Successful Treatment of Acute Craniodorsal Coxofemoral Luxation in a Scarlet Ibis (Eudocimus ruber) Using Closed Reduction and a Modified Ehmer Sling.

Whereas craniodorsal displacement of the coxofemoral joint is the most common luxation reported in small and large mammals, it occurs less often in avian species. Closed reduction and external coaptation with a modified Ehmer sling is the initial treatment, in most cases, for small animals (eg, dogs, cats) that present with a coxofemoral luxation. However, the Ehmer sling is reported to have a low success rate in treating coxofemoral luxations in these animals. Intractable coxofemoral luxations require an open surgical reduction. A few successful closed reductions of coxofemoral luxations have been reported in avian patients, as well as open reduction surgical techniques to repair avian coxofemoral luxations. The successful treatment of an acute craniodorsal coxofemoral luxation in a scarlet ibis (Eudocimus ruber) with a closed reduction and a modified Ehmer sling is described in this clinical report. The specific characteristics of both the patient and the injury are thought to have contributed to the success in this case.

Fracture Management in Avian Species.

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.

Skeletal Bone Structure and Repair in Small Mammals, Birds, and Reptiles.

Bone strength depends on its structure, its composition, and the forces it is subjected to. Bone structure varies greatly between species and these differences may have clinical implications in their assessment or treatment. Fractures occur when the magnitude of the sum of forces affecting it exceeds its ultimate strength. The aim of bone healing is to recover the normal structure of the bone to maintain its normal function, but the mechanisms of bone healing differ greatly among species. This article provides a basic reference for the bone structure of small mammals, birds, and reptiles.

Avian Articular Orthopedics.

In most avian species, luxations occur infrequently compared with other orthopedic conditions. A comprehensive review about avian luxations was published 4 years ago. The aim of this article was to review and describe from an orthopedic point of view the different types of luxations and subluxations reported in birds, their surgical treatment, and, whenever possible, the potential limitations and complications related with these procedures.

Avian Soft Tissue Surgery.

Basic surgical instrumentation for avian soft tissue surgery includes soft tissue retractors, microsurgical instrumentation, surgical loupes, and head-mounted lights. Hemostasis is fundamental during the surgical procedures. The indications, approach, and complications associated with soft tissue surgeries of the integumentary (digit constriction repair, feather cyst excision, cranial wound repair, sternal wound repair, uropygial gland excision), gastrointestinal (ingluviotomy, crop biopsy, crop burn repair, celiotomy, coelomic hernia and pseudohernia repair, proventriculotomy, ventriculotomy, enterotomy, intestinal resection and anastomosis, cloacoplasty, cloacopexy), respiratory (rhinolith removal, sinusotomy, tracheotomy, tracheal resection and anastomosis, tracheostomy, pneumonectomy) and reproductive (ovocentesis, ovariectomy, salpingohysterectomy, cesarean section, orchidectomy, vasectomy, phallectomy) systems are reviewed.

Eye Removal Surgeries in Exotic Pets.

This article covers considerations and techniques of eye removal surgeries in exotic pets. After issues including surgical indications, anesthesia, patient preparation, and instrumentation are explored, surgical techniques are described. Enucleation/exenteration and modified evisceration are discussed, with species-specific nuances of small mammals, birds, reptiles, snakes, amphibians, and fish highlighted.

Comparison of isoflurane and alfaxalone (Alfaxan) for the induction of anesthesia in flamingos (Phoenicopterus roseus) undergoing orthopedic surgery.

Used since the 1970s as an avian anesthetic, the neurosteroid alfaxalone has been reformulated to avoid side effects from its castor oil excipient. This case report describes the clinical use of a new alfaxalone formulation (Alfaxan) as an intravenous anesthetic induction agent in wild isoflurane-anesthetized rose flamingos (Phoenicopterus roseus). Twenty-five male and female rose flamingos underwent orthopedic surgery using isoflurane anesthesia. The animals were induced following one of two protocols: inhaled isoflurane by facemask (ISO; n = 9) or intravenous alfaxalone (2 mg/kg; ALF; n = 16). The time and quality of anesthetic induction (until first signs of muscle relaxation) and the time and quality of recovery (sternal recumbency) were recorded using a scoring system. Mild sedation was first observed at 18.4 +/- 3.8 min and 1.7 +/- 0.3 min, following isoflurane and alfaxalone administration, respectively (P < 0.001). Alfaxalone induction time was significantly shorter and induction quality was considered smoother than in the ISO group. Flamingos given alfaxalone induction required lower isoflurane concentrations for maintenance anesthesia than did flamingos induced with mask isoflurane (1.5-2 % vol vs. 4-5 % vol for ALF vs. ISO, respectively). Alfaxalone produced moderate cardiorespiratory effects not seen in the isoflurane induction group. Recovery times were similar with both protocols without significant differences in quality and length. The new alfaxalone formulation produces a safe and effective anesthetic induction in rose flamingos and has significant isoflurane-sparing effects during anesthesia.

Estudo retrospectivo de afecções cirúrgicas em aves / Retrospective study of surgical disorders in birds

Avaliaram-se retrospectivamente as cirurgias realizadas em aves no Serviço de Cirurgia de Pequenos Animais do Hospital Veterinário da Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, durante período de oito anos. De um total de 90 intervenções cirúrgicas para diagnóstico e/ou tratamento de afecções, 27 foram ortopédicas e 63 de tecidos moles. Quanto ao percentual de cirurgias ortopédicas realizadas segundo as diferentes ordens, observou-se: Psittaciformes 85,19%, Piciformes 7,41%, Anseriformes 3,70% e Falconiformes 3,70%. Para as de tecidos moles os Psittaciformes representaram 92,06%, Columbiformes 3,17%, Passeriformes 3,17% e Anseriformes 1,60%. Entre os tipos de afecções ortopédicas encontradas as fraturas apresentaram a maior ocorrência (88,90%), seguidas de luxação (3,70%), avulsão traumática de extremidade (3,70%) e artrite/osteomielite (3,70%). Dentre as afecções cirúrgicas de tecidos moles as neoplasias apresentaram a maior ocorrência (30,15%), seguidas das neoformações cutâneas ou de anexos não neoplásicos (17,46%), neoformações cutâneas sem diagnóstico (7,94%), distocia (7,94%), fístula de papo (7,94%), hérnia abdominal (4,76%), sinusite (4,76%), gangrena de extremidade de membros (3,17%), perfuração de esôfago (3,17%), prolapso de cloaca (3,17%), "Necrose avascular de dígito" (1,59%), ferida na região da quilha (1,59%), perfuração de cavidade celomática (1,59%), neoformação em cavidade celomática sem diagnóstico (1,59%), corpo estranho em trato gastrointestinal (1,59%) e otite (1,59%). A distribuição das afecções cirúrgicas segundo as espécies acometidas mostrou o "grupo dos papagaios", representado em sua maioria por espécies do gênero Amazona, como prevalente. O conhecimento das afecções cirúrgicas e espécies de aves mais acometidas acrescentam informações para aqueles que já atuam nesta área e servem como indicador de estudo para futuros cirurgiões de aves.

The study assessed retrospectively avian surgeries at the Service of Small Animal Surgery, Veterinary Hospital of the Faculty of Veterinary Medicine and Animal Science, University of São Paulo, performed during eight years. A total of 90 procedures was done for diagnosis or treatment of surgical disorders. From these, 27 were orthopedic and 63 soft tissue surgeries. Considering the orthopedic surgeries performed according to orders we observed: Psittaciformes 85.19%, Piciformes 7.41%, Anseriformes 3.70%, and Falconiformes 3.70%; for soft tissues, the Psittaciformes represented 92.06%, Columbiformes 3.17%, Passeriformes 3.17%, and Anseriformes 1.60%. Fractures presented the highest incidence among orthopedic disorders (88.90%), followed by luxation (3.70%), traumatic avulsion of the end (3.70%) and arthritis/osteomyelitis (3.70%). Among the surgical disorders of soft tissue, neoplasms accounted in 30.15%, followed by cutaneous neoformation or non-neoplastic annexes (17.46%), undiagnosed cutaneous neoformations (7.94%), dystocia (7.94%), crop fistula (7.94%), abdominal hernia (4.76%), sinusitis (4.76%), gangrene of the extremities (3.17%), esophageal perforation (3.17%), cloaca prolapse (3.17%), "avascular necrosis of digit" (1.59%), wound in the region of the keel (1.59%), perforation of the coelomic cavity (1.59%), neoformation in the coelomic cavity without a diagnosis (1.59%), foreign body in the gastrointestinal tract (1.59%), and otitis (1.59%). The distribution of surgical disorders according to species affected showed that the "group of parrots", mainly represented by species of Amazonas genus, was prevalent. Knowledge of surgical and bird species most affected add information for those who work in this area and will be an indicator for future surgeons of birds.

Short-term survival and effects of transmitter implantation into western grebes using a modified surgical procedure.

Two pilot trials and one study in a closely related grebe species suggest that Western grebes (Aechmophorus occidentalis) will not tolerate intracoelomic transmitter implantation with percutaneous antennae and often die within days of surgery. Wild Western grebes (n = 21) were captured to evaluate a modified surgical technique. Seven birds were surgically implanted with intracoelomic transmitters with percutaneous antennae by using the modified technique (transmitter group), 7 received the same surgery without transmitter implantation (celiotomy group), and 7 served as controls (only undergoing anesthesia). Modifications included laterally offsetting the body wall incision from the skin incision, application of absorbable cyanoacrylate tissue glue to the subcutaneous space between the body wall and skin incisions, application of a waterproof sealant to the skin incision after suture closure, and application of a piece of porcine small intestine submucosa to the antenna egress. Survival did not differ among the 3 groups with 7 of 7 control, 6 of 7 celiotomy, and 6 of 7 transmitter birds surviving the 9-day study. Experimental birds were euthanized at the end of the study, and postmortem findings indicated normal healing. Significant differences in plasma chemistry or immune function were not detected among the 3 groups, and only minor differences were detected in red blood cell indices and plasma proteins. After surgery, the birds in the transmitter group spent more time preening tail feathers than those in the control and celiotomy groups. These results demonstrate that, in a captive situation, celiotomy and intracoelomic transmitter implantation caused minimal detectable homeostatic disturbance in this species and that Western grebes can survive implantation of intracoelomic transmitters with percutaneous antennae. It remains to be determined what potential this modified surgical procedure has to improve postoperative survival of Western grebes that are intracelomically implanted with transmitters with percutaneous antennae and released into the wild.

Two surgical approaches to fracture malunion repair.

Two birds were presented with malunion fractures. The first was a young toco toucan (Ramphastos toco) with malunion of the tarsometatarsus that was treated by an opening-wedge corrective osteotomy and an acrylic-pin external skeletal fixator (type II) to stabilize the osteotomy. The second bird was an adult southern caracara (Caracara plancus) with radial and ulnar malunion that was treated by closing-wedge osteotomies. Stabilization of the osteotomy sites was accomplished through a bone plate fixed cranially on the ulna with 6 cortical screws and an interfragmentary single wire in radius. In both cases, the malunion was corrected, but the manus of the southern caracara was amputated because of carpal joint luxation that induced malposition of the feathers.

Clinical use of recombinant human bone morphogenic protein-2 in a whooping crane (Grus americana).

OBJECTIVE: To report use of recombinant human bone morphogenetic protein-2 (rhBMP-2) as adjunctive therapy for treatment of a comminuted, open, proximal humeral fracture in an avian species. STUDY DESIGN: Clinical report. ANIMALS: A 3.5-month-old male whooping crane (Grus americana). METHODS: An open, severely comminuted humeral facture was stabilized with an intramuscular (IM) pin/type IA external skeletal fixator with tie-in configuration. rhBMP-2 was applied in a calcium phosphate matrix (CPM) paste directly to the fracture site as a bone graft substitute. Radiographic evidence of bone healing was monitored for 14 weeks. RESULTS: Substantial bony callus was evident at 4 weeks and at 8 weeks there was bridging callus with obvious bony remodeling. The fixation was destabilized at 9 weeks by IM pin removal, bone healing progressed and the fixator was removed at 11 weeks. By 14 weeks both cortices had been re-established with continued callus remodeling evident. CONCLUSION: rhBMP-2, applied in a CPM paste, was used as a bone graft substitute in the treatment of a comminuted, open humeral fracture in a whooping crane. CLINICAL RELEVANCE: Use of rhBMP-2/CPM should be considered in treatment of avian fractures.

Bandaging, endoscopy, and surgery in the emergency avian patient.

This article is divided into three parts and describes procedures used in avian medicine after initial stabilization. The first part includes the application of bandages and splints for fractures. The second part describes the use of endoscopy to examine the choana, oral cavity, trachea, and, to a lesser extent, internal organs. The last part discusses equipment required and techniques used for esophagostomy tube placement, air sac cannulation, and surgery, with approaches to the coelomic cavity and a select number of surgical procedures. This article is intended to provide the emergency animal clinician with knowledge necessary to provide basic stabilization for avian patients and knowledge of procedures that can be performed by the experienced clinician.

Uso do fixador esquelético externo Tipo II para osteossíntese de tibiotarso em galinhas da raça Plymouth Rock Branca: modelo experimental para uso em aves selvagens / Use of Type II external skeletal fixator for tibiotarsus osteosynthesis in White Plymouth Rock chickens: an experimental model for using in wild birds

Foi avaliada a eficiência do fixador esquelético externo Tipo II para o tratamento de fratura de tibiotarso em oito galinhas adultas da raça Plymouth Rock Branca. As aves foram pré-medicadas com sulfato de morfina e anestesiadas com halotano. Em seguida, foi realizada osteotomia na diáfise do tibiotarso esquerdo, por meio de serra oscilatória. Quatro pinos de Kirschner foram inseridos através das corticais ósseas, dois proximalmente e dois distalmente ao foco da fratura. Após a redução desta, as extremidades dos dois pinos proximais e distais foram torcidas em direção distal ou proximal, respectivamente, sendo os pinos conectados externamente por meio de duas barras de acrílico autopolimerizável, nas faces lateral e medial externa do membro. O retorno da plena capacidade de utilização do membro foi observado em 20,00±7,09 dias, e a cicatrização óssea, avaliada por exame radiográfico, ocorreu em 35,12±8,72 dias. Os resultados do experimento demonstraram que redução aberta e aplicação de fixador esquelético externo Tipo II é método efetivo para o tratamento de fraturas de tibiotarso em galinhas da raça Plymouth Rock Branca.

The efficiency of the Type II external skeletal fixator for the treatment of tibiotarsus fracture in eight adult White Plymouth Rock chickens was evaluated. The individuals were pre-medicated with morphine sulfate and anesthetized with halothane, and submitted to a diaphysary osteotomy in the left tibiotarsus, performed with an oscillatory saw. Four Kirschner wires were inserted through the bone cortices, being two proximally and two distally to the fracture. After the fracture reduction the ends of both proximal and distal wires were twisted in distal or proximal direction, respectively, being the wires connected by two bars of autopolymerizing acrylic resin, in the external lateral and medial faces of the limb. The return to full capability to use the member was observed in 20.00±7.09 days, and the bone healing occurred in 35.12±8.72 days. The results of this study showed that open reduction and use of Type II external skeletal fixator is an effective method for the treatment of tibiotarsus fractures in White Plymouth Rock chickens.

Air sac cannula placement in birds.

Air sac cannulas are indicated in birds with upper respiratory obstruction or for ventilation during surgical procedures involving the head and neck. Proper technique, knowledge of potential complications, and an understanding of the indications for air sac tube placement are important for scientists, veterinarians, and technicians who work with birds.

Coracoid fractures in wild birds: repair and outcomes.

OBJECTIVE: To describe the surgical repair of the fractured avian coracoid and compare release rates back to the wild for birds treated surgically with those treated conservatively. DESIGN: Medical records of 17 birds presented to Healesville Sanctuary with fractured coracoids were examined retrospectively. Nine birds were treated conservatively and eight birds were treated surgically. Release rates back to the wild were compared between the two groups. RESULTS: Of the nine birds treated conservatively two were released back to the wild. Of the eight birds treated surgically six were released back to the wild. CONCLUSIONS: In this study greater success at returning birds with fractured coracoids to the wild was achieved with surgical repair than conservative treatment. Surgical repair is recommended for birds intended to be released back into the wild.

[Anesthesia and analgesia of ornamental birds]. / Anästhesie und Analgesie bei Ziervögeln.

Pet birds are frequently viewed as difficult patients for anaesthesia. The present paper revises the current anaesthetic procedures for injectable and inhalant anaesthetics. Currently the method of choice for the anaesthesia of pet birds is the isoflurane inhalation anaesthesia. Special emphasis is given to the preanaesthetic preparations. Fasting is shorter for pet birds than for mammals. Anaesthetized birds are at special risk for hypothermia. Methods for the prevention of heat loss are given. The use of analgesics are recommended both for welfare reasons but also because of the possibility to reduce the concentration of inhalation anaesthetics and therefore the amount of possible exposure of personnel to waste gases.

The use of surgical lasers in exotic and avian practice.

Use of diode laser energy with fiberoptic endoscopic delivery in exotic animal and avian practice offers a minimally invasive method for performing specific surgical procedures. Trauma and blood loss are minimized, but the absorption characteristics of the diode laser wavelengths (805/980 nm) must be considered to avoid potential postoperative complications due to collateral photothermal coagulative necrosis.

Surgery of the avian reproductive and gastrointestinal systems.

Surgery of the female reproductive system is the most commonly indicated intra-abdominal surgery of avian patients. Surgery of the male reproductive system and avian gastrointestinal tract are less commonly indicated but are occasionally necessary. Indications for surgery of the female reproductive tract include egg-laying-related disorders, dystocia, egg binding, damage or trauma to the oviduct, oviductal torsion and volvulus, abnormal egg production, biopsy or culture of the oviduct, internal laying, egg related coelomitis, oviductal impaction, oviductal or ovarian neoplasia, ovarian cysts, or as a sterilization procedure to stop egg laying. Indications for surgery of the male reproductive tract include castration (most often as a treatment of behavioral problems) and treatment of testicular neoplasia. Indications for gastrointestinal tract surgery include repair of traumatic injury, foreign-body retrieval, obstructive disease, as a treatment for neoplasia, and as a diagnostic tool to retrieve tissue for biopsy. Avian reproductive anatomy and physiology are reviewed. Presurgical and postsurgical patient care ensures successful recovery. Lateral, horizontal, and midline approaches may be preferred based on indication or concurrent disease. Approaches are described in detail. Indications and descriptions of surgery conclude this article.

Surgery of the avian respiratory system.

The avian respiratory system is different from that of mammals. Although some surgical techniques can be adapted from those used in mammals, many are unique to avian patients (e.g., choanal atresia correction and air sac cannulation). This article reviews the common surgeries of the upper and lower respiratory systems and describes surgical techniques for the treatment of chronic sinusitis and cranial coelomic mass removal.