TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

Teknik Operasi Fraktur Radius Ulna

Oleh :
Kelompok
A3
Dwi Arso Purba 1509005047

Ni Made Hani Pujaswarini 1509005056

Ni Ketut Mega Hendrayanti 1509005057

Brigita Galilea Adu 1509005058

Muhamad Alfian Dinika 1509005078

2015 A

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
2018
 RINGKASAN

Perlu diketahui bahwa fraktur adalah gangguan kontinuitas tulang dengan atau tanpa
perubahan letak fragmen tulang yang mengakibatkan tulang yang menderita tersebut
kehilangan kontinuitasnya atau keseimbangannya. Fraktur sering diikuti oleh kerusakan
jaringan lunak dengan berbagai macam derajat, mengenai pembuluh darah, otot dan
persarafan. Terdapat berbagai jenis fraktur tergantung dari lokasi yang mengalami
diskontinuitasnya tersebut. Fraktura adalah patah atau ruptur kontinuitas struktur dari
tulang atau cartilago dengan atau tanpa disertai dislokasio fragmen. Fraktur os radius
dan fraktus os ulna adalah trauma yang terjadi pada bagian tungkai depan. Penyebab
utama dari fraktur adalah faktor ektrinsik dan intrinsic. Diagnosis yang dilakukan untuk
mengeidentifikasi fraktur os radius ulna yakni dengan cara klinikal presentasi, physical
examination findings, radiografi, dan laboratory findings. Untuk mengoptimalkan
penyembuhan, batasi pergerakan hewan serta control perubahan yang tejadi

SUMMARY

It should be noted that a fracture is a disruption of bone continuity with or without changes
in the location of bone fragments which results in the bone suffering from loss of
continuity or balance. Fractures are often followed by damage to soft tissue of various
degrees, regarding blood vessels, muscles and innervation. There are various types of
fractures depending on the location that experienced the discontinuity. Fracture is a
fracture or rupture of the continuity of the structure of the bone or cartilago with or without
a dislocated fragment. Os fracture os radius and fractus is trauma that occurs in the front
limb. The main causes of fractures are extrinsic and intrinsic factors. Diagnosis is done to
identify fractures of the ulna os, namely the clinical way of presentation, physical
examination findings, radiography, and laboratory findings. To optimize healing, limit the
movement of animals and control changes that occur

ii
 KATA PENGANTAR

Puji syukur kehadirat Tuhan Yang Maha Esa atas segala rahmatNYA
sehingga paper ini dapat tersusun hingga selesai. Tidak lupa kami juga
mengucapkan banyak terimakasih atas bantuan dari pihak yang telah
berkontribusi dengan memberikan sumbangan baik materi maupun pikirannya.
Dan harapan kami semoga paper ini dapat menambah pengetahuan dan
pengalaman bagi para pembaca.
Karena keterbatasan pengetahuan maupun pengalaman kami, kami yakin
masih banyak kekurangan dalam paper ini, Oleh karena itu kami sangat
mengharapkan saran dan kritik yang membangun dari pembaca demi
kesempurnaan paper ini.

Denpasar, 13 November 2018

Penulis

iii
 DAFTAR ISI
HALAMAN JUDUL ................................................................................................................................ i
RINGKASAN............................................................................................................................................. ii

KATA PENGANTAR ............................................................................................................................. iii

DAFTAR ISI............................................................................................................................................... iv
DAFTAR GAMBAR................................................................................................................................ v
BAB I PENDAHULUAN ....................................................................................................................... 1
1.1 Latar Belakang ......................................................................................................................... 1
1.2 Rumusan Masalah ................................................................................................................... 2
1.3 Tujuan......................................................................................................................................... 2
1.4 Manfaat ...................................................................................................................................... 2
BAB II TINJAUAN PUSTAKA........................................................................................................... 3
2.1 Definisi Fraktur ...................................................................................................................... 3
2.2 Definisi Fraktur Os Radius/Ulna ....................................................................................... 3
2.3 Fraktur Proksimal Ulnar ....................................................................................................... 4
2.4 Fraktur Kepala Radial ............................................................................................................ 5
2.5 Fraktur Diaphyseal ................................................................................................................. 6
2.6 Fraktur Diaphyseal Distal ..................................................................................................... 7
2.7 Ulnar Styloid Process Fractures ........................................................................................ 7
2.8 Radial Fracture Process Styloid .......................................................................................... 7

BAB III PEMBAHASAN ....................................................................................................................... 8

3.1 Pra Operasi ................................................................................................................................ 7
3.2 Penanganan Fraktur ................................................................................................................ 10
3.3 Pasca Operasi ........................................................................................................................... 15

BAB IV PENUTUP .................................................................................................................................. 17

4.1 Kesimpulan ............................................................................................................................... 17

DAFTAR PUSTAKA .............................................................................................................................. 18

iv
 DAFTAR GAMBAR

Gambar 1 Penanganan fraktur olecranon dengan bone plate.......................................................4

Gambar 2 Penanganan Fraktur pada olecranon dengan band wire ............................................5
Gambar 3 Penanganan Fraktur Radial ................................................................................................6
Gambar 4 Penanganan Fraktur Radial ................................................................................................7
Gambar 5 Fraktur terbuka………………………………………………………………..12
Gambar 6 Penggunaan pelat tulang dan Screw……………………………………………...13

v
 BAB I
PENDAHULUAN

1.1 Latar Belakang

Fraktur adalah terputusnya kontinuitas tulang dan ditentukan sesuai jenis dan
luasnya. Fraktur sering diikuti oleh kerusakan jaringan lunak dengan berbagai
macam derajat, mengenai pembuluh darah, otot dan persarafan. Terdapat berbagai
jenis fraktur tergantung dari lokasi yang mengalami diskontinuitasnya tersebut.
Contohnya fraktur pada os radius ulna. Os radius ulna merupakan bagian dari
ekstremitas cranial atau kaki depan. Secara fisiologis, extremitas memiliki fungsi
sebagai alat gerak. Jika terdapat keabnormalan pada alat gerak hewan, secara
langsung hewan akan mengalami kelainan yang harus segera ditangani.
Radius adalah tulang di sisi lateral lengan bawah merupakan tulang pipa
dengan sebuah batang dan dua ujung dan lebih pendek dari tulang ulna. Ujung
atas radius kecil dan memperlihatkan kepala berbentuk kancing dengan
permukaan dangkal yang bersendi dengan tuberositas dari humerus. Sisi-sisi
kepala radius bersendi dengan takik radial dari ulna. Di bawah kepala terletak
leher dan di bawah serta di sebelah medial dari leher ada tuberositas radii, yang
dikaitkan pada tendon dan insersi otot bisep.
Batang radius. Di sebelah atas batangnya lebih sempit dan lebih bundar
daripada di bawah dan melebar makin mendekati ujung bawah. Batangnya
melengkung ke sebelah luar dan terbagi dalam beberapa permukaan, yang seperti
pada ulna memberi kaitan kepada radius tersebut.
Ujung bawah agak berbentuk segiempat dan masuk dalam formasi dua
buah sendi. Persendian inferior dari ujung bawah radius berbendi dengan ska foid
dan tulang semilunar dalam formasi persendian pergelangan kaki depan.
Permukaan persendian di sebelah medial dari yang bawah bersendi dengan kepala
dari ulna dalam formasi persendian radio-ulna inferior. Sebelah lateral dari ujung
bawah diperpanjang ke bawah menjadi prosesus stiloid radius.

1
 Fungsi dari tulang pada lengan bawah atau tulaang radius adalah untuk
ekstensor dan flexor harus dipertahankan dengan menjaga posisi dan kesejajaran
anatomik yang baik.
Fraktur tulang radius dan tulang ulna merupakan merupakan trauma yang
terjadi pada bagian tungkai depan. Kadang kala sering terjadi fraktur yang
terbuka, hal ini sering terjadi karena trauma terjadi pada lapisan jaringan yang
tipis dan lembut. Fraktur dapat disebabkan oleh pukulan langsung, gaya
meremuk, gerakan puntir mendadak dan kontraksi otot yang ekstrim. Patah tulang
mempengaruhi jaringan sekitarnya mengakibatkan oedema jaringan lunak,
perdarahan ke otot dan sendi, dislokasi sendi, ruptur tendon, kerusakan saraf dan
pembuluh darah. Salah satu cara untuk mengatasi fraktur pada os radius dan os
ulna adalah dengan tindakan operasi. Oleh sebab itu penulis akan membahas
lebih lanjut tentang teknik operasi os radius dan os ulna pada paper ini.

1.2 Rumusan Masalah

1. Apa yang perlu dipersiapkan dalam tindakan pre operasi fraktur os radius ulna?
2. Bagaimana teknik operasi fraktur os radius ulna?
3. Bagaimana perawatan pasca operasi fraktur os radius ulna?

1.3 Tujuan
1. Untuk mengetahui apa yang perlu dipersiapkan dalam tindakan pre operasi
fraktur os radius ulna.
2. Untuk mengetahui teknik operasi fraktur os radius ulna
3. Untuk mengetahui perawatan pasca operasi fraktur os radius ulna.

1.4 Manfaat
Melalui kajian materi dari paper ini, diharapkan mahasiswa mampu untuk
menangani dan menguasai teknik operasi fraktur os radius ulna pada hewan dan
mengaplikasikan ilmunya di lapangan.

2
 BAB II

TINJAUAN PUSTAKA

2.1 Definisi Fraktur

Fraktur atau patah tulang adalah kerusakan jaringan tulang yang berakibat
tulang yang menderita tersebut kehilangan kesinambungan. Fraktur sering diikuti oleh
kerusakan jaringan lunak dengan berbagai macam derajat, mengenai pembuluh darah,
otot dan persyarafan. Fraktur disebabkan oleh suatu trauma atau ruda paksa yang
berasal dari luar tubuh, namun ada pula yang disebabkan oleh suatu penyakit.

Fraktur dibagi atas dua jenis, yaitu fraktur komplit dan fraktur inkomplit.
Fraktur komplit merupakan patah atau diskontinuitas jaringan tulang yang luas
sehingga tulang terbagi menjadi 2 bagian atau garis patah menyeberang dari satu sisi
kesisi lain serta mengenai seluruh korteks. Sedangkan, fraktur inkomplit merupakan
patah atau diskontinuitas jaringan tulang dengan garis patah tidak menyeberang,
sehingga tidak mengenai korteks (kortek masi atau dalam keadaan utuh).

2.2 Definisi Fraktur Os Radius-Os Ulna

Fraktur os radius dan fraktus os ulna adalah trauma yang terjadi pada bagian
extremitas cranial pada os antebrachium. Fraktur os radius dan os ulna sering terjadi
pada hewan kucing dan anjing. Ketika hanya satu tulang dalam antebrachium yang
mempengaruhi tulang yang tersisa dapat bertindak sebagai belat internal, sering
memungkinkan stabilisasi bedah untuk dihindari. Namun, lebih sering kedua tulang
patah dan dalam kebanyakan situasi, ini mengarah pada rekomendasi untuk stabilisasi
bedah. Beberapa metode perbaikan fraktur cocok dalam situasi ini, termasuk fiksasi
eksternal dan internal, meskipun anatomi radius membuat pemasangan pin
intramedulla (IM) tidak mungkin tanpa menyebabkan trauma yang signifikan pada
tulang rawan artikular. Fiksasi plat tulang, sekrup dan K-wires, external skeletal
fixators (ESF), penambatan intramedulla dari ulna dan aplikasi tension-band semua
mungkin.

3
2.3 Fraktur Proksimal Ulnar

Fraktur proksimal ulnar paling sering terlihat pada anjing muda dan biasanya
melibatkan olekranon. Meskipun beberapa pilihan pengobatan ada, pin dan fiksasi
tusuk kawat biasanya merupakan pengobatan pilihan. Dalam kasus pelat pertumbuhan
terbuka, kawat pita ketegangan harus dilepaskan 4 minggu pasca operasi untuk
menghindari penutupan prematur fisis. 2 kirschner wires (kwires) atau pin steinmann
dapat dibiarkan di tempat tambahan 4 hingga 6 minggu untuk memberikan stabilitas
lebih lanjut. Fraktur ulnaris proksimal dalam literatur manusia dan sering dilaporkan
sebagai fraktur di kepala radial, sering dilaporkan pada hewan kecil.

Gambar 1. Penanganan fraktur olecranon dengan bone plate

4
 Gambar 2. Penanganan Fraktur pada olecranon dengan band wire

2.4 Fraktur Kepala Radial

Fraktur kepala radial, yang cukup jarang, biasanya terjadi akibat trauma. Ini
sering melibatkan fraktur artikular, membutuhkan reduksi anatomi sempurna untuk
meminimalkan pembentukan penyakit sendi degeneratif. Ketika mengevaluasi

5
radiografi untuk fraktur kepala radial, penting untuk tidak mengacaukan tulang
ektopik kecil di sekitar kepala dengan fraktur. Radiografi ekstremitas kontralateral
berguna untuk perbandingan

2.5 Fraktur Diaphyseal

Diafisis adalah situs paling umum untuk fraktur radius dan ulna. Secara
khusus, sepertiga distal dari diafisis sering terlibat. Ini dianggap sebagai akibat dari
suplai darah yang buruk dan cakupan jaringan lunak minimal dari antebrachium
distal. Fraktur ulnar hampir selalu ditemukan bersamaan dengan fraktur radial. Anjing
jenis kecil sering menderita patah tulang karena mendarat di kaki depan mereka dari
ketinggian, seperti melompat dari lengan pemiliknya. Sebagai perbandingan, radius /
ulna fraktur pada anjing jenis besar biasanya dihasilkan dari trauma yang lebih parah,
seperti kecelakaan kendaraan. Pemindahan caudolateral dari fragmen distal paling
umum karena kontraksi otot fleksor antebrachium. Karena cakupan jaringan lunak
minimal, fraktur terbuka relatif umum. Rekomendasi perawatan tergantung pada
ukuran, usia, kondisi situs fraktur pasien, dan tingkat keparahan dan konfigurasi
fraktur itu sendiri. Pilihan klinis yang layak dibahas di bawah ini.

Gambar 3. Penanganan Fraktur Radial

6
2.6 Fraktur Diaphyseal Distal

Fraktur diaphyseal distal biasanya ditemukan pada anjing muda dan seringkali
incompleate. Karena pertumbuhan yang cepat dari hewan-hewan ini, koaptasi
eksternal sering dipilih sebagai metode fiksasi. Karena hewan muda cepat meletakkan
tulang baru, penerapan gips harus dilakukan sesegera mungkin setelah fraktur terjadi.
Sebuah gips silinder lengkap dapat diubah menjadi gaya clamshell untuk
mengakomodasi pertumbuhan hewan.

2.7 Ulnar Styloid Process Fractures

Fraktur proses styloid ulnaris sering incompleate dan tidak intra-artikular,

memungkinkan untuk koaptasi eksternal sebagai satu-satunya metode fiksasi. Jika
lengkap, fraktur membutuhkan fiksasi internal dengan kawat ketegangan untuk
menjaga stabilitas sendi lateral dan palmar carpal.

2.8 Radial Fraktur Proses Styloid

Fraktur prosessus styloid radial biasanya intra-artikular dan oleh karena itu,
membutuhkan keselarasan anatomi sempurna dan fiksasi internal. Fraktur ini juga
membahayakan stabilitas sendi medial. Fiksasi dilakukan menggunakan kawat
ketegangan atau sekrup lag.

Gambar 4. Fraktur pada styloid radial

7
 BAB III

PEMBAHASAN

3.1 Pra-Operasi

3.1.1 Persiapan alat dan obat

Berikut ini persiapan alat dan obat yang digunakan dalam operasi
fraktur radius ulna pada hewan :
 Bak instrument steril

 Surgery drape

 Kain kasa steril atau spons

 Blade dan scalpel

 Alat bedah mayor

 Pin

 Bone plate

 Screw

 External fixating rods &
clamps.

 Electric drill / bor tulang

 Benang non absorbable
dan absorbable

 Alcohol

 Yodium tincture

 Anastesi

 Antibiotic

 Anti inflamasi

8
3.1.2 Persiapan ruang operasi
Persiapan ruang operasi meliputi ruang operasi harus bersih,
lantai dan meja operasi hendaknya dibersihkan dan didesinfeksi, ruang
operasi hendaknya memiliki penerangan yang cukup.

3.1.3 Persiapan operator

Operator prosedur operasi, dapat memprediksi hal-hal yang akan
terjadi selama operasi, dapat memperkirakan hasil operasi, mencuci
tangan atau personal hygiene, serta harus siap fisik, mental, tenang dan
terampil

3.1.4 Persiapan pasien

Hewan yang hendak melakukan operasi fraktur sebaiknya
dilakukan terlebih dahulu pengecekan anamnesa, pemeriksaan fisik,
pemeriksaan laboratorium dan tentunya pemeriksaan radiografi. Bila
kondisi hewan dinyatakan normal atau sehat maka hewan dapat
dilakukan operasi. Namun, sebelum operasi, hewan terlebih dahulu
dipuasakan selama 12 jam.
Setelah itu dilakukan premedikasi dengan pemberian atropine
sulfat (0,02 – 0,04 ml/kgBB secara IM) dan di anestesi dengan
pemberian ketamine (ml/kgBB secara IM) dan xylazine (ml/kgBB
secara IM). Dan dilakukan maintenance dengan anestesi inhalasi seperti
isoflurane atau sevoflurane (2% - 3%).
Hewan diposisikan lateral atau dorsal recumbency, tergantung
pada preferensi dokter hewan dan daerah yang akan dioperasi
dibersihkan terlebih dahulu meliputi pencukuran rambut serta pemberian
yodium tincture kemudian dipasangi kain drape pada site operasi.

9
3.2 Penaganan Fraktur

3.2.1 Manajemen konservatif

Manajemen konservatif terdiri dari koaptasi eksternal ditambah dengan
pembatasan aktivitas yang ketat. Modalitas pengobatan ini dicadangkan untuk fraktur
yang baru-baru ini terjadi, tertutup, minimal sampai nondisplaced atau greenstrick
pada hewan yang belum matang sampai besar. Dibutuhkan cetakan gips khusus atau
thomas splint, dan prinsip umum koaksi eksternal berlaku. Yang paling penting,
sangat penting untuk melumpuhkan sendi siku dan karpal.3 Umumnya, setidaknya
50% tumpang tindih dari fragmen tulang pada pandangan radiografi ortogonal
diperlukan untuk penyembuhan tulang yang sukses terjadi. Ketika menerapkan gips,
anggota badan harus disimpan dalam posisi berjalan normal. Untuk menghindari
deformitas valgus, tempatkan hewan dalam posisi berbaring lateral dengan forelimb
bawah yang terkena dan dengan posisi varus yang sedikit

Eksternal coaptation fraktur antebrachial paling efektif untuk fraktur melintang

karena mereka menetralkan kekuatan lentur dengan sangat baik dan membantu
mengurangi kekuatan torsional. Namun, bentuk fiksasi ini sangat sedikit untuk
menghilangkan gaya tekan, geser, atau gaya tarik. Oleh karena itu, fraktur oblik dan
spiral sering gagal untuk sembuh dengan baik dengan koaptasi eksternal saja

Anjing kecil dan anjing toy breed bukanlah kandidat yang baik untuk koping
eksternal. Dilaporkan, hingga 83% dari fraktur radial pada anjing kecil dan anjing
mainan yang diperlakukan dengan kooperasi eksternal mengalami komplikasi
serius termasuk malunions dan nonunions. Ini terutama karena penurunan suplai
darah intraoseus ke sepertiga distal jari-jari. Anjing breed kecil menunjukkan
penurunan kepadatan vaskular dan arborisasi pembuluh darah di metafisis distal
dibandingkan dengan anjing breed sedang. Selain itu, ketidakstabilan
biomekanikal yang melekat karena ukuran tulang yang kecil dan orientasi miring
atau melintang pendek dari banyak fraktur memberikan kontribusi pada kesulitan
dalam mengelola radius distal dan fraktur ulna pada anjing kecil dan anjing mainan

10
3.2.2 Fiksasi internal

Semua fraktur yang tidak stabil dan fraktur paling stabil dari radius dan ulna
memberikan respons terbaik terhadap fiksasi internal. Setelah pengurangan fraktur
yang memadai tercapai, baik melalui teknik tertutup atau terbuka, metode fiksasi
internal harus dipilih. Dua metode yang umumnya direkomendasikan termasuk
fixator eksternal atau sekrup tulang dan pelat

Penempatan pin umumnya mengharuskan menginvasi sendi karpal atau siku,

menghasilkan perubahan degeneratif yang parah di masa depan dari sendi yang
terkena. Selain itu, rongga medular yang sempit dari jari-jari tidak memungkinkan
pemasangan pin intramedulla. Akhirnya, kelengkungan anterior jari-jari adalah
sedemikian rupa sehingga pin lurus sangat sulit untuk dilewati. Sebaliknya,
penambatan intramedulla dari ulna adalah pilihan yang layak dan praktis untuk
memberikan dukungan tambahan dari perbaikan radial. Pin didorong antegrade
dari permukaan proksimal dari olecranon distal sejauh mungkin tanpa menembus
korteks. Radiografi berguna dalam memperkirakan panjang dan diameter pin yang
tepat untuk tujuan ini.

3.2.3 Fixator Eksternal

Fixator eksternal adalah pilihan yang baik untuk dipertimbangkan pada fraktur
terbuka. Penggunaannya berpotensi menghindari invasi situs fraktur dan
memungkinkan untuk pengangkatan implan setelah penyembuhan selesai. Fiksator
eksternal dapat kurang menuntut secara teknis, lebih murah, berpotensi dapat
digunakan kembali, dan menyebabkan lebih sedikit kerusakan pada suplai darah
dan jaringan yang ada.

11
 Gambar5. Fraktur terbuka

3.2.4 Bone Plate and Screws

Penerapan sekrup tulang dan pelat untuk fraktur radial adalah metode fiksasi
yang dapat beradaptasi dan sangat stabil yang memungkinkan untuk segera menahan
beban (Gambar 5 dan 6). Metode fiksasi ini membutuhkan pendekatan bedah standar.
Kerugian dari pendekatan bedah adalah bahwa hal itu mengakibatkan beberapa
gangguan pasokan darah lokal, tetapi pendekatan ini bermanfaat karena

12
memfasilitasi pengurangan fragmen, aplikasi plat, dan memungkinkan penempatan
cangkok tulang cancellous autogenous.

Gambar 6. Penggunaan pelat tulang dan Screw

Pelat tulang diterapkan baik ke aspek canial atau medial dari radius. Pengecualian
untuk ini adalah fraktur radius proksimal, karena aspek medial tulang ini tidak cocok
untuk plating. Sekrup diterapkan dalam bidang medio-lateral secara signifikan lebih
kuat dari sekrup yang ditempatkan dalam bidang cranio-kaudal.

13
 Beberapa jenis pelat dapat digunakan. Fiksasi sementara sering dilakukan
sebelum penempatan plat dengan menggunakan kawat cerclage atau sekrup tulang.
Plat kompresi dinamis direkomendasikan untuk fraktur melintang. Fraktur oblik
atau spiral panjang dapat digunakan untuk menghindari sekrup atau fiksasi
cerclage dengan aplikasi plat netralisasi berikutnya. Fraktur berat yang parah dapat
diatasi dengan pelat penopang setelah tulang diatur kembali. Untuk fraktur yang
sangat distal, plat T berguna pada anjing kecil dan kucing, karena memungkinkan
penempatan 2 sekrup dalam bidang transversal.

Pilihan lain untuk anjing kecil adalah penggunaan pelat cuttable hewan. Pelat
ini memiliki keuntungan dari lubang yang berdekatan untuk memungkinkan
kekuatan memegang maksimal dalam fragmen tulang kecil dan dapat ditumpuk
untuk mengatasi fakta bahwa mereka lebih lemah dari pelat kompresi dinamis.

3.2.5 Teknik Operasi

Teknik operasi pada kejadian fraktur berbeda-beda tergantung dari jenis dan
letak fraktur. Jenis fraktur yang berbeda juga membutuhkan alat-alat fiksasi
fragmen tulang yang berlainan. Adapun beberapa alat fiksasi yang digunakan
yakni: wire, pin intramedular, sekrup tulang dan plate tulang.

Teknik operasi diawali dengan menyiapkan pasien dalam keadaan teranastesi,

kemudian cukur rambut disekitar daerah operasi. Lakukan insisi dengan
pendekatan yang berbeda tergantung dari jenis fraktur dan melakukan metode
fiksasi yang berbeda untuk jenis-jenis fraktur yang berlainan.

1. Pendekatan cranio-medial ke poros radius dilakukan. Kulit diinsisi dari

epikondilus medial humerus ke prosesus styloid radius.
2. Fasia subkutan diiris sepanjang garis yang sama. Sambil menghindari arteri
dan vena brakialis dan saraf median, fasia antebrachial mendalam diinsisi
antara otot pronator teres dan otot ekstensor karpi radialis.

14
 3. Ekstensor karpi radialis ditarik ke lateral, dan otot pronator dan supinator
diangkat untuk sepenuhnya mengekspos situs fraktur.
4. Beberapa pecahan tulang diidentifikasi.
5. Jika diperlukan penggunaan pin maka pin yang telah disesuaikan
panjangnya dengan panjang tulang, dimasukkan ke dalam rongga sumsum
patahan tulang bagian distal dari proximal, dan didorong terus hingga
menembus tulang-tulang persendian baris dorsal dalam keadaan flexio.
6. Patahan tulang bagian proximal kemudian ditekan bersamaan dengan fragmen
distal kembali ke tempatnya sambil mempertemukan ujung-ujung tulangnya.
7. Pin yang berada dalam rongga sumsum tulang bagian distal kemudian
didorong ke arah proximal sehingga memasuki rongga sumsum tulang bagian
proximal dan memfiksir kedua patahan tulang tersebut dalam keadaan seperti
tulang yang utuh.
8. Pemotongan pin dilakukan pada ujung pin bagian distal yang masih berada
diluar persendian sedernikian rupa sehingga apabila setelah dipotong ujung
pin bagian distal dapat tertanam dengan baik di dalam persendian.
9. Otot-otot yang terkuak dan fascia yang tergunting kemudian dijahit menjadi
satu dengan cat gut chromic, setelah sebelumnya dibersihkan dari gumpalan
darah sisa hematoma dan ditetesi dengan larutan Gentamycin 50. Kulit dan
lemak sub kutan dijahit dengan silk 3.5.
Perban kompresi ringan ditempatkan untuk 24 jam pertama pasca operasi untuk
mengurangi pembengkakan jaringan lunak.
3.3 Pasca Operasi

Setelah operasi dapat diberikan antibiotic berupa cefotoxime sodium dengan

dosis 20mg/kg berat badan secara intramuscular 2 kali sehari selama 1 minggu.
Terapi antibiotic dapat diperpanjang lebih dari 3 hingga 5 jika diperlukan. Dapat
diberikan juga meloxicam dengan dosis 0,2 mg/ kg berat badan secara
intramuscular selama 4 hari pasca operasi dan dapat diperpanjang 3-5 hari bila
diperlukan. Pemilik disarankan untuk memantau posisi hewan dan membatasi

15
pergerakannya selama 2 minngu pasca operasi. Evaluasi klinis dilakukan secara
rutin dilakukan untuk melihat tanda-tanda terjadinya pembengkakan, eksudasi,
dan stabilisasi fixator pada hewan. (Rao, J. R. et. al., 2017)

Setelah operasi dilakukan dapat diberikan antibiotic secara intramuscular 2

kali sehari selama 3 hari. Oleskan juga salep iodine dan bioplacenton setiap pagi
dan sore. Hewan sangat dianjurkan menggunakan Ellizabeth collar untuk
menghindari hewan menjilati bekas insisi operasi. Hewan juga diberikan
antiinflamasi.

Hewan diberi perlakuan dengan meletakan hewan yang sakit pada alas yang
empuk dan lembut dan dilakukan pembalutan tekan selama 3-10 hari untuk
menurunkan kebengkakan setelah operasi. Pastikan hewan tidak menggunakan
kaki yang telah dioperasi secara berlebihan dan tahan semua aktivitas selama
proses penyembuhan. Lakukan evaluasi rutin pada fraktur dengan menggunakan
gambaran radiografi setiap 3-4 minggu sampai fraktur mengalami persembuhan
atau dapat di ronsen setelah 2 bulan pasca operasi untuk melihat perkembangannya
dan plate dapat dilepas setahun kemudian pada hewan dewasa.

16
 BAB IV

PENUTUP

4.1 Simpulan
Perlu diketahui bahwa fraktur adalah gangguan kontinuitas tulang
dengan atau tanpa perubahan letak fragmen tulang yang mengakibatkan tulang
yang menderita tersebut kehilangan kontinuitasnya atau keseimbangannya.
Fraktur sering diikuti oleh kerusakan jaringan lunak dengan berbagai macam
derajat, mengenai pembuluh darah, otot dan persarafan.

Terdapat berbagai jenis fraktur tergantung dari lokasi yang mengalami

diskontinuitasnya tersebut. Fraktura adalah patah atau ruptur kontinuitas
struktur dari tulang atau cartilago dengan atau tanpa disertai dislokasio fragmen.
Fraktur os radius dan fraktus os ulna adalah trauma yang terjadi pada bagian
tungkai depan.

Penyebab utama dari fraktur adalah faktor ektrinsik dan intrinsic.

Diagnosis yang dilakukan untuk mengeidentifikasi fraktur os radius ulna yakni
dengan cara klinikal presentasi, physical examination findings, radiografi, dan
laboratory findings. Untuk mengoptimalkan penyembuhan, batasi pergerakan
hewan serta control perubahan yang tejadi.

17
 Daftar Pustaka

Bojrab, M.J et all. 2014. Current Techniques In Small Animal Surgery 5th
Edition. International Standard Book Number-13: 978-1-4987-1656-7
Boudrieau RJ. 2003. Fractures of the radius and ulna. In: Slatter S, editor Textbook of
Small Animal Surgery. 3rd edition. Philadelphia, PA: Saunders.
M. Milovancev & S.C. Ralph. 2004. Radius/Ulna Fracture Repair. Clin Tech Small
Anim Pract. 19:128-133 DOI: 10.1053/j.ctsap.2004.09.005
Rao, J. R., Kumar, V. G., Rao, T.M., Kumar, D. P., Reddy, K. C. S. 2017. Management
of radius-ulna and tibial diaphyseal fractures with type IIa external skeletal
fixation in dogs. The Pharma Innovation Journal 6(8): 372-376.

Sudisma, IGN. 2016. Ilmu Bedah Veteriner dan Teknik Operasi. Universitas Udayana

18
Lampiran

19

ISSN (E): 2277- 7695
ISSN (P): 2349-8242
NAAS Rating 2017: 5.03
TPI 2017; 6(8): 372-376
© 2017 TPI
www.thepharmajournal.com
Received: 03-06-2017
Accepted: 04-07-2017
J Radhakrishna Rao
Department of Veterinary
Surgery and Radiology, College
of Veterinary Science,
P. V. Narsimha Rao Telangana
Veterinary University,
Rajendranagar, Hyderabad,
India
V Gireesh Kumar
Department of Veterinary
Surgery and Radiology, College
of Veterinary Science,
P. V. Narsimha Rao Telangana
Veterinary University,
Rajendranagar, Hyderabad,
India
T Madhava Rao
Department of Veterinary
Surgery and Radiology, College
of Veterinary Science,
P. V. Narsimha Rao Telangana
Veterinary University,
Rajendranagar, Hyderabad,
India
D Pramod Kumar
Department of Veterinary
Surgery and Radiology, College
of Veterinary Science,
P. V. Narsimha Rao Telangana
Veterinary University,
Rajendranagar, Hyderabad,
India
K Chandra Shekar Reddy
Department of Veterinary
Surgery and Radiology, College
of Veterinary Science,
P. V. Narsimha Rao Telangana
Veterinary University,
Rajendranagar, Hyderabad,
India
Correspondence
J Radhakrishna Rao
Department of Veterinary
Surgery and Radiology, College
of Veterinary Science,
P. V. Narsimha Rao Telangana
Veterinary University,
Rajendranagar, Hyderabad,
India
The Pharma Innovation Journal 2017; 6(8): 372-376
Management of radius-ulna and tibial diaphyseal
fractures with type IIa external skeletal fixation in dogs
J Radhakrishna Rao, V Gireesh Kumar, T Madhava Rao, D Pramod
Kumar and K Chandra Shekar Reddy
Abstract
In this study Type IIa external skeletal fixation was applied to stabilize 5 radius-ulna fractures and 1
tibial fracture in dogs. Immediate postoperative radiographs revealed good alignment and apposition of
the fracture fragments in all the dogs. The mean time of sufficient callus formation was 54.33 ± 6.60
days. Postoperative radiographs showed restitution of cortico-medullary continuity by 40th to 55th
postoperative day in all the dogs. The complete weight bearing was ranging from 32nd - 90th
postoperative day. The fixator was found rigid and stable till the completion of bone healing in all the
dogs. The mean time of the fixator removal was 54.33 ± 6.60 days. Minor pin tract infection was noticed
in one dog which was managed by treatment. Type IIa external skeletal fixation was well suited for the
repair of radius-ulna and tibial diaphyseal fractures in dogs with a few negligible minor complications.
Keywords: type IIa external skeletal fixation, radius-ulna and tibial fractures, dogs.
Introduction
Radius-ulna and tibial fractures constitute 19% and 21.5% respectively of total long bone
fractures that occur in dogs [8]. Fractures radius-ulna and tibia cannot be stabilized by internal
fixation like IM pinning, as this technique may damage the joints associated with them [32,
33]
.There are difficulties in the management of fractures of radius-ulna and tibia with bone
plating as this technique requires lot of instrumentation, time consuming and are costly
procedures. That is why external skeletal fixation (ESF) is gaining importance in the treatment
of long bone fractures in dogs as it is easy to apply, cause minimal damage to the structures
associated with the fractured bone fragments, requires minimal equipment and leads to less
complications. External skeletal fixators further provide versatile rigid fixation, avoids metal
implants at the fracture site, allow easy access to the injured area for wound management and
is easily removed after healing is complete. ESF can be applied to stabilize closed, compound,
comminuted and infected fractures [4, 17] with minimal tissue disruption and can be used to
supplement other forms of internal fixation [11, 19, 26, 35]. ESF allows anatomical reconstruction
to the extent possible in severely comminuted and displaced diaphyseal fractures by preserving
the vascularity of the bone and facilitates biological osteosynthesis [3, 21, 29]. Most of the
components of ESF are reusable [3]. The aim of stabilization fractures is to accomplish fast
healing, early weight bearing and ambulation [2, 34].
Hence ESF can be used clinically to manage diaphyseal fractures of radius-ulna and tibia. The
objective of the present study was to evaluate the efficacy of Type IIa ESF in the repair of
radius-ulna and tibial diaphyseal fractures of dogs.
Materials and Methods
Six dogs of different breed, age, sex and body weights were presented to the Veterinary
Clinical Complex, with fractures of radius-ulna and tibia, were first examined as a clinically
and if any soft tissue injuries were present also recorded. The dogs were also observed for loss
of function, abnormal mobility, deformity or change in angulation of the affected limb, signs
of local swelling, pain and crepitation at the fracture site. Neurological status of the dog was
assessed and the dogs with neurological signs were excluded from the study.
The dogs were prepared aseptically for the surgery and general anaesthesia was induced with
Ketemine and Xylazine at the rate of 10 mg/ Kg and 1.0 mg/Kg body weight, respectively,
intramuscularly and the anaesthesia was maintained by giving incremental doses of Propofol at
the rate of 4 mg/Kg body weight intravenously.
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The Pharma Innovation Journal
In the present study, out of 6 dogs, Type IIa ESF was used in
5 cases of radius-ulna and 1 case of tibial fractures. Limited
open approach was used in 4 cases (radius-ulna 3 and tibia 1)
and closed approach used in two cases (radius-ulna fractures).
The dogs with radial and tibial fractures were positioned in
dorsal recumbency and the fractured limb was secured at the
paw with bandage cloth and was suspended from an
intravenous infusion stand. The limb was pulled up
sufficiently tight to allow the limb to be suspended by the
animal’s own weight to achieve indirect reduction of fracture
[12, 18]
. After reduction of the fracture fragments either by
limited open approach [20] or by closed approach [22], the
proximal and the distal most centrally threaded (Thread length
was 25 mm) positive profile full pins of 2-3 mm in diameter
were drilled first through both the cortices of bone and soft
tissues on both sides in craniomedial to caudolateral direction
of the limb in all the dogs [18, 31]. The connecting bars with
required number of clamps attached were fixed to the full pins
of on either side of the limb. Then the intermediate full pins
were drilled through the pre placed clamps in order to bring
the pins in alignment. The clamps were then tightened to fix
the full pins to the connecting bars. Clamps and connecting
bars were positioned close to the skin however far enough
away to allow for tissue swelling i.e., 10 mm. The
subcutaneous tissue was closed in a row of continuous sub-
cuticular sutures using 2-0 chromic catgut and the skin
incision was closed with a row of horizontal mattress sutures
of 1-0 synthetic poly amide. The excess size of pins and
connecting bars was cut with pin cutter (Fig.1). The same
technique applied in stabilization of a tibial fracture.
In the present study, cleaning with normal saline and dressing
of the pin and skin interface with 5% povidone iodine pads
was found effective in rendering the sites clean and sterile in
all the groups of dogs and Inj. cefotoxime Sodium1 was
administered at the rate of 20mg/kg body weight as
intramuscular injection twice daily for one week post
operatively. Antibiotic therapy was prolonged for 3 to 5 more
days whenever needed. Inj. meloxicam2 was administered at
the rate of 0.2 mg/ kg body weight as intramuscular injection
once daily pre operatively and post operatively for four days
and was prolonged for 3 to 5 more days whenever needed.
Owners were advised to monitor the position of construct and
to restrict the movement of the animal for 2 weeks after
surgery and then to allow leash walking.
Clinical evaluation was routinely carried out at periodical
intervals for the signs of swelling, exudation, weight bearing
and stability of the fixator in all the dogs. Radiographs were
obtained immediately after the Type IIa ESF of radius-ulna
and tibial diaphyseal fractures and on 15th, 30th, 45th and 60th
postoperative day and whenever possible on later dates, to
evaluate bone healing. The Type IIa ESF was removed as one
time removal after sufficient callus formation.
Results and Discussion
In this study Type IIa ESF was used in reduction of fracture
fragments in radius-ulna and tibial diaphyseal fractures in
dogs. Preoperative radiographs of the 6 dogs revealed
transverse fractures of radius- ulna in two dogs, comminuted
fractures of radius-ulna in three dogs and long oblique
fracture of tibia in one dog. All the dogs had closed fractures.
Craniomedial approach for radius-ulna and tibia, found
appropriate for the easy application of Type IIa ESF. Good
anatomical reduction was achieved through limited open
approach and hanging limb technique in 4 dogs, by applying
~ 373 ~
hanging limb alone in two dogs with comminuted fractures of
radius-ulna and by applying cerclage wire in 1 dog with long
oblique fracture [12]. Discharge from pins, decreased after few
days postoperatively. Tolerance and stability of the fixator
was good in all the dogs [9, 16, 36].
Taxim injection – Alkem laboratories Ltd. Mumbai. 2.
Melonex injection - Intas Pharmaceuticals Ltd. Ahmedabad.
Evaluation of immediate postoperative radiographs revealed
proper placement of the fixator, good alignment and
apposition of the fracture fragments (Fig.2, 3 and 4) in all the
dogs [14, 25, 31].
The dogs showed partial weight bearing from 3rd - 7th
postoperative day. Moderate limb usage was observed from
7th- 15th post-operative day. Complete weight bearing was
noticed from 32nd day onwards (Fig. 5). One dog with
comminuted radius-ulna fracture showed only partial weight
bearing till fixator removal. It showed complete limb usage 10
days after the removal of ESF. The mean time for complete
limb usage was 51.0±8.71day [15]. Table 1.
Fixator stability was good in all the dogs [5, 6, 19, 28, 36]. The
proximal most pin had become loose nonetheless this did not
affect the fixator’s rigidity.
Postoperative radiographs showed evidence of callus
formation from 15th post-operative day onwards. Gradual
decreasing of Fracture gap and the appearance of progressive
bridging callus with adequate radio-density and the margins
of fracture fragments becoming smooth were observed
radiographically on 30th and 45th post-operative day
respectively [3, 21, 22, 23, 25]. Fracture line disappeared and the
callus became radio-dense with distinct cortical margins was
evident by 60th post-operative day [1]. The fixator was
removed when enough bone callus was seen with sufficient
radio-density (Fig.6 and 7). The mean time of callus
formation was 54.33 ± 6.60. Slight osteolysis around
proximal pins was seen in one dog of group II and in one dog
[7]
.
The fixator was removed between 37 days to 80 days with
mean time of 54.33 ± 6.60 days table. 2. [13, 16, 19, 21, 24].
Ayyappan et al. [6], recorded the mean time for complete
removal of external fixator was 72 days in radius and 68 days
in tibia.
In present study, slight pin tract drainage was observed in all
the dogs for 2-5 days. Minor pin tract infection was noticed in
one dog which was managed by treatment [10, 16, 21, 24].
Conclusions
The Type IIa ESF was well tolerated by all the dogs and
showed remarkable improvement in limb function with good
fixator stability till the completion of bone healing. Use of
cerclage wiring improved the stability of the fracture
fragments in long oblique fracture of tibia in the study. The
Type IIa ESF can be considered for fracture stabilization of
radius-ulna and tibial diaphyseal fractures in dogs. This is a
biomechanically versatile technique and easy to apply, well
tolerated by the patient, easy to disassembly.
Acknowledgements
Authors are thankful to P. V. Narsimha Rao Telangana
Veterinary University, R'nagar, Hyderabad, India, for
providing necessary facilities to carry out this research work.
 
The Pharma Innovation Journal  
 

10th postoperative day

Radius-ulna Tibia
Fig 1: Immediate post-operative appearance of radius-ulna and tibia

30th postoperative day

Fig 5: Postoperative weight bearing in radius-ulna and tibial
fractures

Fig 2: Pre and post-operative radiographs of transverse fracture of

radius-ulna showing proper alignment

30 Post-operative day in group II

Note. Fracture gap, gradually decreasing and the appearance
of progressive bridging callus with adequate radio-density and
the margins of fracture fragments becoming smooth.
Fig 6: Progressive Bone Healing of Comminuted Radius-ulna
Fig 3: Pre and post-operative radiographs of transverse fracture of Fracture
radius-ulna showing proper alignment

Note. Fracture line disappeared and the callus became radio

dense with distinct cortical margins and distinct pin insertion
sites.
Fig.7: Before and after removal of fixator on 60th postoperative day
Fig.4: Post-operative radiographs of oblique tibial fracture showing in a radius-ulna fracture
proper alignment
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The Pharma Innovation Journal
 
Table 1: Table showing postoperative details of lameness score
Post-operative Weight Bearing at the end of
Case No. Pre-operative
1 Week 2 Week 4 Week 6 Week Full weight bearing observed
1. 1 2 2 3 4 45th day
2 1 2 2 2 2 90th day
3 1 2 2 2 4 60th day
4 1 2 3 3 4 37th day
5 1 2 3 3 4 32nd day
6 1 1 2 2 4 42nd day
Mean 1.0 ± 0.0 1.83±0.16 2.33±0.21 2.50±0.22 3.66±0.33 51.0±8.71day
1- No functional limb usage; limb carried most of the time, 2- Slight functional limb usage; limb carried during running but set down when
walking, 3- Moderate functional limb usage and partial weight bearing; lameness evident, 4- Complete, normal functional limb usage.

Table 2: Table showing time of removal of fixator
Case No. Days of ESF Removal
1 62
2 80
3 60
4 47
5 40
6 37
Mean 54.33±6.60
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Radius/Ulna Fracture Repair
Milan Milovancev, DVM* and S. Christopher Ralphs, DVM, DACVS†

Fractures of the radius and ulna are commonly encountered in the small animal population.
Diaphyseal fractures are the most common location and are often repaired with the use of
external fixators or a bone plate. Select patients, such as young large breed dogs, may be
managed with external coaptation. Extremely proximal and distal fractures require special
consideration, especially if articular involvement is present.
Clin Tech Small Anim Pract 19:128-133 © 2004 Elsevier Inc. All rights reserved.

KEYWORDS radius, ulna, fractures, orthopedics

F ractures of the radius and ulna occur relatively frequently

in the small animal population, representing 17 to 18%
of all fractures in dogs and cats.1 Depending on their location
and configuration, these fractures vary greatly in their treat-
ment complexity and potential outcomes.
Clinical Anatomy
The radius and ulna are the paired long bones of the antebra-
chium (Fig. 1). The radius is the main weight bearing bone of
the pair. Its proximal articulation at the elbow is with the
humerus via the articular fovea and the ulna via the ulnar
notch. The distal articulation at the carpus is primarily with
the radial carpal bone, the ulnar carpal bone to a lesser extent,
and the ulna laterally. The radial styloid process is important
because of its function as an attachment for the distal radial
collateral ligament, which provides medial carpal stability.2
The ulna, though not as significant in weight bearing, is an
important component of the antebrachium. Proximally, it
articulates with the humerus via the trochlear notch and the
radius via the radial notch. Its distal articulation is with the
ulnar and accessory carpal bones and radius. The olecranon
acts as a lever arm, serving as an attachment point for the
extensor muscles of forelimb: the triceps brachii, anconeus,
and tensor fasciae antebrachii caudally, and the flexor carpi
ulnaris medially. The ulnar styloid process is important be-
cause of its function as an attachment for both the ulnar
collateral and the palmar ulnocarpal ligaments that provide
lateral and palmar carpal stability, respectively.2
The distal two-thirds of antebrachium are largely uncov-
ered by any significant musculature. The major blood supply
to the radius and ulna is provided by the diaphyseal arteries,
*Veterinary Referral & Emergency Center, Norwalk, CT.
†Pittsburgh Veterinary Specialists, Pittsburgh, PA.
Address reprint requests to Milan Milovancev, DVM, Veterinary Referral &
Emergency Center, 123 West Cedar St., Norwalk, CT 06854. E-mail:
milo0010@hotmail.com
entering via the nutrient foramen. These arise as branches of
the palmar interosseous artery.3
There are a number of clinically relevant factors to con-
sider in radius/ulna fracture repair of the immature animal.
The distal physes of both bones are responsible for the ma-
jority of their bone length, approximately 60% and 85%,
respectively. The distal ulnar physis is cone shaped and con-
sequently prone to asymmetric damage by laterally applied
forces. Additionally, young animals may have contributing
blood supply from vessels in the pronator quadratus muscle
that originates between the radius and ulna on their medial
surfaces.2
Proximal Ulnar Fractures
Proximal ulnar fractures are most frequently seen in young
dogs and usually involve the olecranon. Although multiple
treatment options exist, pin and figure-of-eight tension band
wire fixation is usually the treatment of choice. In a young
animal with open growth plates, the tension band wire
should ideally be removed 4 weeks postoperatively to avoid
premature closure of the physis. The 2 Kirschner wires (K-
wires) or Steinmann pins can be left in place an additional 4
to 6 weeks to provide further stability. A proximal ulnar
fracture with concurrent luxation of the radial head, often
resulting from trauma to the caudal antebrachium, is referred
to as a Monteggia fracture in the human literature and has
been reported in the small animals.1
Radial Head Fractures
Radial head fractures, which are fairly uncommon, usually
occur secondary to trauma. These often involve articular frac-
tures, necessitating perfect anatomical reduction to minimize
formation of degenerative joint disease. When evaluating ra-
diographs for fractures of the radial head, it is important not
to confuse small, variably present, ectopic bones around the

128 1096-2867/04/$-see front matter © 2004 Elsevier Inc. All rights reserved.
doi:10.1053/j.ctsap.2004.09.005
Radius/ulna fracture repair
Figure 1 Schematic illustration of a normal radius and ulna.
head of the radius with fractures. Radiographs of the con-
tralateral limb are useful for comparison.1
Diaphyseal Fractures
The diaphysis is the most common site for fractures of the
radius and ulna. Specifically, the distal third of the diaphysis
is often involved. This is thought to be a result of poor blood
supply and the minimal soft tissue coverage of the distal
antebrachium. Ulnar fractures are almost always found con-
currently with radial fractures.1,4
Small breed dogs often suffer fractures because of landing
on their forelimbs from a height, such as jumping from their
owner’s arms. In comparison, radius/ulna fractures in the
large breed dog usually result from more severe trauma, such
as a vehicular accident. Caudolateral displacement of the dis-
tal fragment is most common because of contraction of the
flexor muscles of the antebrachium. Because of the minimal
soft tissue coverage, open fractures are relatively common.4
Treatment recommendations depend on the patient’s size,
age, condition of the fracture site, and the severity and con-
figuration of the fracture itself. Clinically viable options are
discussed below.
Conservative Management
Conservative management consists of external coaptation
coupled with strict activity restriction. This treatment modal-
ity is reserved for recent, closed, minimally to nondisplaced
or greenstrick fractures in immature medium to large breed
animals. A custom molded cylinder cast or Thomas splint is
129
recommended, and general principles of external coaption
apply. Most importantly, it is critical to immobilize the elbow
and carpal joints. Generally, at least a 50% overlap of the
bone fragments on orthogonal radiographic views is required
for successful bony healing to occur.1 When applying a cast,
the limb should be kept in a normal walking position. To
avoid a valgus deformity, place the animal in lateral recum-
bancy with the affected forelimb down and with a slight varus
position.
External coaptation of antebrachial fractures is most effec-
tive for transverse fractures because they neutralize bending
forces very well and help reduce torsional forces. However,
this form of fixation does very little to eliminate compressive,
shearing, or tensile forces. Therefore, oblique and spiral frac-
tures often fail to heal properly with external coaptation
alone.1
Small and toy breed dogs are not good candidates for ex-
ternal coaptation. Reportedly, up to 83% of radial fractures in
small and toy breed dogs treated with external coaptation
developed serious complications including malunions and
nonunions.5,6 This is primarily because of decreased in-
traosseous blood supply to the distal third of the radius.
Small breed dogs show decreased vascular density and ar-
borization of vessels in the distal metaphysis as compared
with medium breed dogs.7 Additionally, inherent biome-
chanical instability because of the small bone size and short
oblique or transverse orientation of many fractures contrib-
utes to the difficulty in managing distal radius and ulna frac-
tures in small and toy breed dogs.7-9
Internal Fixation
All unstable fractures and most stable fractures of the radius
and ulna respond best to internal fixation. Once adequate
fracture reduction is achieved, either via closed or open tech-
niques, an internal fixation method must be chosen. The 2
commonly recommended methods include either an external
fixator or bone screws and plate.
Smaller dogs require near anatomic reductions with ade-
quate stability to minimize chances of a malunion or non-
union. Generally, the larger the dog, the less need there is to
have perfect anatomical reduction of the fracture. Younger
animals with open physes will heal more completely than
mature animals.1,4
Intramedullary pinning of the radius is not feasible nor is it
recommended. Pin placement generally necessitates invad-
ing either the carpal or elbow joints, resulting in severe future
degenerative changes of the affected joint. Additionally, the
narrow medullary cavity of the radius does not lend itself to
the intramedullary pinning. Finally, the anterior curvature of
the radius is such that a straight pin is very difficult to pass. In
contrast, intramedullary pinning of the ulna is a feasible and
practical option for providing ancillary support of a radial
repair. The pin is driven antegrade from the proximal surface
of the olecranon distally as far as possible without penetrating
the cortex. Radiographs are useful in estimating proper pin
length and diameter for this purpose.10
External Fixators
External fixators are a good option to consider for open
fractures (Figs. 2-4). Their use potentially avoids invasion
130 M. Milovancev and S.C. Ralphs

rior curve of the radius often precludes their use and uni-
lateral pins may be substituted. Type Ia frames are applied
to the medial or craniomedial aspect of the radius to avoid
penetration of major muscle masses. Type II frames are
inherently stronger constructs, but require penetration of
muscle masses that may result in increased implant loos-
ening and morbidity. If additional rigidity is required, a
type III fixator may be considered.1,12 A recent study has
suggested that lower stiffness constructs (ie, type Ia or Ib
with or without an intramedullary pin) may be adequate
for fracture healing to occur in small to medium sized
patients.13
Circular external fixators are also an option but require
special tensioning equipment and careful presurgical con-
struction of rings based on radiographs. These constructs
allow for axial micromotion, which has been shown to pro-
mote bone healing. Anderson and coworkers reported good
long term results in a case series of 14 dogs with radius and
ulna fractures repaired using a circular external fixator, de-
spite a high incidence of complications during the recovery
period.14
Use of polymethylmethacrylate (PMMA) connecting bars
allow versatile placement of fixation pins, optimizing good
quality bone purchase without regard for clamp compatibil-
ity or uniplanar pin placement. These are particularly useful
in distal diaphyseal fractures in small breeds, in part because
of their low weight compared with traditional stainless steel
rods.
Complications associated with external skeletal fixation
include pin loosening, pin tract drainage, infection, valgus or
rotational malalignment, delayed union or nonunion, and
pin breakage.15

Figure 2 Preoperative lateral and cranial-caudal radiographs of com-

minuted, diaphyseal radius, and ulna fractures.

of the fracture site and allows for implant removal after

healing is complete. External fixators can be less techni-
cally demanding to place, less expensive, are potentially
re-usable, and cause less damage to the existing blood
supply and tissues.
It is important to note that closed reduction, although
preferred, can be challenging. Manual distraction of transfix-
ation pins, hanging the limb, and use of a fracture distractor
are all methods used to aid in closed reduction. If an open
approach is necessary, a minimal approach is made in an
attempt to preserve blood supply and avoid causing further
tissue trauma. A recent case series of 6 dogs with radius and
ulna fractures reports good results using closed reduction Figure 3 (A) Intraoperative lateral radiograph of the fracture in Fig.
and a very limited open approach with type II external fix- 2, showing temporary stabilization of transfixation pins with a stain-
ators and an ulnar intramedullary pin.11 less steel connecting bar to check fracture alignment and pin place-
Bilateral transfixation pins are preferred, but the ante- ment before placing (B) PMMA connecting bars.
Radius/ulna fracture repair 131

nuted fractures can be addressed with a buttress plate once

the bone is realigned. For extremely distal fractures, a T plate
is useful in small dogs and cats, as it allows placement of 2
screws in a transverse plane.1
Another option for small dogs is the use of veterinary cut-
table plates. These plates have the advantage of the holes
being close together to allow maximal holding power in small
bone fragments and can be stacked to overcome the fact that
they are weaker than dynamic compression plates.18
A recent study examined bone plate fixation of distal ra-
dius and ulna fractures in 22 small and miniature breed dogs
and found long term outcome to be generally favorable, with
owners reporting normal use of the limb in 11 dogs. An
occasional lameness was reported in 5 dogs, a moderate
lameness was evident in 1 dog, and 1 dog was nonweight
bearing while running.19
Stress protection induced osteopenia is often mentioned as
a concern with the use of bone plates, especially in small and

Figure 4 Follow up cranial-caudal radiograph of the fracture in Fig.

2, repaired using an external fixator with PMMA connecting bars,
showing bone healing with formation of a callus.

Bone Plate and Screws

Application of bone screws and plate for radial fractures is an
adaptable and very stable method of fixation allowing for
immediate weight bearing (Figs. 5 and 6). This method of
fixation requires a standard surgical approach. The disadvan-
tage of the surgical approach is that it results in some disrup-
tion of local blood supply, but the approach is beneficial
because it facilitates fragment reduction, plate application,
and allows placement of an autogenous cancellous bone
graft.
Bone plates are applied either to the cranial or medial
aspects of the radius (Fig. 7). Exceptions to this are fractures
of the proximal radius, as the medial aspect of this bone is not
suitable for plating.16 Screws applied in a medio-lateral plane
are significantly stronger than screws placed in a cranio-cau-
dal plane.17
Multiple types of plates may be used. Temporary fixation is
often achieved before plate placement with the use of cer-
clage wire or bone screws. A dynamic compression plate is
recommended for transverse fractures. Long oblique or spiral
fractures are amenable to lag screw or cerclage fixation with Figure 5 Preoperative lateral and cranial-caudal radiographs of com-
subsequent neutralization plate application. Severely commi- minuted, midshaft, diaphyseal radius, and ulna fractures.
132 M. Milovancev and S.C. Ralphs

Ulnar Styloid Process Fractures

Ulnar styloid process fractures are often incomplete and not
intra-articular, allowing for external coaptation as the sole
method of fixation. If complete, the fracture requires internal
fixation with a tension band wire to preserve lateral and pal-
mar carpal joint stability.1

Radial Styloid
Process Fractures
Radial styloid process fractures are usually intra-articular and
therefore, require perfect anatomical alignment and internal
fixation. These fractures also compromise medial joint stabil-
ity. Fixation is achieved using a tension band wire or lag
screws.1

Case Example 1
A 1.5-year-old female intact Doberman Pinscher presented
for evaluation of nonweightbearing lameness of the right
forelimb after being hit by a car. The dog had no prior ill-
nesses and was systemically stable. General physical exami-
nation was unremarkable. Orthopedic evaluation revealed
obvious pain and crepitance on manipulation of the right
antebrachium. A complete blood count, chemistry profile,
and thoracic radiographs were within normal limits. Radio-
graphs of the right antebrachium revealed a severely commi-
nuted midshaft diaphyseal fracture of the radius and ulna
(Fig. 5).
Surgery was performed to reduce and stabilize the fracture.

Figure 6 Postoperative lateral and cranial-caudal radiographs of the

fracture in Fig. 4, repaired with cerclage wire, bone screws, and a
bone plate.

toy breed dogs. However, Glennon and coworkers reported

no significant differences in radial cortical bone density be-
tween a plated limb and the contralateral limb of the same
dog, after taking into account the effect of the bone plate itself
on photodensitometry readings.20

Distal Diaphyseal Fractures

Distal diaphyseal fractures are commonly found in young
dogs and are often incomplete. Because of the rapid growth of
these animals, external coaptation is often chosen as the
method of fixation. Because young animals rapidly lay down
new bone, application of a cast should be performed as soon
as possible after a fracture occurs. Premature closure of the
physis on the affected forelimb is a concern. The cast should
be kept clean, dry, and regularly rechecked, including radio-
graphic evaluation for union. A complete cylindrical cast can
be converted to a clamshell style to accommodate for growth Figure 7 Schematic illustration of a standard cranial approach to the
of the animal.1 shaft of the radius.
Radius/ulna fracture repair
A cranio-medial approach to the shaft of the radius was per-
formed. The skin was incised from the medial epicondyle of
the humerus to the styloid process of the radius. Subcutane-
ous fascia was incised along the same line. While avoiding the
brachial artery and vein and median nerve, the deep antebra-
chial fasci was incised between the pronator teres muscle and
the extensor carpi radialis muscle. The extensor carpi radialis
was retracted laterally, and the pronator and supinator mus-
cles were elevated to fully expose the fracture site.
Multiple bone fragments were identified. Ancillary fixation
was achieved using surgical cerclage wire. Rigid fixation was
achieved using a 3.5-mm dynamic compression bone plate
applied in buttress fashion (Fig. 6). The deep fascial layer was
closed separately from the subcutaneous layer. Skin staples
were used to close the skin incision. The dog recovered from
anesthesia uneventfully.
A light compression bandage was placed for the first 24
hours postoperatively to reduce soft tissue swelling. The dog
was kept in the hospital 2 days postoperatively for recovery,
monitoring, and supportive care. She was discharged from
the hospital on oral antibiotics and nonsteroidal anti-inflam-
matory pain medications with instructions on strict activity
restriction for the subsequent 6 weeks. At a 6-month follow
up telephone conversation with the owner the dog was re-
portedly doing well with no evidence of lameness on the
affected limb.
An acceptable alternative method of fixation for this pa-
tient would have been an external fixator. The proximal and
distal fragments were both large enough to accommodate 3 to
4 transfixation pins each. An intramedullary pin could have
been placed in the ulna for additional stability. Bone screws
would have been an acceptable alternative to the surgical
cerclage wire that was used for temporary stabilization of
fracture fragments. External coaptation would not have been
a good option in this case because of the dog’s age and frac-
ture configuration.
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