Download PDF
CC BY 4.0 · VCOT Open 2021; 04(01): e24-e31
DOI: 10.1055/s-0041-1723831
Case Report

Internal Radioulnar Fixation for Treatment of Nonunion of Proximal Radius and Ulna Fractures in a Toy Breed Dog

Luca Vezzoni
1   Clinica Veterinaria Vezzonim, Cremona, Italy
,
Paolo Abrescia
1   Clinica Veterinaria Vezzonim, Cremona, Italy
,
Aldo Vezzoni 
1   Clinica Veterinaria Vezzonim, Cremona, Italy
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

In this case report, we describe an alternative surgical procedure to treat proximal radius and ulnar nonunion in a toy breed dog. A 14-month-old, Maltese cross-breed dog was referred after previous treatment with external and internal fixation had failed, resulting in a nonunion of a fracture of the proximal radius and ulna with the proximal radius fragment too small and friable to be used for fixation. A craniomedial approach was made to debride the radius nonunion site and a second approach to the lateral aspect of the ulna was made. The fracture was realigned and a titanium locking plate was applied in bridging fashion, fixed to the proximal ulnar fragment with three locking screws in the most proximal plate holes, a fourth screw was inserted in the mid-shaft of the distal ulnar fragment and three locking screws were inserted in the distal most holes of the plate through the distal ulna to engage the distal radial fragment. A recombinant bone morphogenetic protein 2 graft was inserted into the radius and ulna fracture sites. The dog had a successful clinical and radiographic outcome with bridging of the defect 4 weeks postoperatively and complete callus formation 8 weeks postoperatively. Implants have undergone dynamization and then removal. Use of a locking plate as an internal fixator achieving fixation of the proximal ulna and distal radius can be considered an option for the treatment of proximal radioulnar nonunions with a small proximal radial fragment.

Keywords

locking plates - fracture - radius ulna


Publication History

Received: 25 December 2020

Accepted: 03 May 2020

Article published online:
18 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Denny HR. Fracture of the radius and ulna. In: A Guide to Canine Orthopaedic Surgery. 2nd ed.. Boston: Blackwell Scientific Publications; 1985: 179-185
    Google Scholar
  • 2 Boudrieau RJ. Fractures of the radius and ulna. In: Slatter D. ed. Textbook of Small Animal Surgery. Vol 2. 3rd edition. Philadelphia: WB Saunders; 2003: 1953-1973
    Google Scholar
  • 3 McCartney W, Kiss K, Robertson I. Treatment of distal radial/ulnar fractures in 17 toy breed dogs. Vet Rec 2010; 166 (14) 430-432
    CrossrefPubMedGoogle Scholar
  • 4 Fox DB. Radius and ulna. In: Tobias KM, Johnston SA. eds. Veterinary Surgery: Small Animal. Vol 1. St Louis: Elsevier Saunders; 2012: 760-784
    Google Scholar
  • 5 Waters DJ, Breur GJ, Toombs JP. Treatment of common forelimb fractures in miniature and toy breed dogs. J Am Anim Hosp Assoc 1993; 29: 442
    PubMedGoogle Scholar
  • 6 Lappin MR, Aron DN, Herron HL. Fractures of the radius and ulna in the dog. J Am Anim Hosp Assoc 1983; 19 (05) 643-650
    PubMedGoogle Scholar
  • 7 Piras L, Cappellari F, Peirone B, Ferretti A. Treatment of fractures of the distal radius and ulna in toy breed dogs with circular external skeletal fixation: a retrospective study. Vet Comp Orthop Traumatol 2011; 24 (03) 228-235
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Haas B, Reichler IM, Montavon PM. Use of the tubular external fixator in the treatment of distal radial and ulnar fractures in small dogs and cats. Vet Comp Orthop Traumatol 2003; 3: 132-137
    PubMedGoogle Scholar
  • 9 Bierens D, Unis MD, Cabrera SY, Kass PH, Owen TJ, Mueller MG. 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 2017; 46 (04) 587-595
    CrossrefPubMedGoogle Scholar
  • 10 Hamilton MH, Langley Hobbs SJ. Use of the AO veterinary mini ‘T’-plate for stabilisation of distal radius and ulna fractures in toy breed dogs. Vet Comp Orthop Traumatol 2005; 18 (01) 18-25
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Gibert S, Ragetly GR, Boudrieau RJ. Locking compression plate stabilization of 20 distal radial and ulnar fractures in toy and miniature breed dogs. Vet Comp Orthop Traumatol 2015; 28 (06) 441-447
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 De Arburn Parent R, Benamou J, Gatineau M, Clerfond P, Planté J. Open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs: 102 cases (2008-2015). J Am Vet Med Assoc 2017; 250 (12) 1419-1426
    CrossrefPubMedGoogle Scholar
  • 13 Aikawa T, Miyazaki Y, Shimatsu T, Iizuka K, Nishimura M. 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 2018; 31 (03) 214-217
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Larsen LJ, Roush JK, McLaughlin RM. Bone plate fixation of distal radius and ulna fractures in small- and miniature-breed dogs. J Am Anim Hosp Assoc 1999; 35 (03) 243-250
    CrossrefPubMedGoogle Scholar
  • 15 Saikku-Bäckström A, Räihä JE, Välimaa T, Tulamo RM. Repair of radial fractures in toy breed dogs with self-reinforced biodegradable bone plates, metal screws, and light-weight external coaptation. Vet Surg 2005; 34 (01) 11-17
    CrossrefPubMedGoogle Scholar
  • 16 Muir P. Distal antebrachial fractures in toy-breed dogs. Compend Contin Educ Pract Vet 1997; 19: 137-145
    PubMedGoogle Scholar
  • 17 Sumner-Smith G. A comparative investigation into the healing of fractures in miniature poodles and mongrel dogs. J Small Anim Pract 1974; 15 (05) 323-328
    CrossrefPubMedGoogle Scholar
  • 18 Blaeser LL, Gallagher JG, Boudrieau RJ. Treatment of biologically inactive nonunions by a limited en bloc ostectomy and compression plate fixation: a review of 17 cases. Vet Surg 2003; 32 (01) 91-100
    CrossrefPubMedGoogle Scholar
  • 19 Brinker MR. Nonunions: evaluation and treatment. In: Browner BD, Levine AM, Jupiter JB. et al, eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. 3rd edition. Philadelphia, PA: W.B. Saunders; 2003: 507-604
    Google Scholar
  • 20 Kaderly RE. Delayed union, nonunion and malunion. In: Slatter D. ed. Textbook of Small Animal Surgery. 2nd edition. Philadelphia, PA: Saunders; 1993: 1676-1685
    Google Scholar
  • 21 Vertenten G, Gasthuys F, Cornelissen M, Schacht E, Vlaminck L. Enhancing bone healing and regeneration: present and future perspectives in veterinary orthopaedics. Vet Comp Orthop Traumatol 2010; 23 (03) 153-162
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Ragetly GR, Griffon DJ. The rationale behind novel bone grafting techniques in small animals. Vet Comp Orthop Traumatol 2011; 24 (01) 1-8
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Faria MLE, Lu Y, Heaney K, Uthamanthil RK, Muir P, Markel MD. Recombinant human bone morphogenetic protein-2 in absorbable collagen sponge enhances bone healing of tibial osteotomies in dogs. Vet Surg 2007; 36 (02) 122-131
    CrossrefPubMedGoogle Scholar
  • 24 Boudrieau RJ. Initial experience with rhBMP-2 delivered in a compressive resistant matrix for mandibular reconstruction in 5 dogs. Vet Surg 2015; 44 (04) 443-458
    CrossrefPubMedGoogle Scholar
  • 25 Baltzer WI, Cooley S, Warnock JJ, Nemanic S, Stieger-Vanegas SM. Augmentation of diaphyseal fractures of the radius and ulna in toy breed dogs using a free autogenous omental graft and bone plating. Vet Comp Orthop Traumatol 2015; 28 (02) 131-139
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Hong HS. Ulnar radial nonunion fracture treated with recombinant human bone morphogenetic protein‐2 in a dog. J Vet Clin Seoul 2001; 18: 156-159
    PubMedGoogle Scholar
  • 27 Schmoekel H, Schense JC, Weber FE. et al. Bone healing in the rat and dog with nonglycosylated BMP-2 demonstrating low solubility in fibrin matrices. J Orthop Res 2004; 22 (02) 376-381
    CrossrefPubMedGoogle Scholar
  • 28 Milovancev M, Muir P, Manley PA, Seeherman HJ, Schaefer S. Clinical application of recombinant human bone morphogenetic protein-2 in 4 dogs. Vet Surg 2007; 36 (02) 132-140
    CrossrefPubMedGoogle Scholar
  • 29 Massie AM, Kapatkin AS, Fuller MC, Verstraete FJ, Arzi B. Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2. Vet Comp Orthop Traumatol 2017; 30 (02) 153-159
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Bernard F, Furneaux R, Adrega Da Silva C, Bardet JF. Treatment with rhBMP-2 of extreme radial bone atrophy secondary to fracture management in an Italian Greyhound. Vet Comp Orthop Traumatol 2008; 21 (01) 64-68
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Gatineau M, Planté J. Ulnar interlocking intramedullary nail stabilization of a proximal radio-ulnar fracture in a dog. Vet Surg 2010; 39 (08) 1025-1029
    CrossrefPubMedGoogle Scholar
  • 32 Muir P, Manley PA. Stabilisation of fractures of the proximal radius and ulna in a dog by application of a single plate to the ulna. Vet Rec 1994; 134 (23) 599-601
    CrossrefPubMedGoogle Scholar
  • 33 Piermattei DL, Johnson KA. An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Fourth edition. Philadelphia, PA: Elsevier; 2004: 247-249
    Google Scholar
  • 34 DeAngelis MP. Causes of delayed union and nonunion of fractures. Vet Clin North Am 1975; 5 (02) 251-258
    CrossrefPubMedGoogle Scholar
  • 35 Brianza SZ, Delise M, Maddalena Ferraris M, D'Amelio P, Botti P. Cross-sectional geometrical properties of distal radius and ulna in large, medium and toy breed dogs. J Biomech 2006; 39 (02) 302-311
    CrossrefPubMedGoogle Scholar
  • 36 Johnston SA, Von Pfeil DJF, Dejardin LM. et al. Internal fracture fixation. In: Tobias KM, Johnston SA. eds. Veterinary Surgery: Small Animal. St. Louis, MO: Elsevier Saunders; 2018: 654-690
    Google Scholar
  • 37 Guerrero TG, Kalchofner K, Scherrer N, Kircher P. The Advanced Locking Plate System (ALPS): a retrospective evaluation in 71 small animal patients. Vet Surg 2014; 43 (02) 127-135
    CrossrefPubMedGoogle Scholar
  • 38 Arens S, Schlegel U, Printzen G, Ziegler WJ, Perren SM, Hansis M. Influence of materials for fixation implants on local infection. An experimental study of steel versus titanium DCP in rabbits. J Bone Joint Surg Br 1996; 78 (04) 647-651
    CrossrefPubMedGoogle Scholar
  • 39 Palmer MP, Altman DT, Altman GT. et al. Can we trust intraoperative culture results in nonunions?. J Orthop Trauma 2014; 28 (07) 384-390
    CrossrefPubMedGoogle Scholar
  • 40 Barnhart MD, Rides CF, Kennedy SC. et al. Fracture repair using a polyaxial locking plate system (PAX). Vet Surg 2013; 42 (01) 60-66
    CrossrefPubMedGoogle Scholar
  • 41 Reddi AH, Huggins C. Biochemical sequences in the transformation of normal fibroblasts in adolescent rats. Proc Natl Acad Sci U S A 1972; 69 (06) 1601-1605
    CrossrefPubMedGoogle Scholar
  • 42 Reddi AH. Cell biology and biochemistry of endochondral bone development. Coll Relat Res 1981; 1 (02) 209-226
    CrossrefPubMedGoogle Scholar
  • 43 Wozney JM, Rosen V, Celeste AJ. et al. Novel regulators of bone formation: molecular clones and activities. Science 1988; 242 (4885): 1528-1534
    CrossrefPubMedGoogle Scholar
  • 44 Itoh T, Mochizuki M, Nishimura R. et al. Repair of ulnar segmental defect by recombinant human bone morphogenetic protein-2 in dogs. J Vet Med Sci 1998; 60 (04) 451-458
    CrossrefPubMedGoogle Scholar
  • 45 Suzuki Y, Montagne K, Nishihara A, Watabe T, Miyazono K. BMPs promote proliferation and migration of endothelial cells via stimulation of VEGF-A/VEGFR2 and angiopoietin-1/Tie2 signalling. J Biochem 2008; 143 (02) 199-206
    CrossrefPubMedGoogle Scholar
  • 46 Moyen BJ, Lahey Jr PJ, Weinberg EH, Harris WH. Effects on intact femora of dogs of the application and removal of metal plates. A metabolic and structural study comparing stiffer and more flexible plates. J Bone Joint Surg Am 1978; 60 (07) 940-947
    CrossrefPubMedGoogle Scholar
  • 47 Egger EL, Histand MB, Norrdin RW. et al. Canine Osteotomy Healing when stabilized with decreasingly rigid fixation compared to constantly rigid fixation. Vet Comp Orthop Traumatol 1993; 6: 182-187
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Egger EL, Lewallen DG, Nordin RW. et al. Effects of destabilizing rigid external fixation on healing of unstable canine osteotomies. Trans Orthop Res Soc 1988; 13: 302
    PubMedGoogle Scholar
  • 49 Franczuszki D, Chalman JA, Butler HC. et al. Postoperative effects of experimental femoral shortening in the mature dog. J Am Anim Hosp Assoc 1987; 23: 429-437
    PubMedGoogle Scholar
  • 50 Guillou R, Dejardin L, McDonald C. et al. 3‐Dimensional Kinematics of the Normal Canine Elbow at The Walk and Trot, Proceedings, Annual Meeting of the Veterinary Orthopedic Society, Crested Butte, CO, March 3–10, 2012
    PubMed