Table Of Content

... ", ,: Acromial head of deltoideus m. Lateral head of triceps m. Brachio· cephalicus m. Radial n. Cephalic v. ~II-_;--Anconeus m. m. Radial n. BSAVA Manual of Small Animal Fracture Repair and Management Edited by Andrew R. Coughlan BVSc PhD CertV A CertSAO FRCVS Animal Medical Centre 511 Wilbraham Road, Charlton Manchester M21 I UF, UK and Andrew Miller BVMS DSAO MRCVS Willows Veterinary Centre, 78 Tanworth Lane Shirley, Solihull B90 4DF, UK Published by: British Small Animal Veterinary Association Kingsley House, Church Lane ShurdinglOll, ChcllcnllHlll GL51 5TQ, United Kingdom A Company Limited by Guarantee in England. Registered Comp;my No. 2837793. Registered as ,I eh"Tity. Copyright © 1998 BSAVA All rights reserved. No p.1rl Oflhis publication Inay be reproduced, stored in a retrieval system, or tr;msmittcd, in fonn or by any means, electronic, mechanic,ll, photocopying, recording or otherwise without prior wriucn permission of the copyright holder. All the colour illustrations in this book have been designed and created by Vicki Martin [X--sign, Cambridge, UK and arc printed with their pcnnission. A catalogue record for this book is available from the British Library ISBN 0 905214374 The publishers ~nd cOlllributors cannot take responsibility for information provided on dosages and mcthods of applic3lion of drugs mcntioned in this publication. Details of this kind must be verifiL'd by individual uscrs from the appropriate literature. Typeset and printed by: Fusion Design, Fordingbridge, Hampshire, UK _______________________________ C.OLl h ii Other Manuals Other titles in the BSA V A Manuals series: Manual of Anaesthesiafor Small Animal Practice Manual of Canine and Feline Gastroelllerology Manual of Canine and Feline Nephrology and Urology Manual of Companion Animal Nutrition and Feeding Manual of Canine Behaviour Manual of Exotic Pees Manual of Feline Behaviour Manual of Ornameneal Fish Manual of Psiuacine Birds Manual of RaplOrs, Pigeons and Waterfowl Manual of Reptiles Manual of Small Animal Arthrology Manual of Small Animal Cardiorespiratory Medicine and Surgery Manual of Small Animal Clinical Pathology Manual of Small Animal Dentistry, 2"d edition Manual of Small Animal DermalOlogy Manual of Small Animal Diagnostic Imaging Manual of Small Animal Endocrinology, 2"d edition Manual of Small Animal Neurology, 2"d edition Manual of Small Animal Oncology Manual of Small Animal Ophthalmology Manual of Small Animal Reproduction and NeonalOlogy iii Contents Contents iii List of Contributors v Foo'eword vi Preface vii PART 1 Background to Fracture Management Fmcture Classification and Description 3 D. Gary Clayton Jones 2 History of Fracture T"eatment 9 Leslie C. Vaughan 3 Biomechanical Basis of Bone Fracture and Fracture Repair 17 Simon Roe 4 Fracture Healing 29 Tim M. Skerry 5 Imaging of Fracture Healing 35 D. Gary Clayton Jones PART 2 Principles of Fracture Management 6 Evaluating the Fracture Patient 45 Ralph H. Abercromby 7 Non-surgical Management of Fractures 51 Jonathan Dyce 8 Instruments and Implants 57 John P. Lapish 9 Principles of Fracture Surgery 65 Andrew Miller 10 Complex, Open and Pathological Fractures 95 Chris May II Fractures in Skeletally Immature Animals 103 Stuart Carmichael PART 3 Management of Specific Fractures 12 The Skull and Mandible 115 Harry W. Scott 13 The Spine 133 W. Malcolm McKee iv 14 The Scapula 161 Andy TorringTOn 15 The Humerus 171 Hamish R. Denny 16 Radius and Ulna 197 Warrick 1. Bruce 17 The Pelvis and Sacroiliac Joint 217 Marvin L. Olmstead 18 The Femur 229 A. Colin Stead 19 Tibia and Fibula 249 Steven J. Butterworth 20 Carpus and Tarsus 265 John E.F. HOltltoll 21 The Distal Limb 283 Jonathan Dyee 22 Patella and Fabellae 293 Ralph H. Abereromby PART 4 Complications of Fracture Management 23 Fracture Disease 305 John F. Ferguson 24 Implant Failure 311 Malcolm C. Ness 25 Osteomyelitis 317 Angus A. Anderson 26 Complications of Fracture Healing 329 David Benneu Index 341 v Contributors Ralph H. Abercromby BVMS CertSAO MRCVS Ridgeway Veterinary Centre, 47 The Ridgeway, Flitwick, Beds MK45 IDJ, UK Angus A. Anderson BVetMed PhD DSAS (Orthopaedics) MRCVS Royal (Dick) School of Veterinary Studies, Edinburgh University, Summerhall, Edinburgh EH9 IQH, UK David Bennett BVetMed BSc PhD DSAO MRCVS Department of Veterinary Clinical Studies, University of Glasgow Veterinary School, Bearsden Road, Bearsden, Glasgow G6l lQH, UK Warrick J. Bruce BVSc MVM CertSAO MRCVS Institute of Veterinary, Animal and Biomedical Sciences, Massey University, Palmerston North, New Zealand Steven J. Butterworth MA VetMB CertVR DSAO MRCVS Weighbridge Referrals, Kemys Way, Swansea Enterprise Park, Swansea SA6 8QF, UK Stuart Carmichael BVMS MVM DSAO MRCVS Department of Surgery, University of Glasgow Veterinary School, Bearsden Road, Bearsden, Glasgow G6l IQH, UK D. Gary Clayton Jones BVetMed DVR DSAO MRCVS Pilgrims, Beech House, Salehurst, East Sussex TN32 5PN, UK Hamish R. Denny MA VetMB PhD DSAO FRCVS Cedar House. High Street, Wrington, Bristol BSI8 7QD, UK Jonathan Dyce MA VetMB PhD DSAO MRCVS College of Veterinary Medicine, 601 Vernon L. Tharp Street, Columbus, OH 43210-1082, USA John E.F. Houlton MA VetMB DVR DSAQDipECVS MRCVS Department of Clinical Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 OES, UK John P. Lapish BVetMed BSc MRCVS c/o Veterinary Instrumentation, 62 Cemetery Road, Sheffield S II 8FP, UK Christopher May MA VetMB PhD CertSAO MRCVS Grove Veterinary Hospital, 2 Hibbert Street, New Mills, Stockport, Cheshire SKI2 3JJ, UK W. Malcolm McKee BVMS MVS DSAO MACVSc MRCVS Willows Veterinary Centre, 78 Tanworth Lane, Shirley, Solihull B90 4DF, UK Andrew Miller BVMS DSAO MRCVS Willows Veterinary Centre, 78 Tanworth Lane, Shirley, Soli hull B90 4DF, UK Malcolm Ness BVetMed CertSAO DipECVS FRCVS Croft Veterinary Surgeons, 36 Croft Road, Blyth, Northumberland NE24 2EL, UK Marvin C. Olmstead DVM MS DipACVS College of Veterinary Medicine, 601 Vernon L. Tharp Street, Columbus, OH 43210-1089, USA Simon Roe BVSc PhD MS DipACVS School of Veterinary Medicine, Veterinary Teaching Hospital, North Carolina State University, Raleigh, NC 27606, USA Harry W. Scott BVSc CertSAD CertSAO FRCVS Godiva Referrals, 207 Daventry Road, Cheylesmore, Coventry CV I 2LJ, UK Tim M. Skerry BVetMed PhD CertSAO MRCVS Department of Biology, University of York, York YO I 5YW, UK A. Colin Stead BVMS DVR DSAO FRCVS Royal (Dick) School of Veterinary Studies, University of Edinburgh, Summerhall, Edinburgh EH9 IQH, UK Andy M. Torrington BVMS CertSAO MRCVS Animal Medical Centre, 511 Wilbraham Road, Chorlton, Manchester M21 IUF, UK Leslie C. Vaughan DSc DVR FRCVS Burywick, Beeson End, Harpenden, Herts AL5 2AH, UK vi Foreword This new manual is a very welcome addition to the now world renowned series of BSA VA publications. It complements the existing Arthrology and Diagnostic Imaging manuals and will be an invaluable help to practitioners at all stages of their careers. The full use of colour in both the line drawings and photographs adds to the clarity of the text. Practical tips and warnings are printed in coloured boxes to assist the veterinary surgeon checking on a clinical case. The manual describes the background to fracture repair, radio graphic assessment and the management of specific fractures. The operative techniques are described in a novel and most easily assimi lated form, with every detail listed, including the instruments required and the need for assistance during the operation. The editors are to be congratulated on their choice of contributing authors, who have a truly international standing and a background of academic and orthopaedic referral practice. This has resulted in a work which, I am sure, will rank as one of the main components of the practice bookshelf for years to come. David F. Wadsworth BSA V A President 1997-98 vii Preface Our major objective in producing this manual was to create an orthopaedic text dedicated to the practical management of fractures in the dog and cat. Where surgical treatment is indicated, we did not wish to merely illustrate an idealised repair, but also to guide the surgeon through the procedure, emphasising both the potential pitfalls and practical tips already known to more experienced surgeons. Parts I and 2 provide a comprehensive background to fracture management covering basic sciences and the principles to be appUed later in the book, as well as a sobering review of the Ilistory of fracture treatment. Part 3 describes the management of specific fractures by region. In thc first part of each chapter, types of fracture are described and the most appropriate treatment is indicated. The reader is then referred to the relevant Operative Technique at the end of the chapter. These may describe a particular technique as applied to that region, e.g. bone plating, or may describe the management of specific fractures, e.g. humeral condylar fracture, applying principles detailed in the first two parts of the manual. The surgical approaches illustrated are not comprehensive and it is intended that the Operative Techniques are read and used in conjunction with standard texts on surgical anatomy. Our thanks are due to all the contributing authors who have produced comprehensive texts and we are grateful for their patience tllroughout the massive task of refonnatting text into the current layout which we hope will add to the ease of use of the manual. We also wish to express our appreciation to Fusion Design who have played a major role in defining the layout, to Vicki Martin BSc BVSc who has produced figures of outstanding clarity, and to Marion Jowett, Publishing Manager for BSA VA , who has coordinated it all. Thank you to Simon Petersen-Jones who initially proposed the idea of a fracture manual and guided the development phase. Finally, although we have endeavoured to produce a very practically orientated support text, we do encourage clinicians to recognize particularly challenging fractures and to seek advice from more experienced colleagues or to refer the case. We trust you will find this book both interesting to read and an invaluable companion in the day to day management of your fracture patients. Andrew Coughlan Andrew Miller March 1998 PART ONE - - - - - - - - - - - - - - - Background to Fracture Management