Disaster Round – Fracture Repair I

Multiple fractures of one or several bones, often including the articular surfaces, as well as severely contaminated fractures and major complications in osteosynthesis may be called a disaster. A selection of such fracture cases and their management in small animals will be presented.

Disaster management requires an exact diagnosis with radiographs and/or CT-scans, evaluation of the personal skills and equipment, careful planning of the treatment, and a sufficient time frame for surgery. A selection of pins, conventional and/or locking implants as well as external fixators in a variety of sizes and length is a precondition for optimal fracture repair. It could be of advantage to have the possibility for intraoperative fluoroscopy.

The major reason for a disaster in fracture repair is, in the author`s experience, due to technical error. This may be undetected fissure lines in the bone, inadequate type, size and length of the implant, improper implant position and insufficient screw torque, rotational malalignment, intraoperative destruction of the blood supply, and poor bone quality. Technical errors may lead to unstable fracture reduction, implant failure, screw pull out, refracture, delayed or non-union fracture healing, irritation or impingement of soft tissues by the implant and permanent malfunction. With increasing experience of the surgeon, technical errors can be reduced.

Further reasons for a disaster are infections due to intraoperative contamination or postoperative excessive licking on the fresh wound. The infection could take up a couple of weeks to become apparent. Lameness, draining tracts, delayed bone healing, implant loosening and/or fracture non-union may occur.