Chau Bui 1 308151151 Fracture management in of fractures of the ulna and/or radius in avian wildlife Fractures of the thoracic

limb can alter wing-beat kinematics as well as the gliding process of flight, compromising the aerodynamic ability of the wing (Beaufrre, 2009). Wild birds rely significantly on their ability to fly for survival hence a return to full functional flight is imperative if being returned to the wild (Martin and Ritchie, 1994; Cannon, 2011). Different fixation methods are available for management of ulna and/or radius fractures and this essay describes the means by which they are selected. Minimally displaced, mid-shaft fractures of the radius or ulna are often managed by a figure-of-eight bandage to immobilize the elbow and carpus (Martin and Ritchie, 1994; MacCoy, 1992). The normal position of the wing is along the natural curve of the birds body, and when incorporated into the bandage, provides aligned immobilisation whilst the bone heals (Cannon, 2011). Fractures at the proximal or distal ends, particularly if articular surfaces or surrounding tissue are damaged, will not be well aligned and are not recommended for non-surgical repair (Cannon, 2011). Advantages of non-surgical techniques include less injury to surrounding tissues and blood supply, as well as decreased problems with infection. Disadvantages include a decrease in the range of motion of the elbow and carpal joints (Martin and Ritchie, 1994). Surgical repair is necessary when there is significant displacement of fracture fragments, or for open fractures (Martin and Ritchie, 1994; Cannon, 2011). Generally, external fixators are used (Martin and Ritchie, 1994). MacCoy (1992) recommends fractures of both the radius and the ulna require a type I Kirschner-Ehmer splint whilst Redig (2001) recommends using an IM pin in the radius combined with a Tie-In Fixator in the Ulna. External fixators are able to provide rigid stabilization, preserve joint and periarticular structure as well as neutralize rotational, bending and shearing forces (Martin and Ritchie, 1994). Martin and Ritchie (1994) do not recommend IM pins due to the potential to cause ankylosis of joints, significant tendon or ligament damage, and damage to vasculature which may significantly alter the growth pattern of bones (Martin and Ritchie, 1994). Also, compared to mammals where long bones are principally subject to compression and bending forces, avian long bones of the thoracic limb are subject to significant torsion and fixation methods should hence address torsion forces, which are not provided adequately with IM pins (Beaufrre, 2009). Additionally, IM pin placement through the distal ulna or retrograde placement from the elbow can cause severe periarticular fibrosis and wing dysfunction (Martin and Ritchie, 1994). Repair of a wing fracture (especially near a joint) should not involve any ankylosis and have only minimal soft tissue damage for a return to full flight (Martin and Ritchie, 1994). In avian patients, maintenance and protection of soft tissues is the more imperative aspect of a successful surgery. The degree of soft tissue damage may be more critical in determining the potential for post-surgical return to function than the fracture itself. Significant soft tissue damage can result in local ischaemia and this will result in non-union or delayed union (Martin and Ritchie, 1994). Strict confinement is recommended for at least the first week. Too much exercise early in the healing phase is a major cause of fracture misalignment (Cannon, 2011). Post operative assessment should be performed every 2-4 weeks with radiographs. Once the fracture is more stable (e.g. formation of callus), climbing around the cage or limited flapping of wings can be allowed.

Chau Bui 2 308151151 Diagram 1 (Martin and Ritchie, 1994):

References: Beaufrre H 2009, A Review of Biomechanic and Aerodynamic Considerations of the Avian Thoracic Limb, Journal of Avian Medicine and Surgery, vol. 23, no. 3, pp. 173-185. Cannon M 2011, Small Animal Medicine And Therapeutics 2 Handbook. MacCoy DM 1992, Treatment of Fractures in Avian Species, The Veterinary Clinics of North America, Small Animal Practice, vol. 22, no. 1, pp. 225-238. Martin HD and Ritchie BW 1994, Orthopedic surgical techniques. In: Avian Medicine: Principles and Application, BW Ritchie, GJ Harrison, LR Harrison (eds). Wingers Publishing, Lake Worth, pp. 11371170. Redig PE 2001, Effective Methods for Management of Avian Fractures and other Orthopaedic Problems, Proceedings 6th Annual Conference, Association of Avian Veterinarians European Committee, Munich, pp. 26-42.

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Either way, the approach to the proximal radius and ulna can be achieved via a dorsal or ventral curvilinear incision extending from the distal third of the humerus over the lateral medial condyle and onto the forearm over the separation of the extensor metacarpi radialis and common digital extensor muscles. Muscles can then be retracted anteriorally or posteriorally. Anterior retraction of the extensor metacarpi radialis will expose the edge of the ulna with attached feather follicles which can be freed from the bone with a periosteal elevator if needed. Concurrent posterior retraction of the common digital extensor will expose the radius. The radius is highly movable and fractures of the radius are not expected to heal properly with a figure-of-eight bandage as this does not provide sufficient stabilisation. When the wing is completely folded, the radius becomes slightly disarticulated from the dorsal humeral condyle by the incisura radialis (ulnar facet) of the ulna. Minor extension motions can make the radius renew its contact with the humerus, placing the radius in a moveable position. Additionally, wing extension and flexion will result in a certain degree of compression and tension forces in a fractured radius (Beaufrre, 2009).

Conclusion Generally, proximal fractures were the joint is not involved has a better prognosis for return to functional use than distal fractures. In general, avian fracture healing is faster than in mammals and this may be due to the rapid mobilisation of fibroblasts and formation of collagen fibres which create a fibrous union rather than new bone. A fibrous callus forms initially, and this becomes replaced by cartilaginous callus developing from periosteum and endosteum. Fibrous callus form initially and becomes replaced by cartilaginous callus developing from periosteum and endosteum Avian fracture healing is faster than mammals (21). This may be due to rapid mobilisation of fibroblasts and formation of collagen fibres to develop a fibrous union rather than new bone

Initial assessment Surgical repair preferred if there is significant overlapping of fracture fragments, or cases of open fractures these cases require surgery as it is the only means of returning the bird to full functional flight. Wild birds e.g. Peregrine Falcon require good flight capability to catch food etc. cmpr pet bird which is destined to spend the rest of its time in a cage.

Chau Bui 4 308151151 Anaesthesia should be used for radiology and initial assessment (handling) even for applying bandages or splints as this can be extremely stressful for birds Remember to stabilise patient first before anaesthetising and assessing any fractures. Often birds will come in a shocked state, in these circumstances, minimal handling and interference is recommended (masking tape/vetwrap to immobilise wings and only minimal cleaning of wounds judge how much the bird can tolerate). Antbioitics (amoycillin/clavulanic acid 125-150mg/kg IM) Generally, proximal fractures were the joint is not involved has a better prognosis for return to functional use than distal fractures. Significant soft tissue damage can result in local ischaemia and this will result in non-union or delayed union. Assessment of motor nerve function distal to a fracture important as significant nerve function damage is indicative of amputation or euthanasia.

Bandages and Splints Useful for temporary or permanent stabilisation of fractures. The normal position of the wing is along the natural curve of the bird body, this can be used to align the wing with bandages to provide aligned immobilisation whislt the bone heals. This technique is useful for mid-shaft fractures. Fractures at the proximal or distal ends, particularly if articular surfaces or surrounding tissue are damaged, will not be well aligned. Bandages that are self adhesive e.g. vetwrap is better for application on feathers. Splints can be made of any light, rigid material e.g. plastic spoons, drinking straws, feather quills, hexcelite, fibreglass, paper clips. Good prognosis for external coaptation ulna: proximal to distal, closed. Radius and ulna: midshaft to distal, closed.
Radius and ulna: Secondary remiges have periosteal attachments on the ulna.44 The radius and ulna articulate with each other as well as with the humerus and the carpal bones. The original osteologic configuration of the avian wing allows passive synchronization of elbow and wrist during both flexion and extension. This synchronization occurs when the radius slides along the ulna (socalled drawing-parallels mechanism) in conjunction with passive muscle and tendon activities (Fig 4).11,70 This action may enhance energy saving during flight by reducing muscular fatigue. Furthermore, these features may also help in circumduction motions of the manus during wing beats.70 A synostosis of the radius and ulna would severely compromise wing flexion and extension of the thoracic limb, impairing mobility and the wing beat cycle. Because the radius is highly moveable, a fracture of this bone would not be expected to heal properly without fixation.68 A figure-of-eight bandage will not stabilize the

radius enough because, when the wing is completely folded, the radius is slightly disarticulated distally from the dorsal humeral condyle by the incisura radialis (an ulnar facet) of the ulna, and minor extension motions can make the radius renew its contact with the humerus,70 placing this

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bone in a relative moveable position. Furthermore, a fractured radius will undergo some degree of compression and tension forces with wing - extension and flexion. Fractures of the thoracic limb prevent the wing from supporting aerodynamic forces. Every condition that affects joints, wing orientation, or both (luxation, fractures, propatagial constriction, ankylosis, extensive wound, rotation or angulation of bones, radial-ulnar synostosis) can alter the wing-beat kinematics as well as the gliding flight. A fracture of a bone from the pectoral girdle and any damage to the triosseal canal will alter wing-stroke symmetry and kinematics. A coracoid fracture appears to be detrimental to upstroke, preventing the lifting action of m. supracoracoideus because its tendon passes above the coracoid in the canal. The fixation method selected to repair fractures of the thoracic limb should suit the in vivo stresses of the avian long bones. In mammals, long bones of the thoracic limb are subject principally to compression and bending forces. However, avian long bones of the thoracic limb are subject to - significant torsion

Surgical approach 2/0-4/0 Dexon or Surgicryl for closure of muscles, 4/0 Dexon or Surgicryl for skin closure avoids necessity to remove sutures Wound closure in more circumstances only involves skin closure. Not recommended that muscles be purposely tacked over fractures under the impression that this will help callus growth, rather, this results in muscle fization and poor wing function. This procedure is only useful where devalitised cortex lies underneath the muscle.

Kirschner-Ehmer Splint Intramedullary Pinning Tie- in Fixator Post op Strict confinement for at least the first week. A major cause of failure of fracture healing is too much exercise early in the healing phase. Physiotherapy may help to overcome joint constriction and avoid development of adhesions. Two weeks later radiographAllow climbing around cage or limited flapping of wings

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