The treatment of comminuted tibial shaft fractures in canine patients is burdened by significant risk which involves bone healing complications, such as delayed bone union. Complications may result from iatrogenic damage to blood vessels during fracture stabilization. To minimize this risk, treatment methods increasingly often rely on the concept of biological osteosynthesis. One of such methods involves the treatment of fractures with the use of new hybrid fixator consisted of an interlocking nail connected with type I external fixator. Connection of the nail with external fixator has been recently developed to maximize treatment efficiency. This manner of stabilization increases bone-fixator construct strength on forces acting in the place of fracture. It also enables fracture fixation with minimal damage of the blood supply of bone fragments. This article describes surgical procedure of stabilization of comminuted tibial bone fractures in four dogs by the use of interlocking nail connected with external fixator type I, discusses and evaluates the results of clinical treatment with the involvement of the said fixator. To control bone consolidation process the radiograms were taken in 6 and 8 week of healing.
In all cases, the reviewed methods of clinical treatment were successful in producing bone union after eight week of healing. During the whole period of observations no complication was observed. In all cases the intramedullary nail were left in the medullary canal after the healing process was finished. The fixator supported quick restoration of limb function after treatment.
Adamiak Z, Piórek A (2009) Comminuted tibial fracture treatment with type II frame external fixators with Maynard clamps and Schanz pins. Pol J Vet Sci 12: 275-277.
Aron DN, Palmer RH, Johnson AL (1995) Biologic strategies and a balanced concept for repair of highly comminuted long bone fractures. Comp Cont Educ Pract Vet 17: 35-49.
Augat P, Merk J, Genant HK, Claes L (1997) Quantitative assessment of experimental fracture repair by peripheral computed tomography. Calcif Tissue Int 60: 194-199.
Bernarde A, Diop A, Maurel N, Viguier E (2001) An in vitro biomechanical study of bone plate and interlocking nail in a canine diaphyseal femoral fracture model. Vet Surgery 30: 397-408.
Dejardin LM, Lansdowne JL, Sinnott MT, Sidebotham CG, Haut RC (2006) In vitro mechanical evaluation of torsional loading in simulated canine tibiae for a novel hourglass- shaped interlocking nail with a self-tapping tapered locking design. Am J Vet Res 67: 678-685.
Durall I, Falcón C, D´ıaz-Bertrana MC, Franch J (2004) Effects of static fixation and dynamization after interlocking femoral nailing locked with an external fixator: an experimental study in dogs. Vet Surgery 33: 323-332.
Georgiadis GM, Minster GJ, Moed BR (1990) Effects of dynamization after interlocking tibial nailing: an experimental study in dogs. J Orthop Trauma 4: 323-330.
Goett SD, Sinnott MT, Ting D, Basinger RR, Haut RC, Dejardin LM (2007) Mechanical comparison of an interlocking nail locked with conventional bolts to extended bolts connected with a type Ia external skeletal fixator in a tibial fracture model. Vet Surgery 36: 279-286.
Horstman CL, Beale BS, Conzemius MG, Evans RR (2004) Biological osteosynthesis versus traditional reconstruction of 20 long-bone fractures using an interlocking nail: 1994-2001. Vet Surgery 33: 232-237.
Im GI, Tae SK (2005) Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma 59: 1219-1223.
Johnson AL, DeCamp CE (1999) External skeletal fixation.
Linear fixators. Vet Clin North Am Small Anim Pract 29: 1135-1152.
Kaspar K, Schell H, Seebeck P, Thompson MS, Schu¨tz M, Haas NP, Duda GN (2005) Angle stable locking reduces interfragmentary movements and promotes healing after unreamed nailing. Study of a displaced osteotomy model in sheeptibiae. J Bone Joint Surg Am 87: 2028-2037.
Klein P, Opitz M, Schell H, Taylor WR, Heller MO, Kassi JP, Kandziora F, Duda GN (2004) Comparison of unreamed nailing and external fixation of tibial diastases - mechanical conditions during healing and biological outcome. J Orthop Res 22: 1072-1078.
Lansdowne JL, Sinnott MT, Dejardin LM, Ting D, Haut RC (2007) In vitro mechanical comparison of screwed, bolted, and novel interlocking nail systems to buttress plate fixation in torsion and mediolateral bending. Vet Surgery 36: 368-377.
Lu Y, Nemke B, Lorang DM, Trip R, Kobayashi H, Markel MD (2009) Comparison of a new braid fixation system to an interlocking intramedullary nail for tibial osteotomy repair in an ovine model. Vet Surgery 38: 467-476.
McLaughlin R (1999) Internal fixation. Intramedullary pins, cerclage wires, and interlocking nails. Vet Clin North Am Small Anim Pract 29: 1097-1116.
Moses PA, Lewis DD, Lanz OI, Stubbs WP, Cross AR, Smith KR (2002) Intra-medullary interlocking nail stabilisation of 21 humeral fractures in 19 dogs and one cat. Aust Vet J 80: 336-343.
O’Sullivan ME, Bronk JT, Chao EY, Kelly PJ (1994) Experimental study of the effect of weight bearing on fracture healing in the canine tibia. Clin Orthop Relat Res 302: 273-283.
Palmer RH (1999) Biological osteosynthesis. Vet Clin North Am Small Anim Pract 29: 1171-1185.
Patil DB, Adamiak Z, Piórek A (2008) Veterinary interlocking nailing and its augmentation for fracture repair. Pol J Vet Sci 11: 187-191.
Perren SM (2002) Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 84: 1093-1110.
Pettit GD (1992) History of external skeletal fixation. Vet Clin North Am Small Anim Pract 22: 1-10.
Piórek A, Adamiak Z, Matyjasik H, Zhalniarovich Y(2012) Stabilisation of fractures with the use of veterinary interlocking nails. Pakistan Veterinary Journal 32: 10-14.
Radke H, Aron DN, Applewhite A, Zhang G (2006) Biomechanical Analysis of Unilateral External Skeletal Fixators Combined with IM - Pin and Without IM -Pin Using Finite-Element Method. Vet Surgery 35: 15-23.
Sarmiento A, Schaeffer JF, Beckerman L, Latta LL, Enis JE (1977) Fracture healing in rat femora as affected by functional weight bearing. J Bone Joint Surg Am 59: 369-375.
Seaman JA, Simpson AM (2004) Tibial fractures. Clin Tech Small Anim Pract 19: 151-167.
Unger MP, Montavon M, Heim UF (1990) Classification of fractures of the long bones in the dog and cat: introduction and clinical application. Vet Comp Orthop Traumatol 3: 41-50. von Pfeil DJ, Dejardin LM, DeCamp CE, Meyer EG, Lansdowne JL, Weerts RJ, Haut RC (2005) In vitro biomechanical comparison of a plate - rod combination -construct and an interlocking nail - construct for experimentally induced gap fractures in canine tibiae. Am J Vet Res 66: 1536-1543.
Wyrsch B, McFerran MA, McAndrew M, Limbird TJ, Harper MC, Johnson KD, Schwartz HS (1996) Operative treatment of fractures of the tibial plafond. A randomized, prospective study. J Bone Joint Surg Am 78: 1646-1657.
Zaal MD, Hazewinkel HA (1996) Classifications of 202 tibial fractures in dogs and cats. Tijdschr Diergeneeskd 121: 218-223.