Treatment of fractures. Surgeries for fractures of large limb bones in dogs How much does hip osteosynthesis cost in a dog?

Anatomical and topographical data of the dog. Prevention of surgical infection, sterilization of instruments and materials. Preparing the animal for surgery and performing it by connecting bone fragments with plates. Possible complications and their elimination.

FSBEI HPE “St. Petersburg State Academy of Veterinary Medicine”

Department of Operative Surgery with the basics of topographic anatomy of animals

Course work

Operations on limbs

(osteosynthesis on the pelvic limb for a fracture of the femur in a dog)

Completed by: 3rd year student, 22 groups

Kantserova Anastasia Pavlovna

St. Petersburg 2012

1. Operation name

2. Objectives of the operation

3. General information about the animal

8. Pain relief

9. Technique of the operation

11. Postoperative care of the animal

Conclusion

Bibliography

1. Operation name

Osteosynthesis (osteosynthesis; Greek osteon bone + synthesis compound) - connection of bone fragments. There are two types of osteosynthesis - submersible osteosynthesis and external transosseous osteosynthesis. With immersion osteosynthesis, clamps connecting bone fragments are installed directly in the area of the fracture. External osteosynthesis is performed using various devices located above the skin and fixing bone fragments using knitting needles and rods. The goal of osteosynthesis is stable fixation of bone fragments in the correct position until they consolidate.

2. Objectives of the operation

The purpose of osteosynthesis is to ensure stable fixation of fragments in the correct position while maintaining the functional axis of the segment, stabilizing the fracture zone until complete healing. Fundamentally, there are two types of treatment - surgical and conservative. The goal of these types of treatment is to create conditions for restoring the integrity of damaged bone structures and surrounding tissues, as well as restoring the function of the damaged limb segment. During operational treatment methods fractures, traumatologists, as a rule, act directly on bone fragments. Conservative treatment is treatment without surgery; the doctor does not act on bone fragments, this effect occurs indirectly.

3. General information about the animal

Species, gender: dog, male.

Nickname: Bob

Color, markings: black

Breed: mongrel

Age: about 4 years old

Height, weight: at withers 65 cm, 30 kg

Preliminary diagnosis: fracture of the tibia of the right hind limb

Diagnosis at follow-up: fracture of 1/3 of the distal tibia of the right pelvic limb

Owner: homeless animal

There is no information about living conditions and feeding, as the animal was found on the street. Data on previous diseases and vaccinations are also unknown.

General examination of the animal.

Determination of animal habit:

Body position in space: forced, supine

Body type: average

Fatness: unsatisfactory

Temperament: phlegmatic

Constitution: rough

The pathological focus is located in the area of the right pelvic limb. There you can see well-defined hyperemia, swelling, upon palpation an increase in local temperature, numbness of the area, and slight crepitus.

4. Fixation and location of the operation

Fixation is the strengthening of animals in a certain position in order to protect people carrying out medical work from injury from the patient, preserving the life and health of the patient himself and preventing the destruction of surrounding structures by large and strong animals.

To prevent dogs from biting, their mouths are tied with a strip of gauze, gauze bandage or tape. Covering the mouth with a screw, its ends are first tied in the submandibular space with one simple knot, then finally secure the bandage on the back of the head with a sea knot.

Dogs are usually fixed on the table, giving them the required position. A simple operating table for small animals is made of wood: painted with white oil or enamel paint. The table cover should be concave inward or have a small depression in the middle with drains for liquid. Several holes are drilled in it for tying the mouth with straps (braid) used to secure dogs. Under the table, on its crossbars, a shelf is arranged in the middle, on which a basin is placed to drain liquids from the table top into it and collect used dressing material.

Rice. 9. Strengthening the dog on the table: 1 - dorsal position; 2-lateral; 3-abdominal.

To strengthen the dog on the table in a dorsal position, a rope loop (braid) is tied or secured to its thoracic limbs in the forearm area. A rope from each limb is passed between the limbs and chest and then under the animal’s back to the opposite side of the table to the corresponding hole; by pulling the rope, the dog's limb is brought closer to the chest, after which the rope is tied. The pelvic limbs are extended and both are tied to the back part of the table frame.

During the operation, cats are placed in special leather or thick cloth bags or wrapped in a piece of thick cloth, leaving the area required for the operation open. It is even better for any method of fixation to put special bags (stockings) made of durable fabric on all the cat’s limbs and then fix them accordingly.

During this operation the animal was fixed in a lateral position.

5. Anatomical and topographical data

Musculature of the dog's pelvic limb. A - from the lateral side B - from the medial side 1. sartorius muscle 2. semitendinosus muscle 3. biceps femoris muscle 4. cranial tibialis muscle 5. extensor digitorum longus 6. peroneus longus 7. flexor pollicis longus 8. flexor digitorum brevis 9 . gastrocnemius muscle 10. Achilles tendon 11. interosseous muscles 12. extensor digitorum brevis 13. peroneus brevis 14. flexor digitorum longus 15. gracilis muscle

The affected area is localized on the right pelvic limb. The fracture is on the tibia. It is surrounded by muscles:

Sartorius

Tibialis cranialis muscle

Extensor digitorum longus

Peroneus longus muscle

Flexor pollicis longus

Flexor digitorum brevis

The muscles are innervated by the tibial and peroneal nerves.

Vessels supplying muscles:

Posterior tibial artery

Anterior tibial artery

External iliac vein

Medial vein of saphen

Caudal femoral vein

6. Instruments, dressings, medicines

Pointed scalpel, straight blunt and pointed scissors, wound hooks, anatomical and surgical tweezers, hemostatic clamps, needle holder, surgical needles - curved, semicircular, 5- and 10-gram syringes, injection needles, sterilizers for instruments and syringes, 0.5% novocaine solution, 5% alcohol solution of iodine, 0.5% solution of ammonia, dressing material (sterile bandages, tampons, cotton wool), sterile PHA threads, Polysorb, means for fixing animals, small surgical operating tables of the Vinogradov type, fixing elements: plates , screws, wrench for bending plates, screwdriver for tightening screws.

7. Prevention of surgical infection

STERILIZATION OF INSTRUMENTS

There are basically two ways to sterilize instruments: by high temperatures (boiling, filling, etc.) and “cold” - in disinfectant solutions.

To sterilize instruments by boiling, simple or electric sterilizers are used (Fig. 22), which have a removable grid with handles. Sterilization is carried out in ordinary water with the addition of alkalis: 1% sodium carbonate; 3% sodium tetraborate (borax), 0.1% sodium hydroxide. The duration of boiling depends on the alkali dissolved in the water: with sodium carbonate - 15 minutes, with borax - 20, with caustic soda - 10 minutes. Alkalis prevent metal corrosion, increase the effectiveness of sterilization and reduce boiling time.

Sterilization procedure: the solution is brought to a boil, during this period the water is freed from oxygen dissolved in it and neutralized with alkali. Before sterilization, instruments are checked for suitability. If they were covered with Vaseline, then wipe it off with alcohol or ether. The cutting part of the scalpel is pre-wrapped in gauze. Surgical needles are strung on a piece of gauze so that they do not get “lost” in the sterilizer if there are many instruments.

At the end of sterilization, the instruments are removed from the sterilizer grid and laid out on an instrument table covered in three rows with a sterile sheet or towel. At the same time, a certain order is observed - tools of the same type are placed in one place and in a certain sequence characteristic of each operation. The gauze in which the scalpels were wrapped should be unrolled. The laid out instruments are covered with a sterile sheet or towel.

Used instruments (after opening ulcers, working with cadaveric material) are boiled (at least 30 minutes) in an alkaline liquid with the addition of 2% Lysol or carbolic acid.

Glass objects (syringes, etc.) are placed in the sterilizer in disassembled form before it is heated. Syringes and glassware for anesthetic solutions are boiled in distilled water, since alkaline solutions promote the decomposition of some local anesthetics.

Sterilization of instruments by filling (burning)

The disassembled instrument is laid out in a clean enamel basin or bath, the required amount of alcohol is poured and it is lit. It is advisable to turn the instrument over while the alcohol is burning, since in places where it touches the bottom it cannot be well sterilized. This method is used to provide emergency surgical care, as well as to sterilize enamel utensils and instruments that do not fit into the sterilizer due to their dimensions. Instruments are also sterilized in special cabinets at a temperature of 150-- 160 C for 20--30 minutes.

Sometimes, under production conditions, instruments are sterilized with antiseptic solutions. To do this, the instruments are immersed for 30-40 minutes in one of the following solutions: 1% alcohol solution of brilliant green; ethacridine solution 1:500; 3--5% solution of carbolic acid; 1--2% solution of Lysol or Karetnikov's liquid (formalin 20.0, carbolic acid 3.0, carbonic soda 14.0, distilled water 1 l).

Rubber objects are sterilized by boiling in distilled water. To do this, they are wrapped in gauze (so as not to burn) and boiled for 30 minutes or cold in formaldehyde vapor.

Storage of tools.

After surgery, all instruments are thoroughly washed, sterilized and dried. Then they are laid out in a dry cabinet. To avoid rust on the instruments, place a vessel half filled with calcium chloride in the cabinet. Injection needles can be stored in Nikiforov's liquid (equal parts alcohol and ether), and a mandrin should be inserted into each needle. Dark stains or rust formed on tools can be removed using chalk with ammonia in a 2:1 ratio. Rubber objects are placed separately from metal instruments. Do not store instruments together with iodine preparations, acids, etc.

Suture material and methods for its sterilization

Currently, the classification of suture material mainly takes into account two characteristics: the ability to biodegrade and the structure of the thread.

Based on their ability to biodegrade, they are divided into:

absorbable materials (catgut, collagen, occelon, cacelon, vicryl, dexon, etc.);

non-absorbable materials (silk, nylon, lavsan, nylon, prolene, polyprolene, etc.).

According to the structure of the threads, they are distinguished:

monofilament -- is a homogeneous structure with a smooth surface;

shed -- in cross-section consists of many threads (twisted, braided, complex threads).

The following requirements apply to modern suture material:

Biocompatibility - absence of toxic, allergenic, teratogenic effects of suture thread on body tissue. Ideally, there should be no reaction to the suture material.

Biodegradation is the ability of suture material to disintegrate and be excreted from the body. The suture material must hold the tissue until a scar forms and then becomes unnecessary. In this case, the rate of biodegradation should not exceed the rate of scar formation, in addition, the suture material should be atraumatic.

Linen and cotton threads are also used to apply surgical sutures.

Silk sterilization

Silk threads are produced in spools (non-sterile) or in ampoules (sterile). Silk wound on glass spools or on glasses with polished edges is boiled in distilled water for 30-40 minutes. Store in 96° alcohol or Nikiforov liquid.

Silk can also be sterilized in solutions.

Sadovsky's method. Skeins of silk are placed for 15 minutes in a 0.5% solution of ammonia, and then for 15 minutes in a 2% solution of formaldehyde in 70% alcohol.

Tour method. Silk is placed for 24-48 hours in a 1% alcohol solution of iodine. Store in the same solution.

Sterilization of cotton and linen threads.

These threads are less durable than silk. They are usually used to close skin defects in small animals, on the intestinal wall (ground floor), and peritoneum. Use threads No. 10-20. They are sterilized using the Sadovsky method or immersed for 24 hours in a 4% formaldehyde solution.

Sterilization of catgut.

Catgut is made from the submucosal and partially muscular layers of the intestines of small cattle, and therefore requires special careful processing. Depending on the caliber, it is absorbed in the tissues of the animal body in 7 to 30 days.

Sterilizing it using high temperature excluded. It is mainly used for embedded seams. It is produced in skeins that require sterilization, or sterile - in sealed ampoules.

Gubarev's method. Loosely wound catgut on spools is degreased for 12-24 hours in ether or gasoline and sterilized in an alcohol solution of iodine (1 g iodine, 2 g potassium iodide, 100 g 95° ethyl alcohol) for 14 days, which is replaced with fresh in 7 days.

Method Rolled. Without preliminary degreasing, catgut is immersed in a 4% aqueous solution of formaldehyde for 3 days.

Sadovsky-Kotylev method. Catgut is placed for 30 minutes in a 0.5% solution of ammonia, then transferred for 30 minutes to a 2% solution of formaldehyde in 65° alcohol, in which it is stored until use.

Chubar's method. Catgut is immersed for 3 days in a liquid consisting of rectified alcohol 70°, 200.0; glycerol - 5.0; tinctures of iodine - 8.0 and potassium iodide - 6.0. Catgut is stored in this liquid for a long time.

Sterilization of synthetic threads.

This material is sterilized by boiling in distilled water for 20 minutes. Metal wires and staples, as well as pins used to connect bones, are sterilized by boiling, usually along with the instruments.

Sterilization of dressings, linen and surgical items

Sterilization by autoclaving. Dressings (bandages, napkins, splints, compresses, tampons, etc.) and surgical linen (gowns, sheets, towels, caps) are sterilized in autoclaves under pressure. Sometimes porcelain and glassware, enamel basins, solutions, etc. are placed there. Before autoclaving, the material and linen are loosely placed in containers (Fig. 23). Before placing the bixes in the autoclave, open the side holes and close the lid tightly. If there are no bixes, then surgical items are placed in canvas bags or bags. A pressure of 0.5 atm corresponds to a temperature of 115° C; 1 atm -- 120; 2 atm -- 134° C.

Before using the autoclave, close the release valve of the water-steam chamber, open the lid of the autoclave, pour water through the funnel to 2/3 of the level of the water-meter glass, close the lid tightly and carefully screw in the bolts, after checking the tightness, turn on the heating source and release steam for 15-20 minutes; close the tap and raise the pressure to the level required for sterilization. Sterilization control is carried out by placing substances whose melting point is above 100° C into the tank.

After sterilization is completed, the autoclave is turned off, the release valve is slowly opened, steam is gradually released, reducing the pressure, the autoclave lid is opened, the beakers are removed and the holes in them are immediately closed, and the autoclave lid is closed.

Sterilization with current steam is carried out in a special Koch sterilizer, and if it is not available, in a bucket or pan with a lid. Water is poured into them to 1/3 of the height. The beginning of sterilization is considered from the moment the steam is released, the temperature rises to 100 ° C, the duration is at least 30 minutes.

When sterilizing by ironing, the temperature is brought to 100° C, the duration is at least 30 minutes.

When sterilizing by ironing, the temperature is brought to 150° C. Before sterilization, sheets, gauze, napkins are moistened with water and ironed at a speed of no more than 50 cm per minute, passing over the same place 2-3 times on both sides. The ironed material is rolled up using sterile tweezers and placed in a sterile bag or left wrapped in a sheet.

Preparing the animal and surgeon for surgery

Preparing the animal for surgery.

For a favorable outcome of the operation, preparing the animal for it is important. Before surgery, clinical examinations are carried out on the animal, in particular, body temperature, respiration, and pulse rate are measured. The operation should not be performed on animals with elevated temperatures; it is also not recommended to perform it in the presence of infectious diseases or in malnourished animals. If the operation is not performed urgently, then before the operation the animal’s food supply is reduced and, if possible, a starvation diet is prescribed for no more than 12 hours.

When performing an operation using anesthesia, it should be borne in mind that some drugs, for example Rometar, can cause fetal death in the second half of pregnancy. With a favorable outcome in these cases, the operation can be performed under local anesthesia, since it has been established that it does not affect the development of the fetus.

Before the operation, animals are walked to free the large intestine, cleansing or partial anesthesia is performed.

Preparation of the surgical field

The preparation of the surgical field is carried out in four stages: mechanical cleaning, degreasing, treatment with an antiseptic (aseptization), isolation of the surgical field.

Mechanical cleaning includes washing with soap (preferably household soap), removing hair by shaving or cutting. In this case, the size of the prepared field must be sufficient to ensure sterile operating conditions. Mechanical cleaning is a particularly important step in preparing the surgical field and must be carried out especially carefully, since it is thanks to it that the bulk of dirt and microorganisms are removed.

Preference is given to shaving, since asepsis with this method is more thorough. In practice, a safety razor is most often used. It has been established that shaving hair is best done on the eve of surgery, which allows not only to thoroughly remove hair, but also to thoroughly wash the surgical field, which is usually very dirty. In addition, the skin irritation observed after shaving disappears by the time of surgery, as a result of which the skin becomes less sensitive to the iodine solution and dermatitis develops less frequently. Accidental wounds to the skin during shaving by the time of surgery have time to become covered with a dense scab due to coagulated blood.

Degreasing of the surgical field is carried out with a sterile gauze swab soaked in a 0.5% solution of ammonia or gasoline for 1-2 minutes. The degreased surgical field is treated with an antiseptic using one of the methods listed below.

The Filonchikov-Grossikh method. Its essence lies in the fact that the fat-free field is “tanned” and asepticized with a 5% iodine solution, first after mechanical cleaning, and then immediately before the incision or after infiltration anesthesia. In this case, the interval between treatments should be at least 5 minutes.

The Mouse method is that after shaving, mechanical cleaning and degreasing, the surgical field is treated with a 10% aqueous solution of potassium permanganate.

Borchers' method is based on the use of a 5% solution of formaldehyde in 9% alcohol after mechanical cleaning, shaving and degreasing of the skin. The method makes it possible to achieve (unlike most other methods) sterility in a protein environment (when contaminated with pus), since formalin retains its antiseptic properties.

Treatment of the surgical field with an antiseptic begins from the center (incision or puncture site) to the periphery. The exception is the presence of an opened purulent focus, in which treatment begins from the periphery and ends in the center.

Field isolation operations are carried out using sterile sheets or oilcloths, which are attached to one another with special clamps (Backhouse) or pins.

Preparing hands before surgery.

During the operation, the surgeon's hands are in direct contact with the wound. It is known that the skin of the hands, like any other surface of the body, contains many microbes, a significant part of which are pathogenic. Microbes find refuge in the excretory ducts of the sebaceous and sweat glands, in the subungual spaces, numerous furrows and folds of the skin. The skin of any part of the animal’s body also contains a huge amount of them, so preparing the hands before surgery is especially important.

Hand treatment consists of three stages: a) mechanical cleaning; b) chemical disinfection; c) leather tanning. Some antiseptic substances often combine bactericidal and tanning properties (alcohol solution of iodine, solution of brilliant green, etc.), thus representing a bactericidal tanning agent or tanning antiseptic. Hand treatment is carried out from the fingertips and further to the elbows. For mechanical treatment of hands, it is necessary to have brushes made of plant material (agave, palm, sabur leaves), horsehair, synthetic, as well as soap, warm water, and basins.

Horsehair brushes do not tolerate boiling; they are treated with antiseptic substances. Brushes that have not been used are first thoroughly washed in warm water and soap, rinsed, and then immersed in a 3% solution of carbolic acid, a bactericide solution of 1:3000 for 1 hour. They are also stored in these solutions.

When choosing one or another method of hand treatment, you should always keep in mind that hands cannot be absolutely sterile; they only acquire relative sterility over a certain period of time.

All hand treatment methods are based on two principles: dehydration and tanning of the skin.

Applicable chemical substances have bactericidal properties, act on microbes located on the surface of the skin, and tanning agents lead to the closure of the excretory ducts of the sweat and sebaceous glands and fix microorganisms in them.

The most accessible and easiest to use are the following methods.

Alfeld's method. After thorough mechanical cleaning in warm water with soap and a brush, wash your hands for 3 minutes. If hands are not wiped with a towel, then they are treated with 90° alcohol, if they are wiped - with 70° alcohol. When the skin is dry, the subungual spaces are lubricated with a 5% alcohol solution of iodine.

Olivekov's method is to first wash your hands for 5 minutes. hot water with soap and a brush, then wipe with a towel and treat for 3 minutes with cotton wool soaked in a 1:3000 solution of iodine in alcohol.

For purulent operations, it is recommended to re-treat with iodized alcohol at a dilution of 1:1000.

Spasokukotsky-Kochergin method. According to this method, hands are washed with a 0.5% ammonia solution in two basins for 2.5 minutes or under a flowing stream of this solution. After the second wash, the liquid in the basin should remain clear. IN otherwise Washing is repeated and hands are dried with a towel. During surgery or if hands become dirty, the treatment is repeated.

Napalkov's method involves mechanical cleaning of hands with an aqueous solution of caustic potassium 1:2000 with brushes for 5 minutes or in basins with napkins. Then the hands are dried with a towel and treated with denatured alcohol for 3-5 minutes. Subungual spaces and skin folds are treated with 5% iodine tincture.

Kiyashev's method is based on the use of the cleaning properties of a 0.5% ammonia solution, in which hands are washed with brushes for 5 minutes and dried with a towel. Finish with treatment with a 3% solution of zinc sulfate (3 min). Subungual spaces and nail beds are treated with a 5% iodine solution.

All of the above methods ensure sterility of the skin of the hands for 20-30 minutes.

Currently, new bacteriostatic drugs are used that do not cause irritation and inflammation of the skin.

Zerigel. Apply 3-4 g of the drug to clean, dry hands and rub thoroughly for 8-10 seconds. Then dry your hands for 2-3 minutes. If the film slips, re-processing is not required. Sterility is ensured for 2 hours.

Hand treatment with a 0.5% solution of catapol (sterility of the skin of the hands for up to 3 hours) and a solution of chlorhexidine bigluconate in 70% alcohol at a dilution of 1:40 with a concentration of the active substance of 0.5% is also proposed. The skin of the hands remains sterile for 4 hours.

Aerosols are also used to treat the skin of the hands: Septonex, etc.

Surgical gloves

None of the methods for treating hands brings them to a state of absolute sterility, therefore gloves are the only means by which sterility is ensured in the bacteriological sense of the word; This is especially necessary when performing operations on purulent-putrefactive processes, as well as when performing abdominal operations on small animals.

Since the integrity of the gloves cannot be guaranteed, it is necessary to pre-treat the hands using one of the above methods in order to prevent the transfer of “glove juice”, consisting of sweat, exfoliating epithelium and bacteria, to the wound. Sterilize gloves by boiling in distilled water for 30 minutes, as well as by autoclaving and in solutions: 0.1% bactericide - 15 minutes, 2% chlorocide - 30 minutes or in formaldehyde vapor - 24 hours. After purulent During operations, gloves are washed without removing them from the hands in a 2% solution of Lysol.

8. Pain relief

During this operation the following drugs were used for anesthesia:

Zoletil 50, 25% - 4 ml, administered intramuscularly throughout the operation;

Propofol 1% - 56 ml was administered intravenously throughout the operation

Anesthesia

In this operation, you can use both conduction anesthesia and infiltration anesthesia.

For infiltration anesthesia, a 0.25-0.5% solution of novocaine is usually used, and much less often other drugs of this group are used in an amount of 10-15 ml at a time. With conduction, the same anesthetics are used, but at a higher concentration - 3.4 or 5%, and the amount of anesthetic depends on the thickness of the nerve, the depth of its location, and the accuracy of the doctor’s topographical orientation.

9. Technique of the operation.

Rice. 1. Oblique fracture; osteosynthesis by interfragmentary compression using screws and a neutralizing plate; scheme.

Preparation. The patient is tied in a lateral position and additionally secured with a rope loop passed over the back and through the groin. The operated limb is placed on top and placed on a pillow. Shave the incision site, treat the surgical field with a 5% iodine solution, and cover the field with sterile napkins.

Course of action. The skin incision begins at the greater trochanter and extends along the anterior edge of the femur to the knee joint. The superficial fascia, interfascial adipose tissue and deep fascia are incised along the cranial edge of the biceps femoris muscle, and the incision is made to the same length. After wide opening of the edges of the wound, the intermuscular layer of the fascia lata is dissected, located caudolaterally on the femur, at the site of its attachment, then the vastus lateralis muscle is separated from the bone and pulled cephalad with a retractor. If bleeding occurs as a result of damage to the muscular branches of the femoral artery and vein in the distal part of the incision, the vessels are ligated or coagulated.

A better view of the lateral surface of the femoral shaft can be achieved by retracting the biceps femoris muscle and the lateral head of the quadriceps femoris muscle with a retractor.

Rice. 2 The skin and superficial fascia are dissected and widely opened: A - femur; a - biceps femoris muscle; b - lateral head of the quadriceps muscle, covered with fascia, b" - intermediate head of the quadriceps muscle; c - large and short adductors; a - quadratus femoris muscle; 1 - sciatic nerve; 2 - muscle vessels

Access can be extended cranially by mobilizing the intermediate head of the quadriceps muscle and caudally by elevating the adductors subperiosteally if appropriate.

The femur is a long bone, subject to strong bending forces, and its reconstruction requires good stability.

Rice. 3. Access to the femoral diaphysis was made

Osteosynthesis with a plate. A plate (neutralizing, tightening or supporting) is applied from the craniolateral side and secured to each of the main fragments with at least three, and preferably four, screws. Only for fractures at the junction of the metaphysis, it is enough to screw two screws into a short fragment. In case of multiple fractures with the formation of non-vascularized fragments separated from the periosteum and muscle attachment points, the optimal solution is to apply a plate to the medial side of the fracture (medial support). This is achieved by precise repositioning and correct bending of the plate. The remaining defects are filled with autogenous spongy substance.

In case of comminuted fractures with damage to soft tissues, the fracture zone is not left free according to the principle of biological osteosynthesis, but is connected indirectly, with distraction of the main fragment, with a long plate fixed to the peripheral area, thereby achieving greater rigidity (support function!).

The plate that extends to the knee joint must be adjusted to the curvature of the femur. It should not be located in the lateral recess of the kneecap joint; it should be fixed deep on the cranial edge of the distal fragment.

Closing the wound. After placing the intermuscular sheet of the fascia lata of the thigh in place, the edges of the wound of the deep and superficial fascia are adapted layer by layer with an interrupted suture (absorbable material). If there is sufficient access to the hip and knee joints, further closure of the wound is carried out as described above. A suture is placed on the skin. Treat the seam with a 5% iodine solution.

10. Possible complications, their prevention and elimination

1. Fat embolism. Due to the spread of fat particles in the bloodstream, fat embolism of the systemic circulation, pulmonary circulation and a mixed form may occur. A combination of fat embolism and traumatic shock is possible.

Warning - Treatment of fat embolism is complex. Its main areas: - treatment and prevention of cardiovascular failure (cardiac, hormonal, antihistamines, vitamins, vasodilators); -- treatment and prevention of respiratory failure (oxygen therapy, intubation or tracheostomy with artificial ventilation in severe forms); -- correction of water-salt, protein metabolism, acid-base balance, prevention and treatment of acute renal failure: glucose-saline solutions and low-molecular dextrans intravenously, albumin and protein blood substitutes, sodium bicarbonate, trisbuffer, vasodilators, osmotic diuretics (Lasix), inhibitors proteases (trasylol, contrical), vagosympathetic blockades, exchange blood transfusions, in severe renal failure - hemodialysis; -- careful care for the patient, toilet of the skin, oral cavity, tracheobronchial tree; -- prevention and treatment of infectious complications (antibiotics, sulfonamides, nonspecific and specific globulins, etc.); -- in the first hours after the complication occurs, lipostabil or Essentiale is administered, 1 drop per day. Lipostabil restores the physiological dissolution of disemulsified neutral blood fat within the next few hours and improves the general condition of patients.

2. Anaerobic infection (gas gangrene). Anaerobic wound infection is observed very rarely, is one of the most severe complications of osteosynthesis, has a high percentage of deaths and often forces surgeons to resort to amputation. Although this complication is extremely rare, doctors should be well aware of it. Anaerobic infection occurs with extensive damage to large muscle masses, mainly with injuries to the foot, lower leg, thigh and buttock region. Factors contributing to its development are soil contamination of wounds; impaired blood supply, prolonged tightening of the limb with a hemostatic tourniquet; general weakening of the body caused by fatigue, coldness, and malnutrition.

Treatment for anaerobic infection consists of a set of therapeutic methods used simultaneously, but in a known sequence: - if surgical treatment has not been performed, then it should be done radically, opening all the pockets; - to release swollen muscles from compression, incisions should be made along the axis of the affected limb segment, and the incisions should penetrate to the muscles (“strap” incisions); -- if an anaerobic infection develops in a wound that has already been subjected to surgical debridement, repeated radical surgical debridement should be performed. Suturing after surgical treatment is contraindicated.

3. Osteomyelitis is a purulent inflammation of all bone elements, accompanied by necrosis of part of it. The reason for the development of post-traumatic, postoperative osteomyelitis is massive trauma with the presence of necrotic tissue and microbial contamination (Staphylococcus aureus, hemolytic streptococcus, etc.).

Prevention of postoperative osteomyelitis: - prophylactic administration of antibiotics; - performing surgical interventions only in the absence of inflammation or necrosis of the skin; -- strict adherence to asepsis and antiseptics; - atraumatic operation; - thorough hemostasis; - placing sutures on the wound without tension, and, if necessary, making releasing incisions; -- implementation of active wound drainage for 24 - 48 hours.

Conservative treatment of osteomyelitis: - after culture of pus to determine the flora and its sensitivity to antibiotics, targeted antibiotic therapy is carried out (intramuscular, intravenous, intraosseous, intra-arterial); - the wound must be irrigated with antiseptic liquids. Surgical treatment postoperative forms of osteomyelitis include the following measures: - dissection and excision of the purulent focus, its good drainage; -- removal of metal structures and spokes; -- wide opening of the sequestration box, removal of necrotic tissue, pathological granulations, sequesters; in the future, in order to fix fragments, preference should be given to transosseous osteosynthesis with devices. Closing defects bone tissue carried out using muscle plastics.

4. Suppuration of wounds. Purulent wound infection is the most common complication of both internal and transosseous osteosynthesis. Its clinical signs develop in most cases in the first 5-6 days after surgery. In some cases, purulent processes can occur in more late dates when the substrate of suppuration is areas of late (secondary) necrosis.

Treatment consists of the following: - evacuation of wound discharge and creation of conditions for constant outflow of pus; - if an infection develops in a sutured wound, remove the sutures and widen the edges of the wound; - loose tamponade of the wound cavity with gauze swabs moistened with antiseptic solutions, hypertonic sodium chloride solution; - in the presence of purulent leakage - its wide opening and good drainage and rinsing with antiseptic solutions; -- if the purulent process is supported by the presence of necrotic tissue, repeated radical surgical treatment is indicated; a patient with a pronounced manifestation of a purulent infection should be on bed rest and receive a high-calorie diet rich in proteins and vitamins; - if anemia is detected - transfusion of small doses of fresh blood (250 ml) for replacement and stimulating purposes; - the use of antibiotics, which should be targeted, i.e., only those to which microbes isolated from wounds are sensitive should be used; - The limb must be well immobilized.

5. Impaired blood and lymph circulation. Often, especially when treating femur fractures, significant swelling of the limb develops. After giving the limb an elevated position, it decreases, but does not go away completely. The cause of swelling may be inflammation around the wires, thrombophlebitis, lymphostasis, as well as too forced distraction. In these cases, gradual distraction, dosed load on the limb and therapeutic exercises should be carried out.

6. Secondary displacement of fragments.

Secondary displacement of fragments occurs due to non-compliance with the technique of applying the device. In some cases, displacement of fragments occurs due to their insufficient fixation (weak tension and fastening of knitting needles, threaded rods, and rings), in others - as a result of errors made in the technique of extrafocal osteosynthesis, when they are not eliminated, but, on the contrary, additional displacements are created. efforts. Incorrectly healed fractures can be observed in patients with incompletely aligned fragments or with unresolved secondary displacement. Premature removal of the device often leads to the development of angular deformities. This occurs in cases where the regenerate has weak mechanical strength and its reorganization has not been completed.

7. Violations of asepsis and antisepsis during surgery could lead to the introduction of pathological microflora into the animal’s body, which would cause an inflammatory process or sepsis.

8. Rejection of the base plate.

Prevention includes adherence to septic tanks, asepsis during surgery, and the selection of alternative treatment methods.

11. Postoperative care

Restriction of mobility (interfering bandages, cage or room confinement) until complete consolidation of the fracture or osteosynthesis, respectively. Also, to prevent licking or breaking the integrity of the wound, the dog must be wearing a collar. Be careful on stairs and falling from furniture. Keep warm and calm.

Immediately after the operation, put on a drip with stabizol up to 150-200 ml, Amoxicillin 3 ml subcutaneously, a hemostatic drug - Dicynon 2 ml intravenously. Course - Rimadyl, half a tablet 2 times a day, 5 days; Calcitriol 1 capsule per day, 3 weeks. Treat the seam with a 5% iodine solution, powder, and bandage.

Every day, treat the seam with about 5% chlorhexidine solution or Rometar, terramycin spray.

Do biochemical analysis blood, x-ray, stitches removed after 2 weeks.

Conclusion

Operation was successfully completed. There were no complications during or after the operation. The outcome of the operation is recovery.

During the operation, the doctor and medical staff tried to ensure maximum sterility, the general condition of the animal was monitored, and anesthesia was carefully dosed.

The plate osteosynthesis method was chosen based on the fact that this was the most optimal way to connect bone fragments. It provides maximum strength and is also economically beneficial.

Also, for faster formation of callus, the drug Calcitriol in capsules was prescribed for a three-week course.

fracture dog surgical operation

Bibliography

1. Zelenevsky N.V. “Workshop on veterinary anatomy” volume 1. M.: NiK - 2007. - 852s.

2. Kalashnik I.A. "Workshop on general and private veterinary surgery." M.: Agropromizdat - 1988 - 303 p.

3. Lebedev A.V., V.Ya. Lukyanovsky, B.S. Semenov “General veterinary surgery" M.: Kolos - 2000-448s.

4. Mozgov I.E. “Pharmacology” Moscow Agropromizdat 1985, 414 p.

5. Petrakov K.A., P.T. Salenko, S.M. Paninsky Operative surgery with topographic anatomy of animals. Moscow "Kolos" 2001 - 423 p.

6. Semenov B.S. "Workshop on general and private surgery." M.: Kolos, 2000 - 448 p.

7. Semenov B.S., A.V. Lebedev, A.N. Eliseev “Private veterinary surgery”. M.: Kolos, 1997 - 496 p.

8. Tkachenko S.S. "Portal about bone tissue surgery"

9. Volmerhaus B., J. Frewein “Anatomy of a dog and a cat.” "Aquarium" Moscow 2003 - 580 p.

10. Shebets H., V. Brass “Operative surgery of dogs and cats” “Aquarium” Moscow 2001 - 511 p.

Types of fractures

A bone fracture can have a very complex name (diagnosis), for example, “an open comminuted fracture of the right femoral condyle.” This name is associated with a complex classification of fractures.

When a fracture occurs, the parts of the broken bone are called fragments.

If the fragments have not shifted relative to each other after the fracture, then this is a fracture without displacement. If they have shifted in any direction, then this is a displaced fracture.

Type of fracture without displacement - crack, bone microcrack. With such a fracture, the fragments are not only not displaced, but the fracture itself is not visible on a regular photograph. Such a fracture is a time bomb; it can heal, or it can completely break or, in the worst case, become a constant source of inflammation and pain. To diagnose such fractures, a computed tomography scan is required.

If sharp fragments, after displacement, pierce the surrounding muscles and skin and come out, then this is open fracture, if the skin is not damaged, then such a fracture closed.

If the fragments break obliquely, then the fracture oblique, if the fragments broke at an angle of 90 degrees, then straight(the simplest option), if the fragments break in a spiral, then spiral fracture

If small fragments are formed during a fracture, then such a fracture is called splintered.

The middle of the bone is called the diaphysis, and the end of the bone that meets the other bone at the joint is called the epiphysis. If a bone is broken in the middle, then it is a fracture diaphyseal. If a bone is broken at any end, then such a fracture is called epiphyseal.

Type of epiphyseal fracture - articular fracture With such a fracture, the epiphysis is broken inside the joint, and not only the bone and surrounding muscles are damaged, but also the joint, which significantly worsens the dog’s condition and can result in permanent lameness and arthrosis of the joint.

There are many types of articular fracture.

Breaks. There are muscle separations from the bone or breaks of pieces of bone to which the muscle is attached.

Condylar fractures in which half of the articular surface (condyle) breaks off.

In complex joints, which are formed by several bones, one bone may break while another is not damaged. This incomplete fracture

If there is only one bone fracture, then this is simple fracture If there are several fractures of one bone or the fracture is located inside a joint, then such a fracture difficult. Difficult because treatment of such a fracture requires more experience and knowledge of the doctor, and the operation takes a long time.

After reading these classifications (of which not all are listed), you might think that anything and any way in an animal can break in accordance with the classification.

IN real life everything is a little different. There are statistics and according to them, animals break only a few bones in 70% of cases, the remaining 30% are rare.

Most often, cats and dogs break their paws, then the spine and finally the skull bones.

If you take the paws, the largest bones and main joints break first.

If these are the front paws, then this

fractures of the radius and ulna
fractures of the radius, ulna and elbow joint

humerus fractures
Fractures of the humerus and shoulder joint

even less common are fractures in the wrist and metacarpus

If these are the hind legs, then

femur fractures
knee fractures
fractures of the knee and femur
fractures of the knee joint and tibia
tibia fractures

hip fractures
pelvic fractures
fractures of the pelvis and hip joint

even less common are fractures in the tarsus and metatarsus area

The lower jaw is the leader in fractures in the head area.

In cases of spinal fractures, the most common fractures are

first cervical vertebrae
lumbar spine
sacral spine
thoracic region spine

Working constantly with the same type of cases, a veterinary orthopedic surgeon studies specific types of fractures in relation to certain bones or joints, studies specific methods of treating such fractures and has a huge advantage over a general surgeon in the treatment of fractures in animals.

For a veterinary orthopedist, classifications and treatment methods in relation to a specific joint, and not to the general concept of a bone or joint, come to the fore.

Incomplete fracture of a long bone (greenstick)

Treatment of fractures in dogs and cats

The animal is examined by a doctor, if the cat or dog is in a condition that does not threaten their life, the fracture is diagnosed (X-rays and, in some cases, computed tomography) and the fracture is treated (osteosynthesis).

Osteosynthesis - (ancient Greek ὀστέον - bone; σύνθεσις - connection) a surgical operation to connect bone fragments using various fixing structures that ensure stable fixation of fragments in the correct position.

If there is a threat to the patient’s life, then such a patient is first “stabilized”, no matter how much time it takes, and then fractures are diagnosed and osteosynthesis is carried out.

Anesthesia plays an important role in the treatment of animals with fractures, especially severely injured animals. Without pain relief, the animal may die from shock or simply suffer from severe pain.

The choice of osteosynthesis method plays a very important role. The rate of fracture healing and the animal’s recovery depends on how correctly the method is chosen.

When choosing a method, the materials used during the operation are also important. For example, a bone can be connected using a plate, but plates, due to the large surface of contact with the bone, slow down the formation of callus. Plate application is a factor in slowing down fusion. But there are plates made of very strong materials that are smaller in size compared to conventional ones and have limited contact with the bone due to a specially designed rolling profile. Such plates do not affect the healing rate.

When performing osteosynthesis, the main task is to compare the fragments as anatomically correct as possible and fix them in this position 100% motionless. This is the only way to achieve rapid healing of the fracture.

The second task facing an orthopedic surgeon is to perform the operation quickly and minimally traumatic. Speed is ensured by experience and clear planning of the operation, as well as the chosen method of osteosynthesis.
It is important, during the operation, not to damage the nerves and blood vessels in the surrounding tissues. Damage to them can lead to the loss of a paw.

A person is often put in a cast, but an animal never. This is an unshakable rule that is constantly violated by general surgeons.

Plastering a dog or cat results in:

A. CAST - MOBILITY OF FRAGMENTS - FALSE JOINT - TREATMENT FOR YEARS - RADICAL RESTORATIVE SURGERY - OFTEN EUTHANASIA

Plastering a dog or cat leads to mobility of the fracture, prolonged nonunion and the formation of a pseudarthrosis. A plaster cast cannot tightly fix the short, small and often crooked (unlike human) bones of cats and dogs. Dogs and cats cannot lie down and wait for fusion; they want to run and loosen the already unreliable plaster cast. The bones at the fracture site are constantly moving and prevent the formation of a callus (fracture healing). If the bones constantly move at the fracture site, then they “ruze” against each other, cartilage forms at their ends and a false joint occurs. Such a fracture may not heal for years.

B. GYPSUM - NECROSIS (DECK) OF PAW TISSUE - PAW REMOVAL - OFTEN EUTHANASIA

Plastering a dog or cat leads to necrosis (death of the paw) and loss of the paw (removal).
Or to inflammation of the paw, suppuration, long-term treatment and removal of the paw in extreme cases.
People often euthanize animals because they are not ready to care for a disabled animal.

B. CAST - SEVERE DERMATITIS UNDER THE CAST - SUPUPURATION - SKIN PLASTY - RADICAL RECOVERY SURGERY - OFTEN LOSS OF A PAW AND EUTHANASIA

The application of a cast is always accompanied by severe dermatitis of the skin under the cast (wool, moisture and dirt cannot simply be preserved under a plaster cast; they destroy the skin and paw under the cast). This is followed by a long recovery of the skin, plastic surgery, antibiotic treatment and complex reconstructive surgery.
People often despair and euthanize animals because they are not ready to pay for a complex operation to restore a paw, or are not ready to care for a crippled animal.

THUS, GYPSUM IN 99% OF CASES LEAD TO COMPLICATIONS AND RECOVERY SURGERY WITH A LOWER PROBABILITY OF COMPLETE PAW RECOVERY.

60% of the work of orthopedists and plastic surgeons in our clinic consists of alterations and re-treatment after unsuccessful osteosynthesis and the application of plaster casts at home and in conditions close to the conditions of military field surgery (but these dogs were not on the battlefield), by doctors who do not have experience and knowledge to carry out such operations and do not have the necessary tools and consumables.

Features in the treatment of spinal fractures

There is only one feature - time.

The spinal cord and nerves may be damaged irreversibly, leaving the animal disabled.

Time is not on your side.

If the spine is injured, there is a possibility of damage to the spinal cord from bone fragments and displaced vertebral bodies. The faster the load spinal cord is removed, the faster the spinal cord will begin to recover and the less likely it is that permanent spinal cord damage will occur.

Post-operative care

Caring for your recovering pet depends on the type of fracture and the type of surgery that was performed. Although most pets can be allowed to do some exercise almost immediately after surgery, it is important that unrestricted activity such as running or jumping is avoided. Sometimes it is necessary to keep a pet in a limited area, for example, in a small room. Physiotherapy and hydrotherapy may be recommended as part of a recovery program. In most cases, we will re-examine your pet six to eight weeks after surgery. Once x-rays show that the fracture has been healed, normal activities can be resumed.

Risks and difficulties associated with the treatment of fractures

Even surgery performed flawlessly can carry the risk of certain complications, such as infection and difficulty healing the bone. However, if the surgery is performed by an experienced professional, such complications are rare, and most pets have an uneventful recovery. Joint fractures can lead to osteoarthritis, which may require long-term monitoring by a doctor, but most pets do not experience such complications. Before any treatment is started, all aspects of your pet's post-operative care, including the risk of complications, will be discussed in detail during your initial consultation with your podiatrist.

Prospects

Most pets gain full use of their limbs and can enjoy a normal lifestyle.

Why should you contact us to treat your pet’s fracture?

We have extensive experience in successfully treating a variety of fractures;
We are attentive to every patient;
We use modern technologies and treatment methods;
Our specialists regularly take part in veterinary conferences;

The Department of Traumatology and Orthopedics treats a wide range of pathologies of the musculoskeletal system of small domestic animals:

Joint diseases (arthritis and arthrosis) of various etiologies
Pathologies of the tendon-ligament complex, myopathies
Osteosynthesis in animals- treatment using surgical methods

Fractures in cats

Fractures in cats And fractures in dogs the phenomenon is quite common. A fall from a height, an accident on the road, a collision with other animals - all this can cause serious fractures. In addition, it is important to consider that fractures in dogs and cats can be caused by various factors that weaken bones:

Joint diseases of various origins;
Lack of nutrients in the diet. Including calcium;
Osteosynthesis, etc.

Fractures in dogs

Fractures in cats and dogs can be open or closed. In any case, it is important to contact a specialist for prompt assistance or for an accurate diagnosis. The main signs of a fracture are swelling, pain, the inability to stand on the broken limb and its unnatural position.
Surgery is not always necessary, but may be necessary for severe fractures. To fix fractures, plaster or polymer bandages are most often used, which prevent excessive movement and promote rapid healing of bones. In more difficult situations Intraosseous fixation may be required if standard means cannot reliably fix the position of the bone. Metal fixing plates are also sometimes used, which provide a strong and reliable grip throughout the recovery period.
Of course fractures in dogs And fractures in dogs An unpleasant occurrence, but in the event of such an injury it is very important to immediately contact a veterinarian. Otherwise, the bone may begin to heal incorrectly, which will ultimately cause severe damage to the animal’s health in the future. Or you may need to break the bone again and put it in the right position. Remember that we are responsible for those we have tamed. Take care of your pets!

Analysis of surgical methods for treating fractures in dogs and cats.

Today, the following methods of fixation of fractures are most often used.
Conservative(non-surgical) method of immobilizing fractures using plaster or polymer bandages, grooved splints (polymer tubes cut along the long axis, at worst - large syringes). This method has a number of negative aspects. Firstly, closed reduction of a fracture in itself is difficult to implement, since due to the presence of soft tissues, and even the developing traumatic edema, an accurate comparison of bone fragments is unlikely. The exception is transverse greenstick fractures. The second negative moment occurs after a few days, when the traumatic swelling subsides and the limb begins to move freely inside the plaster cast. At this time, displacement of bone fragments is most likely, and accordingly the fracture either heals crookedly or pseudarthrosis occurs. Therefore in Western Europe Veterinarians change the plaster cast after 1-2 weeks, and this is not a painless process. Since a correctly applied plaster cast should block adjacent joints, contracture may occur when the cast is worn for a long time. The problem of abrasions and decubital ulcers is also very relevant. TO positive aspects The question may be attributed to the fact that neither a plaster cast nor splints slow down the longitudinal growth of the bone, and this is important for young dogs of large and giant breeds, i.e. fast growing. In addition, the bones of such animals have a rather weak cortical layer (they bend under the pressure of a finger - consequences of osteodystrophy), so fixation with a metal structure is very problematic. In conclusion, the price is an important argument.
Surgical methods of fracture immobilization.

Intramedullary osteosynthesis

Historically, until the 1980s, internal bone fixation was widely used. For this purpose, the following were used: Küncher's nail, Bogdanov, Rush, Steinman pins, as well as pins of our own design. Later, a tightening nail was used in humane practice. However, it has not taken root in veterinary practice since the installation method is complex and requires special tools and doctor training. Often in small animals we use a bundle of Kirschner wires. The application inside a bone implant is based on the “sliding splint” principle, i.e. fragments can slide along the pin. However, the action of antagonist muscles promotes convergence rather than divergence of fragments. According to my observations, this type of osteosynthesis is the most durable. In rare cases, bending of the pin was observed, but never fractures. The positive aspects of the use of intramedullary osteosynthesis include low trauma to bone fragments. After all, in fact, we only need open access to the fracture site; the periosteum and muscle insertions are not injured when the pin is inserted, especially with simple, non-comminuted fractures. For greenstick fractures in young, fast-growing animals, an intramedullary pin is preferable because it does not interfere with the longitudinal growth of the bone and, accordingly, its valgus curvature. If the surgeon plans to remove the pin after complete healing of the fracture, then this method is convenient because it requires a minimal incision, and therefore prevents re-injury of soft tissues. Fractures of the humerus are often localized along the projection of the radial nerve, and when removing the plate there is always a danger of its rupture with all the ensuing consequences, whereas when removing the pin this complication is physically impossible. The disadvantages of intramedullary osteosynthesis include the need to have pins of different widths with an interval of 1 mm, as well as drills of the appropriate diameter. In addition, the different shapes of the intramedullary cavity must be taken into account. For example, in cats it has the shape of an even cylinder, while in dogs: the humerus is a triangle; femoral and tibial hourglass, which forces the surgeon to select the width of the pin at the narrowest part. The pin must fit tightly to avoid angular displacement and rotation of fragments. Rotation of fragments is a serious drawback of this method of osteosynthesis. In our clinic, we solved this problem by using pins with sharp edges that cut into the cancellous layer of bone. In humane medicine, for this purpose, screws were used, passed through the entire diameter of the bone and through the intramedullary pin in the upper and lower fragments, or the pin was supplemented with an external bone fixator. Severe, comminuted fractures of the bone diaphysis or a longitudinal fracture of the fragment are a direct contraindication for intramedullary osteosynthesis. Serious disadvantages include injury to a joint when a pin is inserted through it, for example, a knee pin during osteosynthesis of the tibia.

Metal plates for fastening bone fragments (external osteosynthesis).

Application metal plates became an important milestone in the development of the practice of osteosynthesis, as it made it possible to significantly reduce the rehabilitation time for a sick animal. This is achieved by the possibility of early physical activity on the injured limb and, as a result, increased blood circulation and regeneration processes in the fracture zone. In addition, when using plates, the joints adjacent to the fracture are not affected, which also promotes early physical activity and a decrease in pain response. According to the laws of biomechanics, the plate is not The best way to restore bone integrity, bale. the fastening of the fragments is located on the side of the central axis and powerful bending forces act on the metal, which, if the rules for applying the plate are violated, leads to its bending or fracture. Mostly, plate fractures occur in the area of the holes for the screws (where it’s thin, that’s where it breaks). This is facilitated by bone lysis and screw migration. However, osteosynthesis with a plate allows for rigid fastening of fragments, and rotation of fragments is completely eliminated. Compression of bone fragments can significantly reduce the size of the resulting callus. When applying a plate, it is important to consider the tensile forces acting on the bone. Applying a plate to the opposite side of the bone (where compressive forces act) leads to plate fracture. So, the plates differ in shape:

Traditional plates with round holes (Sherman, Lane, Venable, Burns).
AO/AIVF plates, the most common dynamic compression plates (DCP).
Special plates (reconstruction, T-shaped, carved, acetabulum, etc.).

The first two types of plates can be considered universal and interchangeable for fractures of the diaphysis of long tubular bones (humerus, radius, femur, tibia). An important condition is the most accurate repetition of the contour of the bone and its tight fit to the cortical layer, because the inaccuracy of the shape creates a shoulder of forces that contribute to the loosening of the screw and its migration, and hence the weakening of the attachment of bone fragments, and the slowdown of bone healing or the formation of pseudarthrosis. On the other hand, with strong compression of the periosteum under the plate, its ischemia and necrosis occurs. Healing of a fracture, as is known, occurs due to vascularization of the fracture zone from the inside of the bone. bone marrow and externally due to the periosteum. That is why it is so important to maintain contact with the periosteum of even individual fragments. In humane medicine, the problem of ischemia was solved by transverse corrugation of the inner side of the plate. In my practice, I have not noticed a big difference in the timing of fracture healing. However, if it becomes necessary to remove the plate after prolonged wear, then less ingrowth into the bone of the grooved plate was noted.
The use of plates of one form or another is dictated primarily by the type and location of the fracture. Here we come to the different functional applications of the plates:

Compression.
Neutralizing.
Supporting.

For simple, non-comminuted, transverse and obtuse fractures, compression plates are often used. With strong compression between fragments in the fracture zone, vascularization and restoration of osteocytes occurs along the compact layer of bone, and not across it as with diastasis of fragments.
As a result, a voluminous bone callus does not form, the bone restores its shape without defects. The question of the strength of such fusion is discussed in the scientific literature. Indeed, in my practice there were several cases of repeated fracture at the site of the previous one. On the other hand, I witnessed how, after a car injury and a blow to the thigh of a German Shepherd (previously there was a fracture of the femur with the formation of a large callus), the bone remained intact. A large callus is dangerous because
Compression of tendons, muscles and the neurovascular bundle is possible, so compression of bone fragments is preferable. To create compression, you can use both traditional and special compression plates. In a traditional plate, after contouring to the shape of the bone, a small negative angle (1-2 mm) is created above the fracture line. When screwing screws, especially near the fracture line, compression is created on the opposite side of the bone.
As a transitional form to modern compression plates, a traditional plate with a longitudinal groove on half of the plate was used. After inserting the screw into the round hole closest to the fracture line. The second screw is inserted into the hole. Then, a special clamp was used to tighten the fragments, followed by fixing them with screws in other round holes. Modern compression plates have oval holes with a beveled far wall. As the screw is screwed in, its head slides along the beveled edge and the fragment moves along the oval hole to the fracture line. When screwing the screws from the middle of the plate to the edges, the compression only intensifies.
Acute oblique fractures of the diaphysis with displacement of bone fragments, or fractures with large fragments, when it is possible to restore the integrity of the bone with the help of fastening screws, however, require the use of a plate that neutralizes rotational and flexion forces that can displace fragments or large fragments. Both traditional and compression plates are suitable. Lastly, the hole is not drilled along the far edge. Naturally, it is advisable to contour the plate to the shape of a healthy bone, for which it is very desirable to have an X-ray image of a healthy bone. There is one subtlety here; the fastening screws must be screwed in perpendicular to the fracture line, and not to the plane of the bone. This placement of the screw prevents displacement of the fragments. When the ends of the fragments are narrow and screwing in a screw threatens to destroy the bone, it is not a shame to fasten them with a wire ring. The previously known postulate that a wire ring is a “noose on a bone” is not true. Many years of our own observations and data from foreign authors refute this opinion.
Severe, comminuted fractures of the diaphysis of tubular bones, sometimes with a large defect, intra-articular Selter III-V fractures require a different use of plates - functionally supporting ones. In this case, the plate takes on the load from the proximal fragment to the distal one, maintaining the length of the bone and the coaxiality of the fragments. The maximum number of screws screwed into the ends of the plate will not interfere with the strength of the fastening.
According to our observations, osteosynthesis of a severe intra-articular fracture of the knee or elbow joints using a support plate - best option. Replacement of large bone defects with cancellous bone autograft is more convenient when using a support plate.
External bone fixators (EBF).
In the late 1940s, Ehmer adapted the VKF used in humane medicine for veterinary medicine. Indications for the use of VKF are as follows:

simple and comminuted fractures of the diaphysis of the bones of the forearm and tibia;
auxiliary fixation in combination with intraosseous pins of the diaphyses of the humerus, femur and tibia;
fractures of the lower jaw;
open and infected fractures;
metaepiphyseal fractures with bone deficiency.

All VKFs can be classified into groups:

Single-sided one-or two-plane clamps (type 1). When creating such a retainer, incomplete rods are used (a layer of skin is passed through once). VCFs of this type are the least durable. The same problems arise as with the plate, with the only difference being that the lever arm from the axial axis to the support rod increases significantly. The structure quickly becomes loose, and healing of the fracture slows down. Bone infection was observed in two cases. The double connection holders are the weakest link in the structure and require periodic tightening of the screws.
Double-sided single-plane clamps (type II). Here, only full fixation rods are used to create the main frame. At least 2 fixation rods are inserted into each fragment. The balance of forces in such a design is mutually balanced, and the fixation of fragments becomes stronger. The disadvantage of the design is the weak resistance to rotational movements of fragments. Moscow veterinary orthopedists (in my opinion, the Biocontrol clinic) have successfully used this design to treat fractures in small animals (toy breed dogs and small cats). Due to the anatomical characteristics of animals, type II fixation is conveniently performed on bones distal to the ulna or knee joints. For example, the width of the radius in a toy terrier is 3-4 mm, the diameter of the intramedullary space is 1 mm or less. Accordingly, a wire inserted intramedullary cannot withstand either angular or rotational displacements of bone fragments (body weight and the length of the levers must be taken into account). Therefore, the structure must be secured by applying a splint, and this makes the structure heavier, and is not very favorable for the trophism of soft tissues. The end of the wire protruding from the distal end of the radius can cause osteoarthritis of the wrist joint. Microplates and screws with a diameter of 1 mm are still difficult to purchase. Thin knitting needles 0.6 - 0.8 mm serve as fixation rods, and the outer ends, bent at a certain angle and glued with Poxypol (cold welding), create a type II structure. The joints adjacent to the fracture are not damaged and the animal begins to put weight on the limb early.
Bilateral two-plane (biplanar) clamps (type III). This type of fixator is a combination of types I and II VKF, located in 2 planes and connected at the proximal and distal ends. In this way, the disadvantages of the previous types are leveled out.
Ring fasteners. Structurally, they are universal. Because they allow fixing rods to be passed in different directions (different planes), neutralizing the forces of displacement of fragments. A striking example is the Ilizarov apparatus. If 2 rings are enough to correct bone growth and distraction osteogenesis, then for durable osteosynthesis the use of 2 more rings suggests itself. This design of the ring retainer looks heavy, especially for toy breed dogs.

It goes without saying that after the bone has fused, the VCF must be removed.
VKF advantages:

minimal damage to soft tissues;
allow early start physical activity on the injured limb;
provide access to open wounds (especially with infected fractures);
allow avoiding the introduction of implants in the fracture zone.

Disadvantages of VKF:

soft tissue complications;
limitation in use on the proximal limbs;
not always sufficient structural rigidity;
weight of the structure.

IN Lately Video clips of the use of shape memory implants in humane medicine began to appear. Essentially, it is a flat spring, the ends of which are straightened and bent at a certain angle. Holes are pre-drilled into the bone, one from the side of the epiphysis (intramedullary), the other across the diaphysis. The implant is then treated with a cooling spray. A cooled implant softens and stretches easily. It is inserted into the drilled holes and then watered with hydrogen peroxide. The peroxide decomposes and produces heat. The heated implant tends to take its previous shape and tightens the bone fragments. The method is simple and when producing smaller implants, it could well be applicable in veterinary medicine.
P.S. The most effective method is the one that the surgeon knows best!

S.A.Erofeev., N.V.Petrovskaya, A.A.Emanov Russian science Center"Reconstructive traumatology and orthopedics" named after. acad. G.A. Ilizarov, Kurgan

Source: materials of the Moscow International Veterinary Congress

Treatment of animals with fractures of both bones of the forearm remains actual problem modern veterinary traumatology. With this type of injury, the musculoskeletal function of the thoracic limb as a whole is excluded and without the provision of qualified veterinary care the animal may remain “disabled”. According to our data, fractures of the forearm bones account for 15% of the total number of fractures of long tubular bones. To treat forearm fractures, we use the transosseous osteosynthesis method developed by G.A. Ilizarov in the middle of the last century. This method allows us to provide equally favorable conditions for fusion of fragments of the radius and ulna. One of the main conditions for the successful use of transosseous osteosynthesis is knowledge of the topographic anatomy of the segment. This is necessary in order to avoid damage to blood vessels and nerves when carrying out wires, to avoid trauma to the main muscle masses and to prevent fixation of tendon-aponeurotic formations.

The purpose of this study was to develop a technique for placing pins at different levels of the forearm, and to analyze the results of treating dogs with fractures in this area.

The proposed safe method of forearm osteosynthesis is based on literary data on anatomy, topographic anatomy (A.I. Akaevsky., 1984, B.M. Khromov et al., 1972, Coy Alpha, 1996, J.S. Boyd., 1998, H.A. Slesarenko, 2000 ), as well as on the results of our own studies of angiograms, anatomical preparations and Pirogov sections.

At the proximal level of the forearm, we fix the fragments with a pair of intersecting knitting needles, at an angle of 65-70˚, which, in order to avoid hitting the elbow joint, are located 1.0 - 1.5 cm distal to the head of the radial bone. If it is not possible to palpate the head of the radial bone, bony protrusions serve as landmarks for passing the pins: the epicondyles of the humerus and the olecranon. The needles must be passed through the middle of the diameter of the bones at a distance from each other equal to the thickness of the support. We fix the spokes in a tense state on different planes of the arc, which faces the open part cranially, to preserve the anatomical and physiological function of the elbow joint.

We pass one of the spokes through both bones of the forearm from the lateral surface, in the oblique-sagittal plane. The injection point is located at the level of the radial roughness, from which we retreat to the middle of the radius, in the caudal-medial direction. On its way, the wire passes through the common extensor digitorum, superficial and deep flexor digitorum, and must pass the common interosseous artery.

The second needle is placed through the ulna from the medial surface, in the frontal plane. We make the injection in the middle of the flexor carpi radialis, leaving the neurovascular bundle (median artery, vein and nerve) 2-3 mm more cranial. Along its path, the wire inevitably fixes the flexor carpi radialis and ulnaris.

At the distal level of the forearm, we pass three knitting needles through the fragments and fix them in a ring support. The reference points for their implementation are the tops of the styloid processes of the radius and ulna, from which we retreat 2-2.5 cm. In young animals, the crossings of the spokes must be carried out outside the growth zones. We pass one needle through both bones in a plane close to the frontal one, with the injection point on the side of the ulna. In this case, the wire passes through the distal intertendinous muscle, bypassing the cranial interosseous and ulnar arteries.

The other two spokes are through the radius and ulna in the oblique-sagittal planes, with an angle of intersection of 65-70˚ relative to each other, while the medio-caudal surface on which the flexor tendons are grouped remains intact.

The plane of the wires at different levels of the segment should be perpendicular to the axis of the fragments.

Regardless of the level of the fracture, we pass wires through the diaphyseal section of each fragment to complete their reduction and ensure stability of fixation, followed by fastening them in the corresponding ring supports. The plane of their implementation is usually frontal, retreating 1.5-2 cm from the fracture line. The projection lines of the median artery and nerve serve as a guide for determining the injection points. Depending on the clinical situation, we use knitting needles with a thrust platform to reposition and fix the fragments.

The age of the animals ranged from 3.5 months to 7 years. The causes of fractures in 57.9% of cases were domestic trauma, in 34.2% - road trauma, and in 7.9% - gunshot wounds. Dogs with closed injuries were most often admitted (81.6%). The nature of the fractures was distributed as follows: transverse - 51.3%; oblique - 16.2%; splintered - 18.9%. Injuries to the lower third of the forearm accounted for 63.1% of cases, the middle third - 23.7% and the upper third - 13.2%. According to Coy Alpha (1996), the predominance of damage in the lower third of the segment is due to the absence of muscle bellies in the distal part of the forearm.

Admission of the animal began with a medical history, general examination, assessment of local status and radiographic examination of the damaged segment. Contraindications to osteosynthesis were injuries internal organs, concomitant infectious and skin diseases. Surgical intervention was carried out on average on the third day after injury with the obligatory written consent of the owner.

Based on the X-ray picture of the damaged segment, in two standard projections, the device module was assembled before surgery, depending on the level of the fracture. In case of damage to the middle third of the forearm, the device consisted of four supports (arch, 3 rings); for fractures of the upper and lower third - from three supports (arch, 2 rings). Depending on the length of the forearm, in small dogs, two supports (arch, ring) and brackets were used.

Transosseous osteosynthesis was performed in the operating room in compliance with the rules of asepsis and antisepsis. Under intravenous barbiturate anesthesia with preliminary premedication (rometar, droperidol, atropine) in appropriate doses. The animal was fixed in a lateral position on the side of the healthy limb. The surgical field was treated with a 5% alcohol solution of iodine.

Based on the X-ray data, preliminary manual reposition of the fragments was performed, which made it possible to eliminate gross displacement. Application of the device began with one wire passing through the ulna at the proximal level, and through both bones at the distal level. The device was centered relative to the axis of the forearm and distraction was carried out along the rods to eliminate displacement along the length. Then, at the proximal level, a wire was passed through both bones, and at the distal level, two wires were passed separately through the radius and ulna. If the epiphyses of the forearm bones were damaged, a pin was passed through the metacarpal bones for stable fixation of the distal fragments. The quality of reposition was controlled by palpation and using injection needles. One needle was injected 1-1.5 cm on both sides of the fracture line perpendicular to the axis of each fragment. The location of the needle cannulas at the same level indicated the absence of displacement of the fragments.

This technique excluded x-ray control during surgery. Further placement of repositioning and fixation wires in the middle third depended on the displacement of the fragments. In each support, the spokes were tensioned using a calibrated spoke tensioner. The load on the spoke depended on the type (arc, ring), diameter, thickness and material from which the support was made. So, for example, with a diameter of 100 mm and a thickness of 5 mm in a steel arc, the tension of the first knitting needle was made with a force of 90 kg, the second - 80 kg, in the ring - the first - 100 kg, the second - 110 kg. The operation was completed with a control radiography of the segment.

Further treatment of the animals was carried out on an outpatient basis. Owners received recommendations for caring for their dog:

In the first two days, painkillers (analgin, baralgin);
-for open fractures - a course of antibiotic therapy;
-toilet of soft tissues near the knitting needles;
-monitoring the condition of the device and insulating it with a fabric cover;
- leading on a leash and passive work with the joints of the thoracic limb;

If possible, medical monitoring was carried out weekly, radiological monitoring - one week after surgery and every two to three weeks of subsequent fixation. Fracture consolidation was determined by a combination of radiological and clinical signs of union. The duration of fixation of the limb in the apparatus before the onset of fusion ranged from 14 to 65 days, which depended on the age of the animal and the severity of the injury. The average time of fusion was 32.8±1.7 days.

Thus, the use of transosseous osteosynthesis for fractures of the forearm bones in dogs ensures reposition, stable fixation of fragments and preservation of blood supply to the segment. The method allows you to quickly restore the function of the damaged limb and achieve positive anatomical and functional results of treatment.

Summary
Yerofeyev S.A., Petrovskaya N.V., Yemanov A.A. Transosseous osteosynthesis of canine forearm eons. Russian Ilizarov Scientific Center "Restorative Traumatology and Orthopedics", Kurgan, Russia.
, use of transosseous osteosynthesis for fractures of canine forearm bones provides reposition, stable Thus fixation of fragments and maintenance of segmental blood supply. The technique allows to restore function of the limb involved and obtain positive anatomic-and-functional results of treatment in a short time.

Over the past twenty years, a look at treatment of bone fractures in cats and dogs has changed, methods are constantly being improved and approaches are changing.

Today, the modern veterinarian has practically forgotten about the plaster cast. The use of osteosynthesis methods in clinical practice provides conditions optimal existence of cats and dogs with bone fractures and allow adequate and rapid rehabilitation.

The process of a speedy and high-quality recovery affects not only the professional interests of the doctor, but also, first of all, the interests of the owners.

Concept “osteosynthesis” comes from Greek words osteon(bone) and synthesis(connection) and involves connecting bone fragments and eliminating their mobility with the help of fixing devices.

For many years, classical techniques have been used in the treatment of bone fractures, which include internal and external osteosynthesis.

Immersion osteosynthesis is a method that involves the use of stabilizing systems inside the body tissues and structures are located in the fracture zone.

Submersible osteosynthesis, depending on the location of the fixator in relation to the bone, can be intraosseous (intramedullary), extraosseous, or transosseous.

External osteosynthesis involves the use of stabilizing systems outside the area of bone fracture (external fixation devices).

Exist combined methods, which include a combination of two or more methods (intraosseous-intraosseous, transosseous-intraosseous or intraosseous-transosseous).

The main goal of treating fractures of the International Association of Osteosynthesis (AO) is anatomical reduction, stable fixation, and early loading.

Today, repositioning and fixation are recommended to be carried out taking into account tissue viability, therefore, paramount importance is given to reducing injuries and preserving blood supply.

In animals, in our opinion, the main principles are stable fixation, axial reposition and early functional loading, which does not contradict the methods of biological osteosynthesis, and protocols and classification approaches to choosing a treatment method are not entirely suitable for our patients, unlike humans.

Intramedullary osteosynthesis with pins and wires in cats and dogs(photo 1a, b, c).

Osteosynthesis with bone plates in cats and dogs(photo 2a-d).

Methods of external fixation (extrafocal osteosynthesis) in cats and dogs(photo 3a-e).

Combination of various methods of osteosynthesis in cats and dogs(photo 4a-d).

Periarticular and intraarticular fractures in cats and dogs(photo 5a-e).

Arthrodesis in dogs(photo 6a, b, c, d).

Reconstructive methods of osteosynthesis in cats and dogs(photo 7a, b).

Photo 7a. X-ray. Distraction method of tension-tension without osteotomy for “underbite” in a dog. The period of detention is 54 days.

Complications of osteosynthesis and correction methods (false joint)(photo 8a-c).

Photo 8a. X-ray. Hypertrophic pseudarthrosis after osteosynthesis in a dog. Osteotomy and fixation in the Ilizarov apparatus.

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