Retrospective Evaluation of Challenging Delayed Union and Non-union Encountered in Dogs: 16 Cases (2012-2018)


Published: Apr 18, 2023
Updated: 2023-04-18
Versions:
2023-04-18 (2)
Keywords:
Delayed union dog fracture healing complication non-union
KS İnal
https://orcid.org/0000-0003-0690-5743
T Önyay
https://orcid.org/0000-0001-5638-7257
MS Yılmaz
https://orcid.org/0000-0002-0449-0524
C Yardımcı
https://orcid.org/0000-0001-6126-3603
A Özak
https://orcid.org/0000-0002-4359-0691
Abstract

This paper aims to showcase some challenging delayed union and non-union cases, explain their possible causes and the treatment processes they underwent. Most non-union cases included in this study required at least two surgical interventions, and the main reasons for the consecutive interventions were either compromised vasculature of the soft tissues due to extreme trauma or infection. The final successful procedure for cases with excessive soft tissue trauma was external fixator application in most cases. Bone plates were more successful in cases with infection or had poor owner compliance. Minimally invasive external fixator implementation seems to be efficient in preserving the compromised vasculature of the bone while bone plates show better results in cases with localized infection. Harvesting bone grafts from the iliac crest was very practicable, required little time and should be utilized in every possible non-union case given their obvious benefits.

Article Details
  • Section
  • Research Articles
Downloads
Download data is not yet available.
References
Aikawa T, Miyazaki Y, Saitoh Y, Sadahiro S, Nishimura M (2019) Clinical outcomes of 119 miniature‐and toy‐breed dogs with 140 distal radial and ulnar fractures repaired with free‐form multiplanar type II external skeletal fixation. Vet Surg 48:938-946.
Aikawa T, Miyazaki Y, Shimatsu T, Iizuka K, Nishimura M (2018) Clinical outcomes and complications after open reduction and internal fixation utilizing conventional plates in 65 distal radial and ulnar fractures of miniature-and toy-breed dogs. Vet Comp Orthop Traumatol 31:214-217.
Arnault F, Maitre P, Cachon T, Carozzo C, Fau D, Viguier E (2011) Treatment of a nonunion, secondary to gunshot fracture, of the distal radius with circular external fixation and rhBMP-2 in a cat. Vet. Comp. Orthop. Traumatol. 24:289-293.
Atilola M (1984) Nonunion fractures in dogs. J Vet Orthop 3:21-24.
Bartels KE (1987) Nonunion. Vet Clin North Am Small Anim Pract 17:799-809.
Bebchuk TN, Harari J (1995) Gunshot injuries: pathophysiology and treatments. Vet Clin North Am Small Anim Pract 25:1111-1126.
Bierens D, Unis MD, Cabrera SY, Kass PH, Owen TJ, Mueller MG (2017) Radius and ulna fracture repair with the IMEX miniature circular external skeletal fixation system in 37 small and toy breed dogs: A retrospective study. Vet Surg 46:587-595.
Blaeser LL, Gallagher JG, Boudrieau RJ (2003) Treatment of biologically inactive nonunions by a limited en bloc ostectomy and compression plate fixation: A review of 17 cases. Vet Surg 32:91-100.
DeAngelis MP (1975) Causes of delayed union and nonunion of fractures. Vet Clin North Am Small Anim Pract 5:251-258.
DeCamp CE, Johnston SA, Déjardin LcM, Schaefer SL (2016a) Cerclage Wire. In: Brinker, Piermattei, and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair. 5th ed, WB Saunders, St. Louis: pp 105-114.
DeCamp CE, Johnston SA, Déjardin LcM, Schaefer SL (2016b) Fixation Pin Design, Size, and Type. In: Brinker, Piermattei, and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair. 5th ed, WB Saunders, St. Louis: pp 76-77.
Doherty M, Smith M (1995) Contamination and infection of fractures resulting from gunshot trauma in dogs: 20 cases (1987-1992). J Am Vet Med Assoc 206:203-205.
dos Santos JF, Ferrigno CRA, dos Santos Dal-Bó Í, Caquías DFI (2016) Nonunion fractures in small animals-A literature review. Semin Cienc Agrar 37:3223-3230.
Frost PA, Grier RL (1985) Management of gunshot wounds. Iowa State Univ Vet 47:133-135.
Gibert S, Ragetly G, Boudrieau R (2015) Locking compression plate stabilization of 20 distal radial and ulnar fractures in toy and miniature breed dogs. Vet Comp Orthop Traumatol 28:441-447.
Gustilo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am 58:453-458.
Hohn R, Rosen H (1984) Delayed union. In: Manual of internal fixation in small animals. Springer, Berlin: pp 241-254.
Kang B-J, Ryu H-H, Park S, Kim Y, Kweon O-K, Hayashi K (2016) Clinical evaluation of a mini locking plate system for fracture repair of the radius and ulna in miniature breed dogs. Vet Comp Orthop Traumatol 29:522-527.
Karl HK, Benjamin JB (2012) Delayed Unions, Nonunions, and Malunions. In: Veterinary Surgery: Small Animal. Elsevier Health Sciences, Canada: pp 647-656.
Lappin M, Aron D, Herron H, Malnati G (1983) Fractures of the radius and ulna in the dog. J Am Anim Hosp Assoc 19:643-650.
Manchi G, Brunnberg MM, Shahid M, Al Aiyan A, Chow E,
Brunnberg L, Stein S (2017) Radial and ulnar fracture treatment with paraosseous clamp-cerclage stabilisation technique in 17 toy breed dogs. Vet Rec Open 4:1-9.
Marcellin-Little DJ (2003) External Skeletal Fixation. In: Textbook of Small Animal Surgery. 3 ed, Elsevier health sciences, pp 1818-1834.
Nolte DM, Fusco JV, Peterson ME (2005) Incidence of and predisposing factors for nonunion of fractures involving the appendicular skeleton in cats: 18 cases (1998–2002). J Am Vet Med Assoc 226:77-82.
Palmer RH, Hulse DA, Hyman WA, Palmer DR (1992) Principles of bone healing and biomechanics of external skeletal fixation. Vet Clin North Am Small Anim Pract 22:45-68.
Pavletic MM, Trout NJ (2006) Bullet, bite, and burn wounds in dogs and cats. Vet Clin North Am Small Anim Pract 36:873-893.
Piermattei DL, Flo GL, Brinker WO (2006) Delayed Union and Nonunion. In: Handbook of small animal orthopedics and fracture treatment. 4 ed, WB Saunders, St. Louis: pp 168-176.
Ramírez J, Macías C (2016) Conventional bone plate fixation of distal radius and ulna fractures in toy breed dogs. Aust Vet J 94:76-80.
Rhinelander FW (1968) The normal microcirculation of diaphyseal cortex and its response to fracture. J Bone Joint Surg Am 50:784-800.
Schrader SC (1991) Complications associated with the use of Steinmann intramedullary pins and cerclage wires for fixation of long-bone fractures. Vet Clin North Am Small Anim Pract 21:687-703.
Weber BG, Cech O. (1976). Pseudarthrosis: pathophysiology, biomechanics, therapy, results. Bern: H Huber.
Wilber M, Evans E (1978) Fractures of the femoral shaft treated surgically. Comparative results of early and delayed operative stabilization. J Bone Joint Surg Am 60:489-491.
Yardimci C, Özak A, Önyay T, İnal KS, Özbakır BD (2018) Management of femoral fractures in dogs with unilateral semicircular external skeletal fixator-intramedullary pin tie-in configurations. Ankara Univ Vet Fak Derg 65:129-136.