KÖPEKLERDE HUMERUS VE TİBİA KIRIKLARININ AKRİLİK EKSTERNAL FİKSATÖR İLE SAĞALTIMLARININ KLİNİK VE RADYOGRAFİK YÖNTEMLERLE DEĞERLENDİRİLMESİ

Öz

Sunulan çalışmada, köpeklerde humerus ve tibia kırıklarının sağaltımında akrilik eksternal fiksatör uygulamalarının klinik ve radyografik bulguları değerlendirilerek, iyileşme sonuçları ve karşılaşılan komplikasyonların araştırılması amaçlandı. Çalışmada, Jandarma At ve Köpek Eğitim Merkezi Komutanlığı (JAKEM Komutanlığı) hayvan hastanesine özel kliniklerden kırık şüphesiyle sevk edilen ve Erciyes Üniversitesi Veteriner Fakültesi kliniklerine kırık şüphesiyle getirilen değişik ırk, yaş ve cinsiyetteki 14 hasta kullanıldı. Humerus kırığı bulunan altı olgu (olgu 2, 4, 5, 8, 9, 10) ve tibia kırığı bulunan sekiz olguya (olgu 1, 3, 6, 7, 11, 12, 13, 14) akrilik eksternal fiksatör uygulandı. Olguların operasyon sonrası en az 35 gün süreyle klinik ve radyografik muayeneleri gerçekleştirilerek sağaltım sonuçları karşılaştırıldı. Akrilik eksternal fiksatör uygulanan humerus kırıklarının tümünde (olgu 2, 4, 5, 8, 9, 10) fonksiyonel iyileşme tespit edilirken, tibia kırıklarından altı olguda (olgu 6, 7, 11, 12, 13, 14) fonksiyonel iyileşme, iki olguda (olgu 1, 3) hafif topallık belirlendi. Sonuç olarak akrilik eksternal fiksatör uygulamalarının humerus ve tibia kırıklarında etkin bir sağaltım seçeneğini oluşturduğu, ekonomik ve ulaşım kolaylığı açısından klinik pratikte yaygın olarak uygulanabileceği kanısına varıldı.

Anahtar Kelimeler

• Akrilik eksternal fiksatör, humerus, kırık, köpek, tibia

Assesment of Acrylic External Fixator Application for the Treatment of Humerus and Tibia Fractures by Clinic and Radiographic Methods in Dogs

Öz

The purpose of this study was to evaluate the clinical and radiographic findings of acrylic external fixator applications for the treatment of humerus and tibia fractures in dogs, and to assess treatment results and complications encountered. In this study, 14 dogs were used from various breeds, ages and gender referred by private clinics in suspicion of broken leg to Genderma Horse and Dog Training Commandership (JAKEM Commandership) Animal Hospital and Erciyes University, Faculty of Veterinary Medicine. Acrylic external fixator technique was applied to six patients (patients 2, 4, 5, 8, 9, 10) suffering from humeral fracture and eight patients (patients 1, 3, 6, 7, 11, 12, 13, 14) from tibial fracture. Postoperative clinic and radiographic examinations for each patient were carried out for at least 35 days and treatment result compared. Acrylic external fixator technique was applied to the patients with humeral fractures (patients 2, 4, 5, 8, 9, 10). Functional recovery for all animals was observed. Functional recovery was gained in six patients with tibial fractures (patients 6, 7, 11, 12, 13, 14). Slight lameness was observed in two patients (patients 1, 3). As a result, it was deduced that acrylic external fixator applications might be used widely in clinical practice because of economical considerations and easy access in humerus and tibial fractures treatment

Anahtar Kelimeler

• Acrylic external fixator, dog, fracture, humerus, tibia

Kaynakça

1. Aslanbey D. Veteriner Ortopedi ve Travmatoloji. Özkan Matbaacılık, Ankara 2002, ss 1-150.
2. Bruce WJ. Radius and ulna In: Coughlan A, Miller A (eds), BSAVA Manual of Small Animal Fracture Repair and Management. 1st ed. Bsava, United Kingdom 1998, pp 197–215.
3. Denny HR. The Humerus. In: Coughlan A, Miller A. (eds), BSAVA Manual of Small Animal Fracture Repair and Management. 1st ed. Bsava, United Kingdom 1998, pp 170-195.
4. Tomlinson JL. Fractures of the humerus. In: Slatter D (ed), Textbook of Small Animal Surgery, 3rd. ed. W.B. Saunder, Philadelphia 2003, pp 1905-1918.
5. Süer C, Sağlam M. Köpeklerde arka ekstremite travmatik lezyonlarının dağılımı ve sağaltımı üzerine klinik çalışmalar. Ankara Üniv Vet Fak Derg 2006; 53: 15-23.
6. Özsoy S, Altunatmaz K. Treatment of extremity fractures in dogs using external fixators with closed reduction and limited open approach. Vet Med–Czech 2003; 48(5): 133–140.
7. Aron DN. Practical techniques for fractures. In: Bojrab M.J. (ed.): Current Techniques in Small Animal Surgery. 4th ed. Philadelphia, 1998, pp 934–941.
8. Shahar R. Relative stiffness and stress of type I and type II external fixators: Acrylic versus stainless-steel connecting bars-a theoretical approach. Vet Surg 2000; 29: 59–69.

9. Roush JK. Management of fractures in small animals. Vet Clin Small Anim 2005; 35: 1137-1154.
10. Kaya Ü. Köpeklerde tibia kırıklarının minimal invaziv plak osteosentezi ile sağaltımı. Ankara Üniv Vet Fak Derg 2003; 50: 19-23.
11. Boudrieau RJ, Sinibaldi KR. Principles of long bone fracture management. Semin Vet Med Surg (Small Anim) 1992; 7: 44-62.
12. McLaughlin R. Internal fixation, intramedullary pins, cerclage wires and interlocking nails. Vet Clin North Am Small Anim Pract 1999; 29: 1097-1116.
13. Ünlüsoy İ, Bilgili H. Köpeklerde intrameduller çivile- me teknikleri ve uygulama alanları. Ankara Üniv Vet Fak Derg 2005; 52: 85-91.
14. Bilgili H, Aslanbey D. Uzun kemiklerin epifizer bölge kırıkları: Bölüm II Kedi ve köpeklerde epifizer kırık- ların sınıflandırma metodları. Veteriner Cerrahi Der- gisi 1999; 5: 78-84.
15. Clements DN, Gemmill T, Cord SA, et al. Fracture of the proximal tibial epiphysis and tuberosity in 10 dogs. J Small Anim Pract 2003; 44: 355-358.
16. Lillich JD, Roush JK, DeBowes RM, et al. Interlocking intramedullary nail fixation for a comminuted diaphseal femoral fracture In An Alpaca. Vet Comp Orthop Traumatol 1999; 12: 81-84.
17. Beale B. Orthopedic clinical techniques femur fracture repair. Clin Tech Small Anim Pract 2004; 19: 134-150.
18. Gül YN. Bioabsorbable ve biodegradable implantların özellikleri ve kırık sağaltımında kullanımı. Veteriner Cerrahi Dergisi 2000; 6: 108-111.
19. Schrader SC. Complications associated with the use of Steinman intramedullary pins and cerclage wires for fixation of long-bone fractures. Vet Clin North Am Small Anim Pract 1991; 21: 687-703.
20. McCartney WT. Use of an acrylic external fixator with an intramedullary tie-in pin for the treatment of tibial fractures in 85 dogs. Vet Rec 2007; 27: 596- 597.
21. Milovancev M, Ralphs CS. Radius-ulna fracture repair Clin Tech Small Anim Pract 2004; 19: 128-133.
22. Weinstein J, Ralphs SC. External coaptation. Clin Tech Small Anim Pract 2004; 19: 98-104.
23. Nispet ÖH, Çaptug Ö, Bilgili H. Uzun kemik kırıkların- da sağaltım seçenekleri. Bölüm I: Bandajın endikasyonları, çesitleri ve temel uygulama prensip- leri. Veteriner Cerrahi Dergisi 2006; 13: 97-106.
24. Piermattei DL, Flo GL, DeCamp CE. Brinker, Piermattei and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair. 4th ed. Saunders Philadelphia 2006, pp 1-790.
25. Yurdakul M, Sağlam M. Kedi ve Köpeklerde Ekstremite Uzun Kemiklerinin Diyafizer Kırıklarının Sağaltımında Uygulanan Biyolojik Osteosentez Tek- niklerinin Klinik Değerlendirilmesi. Ankara Üniv Vet Fak Derg 2009; 56: 31-36.
26. Court-Brown CM. Intramedullary nailing of open tibial fractures. Curr Orthopaed 2003; 17: 161-166.
27. Necas A, Proks P, Urbanova L, et al. Radiographic assesment of implant failures 3.5 LCP vs. 4.5 LCP used for flexible bridging osteosynthesis of large segmental femoral diaphyseal defects in a miniature pig model. Acta Vet Brno 2010; 79: 599-606.
28. Johnson K. Locking plates-The ultimate implant? Vet Comp Orthop Traumatol 2009; 2: 1-2.
29. Mutlu Z, Özsoy S. Köpeklerin Ekstremitelerinde İlizarov Eksternal Fiksatör Uygulamaları Üzerine Klinik Çalışmalar. İstanbul Üniversitesi Veteriner Fakültesi Dergisi 2003; 29: 119-135.
30. Beck JA, Simpson DJ. Type 1-2 hybrid external fiksator with tied-in intramedullary pin for treating comminuted distal humeral fractures in a dog and a cat. Aust Vet J 1999; 77: 18-20.
31. Özak A, Yardımcı C, Nisbet HÖ, ve ark. Treatment of long bone fractures with acrylic external fixation in dogs and cats: retrospective study in 30 Cases (2006- 2008). Kafkas Univ Vet Fak Derg 2009; 15: 615-622.
32. Marcellin-Little DJ. External skelatal fixation. In: Slatter D (ed), Textbook of Small Animal Surgery, 3rd. ed. W.B. Saunders Philadelphia, 2003, pp 1818-1835.
33. Matthiesen DT. Fractures of the humerus. Vet Clin North Am Small Anim Pract 1992; 22: 121-133.
34. Owen MR, Langley Hobbs SJ, Moores AP, et al. Mandibular fracture repair in dogs and cats using epoxy resin and acrylic external skeletal fixation. Vet Comp Orthop Traumatol 2004; 17: 189–197.
35. Kraus KH, Toombs JP, Ness MG. External Fixsation in Small Animal Pratice. Blackwell, UK 2003; pp 1-215,
36. Stampley AR, Lawrence D. Acrylic external skeletal fixation in the treatment of complex mandibular fractures. Canine Pract 1993; 18: 15-19.
37. Toombs JP. Transarticular application of external skeletal fixation. Vet Clin North Am Small Anim Pract 1992; 22: 181-193.
38. Tomlinson JL, Constantinescu GN. Compendium of Continuing Education for the Practicing Veterinarian 1991; 3: 235.
39. McCartney W. Use of the modified acrylic external fixator in 54 dogs and 28 cats. Veterinary Record 1998; 143: 330-334.
40. Denny HR, Butterworth SJ. A Guide to Canine and Feline Orthopaedic Surgery 4th Ed. Blackwell United Kingdom 2006, pp 299-600.
41. Bergmann HM, Nolte I, Kramer S. Comparison of analgesic efficacy of preoperative or postoperative carprofen with or without preincisional mepivacaine epidural anesthesia in canine pelvic or femoral fracture repair. Vet Surg 2007; 36: 623–632.
42. Piermattei DL, Johnson KA. An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. Okumuş (4th ed) Çeviri: Okumuş Z, Kaya M. Ki- tap: Kedi ve Köpeklerde Kemik ve Eklemlere Cerrahi Yaklaşım Atlası. Medipres Matbaacılık, Malatya 2011; ss 149-390.
43. Fossum TW. Small Animal Surgery. 3rd ed. Elsevier Philadelphia, 2007; pp 1583-1883.
44. Endo K, Nakamura K, Maeda H, et al. Interlocking intramedullary nail method fort he treatment of femoral and tibial fractures in cats and small dogs. J Vet Med Sci 1998; 60: 119-122.
45. Çaptuğ Ö, Bilgili H. Treatment of long bone fractures by interlocking nailing fixation technique in 5 cats. Veteriner Cerrahi Dergisi 2006; 12: 36-44.
46. Hulse D, Hyman B. Biomechanics of fracture fixation failure. Vet Clin North Am Small Anim Pract 1991; 21: 647-668.
47. Johnston SA, Lancaster RL, Hubbard RP, et al. A biomechanical comparison of 7 hole 3,5 mm broad and 5 hole 4,5 mm narrow dynamic compression plates. Vet Surg 1991; 20: 235-239.
48. Bilgili H, Olcay B. Ilizarov’un sirküler eksternal fiksasyon sistemi: Bölüm 1. Sistemin tarihçesi, bölüm- leri, endikasyonları ve prensipleri. Veteriner Cerrahi Dergisi 1998; 4: 62-67.
49. Dudley M, Johnson AL, Olmstead M, et al. Open reduction and bone plate stabilization, compared with closed reduction and external fixation, for treatment of comminuted tibial fractures: 47 cases (1980-1995) in dogs. J Am Vet Assoc 1997; 211: 1008 -1012.
50. Gül NY. Köpeklerde Ortofiks Tipi Dinamik Aksiyal Eksternal Fiksatör İle Tibia Kırıklarının Onarımı. Doktora Tezi. Uludağ Üniversitesi Sağlık Bilimleri Enstitüsü, Bursa, 2003, ss 1-99.
51. Boothe HW, Tangner CH. Clinical application of Kirschner apparatus in long bone fractures. J Am Anim Hosp Assoc 1983; 19: 679-686.
52. Harari J. Complications of external skeletal fixation. Vet Clin North Am Small Anim Pract 1992; 22: 99- 107.
53. Hass B, Reichler IM, Montavon PM. Use of the tubular external fixator in the treatment of distal radial and ulnar fracture in small dogs and cats. A retrospective clinical study. Vet Comp Orthop Traumatol 2003; 3: 132-140.
54. Anderson GM, Lewis DD, Radasch RM, et al. Circular external skeletal fixation stabilization of antebrachial and crural fractures in 25 dogs. J Am Anim Hosp Assoc 2002; 39: 479-498.
55. Kraus KH, Wotton HM, Boudrieau RJ, et al. Type II eksternal fixation, using new clamps and positive profile threaded pins, for treatment of fractures of the radius and tibia in dogs. J Am Vet Med Assoc 1998; 212: 1267-1270.
56. Canpolat İ, Bulut S, Kılıç S, et al. Treatment of tibia and fibula fractures with full pin (bilateral) experimental external fixation method using acrylic, hard dental plaster and normal plaster in dogs. Turkish J Vet Surg 1997; 3: 14-18.
57. Canpolat İ, Bulut S, Kılıç S ve ark. Kırıkların yarım pin yöntemi uygulanarak akrilik barlı eksternal fiksasyonla sağaltımında pin ve vida kullanılmasının karşılaştırılması. Veteriner Cerrahi Dergisi 1997; 3: 32-36.
58. Chevalley F, Amsutz C, Bally A. Experimental study of external fixation of femoral fractures. Mechanical properties of different kinds of fixation. Clinical implications. Rev Chir Orthop Reparatrice Appar Mot 1992; 78: 423-429.
59. Gül NY, Yanık K. Management of tibial fractures with orthofix axial external skeletal fixator in 15 dogs. Vet Comp Orthop Traumatol 2006; 4(19): 228-235.
60. Egger EL. Instrumentation for external fixation. Vet Clin North Am Small Anim Pract 1992; 22: 19-43.
61. Bach AW, Hansen ST. Plates versus external fixation in severe open tibial shaft fractures. A randomized trial. Clin Orthopaedics 1989; 241: 89-94.
62. Özak A. Köpeklerin Antebrachium Kırıklarında Radius’un Osteosentezinde Dinamik Kompresyon Plağı (DCP) ve İntramedüllar Çivileme Yöntemi İle Sağlanan Sonuçların Karşılaştırmalı Değerlendirilme- si. Doktora Tezi. Ankara Üniversitesi Sağlık Bilimleri Enstitüsü, Ankara, 2000, ss 1-88.
63. Willson JW. Vasculary supply to normal bone and healing fractures. Semin Vet Med (Small Anim) 1991; 6: 26-38.
64. Olmstead ML. Complications of fractures repaired with plates and screws. Vet Clin North Am Small Anim Pract 1991; 21: 669-686.
65. Boudrieau RJ. Fractures of the Tibia and Fibula. In: Slatter D (Ed), Textbook of Small Animal Surgery, 3rd ed, WB Saunders, Philadelphia 2003, pp 2144-2157.
66. Nolte DM, Fusco JV, Peterson ME. Incidence of and predisposing factors for nonunion of fractures involving the appendicular skeleton in cats: 18 cases (1998-2002). J Am Vet Med Assoc 2005; 226: 77-82.
67. Johnson AL, Schaeffer DJ. Evolution of the treatment of canine radial and tibial fractures with external fixators. Vet Comp Orthop Traumal 2008; 21: 256- 261.