J. Anim, Health Prod. Technol. Vol.1, No. 1 (July-Dee) 2017 os Surgical management of “T” fracture of femur in dog - A case report Hari Krishna N.V.V."', Makkena Sreenu?, Devi Prasad V° and Ravi Kumar P! Dept of Veterinary Surgery and Radiology, NTR College of Veterinary Science, Gannavaram Fracture of the long bone is a commonly encountered orthopedic problem in canine practice especially in young dogs (Newton and Nunamaker, 1985), Femur is the most frequently affected bone, followed by tibia, radius-ulna and humerus (Aithal et.al., 1999, Seaman and Simpson, 2004 and Simon et. al., 2010).The supracondylar and intercondylar fracture in combination, commonly called aT or Y fracture (Piermattei et. al., 2006). Supracondylar fractures are most common in mature patients. They involve the distal metaphyseal region of the femur and can occur as an isolated fracture or may be found in association with femoral shaft or condylar fractures. Fractures of this type may be highly couninuted. This type of fracture can be difficult to anatomically reduce and stabilize adequately because of the pull of muscles and distal nature of the fracture (Beale 2004). T” or “ more difficult to treat (Newton and Nunamaker, 1985). The present paper reports about an uncommon case of T-fracture in femur and its successful surgical treatment. fractures are Six months old male Great Dane dog was ‘brought to the department of Veterinary Surgery and Radiology, NTR College of Veterinary Science, Gannavaram with a history of road traffic accident and subsequent non-weight bearing lameness on left hindlimb. Physical examination showed swelling, pain and erepitation on palpation at the distal end of left femur. All the physiological and biochemical parameters were within normal range. Lateral and 521 102. cranio caudal radiographic views of the affected limb showed distal physeal fracture (Fig. 1) and long arm of the ‘T’ fracture couldn’ tbe identified. It was decided to stabilize the fracture by internal fi technique. Fracture was temporarily stabilized by Modified Roberts Jone’s bandage after applying magsulph glycerine paste to reduce the swelling till surgery. ‘The animal was prepared for surgery following standard aseptic principles. The dogs were premedicated with atropine sulphate @ 0.04mg/ke b. wt. im, and induction is achieved by administering the ketamine @ Smg/kg b. wt. and diazepam @ 0.3mg/kg b. wt. iv, Anaesthesia maintained by 2-3% Isoflurane. The animal is positioned in lateral recumbency with affected limb positioned upper most. Cranio-lateral parapatellar incision followed by stifle arthnotnny approach was followed. Patella with attached quadriceps muscles was luxated medially exposing fracture fragments. A vertical fissure extending almost full length of the condyle except the articular cartilage (1 fracture) was noticed (Fig. 2). It was first stabilized by passing a 1.8mm K-wire uansversely through both the condyles and the fracture was reduced (Fig. 3). Following reduction, stifle was flexed to allow better exposure of femoral condyles. The pins are inserted lateral to the trochlear ridge so that the pins cross above the fracture site and pierce through the opposite cortex, the distal ends of the pins seated under the condylar surface. Two K-wires were passed from the femoral condyle into the proximal ion 1+ Corresponding author, Assistant Professor; drharikrishnavet @gmail.com 2. Professor and Head; drmakkena@ yahoo.co.in 3. Professor; professorprasad@gmail.com 4. Assistant professor; ravikumarpallitvm 1018 @gmail.comshaft from each side. One side two 1.8 mm K wires were applied whereas from other side one 1.8 and one 1.5mm K-wire were used (Fig. 4). ‘The arthrotomy incision was closed by continuous suture using 2/0 polyglactin 910 followed muscle and subcutis, Skin closed by nylon using cross mattress pattern, Post-operatively cefotaxime @ 22mg/kg b. wt. im. daily for 7days and inj. meloxicam @ 0.2mg/ kgb. wt. im, for 3 days were administered. E-collar was advised to prevent self-mutilation af the wound Modified Roberts Jone’s bandage was applied. Owners were advised to restrict the activity of the dogs by keeping in confined area during the first week and early post-operative weight bearing and mild physical activities such as leash walking to avoid fracture disease. Advised wound dressing once in three days and skin sutures were removed on 10* post-operative day. The animal started bearing weight on 3" post- operative day, Hari Krishna er. al.,(2013) observed weight bearing on the 3" post-operative day itself following internal fixation of distal femur fracture in a dog. Fractures involving the distal femoral physis are common in puppies and kittens of 4 to 11 months of age which account for 37 per cent of the total physcal fractures seen in dogs (Harasen, 2001). T- Fracture of the femoral condyle is relatively rare and is usually accompanied by displacement, extensive soft tissue damage, and heunaituosis. The joint should be checked for ligament and meniscal damage. Anatomical reduction, rigid fixation of the fracture segments, and early postoperative movement of the stifle joint are essential 10 ensure good return of function (Picrmatici et. al, 2006). Swelling of the thigh and edema at the lower flank with displacement of fracture fragments were observed in the present case. No complications were observed during healing process and the animal made uneventful recovery. The fracture healed by little callus formation and pins were removed on 60" post- operative day. REFERENCES Aithal, H. P, Singh, GR. and Bisht, G S., (1999) Fractures in dogs: A survey of 402 cases, Indian Journal of Veterinary Surgery., 20(1): 15-21. Beale, B., (2004) Orthopedic clinical techniques femur fracture repair. Clinical Techniques in Small Animal Practice 193): 134-150 Harasen, G., (2001). Fractures involving the distal extremity of the femur pass-1 The immature inadian Veterinary Journal., 42: 949- Hari Krishna, N,V. V., Jayaprakash, R., Ayyappai, S. and Justin William, B., (2013). Surgical treatment of distal femur fracture using locking reconstruction plate in a dog. Indian Veterinary Journal., 90(12): 72-73. Newton, C. D. and Nunamaker, D. M., (1985) Fracture of femur in text book of Small Animal Orthopaedics edited hy Newton, C.D. and Nunamaker, D, M., J. B. Lippincott Company, Philadelphia, pp. 415-432. Piermattei, D. L., Flo, G L. and Decamp, C. E. (2006) Fractures: Classification, diagnosis and treatment in text book of Handhook of Small Animal Orthopedics and Fracture Repair Saunders Elsevier, Philadelphia., pp. 25 - 139. Seaman, J. A. and Simpson, A. M., (2004) Tibial fractures, Clinical Techniques in Small Animal Practice., 19: 151-167. Simon, S., Ganesh, M. R., Ayyappan, S., Rao, G. D., Sureshkumar, R., Kundave, V.R. and das, B.C., (2010). Incidenced of pelvic limb fractures in dogs: A survey of 478 dogs. Veterinary Wotld., 3(3): 120-121.J. Anim, Health Prod. Technol. Vol.1, No. 1 (July-Dec) 2017 96 shafi from each side. One side wo 1.8 mm K wires were applied whereas from other side one 1.8 and one 1.5mm K wire were used (Fig. 4). The arthrotomy incision was closed by continuous suture using 2/0 polyglactin 910 followed muscle and subcutis. Skin closed by nylon using cross mattress, pattern. Post-operatively cefotaxime @ 22mg/kg b. wt. im. daily for 7days and inj. meloxicam @ 0.2mg/ kgb. wt. im. for 3 days were adi ‘was advised to prevent self-mutilation of the wound. Modified Roberts Jones bandage was applied. ‘Owners were advised to restrict the activity of the dogs by keeping in confined area during the first weck and carly post-operative weight bearing and istered. B-vullat mild physical activities such as leash walking to avoid fracture disease. Advised wound dressing once in three days and skin sutures were removed on 10 post-operative day. ‘The animal started bearing weight on St post- operative day. Hari Krishna ef. al.,(2013) observed weight bearing on the 3% post-operative day itself following internal fixation of distal femur fracture in @ dog. Fractures involving the distal femoral physis are common in puppies and kittens of 4 to 11 months of age which account for 37 per cent of the total physeal fractures seen in dogs (Harasen, 2001). T- Fracture of the femoral condyle is relatively rare and is usually accompanied by displacement, extensive soft tissue damage, and hemarthrosis. The joint should be checked for ligament and meniscal damage. Anatomical reduction, rigid fixation of the fracture segments, and early postoperative movement of the stifle joint are essential to ensure good return of function (Piermattei et. a., 2006). Swelling of the thigh and edema at the lower flank with displacement of fracture fragments were observed in the present case. No complications were observed during healing process and the animal made uneventful recovery. The fracture healed by Iittle callus formation and pins were removed on 60" post- operative day. REFERENCES: Aithal, II. P., Singh, G. R. and Bisht, G. S., (1999) Fractures in dogs: A survey of 402 cases. Indian Journal of Veterinary Surgery., 20(1): 15.21 Beale, B., (2004) Orthopedic clinical techniques, femur fracture repair. Clinical Techniques in Small Animal Practice 19(3): 134-150. Harasen, G, (2001). Fractures involving the distal extremity of dhe femur pass-1 The immature patient. Canadian Veterinary Journal.,42: 949- 950. Hari Krishna, N. V. V., Jayaprakash, R.. Ayyappan, S. and Justin William, B., (2U13). Surgical treatment of distal fermur fracture using locking reconstruction plate in adog. Indian Vetesinaty Journal. 90(12): 72-73, Newton, C. D. and Nunamaker, D. M., (1985), Fracture of femur in text book of Small Animal Orthopaedics edited by Newton, C.D. and Nunamaker, D.M.,J.B. Lippincott Company, Philadelphia, pp. 415-432. Pictmattei, D. L., Flo, GL. and Decamp, C. E., (2006) Fractures: Classification, diagnosis and treatment in text book of Handbook of Small Animal Orthopedics and Fracture Repair Saunders Flsevier, Philadelphia., pp. 25 - 139. Sea 1, J. A. and Simpson, A. M., (2004) Tibial fractures. Clinical Techniques in Small Animal Practice., 19: 151-167. Simon, S., Ganesh, M. R., Ayyappan, S., Rao, G. D., Sureshkumar, R., Kundave, V. R. and das, B.C,, (2010). Incidenced of pelvic limb fractures in dogs: A survey 0 £478 dogs. Veterinary World.,TF Anim. Health Prod, Technol. Vol.1, No. 1 (July-Dec) 2017 97 Fig.2 : Intraoperative picture showing fissure Fig.1 : Skiagram showing distal physeal fracture, extending between the condyles. Fig. 3 Intraoperative picture showing stabilisation of intercondylar fracture using 1.8 mm K- iagram showing immes operative reduction. iale post- re,