External skeletal fixation in large animals: A review

Milena Carol Sbrussi Granella; Anderson Fernando de Souza; André Luis do Valle De Zoppa

doi:10.31893/avr.2024004

Keywords:

Abstract

External skeletal fixation (ESF) was first adapted for veterinary medicine in 1934; this fixation method consisted of devices for stabilizing musculoskeletal injuries, such as fractures, dislocations, tendon ruptures, and angular deviation; using transcortical pins or wires connected in sidebars or cast to cover the region of instability. The evolution of orthopedics in veterinary medicine, together with the development of diagnostic imaging and the field of anesthesia, has allowed a substantial increase in success rates in cases of fractures in animals. However, orthopedic cases in large animals, especially, are still challenging due to the unique characteristics of the species, which are associated with bone regeneration and depend on the specific type of lesion and the use of implants that adequately support the stress distribution. External fixation techniques in large animals are plausible strategies for cases of open and/or comminuted fractures of long bones, and the literature shows that these approaches are successful. The objective of this study was to conduct a literature review of the possible configurations of ESF used in large animals and their indications. In addition, we aimed to determine the factors that influence the success rate of these techniques, as well as the advantages and disadvantages, to determine whether the use of ESF in orthopedic patients is a reasonable option for the management of certain diseases.
References
1. Aithal HP, Amarpal, Kinjavdekar P, Pawde AM, Singh GR, Hoque M, Maiti SK, Setia HC. (2007) Management of fractures near the carpal joint of two calves by transarticular fixation with a circular external fixator. Veterinary Record, 161:193–198. https://doi.org/10.1136/vr.161.6.193
2. Aithal HP, Kinjavdekar P, Pawde AM, Singh GR, Setia HC. (2010) Management of tibial fractures using a circular external fixator in two calves: circular external fixator use in calves. Veterinary Surgery, 39:621–626. https://doi.org/10.1111/j.1532-950X.2009.00643.x
3. Anderson DE, Jean GS. (1996) External skeletal fixation in ruminants. Veterinary Clinics of North America: Food Animal Practice, 12:117–152. https://doi.org/10.1016/S0749-0720(15)30439-4
4. Anderson DE, Jean GS. (2008) Management of fractures in field settings. Veterinary Clinics of North America: Food Animal Practice, 24:567–582. https://doi.org/10.1016/j.cvfa.2008.07.006
5. Artioli DP. (2013) O tempo de imobilização pós fraturas / cirurgias e seus efeitos na reabilitação. UNILUS Ensino e Pesquisa, 9:Article 17.
6. Auer J. (2023) History of Equine AOVET. Pferdeheilkunde, 39:204–216. https://doi.org/10.21836/PEM20230301
7. Auer JA. (2019) Principles of Fracture Treatment. In Equine Surgery 1277–1314. Elsevier. https://doi.org/10.1016/B978-0-323-48420-6.00077-6
8. Calhoun JH, Li F, Ledbetter BR, Gill CA. (1992) Biomechanics of the Ilizarov fixator for fracture fixation. Clinical Orthopaedics and Related Research®, 280, 15.
9. Camacho A, Barbosa J, Moreira R, Moreira J. (2012) Artrodese do joelho: Revisão teórica e resultados retrospetivos de 22 casos consecutivos. Revista Portuguesa de Ortopedia e Traumatologia, 20(3):325–334.
10. Câmara ACL, Calado EB, Antunes JMADP, Oliveira CMDM, Afonso JAB, Costa NDA. (2014) Tratamento conservativo e cirúrgico em 22 ruminantes com fraturas em membros. Pesquisa Veterinária Brasileira, 34:1045–1050. https://doi.org/10.1590/S0100-736X2014001100001
11. Cervantes C, Madison JB, Miller GJ, Casar RS. (1996) An in vitro biomechanical study of a multiplanar circular external fixator applied to equine third metacarpal bones. Veterinary Surgery, 25:1–5. https://doi.org/10.1111/j.1532-950X.1996.tb01370.x
12. Costa MT, Hungria Neto JS. (2007) Estudo comparativo dos métodos conservador e cirúrgico para tratamento das lesões agudas do tendão do calcâneo. Acta Ortopédica Brasileira, 15:50–54. https://doi.org/10.1590/S1413-78522007000100011
13. De Godoy RF, Filgueiras RR, Gontijo LA, Ximenes FHB, De Gouvêa LV, Da Silva Pereira C, Almeida RM, Leite CR, Neto ART, Borges JRJ. (2009) Treatment of a periarticular tibial fracture in a foal with a hybrid external fixator. Veterinary Surgery, 38:650–653. https://doi.org/10.1111/j.1532-950X.2009.00549.x
14. Dudley M, Johnson AL, Olmstead M, Smith CW, Schaeffer DJ, Abbuehl U. (1997) Open reduction and bone plate stabilization, compared with closed reduction and external fixation, for treatment of comminuted tibial fractures: 47 cases (1980–1995) in dogs. Journal of the American Veterinary Medical Association, 211:1008–1012. https://doi.org/10.2460/javma.1997.211.08.1008
15. Elce YA, Southwood LL, Nutt JN, Nunamaker DM. (2006) Ex vivo comparison of a novel tapered-sleeve and traditional full-limb transfixation pin cast for distal radial fracture stabilization in the horse. Veterinary and Comparative Orthopaedics and Traumatology, 19:93–97. https://doi.org/10.1055/s-0038-1632981
16. Glass K, Watts AE. (2017) Diagnosis and treatment considerations for nonphyseal long bone fractures in the foal. Veterinary Clinics of North America: Equine Practice, 33:431–438. https://doi.org/10.1016/j.cveq.2017.03.013
17. Guerin SR, Lewis DD, Lanz OI, Stalling JT. (1998) Comminuted supracondylar humeral fractures repaired with a modified type I external skeletal fixator construct. Journal of Small Animal Practice, 39:525–532. https://doi.org/10.1111/j.1748-5827.1998.tb03699.x
18. Janicek JC, McClure SR, Lescun TB, Witte S, Schultz L, Whittal CR, Whitfield-Cargile C. (2013) Risk factors associated with cast complications in horses: 398 cases (1997–2006). Journal of the American Veterinary Medical Association, 242:93–98. https://doi.org/10.2460/javma.242.1.93
19. Joyce J, Baxter GM, Sarrafian TL, Stashak TS, Trotter G, Frisbie D. (2006) Use of transfixation pin casts to treat adult horses with comminuted phalangeal fractures: 20 cases (1993–2003). Journal of the American Veterinary Medical Association, 229:725–730. https://doi.org/10.2460/javma.229.5.725
20. Kaneps AJ. (1996) Orthopedic conditions of small ruminants: llama, sheep, goat, and deer. Veterinary Clinics of North America: Food Animal Practice, 12:211–231. https://doi.org/10.1016/S0749-0720(15)30444-8
21. Lescun TB, McClure SR, Ward MP, Downs C, Wilson DA, Adams SB, Hawkins JF, Reinertson EL. (2007) Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994–2004). Journal of the American Veterinary Medical Association, 230:1340–1349. https://doi.org/10.2460/javma.230.9.1340
22. Lewis DD, Cross AR, Carmichael S, Anderson MA. (2001) Recent advances in external skeletal fixation. Journal of Small Animal Practice, 42:103–112. https://doi.org/10.1111/j.1748-5827.2001.tb02006.x
23. Marval CAD, Oliveira HP, Alves GES, Chaves GG, Borges KDA, Faleiros RR. (2004) Redução de fratura de rádio e ulna em bezerro neonato utilizando-se de placa óssea de neutralização associada a imobilização externa com gesso e muleta de thomas modificada. Brazilian Journal of Veterinary Research and Animal Science, 41:249–250. https://doi.org/10.11606/issn.2318-3659.v41isupl.p249-250
24. Melo U, Ferreira C, Flório R. (2008) Luxação da articulação intertársica proximal em eqüino: Relato de caso. Acta Veterinaria Brasilica, 2:140–145.
25. Nagar S, Singh R, Shahi A, Vaish R. (2019) External fixation using acrylic versus epoxy as a connecting bar for repair of compound fracture in goat. Journal of Animal Research, 9 https://doi.org/10.30954/2277-940X.01.2019.20
26. Palmer RH. (2012) External fixators and minimally invasive osteosynthesis in small animal veterinary medicine. Veterinary Clinics of North America: Small Animal Practice, 42:913–934. https://doi.org/10.1016/j.cvsm.2012.06.001
27. Paretsis NF, Andrade FSRMD, Spagnolo JD, Ojeda JAF, Nóbrega FS, Benesi FJ, Corrêa, RR, Zoppa ALV. (2016) Utilização de fixador externo tipo I para correção de fratura de olécrano em caprino: Relato de caso. Pubvet, 10:889–894. https://doi.org/10.22256/pubvet.v10n12.889-894
28. Pentecost R, Niehaus AJ, Anderson DE. (2016) Surgical management of fractures and tendons. Veterinary Clinics of North America: Food Animal Practice, 32:797–811. https://doi.org/10.1016/j.cvfa.2016.05.012
29. Pettit GD. (1992) History of external skeletal fixation. Veterinary Clinics of North America: Small Animal Practice, 22:1–10. https://doi.org/10.1016/S0195-5616(92)50001-8
30. Rossignol F, Vitte A, Boening J. (2014) Use of a modified transfixation pin cast for treatment of comminuted phalangeal fractures in horses. Veterinary Surgery, 43:66–72. https://doi.org/10.1111/j.1532-950X.2013.12075.x
31. Simpson AM. (2004). Fractures of the humerus. Clinical Techniques in Small Animal Practice, 19:120–127. https://doi.org/10.1053/j.ctsap.2004.09.004
32. Singh GR, Aithal HP, Saxena RK, Kinjavdekar P, Amarpal, Hoque M, Maiti SK, Pawde AM, Joshi HC. (2007) In vitro biomechanical properties of linear, circular, and hybrid external skeletal fixation devices for use in large ruminants. Veterinary Surgery, 36:80–87. https://doi.org/10.1111/j.1532-950X.2007.00239.x
33. Vechiato TAF, Siqueira RF, Coutinho A, Marchioni GG, Kolber M, Peixoto Jr, KC, Toffoli PZ, Zanco NA. (2009) Utilização de fixação externa em fratura de úmero em caprino. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 61:1242–1245. https://doi.org/10.1590/S0102-09352009000500033
34. Vogel SR, Anderson DE. (2014) External Skeletal Fixation of Fractures in Cattle. Veterinary Clinics of North America: Food Animal Practice, 30:127–142. https://doi.org/10.1016/j.cvfa.2013.12.001
35. Williams JM, Elce YA, Litsky AS. (2014) Comparison of 2 equine transfixation pin casts and the effects of pin removal. Veterinary Surgery, 43:430–436. https://doi.org/10.1111/j.1532-950X.2014.12182.x
36. Wright IM. (2022) External Coaptation. In I. Wright (Ed.), Fractures in the Horse (1st ed., pp. 259–282). Wiley. https://doi.org/10.1002/9781119431749.ch13

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How to cite

Granella, M. C. S., Souza, A. F. de, & De Zoppa, A. L. do V. (2024). External skeletal fixation in large animals: A review. Applied Veterinary Research, 3(1), 2024004. https://doi.org/10.31893/avr.2024004

[1] Aithal HP, Amarpal, Kinjavdekar P, Pawde AM, Singh GR, Hoque M, Maiti SK, Setia HC. (2007) Management of fractures near the carpal joint of two calves by transarticular fixation with a circular external fixator. Veterinary Record, 161:193–198. https://doi.org/10.1136/vr.161.6.193

[2] Aithal HP, Kinjavdekar P, Pawde AM, Singh GR, Setia HC. (2010) Management of tibial fractures using a circular external fixator in two calves: circular external fixator use in calves. Veterinary Surgery, 39:621–626. https://doi.org/10.1111/j.1532-950X.2009.00643.x

[3] Anderson DE, Jean GS. (1996) External skeletal fixation in ruminants. Veterinary Clinics of North America: Food Animal Practice, 12:117–152. https://doi.org/10.1016/S0749-0720(15)30439-4

[4] Anderson DE, Jean GS. (2008) Management of fractures in field settings. Veterinary Clinics of North America: Food Animal Practice, 24:567–582. https://doi.org/10.1016/j.cvfa.2008.07.006

[5] Artioli DP. (2013) O tempo de imobilização pós fraturas / cirurgias e seus efeitos na reabilitação. UNILUS Ensino e Pesquisa, 9:Article 17.

[6] Auer J. (2023) History of Equine AOVET. Pferdeheilkunde, 39:204–216. https://doi.org/10.21836/PEM20230301

[7] Auer JA. (2019) Principles of Fracture Treatment. In Equine Surgery 1277–1314. Elsevier. https://doi.org/10.1016/B978-0-323-48420-6.00077-6

[8] Calhoun JH, Li F, Ledbetter BR, Gill CA. (1992) Biomechanics of the Ilizarov fixator for fracture fixation. Clinical Orthopaedics and Related Research®, 280, 15.

[9] Camacho A, Barbosa J, Moreira R, Moreira J. (2012) Artrodese do joelho: Revisão teórica e resultados retrospetivos de 22 casos consecutivos. Revista Portuguesa de Ortopedia e Traumatologia, 20(3):325–334.

[10] Câmara ACL, Calado EB, Antunes JMADP, Oliveira CMDM, Afonso JAB, Costa NDA. (2014) Tratamento conservativo e cirúrgico em 22 ruminantes com fraturas em membros. Pesquisa Veterinária Brasileira, 34:1045–1050. https://doi.org/10.1590/S0100-736X2014001100001

[11] Cervantes C, Madison JB, Miller GJ, Casar RS. (1996) An in vitro biomechanical study of a multiplanar circular external fixator applied to equine third metacarpal bones. Veterinary Surgery, 25:1–5. https://doi.org/10.1111/j.1532-950X.1996.tb01370.x

[12] Costa MT, Hungria Neto JS. (2007) Estudo comparativo dos métodos conservador e cirúrgico para tratamento das lesões agudas do tendão do calcâneo. Acta Ortopédica Brasileira, 15:50–54. https://doi.org/10.1590/S1413-78522007000100011

[13] De Godoy RF, Filgueiras RR, Gontijo LA, Ximenes FHB, De Gouvêa LV, Da Silva Pereira C, Almeida RM, Leite CR, Neto ART, Borges JRJ. (2009) Treatment of a periarticular tibial fracture in a foal with a hybrid external fixator. Veterinary Surgery, 38:650–653. https://doi.org/10.1111/j.1532-950X.2009.00549.x

[14] Dudley M, Johnson AL, Olmstead M, Smith CW, Schaeffer DJ, Abbuehl U. (1997) Open reduction and bone plate stabilization, compared with closed reduction and external fixation, for treatment of comminuted tibial fractures: 47 cases (1980–1995) in dogs. Journal of the American Veterinary Medical Association, 211:1008–1012. https://doi.org/10.2460/javma.1997.211.08.1008

[15] Elce YA, Southwood LL, Nutt JN, Nunamaker DM. (2006) Ex vivo comparison of a novel tapered-sleeve and traditional full-limb transfixation pin cast for distal radial fracture stabilization in the horse. Veterinary and Comparative Orthopaedics and Traumatology, 19:93–97. https://doi.org/10.1055/s-0038-1632981

[16] Glass K, Watts AE. (2017) Diagnosis and treatment considerations for nonphyseal long bone fractures in the foal. Veterinary Clinics of North America: Equine Practice, 33:431–438. https://doi.org/10.1016/j.cveq.2017.03.013

[17] Guerin SR, Lewis DD, Lanz OI, Stalling JT. (1998) Comminuted supracondylar humeral fractures repaired with a modified type I external skeletal fixator construct. Journal of Small Animal Practice, 39:525–532. https://doi.org/10.1111/j.1748-5827.1998.tb03699.x

[18] Janicek JC, McClure SR, Lescun TB, Witte S, Schultz L, Whittal CR, Whitfield-Cargile C. (2013) Risk factors associated with cast complications in horses: 398 cases (1997–2006). Journal of the American Veterinary Medical Association, 242:93–98. https://doi.org/10.2460/javma.242.1.93

[19] Joyce J, Baxter GM, Sarrafian TL, Stashak TS, Trotter G, Frisbie D. (2006) Use of transfixation pin casts to treat adult horses with comminuted phalangeal fractures: 20 cases (1993–2003). Journal of the American Veterinary Medical Association, 229:725–730. https://doi.org/10.2460/javma.229.5.725

[20] Kaneps AJ. (1996) Orthopedic conditions of small ruminants: llama, sheep, goat, and deer. Veterinary Clinics of North America: Food Animal Practice, 12:211–231. https://doi.org/10.1016/S0749-0720(15)30444-8

[21] Lescun TB, McClure SR, Ward MP, Downs C, Wilson DA, Adams SB, Hawkins JF, Reinertson EL. (2007) Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994–2004). Journal of the American Veterinary Medical Association, 230:1340–1349. https://doi.org/10.2460/javma.230.9.1340

[22] Lewis DD, Cross AR, Carmichael S, Anderson MA. (2001) Recent advances in external skeletal fixation. Journal of Small Animal Practice, 42:103–112. https://doi.org/10.1111/j.1748-5827.2001.tb02006.x

[23] Marval CAD, Oliveira HP, Alves GES, Chaves GG, Borges KDA, Faleiros RR. (2004) Redução de fratura de rádio e ulna em bezerro neonato utilizando-se de placa óssea de neutralização associada a imobilização externa com gesso e muleta de thomas modificada. Brazilian Journal of Veterinary Research and Animal Science, 41:249–250. https://doi.org/10.11606/issn.2318-3659.v41isupl.p249-250

[24] Melo U, Ferreira C, Flório R. (2008) Luxação da articulação intertársica proximal em eqüino: Relato de caso. Acta Veterinaria Brasilica, 2:140–145.

[25] Nagar S, Singh R, Shahi A, Vaish R. (2019) External fixation using acrylic versus epoxy as a connecting bar for repair of compound fracture in goat. Journal of Animal Research, 9 https://doi.org/10.30954/2277-940X.01.2019.20

[26] Palmer RH. (2012) External fixators and minimally invasive osteosynthesis in small animal veterinary medicine. Veterinary Clinics of North America: Small Animal Practice, 42:913–934. https://doi.org/10.1016/j.cvsm.2012.06.001

[27] Paretsis NF, Andrade FSRMD, Spagnolo JD, Ojeda JAF, Nóbrega FS, Benesi FJ, Corrêa, RR, Zoppa ALV. (2016) Utilização de fixador externo tipo I para correção de fratura de olécrano em caprino: Relato de caso. Pubvet, 10:889–894. https://doi.org/10.22256/pubvet.v10n12.889-894

[28] Pentecost R, Niehaus AJ, Anderson DE. (2016) Surgical management of fractures and tendons. Veterinary Clinics of North America: Food Animal Practice, 32:797–811. https://doi.org/10.1016/j.cvfa.2016.05.012

[29] Pettit GD. (1992) History of external skeletal fixation. Veterinary Clinics of North America: Small Animal Practice, 22:1–10. https://doi.org/10.1016/S0195-5616(92)50001-8

[30] Rossignol F, Vitte A, Boening J. (2014) Use of a modified transfixation pin cast for treatment of comminuted phalangeal fractures in horses. Veterinary Surgery, 43:66–72. https://doi.org/10.1111/j.1532-950X.2013.12075.x

[31] Simpson AM. (2004). Fractures of the humerus. Clinical Techniques in Small Animal Practice, 19:120–127. https://doi.org/10.1053/j.ctsap.2004.09.004

[32] Singh GR, Aithal HP, Saxena RK, Kinjavdekar P, Amarpal, Hoque M, Maiti SK, Pawde AM, Joshi HC. (2007) In vitro biomechanical properties of linear, circular, and hybrid external skeletal fixation devices for use in large ruminants. Veterinary Surgery, 36:80–87. https://doi.org/10.1111/j.1532-950X.2007.00239.x

[33] Vechiato TAF, Siqueira RF, Coutinho A, Marchioni GG, Kolber M, Peixoto Jr, KC, Toffoli PZ, Zanco NA. (2009) Utilização de fixação externa em fratura de úmero em caprino. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 61:1242–1245. https://doi.org/10.1590/S0102-09352009000500033

[34] Vogel SR, Anderson DE. (2014) External Skeletal Fixation of Fractures in Cattle. Veterinary Clinics of North America: Food Animal Practice, 30:127–142. https://doi.org/10.1016/j.cvfa.2013.12.001

[35] Williams JM, Elce YA, Litsky AS. (2014) Comparison of 2 equine transfixation pin casts and the effects of pin removal. Veterinary Surgery, 43:430–436. https://doi.org/10.1111/j.1532-950X.2014.12182.x

[36] Wright IM. (2022) External Coaptation. In I. Wright (Ed.), Fractures in the Horse (1st ed., pp. 259–282). Wiley. https://doi.org/10.1002/9781119431749.ch13

Abstract

References

How to cite