Fracture repair surgery

• Fracture repair when performed correctly will successfully heal over 90% of fractures with no long term consequences or adverse effects even in severe multiple fragment fractures.
• Correct fracture repair requires a full assessment of the animals health overall as well as a complete assessment of the fracture both clinically and radiographically.
• There are a number of different techniques for repairing fractures including various bone plating systems, conventional, circular and hybrid external fixators, interlocking nails to name a few, each with it’s advantages and disadvantages. The best technique for a particular fracture is based on clinical and radiographic assessment.
• Due to the high morbidity and long term complication rate of poor healing we no longer recommend any form of “casting” for fracture stabilisation.
• Adequate postoperative care and follow up assessments are crucial to minimise complications and get the best outcome for the animal.

Bone fractures are highly traumatic and often very painful injuries. In the past repair and healing often required long periods of forced rest or non weight bearing on the affected bone as we attempted to reconstruct the bone and literally almost glue it together in what we believe was the best way to repair fractures. Unfortunately complications were common and could sometimes lead to non functional bones and require amputation of limbs.

Thankfully our understanding of bone healing and biomechanics has improved dramatically in the last 20 years. We now know that piecing together a shattered bone is not only not effective, the handling of fragments may decrease their ability to heal. The focus of modern fracture repair is now to transfer weight bearing away from the fracture location and to maintain the orientation of joints above and below / either side of the fracture. Fragments are generally left alone for the body to heal with it’s own natural processes and surgical techniques to minimise interference to blood supply are employed.

Fracture Types

Fractures can be broadly classified into:

1. Open or Closed. An open fracture is where the bone has been exposed to the environment and possible infection. Any fracture where the surrounding skin has been damaged should be treated as possibly open. Open fractures are far more prone to infection and ideally implants should not be left in the animal if a possible infection is suspected.
2. Simple or comminuted. This is the number of pieces the bone has fractured into. If there is only 1 fracture line with 2 pieces, or perhaps a 3rd large fragment, then the fracture is known as simple. If however there are multiple fragments, particularly small fragments, then it is known as comminuted. Simple fractures can be pieced back together with minimal complications however if the are multiple small fragments then the aim is to minimise handling of those fragments as much as possible.

Fracture repair techniques

It is generally acknowledged that successful complication free healing for fractures requires surgical intervention and the use of implants to support the fractured limb. There are however a variety of implants and implant systems, each with their advantages and disadvantages. The best option is often a combination of a variety of factors and weighing up the pro’s and con’s of each technique.

Bone Plates

Bone plates and screws have been the mainstay of fracture fixation for the last 40 years in both human and veterinary fractures. Recent advances in the development of locking bone plates will in all likelihood mean they continue to be the preferred method of fracture fixation for most fractures.  The technique consists of securing a rigid metal plate to the bone with screws. The plate serves two functions, firstly it provides a rigid mechanism to transfer weight from one side of the fracture to the other, and secondly it brings the fragments into alignment to allow healing in an anatomically correct position.

Pros

• Single surgery definitive repair. i.e. their is usually no requirement for additional surgeries to remove implants.
• Anatomical reduction and alignment generally very accurate.
• High rigidity particularly of new Locking plate technology means that animals are often weight bearing almost immediately after surgery.