Postoperative management of external fixators in dogs and cats - Veterinary Medicine
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Postoperative management of external fixators in dogs and cats
Despite the widespread use of external skeletal fixation in small-animal practice, little information is available regarding postoperative care. Here are some tips to promote optimal healing, keep patients comfortable, and avoid complications.


VETERINARY MEDICINE


RECHECK EXAMINATIONS

The time between routine recheck examinations should be based on the patient's clinical progress, the development of complications, and the owner's compliance level of caring for the animal and fixator at home.1,6 At each recheck examination, inspect the apparatus and tighten any loose components. If at any point the owner thinks that any portion of the construct is loose or a complication is developing, perform an evaluation as soon as possible. Obtain radiographs at four- to six-week intervals, as warranted by the procedure performed and radiographic assessment of healing.

Staged destabilization of the construct is the practice of removing portions of the frame to decrease fixator stiffness and potentially increase the rate of healing by increasing the load placed on the bone.19 Destabilization is typically begun about six weeks after surgery.19 Staged destabilization is not uniformly accepted, and studies investigating its efficacy have yielded variable results.19,20 We typically only remove fixator components that are causing morbidity.

The fixator can be removed when clinical and radiographic evidence of bone healing are noted. Most fixation elements can be removed by hand using a Jacobs chuck. Sedation or a brief period of anesthesia with concurrent analgesic administration is recommended, as removal of fixation elements can cause painful stimulation of the periosteum.5 Obtain radiographs after fixator removal to ensure that superimposition of the radiopaque portions of the frame over the bone did not conceal any areas of nonunion or complications. Leave the pin and wire tracts to heal by second intention, and place the entire limb in a soft padded bandage for 48 to 72 hours.5

CONCLUSION

External skeletal fixation is a highly versatile and effective treatment modality, but it requires diligent care during the convalescent period. Consider the likelihood that clients and their pets will comply with postoperative care instructions before deciding to use an external fixator. Fixators often need to be maintained for a prolonged period, and if owner compliance or the pet's tolerance of the construct is poor, the outcome will likely be less than optimal.

Christina J. Choate, DVM* Robert M. Radasch, DVM, MS, DACVS
Dallas Veterinary Surgical Center
4444 Trinity Mills Road, Suite 203
Dallas, TX 75287

Daniel D. Lewis, DVM, DACVS
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
University of Florida
Gainesville, FL 32610

*Current address: Comparative Orthopaedics Biomechanics Laboratory
Colleges of Medicine and Veterinary Medicine
University of Florida
Gainesville, FL 32610


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Source: VETERINARY MEDICINE,
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