Tie-cross acrylic external skeletal fixator: Technique and 13 cases

Abstract

This study aims to describe a novel design of an acrylic external skeletal fixator (ESF) system for stabilizing epiphyseal/metaphyseal fractures with or without articular involvement and evaluate its efficiency in 13 cases. Client-owned five cats and eight dogs with epiphyseal/metaphyseal fractures were included in this study. Cross pins with or without a transcortical pin were included in "J" shaped acrylic ESF, and this novel technique was called the Tie-cross ESF. The functional use of the extremity was evaluated, and the joint range of motion was assessed and compared with the contralateral side. Radiographs were evaluated for bone healing and potential complications. The first use of the extremities changed from the day of surgery to the 3rd day. Fracture healing occurred in 35-69 days, and ESFs were removed. No persistent lameness was observed, and total functional recovery was provided in all cases. Fixation of epiphyseal and metaphyseal fractures can be challenging, especially when it involves the articular surface. Including cross-pins in an acrylic ESF (Tie-cross ESF) is useful and can be considered an alternative technique for stabilizing these fractures. This technique encourages the patient to use the extremity during the fracture healing and enables joint functions; therefore, additional physical therapy will not be necessary.

Keywords

• Articular fracture
• cross pin
• epiphyseal fracture
• metaphyseal fracture
• tie-cross ESF

References

1. Aron DN, Foutz TL, Keller WG, et al (1991): Experimental and clinical experience with an IM pin external skeletal fixator tie-in configuration. Vet Comp Orthop Traumatol, 4, 86-94.
2. Burton N (2016): The femur. 276-300. In: Gemmill TJ, Clements DN (Eds), BSAVA Manual of Canine and Feline Fracture Repair and Management. 2nd ed. British Small Animal Veterinary Association.
3. Butterworth SJ (2016): The tibia and fibula. 301-318. In: Gemmill TJ, Clements DN (Eds), BSAVA Manual of Canine and Feline Fracture Repair and Management. 2nd ed. British Small Animal Veterinary Association.
4. Cagatay S, Saglam M (2013): Clinical and radiographical assessments of treatment of Salter-Harris type fractures in cat and dog. Ankara Univ Vet Fak Derg, 60, 109-116.
5. Case JB, Egger EL (2011): Evaluation of Strength at the Acrylic–Pin Interface for Variably Treated External Skeletal Fixator Pins. Vet Surg, 40, 211-215.
6. Cebeci MT, Karsli B (2021): Treatment of Cats Distal Diaphyseal and Supracondylar Femur Fractures with Dynamic Intramedullary Cross Pinning Technique. Harran Univ Vet Fak Derg, 10, 184‐190.
7. Clarke S (2016): The humerus. 198-226. In: Gemmill TJ, Clements DN (Eds), BSAVA Manual of Canine and Feline Fracture Repair and Management. 2nd ed. British Small Animal Veterinary Association.
8. Cross AR (2012): Fracture biology and biomechanics. 565-571. In: Tobias KM, Johnston SA (Eds), Veterinary Surgery: Small Animal. 1st ed. Philadelphia: Elsevier.

9. Farese JP, Lewis DD, Cross AR, et al (2002): Use of IMEX SK-circular external fixator hybrid constructs for fracture stabilization in dogs and cats. J Am Anim Hosp Assoc, 38, 279-289.
10. Fox SM, Bray JC, Guerin SR, et al (1998): Antebrachial deformities in the dog: treatment with external fixation. J Small Anim Pract, 36, 315–320.
11. Guerin SR, Lewis DD, Lanz OI, et al (1998): Comminuted supracondylar humeral fractures repaired with a modified type I external skeletal fixator construct. J Small Anim Pract, 39, 525-553.
12. Guiot LP, Guillou RP, Déjardin LM (2019): Minimally invasive percutaneous medial plate-rod osteosynthesis for treatment of humeral shaft fractures in dog and cats: Surgical technique and prospective evaluation. Vet Surg, 48, O41–O51.
13. Hammer M, Irubetagoyena I, Grand JG (2020): Tarsocrural Instability in Cats: Combined Internal Repair and Transarticular External Skeletal Fixation. VCOT Open, 03, e103-e111.
14. Hayashi K, Schulz KS, Fossum TW (2019): Management of Specific Fractures. 1036-1133. In: Fossum TW (Ed), Small Animal Surgery. 5th ed. Philadelphia: Elsevier.
15. Jaegger G, Marcellin-Little DJ, Levine D (2002): Reliability of goniometry in Labrador Retrievers. Am J Vet Res, 63, 979-986.
16. Jaeger GH, Wosar MA, Marcellin-Little DJ, et al (2005): Use of hinged transarticular external fixation for adjunctive joint stabilization in dogs and cats: 14 cases (1999-2003). J Am Vet Med Assoc, 227, 586-591.
17. Johnson KA (2014): Piermattei's Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. 5th ed. St. Louis, Missouri: Elsevier Saunders.
18. Kim S E, Hudson CC, Pozzi A (2012): Percutaneous Pinning for Fracture Repair in Dogs and Cats. Vet Clin North Am Small Anim, 42, 963–974.
19. Kulendra E, Grierson J, Okushima S, et al (2011): Evaluation of the transarticular external skeletal fixator for the treatment of tarsocrural instability in 32 cats. Vet Comp Orthop Traumatol, 24, 320-325.
20. Lavini F, Dall'Oca C, Mezzari S, et al (2014): Temporary bridging external fixation in distal tibial fracture. Injury, 45, S58-S63.
21. Lazarus MA, Lewis DD, Johnson MD, et al (2021): Use of a circular fixator construct to facilitate closed reduction and percutaneous stabilization of a distal femoral physeal fracture in a dog. Open Veterinary Journal, 11, 89–95.
22. Lowenberg DW, Smith RM (2019): Distal Tibial Fractures With or Without Articular Extension: Fixation With Circular External Fixation or Open Plating? A Personal Point of View. J Orthop Trauma, 33, S7-S13.
23. Macias C, McKee M (2003): Articular and periarticular fractures in the dog and cat. In Practice, 25, 446-465.
24. Marcellin-Little DJ, Levine D (2015): Principles and application of range of motion and stretching in companion animals. Vet Clin North Am Small Anim Pract, 45, 57-72.
25. Marsh JL, Buckwalter J, Gelberman R, et al (2002): Articular fractures: does an anatomic reduction really change the result? J Bone Joint Surg Am, 84, 1259-1271.
26. McCartney WT (1998): Use of modified external fixator in 54 dogs and 28 cats. Vet Rec, 143, 330-334.
27. McCartney WT (2007): Use of an acrylic external fixator with an intramedullary tie-in pin for the treatment of tibial fractures in 85 dogs. Vet Rec, 161, 596-597.
28. McKinley TO, Borrelli J Jr, D'Lima DD, et al (2010): Basic science of intra-articular fractures and posttraumatic osteoarthritis. J Orthop Trauma, 24, 567-570.
29. Milenković S, Mitković M, Micić I, et al (2013): Distal tibial pilon fractures (AO/OTA type B, and C) treated with the external skeletal and minimal internal fixation method. Vojnosanit Pregl, 70, 836-841.
30. Miraldo D, Salmelin B, Yeadon R (2020): Feline Distal Tibial Physeal Fracture Repair Using a Modified Cross-Pin Technique with Four Pins. Vet Comp Orthop Traumatol, 33, 220-226.
31. Perry KL, Woods S (2018): Fracture management in growing animals. Companion Animal, 23, 120-129.
32. Roberts VJ, Meeson RL (2022): Feline Femoral Fracture Fixation: What are the options? J Feline Med Surg, 24, 442-463.
33. Rovesti GL, Bosio A, Marcellin-Little DJ (2007): Management of 49 antebrachial and crural fractures in dogs using circular external fixators. J Small Anim Pract, 48, 194-200.
34. Sagliyan A, Han MC (2016): Kedi ve Köpeklerde Uzun Kemik Kırıklarının Sağaltımında Akrilik Eksternal Fiksasyon ve İntramedullar Pin Uygulama. F Ü Sağ Bil Vet Derg, 30, 45-54.
35. Schenker ML, Mauck RL, Ahn J, et al (2014): Pathogenesis and prevention of posttraumatic osteoarthritis after intra-articular fracture. J Am Acad Orthop Surg, 22, 20-28.
36. Singh AP (2021): Intraarticular Fractures Principles and Management [full text]. Bone and Spine [online]. Available at https://boneandspine.com/intraarticular-fractures-principles-and-management/ (Accessed July 23, 2021).
37. Tyagi SK, Aithal HP, Kinjavdekar P, et al (2015): In vitro biomechanical testing of different configurations of acrylic external skeletal fixator constructs. Vet Comp Orthop Traumatol, 28, 227–233.
38. von Pfeil DJF, Glassman M, Ropski M (2017): Percutaneous tibial physeal fracture repair in small animals: technique and 17 cases. Vet Comp Orthop Traumatol, 30, 279-287.