Fractures in dogs. Transosseous osteosynthesis for forearm bone fractures in dogs

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 for the treatment of long fractures 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. Negative side this method is sufficient high price operations involving the use of expensive materials (plates, bolts and special tools).

Forearm fracture in a dog

Bony osteosynthesis

Gunshot wound to the lower jaw with fracture of both branches 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 Supplies, 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 image 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 high altitude. 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 is a fracture of the pubic and ischial bones, on the left is a fracture of the acetabulum.

The same dog after osteosynthesis

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

Our veterinary clinic has accumulated extensive experience in using 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

Question answer

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 using the endoscopic method as soon as possible. We need to come to you on May 16, 2019 for a follow-up appointment and x-ray. Is it possible to have a dog sterilized 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. Risks taking into account normal tests no more than in other planned patients. Propofol anesthesia is used.

Currently, dwarf and dwarf dogs have become extremely popular. ornamental breeds: Yorkshire terriers, Biewer Yorkies, Chihuahuas, Spitz dogs, Griffons, Papillons, etc.

But small size dogs, sometimes involves quite a lot of problems.

Today I would like to focus on a fairly common problem in these dog breeds – a fracture of the forearm. As a rule, this fracture is traumatic in nature: a jump from a height of 0.5 to 1.0 m (sometimes a lower jump height is sufficient).

And then the dog jumped off the sofa, squealed and began to tuck its front (chest) limb. (photo 1) When walking and running, the animal does not step on the sore paw; when the owner tries to touch the paw, sharp pain occurs.

What the owner needs to remember: do not forcibly touch or try to feel the place, painful, but you shouldn’t turn a blind eye to the problem, hoping that everything will go away on its own. I also do not advise you to rush headlong, whether day or night, calling a doctor at home or going to any veterinary clinic to get an answer to the question: is there a fracture or not. Even if your dog fracture is a problem this is not fatal and does not threaten the life of the animal; you have exactly 1-3 days to find a clinic with X-ray equipment and a specialist in traumatology and orthopedics.

So, you arrived at the clinic, the dog was x-rayed (usually in 2 projections), a traumatologist looked at the pictures and rendered a verdict: a fracture of the forearm, namely the radius and ulna.

Why does such an injury occur, despite the seemingly low load on the paw? For a long time it was believed that a fracture of the radius (namely, it takes on all the load at the moment of a jump) occurs due to a narrowing of the width of the radius in the distal third according to the hourglass principle. But recent studies have shown that a decrease in bone diameter in a certain place is also characteristic of many large breeds dogs and, accordingly, this is not the root cause of this pathology. Density studies bone tissue at the site of narrowing, they also did not give clear answers. And the problem lies in the structure of the intramedullary canal of the radius. U dwarf breeds dogs, the intramedullary canal in a certain segment of the radius can either narrow to minimum sizes, or absent altogether. (photo 2)

In simple terms, the radius, at the site of the narrowing of the intramedullary canal, looks not like a “tube”, but like a “rod”. (photo 3) At the moment of landing after a jump, physics comes into play: the transfer of high specific stress to the site of narrowing of the intramedullary canal is approximately 5 times higher than to the rest of the surface of the radius, as a result of which it fractures.

In most cases, a fracture of the forearm in dogs occurs with displacement of fragments of the radial and ulna relative to each other (photo 4).

For functional stabilization of the fracture and its further consolidation (fusion), it is necessary to take into account 3 forces acting on bone fragments: torsion, flexion, displacement. (photo 5). Neither splints nor plaster can completely eliminate all three loads on radius, and can even aggravate the situation with the formation of pseudarthrosis, atrophy and bone lysis.

The main method of treating these fractures is stable functional osteosynthesis, i.e. surgery to stabilize the fracture. At the moment, there are two most effective methods for surgical stabilization of a forearm fracture in toy dog breeds:

Bilateral single-plane external fixator.

The method originates from human medicine, namely the installation of the Illizarova apparatus. The principle is practically the same - to provide external fixation of the fracture. But because The Illizar apparatus design is quite massive, and we are talking about patients weighing up to 10 kg, then the way to achieve this fixation is slightly different: Kirchner wires are passed through the soft tissue and bone at an angle to each other (at least 2 in each fragment), the fracture is repositioned, the pins are bent from the outside and fixed with bone cement or cold welding. The result is approximately the following design (photo 6) The photo shows the external fixator 30 days after its installation.

This method is very good for stabilizing complex, comminuted fractures.

I give an example of a series of x-ray images of the staged healing of a complex fracture of the forearm: Yorkshire terrier, 6.5 months, complex comminuted fracture of the radius and ulna of the right thoracic limb (RPL).

Bony fixation with mini-plate DCP.

The main difference from the first method is the absence of any external fixators. The fracture is stabilized by placing a compression plate directly on the bone and fixing it with 2 mm cortical screws. The plate itself is made of titanium alloy and despite its tiny dimensions (thickness 1 mm, width 4 mm), it is able to withstand the load of the entire weight of the animal, even at the moment of loading (jumping or running). (photo 7).

Both methods equally well eliminate the 3 forces acting on the fracture, which I wrote about earlier. The main difference is the aesthetic aspect, because... the plate is attached to the bone and hidden under soft tissues animal (skin, muscles, tendons) But this method is not suitable for complex (comminuted) fractures of the forearm bones!

Immediately after installing the plate, the paw looks something like this (photo 8):

And examples of x-rays:

Example 1: Yorkshire Terrier, 3 months

Example 2: Brussels Griffon, 4.5 months

Example 3: Yorkshire Terrier, 4.5 months

Example 4: Papillon, 11 months

I want to emphasize Special attention owners about the need to carry out repeated x-rays after a certain time interval (usually 4-5 weeks after surgery)! Even despite your pet’s good health and full weight-bearing ability, in some rare cases and if there are indications (age of the animal / proximity of the plate installation to the bone growth zone in puppies), the DCP plates must be removed.

In conclusion, I would like to say that osteosynthesis with a plate or a bilateral single-plane external fixator is a comfortable method of treating a forearm fracture for the animal and its owner, and provides maximum clinical effect if adhered to basic principles osteosynthesis.

Bibliography:

1. Yagnikov S.A., Kozhushko P.S., Anatomical and biomechanical prerequisites for the occurrence of forearm bone fractures in dogs of dwarf breeds. Russian veterinary journal. Small pets. No. 3. 2014 p. 23-28.

Surgeon-traumatologist at the Argos Veterinary Center

Anatomical and topographical data of the dog. Prevention of surgical infection, sterilization of instruments and materials. Preparing the animal for surgery and performing it by connecting bone fragments with plates. Possible complications and their elimination.

FSBEI HPE “St. Petersburg State Academy Veterinary Medicine"

Department of Operative Surgery with the basics of topographic anatomy of animals

Course work

Operations on limbs

(osteosynthesis on the pelvic limb during a fracture femur in a dog)

Completed by: 3rd year student, 22 groups

Kantserova Anastasia Pavlovna

St. Petersburg 2012

1. Operation name

2. Objectives of the operation

3. General information about the animal

8. Pain relief

9. Technique of the operation

11. Postoperative care of the animal

Conclusion

Bibliography

1. Operation name

Osteosynthesis (osteosynthesis; Greek osteon bone + synthesis compound) - connection of bone fragments. There are two types of osteosynthesis - submersible osteosynthesis and external transosseous osteosynthesis. With immersion osteosynthesis, clamps connecting bone fragments are installed directly in the area of the fracture. External osteosynthesis is performed using various devices located above the skin and fixing bone fragments using knitting needles and rods. The goal of osteosynthesis is stable fixation of bone fragments in the correct position until they consolidate.

2. Objectives of the operation

The purpose of osteosynthesis is to ensure stable fixation of fragments in the correct position while maintaining the functional axis of the segment, stabilizing the fracture zone until complete healing. Fundamentally, there are two types of treatment - surgical and conservative. The goal of these types of treatment is to create conditions for restoring the integrity of damaged bone structures and surrounding tissues, as well as restoring the function of the damaged limb segment. During operational treatment methods fractures, traumatologists, as a rule, act directly on bone fragments. Conservative treatment is treatment without surgery; the doctor does not act on bone fragments, this effect occurs indirectly.

3. General information about the animal

Species, gender: dog, male.

Nickname: Bob

Color, markings: black

Breed: mongrel

Age: about 4 years old

Height, weight: at withers 65 cm, 30 kg

Preliminary diagnosis: fracture of the tibia of the right hind limb

Diagnosis at follow-up: fracture of 1/3 of the distal tibia of the right pelvic limb

Owner: homeless animal

There is no information about living conditions and feeding, as the animal was found on the street. Data on previous diseases and vaccinations are also unknown.

General examination of the animal.

Determination of animal habit:

Body position in space: forced, supine

Body type: average

Fatness: unsatisfactory

Temperament: phlegmatic

Constitution: rough

The pathological focus is located in the area of the right pelvic limb. There you can see well-defined hyperemia, swelling, upon palpation an increase in local temperature, numbness of the area, and slight crepitus.

4. Fixation and location of the operation

Fixation is the strengthening of animals in a certain position in order to protect people conducting therapeutic work from injuries on the part of the patient, preserving the life and health of the patient himself and preventing the destruction of surrounding structures by large and strong animals.

To prevent dogs from biting, their mouths are tied with a strip of gauze, gauze bandage or braid. Covering the mouth with a screw, its ends are first tied in the submandibular space with one simple knot, then the bandage is finally secured on the back of the head with a nautical knot.

Dogs are usually fixed on the table, giving them the required position. A simple operating table for small animals is made of wood: painted with white oil or enamel paint. The table cover should be concave inward or have a small depression in the middle with drains for liquid. Several holes are drilled in it for tying the mouth with straps (braid) used to secure dogs. Under the table, on its crossbars, a shelf is arranged in the middle, on which a basin is placed to drain liquids from the table top into it and collect used dressing material.

Rice. 9. Strengthening the dog on the table: 1 - dorsal position; 2-lateral; 3-abdominal.

To strengthen the dog on the table in a dorsal position, a rope loop (braid) is tied or secured to its thoracic limbs in the forearm area. A rope from each limb is passed between the limbs and chest and then under the animal’s back to the opposite side of the table to the corresponding hole; by pulling the rope the dog's limb is brought closer to chest, after which the rope is tied. The pelvic limbs are extended and both are tied to the back part of the table frame.

During the operation, cats are placed in special leather or thick cloth bags or wrapped in a piece of thick cloth, leaving the area required for the operation open. It is even better for any method of fixation to put special bags (stockings) made of durable fabric on all the cat’s limbs and then fix them accordingly.

During this operation the animal was fixed in a lateral position.

5. Anatomical and topographical data

Musculature of the dog's pelvic limb. A - from the lateral side B - from the medial side 1. sartorius muscle 2. semitendinosus muscle 3. biceps femoris muscle 4. cranial tibialis muscle 5. extensor digitorum longus 6. peroneus longus muscle 7. flexor longus muscle thumb 8. flexor digitorum brevis 9. gastrocnemius 10. Achilles tendon 11. interosseous muscles 12. extensor digitorum brevis 13. peroneus brevis 14. flexor digitorum longus 15. gracilis muscle

The affected area is localized on the right pelvic limb. The fracture is on the tibia. It is surrounded by muscles:

Sartorius

Tibialis cranialis muscle

Extensor digitorum longus

Peroneus longus muscle

Flexor pollicis longus

Flexor digitorum brevis

The muscles are innervated by the tibial and peroneal nerves.

Vessels supplying muscles:

Posterior tibial artery

Anterior tibial artery

External iliac vein

Medial vein of saphen

Caudal femoral vein

6. Instruments, dressings, medicines

Pointed scalpel, straight blunt and pointed scissors, wound hooks, anatomical and surgical tweezers, hemostatic clamps, needle holder, surgical needles - curved, semicircular, 5- and 10-gram syringes, injection needles, sterilizers for instruments and syringes, 0.5% novocaine solution, 5% alcohol solution of iodine, 0.5% solution ammonia, dressings (sterile bandages, tampons, cotton wool), sterile PGA threads, Polysorb, means for fixing animals, small surgical operating tables of the Vinogradov type, fixing elements: plates, screws, a wrench for bending plates, a screwdriver for tightening screws.

7. Prevention of surgical infection

STERILIZATION OF INSTRUMENTS

There are basically two ways to sterilize instruments: by high temperatures (boiling, filling, etc.) and “cold” - in disinfectant solutions.

To sterilize instruments by boiling, simple or electric sterilizers are used (Fig. 22), which have a removable grid with handles. Sterilization is carried out in ordinary water with added alkalis: 1% sodium carbonate; 3% sodium tetraborate (borax), 0.1% sodium hydroxide. The duration of boiling depends on the alkali dissolved in the water: with sodium carbonate - 15 minutes, with borax - 20, with caustic soda - 10 minutes. Alkalis prevent metal corrosion, increase the effectiveness of sterilization and reduce boiling time.

Sterilization procedure: the solution is brought to a boil, during this period the water is freed from oxygen dissolved in it and neutralized with alkali. Before sterilization, instruments are checked for suitability. If they were covered with Vaseline, then wipe it off with alcohol or ether. The cutting part of the scalpel is pre-wrapped in gauze. Surgical needles are strung on a piece of gauze so that they do not get “lost” in the sterilizer if there are many instruments.

At the end of sterilization, the instruments are removed from the sterilizer grid and laid out on an instrument table covered in three rows with a sterile sheet or towel. At the same time, a certain order is observed - tools of the same type are placed in one place and in a certain sequence characteristic of each operation. The gauze in which the scalpels were wrapped should be unrolled. The laid out instruments are covered with a sterile sheet or towel.

Used instruments (after opening ulcers, working with cadaveric material) are boiled (at least 30 minutes) in an alkaline liquid with the addition of 2% Lysol or carbolic acid.

Glass objects (syringes, etc.) are placed in the sterilizer in disassembled form before it is heated. Syringes and glassware for anesthetic solutions are boiled in distilled water, since alkaline solutions promote the decomposition of some local anesthetics.

Sterilization of instruments by filling (burning)

The disassembled instrument is laid out in a clean enamel basin or bath, the required amount of alcohol is poured and it is lit. It is advisable to turn the instrument over while the alcohol is burning, since in places where it touches the bottom it cannot be well sterilized. This method is used when providing emergency surgical care, as well as for sterilizing enamel utensils and instruments that, due to their dimensions, do not fit into the sterilizer. Instruments are also sterilized in special cabinets at a temperature of 150-- 160 C for 20--30 minutes.

Sometimes in production conditions instruments are sterilized antiseptic solutions. To do this, the instruments are immersed for 30-40 minutes in one of the following solutions: 1% alcohol solution of brilliant green; ethacridine solution 1:500; 3--5% solution of carbolic acid; 1--2% solution of Lysol or Karetnikov's liquid (formalin 20.0, carbolic acid 3.0, carbonic soda 14.0, distilled water 1 l).

Rubber objects are sterilized by boiling in distilled water. To do this, they are wrapped in gauze (so as not to burn) and boiled for 30 minutes or cold in formaldehyde vapor.

Storage of tools.

After surgery, all instruments are thoroughly washed, sterilized and dried. Then they are laid out in a dry cabinet. To prevent rust from appearing on the instruments, place a vessel half-filled in the cabinet. calcium chloride. Injection needles can be stored in Nikiforov's liquid (equal parts alcohol and ether), and a mandrin should be inserted into each needle. Dark spots or rust formed on tools can be removed using chalk with ammonia in a ratio of 2:1. Rubber objects are placed separately from metal instruments. Do not store instruments together with iodine preparations, acids, etc.

Suture material and methods for its sterilization

Currently, the classification of suture material mainly takes into account two characteristics: the ability to biodegrade and the structure of the thread.

Based on their ability to biodegrade, they are divided into:

absorbable materials (catgut, collagen, occelon, cacelon, vicryl, dexon, etc.);

non-absorbable materials (silk, nylon, lavsan, nylon, prolene, polyprolene, etc.).

According to the structure of the threads, they are distinguished:

monofilament -- is a homogeneous structure with a smooth surface;

shed -- in cross-section consists of many threads (twisted, braided, complex threads).

The following requirements apply to modern suture material:

Biocompatibility - absence of toxic, allergenic, teratogenic effects of suture thread on body tissue. Ideally, there should be no reaction to the suture material.

Biodegradation is the ability of suture material to disintegrate and be excreted from the body. The suture material must hold the tissue until a scar forms and then becomes unnecessary. In this case, the rate of biodegradation should not exceed the rate of scar formation, in addition, the suture material should be atraumatic.

Linen and cotton threads are also used to apply surgical sutures.

Silk sterilization

Silk threads are produced in spools (non-sterile) or in ampoules (sterile). Silk wound on glass spools or on glasses with polished edges is boiled in distilled water for 30-40 minutes. Store in 96° alcohol or Nikiforov liquid.

Silk can also be sterilized in solutions.

Sadovsky's method. Skeins of silk are placed for 15 minutes in a 0.5% solution of ammonia, and then for 15 minutes in a 2% solution of formaldehyde in 70% alcohol.

Tour method. Silk is placed for 24-48 hours in a 1% alcohol solution of iodine. Store in the same solution.

Sterilization of cotton and linen threads.

These threads are less durable than silk. They are usually used to close skin defects in small animals, on the intestinal wall (ground floor), and peritoneum. Use threads No. 10-20. They are sterilized using the Sadovsky method or immersed for 24 hours in a 4% formaldehyde solution.

Sterilization of catgut.

Catgut is made from the submucosal and partially muscular layers of the small intestine cattle, therefore requiring special careful processing. Depending on the caliber, it is absorbed in the tissues of the animal body in 7 to 30 days.

Sterilization using high temperature is excluded. It is mainly used for embedded seams. It is produced in skeins that require sterilization, or sterile - in sealed ampoules.

Gubarev's method. Loosely wound catgut on spools is degreased for 12-24 hours in ether or gasoline and sterilized in an alcohol solution of iodine (1 g iodine, 2 g potassium iodide, 100 g 95° ethyl alcohol) for 14 days, which is replaced with fresh in 7 days.

Method Rolled. Without preliminary degreasing, catgut is immersed in a 4% aqueous solution of formaldehyde for 3 days.

Sadovsky-Kotylev method. Catgut is placed for 30 minutes in a 0.5% solution of ammonia, then transferred for 30 minutes to a 2% solution of formaldehyde in 65° alcohol, in which it is stored until use.

Chubar's method. Catgut is immersed for 3 days in a liquid consisting of rectified alcohol 70°, 200.0; glycerol - 5.0; tinctures of iodine - 8.0 and potassium iodide - 6.0. Catgut is stored in this liquid for a long time.

Sterilization of synthetic threads.

This material is sterilized by boiling in distilled water for 20 minutes. Metal wires and staples, as well as pins used to connect bones, are sterilized by boiling, usually along with the instruments.

Sterilization of dressings, linen and surgical items

Sterilization by autoclaving. Dressings (bandages, napkins, splints, compresses, tampons, etc.) and surgical linen (gowns, sheets, towels, caps) are sterilized in autoclaves under pressure. Sometimes porcelain and glassware, enamel basins, solutions, etc. are placed there. Before autoclaving, the material and linen are loosely placed in containers (Fig. 23). Before placing the bixes in the autoclave, open the side holes and close the lid tightly. If there are no bixes, then surgical items are placed in canvas bags or bags. A pressure of 0.5 atm corresponds to a temperature of 115° C; 1 atm -- 120; 2 atm -- 134° C.

Before using the autoclave, close the release valve of the water-steam chamber, open the lid of the autoclave, pour water through the funnel to 2/3 of the level of the water-meter glass, close the lid tightly and carefully screw in the bolts, after checking the tightness, turn on the heating source and release steam for 15-20 minutes; close the tap and raise the pressure to the level required for sterilization. Sterilization control is carried out by placing substances whose melting point is above 100° C into the tank.

After sterilization is completed, the autoclave is turned off, the release valve is slowly opened, steam is gradually released, reducing the pressure, the autoclave lid is opened, the beakers are removed and the holes in them are immediately closed, and the autoclave lid is closed.

Sterilization with current steam is carried out in a special Koch sterilizer, and if it is not available, in a bucket or pan with a lid. Water is poured into them to 1/3 of the height. The beginning of sterilization is considered from the moment the steam is released, the temperature rises to 100 ° C, the duration is at least 30 minutes.

When sterilizing by ironing, the temperature is brought to 100° C, the duration is at least 30 minutes.

When sterilizing by ironing, the temperature is brought to 150° C. Before sterilization, sheets, gauze, napkins are moistened with water and ironed at a speed of no more than 50 cm per minute, passing over the same place 2-3 times on both sides. The ironed material is rolled up using sterile tweezers and placed in a sterile bag or left wrapped in a sheet.

Preparing the animal and surgeon for surgery

Preparing the animal for surgery.

For a favorable outcome of the operation important has the animal's preparation for it. Before surgery, clinical examinations are carried out on the animal, in particular, body temperature, respiration, and pulse rate are measured. Surgery should not be performed on animals with elevated temperature, it is also not recommended to carry it out in the presence of infectious diseases or in malnourished animals. If the operation is not performed urgently, then before the operation the animal’s food supply is reduced and, if possible, a starvation diet is prescribed for no more than 12 hours.

When performing an operation using anesthesia, it should be borne in mind that some drugs, for example Rometar, can cause fetal death in the second half of pregnancy. With a favorable outcome in these cases, surgery can be performed under local anesthesia, since it has been established that it does not affect the development of the fetus.

Before the operation, animals are walked to free the large intestine, cleansing or partial anesthesia is performed.

Preparation of the surgical field

The preparation of the surgical field is carried out in four stages: mechanical cleaning, degreasing, treatment with an antiseptic (aseptization), isolation of the surgical field.

Mechanical cleaning includes washing with soap (preferably household soap), removing hair by shaving or cutting. In this case, the size of the prepared field must be sufficient to ensure sterile operating conditions. Mechanical cleaning is a particularly important step in preparing the surgical field and must be carried out especially carefully, since it is thanks to it that the bulk of dirt and microorganisms are removed.

Preference is given to shaving, since asepsis with this method is more thorough. In practice, a safety razor is most often used. It has been established that shaving hair is best done on the eve of surgery, which allows not only to thoroughly remove hair, but also to thoroughly wash the surgical field, which, as a rule, is heavily contaminated. In addition, the skin irritation observed after shaving disappears by the time of surgery, as a result of which the skin becomes less sensitive to the iodine solution and dermatitis develops less frequently. Accidental wounds to the skin during shaving by the time of surgery have time to become covered with a dense scab due to coagulated blood.

Degreasing of the surgical field is carried out with a sterile gauze swab soaked in a 0.5% solution of ammonia or gasoline for 1-2 minutes. The degreased surgical field is treated with an antiseptic using one of the methods listed below.

The Filonchikov-Grossikh method. Its essence lies in the fact that the fat-free field is “tanned” and asepticized with a 5% iodine solution, first after mechanical cleaning, and then immediately before the cut or after infiltration anesthesia. In this case, the interval between treatments should be at least 5 minutes.

The Mouse method is that after shaving, mechanical cleaning and degreasing, the surgical field is treated with a 10% aqueous solution of potassium permanganate.

Borchers' method is based on the use of a 5% solution of formaldehyde in 9% alcohol after mechanical cleaning, shaving and degreasing of the skin. The method makes it possible to achieve (unlike most other methods) sterility in a protein environment (when contaminated with pus), since formalin retains its antiseptic properties.

Treatment of the surgical field with an antiseptic begins from the center (incision or puncture site) to the periphery. The exception is the presence of an opened purulent focus, in which treatment begins from the periphery and ends in the center.

Field isolation operations are carried out using sterile sheets or oilcloths, which are attached to one another with special clamps (Backhouse) or pins.

Preparing hands before surgery.

During the operation, the surgeon's hands are in direct contact with the wound. It is known that the skin of the hands, like any other surface of the body, contains many microbes, a significant part of which are pathogenic. Microbes find refuge in the excretory ducts of the sebaceous and sweat glands, in the subungual spaces, numerous furrows and folds of the skin. The skin of any part of the animal’s body also contains a huge amount of them, so preparing the hands before surgery is especially important.

Hand treatment consists of three stages: a) mechanical cleaning; b) chemical disinfection; c) leather tanning. Some antiseptic substances often combine bactericidal and tanning properties (alcohol solution of iodine, solution of brilliant green, etc.), thus representing a bactericidal tanning agent or tanning antiseptic. Hand treatment is carried out from the fingertips and further to the elbows. For mechanical treatment of hands, it is necessary to have brushes made of plant material (agave, palm, sabur leaves), horsehair, synthetic, as well as soap, warm water, and basins.

Horsehair brushes do not tolerate boiling; they are treated with antiseptic substances. Brushes that have not been used are first thoroughly washed in warm water with soap, rinse, and then immerse in a 3% solution of carbolic acid, a bactericide solution of 1:3000 for 1 hour. They are also stored in these solutions.

When choosing one or another method of hand treatment, you should always keep in mind that hands cannot be absolutely sterile; they only acquire relative sterility over a certain period of time.

All hand treatment methods are based on two principles: dehydration and tanning of the skin.

The chemicals used have bactericidal properties, affect microbes located on the surface of the skin, and tanning ones lead to the closure of the excretory ducts of sweat and sebaceous glands and fix microorganisms in them.

The most accessible and easiest to use are the following methods.

Alfeld's method. After thorough mechanical cleaning in warm water with soap and a brush, wash your hands for 3 minutes. If hands are not wiped with a towel, then they are treated with 90° alcohol, if they are wiped - with 70° alcohol. When the skin is dry, the subungual spaces are lubricated with 5% alcohol solution Yoda.

Olivekov’s method consists of first washing hands for 5 minutes with hot water with soap and a brush, then drying them with a towel and treating them for 3 minutes with cotton wool soaked in a 1:3000 solution of iodine in alcohol.

For purulent operations, it is recommended to re-treat with iodized alcohol at a dilution of 1:1000.

Spasokukotsky-Kochergin method. By this method wash hands with a 0.5% ammonia solution in two basins for 2.5 minutes or under a flowing stream of this solution. After the second wash, the liquid in the basin should remain clear. Otherwise, repeat the washing and dry your hands with a towel. During surgery or if hands become dirty, the treatment is repeated.

Napalkov's method involves mechanical cleaning of hands with an aqueous solution of caustic potassium 1:2000 with brushes for 5 minutes or in basins with napkins. Then the hands are dried with a towel and treated with denatured alcohol for 3-5 minutes. Subungual spaces and skin folds are treated with 5% iodine tincture.

Kiyashev's method is based on the use of the cleaning properties of a 0.5% ammonia solution, in which hands are washed with brushes for 5 minutes and dried with a towel. Finish with treatment with a 3% solution of zinc sulfate (3 min). Subungual spaces and nail beds are treated with a 5% iodine solution.

All of the above methods ensure sterility of the skin of the hands for 20-30 minutes.

Currently, new bacteriostatic drugs are used that do not cause irritation and inflammation of the skin.

Zerigel. Apply 3-4 g of the drug to clean, dry hands and rub thoroughly for 8-10 seconds. Then dry your hands for 2-3 minutes. If the film slips, re-processing is not required. Sterility is ensured for 2 hours.

Hand treatment with a 0.5% solution of catapol (sterility of the skin of the hands for up to 3 hours) and a solution of chlorhexidine bigluconate in 70% alcohol at a dilution of 1:40 with a concentration of the active substance of 0.5% is also proposed. The skin of the hands remains sterile for 4 hours.

Aerosols are also used to treat the skin of the hands: Septonex, etc.

Surgical gloves

None of the methods for treating hands brings them to a state of absolute sterility, therefore gloves are the only means by which sterility is ensured in the bacteriological sense of the word; This is especially necessary when performing operations regarding purulent-putrefactive processes, as well as when performing abdominal operations in small animals.

Since the integrity of the gloves cannot be guaranteed, it is necessary to pre-treat the hands using one of the above methods in order to prevent the transfer of “glove juice”, consisting of sweat, exfoliating epithelium and bacteria, to the wound. Sterilize gloves by boiling in distilled water for 30 minutes, as well as by autoclaving and in solutions: 0.1% bactericide - 15 minutes, 2% chlorocide - 30 minutes or in formaldehyde vapor - 24 hours. After purulent operations gloves are washed without removing them from the hands in a 2% solution of Lysol.

8. Pain relief

During this operation the following drugs were used for anesthesia:

Zoletil 50, 25% - 4 ml, administered intramuscularly throughout the operation;

Propofol 1% - 56 ml was administered intravenously throughout the operation

Anesthesia

In this operation you can use both conduction anesthesia, and infiltration.

For infiltration anesthesia, a 0.25-0.5% solution of novocaine is usually used, and much less often other drugs of this group are used in an amount of 10-15 ml at a time. With conduction, the same anesthetics are used, but more high concentration- 3.4 or 5%, and the amount of anesthetic depends on the thickness of the nerve, its depth, and the accuracy of the doctor’s topographical orientation.

9. Technique of the operation.

Rice. 1. Oblique fracture; osteosynthesis by interfragmentary compression using screws and a neutralizing plate; scheme.

Preparation. The patient is tied in a lateral position and additionally secured with a rope loop passed over the back and through the groin. The operated limb is placed on top and placed on a pillow. Shave the incision site, treat the surgical field with a 5% iodine solution, and cover the field with sterile napkins.

Course of action. The skin incision begins at the greater trochanter and extends along the anterior edge of the femur to the knee joint. Superficial fascia, interfascial adipose tissue and the deep fascia is incised along the cranial edge of the biceps femoris muscle, the incision is made of the same length. After wide opening of the edges of the wound, the intermuscular layer of the fascia lata is dissected, located caudolaterally on the femur, at the site of its attachment, then the vastus lateralis muscle is separated from the bone and pulled cephalad with a retractor. If bleeding occurs as a result of damage to muscle branches femoral artery and the veins in the distal part of the incision are ligated or coagulated.

Better review lateral surface The shaft of the femur can be reached by retracting the biceps femoris muscle and the lateral head of the quadriceps femoris muscle with a retractor.

Rice. 2 The skin and superficial fascia are dissected and widely opened: A - femur; a - biceps femoris muscle; b - lateral head of the quadriceps muscle, covered with fascia, b" - intermediate head of the quadriceps muscle; c - large and short adductors; a - quadratus femoris muscle; 1 - sciatic nerve; 2 - muscle vessels

Access can be extended cranially by mobilizing the intermediate head of the quadriceps muscle and caudally by elevating the adductors subperiosteally if appropriate.

The femur is a long bone, subject to strong bending forces, and its reconstruction requires good stability.

Rice. 3. Access to the femoral diaphysis was made

Osteosynthesis with a plate. A plate (neutralizing, tightening or supporting) is applied from the craniolateral side and secured to each of the main fragments with at least three, and preferably four, screws. Only for fractures at the junction of the metaphysis, it is enough to screw two screws into a short fragment. In case of multiple fractures with the formation of non-vascularized fragments separated from the periosteum and muscle attachment points, the optimal solution is to apply a plate to the medial side of the fracture (medial support). This is achieved by precise repositioning and correct bending of the plate. The remaining defects are filled with autogenous spongy substance.

In case of comminuted fractures with damage to soft tissues, the fracture zone is not left free according to the principle of biological osteosynthesis, but is connected indirectly, with distraction of the main fragment, with a long plate fixed to the peripheral area, thereby achieving greater rigidity (support function!).

The plate that extends to the knee joint must be adjusted to the curvature of the femur. It should not be located in the lateral recess of the kneecap joint; it should be fixed deep on the cranial edge of the distal fragment.

Closing the wound. After placing the intermuscular sheet of the fascia lata of the thigh in place, the edges of the wound of the deep and superficial fascia are adapted layer by layer with an interrupted suture (absorbable material). With sufficient access to the hip and knee joint further closure of the wound is carried out as described above. A suture is placed on the skin. Treat the seam with a 5% iodine solution.

10. Possible complications, their prevention and elimination

1. Fat embolism. Due to the spread of fat particles in the bloodstream, a fat embolism may occur. great circle blood circulation, pulmonary circulation and mixed form. A combination of fat embolism and traumatic shock is possible.

Warning - Treatment of fat embolism is complex. Its main directions: - treatment and prevention of cardiovascular failure (cardiac, hormonal, antihistamine, vitamin, vasodilators); -- treatment and prevention respiratory failure(oxygen therapy, intubation or tracheostomy with artificial ventilation lungs with severe forms); -- correction of water-salt, protein metabolism, acid-base balance, prevention and treatment of acute renal failure: glucose-saline solutions and low-molecular dextrans intravenously, albumin and protein blood substitutes, sodium bicarbonate, trisbuffer, vasodilators, osmotic diuretics (Lasix), protease inhibitors (trasylol, contrical), vagosympathetic blockades, exchange blood transfusions, in severe renal failure - hemodialysis ; - careful care of the patient, toilet of the skin, oral cavity, tracheobronchial tree; -- prevention and treatment of infectious complications (antibiotics, sulfonamides, nonspecific and specific globulins, etc.); -- in the first hours after the complication occurs, lipostabil or Essentiale is administered, 1 drop per day. Lipostabil restores the physiological dissolution of disemulsified neutral blood fat within the next few hours and improves general state sick.

2. Anaerobic infection (gas gangrene). Anaerobic wound infection is very rare and is one of the most severe complications osteosynthesis, produces a high percentage of deaths and often forces surgeons to resort to amputation. Although this complication is extremely rare, doctors should be well aware of it. Anaerobic infection occurs with extensive damage to large muscle masses, mainly with injuries to the foot, lower leg, thigh and buttock region. Factors contributing to its development are soil contamination of wounds; impaired blood supply, prolonged tightening of the limb with a hemostatic tourniquet; general weakening of the body caused by fatigue, coldness, and malnutrition.

Treatment for anaerobic infection consists of a complex therapeutic methods, used simultaneously, but in a known sequence: - if surgical treatment has not been performed, then it should be carried out radically, opening all the pockets; - to release swollen muscles from compression, incisions should be made along the axis of the affected limb segment, and the incisions should penetrate to the muscles (“strap” incisions); -- If anaerobic infection develops in a wound that has already undergone surgical treatment, repeated radical surgical treatment should be performed. Suturing after surgical treatment is contraindicated.

3. Osteomyelitis -- purulent inflammation of all bone elements, accompanied by necrosis of part of it. The reason for the development of post-traumatic, postoperative osteomyelitis is massive trauma with the presence of necrotic tissue and microbial contamination ( Staphylococcus aureus, hemolytic streptococcus, etc.).

Prevention of postoperative osteomyelitis: - prophylactic administration of antibiotics; - performing surgical interventions only in the absence of inflammation or necrosis of the skin; -- strict adherence to asepsis and antiseptics; - atraumatic operation; - thorough hemostasis; - placing sutures on the wound without tension, and, if necessary, making releasing incisions; -- implementation of active wound drainage for 24 - 48 hours.

Conservative treatment of osteomyelitis: - after culture of pus to determine the flora and its sensitivity to antibiotics, targeted antibiotic therapy is carried out (intramuscular, intravenous, intraosseous, intra-arterial); - the wound must be irrigated with antiseptic liquids. Surgical treatment postoperative forms of osteomyelitis include the following measures: - dissection and excision of the purulent focus, its good drainage; -- removal of metal structures and spokes; -- wide opening of the sequestration box, removal of necrotic tissue, pathological granulations, sequesters; in the future, in order to fix fragments, preference should be given to transosseous osteosynthesis with devices. Bone tissue defects are closed using muscle grafting.

4. Suppuration of wounds. Purulent wound infection is the most a common complication both internal and transosseous osteosynthesis. Clinical signs it develops in most cases in the first 5-6 days after surgery. In some cases, purulent processes can occur at a later date, when the substrate for suppuration is areas of late (secondary) necrosis.

Treatment consists of the following: - evacuation of wound discharge and creation of conditions for constant outflow of pus; - if an infection develops in a sutured wound, remove the sutures and widen the edges of the wound; - loose tamponade of the wound cavity with gauze swabs moistened with antiseptic solutions, hypertonic solution sodium chloride; - in the presence of purulent leakage - its wide opening and good drainage and rinsing with antiseptic solutions; -- If purulent process supported by the presence of necrotic tissue, repeated radical surgical treatment is indicated; a patient with a pronounced manifestation of a purulent infection should be on bed rest and receive high-calorie nutrition, rich in proteins and vitamins; - if anemia is detected - transfusion of small doses of fresh blood (250 ml) for replacement and stimulating purposes; - the use of antibiotics, which should be targeted, i.e., only those to which microbes isolated from wounds are sensitive should be used; - The limb must be well immobilized.

5. Impaired blood and lymph circulation. Often, especially when treating femur fractures, significant swelling of the limb develops. After giving the limb an elevated position, it decreases, but does not go away completely. The cause of swelling may be inflammation around the wires, thrombophlebitis, lymphostasis, as well as too forced distraction. In these cases, gradual distraction, dosed load on the limb and therapeutic exercises should be carried out.

6. Secondary displacement of fragments.

Secondary displacement of fragments occurs due to non-compliance with the technique of applying the device. In some cases, displacement of fragments occurs due to their insufficient fixation (weak tension and fastening of knitting needles, threaded rods, and rings), in others - as a result of errors made in the technique of extrafocal osteosynthesis, when they are not eliminated, but, on the contrary, additional displacements are created. efforts. Incorrectly healed fractures can be observed in patients with incompletely aligned fragments or with unresolved secondary displacement. Premature removal of the device often leads to the development of angular deformities. This occurs in cases where the regenerate has weak mechanical strength and its reorganization has not been completed.

7. Violations of asepsis and antisepsis during surgery could lead to the introduction of pathological microflora into the animal’s body, which would cause an inflammatory process or sepsis.

8. Rejection of the base plate.

Prevention includes adherence to septic tanks, asepsis during surgery, selection alternative methods treatment.

11. Postoperative care

Restriction of mobility (interfering bandages, cage or room confinement) until complete consolidation of the fracture or osteosynthesis, respectively. Also, to prevent licking or breaking the integrity of the wound, the dog must be wearing a collar. Be careful on stairs and falling from furniture. Keep warm and calm.

Immediately after the operation, put on a drip with stabizol up to 150-200 ml, Amoxicillin 3 ml subcutaneously, a hemostatic drug - Dicynon 2 ml intravenously. Course - Rimadyl, half a tablet 2 times a day, 5 days; Calcitriol 1 capsule per day, 3 weeks. Treat the seam with a 5% iodine solution, powder, and bandage.

Every day, treat the seam with about 5% chlorhexidine solution or Rometar, terramycin spray.

Do biochemical analysis blood, x-ray, stitches removed after 2 weeks.

Conclusion

Operation was successfully completed. There were no complications during or after the operation. The outcome of the operation is recovery.

During the operation, the doctor and medical staff tried to ensure maximum sterility, the general condition of the animal was monitored, and anesthesia was carefully dosed.

The plate osteosynthesis method was chosen based on the fact that this was the most optimal way to connect bone fragments. It provides maximum strength and is also economically beneficial.

Also for faster education callus The drug Calcitriol in capsules was prescribed for a three-week course.

fracture dog surgical operation

Bibliography

1. Zelenevsky N.V. “Workshop on veterinary anatomy” volume 1. M.: NiK - 2007. - 852s.

2. Kalashnik I.A. "Workshop on general and private veterinary surgery." M.: Agropromizdat - 1988 - 303 p.

3. Lebedev A.V., V.Ya. Lukyanovsky, B.S. Semenov “General Veterinary Surgery”. M.: Kolos - 2000-448s.

4. Mozgov I.E. “Pharmacology” Moscow Agropromizdat 1985, 414 p.

5. Petrakov K.A., P.T. Salenko, S.M. Paninsky Operative surgery with topographic anatomy of animals. Moscow "Kolos" 2001 - 423 p.

6. Semenov B.S. "Workshop on general and private surgery." M.: Kolos, 2000 - 448 p.

7. Semenov B.S., A.V. Lebedev, A.N. Eliseev “Private veterinary surgery”. M.: Kolos, 1997 - 496 p.

8. Tkachenko S.S. "Portal about bone tissue surgery"

9. Volmerhaus B., J. Frewein “Anatomy of a dog and a cat.” "Aquarium" Moscow 2003 - 580 p.

10. Shebets H., V. Brass “Operative surgery of dogs and cats” “Aquarium” Moscow 2001 - 511 p.

Intramedullary osteosynthesis with pins and wires in cats and dogs(photo 1a, b, c).

Osteosynthesis with bone plates in cats and dogs(photo 2a-d).

Methods of external fixation (extrafocal osteosynthesis) in cats and dogs(photo 3a-e).

Combination of various methods of osteosynthesis in cats and dogs(photo 4a-d).

Periarticular and intraarticular fractures in cats and dogs(photo 5a-e).

Arthrodesis in dogs(photo 6a, b, c, d).

Reconstructive methods of osteosynthesis in cats and dogs(photo 7a, b).

Photo 7a. X-ray. Distraction method of tension-tension without osteotomy for “underbite” in a dog. The period of detention is 54 days.

Complications of osteosynthesis and correction methods (false joint)(photo 8a-c).

Photo 8a. X-ray. Hypertrophic pseudarthrosis after osteosynthesis in a dog. Osteotomy and fixation in the Ilizarov apparatus.

Fracture represents a violation of bone integrity 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 hurts 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 sharp 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 those that occur under the influence of certain traumatic forces that exceed the physiological elasticity of bone tissue (falls from a height, car 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 location 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 the maximum favorable conditions, promoting normal bone fusion.

Depending on the complexity of the fracture, it may be prescribed surgical or conservative treatment. Surgical intervention is 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.