3/4/2014

Surgery in pet birds Part II Orthopedic surgery

Yvonne R.A. van Zeeland, DVM, PhD, MVR, Dip. ECZM (avian)
Division of Zoological Medicine, Utrecht University

Surgery in pet birds:

Part II Orthopedic surgery
Yvonne van Zeeland

Internacionalizace vukyveterinrnmedicnyjakocestanaevropsktrh
prce
projekt .CZ.1.07/2.2.00/28.0288

Division of Zoological Medicine

Department of Clinical Sciences of Companion Animals
Faculty of Veterinary Medicine, Utrecht University

Brno, Czech Republic

March 4, 2014

Introduction

Beak surgery

EAAV Madrid 2011

(Functional) anatomy of the avian skull and beak

Surgery of the beak

Common procedures

Congenital deformities

Correction of scissors beak

Thoracic & pelvic limb surgery

Trans-sinus pinning

Bandaging techniques

Ramp prosthesis

Correction mandibular prognathism

Fracture repair

Scaffolding

Bumblefoot

Beak prosthesis

Form & function the beak

EAAV Madrid 2011

Basic anatomy similar in most species

Congenital deformities
Mostly seen in juvenile birds, occasionally adults

Species-specific differences in shape are related to the diet

Beak
Upper mandible or bill
(Pre)maxillary, nasal bones
Lower mandible or bill
Two rostrally fused rami
Composed of keratin, dermis, bone

Beak movement via prokinesis, rhynchokinesis

Parrots have a craniofacial hinge (synovial joint)

Scissors beak deformity

Mandibular prognatism

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Scissors Beak Deformity

Scissors beak deformity

Progressive, asymmetric beak growth

Delayed on one side vs. other
Trauma, bruising of the rictal edges

Causes may include

Handfeeding technique
Incubation flaws
Genetics
Malnutrition
Infections (sinusitis)
Trauma

Options for intervention

EAAV Madrid 2011

Conservative treatment
Daily manual manipulation
Only effective if discovered in very early stages

Surgical intervention

Ramp prosthesis
Mainly in juvenile parrots
Ramp exerts an opposing
force to the scissors deformity

Ramp prosthesis

Fixed to the lower mandible

Trans-sinus pinning
Corrective dremmeling of overgrown keratin

Left in place for 2-3 weeks

Temporary relief, mainly in older birds

Technique
a.

Upper beak deviated to the right

Technique
a. Upper beak deviated to the right
b. Preparations for placing ramp
Corrective dremmeling of beak
Roughening of lower beak surface

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Technique

Technique

a. Upper beak deviated to the right

b. Preparations for placing ramp

a. Upper beak deviated to the right

b. Preparations for placing ramp

Corrective dremmeling of beak

Roughening of lower beak surface

Corrective dremmeling of beak

Roughening of lower beak surface

c.

Creation of a ramp on the right

Wire mesh foundation, cut and shaped
to fit over the entire mandible
Attached with 2 cerclage wires
Placement of layers of acrylics or
methacrylate to create a functional cap

c.

Creation of a ramp on the right

Wire mesh foundation, cut and shaped
to fit over the entire mandible
Attached with 2 cerclage wires
Placement of layers of acrylics or
methacrylate to create a functional cap

d. End result
Left in place for 2-3 weeks

Trans-sinus pinning
EAAV Madrid 2011

Tension band exerting lateral

pulling force to tip of beak
Fixed to IM pin driven through

Technique
a. Place IM pin transversely into
frontal bone

Start at side opposite of deviation

Correct insertion point

Just caudal to naso-frontal hinge
Caudal-ventral to the nares
Seat identically on opposite side

frontal bone
Left in place for 2-3 months
duration

Mainly subadult parrots of

larger species

Mandibular prognatism
Upper beak is placed inside lower beak => malocclusion
Most common in cockatoos
Causes similar to those described for scissors beak

b. Bend pin to 90 angle

Parallel to longitudinal axis of beak

c. Cut pin at length of upper beak

d. Curl or bend ends of the pin
e. Use rubber bands to apply
tension from pin to beak tip

Upper beak extension prosthesis

Application in young subadults
Prosthesis functionally
extends the upper beak
Prevents placement of the
upper into lower beak
Rapidly enables normal
occlusion and normalization of
range of motion

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Technique
Creation of a functional cap
Extending distally from cere
Encompassing pressure bearing
keratin at occlusal ledge of maxilla

Scaffolding
Primarily used in adult birds with marked deformities
Chronic deformities present
Hyperflexion of the nasal-frontal hinge,

Use acrylic/methacrylate products

caudal retraction of quadrate,

Lower mandible must not extend

out and beyond the prosthesis

hyperextended quadrate-mandibular joint

Tomium of gnathotheca should be

able of applying normal force at
occlusal ledge

Technique
Non-threaded IM pin placed
Similar to trans-sinus pinning

Bend pins close to their exit

symmetrically on both sides
Insert second S-shaped pin at
distal end of rhinotheca
Place rubber bands around hooks
of the transverse sinus pin and
ventral S-pin

Muscle contraction, range of motion

Lacking of significant lower mandibular deformities

Not recommended as a first-step intervention

Limb surgery
Treatment of common conditions
Fractures of the thoracic and pelvic limb
Pododermatitis or bumblefoot

Keep traction on band with sutures

Fractures
Long bones commonly involved
Thin cortices, little soft tissue

Most often trauma-related

Malnutrition, neoplasia, infection

Clinical signs
Wing droop, inability to fly
Lameness, unequal weight bearing

Note: connection to air sacs!

Radiographic evaluation

Initial therapeutic plan

ALWAYS stabilize the patient FIRST!!!
Stabilize the fracture (bandaging)
Provide analgesia
Carprofen 2 mg/kg q12h PO
Meloxicam 1.5 mg/kg q12h PO

Antibiotics indicated for open fractures

Adaptations to enclosure
Leg band removal

Collar to prevent damage?

Provide distraction with tapes

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Fracture repair

Methods of fracture repair

Principles of fracture repair & healing

Conservative treatment external coaptation

Prevent contamination, treat infections

Surgical (osteosynthesis)

Minimize soft tissue damage

Maintenance of form & function
Anatomic alignment
50% contact between fracture ends

Rigid stabilization
disturbance of callus formation
Neutralization of forces

Sheer

Bending

Rotation Compression

Bones heal quicker in birds compared to mammals

Fracture repair
External coaptation

Bandaging materials
Primary layer (dressing) = in contact with wound

Bandage

Non-adherent - Adherent - Occlusive dressings

Splint
Sling

Stabilization
Bending forces

Minimal stabilization

Torsional forces

Minimal stabilization

Axial loading

Poor stabilization

stability with splint

Bandaging materials
Secondary layer = support and/or absorption
Artiflex

Bandaging materials
Splints = provide extra stability
Articast Cellacast Vet-lite

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Bandaging materials

Wing bandaging techniques

Tertiary layer = outer covering layer

Figure-of-eight bandage
&
Body-wrap

Vetrap Elastikon

Leg bandages
Femur difficult!
Schroeder Thomas splint

Leg bandages
Tibiotarsus - difficult
Robert Jones bandage

Spica splint

Leg bandages
Tarsometatarsus
Metatarsal bandage
Tape splint

Leg bandages
Metatarsal bandage
&
Ball bandage

Useful in smaller birds

A ball bandage is used to stabilize the toes

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Ball bandage
The different layers of a ball bandage

Fracture repair
Surgical (osteosynthesis)
Internal fixation
External fixation

Stabilization
Bending forces

Very good stabilization

Torsional forces

Depending on the type of fixation:

IM Pin

Poor stabilization

KE & Plates

Axial loading

Fracture repair
Surgical (osteosynthesis)

Very good stabilization

Depending on the type:

IM Pin

Poor stabilization

KE & Plates

Very good stabilization

Osteosynthesis
Intramedullary (IM) pins
Kirschner Pin

Intramedullary pins
Bone plating
External fixation

Cerclage wire can be used

Type I, II, III

The combination with a Type-1

Combination IM-EF (tie-in)

KE-Fixator (Tie-in) is also possible

Osteosynthesis
Intramedullary (IM) pins

A wire is threaded through the

polypropylene pin

Kirschner Pin
Shuttle Pin

Osteosynthesis
Intramedullary (IM) pins
Kirschner Pin

This pin is then inserted into

the bone shaft

The pin can be inserted into the other

shaft by pulling on the wire

Shuttle Pin

It is possible to place an external

fixator through the Shuttle Pin

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Osteosynthesis
Intramedullary (IM) pins

Osteosynthesis
Intramedullary (IM) pins

Kirschner Pin

Plate osteosynthesis

Shuttle Pin

External fixator

Plate osteosynthesis

Type-I

FESSA

Unilateral fixation = Type I

Osteosynthesis

Osteosynthesis

Intramedullary (IM) pins

Intramedullary (IM) pins

Plate osteosynthesis

Plate osteosynthesis

External fixator

External fixator

Type-I

Type-I

Type-II

Type-II

Uncertain if this
technique is
used in birds

Type-III
= a combination of
Type-I and Type-II

Bilateral fixation = Type II

Osteosynthesis

Osteosynthesis

Fractures

Fractures

Wing

Femur

Humerus
Radius & ulna
Not enough room for a Type-II K-E

Not enough room for a Type-II K-E

A Type-I K-E or EF-IM tie-in

are possible

A Type-I K-E or tie-in are possible

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Osteosynthesis

Osteosynthesis

Fractures

Fractures

Femur

Femur
Tibiotarsus

Not enough room for a Type-II K-E

A Type-I K-E or tie-in are possible

A Type-I K-E is possible, but is not

as stable as a Type-II KE

When the bone is big enough, a plate

osteosynthesis gives the best results

When using a Type-I KE it is

recommended to use threaded pins

Osteosynthesis

Osteosynthesis

Fractures

Fractures

Femur

Femur

Tibiotarsus

Tibiotarsus

A Type-II KE results in a good outcome and

may be used simultaneously on two legs

A Type-II KE results in a good outcome and

may be used simultaneously on two legs
The KE-osteosynthesis can be
combined with an IM pin

Type-2 KE Osteosynthesis

Type-2 KE Osteosynthesis

Example case
Hawk
Female
1.5 years old

Fractured
left tibiotarsus
due to trauma

A closed reduction was performed in this bird

Anterior-Posterior

Lateral

Two Kirschner pins were placed and three Kirschner pins were
in the proximal fragment
placed in the distal fragment

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Type-2 KE Osteosynthesis

The pins are bent parallel to the limb

Type-2 KE Osteosynthesis

ESF Putty (Epoxy resin) is placed around the pins

Type-2 KE Osteosynthesis

The pins on the other side are bent in a similar fashion

Type-2 KE Osteosynthesis

The pins are bent parallel to the limb

Type-2 KE Osteosynthesis

ESF Putty from Veterinary Instrumentation

Type-2 KE Osteosynthesis

ESF-Putty is also applied on the other side

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Type-2 KE Osteosynthesis

Type-2 KE Osteosynthesis

A pressure bandage is applied between the leg and the fixator

Post operative radiographs were made a day later

Bumblefoot

Bumblefoot
Five stages

Condition comparable to a bedsore

Stage I

Hyperemia and slight sloughing of the skin

Etiology
Obesity
Lack of excercise
Contact with rough surfaces
Too smooth perches

Bumblefoot

Bumblefoot

Five stages
Stage I
Hyperemia and slight sloughing of the skin

Stage II
Inflammation with crusts
and slight thickening

Five stages
Stage I
Hyperemia and slight sloughing of the skin

Stage II
Inflammation with crusts and slight thickening

Stage III
Abscess with obvious
inflammation, including
thickening and pain

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Bumblefoot

Bumblefoot

Five stages
Stage I

Five stages
Stage I

Hyperemia and slight sloughing of the skin

Stage II

Hyperemia and slight sloughing of the skin

Stage II

Inflammation with crusts and slight thickening

Stage III

Inflammation with crusts and slight thickening

Stage III

Abscess with obvious inflammation, incl. thickening and pain

Stage IV

Abscess with obvious inflammation, incl. thickening and pain

Stage IV

Deeper structures involved,

but foot function retained

Deeper structures involved, but foot function retained

Stage V
Involvement of deeper structures, loss of function

Bumblefoot
Treatment
Donut bandage to decrease pressure on foot

Bumblefoot
Treatment
Bandage to decrease pressure
A doughnut bandage

Antibiotics (often associated with Staphylococcus aureus)

Amoxicillin with clavulanic acid
TID 100 mg/kg oral; or
BID 125 mg/kg oral

Surgery required in severe cases

Pressure transferred to toes, evenly divided

Bumblefoot
Treatment
Bandage to decrease pressure
A doughnut bandage

Antibiotics (often associated with Staphylococcus aureus)

Amoxicillin with clavulanic acid
TID 100 mg/kg oral; or
BID 125 mg/kg oral

Bumblefoot
Treatment
Bandage to decrease pressure
A doughnut bandage

Antibiotics (often associated with Staphylococcus aureus)

Amoxicillin with clavulanic acid
TID 100 mg/kg oral; or
BID 125 mg/kg oral

Surgery required in severe cases

Surgery required in severe cases

Promote circulation

Promote circulation
Provide perches with variable diameters

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Questions???

Thank you for your attention!

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