Table Of Content

BSAVA Manual of Canine and Feline BSAVA Manual of B Fracture Repair and Management S A Canine and Feline Second edition V A Edited by Toby J. Gemmill and Dylan N. Clements M Fracture Repair a n Fracture management has developed rapidly u since the first edition of this ever popular manual a was published. Fully revised and updated, l and Management this second edition has an increased focus on o f operative techniques and includes easy to follow C guides with specially commissioned full-colour a illustrations. n i n The BSAVA Manual of Canine and Feline Fracture e second edition Repair and Management covers the background a to fracture management, principles of fracture n management, repair and management of specific d fractures and the treatment and prevention of F complications. New chapters address topics e such as minimally invasive surgery, orthopaedic li n implants and bone grafts. e F r a c t u CONTENTS: History of fracture treatment; Fracture classification and description; Bone r e development and physiology; Biomechanical basis of bone fracture and fracture repair; Fracture healing; Imaging of fractures; Preoperative assessment of the fracture patient; Principles of fracture R fixation; Orthopaedic instrumentation; Orthopaedic implants; Basic surgical techniques; Open e p fractures; Pathological fractures; Bone grafts and alternatives; Minimally invasive osteosynthesis; a Non-surgical management of fractures; The skull and mandible; The spine; The scapula; The i humerus; The radius and ulna; The pelvis and sacroiliac joint; The femur; The tibia and fibula; The r carpus and tarsus; The distal limb; The patella, fabellae and popliteal sesamoids; Fracture disease; a n Implant failure; Osteomyelitis; Complications of fracture healing; Index. d M Toby J. Gemmill BVSc MVM DSAS(Orth) DipECVS MRCVS a RCVS and European Specialist in Small Animal Surgery n Toby graduated from the University of Bristol and then spent a number of years a in mixed and small animal practice before undertaking a residency in small g animal surgery at the University of Glasgow. He passed the ECVS and RCVS e m Diploma in Small Animal Surgery examinations in 2005, and was awarded an MVM for research into canine elbow dysplasia. Toby has been an examiner e for the RCVS at Certificate and Diploma levels. He has published widely in the n fields of small animal orthopaedics and spinal surgery, and given numerous t , presentations at national and international meetings. He is currently a member s of the AOVET European board and the AOVET Education commission. Toby e has worked at Willows Referral Service in the West Midlands for over 10 years. c o Dylan N. Clements BSc BVSc PhD DSAS(Orth) DipECVS MRCVS n European Specialist in Small Animal Surgery d Dylan graduated from the University of Liverpool in 1997, having also e intercalated at the University of Edinburgh in 1995. He worked at the PDSA d in Liverpool for 3 years before completing a surgical residency and registrar i t post in small animal orthopaedics at the University of Glasgow. Dylan i returned to the University of Liverpool where he was awarded a PhD for o n studies into the molecular genetics of canine osteoarthritis in 2007. Dylan is currently Senior Lecturer in Small Animal Orthopaedics at the University of Edinburgh, where he is involved in clinical service, teaching and research, 6 Edited by 1 with a particular focus on molecular genetics, longitudinal cohort studies UBS Toby J. Gemmill and Dylan N. Clements and outcome assessments for canine diseases. 9P 1 2 3 3219 Fractures Cover SPREAD.indd 1 Untitled-3 1 1159//1011//22001166 1125::3302 BSAVA Manual of Canine and Feline Fracture Repair and Management second edition Editors: Toby J. Gemmill BVSc MVM DSAS(Orth) DipECVS MRCVS Willows Referral Service, Highlands Road, Shirley, Solihull, West Midlands B90 4NH, UK Dylan N. Clements BSc BVSc PhD DSAS(Orth) DipECVS MRCVS Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Hospital for Small Animals, Easter Bush Veterinary Centre, Roslin, Midlothian EH25 9RG, UK Published by: British Small Animal Veterinary Association Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB A Company Limited by Guarantee in England Registered Company No. 2837793 Registered as a Charity Copyright © 2016 BSAVA All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission of the copyright holder. Figures 2.3 (part), 4.2, 4.3, 4.4, 4.6, 4.8, 4.10, 4.11, 5.3, 7.2, 11.2, 11.3, 11.4, 11.5, 11.6, 11.7, 11.8, 11.9, 11.11, 11.12, 11.13, 11.14, 11.15, 11.17, 11.18, 11.21, 13.6, 15.15, 15.17, 15.19, 15.21, 17.7, 17.8, 18.13, 19.1, 19.14, 19.15, 19.17c, 19.19, 20.6, 20.28a, 20.31, 20.32, 20.33, 20.36, 20.38, 20.39, 21.4, 21.14, 21.15, 21.17, 21.19, 21.20, 21.23, 21.24, 21.25, 21.26, 21.27, 21.29, 21.30, 21.34, 21.35, 21.36, 21.41, 21.42, 21.47, 22.7, 22.13, 22.16, 22.17, 22.20, 22.21, 23.1, 23.7, 23.11, 23.15, 23.18, 23.19, 23.21, 23.22, 23.23, 23.24, 23.25, 23.28, 24.8c, 25.2d, 25.6, 26.7, 26.15, 26.16, 26.17, 26.18, 26.19, 27.6d, 27.7, 27.9, 27.10, 27.11, 27.12, 29.5 and 31.3 were drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and are printed with her permission. Figures 2.3 (part), 2.5, 2.6, 4.5, 10.10, 10.15, 10.16, 10.30, 11.10, 11.16, 11.19, 11.20, 17.1, 17.2, 17.4, 17.15, 18.6, 18.12, 18.14, 18.16, 18.17, 18.18, 18.19, 18.20, 18.21, 18.22, 18.24, 19.7, 19.11, 19.13, 19.16, 19.17a, 19.17b, 19.18, 19.20, 19.21, 20.1, 20.7, 20.29, 20.30, 20.35, 20.37, 21.1, 21.2, 21.3, 21.5, 21.8, 21.12, 21.13, 21.16, 21.18, 21.28, 21.31, 21.32, 21.33, 21.37, 21.38, 21.43, 21.45, 21.46, 23.10, 23.12, 23.13, 23.14, 23.16, 23.17, 23.26, 23.27, 23.29, 24.6, 24.8a, 24.8b, 24.11, 24.13, 24.19, 24.21, 24.22, 24.25, 24.27, 25.1, 25.2a. 25.2b, 25.2c, 25.3, 25.7, 25.10, 25.11, 25.15, 25.17, 25.18, 25.20, 25.22, 25.23, 25.24, 25.25, 25.26, 25.27, 25.28, 25.29, 25.30, 25.31, 25.32, 25.33, 27.6a, 27.6b, 27.6c, 27.8, 29.3, 29.4, 29.6, 30.1, 30.11, 30.13 and 30.17 were drawn by Vicki Martin Design, Cambridge, UK and are printed with her permission. A catalogue record for this book is available from the British Library. ISBN 978 1 905319 68 8 e-ISBN 978 1 910443 27 9 The publishers, editors and contributors cannot take responsibility for information provided on dosages and methods of application of drugs mentioned or referred to in this publication. Details of this kind must be verified in each case by individual users from up to date literature published by the manufacturers or suppliers of those drugs. Veterinary surgeons are reminded that in each case they must follow all appropriate national legislation and regulations (for example, in the United Kingdom, the prescribing cascade) from time to time in force. Printed in India by Imprint Digital Printed on ECF paper made from sustainable forests 3219PUBS16 pg i Fractures.indd 1 15/11/2016 12:29 Titles in the BSAVA Manuals series Manual of Canine & Feline Abdominal Imaging Manual of Canine & Feline Abdominal Surgery Manual of Canine & Feline Advanced Veterinary Nursing Manual of Canine & Feline Anaesthesia and Analgesia Manual of Canine & Feline Behavioural Medicine Manual of Canine & Feline Cardiorespiratory Medicine Manual of Canine & Feline Clinical Pathology Manual of Canine & Feline Dentistry Manual of Canine & Feline Dermatology Manual of Canine & Feline Emergency and Critical Care Manual of Canine & Feline Endocrinology Manual of Canine & Feline Endoscopy and Endosurgery Manual of Canine & Feline Fracture Repair and Management Manual of Canine & Feline Gastroenterology Manual of Canine & Feline Haematology and Transfusion Medicine Manual of Canine & Feline Head, Neck and Thoracic Surgery Manual of Canine & Feline Musculoskeletal Disorders Manual of Canine & Feline Musculoskeletal Imaging Manual of Canine & Feline Nephrology and Urology Manual of Canine & Feline Neurology Manual of Canine & Feline Oncology Manual of Canine & Feline Ophthalmology Manual of Canine & Feline Radiography and Radiology: A Foundation Manual Manual of Canine & Feline Rehabilitation, Supportive and Palliative Care: Case Studies in Patient Management Manual of Canine & Feline Reproduction and Neonatology Manual of Canine & Feline Surgical Principles: A Foundation Manual Manual of Canine & Feline Thoracic Imaging Manual of Canine & Feline Ultrasonography Manual of Canine & Feline Wound Management and Reconstruction Manual of Canine Practice: A Foundation Manual Manual of Exotic Pet and Wildlife Nursing Manual of Exotic Pets: A Foundation Manual Manual of Feline Practice: A Foundation Manual Manual of Ornamental Fish Manual of Practical Animal Care Manual of Practical Veterinary Nursing Manual of Psittacine Birds Manual of Rabbit Medicine Manual of Rabbit Surgery, Dentistry and Imaging Manual of Raptors, Pigeons and Passerine Birds Manual of Reptiles Manual of Rodents and Ferrets Manual of Small Animal Practice Management and Development Manual of Wildlife Casualties For further information on these and all BSAVA publications, please visit our website: www.bsava.com ii Prelims Fractures.indd 2 19/01/2016 13:41 Contents List of contributors Foreword Preface History of fracture treatment 1 1 Toby Gemmill Fracture classification and description 7 2 Gareth Clayton Jones Bone development and physiology 12 3 Russell Yeadon Biomechanical basis of bone fracture and fracture repair 20 4 Andy P. Moores Fracture healing 32 5 John Houlton Imaging of fractures 37 6 Gawain Hammond Preoperative assessment of the fracture patient 49 7 Ralph Abercromby Principles of fracture fixation 55 8 Rob Pettitt Orthopaedic instrumentation 65 9 Jonathan Pink Orthopaedic implants 72 10 Mike Farrell Basic surgical techniques 88 11 James Grierson Open fractures 106 12 Steve Bright Pathological fractures 112 13 Ignacio Calvo Bone grafts and alternatives 120 14 Gareth Arthurs Minimally invasive osteosynthesis 126 15 Antonio Pozzi and Stan Kim Non-surgical management of fractures 142 16 Jon Dyce iii Prelims Fractures.indd 3 19/01/2016 13:41 The skull and mandible 149 17 Harry Scott The spine 166 18 Malcolm McKee The scapula 188 19 Rob Rayward The humerus 198 20 Steve Clarke The radius and ulna 227 21 Sarah Girling The pelvis and sacroiliac joint 257 22 Mark Bush The femur 276 23 Neil Burton The tibia and fibula 301 24 Steven J. Butterworth The carpus and tarsus 319 25 Alessandro Piras and Tomás Guerrero The distal limb 342 26 Mike Guilliard The patella, fabellae and popliteal sesamoids 353 27 Sorrel J. Langley-Hobbs Fracture disease 363 28 Carlos Macias Implant failure 368 29 Gordon Brown Osteomyelitis 374 30 Angus Anderson Complications of fracture healing 386 31 Bill Oxley Index 398 iv Prelims Fractures.indd 4 19/01/2016 13:41 Contributors Ralph H. Abercromby Stephen Clarke BVMS CertSAO MRCVS BVM&S DSAS(Orth) DipECVS MRCVS Anderson Abercromby Veterinary Referrals, Willows Referral Service, 1870 Building, Jayes Park Courtyard, Highlands Road, Shirley, Forest Green Road, Ockley, Solihull, West Midlands B90 4NH, UK Surrey RH5 5RR, UK D. Gareth Clayton Jones Angus A. Anderson BVetMed DVR DSAO HonFRCVS DHSMA BVetMed PhD DSAS(Orth) MRCVS Bayswater Referrals, Anderson Abercromby Veterinary Referrals, 35 Alexander Street, Bayswater, 1870 Building, Jayes Park Courtyard, London W2 5NU, UK Forest Green Road, Ockley, Dylan N. Clements Surrey RH5 5RR, UK BSc BVSc PhD DipECVS DSAS(Orth) MRCVS Gareth I. Arthurs Royal (Dick) School of Veterinary Studies and PGCertMedEd MA VetMB CertVR CertSAS DSAS(Orth) FHEA MRCVS The Roslin Institute, Queens Veterinary School Hospital, The University of Edinburgh, Hospital for Small Animals, University of Cambridge, Easter Bush Veterinary Centre, Roslin, Madingley Road, Midlothian EH25 9RG, UK Cambridge CB3 0ES, UK Jonathan Dyce Steve R. Bright MA VetMB DSAO DipACVS MRCVS BVMS CertSAS DipECVS MRCVS Ohio State University Veterinary Medical Center, Manchester Veterinary Specialists, Hospital for Companion Animals, Priestley Road, Worsley, 601 Vernon L Tharp Street, Manchester M28 2LY, UK Columbus, OH 43210-1089, USA Gordon Brown Mike Farrell BVM&S CertSAO MRCVS BVetMed CertVA CertSAS DipECVS MRCVS Grove Referrals, Fitzpatrick Referrals, Grove House, Holt Road, Halfway Lane, Fakenham, Norfolk NR21 8JG, UK Eashing, Godalming, Surrey GU7 2QQ, UK Neil J. Burton BVSc DSAS(Orth) CertSAS PGCert(TLHE) FHEA MRCVS Toby J. Gemmill Langford Veterinary Services, BVSc MVM DSAS(Orth) DipECVS MRCVS University of Bristol, Willows Referral Service, Langford House, Highlands Road, Shirley, Solihull, Langford, Bristol BS40 5DU, UK West Midlands B90 4NH, UK Mark A. Bush Sarah L. Girling MA VetMB CertSAS DSAS(Orth) MRCVS BSc BVSc CertSAS DipECVS MRCVS Dick White Referrals, Fitzpatrick Referrals, Station Farm, London Road, Halfway Lane, Six Mile Bottom, Suffolk CB8 0UH, UK Eashing, Godalming, Surrey GU7 2QQ, UK Steven J. Butterworth MA VetMB CertVR DSAO MRCVS James M. Grierson Weighbridge Referrals, BVetMed CertVR CertSAS DipECVS FHEA MRCVS Kemys Way, Anderson Moores Veterinary Specialists, Swansea Enterprise Park, The Granary, Bunstead Barns, Swansea SA6 8QF, UK Poles Lane, Hursley, Winchester, Hampshire SO21 2LL, UK Ignacio Calvo LdoVet CertSAS DipECVS FHEA MRCVS Tomás G. Guerrero The Royal Veterinary College, PD Dr. med. vet. DipECVS Department of Clinical Sciences and Services, St. George’s University, Hawkshead Lane, North Mymms, School of Veterinary Medicine, Hatfield, Hertfordshire AL9 7TA, UK True Blue, Grenada, West Indies v Prelims Fractures.indd 5 19/01/2016 13:41 Michael Guilliard Bill Oxley MA VetMB CertSAO FRCVS MA VetMB DSAS(Orth) MRCVS Anvil Cottage, Wrinehill Road, Willows Referral Service, Wybunbury, Nantwich, Highlands Road, Shirley, Cheshire CW5 7NU, UK Solihull, West Midlands B90 4NH, UK Gawain Hammond Rob Pettitt MA VetMB MVM CertVDI DipECVDI FHEA MRCVS BVSc PGCertLTHE DSAS(Orth) FHEA MRCVS School of Veterinary Medicine, Small Animal Teaching Hospital, University of Glasgow, School of Veterinary Science, Bearsden Road, University of Liverpool, Glasgow G61 1QH, UK Leahurst Campus, Chester High Road, Neston, Wirral CH64 7TE, UK John E.F. Houlton Jonathan J. Pink MA VetMB DVR DSAO DipECVS MRCVS Empshill, BSc BVetMed CertSAS DipECVS MRCVS Willows Referral Service, Robins Lane, Lolworth, Highlands Road, Shirley, Cambridge CB23 8HH, UK Solihull, West Midlands B90 4NH, UK Stanley E. Kim Alessandro Piras BVSc MS DipACVS DVM SVS Department of Small Animal Clinical Science, Referral Centre and Canine Sport Medicine, College of Veterinary Medicine, Russi, Via Faentina Nord, University of Florida, 125/6, 48026 Russi, RA, Italy Gainesville, FL 32611 USA Antonio Pozzi Sorrel J. Langley-Hobbs Prof. Dr.med.vet. DipECVS DipACVS DipACVSMR MA BVetMed DSAS(Orth) DipECVS FHEA MRCVS Department for Small Animals, Langford Veterinary Services, Vetsuisse Faculty Zurich, University of Bristol, Winterthurerstrasse 258c, Langford House, Langford, 8057 Zurich, Switzerland Bristol BS40 5DU, UK Rob Rayward Carlos Macias MA VetMB DSAS(Orth) MRCVS Ldo Vet DSAS(Orth) MRCVS Coast Veterinary Referrals, Centro Veterinario de Referencia Bahia de Malaga, Unit 2 Glennys Estate, Parque Empresarial Laurotorre, 25, 158 Latimer Road, Eastbourne, 29130 Alhaurín de la Torre, East Sussex BN22 7ET, UK Málaga, Spain Harry W. Scott W. Malcolm McKee BVSc CertSAD CBiol FRSB DSAS(Orth) CCRP FRCVS BVMS MVS DSAO MACVSc MRCVS Southern Counties Veterinary Specialists, Willows Referral Service, Unit 6, Forest Corner Farm, Highlands Road, Shirley, Hangersley, Ringwood, Solihull, West Midlands B90 4NH, UK Hampshire BH24 3JW, UK Andy P. Moores Russell Yeadon BVSc DSAS(Orth) DipECVS MRCVS VetMB MA CertSAS DipECVS MRCVS Anderson Moores Veterinary Specialists, Fitzpatrick Referrals, The Granary, Bunstead Barns, Halfway Lane, Poles Lane, Hursley, Winchester, Eashing, Godalming, Hampshire SO21 2LL, UK Surrey GU7 2QQ, UK vi Prelims Fractures.indd 6 19/01/2016 13:41 Foreword Fracture fixation has been on the fast-track in the recent past and many new advances have taken place since the last edition of this manual. The downside of the expansion of the field is the greater amount of information, knowledge and training that a veterinary surgeon requires to accomplish acceptably good results from fracture repair, as the bar has been raised considerably. With this manual the editors have collected a wealth of information which addresses the needs of the busy veterinary surgeon who wishes to understand modern fracture fixation. They have also made available a massive body of practical experience, shared from an impressive array of contributors. The format is the same as with the earlier manual which proved so user friendly in the past. Successful fracture management is achieved through an understanding of fundamental principles and their correct application. This manual seeks to provide these principles and demonstrates how they can be best used in various situations. It is worth remembering that, even with increasing complexity, the surgeon should be seeking the simplest solution that addresses the problems provided by the fracture. This approach gives the best chance of a successful outcome. The editors should be congratulated as once more this excellent source of practical information can be returned to pride of place on practice bookshelves. Stuart Carmichael BVMS MVM DSAO MRCVS Professor of Veterinary Science, University of Surrey vii Prelims Fractures.indd 7 19/01/2016 13:41 Preface The original BSAVA Manual of Small Animal Fracture Repair and Management, edited by Andrew Coughlan and Andrew Miller, has for many years been an essential text for veterinarians undertaking orthopaedic surgery in small animal practice. The style of the original manual, published in 1998, was unique at the time, providing the perfect balance of a detailed yet readable text with clear colour illustrations to explain the nuances of operative techniques. There can be few veterinary surgeons performing orthopaedic surgery in recent years who have not referred to the manual at some point for guidance. Indeed, such was the impact of the original manual that that its format was used as a template for subsequent BSAVA Manuals covering other areas of veterinary medicine in the years to come. As in other fields, fracture surgery has developed rapidly since the first edition of the manual was published. Advances in imaging modalities and implant systems have led to significant improvements in our ability to treat patients with fractures. The continual re-appraisal of the basic principles underpinning treatment of fractures has also changed the way in which many cases are managed. As a result many fractures which were once deemed irretrievable can now be treated successfully. For the busy practitioner, keeping abreast of these changes can be daunting, and the time had come to collate these developments and advances in the form of a new manual. With this new manual we aimed to keep the vernacular of the first edition, using the same clear format with chapters organized into sections covering basic principles, different anatomical regions and complications. Chapters from the original manual have been extensively re-written to convey the advances which have occurred over the past two decades, and several new chapters have been introduced covering emerging areas such as minimally invasive fracture surgery. The original line drawings that were such a benefit in the previous edition of the manual have been retained and expanded, giving practitioners rapid access to essential information when faced with specific fractures. In addition, the clinical images and case examples have been expanded to give context to the concepts being presented. A panel of renowned authors from the UK and overseas have contributed to this manual, bringing with them a huge wealth of practical experience and making its content internationally applicable. We hope that the new manual will be of value and interest to anyone involved in the management of small animals with fractures, including veterinary nurses, undergraduates, general practitioners, residents, diagnostic imagers and specialist orthopaedic surgeons. As editors we would like to extend our sincere thanks to everyone who has contributed to this edition of the manual, including all the authors and the editorial team at BSAVA. Lastly we would also like to thank our families for their support whilst the manual was in production. We hope you will find the new manual as inspiring to use as we ourselves found the original nearly 20 years ago. Toby Gemmill and Dylan Clements January 2016 viii Prelims Fractures.indd 8 19/01/2016 13:41 Chapter 1 History of fracture treatment Toby Gemmill There is evidence that attempts have been made to treat fractures, usually performed on soldiers following battle fractures since 4000 years BC. Early medical practitioners field injuries, was generally limited to amputations. How appreciated that, if left unsupported, fractures either would ever, mortality associated with these procedures was high not heal or would develop significant malunions, compro and, due to the excruciating pain of surgery, patients often mising future use of the limb. Therefore, attempts were preferred to choose near certain death from their injuries made to realign broken bones and maintain their reduction rather than elect for any form of operative treatment. during the healing period, using various forms of splints A number of important innovations occurred during the and bandages. Wooden splints were used by the Egyptians 19th century. Firstly, in 1846 Morton demonstrated that around 5000 years ago (Elliot Smith, 1908) but, whilst it general anaesthesia could be performed relatively safely appears these splints were often effective at facilitating with the careful administration of ether. In the same year, bone healing, limb shortening due to overriding of frag Liston performed the first operation on a patient under ments was common. Splinting of fractures was also used anaesthesia; a midfemoral limb amputation. Secondly, by other civilizations with some success, notably in India improved understanding of microbial infections led to the where bamboo splints were used and in ancient Greece development of a system of antisepsis by Lister (1867), where support was provided using bandages impregnated who used carbolic acid on instruments and wounds and with resin or wax that subsequently set hard. demonstrated that this could reduce the risk of postopera The ancient civilizations declined and, for over 1000 tive infections. Finally, Xrays were discovered by Röntgen years during the Dark Ages, there was very little advance in 1895, which enabled the detailed in vivo assessment of ment in the management of fractures. However, scientific bone injury and healing for the first time. Cases with poor thinking was revived in the 15th and 16th centuries during results could be better investigated and explanations given the Renaissance in Europe. Despite advances in anatom for failures. These vital discoveries led to a more wide ical understanding, fracture treatment was still limited spread consideration of operative techniques for fracture to the use of external coaptation. Attempts were made to management, which began to be developed in the late overcome the problem of limb shortening by using traction 19th and early 20th centuries. devices (Figure 1.1); however, the results were still some what unpredictable. Patients were often confined to their beds for several months during the healing period, and poor limb use and deformities were common sequelae Treatment of fractures in to fractures managed in this way. Operative treatment of animals The concept of animal welfare is relatively modern; for many centuries animals with fractures would be abandoned or euthanased, often using somewhat barbaric techniques. A notable exception was the horse, which clearly had value for use in work or war. Forms of farriery existed in ancient Greece, and the Romans used a metal device known as a ‘hipposandal’ to protect horses’ hooves. Fractures of the distal phalanx could be managed by simple rest, and attempts were made to manage more proximal limb frac tures using external splints with the horses suspended in slings, often for many months (Gibson, 1729). The treatment of femoral fractures in dogs using an external wooden splint was described by Blaine in 1824. Subsequently, alternative materials such as plaster of Paris or sodium silicate were used. For the proximal limb, where Application of an extension device to a fractured arm by poor reduction and overriding of the fracture were con 1.1 Gersdoff in 1517. cerns, attempts were made to apply traction, either by (Reproduced from Guthrie (1958) with permission from the publisher) suspending dogs by their hindlimbs during the healing BSAVA Manual of Canine and Feline Fracture Repair and Management, 2nd edition. Edited by Toby Gemmill and Dylan Clements. ©BSAVA 2016 1 Ch01 Fractures.indd 1 19/01/2016 13:44