Fracture of the ulna and radius of that terrier. Treatment of fractures in dogs and cats. Anatomical and topographic data of the dog. Prevention of surgical infection, sterilization of instruments and materials. Preparation of the animal for the operation and its implementation by the method of

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As with humans, fractures in dogs and cats are not uncommon. Treatment of fractures in animals is comparable in complexity to that in humans, and is often much more complex and comparable in complexity to pediatric traumatology.

There are a huge number of different types of fractures, and each type requires a different approach.

Types of fractures

A bone fracture can have a very complex name (diagnosis), such as "open comminuted fracture of the right condyle of the femur." This name is associated with a complex classification of fractures.

When broken, 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 fracture with a displacement.

A type of fracture without displacement - crack, microfracture of the bone. With such a fracture, the fragments are not only not displaced, but the fracture itself is not visible on a regular x-ray. Such a fracture is a time bomb, it can grow together, or it can finally break or, in the worst case, become a constant source of inflammation and pain. Computed tomography is required to diagnose these fractures.

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

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

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

The middle of a bone is called the diaphysis, and the end of the bone that meets another bone at a joint is called the epiphysis. If the bone is broken in the middle, then it is a fracture. diaphyseal. If the bone is broken at either 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 condition of the dog and can result in permanent lameness and arthrosis of the joint.

There are many types of articular fracture.

Detachments. There are separations of muscles 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 can break and the other is not damaged. This is incomplete fracture.

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

After reading these classifications (which are far from all listed), one might think that anything and in any way can break down in an animal in accordance with the classification.

In real life, things are a little different. There are statistics and according to her data, 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 bones of the skull.

If you take paws, then large bones and major joints break first of all.

If it's front paws, then it's

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

humerus fractures
fractures of the humerus and shoulder joint

even more rarely fractures in the wrist and metacarpus

If it's the hind legs, then

femur fractures
knee fractures
fractures of the knee and femur
fractures of the knee and tibia
tibial fractures

fractures hip joint
pelvic fractures
pelvic and hip fractures

even less often fractures in the area of the tarsus and metatarsus

In terms of fractures in the head area, the lower jaw leads.

In fractures of the spine, most often break

first cervical vertebrae
lumbar spine
sacral spine
thoracic spine

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

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

Incomplete fracture of a long tubular 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, a diagnosis of the fracture (X-rays and, in some cases, computed tomography) is performed, and the fracture is treated (osteosynthesis).

Osteosynthesis - (ancient Greek ὀστέον - bone; σύνθεσις - connection) is 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 life of the patient, then such a patient is first “stabilized”, no matter how much time it takes, and then diagnostics of fractures and osteosynthesis are carried out.

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

The choice of the osteosynthesis method plays a very important role. The rate of fracture healing and recovery of the animal 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 with a plate, but the plates, due to the large surface of contact with the bone, slow down the formation of callus. The imposition of the plate is a factor in slowing down the union. But there are plates made of very strong materials, which are smaller than 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 match the fragments as anatomically correctly as possible and fix them in this position 100% immobile. This is the only way to achieve the fastest healing of the fracture.

The second task facing the orthopedic surgeon is to perform the operation quickly and minimally traumatically. The speed is ensured by experience and clear planning of the course 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. Their damage can lead to the loss of the paw.

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

Plastering a dog or cat results in:

A. GYPSUM - MOBILITY OF FRAGMENTS - FALSE JOINT - TREATMENT FOR YEARS - RADICAL RECOVERY SURGERY - FREQUENTLY EUTHANASIA

The imposition of plaster on a dog or cat leads to the mobility of the fracture, its long-term non-union and the formation of a false joint. 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 the fusion, they want to run and loosen the already unreliable plaster cast. The bones at the fracture site are constantly moving and do not allow the formation of callus (fracture union). If the bones are constantly moving at the fracture site, then they “grind” to each other, cartilage is formed at their ends and a false joint occurs. Such a fracture may not grow together for years.

B. GYPSUM - NECROSIS (DEATHING) OF THE PAWS TISSUES - REMOVAL OF THE PAWS - OFTEN EUTANASIUM

Casting a dog or cat results in 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 take care of a disabled animal.

C. GYPSUM - SEVERE DERMATITIS UNDER GYPSUM - SUPPRESSION - SKIN PLASTY - RADICAL RECOVERY SURGERY - FREQUENTLY LOSS OF PAWS AND EUTHANASIS

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

THUS, GYPSUM IN 99% OF CASES LEADS TO COMPLICATIONS AND RECOVERY SURGERY WITH A LOWER PROBABILITY OF COMPLETE RECOVERY OF THE PAWS.

60% of the work of orthopedists, plastic surgeons in our clinic is made up of alterations and retreatment after unsuccessful osteosynthesis and plastering at home and in conditions close to those 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

The only difference is time.

The spinal cord and nerves can be destroyed irreversibly and the animal will remain disabled.

Time is not playing into your hands.

If the spine is damaged, there is a possibility of damage to the spinal cord by bone fragments and displaced vertebral bodies. The sooner the load on the spinal cord is removed, the faster the spinal cord will begin to recover and the less likely that irreversible damage to the spinal cord will occur.

Care after surgery

Care for a recovering pet depends on the type of fracture and the type of surgery that has been 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 required 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 re-examine the pet six to eight weeks after surgery. When x-rays show that the fracture has healed, normal activity can be resumed.

Risks and difficulties associated with the treatment of fractures

Even an operation performed flawlessly can carry the risk of certain complications such as infection and difficulty in bone healing. However, if the operation is performed by an experienced specialist, such complications are rare, and most pets recover without complications. Joint fractures can lead to osteoarthritis, which may require long-term follow-up with a doctor, however, most pets do not experience such complications. Before any treatment is started, all aspects of your pet's postoperative care, including the risk of complications, will be detailed during your initial consultation with the orthopedist.

prospects

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

Why should you contact us for the treatment of a fracture in your pet?

We have extensive experience in the successful treatment of various fractures;
We are attentive to each patient;
We use modern technologies and methods of treatment;
Our experts regularly take part in veterinary conferences;

Anatomical and topographic data of the dog. Prevention of surgical infection, sterilization of instruments and materials. Preparation of the animal for surgery and its implementation 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 with a fracture of the femur in a dog)

Completed by: 3rd year student of 22 groups

Kantserova Anastasia Pavlovna

St. Petersburg 2012

1. Operation name

2. Goals of the operation

3. General information about the animal

8. Pain relief

9. Technique of the operation

11. Postoperative animal care

Conclusion

Bibliography

1. Operation name

Osteosynthesis (osteosynthesis; Greek osteon bone + synthesis connection) is the connection of bone fragments. There are two types of osteosynthesis - submersible osteosynthesis and external transosseous osteosynthesis. With submersible osteosynthesis, fixators 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 pins and rods. The purpose of osteosynthesis is stable fixation of bone fragments in the correct position until their consolidation.

2. Goals 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, stabilization of the fracture zone until complete fusion. Basically, there are two types of treatment - surgical and conservative. The purpose 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. With 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

Type, gender: dog, male.

Nickname: Bob

Color, markings: black

Breed: outbred

Age: about 4 years old

Height, weight: at the 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 the conditions of keeping and feeding, as the animal was found on the street. Data on previous diseases and vaccinations are also unknown.

General study of the animal.

Determining the habitus of an animal:

Body position in space: forced, recumbent

Body type: average

Fatness: unsatisfactory

Temperament: phlegmatic

Constitution: rough

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

4. Fixation and location of the operation

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

In dogs, so that they cannot bite, their mouths are tied with a strip of gauze, a gauze bandage or braid. Covering the mouth with a screw, its ends are first tied in the submandibular space with one simple knot, then the bandage is finally fixed on the back of the head with a marine knot.

Dogs are usually fixed on the table, giving them the necessary position. A simple operating table for small animals is made of wood: painted with white oil or enamel paint. The lid of the table should be concave inward or have a small recess in the middle with drains for liquid. Several holes are drilled in it for tying the mouth with straps (braid) used to fix 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 the used dressing material.

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

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

For the duration of the operation, cats are placed in special leather or dense material bags or wrapped in a piece of dense material, leaving the area necessary for the operation open. Even better, with any method of fixation, put on all the limbs of the cat special bags (stockings) made of durable fabric and then fix them accordingly.

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

5. Anatomical and topographic data

Musculature of the pelvic limb of a dog. A - from the lateral side B - from the medial side 1. sartorius muscle 2. semitendinosus muscle 3. biceps femoris muscle 4. cranial tibial muscle 5. long extensor of the fingers 6. long peroneal muscle 7. long flexor of the thumb 8. short flexor of the fingers 9 calf muscle 10. Achilles tendon 11. interosseous muscles 12. short extensor of fingers 13. short peroneal muscle 14. long flexor of fingers 15. slender muscle

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

Sartorius

Cranial tibialis muscle

Long finger extensor

Peroneus longus muscle

flexor thumb longus

Short finger flexor

Muscles are innervated by the tibial and peroneal nerves.

Vessels supplying muscles:

Posterior tibial artery

Anterior tibial artery

External iliac vein

Medial vein of saphenous

Caudal femoral vein

6. Instruments, dressings, medicines

Pointed scalpel, straight blunt and pointed scissors, wound hooks, anatomical and surgical tweezers, hemostatic forceps, 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% ammonia solution, 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 records, screwdriver for driving screws.

7. Prevention of surgical infection

STERILIZATION OF INSTRUMENTS

Basically, there are two ways to sterilize instruments: the action of high temperatures (boiling, sealing, etc.) and "cold" - in disinfectant solutions.

To sterilize instruments by boiling, simple or electric sterilizers are used (Fig. 22), which have a removable grill 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 water: with sodium carbonate - 15 minutes, with borax - 20, with caustic soda - 10 minutes. Alkalis prevent metal corrosion, enhance sterilization efficiency and reduce boiling time.

The order of sterilization: the solution is brought to a boil, during this period the water is released from the oxygen dissolved in it and neutralized with alkali. Instruments are checked for suitability before sterilization. If they were covered with petroleum jelly, then it is wiped 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 are not "lost" in the sterilizer if there are a lot of instruments.

At the end of sterilization, the instruments are removed with the sterilizer grill 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 tools are covered with a sterile sheet or towel.

Used instruments (after opening abscesses, 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 disassembled before it is heated. Syringes and glassware for anesthetic solutions are boiled in distilled water, since alkaline solutions contribute to the decomposition of some local anesthetics.

Sterilization of instruments by flombing (burning)

The disassembled tool is laid out in a clean enameled basin or bath, the required amount of alcohol is poured and it is lit. During the period of alcohol burning, it is advisable to turn the instrument over, since it cannot be sterilized well at the points of contact with the bottom. This method is used when providing emergency surgical care, as well as for sterilizing enameled dishes and tools 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 in production conditions, tools are sterilized with antiseptic solutions. To do this, the tools 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% Lysol solution or Karetnikov's liquid (formalin 20.0, carbolic acid 3.0, carbon dioxide 14.0, distilled water 1 l).

Rubber items 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 formalin vapor.

Tool storage.

All instruments after the operation are thoroughly washed, sterilized and dried. Then they are laid out in a dry cabinet. To prevent rust on the instruments, a vessel half-filled with calcium chloride is placed in the cabinet. Injection needles can be stored in Nikiforov's liquid (alcohol and ether equally), while mandrin should be inserted into each needle. Dark spots or rust that has formed on tools can be removed with 2:1 chalk and ammonia. Rubber objects are placed separately from metal instruments. Do not store instruments together with iodine preparations, acids, etc.

Suture material and methods of its sterilization

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

According to the ability to biodegradation, there are:

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

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

According to the structure of the thread, they distinguish:

monofilament - is a homogeneous structure with a smooth surface;

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

The following requirements are imposed on modern suture material:

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

Biodegradation - the ability of the suture material to disintegrate and be excreted from the body. The suture material must hold the tissue until a scar is formed, and then become unnecessary. At the same time, the rate of biodegradation should not exceed the rate of scar formation, in addition, the suture material should be atraumatic.

For the imposition of surgical sutures, linen and cotton threads are also used.

Silk sterilization

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

Sterilize silk and 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 formalin 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 threads. They are usually used to close skin defects in small animals, on the intestinal wall (ground floor), peritoneum. Use threads No. 10-20. They are sterilized according to the Sadovsky method or immersed for 24 hours in a 4% formalin 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 from 7 to 30 days.

Sterilization using high temperature is excluded. It is mainly used for submerged seams. It is produced in coils that require sterilization, or sterile - in sealed ampoules.

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

Method Ride. Without preliminary degreasing, the catgut is immersed in a 4% aqueous solution of formalin for 3 days.

Sadovsky-Kotylev method. The catgut is placed for 30 minutes in a 0.5% solution of ammonia, then transferred for 30 minutes to a 2% solution of formalin 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; glycerin - 5.0; tinctures of iodine - 8.0 and potassium iodide - 6.0. In this liquid, catgut is stored 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 for connecting bones, are sterilized by boiling, usually together with instruments.

Sterilization of dressings, underwear and surgical items

Sterilization by autoclaving. Dressings (bandages, napkins, splints, compresses, tampons, etc.) and surgical underwear (gowns, sheets, towels, caps) are sterilized in autoclaves under pressure. Sometimes porcelain and glassware, enameled basins, solutions, etc. are placed there. Before autoclaving, the material and linen are loosely placed in biks (Fig. 23). Before placing the bixes in the autoclave, open the side holes, tightly close the lid. 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-gauge glass, close the lid tightly and carefully tighten the bolts, after checking the tightness, turn on the heating source and release steam for 15-20 minutes; close the valve and raise the pressure to the level necessary for sterilization. Sterilization control is carried out by placing in the bix substances whose melting point is above 100 ° C.

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

Sterilization with flowing steam is carried out in a special Koch sterilizer, and in its absence, in a bucket or pan with a lid. They are filled with water to 1/3 of the height. The beginning of sterilization is considered from the moment steam is released, the temperature rises to 100 ° C, the duration is at least 30 minutes.

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

During sterilization 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, swiping the same place 2-3 times on both sides. The ironed material is folded with sterile tweezers and placed in a sterile bix or left wrapped in a sheet.

Preparing the animal and the surgeon for surgery

Preparing the animal for surgery.

For a favorable outcome of the operation, the preparation of the animal for it is important. Before the operation, the animal undergoes clinical studies, in particular, body temperature, respiration, and pulse rate are measured. It is impossible to perform the operation in animals with elevated temperature, it is also not recommended to perform it in the presence of infectious diseases, in malnourished animals. If the operation is not carried out urgently, then before it the animal is reduced to feed and, if possible, then a starvation diet is prescribed for no more than 12 hours.

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

Before the operation, the animals are walked in order to free the large intestine, clean or partially anesthetize.

Operating field preparation

Preparation of the operation field is carried out in four stages: mechanical cleaning, degreasing, antiseptic treatment (asepticization), isolation of the operation field.

Mechanical cleaning includes washing with soap (preferably household soap), removing hair by shaving or clipping. In this case, the size of the prepared field should be sufficient to ensure sterile conditions for the operation. Mechanical cleaning is a particularly important stage in the preparation of the operation field and must be carried out with particular care, since it is due to it that the main amount of dirt and microorganisms is removed.

Preference is given to shaving, since asepticization with this method is more thorough. In practice, a safety razor is most often used. It has been established that hair shaving is best done on the eve of the operation, which allows not only to thoroughly remove the hair, but also to wash the surgical field well, which, as a rule, is heavily contaminated. In addition, skin irritation observed after shaving disappears by the time of surgery, as a result of which the skin becomes less sensitive to iodine solution and dermatitis develops less frequently. Accidental wounds of the skin during shaving by the time of the operation have time to become covered with a dense scab due to clotted 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 fat-free operation field is treated with an antiseptic according to one of the following methods.

The Filonchikov-Grossich method, Its essence lies in the fact that the fat-free field is "tanned" and aseptic 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 consists in the fact that after shaving, mechanical cleaning and degreasing, the operation field is treated with a 10% aqueous solution of potassium permanganate.

The Borchers method is based on the use of a 5% solution of formalin in 96% alcohol after mechanical cleaning, shaving and degreasing the skin. The method makes it possible to achieve (unlike most other methods) sterility in a protein medium (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 open purulent focus, in which the treatment starts 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 terminals (Backhaus) or pins.

Hand preparation 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, most of which are pathogenic. Microbes find refuge in the excretory ducts of the sebaceous and sweat glands, in the subungual spaces, numerous furrows and skin folds. The skin of any part of the animal's body also contains a huge amount of them, so the preparation of the hands before the operation is of particular importance.

Hand treatment consists of three stages: a) mechanical cleaning; b) chemical disinfection; c) leather tanning. Some antiseptic substances often combine bactericidal and tanning properties (iodine alcohol solution, brilliant green solution, etc.), thus representing a bactericidal tanning agent or tanning antiseptic. Processing of hands is carried out from the fingertips and further to the elbows. For the mechanical processing of hands, it is necessary to have brushes made of plant material (agave leaves, palm trees, sabura), 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 in use are first thoroughly washed in warm soapy water, rinsed, and then immersed in a 3% solution of carbolic acid, a bactericide solution 1:3000 for 1 hour. They are also stored in these solutions.

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

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

The chemicals used have bactericidal properties, affect the microbes that are 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 simple to use are the following methods.

Alfeld method. After thorough mechanical cleaning in warm water with soap and a brush, hands are washed 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 smeared with a 5% alcohol solution of iodine.

Olivkov's method consists in the fact that the hands are first washed for 5 minutes with hot water, soap and a brush, after which they are wiped with a towel and treated for 3 minutes with cotton wool soaked in a 1:3000 solution of iodine in alcohol.

In case of 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 fluid stream of this solution. After the second wash, the liquid in the basin should remain clear. Otherwise, the washing is repeated and the hands are wiped with a towel. During the operation or when the hands are contaminated, the treatment is repeated.

The Napalkov 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 wiped with a towel and treated with denatured alcohol for 3-5 minutes. Subungual spaces and skin folds are treated with 5% tincture of iodine.

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

All of the above methods provide 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. On clean, dry hands, apply 3–4 g of the drug and rub thoroughly for 8–10 s. Then dry hands for 2-3 minutes. If the film slips, re-treatment is not required. Sterility is ensured for 2 hours.

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

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

Surgical gloves

None of the methods of processing 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 carrying out operations for purulent-putrefactive processes, as well as when performing abdominal operations in 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: bactericide 0.1% - 15 minutes, chlorocide 2% - 30 minutes or in formalin vapor - 24 hours. After purulent operations, gloves are washed without removing them from the hands in a 2% solution of lysol.

8. Pain relief

During this operation, drugs for anesthesia were used:

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

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

Anesthesia

In this operation, both conduction anesthesia and infiltration anesthesia can be used.

With infiltration anesthesia, a 0.25-0.5% solution of novocaine is usually used and much less often other drugs of this group in the amount of 10-15 ml at a time. During 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, its depth, and the accuracy of the doctor's topographic orientation.

9. Technique of the operation.

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

Training. The patient is tied in a lateral position and additionally fixed with a rope loop passed over the back and through the groin. The operated limb is placed on top and placed on a pillow. The incision site is shaved, the surgical field is treated with a 5% iodine solution, the field is covered with sterile napkins

The course of action. The skin incision begins at the greater trochanter and is carried along the anterior edge of the femur to the knee joint. Superficial fascia, interfascial adipose tissue and deep fascia are dissected along the cranial edge of the biceps femoris muscle, the incision is made of the same length. After a wide opening of the edges of the wound, the intermuscular sheet of the broad fascia of the thigh is dissected, located caudolaterally on the femur, at the site of its attachment, then the lateral vastus muscle of the thigh is separated from the bone and retracted cranially 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 body can be achieved by retracting the biceps femoris and the lateral head of the quadriceps femoris with a retractor.

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

Access can be extended cranially by mobilization of the intermediate head of the quadriceps muscle and caudally by subperiosteal elevation of the adductors, if appropriate.

The femur is long, subject to strong flexion, and its reconstruction requires good stability.

Rice. 3. Access to the diaphysis of the femur

Osteosynthesis with a plate. A plate (neutralizing, tightening or supporting) is applied from the craniolateral side and fixed on each of the main fragments with at least three, and preferably four screws. Only in case of fractures at the point of transition to the metaphysis, it is enough to screw in two screws into a short fragment. In case of a multiple fracture with the formation of fragments that are not supplied with blood, separated from the periosteum and muscle attachment points, the optimal solution is to apply a plate on the medial side of the fracture (medial support). It 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 the distraction of the main fragment, with a long plate fixed in the peripheral area, which achieves greater rigidity (support function!).

The plate extending to the knee joint must be adapted to the curvature of the femur. It should not be located in the lateral recess of the patella joint, it is fixed deep on the cranial edge of the distal fragment.

Wound closure. After placing the intermuscular sheet of the broad fascia of the thigh in place, the edges of the wound of the deep and superficial fascia are adapted in layers with an interrupted suture (absorbable material). With sufficient access to the hip and knee joint, further wound closure is carried out as described above. Suture the skin. Treat the seam with a 5% iodine solution.

10. Possible complications, their prevention and elimination

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

Warning - The treatment of fat embolism is complex. Its main directions are: - treatment and prevention of cardiovascular insufficiency (cardiac, hormonal, antihistamine, vitamin, vasodilating drugs); - treatment and prevention of respiratory failure (oxygen therapy, intubation or tracheostomy with artificial ventilation of the lungs in severe forms); -- correction of water-salt, protein metabolism, acid-base balance, prevention and treatment of acute renal failure: glucose-salt solutions and low molecular weight dextrans intravenously, albumin and protein blood substitutes, sodium bicarbonate, trisbufer, vasodilators, osmotic diuretics (lasix), inhibitors proteases (trasilol, contrykal), vagosympathetic blockades, exchange blood transfusions, in severe renal failure - hemodialysis; - careful patient care, toilet skin, oral cavity, tracheobronchial tree; -- prevention and treatment of infectious complications (antibiotics, sulfonamides, nonspecific and specific globulins, etc.); - in the first hours after the onset of complications, lipostabil or Essentiale is administered 1 drop per day. Lipostabil restores the physiological dissolution of demulsified neutral blood fat in the next few hours and improves the general condition of patients.

2. Anaerobic infection (gas gangrene). Anaerobic infection of wounds is observed very rarely, is one of the most severe complications of osteosynthesis, gives 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 gluteal region. Factors contributing to its development are contamination of wounds with earth; violation of blood supply, prolonged pulling of the limb with a hemostatic tourniquet; general weakening of the body caused by fatigue, cooling, malnutrition.

Treatment for anaerobic infection consists of a complex of therapeutic methods used simultaneously, but in a known sequence: - if surgical treatment has not been performed, then it should be carried out radically, opening all pockets; - to release edematous muscles from compression, incisions should be made along the axis of the affected segment of the limb, and the incisions should penetrate to the muscles ("lamp" incisions); - If an anaerobic infection develops in a wound that has already undergone surgical debridement, a second radical debridement should be performed. Suturing after surgical treatment is contraindicated.

3. Osteomyelitis - purulent inflammation of all elements of the bone, accompanied by necrosis of part of it. The reason for the development of post-traumatic, postoperative osteomyelitis is a massive injury with the presence of necrotic tissues 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 skin necrosis; - strict observance of asepsis and antisepsis; - atraumatic operation; - meticulous hemostasis; - suturing the wound without tension, and if necessary - holding laxative incisions; - implementation of active drainage of the wound for 24 - 48 hours.

Conservative treatment of osteomyelitis: - after the sowing of pus on the flora and its sensitivity to antibiotics, targeted antibiotic therapy is carried out (intramuscularly, intravenously, intraosseously, intraarterially); - The wound must be irrigated with antiseptic fluids. Surgical treatment of postoperative forms of osteomyelitis includes the following activities: - dissection and excision of the purulent focus, its good drainage; -- removal of metal structures and spokes; -- wide opening of the sequester box, removal of necrotic tissues, pathological granulations, sequesters; in the future, in order to fix fragments, preference should be given to transosseous osteosynthesis with devices. The closure of bone tissue defects is carried out with the help of muscle plasty.

4. Suppuration of wounds. Purulent infection of wounds is the most common complication of both internal and transosseous osteosynthesis. Clinical signs of it develop in most cases in the first 5 - 6 days after surgery. In some cases, purulent processes may also occur at a later date, when areas of late (secondary) necrosis are the substrate for suppuration.

Treatment consists in the following: - evacuation of the wound discharge and the creation of conditions for a constant outflow of pus; - with the development of infection in a sutured wound - removal of sutures and wide dilution of 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 washing with antiseptic solutions; - if the purulent process is supported by the presence of necrotic tissues, 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; - when anemia is detected - transfusion of small doses of fresh blood (250 ml) with a substitution and stimulating purpose; - 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. Violation of blood and lymph circulation. Often, especially in the treatment of fractures of the femur, a significant swelling of the limb develops. After giving the limb an elevated position, it decreases, but does not completely disappear. The cause of edema can be inflammation around the pins, thrombophlebitis, lymphostasis, as well as too forced distraction. In these cases, gradual distraction, a 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 apparatus. In some cases, the displacement of fragments occurs when they are not sufficiently fixed (weak tension and fastening of the spokes, threaded rods, and rings), in others, as a result of errors made in the extrafocal osteosynthesis technique, when additional displacements are not eliminated, but, on the contrary, are created. efforts. Incorrectly fused fractures may occur in patients with incompletely aligned fragments or with unrepaired secondary displacement. Premature removal of the apparatus often leads to the development of angular deformities. This happens in those cases when the regenerate has a weak mechanical strength and its restructuring has not been completed.

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

8. Rejection of the base plate.

Prevention is the observance of septic, asepsis during surgery, the selection of alternative methods of treatment.

11. Postoperative care

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

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

Every day, treat the seam with o, o5% chlorhexidine solution or rometar, terramycin spray.

Make a biochemical blood test, X-ray, remove the stitches after 2 weeks.

Conclusion

The operation was successful. There were no complications during and 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, anesthesia was carefully dosed.

The method of osteosynthesis with plates was chosen based on the fact that this was the most optimal way to connect bone fragments. It provides maximum strength, as well as economic benefits.

Also, for a 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 - 303s.

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, 414p.

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 - 448s.

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

8. Tkachenko S.S. "Portal about bone 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 for dogs and cats" "Aquarium" Moscow 2001-511p.

Treatment of fractures in dogs and cats

Fractures in animals usually occur as a result of road accidents, falls from a great height (mainly in cats), fights, and also strong blows with heavy objects, sometimes as a result of shooting from a gun. Also, many breeds of small dogs are prone to fractures at home, for example, mini-Yorks, Chihuahuas - these animals can earn a fracture even if they fail to jump off the couch.

Fractures in animals are just as treatable as human injuries. However, one should take into account the characteristics of animals when choosing a treatment, because you cannot explain to them, for example, that you need to be at rest and not disturb the diseased limb and other similar factors.

In the past, veterinarians used a cast to treat broken bones in animals. But many years of practice show that plaster fixation of fractures is not effective enough in treatment: atrophy of the muscles of the limbs could occur; gypsum does not fix well enough, for example, crushed bones; the animal is not very comfortable with heavy gypsum and it can damage it when walking, as a result of which the proper effect will not be achieved and the bones simply will not grow together or grow together incorrectly, which can only aggravate the situation and complicate rehabilitation.

Now most veterinarians in Russia use such a method of treating fractures in animals as osteosynthesis. It is an operation in which the surgeon matches the broken bones and then fixes them with the help of surgical structures made of metal.

Our clinic knows all the advantages of this method and has prepared a price list where you can find out the cost of osteosynthesis surgery and related services.

Osteosynthesis for cats is carried out in exactly the same way as for dogs. However, here one should take into account the characteristics of animals, because cats, unlike dogs, are harder to keep in one position and make them not move, not step on a fixed limb.

Also, not all methods of osteosynthesis are applicable to cats, since in some cases the fixed constructions of a cat can inevitably gnaw, trying to get rid of them. Therefore, to determine which of the methods of surgery is suitable for your cat, can only be based on its physiological and psychological characteristics.

For the treatment of fractures, the use of an immobilizing dressing (gypsum) has traditionally been used, this method of treatment has a number of disadvantages - the development of atrophy of the muscles of the limb, frequent malunion of bones, the formation of bedsores under the bandage, impaired blood supply to bones and soft tissues. All these complications led to the abandonment of the widespread use of gypsum for the treatment of fractures, so now this treatment method is used only for the treatment of cracks. A more modern method of treating fractures is osteosynthesis- surgery for surgical comparison of bone fragments with the use of fixing metal structures.

Types of osteosynthesis:

1. Intramedullary osteosynthesis - used to treat fractures of long bones. With this method, a special pin or needle is installed inside the bone. But there are limitations to this method - for example, it is not suitable for the treatment of fractures of the pelvis, skull, spine, jaw, as well as for the treatment of comminuted fractures.

ferret hip fracture

The use of intramedullary osteosynthesis for hip fracture

2. Bone osteosynthesis - with this method, a metal plate is attached to the bones with the help of special bolts. As a result, good stabilization of bone fragments is achieved. This method can treat not only fractures of tubular bones, but also injuries of the pelvis, skull, spine, scapula, etc. The negative side of this method is the rather high cost of the operation associated with the use of expensive materials (plates, bolts and special tools).

Fracture of the forearm in a dog

Bone osteosynthesis

Gunshot wound to the lower jaw with a fracture of both branches of the lower jaw

View after osteosynthesis

3. Extrafocal osteosynthesis - is used to treat not only fractures, but also dislocations, and consists in passing the spokes through the bone above and below the fracture site with their subsequent fixation from the outside with a special polymer. The advantages of this method are the relative cheapness of consumables, the speed of the operation, and the reliability of fixing debris. The disadvantage of this method is the impossibility of applying an external fixation device in large and giant breeds of dogs.

X-ray after extrafocal osteosynthesis

4. Combined osteosynthesis - consists in the use of several of the above methods and is used mainly for complex comminuted fractures.

A cat with a compound comminuted fracture of the femur

Cat after combined osteosynthesis

Intercondylar fracture of the humerus in a dog

After osteosynthesis

Separately, it is worth considering fractures of the pelvis. As a rule, such injuries are received by dogs as a result of car accidents, and cats by falling from a great height. In case of damage to the pelvic bones, fractures are usually multiple, which makes them the most difficult in the practice of a traumatologist.

Multiple pelvic fractures in a dog. On the right - a fracture of the pubic and ischial bones, on the left - a fracture of the acetabulum.

The same dog after osteosynthesis

Use of a compression plate for a complex fracture of the acetabulum

Our veterinary clinic has accumulated extensive experience in the use of all types of osteosynthesis in animals of all sizes, which allows us to approach the treatment of each case individually and recommend the most optimal method of reconstructive surgery.

Prices, rub.

The price does not include consumables and additional work

Question answer

Is it possible to fix an old fracture (the radius of the front right paw in a dog)? If so, what is the name of this operation? A week later, we were booked in for an examination and an x-ray of an old fracture, we are waiting for what they say. But I would also like to get an answer to the question above ... The fracture has grown together crookedly, the dog is from the street. Julia

Q: Is it possible to fix an old fracture in a dog?

Hello! Maybe. This is metal osteosynthesis. But the only way to tell for sure is from the picture.

Hello. Tell me the approximate amount of total expenses, including additional ones, for prosthetics of the cat's paw. Amputated as a result of falling into a trap, in the area of the wrist.

Question: Can you tell me the approximate amount for prosthetics for a cat's paw?

Hello! For prosthetics please email us. [email protected] with a note to Sergey Sergeevich Gorshkov. It needs to be reviewed and reviewed. On the offhand, no one will say the approximate cost.

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

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

Fractures in cats

Fractures in cats and fractures in dogs a fairly common phenomenon. A fall from a height, an accident on the road, a skirmish with other animals - all this can cause serious fractures. Moreover, it is important to take into account that fractures in dogs and cats can be caused by a variety of bone-weakening factors:

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 and closed. In any case, it is important to contact a specialist for prompt assistance or for accurate diagnosis. The main signs of a fracture are swelling, pain, inability to stand on a 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 bone fusion. In more complex situations, intraosseous fixation may be required if it is impossible to securely fix the position of the bone using standard means. Also, fixing metal plates are sometimes used, which provide a strong and reliable grip throughout the recovery period.
Of course fractures in dogs and fractures in dogs an unpleasant phenomenon, but in the event of such an injury, it is very important to immediately consult a veterinarian. Otherwise, the bone may begin to grow together incorrectly, which will ultimately cause severe damage to the health of the animal 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 the treatment of fractures in dogs and cats.

To date, the following methods of fixation of fractures are most often used.
Conservative(non-surgical) method of immobilization of 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 points. Firstly, the closed reduction of the fracture itself is difficult to implement, because 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 fractures of the "green branch" type. The second negative moment occurs after a few days, when the traumatic edema subsides and the limb begins to move freely inside the plaster cast. At this time, the displacement of bone fragments is most likely, and, accordingly, the fracture either grows crookedly, or pseudarthrosis occurs. Therefore, in Western Europe, veterinarians change the plaster cast after 1-2 weeks, and this process is not painless. Since a properly applied plaster cast should block adjacent joints, their contracture may occur when the bandage is worn for a long time. The problem of abrasions and decubitus ulcers is also very relevant. On the positive side of the issue, it can be attributed 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 bulge under finger pressure - the consequences of osteodystrophy), so fixation with a metal structure is very problematic. Finally, 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, the following were used: Küncher's nail, Bogdanov's, Rush's, Steinman's pins, as well as pins of our own design. Later, in humane practice, a tightening nail began to be used. However, in veterinary practice, it did not take root, since the installation technique is complex and requires a special tool and the doctor's training. Often in small animals we use a bundle of Kirschner wires. Application inside a bone implant is based on the “sliding bar” principle, i.e. fragments can slide along the pin. However, the action of the antagonist muscles contributes to the convergence, and not the divergence of the fragments. According to my observations, this type of osteosynthesis is the most durable. In rare cases, pin flexion has been observed, but never fractures. The positive aspects of the use of intramedullary osteosynthesis include minor traumatization of bone fragments. Indeed, in fact, we only need open access to the fracture site, the periosteum, muscle insertions are not injured when the pin is inserted, especially with simple, comminuted fractures. In case of “green line” fractures in young, fast-growing animals, an intramedullary nail 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 the fracture has completely healed, then this method is convenient because it requires a minimal incision, which means it prevents re-injury to the soft tissues. Humerus fractures are often localized along the projection of the radial nerve, and when the plate is removed, there is always a danger of its rupture with all the ensuing consequences, while this complication is physically impossible when the pin is removed. 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, it is necessary to take into account the different shape of the intramedullary cavity. 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 choose the width of the pin at the narrowest part. The pin should go in tightly so that there is no angular displacement and rotation of the fragments. Rotation of fragments is a serious disadvantage 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 the bone. In human medicine, for this purpose, screws were used, passed through the entire diameter of the bone and through the intramedullary nail in the upper and lower fragments, or the nail was supplemented with an external bone fixator. Severe, comminuted fractures of the bone diaphysis or a longitudinal fracture of a fragment is a direct contraindication for intramedullary osteosynthesis. Serious disadvantages include injury to the joint when a pin is inserted through it, for example, the knee during osteosynthesis of the tibia.

Metal plates for fastening bone fragments (osseous osteosynthesis).

The use of metal plates has become an important milestone in the development of the practice of osteosynthesis, since it has significantly reduced the rehabilitation time for a sick animal. This is achieved by the possibility of early physical exertion on the injured limb and, as a result, increased blood circulation and regeneration processes in the fracture zone. In addition, when using the plates, the joints adjacent to the fracture are not affected, which also contributes to early physical activity and a decrease in pain response. According to the laws of biomechanics, a plate is not the best way to restore the integrity of a bone, 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. Basically, plate fractures occur in the area of the holes for the screws (where it is thin, it breaks there). This is facilitated by bone lysis and screw migration. Nevertheless, osteosynthesis with a plate allows for rigid fastening of fragments, rotation of fragments is completely excluded. The implementation of compression of bone fragments can significantly reduce the resulting callus in size. When applying a plate, it is important to take into account the tensile forces acting on the bone. Placement of the plate on the opposite side of the bone (where compression forces act) leads to a fracture of the plate. So, the plates differ in shape:

Traditional plates with round holes (Sherman, Lane, Vinable, Burns).
AO/AIWF plates, the most common dynamic compression plates (DCT).
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 fastening of bone fragments, and slowing down the fusion of the bone or the formation of pseudoarthrosis. On the other hand, with strong compression of the periosteum under the plate, its ischemia and necrosis occur. Fracture healing, as is known, occurs due to the vascularization of the fracture zone from the inside of the marrow bone and from the outside due to the periosteum. That is why it is so important to maintain contact with the periosteum of even individual fragments. In human medicine, the problem of ischemia was solved by transverse corrugation of the inside of the plate. In my practice, I did not notice a big difference in the timing of fracture healing. However, if it becomes necessary to remove the plate after prolonged wear, less ingrowth into the bone of the corrugated 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 various functional uses of the plates:

Compression.
Neutralizing.
Support.

For simple, comminuted, transverse and blunt fractures, compression plates are often used. With strong compression between fragments in the fracture zone, vascularization and restoration of osteocytes proceeds along the compact bone layer, and not across, as in diastasis of fragments.
As a result, no voluminous callus is formed, the bone restores its shape without defects. The question of the strength of such an accretion 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 accident and a blow to the thigh of a German shepherd (previously there was a fracture of the femur with the formation of a large bone callus), the bone remained intact. A large bone callus is dangerous because
Compression of tendons, muscles and neurovascular bundle is possible, therefore 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 notch 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 groove. Then, with a special clamp, the fragments were pulled together, followed by their fixation 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 screws from the middle of the plate to the edges, the compression only increases.
Acute 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 the forces of rotation and flexion, capable of displacing fragments or large fragments. Both traditional and compression plates are suitable. Lastly, the hole is not drilled along the far edge. Naturally, it is desirable to contour the plate according to the shape of a healthy bone, for which it is very desirable to have a radiographic picture 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 fragments. When the ends of the fragments are narrow and screwing in the screw threatens to destroy the bone, it is not shameful to fasten them with a wire ring. The previously known postulate that a wire ring is a “noose on a bone” is not true. Long-term own observations and data of foreign authors refute this opinion.
Severe, multi-comminuted fractures of the diaphysis of tubular bones, sometimes with a large defect, intra-articular fractures according to Selter III-V require a different use of plates - functionally supporting. In this case, the plate takes on the load from the proximal to the distal fragment, maintaining the length of the bone and the alignment of the fragments. The maximum number of screwed screws from 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 base plate is the best option. Replacement of large bone defects with cancellous bone autograft is more convenient when using a base plate.
External bone fixators (VKF).
In the late 1940s, Ehmer adapted the VKF used in human 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 lower leg;
auxiliary fixation in combination with intraosseous wires of the diaphysis of the humerus, femur and tibia;
fractures of the lower jaw;
open and infected fractures;
metaepiphyseal fractures with bone deficiency.

All VKF can be classified into groups:

One-sided one-or two-planar clamps (type 1). When creating such a retainer, incomplete rods are used (the skin layer is passed once). VKF 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 many times. The design is quickly loosened, the healing of the fracture slows down. In two cases, infection of the bone was observed. Double connecting holders are the weakest link in the design and require periodic tightening of the screws.
Bilateral 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 alignment 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 the fragments. Moscow veterinary orthopedists (in my opinion, the Biocontrol clinic) successfully used this design to treat fractures in small animals (toy breed dogs and small cats). Due to the anatomical features of animals, type II fixation is conveniently performed on bones distal to the elbow 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 (it is necessary to take into account the body weight and the length of the levers). Therefore, the structure must be insured by applying a splint, and this makes the structure heavier, and it is not very favorable for soft tissue trophism. The end of the pin protruding from the distal end of the radius can cause osteoarthritis of the wrist. To this day, microplates and screws with a diameter of 1 mm are difficult to obtain. Thin needles 0.6 - 0.8 mm serve as fixation rods, and the outer ends, bent at a certain angle and glued with Poxipol (cold welding), create a type II construction. The joints adjacent to the fracture are not damaged and the animal begins to load the limb early.
Bilateral two-plane (biplanar) retainers (type III). This type of fixator is a combination of I and II types of VKF located in 2 planes and connected at the proximal and distal ends. Thus, the shortcomings of the previous types are leveled.
Ring fasteners. Structurally, they are universal. Since they allow holding the fixing rods in different directions (different planes), neutralizing the displacement forces of the fragments. A striking example is the Ilizarov apparatus. If 2 rings are enough to correct bone growth and distraction osteogenesis, then 2 more rings are required for stable osteosynthesis. This design of the ring retainer looks heavy, especially for toy breeds.

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

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

Disadvantages of VKF:

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

Recently, videos of the use of shape memory implants in human medicine have begun to appear. In fact, this is a flat spring, the ends of which are straightened and bent at a certain angle. Holes are pre-drilled in the bone, one from the side of the epiphysis (intramedullary), the other across the diaphysis. Then the implant is treated with a cooling spray. The cooled implant softens and stretches easily. It is inserted into the drilled holes, and then poured with hydrogen peroxide. The peroxide decomposes and releases heat. The heated implant tends to take its former shape and tightens the bone fragments. The method is simple and in the manufacture of implants of smaller sizes, it could well be applicable in veterinary medicine.
P.S. The most effective is the method that the surgeon knows best!

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Plastering a dog or cat results in:

A. GYPSUM - MOBILITY OF FRAGMENTS - FALSE JOINT - TREATMENT FOR YEARS - RADICAL RECOVERY SURGERY - FREQUENTLY EUTHANASIA

B. GYPSUM - NECROSIS (DEATHING) OF THE PAWS TISSUES - REMOVAL OF THE PAWS - OFTEN EUTANASIUM

C. GYPSUM - SEVERE DERMATITIS UNDER GYPSUM - SUPPRESSION - SKIN PLASTY - RADICAL RECOVERY SURGERY - FREQUENTLY LOSS OF PAWS AND EUTHANASIS

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All VKF can be classified into groups: