From the book "Diseases of the skeletal system of animals"
Lukyanovsky V. A. et al. Publishing house “Kolos”, 1984

At closed fractures the animal is given first aid. It is necessary to limit the movements and displacement of bone fragments, which can injure muscles, damage blood vessels and nerves, and also cause severe pain. In addition, it is necessary to prevent the transition of a closed fracture to an open one due to possible damage and rupture of the skin by fragments of damaged bone, for which a temporary immobilizing bandage is applied and the animal is given complete rest.

In case open fractures perform surgical treatment of the wound. It is freed from contaminants and foreign objects, dead tissue is removed, the area around the wound is treated with 5% tincture of iodine and covered with a napkin, and then immobilized. For this, splints made of plywood, thin boards, splints, wire rods, tin or plastic strips, etc. are used. Special metal splints are also used. In order to prevent the formation of bedsores in the bandage area, soft lining material or layers of gray wool are used, which are applied to the affected surface under a splint.

Immobilizing splint bandage provides the necessary fixation for fractures if it blocks the mobility of the joints above and below the site of a fracture of a particular bone.

Depending on the nature of the fracture, the type of animal, the anatomical and topographical location of a particular bone and other conditions, treatment of bone fractures can be conservative or surgical. It includes non-bloody and bloody methods of connecting fragments, as well as methods and means that help stimulate the formation callus and in general osteogenesis, consolidation of fragments.

Conservative treatment of closed bone fractures involves repositioning displaced fragments and immobilizing them, creating good conditions for regeneration and stimulating fracture healing. It should be taken into account that in advanced cases bone fragments are very difficult to set. Therefore, it is necessary to ensure as much muscle relaxation as possible through anesthesia and local anesthesia.

Good connection of adjacent bone fragments after reduction is achieved by applying immobilizing bandage. It may be different. However, with any dressing, the main thing is to ensure suction of wound discharge and reliable antiseptics. The bandage is removed in young large animals on the 35-40th day, in small animals - on the 20-25th day, i.e. during the period of restoration of the supporting function of the damaged limb, in old ones - a week later.

The conservative method of treating long bone fractures in animals has advantages and disadvantages. An immobilizing bandage, squeezing tissue for a long time, makes it difficult to restore impaired blood and lymph circulation, resulting in the development of stagnation. In addition, fixation of the joints with a bandage excludes the injured limb from the functional load, and this leads to a delay in the formation of callus and other complications.

At open fractures it is necessary to clean the wound, treat it with tincture of iodine, complex powders and apply a protective immobilizing bandage. In case of complications, a hole (window) is made in such a bandage. This makes it possible to systematically treat the wound and constantly monitor the nature of fracture healing. In case of severe contamination of the wound and significant trauma to surrounding tissues, a complex of intensive antiseptic therapy is carried out.

Surgical treatment. The operation of connecting bone fragments using a bloody method is called osteosynthesis. Indications for its implementation are open and closed fractures of the ulnar and calcaneal processes, femoral, humeral, metacarpal, metatarsal bones in small animals and lower jaw in large and small animals, as well as fracture of the radial and tibia in large animals.

To connect fragments, metal sutures, aluminum, brass, nickel, molybdenum, and copper wire with a diameter of 0.6-1 mm or more, stainless steel knitting needles, nails, screws, plates, staples, bone grafts, metal splints, for intramedullary osteosynthesis, wooden ones, are used. metal pins. Recently, polymer pins, strong adhesives, and ultrasonic cladding and bone welding have been developed and successfully introduced.

For closed fractures, osteosynthesis should be done one day after the injury. At a later date, it is difficult to carry out traction and reposition of fragments. In open fractures, osteosynthesis should be done as early as possible in order to prevent the development of microflora.

Connecting fragments with a wire splint used for fractures of the body of the lower jaw. For this purpose, a so-called intraoral splint (wire ligature) is used to connect bone fragments after appropriate surgical treatment for open fractures. For large animals, wire 2 mm thick is used. For metaphyseal fractures, the bones are fixed with two wire ligatures: one is placed around the lateral incisors with hooks, and the other around all the incisor teeth. In case of transverse oblique fractures of the body of the lower jaw in male horses, the fragments are fixed by connecting the canines and the edges of the corresponding side of the jaw (see Fractures of the lower jaw).

The bone suture is made with wire, passing it through holes made in the bone. The ends of the wire are twisted with pliers until the fragments are firmly connected. A bone suture is used for oblique or spiral fractures of tubular bones and fractures of the horizontal branches of the lower jaw. However, as noted by B. M. Olivekov (1949), connecting the bones of the lower jaw with a bone wire suture should be performed only in extreme cases, where it is impossible to apply an intraoral wire splint, since passing through the holes of the wire causes an exacerbation of inflammatory processes in the bones, delays callus formation, and sometimes causes necrosis and other pathological changes.

Fixation of bone fragments with steel staples, previously used for femoral fractures in dogs, has now been successfully replaced by intramedullary osteosynthesis with pins of plant, metal or polymer origin. In some cases, this method can be used to attach heel bone fragments in horses. To do this, triangular or U-shaped stainless steel brackets are made of the required sizes based on an x-ray photograph and used to fix the heel tubercle using the following method. The fracture area is not opened first; the ends of the staples are carefully driven into the drilled holes in the bone.

Connecting bone fragments with nails. The fragments are connected in case of oblique, longitudinal or spiral fractures of tubular bones and fractures of the femoral neck. To do this, a nickel-plated nail is driven into the drilled hole with light blows of a hammer perpendicular to the direction of the fracture line.

Connecting bone fragments with screws (screws). Nickel-plated screws are used for fractures of the ulnar and calcaneal tuberosities, macular and greater trochanter of the femur, and also sometimes for metaphyseal fractures of tubular bones. To do this, use two drills of different diameters. A drill close to the diameter of the neck of the screw (but slightly smaller) is used to drill through the broken section of the bone, and a drill with a diameter 1-2 mm smaller than the middle part of the screw body is used to drill through the body of the bone to which the fragment will be fixed. This method makes it possible to connect the fracture very firmly and reliably and does not cause bone splitting. After the operation, a fixing bandage is applied if possible. The screw is removed through a new skin incision after 35-45 days.

Connecting fragments with metal plates used for various fractures. For this purpose, strong, unbending plates and screws are used. Through the holes in the plate and symmetrical holes in the bone, the fracture is connected with screws. Plates and screws must be made of homogeneous metal. Otherwise, in the tissue fluid, one of the electrodes will “corrode” and undergo corrosion.

The plates are not removed until the fractures are completely healed. If lameness, secondary osteitis or fistulas appear in the operated area after 3-4 weeks, the plates are removed.

Distraction splints. Such splints have been very successfully used in medical practice in recent years. In veterinary medicine, they are used in exceptional cases: for comminuted fractures and large discrepancies in length of fragments, to prevent shortening of the limb.

Distraction splints allow you to combine osteosynthesis with traction. To do this, take two knitting needles with screw threads and two metal plates with holes. The wires are inserted through the drilled holes into the distal and proximal fragments, and the plates are put on the free ends of the wires from the outer and inside limbs. Correct reposition of fragments is carried out using plates by lengthening the distance between the ends of the spokes. Such splints allow you to fix bone fragments for the required period after their reduction.

The application of distraction splints must be accompanied by the use of a splint bandage. The latter is removed simultaneously with the distraction splints after 20-30 days, depending on the nature of the fracture healing.

Intramedullary osteosynthesis with a metal pin. The operation involves precise selection of the pin. For this purpose, radiography is performed. The operation is done as early as possible. When increasing general temperature body to suppress the development of microflora, it is necessary to use antibiotics (introduced into the extravasation and intramuscularly), and then after improvement general condition start the operation.

Over the past 20 years, metal pins have become widely used in veterinary surgery. This is a stainless steel plate pin for small animals (G. A. Michalsky, 1954) and a grooved pin for large animals (A. D. Belov, M. V. Plakhotin, 1957). Pins are usually selected based on radiographs. Its width should correspond to the narrowest part of the medullary canal, and its length may vary depending on the nature of the fracture and the size of the damaged bone. For example, in case of high fractures, it is not necessary to make a pin along the entire length of the bone. To do this, it is enough for the pin to penetrate 4-6 cm into the peripheral fragment. For low fractures, the length of the pin must be large so that it can be passed to the epiphysis.

The operation is performed under both combined and local anesthesia. In the latter case, a 0.25% aqueous solution of novocaine is infiltrated into the skin, and a 2% solution of novocaine in 30% wine alcohol is infiltrated into the soft tissues and bone marrow. Novocaine alcohol should be injected into the bone marrow canal from the side of the fracture. Sheep and calves are injected with 10-15 ml, small dogs and cats - 5-7 ml.

Osteosynthesis of the femur in large animals(cattle, young animals, sheep, goats, large dogs) is carried out with a pin through two incisions. One incision 7-10 cm long is made above the fracture site. The muscles are not cut, but dissected from one another (biceps femoris, superficial gluteus and lateral head of the quadriceps femoris). After this, blood clots, bone fragments, crushed tissues are removed and novocaine alcohol is injected into the bone canal. Then the wound is covered with a sterile napkin and a second incision 4-5 cm long is made above the greater trochanter.

The superficial gluteal muscle is retracted forward with a wound hook, thereby opening access to the bottom of the acetabulum. A hole in the medullary canal is drilled from the side of the acetabulum. The hole can also be made with a trocar from the side of the bone marrow cavity. The pin is inserted into the upper fragment until its end extends beyond the fracture line by 0.5-1 cm, the ends of the fragments are brought closer to each other at an obtuse angle and, by directing the end of the pin into the medullary canal of the distal fragment, the latter is given the correct axial position. Only after this, with light blows of the hammer, the pin is advanced into the medullary canal of the distal fragment. The operation is completed by dusting with a complex antiseptic powder, the wound is closed with a two-story suture and the application of a protective coating or a light cotton-colloid dressing (Fig. 59).

Rice. 59. Scheme of introducing a metal pin into the medullary canal (MVA surgical clinic, according to A. D. Belov): A - hips; B - shoulder.

In case of fractures of the femur in small animals (small dogs, cats) and fractures in the upper third of the diaphysis in sheep, goats and large dogs, the operation is performed through a single incision, starting 3-5 cm above the greater trochanter and ending 3-5 cm below break line locations. Surgical access for fractures of the humerus in all species of animals is made through one incision on the lateral side along this bone.

The incision begins 5-7 cm above the fracture and ends 2-3 cm below it. Then the muscles are bluntly disconnected, novocaine alcohol is injected into the medullary canal, and only after that a hole is drilled at an angle of 45-50° to insert a pin on the lateral surface of the proximal fragment 3-5 cm above the fracture line. To give the pin the correct direction, the upper edge of the hole is cut off in the form of a groove. Correct reposition of fragments and insertion of a pin are carried out in the same way as for fractures of the femur.

At osteosynthesis of the tibia and radius also make one incision on medial surface shin and forearm (operation technique, as for a fracture of the humerus). After fastening the bone with a pin, a blind suture and a light protective bandage are applied to the surgical wound. No additional immobilization is required.

Strong fixation of the fragments ensures a free position of the joints and allows the animal to include the limb in a functional load in a short time after surgery. This prevents contractures and muscle atrophy, and to a certain extent normalizes blood and lymph circulation in damaged tissues and significantly accelerates callus formation and fracture healing.

Fracture consolidation is established clinically and radiographically, and the pin is removed under local anesthesia. To do this, the head of the pin is probed through the skin and a 2-3 cm long incision is made above it.

A hook is inserted into the hole in the head and the pin is either removed freely or with light blows of a hammer. Postoperative wound closed using standard methods. Pin at good conditions healing is removed in the following periods: in large cattle, sheep, goats and pigs on the 25-30th day, in dogs and cats on the 35-45th day.

Recently, a promising method of osteosynthesis with a polymer absorbable pin deserves to be used (M. V. Plakhotin, L. Ya. Loktionova, V. A. Lukyanovsky, Yu. I. Filippov, N. I. Ochirov et al., 1973). Such a pin is a rod with four longitudinal stiffeners. It is made from a biodegradable copolymer of vinyl nitrogen-containing monomer with acrylate, reinforced with absorbable polymer fiber. The diameter of the pin is 5-14 mm with an interval of 1 mm and the length is 250-420 mm, depending on the diameter of the pin. They are sterilized either by radiation exposure with a dose of 2.5 billion and sent to consumers in sterile packaging, or by keeping them in steam for 24 hours.

Intramedullary osteosynthesis absorbable polymer pin is recommended for diaphyseal fractures of the tibia, femur and humerus in dogs, cats, sheep, foxes and other small animals. After dissecting the soft tissue above the fracture zone and removing the fragments from the wound, the medullary canal is drilled from the fracture side with a drill with a T-shaped handle and a diameter corresponding to the cross-section of the pin.

In the upper fragment, with the same drill, through the medullary canal, a hole is made in the bone to insert the pin from above (in the femur in the area of ​​the acetabulum, in the tibia - above the lateral ridge, in the humerus - above the external tubercle). The length of the pin is determined by the depth of the medullary canal, the pin is adjusted and cut with a scalpel. To avoid fiber disintegration, it is cut at an angle of 30-45° relative to the axis of the pin.

A pin is inserted from the side of the fracture into the upper fragment of the bone until it comes out under the skin, then an incision is made above it and brought upward into the wound until the end of its fracture remains protruding 1 cm. Then the fragments are connected and the pin is pushed along the bone marrow with light blows of a hammer channel into the lower fragment along its entire length. To eliminate possible fiber disintegration of the pin during a hammer blow when inserting it into the medullary canal, special metal attachments are used, the inner diameter of which must correspond to the diameter of the pin.

Intramedullary osteosynthesis with a polymer pin carried out in the surgical clinic of the Department of General and Private Surgery of the Moscow veterinary academy on dogs and sheep for experimental fractures of the diaphyseal tibia and femur. In the postoperative period, the animals felt satisfactory, their general condition returned to normal on days 3-7, and clinical parameters after 2 weeks approached the initial values. The function of the damaged limb in most animals was completely restored after 4-5 weeks (with proper restoration long axis of the bone). In some dogs and sheep, due to some displacement of the fragments, the bone has grown together at a slight angle.

It was found that during the healing process of fractures, the polymer absorbable pin gradually swelled and became unfibered. This began at the junction of the fragments and then spread along the pin located in the medullary canal. The resorption period of the pin is 1.5-2 years.

When inserted intramedullary, a polymer absorbable pin is non-toxic, does not cause a pronounced reaction in the body to a foreign body, and provides immobilization of fragments in fractures of the tibia and femur in dogs and sheep. The use of a polymer absorbable pin eliminates secondary surgery, which is required in cases where a metal pin is used.

ULTRASONIC SURFACING AND WELDING OF BONE TISSUE

Ultrasound is currently finding increasing use in medicine and veterinary medicine for therapeutic and diagnostic purposes. In case of bone injuries, it is used for surfacing and welding of injured bones. In medicine, extensive research has been carried out to find the most rational methods for ultrasonic welding of bones. In veterinary medicine, at the Department of General and Private Surgery of the Moscow Veterinary Academy, since 1973, in creative collaboration with the Department of Welding of the Moscow Higher Technical School named after N. E. Bauman, research has been carried out on optimal options for ultrasonic surfacing.

To date, experimental studies have established the specific features of replacing ultrasonic surfacing with bone regenerate in long bones of sheep and dogs in the process of bone tissue regeneration after experimental defectiveness. The experiments used 20 sheep and 19 dogs, in which a rectangular bone plate of the diaphysis 12-20 mm long and 4-5 mm wide was cut out with ultrasound or mechanically in the area of ​​the radius and tibia. In some cases, the bone marrow was removed from the defect area, in others it was preserved.

The bone defect, dried with sterile gauze drains, was filled with bone chips to the outer edges. Porous surfacing was obtained by exposing bone chips to ethyl-a-cyanoacrylate, as well as adding 5% ethoxylethylcyanoacrylate or arotic acid to it, dense surfacing was obtained by using hetero-chips in dextran with exposure to ethyl-a-cyanoacrylate.

In all cases, the polymerization of the surfacing was carried out with an ultrasonic device for 15-20 s at an oscillation frequency of 26.5 kHz, an amplitude of 50-55 μm (Fig. 60). Subsequently, after dusting with antiseptic powders, regular sutures were placed on the surgical wound and covered with an antiseptic bandage (sometimes plaster).

During the postoperative period, the animals' general condition, pulse rate, respiration rate were determined, temperature was measured, and histological and biochemical blood tests were performed (total protein, protein fractions, Ca and P). On the 15-20, 30, 40, 50, 60, 80, 100, 120, 140, 160, 180 and 200 days after ultrasonic surfacing, pathological material was taken and pathological, radiological, biochemical and histological studies were carried out. It was found that the general condition of the animals during the experiments was satisfactory in all cases. In the first 2-3 days after the operation, both sheep and dogs had increased body temperature, breathing and pulse increased to the maximum physiological norm or slightly higher. During the first 5 days. mild lameness was observed. Wound healing proceeded by primary intention. Bandages and the sutures were removed on the 10-12th day after the ultrasonic surfacing operation.

It was noted that the reaction to ultrasonic fusion of bone defects in both sheep and dogs is close to the usual reaction to surgical bone trauma.

According to X-ray studies, the periosteal reaction after surfacing appears on the 17th-20th day. The endosteal reaction with porous surfacing appears on radiographs on the 25-30th day, and with dense surfacing - on the 40-50th day. In subsequent periods, until the surfacing is completely replaced with bone regenerate, the periosteal and endosteal reactions are more pronounced.

Until the 40-60th day, according to radiographs, the difference in the development of the postoperative reaction in the fusion zone in sheep and dogs cannot be established. It should be noted that during these periods, the contours of the defect are expressed quite prominently, and a light gray shadow forms in the surfacing zone on X-ray photographs, which indicates the development of regenerative processes.

By 80 days, overlap of the bone marrow canal proximal and distal to the fusion zone was noted as a result of endosteal formation of bone tissue. On radiographs this was revealed as dense gray shadows. This reaction in sheep and dogs is most pronounced when removing bone marrow. At this time, the contours of the defect are less noticeable; the defect zone in sheep is darker on radiographs than in dogs.

In sheep, the contours of the defect are faintly visible by 100-110 days; the bone regenerate at the site of the defect is clearly marked, the density of which, in terms of the intensity of the shadow, approaches the density of the intact bone tube. This radiograph was installed in dogs for 20-30 days. later (incl., Fig. 30).

Clinical and radiological studies have noted that in sheep and dogs the defect is completely replaced by bone regenerate at different times. So, in sheep with porous surfacing this occurred by 140-160 days, in dogs - later than 180 days, with dense surfacing by 110-120 and 160-180 days, respectively. With dense fusion with preservation of bone marrow after surgery, the medullary canal takes the shape of a regular tube, and the tubular bone in the fusion zone takes on the correct shape. With porous surfacing, the wall of the tubular bone in the defect zone during these periods is somewhat thickened inside the medullary canal.

Studies have established that complete replacement of the surfacing with bone regenerate occurs faster in sheep than in dogs, and this difference is most pronounced when using dense surfacing. Thus, ultrasonic devices can be successfully used in clinics for surfacing when defecting various bones in animals.

BIOLOGICAL ESSENCE OF HEALING OF BONE FRACTURES
(CLINICAL-X-RAY, HEMATOLOGICAL, BIOCHEMICAL AND RADIOISOTOPIC INDICATORS OF HEALING OF TUBULAR BONE FRACTURES

Healing of bone fractures is accompanied by both local and general changes in the body. Bone tissue after a fracture is restored through the formation of a callus (incl., Fig. 34). The regeneration process involves: the inner (cambial) layer of the periosteum, endosteum, bone marrow, endothelium of the vessels of the Haversian canals, young connective tissue, which subsequently metaplasizes into bone (Fig. 61).

Rice. 61. Rib fractures. Callus formation.

In the primary callus (A.D. Belov, 1966) there are: periosteal, or external, callus, developing from the cells of the cambial layer of the periosteum; endosteal, or internal, callus, formed from endosteal cells and bone marrow of both fragments; intermediate callus, developing from the Haversian canals of the cortical layer of bone and partly from endosteal and periosteal cells; parosseous, or periosteal callus, formed from soft tissue near the fracture. The development of this callus depends on the degree of damage to surrounding tissue.

In the process of callus formation, the following main phases are distinguished.

First phase- preparatory - within 48-72 hours, in response to injury, serous aseptic inflammation, exudation and emigration of leukocytes into soft tissues develop. At the same time, traumatic osteitis occurs at the ends of the fragments. Under the influence of osteoclasts and their enzyme (acid phosphatase), under conditions of local acidosis, demineralization of the ends of fragments occurs along the fracture line.

Second phase occurs 3 days after injury and is characterized by the formation of connective tissue callus. Initially, osteoid tissue is formed in the cellular elements of the periosteum, endosteum and bone marrow at some distance from the fracture line, that is, in the intact zone from the injury, and then this process continues to the fracture line.

At the same time, osteogenic cells of the cambial layer of the periosteum, bone marrow and endosteum penetrate into the blood clot in the fracture zone, gradually multiplying, they grow into a dense network blood capillaries. Around bone fragments a peculiar granulation tissue, which represents a connective tissue callus, where the cellular elements in it, through differentiation, turn into osteoblasts and bone cells, and the intermediate substance into collagen fibers - the main substance.

This phase is characterized by an increase in the activity of alkaline phosphatase and the intensity of phosphorus-calcium metabolism. In addition, the content of phosphorus and calcium in the blood serum increases, the activity of alkaline phosphatase and the complexing properties of proteins with phosphorus-calcium salts increases.

Third phase. After 10-12 days. callus is formed, characterized by the process of ossification. Osteoid tissue at this time is characterized by the process of ossification. The main role here is played by osteoblasts, which produce alkaline phosphatase and carbonic acid. The resulting bone tissue does not have a physiologically correct structure. Gradually with recovery musculoskeletal function it undergoes static-dynamic restructuring.

Fourth phase is accompanied by the final restructuring of the formed callus with the rearrangement of bone beams according to the laws of statics and dynamics. This process takes a long time. During this time, the bone beams of the callus, which do not function under static-dynamic load, dissolve, and those under load are formed and, in their architectonics, approach normal bone. General changes in the body are characterized by gradual normalization biochemical parameters, which are established within normal limits after 5-8 months.

The healing of fractures in different animals has its own characteristics. Thus, horses and dogs strictly protect the limb after a fracture and include it in the supporting function when the fragments are firmly fixed by callus. In these animals, the fracture is accompanied by the development of serous inflammatory edema, proliferation phenomena are weakly expressed, connective tissue callus is formed by 10-15 days. Bone fragments heal by 35-45 days.

Cattle, sheep and pigs spare the grassed limb in the first 3-5 days, and then they begin to gradually include it in the supporting function. The area of ​​inflammatory edema in them is more localized than in horses and dogs; a connective tissue callus is formed by 8-10 days. Bone fragments in these animals heal by 25-35 days.

Fractures can cause complications. The most dangerous are osteomyelitis in open and gunshot fractures, contractures and false joints (pseudoarthrosis). In the latter case, there is persistent abnormal mobility in place former fracture, which can occur as a result of disruption of the callus formation process (Fig. 62).

Rice. 62. Scheme of pseudarthrosis formation:
1 - post-traumatic hemorrhage; diastasis of fragments; 2 - education connective tissue V blood clot(inflammatory osteoporosis of fragments); 3 - proliferation of bone tissue around fragments (transformation of connective tissue callus into fibrous callus); 4 - formed pseudarthrosis.

Currently, clinical-radiological, hematological, biochemical, histological, radioisotope and other research methods have established that the body’s response to injury is accompanied by significant shifts in the balance of the animal’s body, a number of local and general disorders, biochemical changes in the blood and skeletal system, metabolic disorders both in the area of ​​the injured segment and in the body as a whole.

Research of domestic and foreign authors, as well as experimental and clinical studies conducted on dogs, sheep, pigs and young cattle at the Department of General and Private Surgery of the Moscow Veterinary Academy (M.V. Plakhotin, G.A. Michalsky, R.G. Mustakimov, A. D. Belov, V.A. Lukyanovsky, L.Ya. Loktionova, Yu.I. Filippov, N.I. biological entity healing of bone fractures.

In case of fractures of tubular bones, significant changes occur in the first 10 days both in the fracture zone and in the body as a whole. This period is characterized by pronounced clinical, biochemical, and histological changes. Thus, after a fracture and osteosynthesis in animals, the appetite decreases, the body temperature rises, the pulse and breathing become more frequent, and an inflammatory process with more or less pronounced edema occurs locally in the area of ​​damage.

Against this background, significant changes are observed already on the 5th and 10th days, accompanied by a decrease in the amount of total protein, albumin, albumin-globulin ratio (A/G) and an increase in the content of inorganic phosphorus in the blood. During this period, the content of inorganic phosphorus at the ends of the fragments decreases, which is apparently associated with local acidosis, the predominance of acid phosphatase and an increase in osteoclast activity that occurs against the background inflammatory reaction. These phenomena are also noted by V. M. Vasyutochkin, E. M. Guseva (1930), N. P. Altshuller, M. N. Pogorelov (1936), M. V. Plakhotin and A. D. Belov (1967), Mohamed -El-Mustafa (1963), Z.M. Zelenskaya (1968) and others. It was established that after bone fractures there is a shift in the active reaction of the blood towards acidosis, and subsequently, as acute reactive phenomena weaken, the inflammatory swelling of the soft tissues disappears, the predominance of regenerative processes and the formation of callus, the active reaction of the blood and the tissue environment gradually disappears towards alkalosis. Most authors believe that against the background of acidosis in the bones, the processes of rarefaction and recrystallization predominate, and with moderate alkalosis, condensation and crystallization prevail.

A decrease in the level of mineral metabolism at the ends of fragments and an increase in the content minerals in the blood in the first period after a fracture are apparently associated with the resorption of minerals from bone tissue and their entry into the blood.

By the 10th day, the intensity of protein-mineral metabolism in the bone-forming elements of the damaged bone increases, hypoproteinemia increases against the background of increased biosynthesis of alpha and beta globulins with the simultaneous predominance of their breakdown and a strong decrease in albumin levels. The biosynthesis of gamma globulins exceeds the intensity of their decay, and therefore the amount of gamma globulins in the blood serum becomes higher than the original. Radiographically, by this time, light gray shadows of periosteal layers are established at a considerable distance from the fracture site.

Consequently, in the initial period, within 10 days after a fracture of long bones and intramedullary osteosynthesis, acute reactive phenomena occur, accompanied by a pronounced inflammatory reaction, increased body temperature, increased heart rate and respiration. At the same time, the amount of total protein, albumin, alpha globulins decreases and the content of minerals in the blood serum increases. At the ends of the fragments and epiphyses of the damaged bone, the level of calcium and phosphorus increases. In the symmetrical areas of the diaphysis and epiphyses of the intact tubular bone, no significant changes are observed. Radiologically, by this time, light gray shadows are established in the area of ​​the developing callus, and radioisotope studies using Ca45, P32 and methionine S35 reveal a fairly high level of protein and mineral metabolism (incl., Fig. 54).

In the period from the 10th to the 25th day, acute reactive phenomena subside and the forming bone callus is quite clearly visible on radiographs. The total protein content is normalized, but the amount of albumin and the albumin-globulin index remain at a low level. The enzymatic activity of alkaline phosphatase increases to the maximum. By the end of 25 days, radiographs show the beginning of closure of the periosteal callus of the proximal and distal fragments.

During this period, the content of mineral components in the periosteal callus adjacent to the ends of the fragments increases significantly; and in the callus at the fracture level. Moreover, there are more of them in the periosteal callus. The level of minerals in the epiphyses increases slightly, and at the ends of the fragments, on the contrary, decreases. Radioisotope studies have established that in the developing callus the maximum intensity of protein metabolism is established on the 15th day, and mineral metabolism by the 25th day. By the end of this period, consolidation of fragments occurs in full recovery supporting function of the injured limb. Consequently, in the period from 10 to 25 days after the fracture and osteosynthesis surgery, acute reactive phenomena subside and pronounced regeneration in the fracture zone predominates. This period is characterized by an increase in the content of total protein in the blood to the initial values, a slight increase in the amount of albumin, normalization of alpha and beta globulins, a high level of gamma globulins and a significant decrease in mineral elements in the blood. The content of the latter is slightly higher than the initial values; there is a slight decrease in their level at the ends of the fragments while simultaneously increasing it in the callus. This period is characterized by a maximum increase in the enzymatic activity of alkaline phosphatase, protein and mineral metabolism in the bone-forming elements of the damaged bone and the developing callus.

It should be noted that the maximum level of protein metabolism in the developing callus precedes a period of high intensity and phosphorus-calcium metabolism. This ratio in protein-mineral metabolism during the process of bone tissue regeneration corresponds to existing biological ideas that first of all a protein matrix is ​​formed, and then crystallization of mineral substances occurs.

In the period from the 25th to the 60th day after the fracture and the operation of intramedullary osteosynthesis, albumin, gamma-globulin fractions and the A/G ratio (albumin-globulin coefficient) are normalized, the content of mineral components in the blood decreases and the intensity of protein and some phosphorus decreases. calcium metabolism in bones and callus. After clinical recovery (8-12 months), the activity of bone phosphatases and phosphorus-calcium metabolism in the area of ​​the former fracture remains for a long time slightly above the initial level.

Radiographically, in the period from the 25th to the 60th day, the consolidation of fragments is established. The density of the shadows of the callus approaches the cortical layer of the ends of the tubular bone fragments. In the background. These changes normalize gamma-globulin fractions, increase the amount of albumin and the A/G ratio, the content of which reaches the initial values ​​on the 60th day. Indicators of phosphorus-calcium metabolism in the blood serum, after a slight increase on the 35th day, subsequently decrease, but continue to remain higher than the initial data. The content of mineral elements at the ends of fragments after a slight increase! by the 35th day it decreases again on the 45th day and only by the 60th day it increases and remains slightly higher than their level in the cortical layer of the intact diaphysis.

In the periosteal callus adjacent to the ends of the fragments, and in the callus at the level of the fracture, the amount of calcium and phosphorus increases and continues to remain for a long time, as noted earlier, above the initial level. The intensity of protein metabolism, according to radioisotope research with the use of radioactive methionine S35, gradually decreases after 60 days. from the moment of fracture and osteosynthesis surgery it becomes almost the same. However, the intensity of protein metabolism remains 2-3 times higher than at the ends of the fragments.

Consequently, in the period from the 25th to the 60th day of healing of fractures of tubular bones, the electrophoretic pattern of serum proteins is normalized, the A/G coefficient and the content of inorganic phosphorus in damaged and intact bones are restored almost to the level of the initial values, with the exception of the developing callus, in which still has a high level of mineral elements.

According to radioisotope studies, the level of protein and phosphorus-calcium metabolism decreases, but on the 60th day it continues to remain higher than in the ends of the fragments and symmetrical areas of the diaphysis of the intact femur. At this time, strong consolidation of the fragments occurs and the supporting function of the damaged limb is completely restored.

It should be noted that the healing process in different animals has some of its own characteristics. Thus, in sheep and cattle in comparison with dogs: in the area of ​​damage, fibrous proliferative inflammation prevails over exudative inflammation. They experience earlier fixation of fragments with paraosseous fibrous callus and consolidation of the fracture occurs much faster. Bone fractures in sheep and calves heal within 10 days. earlier than in dogs and horses.

When bones are broken in animals, there may be various complications. The most dangerous of them are osteomyelitis in open and gunshot fractures, contractures and false joints (pseudoarthrosis). Osteomyelitis is described in the corresponding section of this book.

Complications during fracture healing

Contractures are formed when fractures heal improperly and are persistent and irreversible. Inferior sick animals are discarded.

False joint- persistent abnormal mobility at the site of the former fracture, resulting from disruption of the callus formation process (incl., Fig. 25). It is necessary to distinguish between a false joint and delayed healing of fractures of injured bones. If there is mobility at the fracture site even at a relatively long time after the fracture, but the characteristic symptoms of a pseudarthrosis are absent on the radiograph, then this phenomenon is considered to be delayed healing of the fracture.

According to the pathological picture, they are distinguished: fibrous false joints (the ends of the fragments are connected by fibrous tissue with a transverse direction of the fibers to the bone axis); dangling false joints (the ends of the fragments have a fairly strong divergence and mobility within wide limits); fibrosynovial, or true false joints (modeling of the ends of the fragments according to the shape of the joint, covering them with cartilage and connecting them with a fibrous capsule containing serous-mucosal fluid is noted).

Etiology. False joints occur as a result of a disruption in the formation of connective tissue and then callus. They can occur in the presence of large bone defects at the fracture site and are formed as a result of untimely and incorrect reposition of bone fragments and immobilization. Pseudarthrosis occurs when the process of bone tissue regeneration is disrupted and under conditions that slow down the stimulation and formation of callus. Prolonged inflammatory purulent processes in open fractures are also one of the reasons for the appearance of pseudarthrosis.

Clinical signs. Characteristic symptoms- painless abnormal mobility, absence of inflammatory reaction in the fracture zone and atrophy of muscles not involved in movement. The radiograph shows no callus and no regeneration process; divergences of bone fragments, rounded ends and closure of the medullary canal with a compact layer of bone substance are observed (with false joints in the long term). The rounded ends of the fragments are covered with a thin layer of cartilage tissue, and a kind of bag (false joint capsule) is formed around them.

Diagnosis established on the basis of clinical signs and X-ray data.

Forecast in the sense of restoring the function of the limb, it is unfavorable, but for the life of the animal it is favorable.

Treatment. False joints are eliminated surgically. After appropriate surgical preparation, the pseudarthrosis area is opened, the ends of the fragments are removed and connected with pins. After the operation, the animals are given rest and agents that stimulate osteogenesis are used.

Prevention. To prevent pseudarthrosis, it is necessary to promptly and correctly reposition and immobilize bone fragments after a fracture. At significant defects in the fracture zone, the edges of the fragments should be brought together as closely as possible. If they are sharp, they are cut down. Suppurative processes are also eliminated. In case of disruption of bone regeneration processes, it is necessary to find out the etiological reasons of the underlying and predisposing nature and take appropriate measures.
CONDITIONS THAT SLOW DOWN AND STIMULATE BONE CALL FORMATION

The biological process of fracture healing and the duration of callus formation depend on timely and high-quality surgical care, the nature and location of the fracture, the general condition of the animal, feeding and housing conditions, age and other reasons.

The reasons that slow down the formation of callus and the healing of fractures can be general and local. Common ones include rickets, osteomalacia, vitamin deficiencies, pregnancy, disorders of the thyroid and parathyroid glands, as well as infectious diseases.

TO local reasons include poor immobilization of fragments, divergence of their ends, penetration of soft tissue between them, significant destruction of the blood vessels of the periosteum and bone marrow, penetration synovial fluid in the gap between fragments (with intra-articular fractures), purulent osteitis and osteomyelitis.

Treatment for delayed callus formation after eliminating the causes, it should be directed to the use of general and local agents that stimulate the development of osteoid tissue and its calcification. For these purposes, it is necessary to provide animals with complete feed, enrich their diets with vitamins C, D, mineral supplements, bone filings, and also use functional therapy (passive movements, wiring, dosed light work). Pathogenetic therapy should include novocaine blockades and tissue therapy, and also ultraviolet irradiation, diathermy, calcium electrophoresis.

To stimulate bone tissue regeneration, it is worthy of attention to introduce an alcohol-novocaine solution (2% solution of novocaine in 30% wine alcohol) into the bone marrow canal on the first day after injury and 5-6 days later. again to the fracture zone. Travertines with food at a dose of 0.2-0.5 g per 1 kg of animal weight for 30 days give good results. This helps to normalize mineral metabolism and accelerate the consolidation of the fracture by 5-10 days. The same results are obtained when using pyrogenal at a dose of 1.5 gamma (15 MTD - minimum pyrogenic doses) per 1 kg of animal weight for 20-30 days. with an injection interval of 48 hours.

A large number of experimental and clinical studies have been devoted to the issue of stimulating bone tissue regeneration during fractures. Some of the stimulation methods proposed at one time are not used in surgical clinics and are mainly of historical interest only.

Special literature provides data on the influence of various hormones on the recovery process, since it is known that as a result of injury, adaptive mechanisms in the pituitary gland-adrenal cortex system are activated with increased release of the corresponding hormones.

Of greatest interest is the recently discovered thyroid hormone thyrocalcitonin (D. H. Coppetal, 1962; F. P. Hirschetal, 1963), produced by parafollicular cells. It has been proven that during fractures this hormone inhibits the resorptive process in bone tissue, while simultaneously increasing the level of protein metabolism and the activity of osteoblasts in the bone regenerate.

Parathyroid hormones of the thyroid gland, unlike other hormones, have a targeted effect on the cellular elements of bone tissue. They influence the transformation of osteoblasts, enhance the synthesis of specific proteins, RNA and alkaline phosphatase.

It has been established that steroid hormones normalize metabolic processes in case of injury, they reduce necrobiosis, increase the synthesis of mucopolysaccharides, and increase the mineralization of callus.

Studies of other substances - acetylcholine, norepinephrine, histamine, vasopressin - have established their positive influence for the regenerative process. This was manifested in improved vascularization of the regenerate, a decrease in chondroid tissue, and increased ossification.

In experiments and clinics, a number of researchers have widely tested the stimulating effect of travertines on the healing process bone fractures in dogs, sheep and cattle. It was noted that travertine feeding at the rate of 0.5 g per 1 kg of animal weight for 30 days. from the moment of injury, it increases the enzymatic activity of alkaline phosphatase in bones and blood serum, the intensity of phosphorus-calcium metabolism in the bone-forming elements of the damaged bone and the tissues of the developing callus and accelerates it by 10-15 days. consolidation of the fracture. Travertine normalizes mineral metabolism in bones and significantly reduces the negative effect of a metal pin on damaged bone, reducing rarefaction phenomena in it.

Some scientists have tested different types animals with bone fractures, alcohol-novocaine solutions of weak concentrations (1-2% solution of novocaine in 30% wine alcohol). A double injection of this solution into the medullary canal and soft tissue surrounding the fracture site (during osteosynthesis surgery or in the first days after the fracture and on the 5-6th day after the injury) causes long-term pain relief and accelerates the healing process.

A number of researchers’ works have noted that when intramuscular injection pyrogenal to animals with bone fractures during intramedullary osteosynthesis at a dose of 1.5 gamma (15 MTD) per 1 kg of animal weight for 30 days. with injection intervals of 48 hours promotes earlier normalization of total serum protein levels, increased intensity of protein-mineral metabolism, alkaline phosphatase activity in bones and acceleration by 5-10 days. fracture healing (incl., Fig. 35).

Advances in physics associated with the discovery of isotopes have created new possibilities for using the latter with therapeutic purpose in medicine and veterinary medicine. A number of researchers come to the conclusion that if relatively large doses of radioactive substances inhibit the process of callus formation, then small doses, on the contrary, actively stimulate it.

P32 introduced into the body orally and parenterally quickly disappears from the bloodstream (after 1.5-2 hours only 2-3% of the administered amount remains). Especially large cluster P32 is observed in the skeleton and at the site of fracture, as well as in the liver, spleen, kidneys, intestines, muscles and less in the blood, skin and brain.

According to L.M. Kapitsa and A.D. Fedorova (1954), radioactive phosphorus introduced between bone fragments at a dose of 1.6 microcuries per 1 kg of animal weight accelerates fracture healing every other day, and large doses of this drug have a depressing effect on callus formation.

It has been established that a single injection of microdoses of phosphorus (32/0.01 microcuries per 1 kg of animal weight) into the bone fracture zone has a beneficial effect on the healing of fractures, accelerating the healing by 5-10 days. consolidation of fragments. It has been noted that local application of a 2% solution of lactic acid to stimulate bone formation during delayed callus maturation enhances regenerative processes mainly due to the activation of the cambial layer of the periosteum.

To stimulate the healing of fractures of long bones in rabbits, complex compounds of microelements cobalt (Co35 and Co50) and copper (Cu5) were used by electrophoresis. It consisted of the following: a gasket impregnated with a 0.3% Co35 solution was applied to the fracture site and connected to the anode of the galvanic apparatus; current strength 2.5 mA, exposure 25 minutes, daily sessions, course of treatment 25-30 procedures.

To date, a lot of data have been accumulated indicating that external electric fields affect the recovery processes in the bone after a fracture.

Low-power ultrasound (0.05-0.2 W/cm2) stimulates consolidation processes, while strong ultrasound can slow them down and even stop. Many researchers report a significant acceleration of the process of bone tissue regeneration under the influence of low doses of ultrasound (0.1-1 W/cm2), and at a dose above 4 W/cm2 they note a slowdown in the healing of bone fractures.

The stimulating effect of ultrasound on the formation of callus is explained by the fact that micromassage of cells and tissues with ultrasound leads to the displacement of molecular atoms in them, causes a kind of shaking of the constituent parts of the cytoplasm, and an unusual normal conditions contact between cell substances. This determines an increase in the intensity of enzymatic metabolic processes.

Regeneration of bone tissue after irradiation with a helium-neon laser with a wavelength of 6328° A° and various output powers of 12 mW leads to earlier formation of callus in irradiated groups of animals (N. A. Shugarov, D. V. Voronkov, 1973; V. N. Koshelev et al., 1973; D.V. Voronkov, 1976), and with increasing exposure from 1 to 10 minutes, the stimulating effect increases accordingly.

Noteworthy is the study by N.K. Ternova et al. (1977) in an experiment on the influence of the stimulating effect of interferon on reparative osteogenesis. Among the most active interferon inducers is a synthetic double-stranded polyribonucleotide of inosinic and cytidylic acids.

Interferon (I. Pofy, S. Pofy, 1963) was prepared in sterile physiological solution with pH adjusted to 7.6 at a concentration of 1 mg/ml. The drug was administered intravenously 24 hours before surgery at the rate of 0.2 mg per 1 kg of animal weight, then immediately after surgery and subsequently 5 days later during the first month.

The authors note that the stimulating effect of interferon can be observed at all stages of bone tissue regeneration. Apparently, the basis of stimulation is the acceleration of differentiation of cellular elements, and not the elementary mobilization of the proliferative properties of cellular elements. A more active course of osteogenesis is manifested by the early formation of bone beams.

The main phenomenon is a noticeable activation of the processes of restructuring of the bone tissue regenerate up to an earlier maturation of the newly formed bone tissue and its organ restructuring. The interferon inducer affects the rate of differentiation of cellular elements and activates the proliferation of fibroblasts - connective tissue cells.

Pyrimidine derivatives (methyluracil and pentoxyl) have been widely tested under experimental conditions and tested in clinical practice in various pathologies humans and animals due to their pronounced anabolic effect on the body, caused by active interference in the synthesis of nucleic acids and protein.

V. I. Rusakov and I. F. Grekh (1954, 1969, 1970, 1972) proved the anti-inflammatory effect of pyrimidines. V. G. Garibyan et al. (1959) studied the effect of metacil on the course of experimental fractures and noted that in the control group the bone defect was replaced on average in 78 days, while in animals after administration of metacil it took 61 days and cytosine - in 55 days.

M. A. Korendyasov (1961) conducted a clinical experimental study of the effect of some pyrimidines (methyluracil, panthoxyl and citrosine) on bone tissue regeneration. 256 experiments were carried out on rabbits aged from 2 months to 3 years. All animals underwent the same type of surgery: 0.6 cm of the radius bone was resected on the front paw and pyrimidines were injected into the defect area along with antibiotics.

It was found that local application of pentoxyl had no effect on bone restoration, and methyluracil and citrosine caused accelerated healing of the bone defect. Histological studies have shown that pyrimidines act in the early stages of osteogenesis. In experimental series, a pronounced periosteal reaction, massive growth of bone beams, and early appearance of osteoid tissue were observed. By the end of 3-4 weeks, bone consolidation occurred, and in the control series by 7-10 days. later.

Orotic acid, which was discovered in 1905 by Biscaro and Belloni, who isolated it from cow's milk whey, is used as a stimulator of regeneration and healing of bone fractures. Later it was discovered in biological objects of the animal and plant origin: liver, milk, yeast, mold, fungi, bacteria, blood, urine, etc.

Orotic acid is a derivative of pyrimidine bases. In the free state, it appears as white crystals with a melting point of 345-346°C (with decomposition). It is insoluble in acids, but dissolves well in alkalis and hot water (solubility in water at 18°C ​​is 0.2%) and has pronounced acidic properties, clearly forming salts with metals.

Unlike synthetic analogues uracil (methyluracil and pentoxyl) orotic acid is a normal intermediate in the biosynthesis of pyrimidine nucleotides and is actively involved in the synthesis of nucleic acids. In addition, it participates in the construction of other biopolymers: glycogen, complex lipids, mucopolysaccharides. An essential feature of orotic acid, which distinguishes it from other natural pyrimidines (thymine, uracil, cyrosine), is the ability to be included in macromolecular metabolism not in activated, but in free form due to the existence of a specific enzyme pyrophosphorylase, which converts orotic acid into orotidine-5-phosphate.

According to M. M. Pates et al. (1937), orotic acid and its derivatives stimulate erythro- and leukopoiesis. It is effective in cases of hematopoietic disorders caused by radiation exposure, and provides preventive and therapeutic effect for liver damage caused by various hypotoxemic substances.

The use of potassium orotate for the treatment of liver disorders in diabetes mellitus is fundamentally new (A. V. Lesnichy, 1970). Many scientists have established a distinct anti-inflammatory effect and an increase in the immunological activity of the body with the introduction of potassium orotate. At a dose of 100 mg/kg, the drug increases the activity of leukocytes and the formation of antibodies in rabbits with altered reactivity of the body.

Consequently, the diverse effect of pyrimidines on the regeneration of various tissues and organs is associated with their active interference in metabolic processes and, first of all, stimulation of protein synthesis. Anabolic effect pyrimidines has been confirmed by a number of researchers.

The activity of orotic acid is manifested primarily in its distinct anabolic and anti-catabolic effects. Numerous researchers have noted the pronounced ability of orotic acid to accelerate the proliferation of bacteria and stimulate tissue growth.

When studying some aspects of the mechanism of action of orotic acid, V.I. Porallo et al. (1975), G.I. Bilic et al. (1975) concluded that it increases the content of nucleic acids and active acidic nucleases in regenerating lung tissues in the early stages after surgery, while the use of potassium orotate after gastrotomy, along with an increase in the amount of nucleic acids, leads to a decrease in the activity of acidic DNA.

K. G. Berkhout (1969) successfully used potassium orotate in postoperative treatment traumatic injuries nerves. B. M. Novikov (1976) studied the effect of orotic acid on the regeneration of damage to the anterior abdominal wall and stomach. The author notes that orotic acid is an effective stimulator of reparative regeneration of soft tissues and the stomach due to direct active interference in the synthesis of nucleic acids, and consequently, in the entire protein synthesis. At the same time, as histological studies have shown, it exhibits local anti-inflammatory and anti-edema effects.

The diverse influence of pyrimidines on the body essentially boils down to one phenomenon - stimulation of protein synthesis, which causes the acceleration of the regeneration of various tissues (connective, bone, muscle tissue, epithelium, antibody production, etc.) against the background of a more or less intense course of reparative processes.

The effect of orotic acid on osteogenesis in bone trauma was studied (M. V. Plakhotin, L. Ya. Loktionova, V. A. Lukyanovsky, Yu. I. Filippov and N. I. Ochirov, 1976-1980). It was applied to the surface of the polymer pin under the polymer film in a dose of 30-50 mg. X-ray and histological studies The authors found that a polymer pin implanted into the medullary canal of the epiphyses with subsequent closure of the bone defect with an autoreplant does not cause any pathological changes in the bone tissue. Orotic acid applied to the pin at a dose of 35-50 mg stimulates osteogenesis and accelerates the engraftment of the autoreplant 2 times faster compared to control animals (incl., Fig. 32, 33).

It has also been established that orotic acid during intramedullary metal osteosynthesis has a positive effect on regenerative processes and the development of callus (incl., Fig. 31). The metal pin used for osteosynthesis in combination with orotic acid is removed from the bone marrow canal on the 5-7th day earlier than usual. In addition to its positive properties, the acid prevents the early development of aseptic osteomyelitis.

Thus, to stimulate the healing of bone fractures, there are a large number of means, the timely use of which gives positive results when treating animals.

Prevention of bone fractures. The prevention of most bone fractures is based on measures aimed at excluding closed and open mechanical damage, acute purulent inflammatory processes localized near the bones. Creating appropriate living conditions, sufficient intake of vitamin and mineral components into the animal’s body, and physiologically normal metabolism also make it possible to prevent bone fractures. It should be borne in mind that even minor injuries, bruises, mechanical violence in some cases with weak body resistance and delayed surgical care can lead to severe complications. Therefore, first aid to a sick animal must be provided as early and professionally as possible.

Fracture is a violation of the integrity of bone and/or cartilage tissue, which usually occurs as a result of injury. Bone fractures in dogs can be either open, when bone or its fragments protrude from the wound, or closed.

How to diagnose a fracture

Very often, lameness indicates damage to a bone or joint - it is painful for the dog to step on its paw and it tries to keep it suspended all the time. Touching the damaged area can cause severe and acute pain due to injury to the tissues surrounding the fracture. In some cases, a broken paw in a dog is accompanied by general weakness, increased body temperature, and a state of shock (if the injury is multiple).

Types of fractures

Bone fractures can be divided into two large groups: pathological and traumatic. The former are caused by changes in the physiological structure of bone tissue caused by inflammatory tumor or degenerative diseases. Traumatic fractures include fractures that occur under the influence of certain traumatic forces that exceed the physiological elasticity of bone tissue (falls from a height, auto injuries, bruises and impacts).

Based on the type of injury, fractures in dogs are divided into closed and open. Closed injuries are considered to be those injuries to bones or cartilage tissue in which the structure of the skin is not disturbed. If the integrity of the skin is broken and the bone or its fragments come into contact with the external environment, then we are dealing with an open fracture.

There is also a division according to localization into fractures of flat, tubular and other bones, and according to the anatomy of tubular bones - into epiphyseal, diaphyseal and metaphyseal

First aid and treatment

Treatment of fractures in dogs involves securing the site of bone loss and creating as much favorable conditions, promoting normal bone fusion.

Depending on the complexity of the fracture, it may be prescribed surgical or conservative treatment. Surgical intervention accompanied by osteosynthesis - joining bone fragments and parts using special structures. Conservative treatment involves ensuring complete rest, applying supportive bandages, as well as special fixing plaster casts or splints. The second method is effective for ordinary fractures without complications such as cracks or displacements.

Osteosynthesis allows for proper fixation of bones and their immobility, and this, in turn, allows bone tissue to grow together faster. Fixation can be either focal (internal fixation) or extrafocal.

The most important thing in the treatment of any fractures is to accurately align the fragments and parts of the bones and securely hold them in the desired position until the bones completely heal and recover.

Article prepared by doctors surgical department"MEDVET"
© 2014 SEC "MEDVET"

For the treatment of fractures, the use of an immobilizing bandage (plaster) has traditionally been used; this method of treatment has a number of disadvantages - the development of atrophy of the muscles of the limb, frequent improper fusion of bones, the formation of bedsores under the bandage, and impaired blood supply to bones and soft tissues. All these complications forced us to abandon the widespread use of plaster for the treatment of fractures, so now this method of treatment is used only for the treatment of cracks. A more modern method of treating fractures is osteosynthesis- an operation for surgical comparison of bone fragments using fixing metal structures.

Types of osteosynthesis:

1. Intramedullary osteosynthesis - used to treat fractures of long tubular bones. With this method, a special pin or wire is installed inside the bone. But there are also limitations to this method - for example, it is not suitable for the treatment of fractures of the pelvis, skull, spine, jaw, or for the treatment of comminuted fractures.

Ferret hip fracture

Application of intramedullary osteosynthesis for hip fracture

2. Bone osteosynthesis - with this method, a metal plate is attached to the bones using special bolts. As a result, good stabilization of bone fragments is achieved. This method can treat not only fractures of tubular bones, but also injuries to the pelvis, skull, spine, scapula, etc. The negative side of this method is the fairly high cost of the operation associated with the use of expensive materials (plates, bolts and special tools).

Forearm fracture in a dog

Bony osteosynthesis

Gunshot wound in the lower jaw with a fracture of both branches of the lower jaw

View after osteosynthesis

3. Extrafocal osteosynthesis - used to treat not only fractures, but also dislocations, and consists of passing wires through the bone above and below the fracture site with their subsequent fixation from the outside with a special polymer. The advantages of this method are its relative cheapness consumables, speed of operation, reliability of fixation of debris. The disadvantage of this method is the impossibility of applying an external fixation device in large and giant breeds of dogs.

X-ray after extrafocal osteosynthesis

4. Combined osteosynthesis - consists of using several of the above methods and is used mainly for complex comminuted fractures.

Cat with a complex comminuted hip fracture

Cat after combined osteosynthesis

Intercondylar fracture of the humerus in a dog

After osteosynthesis

Separately, it is worth considering pelvic fractures. As a rule, dogs receive such injuries as a result of car injuries, and cats receive such injuries as a result of falling from a great height. When the pelvic bones are damaged, there are usually multiple fractures, which makes them the most difficult in the practice of a traumatologist.

Multiple pelvic fractures in a dog. On the right - a fracture of the pubic and ischial bones, on the left - a fracture of the acetabulum.

The same dog after osteosynthesis

The use of a compression plate for a complex fracture of the acetabulum

In our veterinary clinic We have accumulated extensive experience in the use of all types of osteosynthesis in animals of all sizes, which allows us to approach the treatment of each case individually and recommend the most optimal method of reconstructive surgery.

Prices, rub.

The price does not include consumables and additional work

Good day. In your clinic, a dog (Labrador) underwent ACL surgery using the TPLO method. 04/16/2019 will be a month. There will be a similar one on the second paw. But there is a desire to sterilize the dog endoscopic method ASAP. We need to come to you on May 16, 2019 for a follow-up appointment and x-ray. Is it possible to perform an operation to sterilize a dog on the same day? Or is it early? And all these manipulations can harm speedy recovery dogs (taking into account the fact of the frequency of use of anesthesia and other medications), as well as the recovery course for the development of the operated paw. Thank you! Irina

Question: Is it possible to do TPLO surgery and sterilization at the same time?

Hello! Yes, everything can be done at the same time. This does not affect the recovery process in any way.

Hello! The dog had acute renal failure after anesthesia 2 years ago. For two years now, the tests have been normal. The dog is now 8 years old. After each heat, she has severe cramps. The dog has not given birth. Can she be sterilized? What anesthesia is best to use? Now I'm very afraid of anesthesia. Tatiana

Question: is it possible to sterilize a dog if there was acute renal failure after anesthesia?

Hello! Sterilization is indicated. The risks, taking into account normal tests, are no greater than for other planned patients. Propofol anesthesia is used.