Treatment of a Mandibular Diastemal Fracture Using Locking Compression Plate and Cerclage Wire in a Mare.

This report describes the combination of two surgical fracture repair techniques and the postoperative management of a mandibular diastemal fracture in a two-year-old mare. The mare was referred to a veterinary hospital with a laceration over the body of the right mandible. Radiographic assessment revealed two mesial fracture lines involving the second premolar tooth and a ventrally displaced bone fragment. The mare was treated under general anesthesia and the fracture was corrected using open reduction and plate fixation. A 3.5 mm narrow 15-hole locking compression plate with seven locking screws were used in a bridge form. Cerclage wire was also used to anchor the incisor teeth to the second and third premolar teeth. The cerclage wire and incisor teeth were covered with polymethylmethacrylate to prevent implant failure and avoid injury to the oral mucosa. Implants were removed 55 days after surgery and the mare was discharged from hospital five days later. The mare returned for cerclage wire removal after 90 days and was allowed to resume exercise thereafter. The combination of two surgical techniques, proper implant choice and appropriate postoperative management, including use of pelleted feed, contributed to successful bone healing and return to function.

Manejo de fracturas conminutas del polo distal de la patela con asas verticales de alambre: reporte de casos / Management of comminuted fractures of the distal pole of the patela with vertical wire loops: case report

INTRODUCCIÓN Las fracturas conminutas del polo distal de la patela representan un desafío para el cirujano de rodilla, pues no existe un tratamiento estándar que permita una rehabilitación acelerada. Recientemente se han descrito la osteosíntesis y la reinserción del polo distal utilizando asas de alambre verticales. MATERIALES Y MÉTODOS Presentamos dos casos de fractura conminuta del polo distal de la patela resueltos con asas de alambre verticales y modificaciones de esta técnica. RESULTADOS Se realizó osteosíntesis del polo distal de la patela, y se logró una reducción radiográfica satisfactoria, lo que permitió una rehabilitación acelerada, con un rango de movilidad progresivo a tolerancia desde el día siguiente tras la cirugía. Los pacientes lograron recuperar el rango de movimiento completo a los dos y tres meses de operados, evolucionaron satisfactoriamente, sin complicaciones relacionadas a esta técnica y sus variaciones, y recibieron el alta médica tras cuatro meses de la reducción y osteosíntesis. DISCUSIÓN Las técnicas tradicionales para el manejo de fracturas del polo distal implican consideraciones especiales en la rehabilitación y complicaciones asociadas. Se utilizó la técnica de asas de alambres verticales en dos pacientes: en uno de ellos, el procedimiento fue complementado con sutura tipo Krackow; y, en el otro, con una placa para minifragmentos, lo que permitió una rehabilitación acelerada y retorno precoz a sus actividades laborales. CONCLUSIÓN El uso de asas de alambre vertical aparece como una técnica segura, que permite una rehabilitación acelerada y un reintegro laboral precoz.

INTRODUCTION Comminuted fractures of the distal pole of the patella represent a challenge for the knee surgeon, as there is no standard treatment that enables accelerated rehabilitation. Osteosynthesis and reattachment of the distal pole using vertical wire loops has recently been described. MATERIALS AND METHODS We herein present two cases of omminuted fracture of the distal pole of the patella resolved with vertical wire loops and modifications of this technique. RESULTS Osteosynthesis of the distal pole of the patella was performed, achieving a satisfactory radiographic reduction and enabling accelerated rehabilitation, with a progressive range of motion the day after the surgery. The patients achieved full range of motion two and three months after surgery. They progressed satisfactorily, without complications related to this technique and its variations, and were discharged four months after the reduction and osteosynthesis. DISCUSSION The traditional techniques for the management of distal pole fractures involve special considerations regarding rehabilitation and associated complications. The vertical wire loop technique was used in two patients: in one of them, it was supplemented with a Krackow suture; and, in the other, with a mini-fragment plate, which enabled accelerated rehabilitation and early return to work. CONCLUSION The use of vertical wire loops appears to be a safe technique, which enables accelerated rehabilitation and early return to work.

Boyd Amputation Using the Tension Band Technique.

BACKGROUND: Amputation at the level of the hindfoot results in an equinus deformity from an imbalance of muscle-tendons acting across the ankle. Boyd's reconstruction for hindfoot amputations is a well-known technique that retains the calcaneus and fuses it with the distal tibia at the ankle mortise. It provides an excellent weight-bearing stump and in most cases does not require an artificial limb but its use has been restricted because of the difficulty in obtaining high union rates in the tibiocalcaneal fusion. MATERIALS AND METHODS: Five patients (four unilateral and one bilateral) underwent leg amputations from January 2012 to November 2013 using the Boyd technique for reconstructing the stump and were stabilized with a tension band. The study sample consisted of adult patients who had traumatic reasons for the amputation. Patients under 18 years old with a hindfoot that was inadequate for Boyd reconstruction (i.e., insufficient soft tissue coverage or no posterior tibial artery pulse) were excluded. One (case #2) had systemic comorbidities (e.g., hypertension, diabetes, chronic vascular insufficiency) as well as being a smoker. Three men and two women (mean age 39 years; range 21-61 years) were included. Three patients underwent amputation on the right side, one on the left side, and one bilaterally (case #5). All patients presented with Gustillo and Anderson IIIC open fractures. The mean time from lesion to amputation was 2.25 weeks (range 1-4 weeks). The mean follow-up duration was 16 (range 12-24) months. The post-surgery examination included a clinical examination and radiography. A 6 minute walk test (6 MWT) was performed on week 32 after the amputation. This study was carried out with the approval of our institution's ethics committee. All patients provided a written informed consent form in accordance with the World Medical Association and the Declaration of Helsinki. RESULTS: All six stumps fused successfully. The 6 MWT results were comparable to those found in the literature for other lower limb amputees. CONCLUSION: The tension band technique used as part of the Boyd amputation to achieve tibiocalcaneal fusion was effective in all five trauma patients. Sound fusion was achieved in all cases with the 6 MWT scores comparable to that in the literature. This technique should be considered an osteosynthesis option for the Boyd procedure. LEVEL OF EVIDENCE: Level IV, retrospective study. HOW TO CITE THIS ARTICLE: Mongon MLD, Sposito AL, Nunes GMN, et al. Boyd Amputation Using the Tension Band Technique. Strategies Trauma Limb Reconstr 2019;14(2):102-105.