Veterinary Fracture Repair: Minimizing Errors to Reduce Complication Risks
Sponsored by Arthrex
Orthopedic fracture repairs are commonly performed by veterinarians in both general and specialty practice. Regardless of the practice setting, there are a variety of techniques available for fracture repair, including intramedullary pins, interlocking nails, bone plates with screws, and external skeletal fixation. Complication rates associated with fracture repair can vary significantly, depending on patient characteristics, the repair method used,1 surgeon expertise, and owner compliance.
With somewhat limited veterinary-specific surgical complication data available, paying careful attention to these 5 common errors in human fracture repair can potentially help decrease complication rates in veterinary orthopedic surgery.
1. Failure to Plan Properly
Fracture repair planning is widely recognized as vitally important; however, many surgeons in the human medical field have admitted that they do not always perform thorough presurgical planning.2 This trend likely holds true in veterinary practice. Determining the goal and outcomes of surgery and the logistics of how to best perform the needed repair are essential to improving surgical outcomes.
2. Inadequate Intraoperative Fracture Reduction
A 2016 study found that nearly 30% of the errors involved in human fracture repair were associated with inadequate fracture reduction, which increases the risk for complications.3 Fracture ends should have at least 50% contact in order for healing to be possible,4 and achieving adequate fracture reduction requires careful positioning and use of the correct instruments.
Fracture ends should have at least 50% contact in order for healing to be possible, and achieving adequate fracture reduction requires careful positioning and use of the correct instruments.
3. Incorrect Implant Positioning
Implant positioning errors have been found to be an issue in 30% of human fracture repair cases involving surgical errors.3 Improper implant positioning can lead to an increased risk for hardware failure, depending on the forces that are applied to the implant.
4. Use of the Wrong Surgical Implant
Incorrect implant selection has been implicated in 18% of human orthopedic surgical errors.3 This may be even more of a concern in veterinary medicine, as many veterinary practices stock a limited inventory of surgical implants and veterinary patients vary significantly in size. A limited selection can make it difficult to select the optimal implant for a given patient and fracture.
5. Lack of Wound Monitoring in the Postoperative Period
Close patient monitoring is essential, as it allows for the early detection of infection, dehiscence, and other complications. When clients are unable to properly monitor their pet’s surgical wound effectively, the rate of complications, as well as their severity, can increase.
The OrthoLine™ Fracture Management System
The OrthoLine™ fracture system by Arthrex is geared toward setting veterinarians up for surgical success. This system enables surgeons to repair fractures using the same screws that are used in the Arthrex TPLO system, allowing for a streamlined orthopedic repair system in practice. The OrthoLine™ system includes >70 color-coded fracture repair plates in a variety of sizes, which can be used in patients ranging from small cats to large-breed dogs. Plates can also be contoured using size-specific bending irons and cannulated bending plugs to improve implant positioning.
The OrthoLine™ fracture system by Arthrex is geared toward setting veterinarians up for surgical success.
OrthoLine™ plates feature a low-profile design, as well as a tight screw density on the proximal and distal ends to allow for placement of more screws. The OrthoLine™ system offers a wide variety of screw types, including fully threaded headless compression screws, partially threaded screws, cannulated lag screws, low-profile screws, and QuickFix™ cannulated screws to fulfill case-specific needs. In addition, the availability of slide holes, compression holes, and K-wire holes allows for flexible positioning and further customization so the veterinary team can ensure that a patient’s plate is being applied in the most functional manner.
Conclusion
Providing the best possible outcomes for fracture repair and achieving optimal reduction of bone fragments requires use of the correct implant and screw type with proper positioning. The OrthoLine™ fracture system provides a wide range of options, allowing for selection of the best plate for any fracture that is amenable to repair with a plate and screws. Proper use of this system, along with strategic surgical planning and diligent postoperative monitoring, can help improve the veterinary team’s confidence when managing orthopedic surgical cases.
