Case Report - (2022) Volume 13, Issue 6
Received: 01-Jun-2022, Manuscript No. JVST-22-57794;
Editor assigned: 04-Jun-2022, Pre QC No. P-57794;
Reviewed: 15-Jun-2022, QC No. Q-57794;
Revised: 22-Jun-2022, Manuscript No. R-57794;
Published:
29-Jun-2022
, DOI: 10.37421/2157-7579.2022.13.134
Citation: Mana, Hope Philip, Haruna Aliyu and Abba Ali Mutah. “Management of Compound fracture of the Radius and Ulna Using Pop and Splints in
a Nigerian Indigenous Breed of Dog.” J Vet Sci Techno 13 (2022): 136.
Copyright: © 2022 Mana HP, et al. This is an open-access article distributed under the terms of the creative commons attribution license which permits
unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Background: This particular case illustrate the possibility of managing a compound fracture using POP and splints in a dog. Conventionally, management of such fractures requires the use of either intramedullary pin or bone plates as internal fixatives or Illizarov apparatus, Octopod and Taylor spatial frame as external fixatives. Due to the expensive nature of using such fixatives, some clients sometimes have no option than either to take back their pets unattended to or abandon their pets in the hospital for someone else to adopt and manage the underlying condition. As a result, we improvised this particular technique which is affordable to low income clients and less traumatic to the dog, with less hospital stay.
Presentation of case: A case of compound fracture of both radius and ulnar which occurs from trauma as a result rodent’s trap was presented to the small animal unit of the Veterinary Teaching Hospital, University of Maiduguri with the chief complaint of trauma and severe bleeding which was haphazardly managed before presentation. It was then referred to the Surgery and Radiology unit of the hospital, where it was managed using external fixatives consisting of Plaster of Paris and splints around the unaffected area, where the affected area was sutured and treated as open wound until it healed.
Discussion: Fracture repair progression involves some complex cascades of events at cellular level right from the inflammatory stage to the hard callus stage. Furthermore, management of compound fractures requires the use of internal and, or external fixatives which are relatively expensive to some dog owners, hence the need to improvise less expensive procedure that will aid the repair process without any obstruction. In this case, the fractured bones were closely managed post operatively for six (6) weeks. The Plaster of Paris and the splints used in this procedure were removed and the dog was able to bear weight on the affected limb with ease. The dog was discharged home, twelve weeks after, there was no any sign of wound dehiscence, mal union or non-union, hence the fracture healed completely.
Nigerian Indigenous Breed • Diagnostic criteria
Fracture healing is a complex biological process that follows specific regenerative patterns involving the interplay of physiological, cellular and molecular/genetic factors as well as extracellular matrix [1]. The overall pathways of both the anatomical and biochemical events have been thoroughly investigated and knowledge of physiological processes of the sequence of events that occur following a fracture have become clearer [2]. Generally, fracture repair commences following the initial trauma, thereafter bone heals by either direct intramembranous or indirect fracture healing, which consists of both intramembranous and endochondral bone formation. The most common pathway is indirect healing, since direct bone healing requires an anatomical reduction and rigidly stable conditions, usually only obtained by open reduction and internal fixation [3]. However, when such conditions are achieved, the direct healing cascade allows the bone structure to immediately regenerate anatomical lamellar bone and the Haversian systems without any remodeling steps necessary [1,4]. In all other non-stable conditions, bone healing follows a specific biological pathway. It involves an acute inflammatory response including the production and release of several important molecules, and the recruitment of mesenchymal stem cells in order to generate a primary cartilaginous callus [5]. This primary callus later undergoes vascularization and calcification, and is finally remodeled to fully restore a normal bone structure. Indirect (secondary) fracture healing is the most common form of fracture healing, and consists of both endochondral and intramembranous bone healing [6]. It does not require anatomical reduction or rigidly stable conditions. On the contrary, it is enhanced by micro-motion and weight-bearing [7]. Indirect bone healing typically occurs in non-operative fracture treatment and in certain operative treatments in which some motion occurs at the fracture site such as intramedullary nailing, external fixation, or internal fixation of complicated comminuted fractures [8].
Bone repair is driven by complex events at both cellular and tissue proliferation and differentiation levels [9] culminating in the formation of new bones. These include osteogenic growth factors, inflammatory cytokines, antioxidants, osteoclast, osteoblast, hormones and some essential amino acids [10]. The repair cells originate from the inner osteogenic layer of the periosteum, osteoprogenitor cells associated with the blood vessels of the Haversian systems within the cortical bone, the endosteum inner cortex, undifferentiated mesenchymal cells of the bone marrow, and possibly from the undifferentiated cells of the surrounding muscle and connective tissue based on their ability to differentiate as needed [11].
A Nigerian indigenous breed (NIB) of dog was presented to the small animal unit of the Veterinary Teaching Hospital, University of Maiduguri with a case of compound fracture of both the radius and ulnar resulting from locally made rodent trap. There was a severe bleeding which was haphazardly managed using a tourniquet before it was presented. It was then referred to the Surgery and Radiology unit of the hospital where clinical assessment and management plan of the patient was ascertained.
Signalmen
The dog weighed 15 kg, the temperature was 38.5°C, and respiratory rate was 40 cycles per minute while the pulse was 120 beats per minute.
Physical examination of the patient
Upon physical examination of the affected limb, the skin covering the radius and ulna was torn at three different region, the fractured bones were visible, and they were communicating with the surrounding muscles and external environment. The Pronator quadratus and the deep digital flexor muscles were torn as a result of the trauma. Radial nerves were exposed yet they remain intact. The radial vein together with some of its bifurcations was transected, resulting to severe bleeding at the fracture site. There was dyspnea and tachycardia.
Vaccination history
The vaccination history of the dog was traced; it revealed that the dog’s vaccination was up to date for all the canine viral infections including the highly infectious rabies.
Case management plan
The contaminated wound was drained with 0.3% chlorhexidine gluconate. The fractured bones were assessed to see the possibility of using an improvised splint and POP on both proximal and distal part of the aligned bone to so as to make a window on the wounds, for it to be treated as open wound.
Differential diagnosis
Automobile Accident, trauma arising from trap, hit from neighbors etc. this particular case was identified as trauma from rodents/feline trap based on histology and clinical examination.
Surgical intervention
The surgical procedure was performed under sedation and general anaesthesia using a combination of 2% xylazine (VMD, Belgium) at 1 mg/kg and 5% ketamine Hcl (Rotex) at 5 mg/kg body weight respectively. The surgical site was cleaned and irrigated with 0.3% chlorhexidine gluconate and povidone iodine, the bleeders were individually ligated while 0.1% adrenaline (Par sterile products, USA) was infiltrated on the wound surface to cauterize minor bleeders and capillaries. The fracture was reduced using manual traction, where a bandage was applied on the affected limb distally on the digits, then pulled backward to allow the fractured bones align at the same time extending the relaxed muscles that surrounds the bones. Furthermore, the wound edges were sutured using polyglactone size 2.0 while povidone iodine was applied judiciously on the sutured wound. The limb was padded using an orthopedic pad, then splints were applied on the limbs, avoiding the injured portion and secured. The splints were secured with bandage. POP was applied on both the proximal and distal portion of the affected limbs avoiding the sutured site which will be treated as open wound until it healed completely.
Post-surgical medication
Immediately after the procedure, we applied the following medications; Oxytetracycline (Oxypharma®) spray (Topically) (topical antibiotics) Inj. Amoxycillin (1 ml) Intramuscular × 5/7 (antibiotics); Ketoprofen 0.2 mg/kg: (4 mg total dose), Intramuscular × 3/7 (analgesics).
Follow up
The patient was admitted in the kennel and was monitored closely for 6 weeks in the hospital, whereas the wound healed smoothly, we didn’t notice any post-surgical complications such as osteomyelitis, mal union, non-union etc., hence, it was discharged to its owner (Figures 1-6).
Figure 1. The dog upon presentation, torn skin, muscles, multiple fracture and damaged blood vessels (yellow circle).
Figure 2. Close Examination and appraisal of the fractured tibia and fibular.
Figure 3. Surgical Management of the affected limb, a window was created around the open wound for daily dressings.
Figure 4. Patient upon follow up, showing application of oxytet spray on the open wound.
Figure 5. Arrow showing point of fracture completely healed, patient bearing weight on the affected 6 weeks after surgery.
Figure 6. Patient, 16 weeks after Surgery, no any post-surgical complication, the fracture healed completely.
Tibial fractures are the most common type of fracture usually encountered in canines. This is due to the fact that tibia is covered with minimal muscles, which predisposes it to various degrees of fracture. Fractured bone comminution in various degrees has been particularly difficult to control during fracture healing [12]. The degree of fracture comminution can affect the formation of callus. The inadequate stability of internal or external fixation leads to variable degrees of displacement and repeated movements of the bone fragments during the healing period [13]. Fracture repair progression usually constitutes the initial hematoma/inflammation phase characterized by clot formation, leucocyte infiltration and presence of megakaryocytes. This is followed by fibrocartilage formation and angiogenesis and which leads to the stage of the calcification of the cartilage and bone formation known as hard callus phase during which osteoblasts populates the fracture sites. The fourth and final phase is ultimately bone remodeling typified by the presence of osteoclasts and reduction in the volume of the callus. In this case, the dog was unable to bear weight on the affected limb on days 14, 21 and 28, however, the dog starting bearing weight on the affected limb at six weeks, this agrees with [14] and [15] who states that callus index was lower at week 2 and reached a maximum level at weeks 3 and 4 before decreasing at week 6. This is implies that remodeling usually occurs after 6 weeks in dogs.
Closed reduction and external fixation in a compound fracture is usually done with external fixators such as illizarov apparatus, Octopod external fixator and Taylor spatial frame. However, we couldn’t get any of this within our reach, we had to use POP and splint which is more affordable. The main advantage of close reduction is that blood supply to the fracture site is not disrupted by an open surgical procedure and less trauma to the already injured limb.
We therefore recommend that compound fractures of the radius and ulnar can be managed with external fixators such as splints and POP provided that windows are created to allow the injury to be treated as open wound until it healed completely.
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