand the traction caused by the suture threads and allowed the proper repositioning of the sternum, at the same time it was comfortable and caused minimal injuries to the patient.

Fracture Stabilization and Management in the Field.

Management of fractures in the field starts with successful assessment and stabilization of the patient by the practitioner on the front lines. A careful examination is vital to succesful patient management. This includes identifying the fracture location and severity, evaluating skin integrity and potential contamination of the fracture, and treating any ongoing hemorrhage, hypovolemia or stress. Appropriate application of splints in the field will minimize ongoing tissue damage and improve patient comfort. This ultimately aids further assessment, facilitates referral, and improves opportunities for successful fracture repair.

Aluminium Splint Incorporated Fibreglass Cast Preserves Limb Function in Bovines with Olecranon Fracture.

OBJECTIVE: Olecranon process fractures are rare in bovines. The aim of the study was to put on record satisfactory limb usage in cattle and buffaloes suffering from olecranon fractures and treated conservatively, primarily for carpal contracture or to prevent it, using aluminum splints incorporated within a fiberglass cast along with stall confinement. STUDY DESIGN: This one year study included 19 olecranon fractures in bovines (15 buffaloes and 4 cattle). Out of 19, 12 bovines (9 buffaloes and 3 cattle) were treated primarily to manage the associated carpal contracture, using external coaptation of aluminium splints incorporated within a fiberglass cast for 6 to 8 weeks. The owners of the remaining 7 bovines (6 buffaloes and 1 bullock) were only advised to keep their animal in stall-confinement, due to various reasons. RESULTS: Slipping and falling on hard surfaces was the primary aetiology of olecranon fractures (17/19). Most of the fractures (14/19) were presented more than 10 days after a traumatic event, with a mean duration of 24.0 ± 26.6 days. On follow up, all the treated bovines showed satisfactory limb usage whereas all stall-confined buffaloes showed no improvement. CONCLUSION: Slipping and falling on hard surfaces is a common cause of olecranon fracture in bovines. Olecranon fractures associated carpal contracture can be successfully treated/prevented by applying full limb cast (if possible including elbow) along with aluminum splints leading to satisfactory limb usage in bovines. Further it is concluded that stall confinement alone is insufficient to prevent limb contracture (which usually develops with olecranon fracture in bovines) leading to permanent non-weight bearing disability.

Evaluating Stiffness of Fibreglass and Thermoplastic Splint Materials and Inter-fragmentary Motion in a Canine Tibial Fracture Model.

OBJECTIVES: Various materials are used to construct splints for mid-diaphyseal tibial fracture stabilization. The objective of this study was to compare construct stiffness and inter-fragmentary bone motion when fibreglass (FG) or thermoplastic (TP) splints are applied to either the lateral or cranial aspect of the tibia in a mid-diaphyseal fracture model. METHODS: A coaptation bandage was applied to eight cadaveric canine pelvic limbs, with a custom-formed splint made of either FG or TP material applied to either the lateral or cranial aspect of the osteotomized tibia. Four-point bending tests were performed to evaluate construct stiffness and inter-fragmentary motion in both frontal and sagittal planes. RESULTS: For a given material, FG or TP, construct stiffness was not affected by splint location. Construct stiffness was significantly greater with cranial FG splints than with cranial TP splints (p < 0.05), but this difference was not significant when comparing splints applied laterally (p = 0.15). Inter-fragmentary motions in the sagittal and frontal planes were similar across splint types for cranial splints, but for lateral splints there was a 64% reduction in frontal plane motion when FG was used as the splint material (p = 0.03). CLINICAL SIGNIFICANCE: FG produces a stiffer construct, but the difference is not reflected in a reduction in inter-fragmentary motion. For lateral splints, FG splints are associated with reduced inter-fragmentary motion as compared with TP and may therefore have slight superiority for this application.

Mandibular body fracture repair with wire-reinforced interdental composite splint in small dogs.

OBJECTIVE: To report the outcome of mandibular body fractures treated with a wire-reinforced interdental composite splint (WRICS) in small breed dogs. STUDY DESIGN: Retrospective case series. ANIMALS: Client-owned small breed dogs (n = 24). METHODS: Medical records (1998-2012) of small breed dogs (<10 kg) with mandibular body fractures treated by WRICS were reviewed for signalment, history, type of fracture, treatment, and clinical and radiological follow-up. The angle of the fracture line (ANG) was measured on dental radiographs. A mandibular injury severity score (MISS) and a dental injury score (DIS) were evaluated as potential prognostic factors. RESULTS: Fractures most commonly involved P4-M1 (56%), and healed in a mean time of 2.37 ± 0.7 months. Healing was slower (P = .012) if teeth were present in the fracture line and required extraction, hemisection, or root canal therapy prior to WRICS placement (2.39 ± 0.7 months) than if no dental treatment was required (1.46 ± 0.8 months). Contrary to the MISS, the DIS was associated with longer time to bone healing (P = .001; r = .63) and risk of complications (P = .004). Bone healing time was decreased (P = .003; r = .61) with increasing fracture angles. CONCLUSION: WRICS can be considered to treat mandibular body fractures in small breed dogs if the fracture is not severely comminuted, and if at least the canine and first molar tooth can be used for anchorage. More severe lesions, such as those with teeth in the fracture line and a shorter fracture surface, are associated with prolonged bone healing.

Modified Thomas splint-cast combination for the management of limb fractures in small equids.

OBJECTIVE: To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). STUDY DESIGN: Retrospective case series. ANIMALS: Client owned horses and donkeys. METHODS: Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. RESULTS: Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb. CONCLUSION: Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure.

Novel Nonsurgical Approach to Stabilization of Bilateral Pathologic Femoral Fractures in an Egg-laying Maroon-bellied Conure (Pyrrhura frontalis).

A 2-year-old, egg-laying maroon-bellied conure (Pyrrhura frontalis) was referred for treatment of bilateral femoral fractures believed to be secondary to recent egg laying and nutritional and husbandry deficiencies. On radiographs, all skeletal components were diffusely osteopenic, precluding surgical fixation. A novel device to stabilize the bilateral femoral fractures was manufactured with polyvinyl chloride piping, which braced the bird's feet at the level of the perch and supported its upper body weight via a breast plate, thus maintaining the bird in a physiologically appropriate perching position. The conure was ambulatory and returned to normal function after 3 weeks of external coaptation with this device. After 6 weeks, callus formation was palpable over both fracture sites even though minimal bone remodeling was visible radiographically. This body splint device may present a viable alternative to euthanasia in select cases of bilateral femoral fractures in companion birds.

Relative stiffness of 3 bandage/splint constructs for stabilization of equine midmetacarpal fractures.

OBJECTIVE: Determine the relative stiffness of 3 bandage/splint constructs intended for emergency fracture stabilization. DESIGN: Experimental model. A single plane free end deflection model was developed to simulate the forces placed on a bandage/splint construct during stabilization of a complete mid-metacarpal bone fracture. The total deflection of the model in one plane was measured following application of 3 different bandage/splint combinations including a classic, 3 layered Robert Jones Bandage (RJB) with a splint placed on the outside of the bandage (RJB-3), an RJB with splint placed after the first of 3 bandage layers (RJB-1), and a single layer full limb bandage with external splint (SS). Comparisons were made between the deflections of the model with each bandage/splint combinations in an effort to determine the most effective method for field fracture stabilization. SETTING: Laboratory. ANIMALS: No animals were utilized in data collection for this study. Two live horses were utilized during the pilot study. INTERVENTIONS: Application of bandage and splint to a model intended to simulate the bending force on a lower forelimb fracture in a horse MEASUREMENTS AND MAIN RESULTS: Deflection was determined by the difference between the height of the model's supported free end before application of a 4.5 kg weight and at the conclusion of the deflection test. There was no significant difference in the amount of deflection between bandage/splint combinations (78 ± 32 mm (RJB-1), 94 ± 44 mm (RJB-3), and 93 ± 33 mm (SS)) CONCLUSIONS: The one-layer bandage with splint was equivalent to either RJB configuration in the mean amount of deflection in the simple model of a fracture.

Chronic Achilles tendon rupture augmented by transposition of the fibularis brevis and fibularis longus muscles.

A 1 year and 8 months old castrated male Pyrenean mountain dog was presented with an Achilles tendon rupture at least 5 weeks old. The defect between the two tendon ends was 2 cm in full extension of the tarsal joint. A new technique was successfully applied; a transposition and tenodesis of the fibularis brevis and fibularis longus muscles, combined with a 3 loop pulley suture and a tensor fascia lata graft. A transarticular external fixator was used for the first 3.5 weeks after surgery and a splint for the two following weeks. A 3 years follow-up shows the dog walking without any lameness.

Indications and limitations of splints and casts.

Long bone fractures are relatively common in cattle, whether they result from a self-inflicted trauma or from external actors (herd mate or farm machinery). Various advanced orthopedic techniques have been described to stabilize and treat fractures in cattle with success. Unfortunately the use of most of those techniques remains unrealistic in a field setting, rendering the realization of splints and casts still accurate for the treatment of long bone fracture in cattle. This article refers to the use of all external coaptation and their specific indications as well as their limitations.

Use of the Thomas splint and cast combination, walker splint, and spica bandage with an over the shoulder splint for the treatment of fractures of the upper limbs in cattle.

Many tibial and radial-ulnar fractures in cattle and small ruminants may be treated successfully with Thomas splint and cast combinations (TSCC). The Walker splint has been specifically designed for treating tibial fractures and stifle injuries in cattle.It usually fits better in rear limbs of cattle than the TSCC and thus can provide more stability. Spica bandages combined with lateral splints placed over the dorsum of the affected limb and down the contralateral shoulder may be used for partial immobilization of humeral fractures in calves and small ruminants when surgical repair is not an option.

Bilateral carpal contracture in a neonatal addax (Addax nasomaculatus).

A neonate male addax calf displayed an inability to extend its forelimbs bilaterally (range of motion restricted to 45 degrees-50 degrees on full extension) with resultant inability to stand. Based on examination and radiographs, the congenital defect was attributed to contracted soft tissue structures (joint capsule and/or intercarpal ligaments). Splinting, support of the limbs, and physical therapy resulted in moderate improvement of the angle of contraction (full flexion to approximately 120 degrees on extension at day 10). The animal was able to walk with splints but died at 10 days from acute head trauma, presumably related to a traumatic fall caused by challenges with ambulation. Postmortem examination confirmed soft-tissue contracture of the forelimbs. Malposition of the calf in utero was considered a possible cause of the defect.

Bilateral radial hemimelia and multiple malformations in a kitten.

Hemimelia is a congenital disease of complete or partial absence of one or more bones. The most important hypothesis is that radial agenesis is a consequence of neural crest injury. Treatment selection depends on the degree of the deformity and the reduction of limb function. This report describes a case of bilateral radial hemimelia and multiple malformations in a kitten aged 2 months treated conservatively with splint bandage, until bone maturity. The re-evaluation was performed 4 years later.

Open surgical correction combined with an external splint for correction of a non-compliant pectus excavatum in a cat.

A 4-month-old domestic shorthair female cat weighing 1.3 kg was presented for evaluation of respiratory distress. The animal showed evident dyspnoea with exercise intolerance and a marked concave deformation of the sternum. After measurements of the fronto-sagittal and vertebral indexes, the pectus was classified as moderate and surgery was elected. Surgical correction was performed using an open approach to the sternum with osteotomy of the last sternebra and costochondral junctions of the eighth and ninth ribs bilaterally. A silicone based, U-shape external splint was manufactured and used to stabilise the sternum. Immediate and 5-week postsurgical radiographs revealed a decreased concavity of the sternum and an increase thoracic height at the level of the last sternebra. Postoperative results suggest that this technique could be an effective and economical option for cats with pectus excavatum with a non-compliant sternum.

[Fractures and luxations in small mammals]. / Frakturen und Luxationen beim Kleinsäuger.

Most traumata in small mammals occur at home. Diagnosis and therapy can be compared with that in the dog and cat, but species-specific differences have to be considered. For fracture treatment a butterfly-cast can be sufficient for stabilization in special cases. In most cases satisfying results can be obtained with a "tie-in-fixator" treatment. Dislocations of the elbow joint are treated by reduction or stabilization through suture techniques or temporary arthrodesis.

Traumatic elbow luxation in 14 dogs and 11 cats.

OBJECTIVE: To report the presentation and treatment of traumatic elbow luxation and to evaluate success following closed or open reduction. DESIGN: Retrospective case series conducted between April 1999 and April 2009. METHODS: Records of 14 dogs and 11 cats were reviewed for signalment, history, radiographic findings and treatment; 14 owners were contacted via phone questionnaire to assess for limb function following treatment. Fisher's two-tailed P test was used to evaluate potential risk factors for lameness. RESULTS: The majority of luxations were caused by car accident and 96% of the cases luxated in a lateral direction. Closed reduction was successful in all cats and 11 dogs; 3 dogs required open reduction. Owners rated the animals' limb function as excellent (71%), good (7%), fair (22%) or poor (0%). All cats were rated excellent. An excellent result following closed reduction was achieved in 67% of canine cases. All cases of open reduction achieved fair results. All owners were satisfied with the outcome. No risk factors were significantly associated with post-reduction lameness. CONCLUSIONS: Elbow joints with good stability following closed reduction have a favourable outcome. Poor stability following closed reduction is an indication for surgery. Results suggest that cats tolerate elbow luxation better than dogs.

[Rupture of the extensor carpi radialis tendon in two horses]. / Ruptur der Sehne des Musculus extensor carpi radialis bei zwei Pferden.

Symptoms, diagnosis, therapy and clinical outcome of 2 horses which acquired a complete rupture of the extensor carpi radialis tendon by accident are described. The resulting gait abnormalities are very typical, so that the problem can be diagnosed already by clinical examination. With the help of ultrasound the diagnosis could be confirmed and the degree of damage quantified. The open wounds in the carpal region were surgically treated in a standing position and the limbs of both horses were kept under a splint bandage for 6 to 8 weeks. Prognosis in these cases was good, as both horses returned within 6 months back to their previous work.