TUGAS MATA KULIAH

ILMU BEDAH KHUSUS

JUDUL :
BEDAH ORTHOPEDI
“Teknik Operasi Fraktur Os Humerus”

Oleh : Kelas A Kelompok 2

Widihantoro Gunawan Putra 1409005013
Abdul Nafis 1409005015
Ni Made Ria Andini 1409005019
Thalia Carolina 1409005021
Gabriella Jenni Alfades Loa 1409005023

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN
UNIVERSITAS UDAYANA
DENPASAR
2017
 RINGKASAN

Paper ini menjelaskan tentang teknik operasi fraktur humerus. Metode

pengobatan dalam penanganan fraktur dilakukan dengan reposisi tanpa operasi,
reposisi dengan operasi dan amputasi. Teknik dan metode penangannya sangat
tergantung dari tingkat kerusakan yang dialami oleh tulang tersebut. Dalam
penatalaksanaan operasi ortophedi fraktur dikenal konsep 4 R yakni rekognisis,
reposisi, retensi dan rehabilitasi.Setelah operasi dilakukan berikan antibiotik
secara intramuskuler 2 kali sehari selama 3 hari. Oleskan juga salep iodine dan
bioplacenton setiap pagi dan sore. Usahakan hewan dijaga jangan sampai
menjilat insisi bekas operasi sehingga pemasangan elizabeth collar sangatlahh
dianjurkan.

Kata Kunci : Fraktur Humerus

ii
 SUMMARY

This paper describes the technique of humerus fracture surgery.

Methods of treatment in the treatment of fractures performed by repositioning
without surgery, repositioning with surgery and amputation. The technique and
method of handling depends on the extent of damage experienced by the bone.
In the operation of orthopedic fracture is known 4 R concept of rekognisis,
repositioning, retention and rehabilitation. After the operation, give antibiotics
intramuscularly 2 times a day for 3 days. Apply also iodine ointment and
bioplacenton every morning and afternoon. Keep the animals guarded not to
lick the incision of the surgery so that the installation of elizabeth collar is
highly recommended.

Keywords: Humerus Fracture

iii
 KATA PENGANTAR

Puji syukur penulis panjatkan atas karunia dan rahmat-Nya, sehingga

paper yang berjudul “Teknik Oprasi Fraktur Humerus”dapat terselesaikan tepat
pada waktunya.
Adapun paper ini merupakan tugas kelompokyang diberikan oleh dosen
mata kuliah Ilmu Bedah Khusus Veteriner Fakultas Kedokteran Hewan
Universitas Udayana kepada mahasiswa/mahasiswi dan disamping itu juga
sebagai wadah untuk meningkatkan kreatifitas mahasiswa/mahasiswi dan juga
untuk menambah wawasan mahasiswa/mahasiswi mengenai teknik
pembedahan. Tidak lupa penulis juga mengucapkan terima kasih kepada pihak-
pihak yang telah membantu dan membimbing penulis dalam pembuatan karya
tulis ini.
Penulis sadar bahwa paper ini belum bisa mencakup keseluruhan dari
materi yang dibahas dan yang dipertanyakan atau dibutuhkan oleh pihak terkait
sehingga belum mencapai kesempurnaan. Oleh karena itu penulis mohon maaf
baik dalam penyajian materi ataupun dalam penulisan dan hal-hal yang
menyangkut di dalamya. Penulis juga menerima kritik dan saran dari pembaca
demi kesempurnaan paper ini.

Denpasar, 18 Nopember 2017

Penulis

iv
 DAFTAR ISI

SAMPUL ................................................................................................................. i
RINGKASAN ........................................................................................................ ii
SUMMARY .......................................................................................................... iii
KATA PENGANTAR .......................................................................................... iv
DAFTAR ISI .......................................................................................................... v
DAFTAR GAMBAR ............................................................................................ vi
DAFTAR LAMPIRAN ....................................................................................... vii
BAB I PENDAHULUAN
1.1 Latar Belakang ............................................................................................ 1
1.2 Rumusan Masalah ....................................................................................... 2
BAB II TUJUAN DAN MANFAAT PENULISAN
2.1 Tujuan Penulisan ......................................................................................... 3
2.2 Manfaat Penulisan ....................................................................................... 3
BAB III TINJAUN PUSTAKA
3.1 PengertianFraktur ........................................................................................ 4
3.2 Penyebab Fraktur ........................................................................................ 5
3.3 Metode Pengobatan ..................................................................................... 5
3.4 Prinsip Operasi ............................................................................................ 6
3.5 Faktor yang Mempengaruhi Kesembuhan .................................................. 7
BAB IV PEMBAHASAN
4.1 Teknik Operasi ............................................................................................ 8
4.1.1 Persiapan Operasi Fraktur Humerus ................................................. 8
4.1.2 Teknik Operasi Fraktus Humerus ................................................... 11
4.1.3 Pasca Operasi Humerus .................................................................. 16
BAB V PENDAHULUAN
5.1 Simpulan ................................................................................................... 18
5.2 Saran .......................................................................................................... 18
DAFTAR PUSTAKA

v
 DAFTAR GAMBAR

Gambar 1. Cranial-caudal (A) and medial-lateral (a) radiographic views of a

normal humerus from a Great Dane ................................................................... 4
Gambar 2. A transverse midshaft fracture of the humerus (A,B) ........................... 4
Gambar 3. Skema terapi fraktur humerus ............................................................... 6
Gambar 4. Sekrup dan Plate .................................................................................... 9
Gambar 5. Pin intrameduler ................................................................................. 10
Gambar 6. Kirschner wire ..................................................................................... 10
Gambar 7. Contoh Fraktur Proksimal Os Humerus .............................................. 11
Gambar 8. Pendekatan insisi mencapai daerah proksimal Os Humerus ............... 12
Gambar 9. Pemasangan Intramedular Pin (IM Pin) .............................................. 12
Gambar 10. Contoh Fraktur Diaphyseal Os Femur .............................................. 13
Gambar 11. Pendekatan insisi mencapai bagian medial Os Humerus .................. 14
Gambar 12. Pemasangan sekrup dan plate ............................................................ 14
Gambar 13. Fraktur di bagian condyles ................................................................15
Gambar 14. Pendekatan insisi mencapai bagian medial condyles ........................16
Gambar 15. Pemasangan skrup tulang ..................................................................16

vi
 DAFTAR LAMPIRAN

1. Treatment of extremity fractures in dogs using external fixators with closed

reduction and limited open approach
2. Humeral condylar fractures and incomplete ossification of the humeral
condyle in dogs
3. Outpatient Treatment for Humeral Fractures in Five Calves

vii
 BAB I
PENDAHULUAN

1.1 Latar Belakang

Humerus adalah tulang lengan panjang yang kokoh, yang membentang
dari bahu ke siku. Anatomi humerus terutama terkait dengan poros, ujung atas
dan ujung bawah. Ujung atas membentuk sendi bahu bulat dan berartikulasi
dengan glenoid rongga. Ujung bawah tidak teratur dalam bentuk karena untuk
mendukung berbagai gerakan, seperti siku menekuk (fleksi), rotasi
(pronasi dan supinasi ).ujung bawah juga disebut kondilus humeri, berartikulasi
dengan radius tulang serta tulang ulna untuk membentuk sendi siku. Beberapa
otot-otot penting lengan berasal baik atau melampirkan pada poros tulang
humerus, seperti brachalis, trisep, dan sebagainya, yang memberikan gerakan
pada siku dan sendi bahu. Sebagai telah diketahui bahwa semua benda keras
mempunyai daya lentur, begitu pula tulang juga mempunyai daya lentur. Batas
lentur tulang tersebut apabila terlampaui maka akan terjadi patah tulang atau
fraktur. Daya lentur inilah yang membedakan tulang terhadap ketahanannya
pada masing-masing idividu. Pada umur tua kemungkinan mudah patah lebih
besar dibandingkan dengan muda. Fraktur juga dapat terjadi pada tulang
humerus. Fraktur tulang Humerus atau patah tulang humerus adalah cedera
yang sangatserius. Fraktur ini dikaitkan dengan beberapa komplikasi dan
bisa menjadi bencana jika tidak dikelola dengan baik.Kadang-kadang
juga disertai dengan dislokasi siku atau sendi bahu.
Metode pengobatan dalam penanganan fraktur dilakukan dengan
reposisi tanpa operasi, reposisi dengan operasi dan amputasi. Teknik dan
metode penangannya sangat tergantung dari tingkat kerusakan yang dialami
oleh tulang tersebut. Dalam penatalaksanaan operasi ortophedi fraktur dikenal
konsep 4 R yakni rekognisis, reposisi, retensi dan rehabilitasi.Rekognisi atau
pengenalan adalah melakukan berbagai diagnose yang benar sehingga akan
membant dalam penanganan fraktur karena perencanaan terapinya dapat
dipersiapkan lebih sempurna.Reposisi adalah tindakan mengembalikan kondisi
patah tersebut semirip mungkin dengan keadaan atau kedudukan semula.

1
 Retensi atau imobilisasi adalah tindakan mempertahankan fragmen tulang
tersebut agar proses penyembuhan berlangsung secara optimal.Rehabilitasi
merupakan tindakan dengan maksud agar bagian yang menderita tersebut dapat
kembali dengan normal.
Operasi bedah yang dilakukan akan mendapatkan hasil yang optimal
bila dilakukan berdasarkan cara kerja dan teknik terapi yang tepat dan selalu
berpegang teguh pada prinsip dasar pembedahan ortophedi. Operasi juga
diusahakan dengan penyembuhan yang relatif singkat dan timbulnya trauma
akibat pembedahan ditekan semaksimal mungkin. Maka dari itu penting untuk
diketahui teknik operasi fraktur khususnya humerus. Sehingga penulis menulis
paper ini dengan judul Teknik Operasi Fraktur Humerus

1.2 Rumusan Masalah

Berdasarkan latar belakang diatas, maka didapatkan rumusan masalah
bagaimanakah teknik operasi fraktur humerus.

2
 BAB II
TUJUAN DAN MANFAAT TULISAN

2.1 Tujuan Penulisan

Berdasarkan rumusan masalah yang ada, adapun tujuan dari penulisan
paper ini adalah untuk mengetahui teknik operasi humerus

2.2 Manfaat Penulisan

Berdasarkan tujuan diatas, adapun manfaat yang diperoleh dari
penulisan paper ini adalah sebagai berikut :
2.2.1 Manfaat teoritis
Penulis mengharapkan pembaca mampu memahami dan mengerti
mengenai teknik operasi fraktus humerus.
2.2.2 Manfaat empiris
Penulis berharap pembaca mampu nantinya menularkan kepada
masyarakat mengenai segala informasi tentang teknik operasi fraktur
humerus.

3
 BAB III
TINJAUN PUSTAKA

3.1 PengertianFraktur
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. Fraktur tulang Humerus atau
patah tulang humerus adalah cedera yang sangatserius.

Gambar 1. Cranial-caudal (A) and medial-lateral (a) radiographic views of a

normal humerus from a Great Dane
(sumber :http://cal.vet.upenn.edu)

Gambar 2. A transverse midshaft fracture of the humerus (A,B)

(sumber :http://cal.vet.upenn.edu)

4
3.2 Penyebab Fraktur
Secara umum penyebab fraktur dapat dibagi menjadi dua macam :
1. Penyebab ekstrinsik. Gangguan langsung misalnya yang diakibatkan oleh
trauma misalnya tertabrak, pemukulan atau jatuh dari ketinggian, gangguan
tidak langsung misalnya akibat dari perputaran.
2. Penyebab intrinsik. Kontraksi dari otot yang menyebabkan avulsion fraktur,
seperti fraktur yang sering terjadi pada hewan yang belum dewasa. Fraktur
patologis yang disebabkan oleh penyakit sistemik, seperti neoplasia, cyste
tulang, ricketsia, osteoporosis, hyperparatyroidism, osteomalacia.

3.3 Metode Pengobatan

Metode pengobatan dalam penanganan fraktur dapat dilakukan dengan:
1. Reposisi tanpa operasi (Pemasangan gips (gybsona), Spalk (upih), Thomas
Splint)
2. Reposisi dengan operasi (Kirschner wire, Bone plate, Bone pinning
(intermedullary pin), Prosthesis insertid (Stainles Steel Screw), Bone Wire,
Kombinasi dengan Metode 1 – 5)
3. Solusi Akhir (Amputasi)
Teknik dan metode penanganannya sangat tergantung dari tingkat
kerusakan yang dialami oleh tulang tersebut. Meskipun sangat banyak metode
yang dapat digunakan dalam usaha penanganan fraktur humerus, tindakan
medis yang paling banyak diberikan adalah bone pinning (intermedullary pin).

5
 Gambar 3. Skema terapi fraktur humerus
(sumber : Maaruf, Adrin. 2015)

3.4 Prinsip Operasi

Dalam penatalaksanaan operasi ortophedi fraktur dikenal konsep 4 R
yakni rekognisis, reposisi, retensi dan rehabilitasi.
1. Rekognisi atau pengenalan adalah melakukan berbagai diagnose yang benar
sehingga akan membant dalam penanganan fraktur karena perencanaan
terapinya dapat dipersiapkan lebih sempurna.
2. Reposisi adalah tindakan mengembalikan kondisi patah tersebut semirip
mungkin dengan keadaan atau kedudukan semula.
3. Retensi atau imobilisasi adalah tindakan mempertahankan fragmen tulang
tersebut agar proses penyembuhan berlangsung secara optimal.
4. Rehabilitasi merupakan tindakan dengan maksud agar bagian yang menderita
tersebut dapat kembali dengan normal
Operasi bedah yang dilakukan akan mendapatkan hasil yang optimal
bila dilakukan berdasarkan cara kerja dan teknik terapi yang tepat dan selalu
berpegang teguh pada prinsip dasar pembedahan ortophedi. Operasi juga
diusahakan dengan penyembuhan yang relatif singkat dan timbulnya trauma
akibat pembedahan ditekan semaksimal mungkin. Beberapa prinsip yang harus
dipegang pada reparasi tulang antara lain sebagai berikut :

6
 1. Suplai darah pada tulang dan fragmen tulang harus selalu diperhatikan dan
dilindungi dari trauma pembedahan.
2. Restorasi yang akurat dari bentuk tulang, khususnya pada daerah persendian.
3. Reposisi secara mekanik harus stabil fiksasinya.
4. Teknik yang dipaka diusahakan menimbulkan trauma yang minimal.
5. Rehabilitasi mutlak harus ada dan esensial. Rehabilitasi dimulai sedini
mugnkin setelah diberikan terapi definitive. Tujuannya adalah untuk
menyelamatkan fungsi selama patah tulang dalam penyembuhan dan
mengembalikan fungsi senormal dan secepat mungkin sesudah penyembuhan.

3.5 Faktor yang Mempengaruhi Kesembuhan

Terdapat beberapa faktor yang mempengaruhi kesembuhan patah tulang yakni :
1. Umur, pada usia muda kejadian fraktur lebih mudah sembuh daripada usia
tua.
2. Keadaan kesehatan umum.
3. Sifat fraktur, bila fraktur disertai kejaringan yang hebat maka
penyembuhannya akan menjadi lama, fraktur kominutiva akan memerlukan
waktu yang lebih lama.
4. Lokasi fraktur. Pada daerah yang vaskularisasinya jelek maka penyembuhan
akan lama dan lebih sulit. Sebagai contoh fraktur di caput femuris.
5. Ada atau tidaknya infeksi.
6. Jenis fraktur

7
 BAB IV
PEMBAHASAN

4.1 Teknik Operasi

4.1.1 Persiapan Operasi Fraktur Humerus
a. Persiapan Hewan
Diagnosis fraktur dilakukan dengan anamnesis, inspeksi,
pergerakan, pengukuran, palpasi dan pemeriksaan foto rontgent.
Anamnesis dilakukan untuk mengetahui fraktur, penyebab, kapan
terjadinya sehingga dapat membantu diagnosis. Inspeksi dilakukan dengan
seksama pada anggota gerak, apakah ada kepincangan, pembengkakan,
kekakuan gerak, perubahan warna, kebiruan, pucat dan
sebagainya. Pengukuran dilakukan dengan cara membandingkan bagian
kaki yang sehat dengan yang sakit, apakah terlihat simetris. Palpasi
dilakukan dengan cara yang hati–hati untuk mengetahui untuk mengetahui
adanya krepitasi, oedema, rasa sakit, dan lain-lain. Diagnosis paling tepat
adalah dengan foto rontgent. Pemotretan fraktur harus diambil dari 2 sisi
yang saling tegak lurus sehingga diperoleh gambaran kedudukan tulang
yang mengalami fraktur secara jelas sehingga akan membantu terapinya.
Dilanjutkan pemeriksaan kondisi tubuh hewan secara umum
meliputi: frekuensi pulsus, nafas, suhu tubuh, postur dan pemeriksaan
darah rutin. Hal ini dilakukan untuk mengetahui apakah anjing memenuhi
syarat operasi atau tidak. Anjing harus dipuasakan makan selama 12 jam
dan puasa minum selama 2 jam sebelum operasi dilakukan, dengan tujuan
agar kondisi usus dalam keadaan kosong sehingga anjing tidak muntah
dalam kondisi teranestesi.Bagian tubuh yang akan diincisi yaitu daerah
craniolateral dari humerus dibasahi dengan air sabun untuk memudahkan
pencukuran. Rambut anjing tersebut dicukur dengan menggunakan silet
yang tajam, dibersihkan dengan air, kemudian diolesi dengan yodium
tincture. Setelah itu, lakukan penimbangan berat badan anjing untuk
menentukan semua volume obat yang akan digunakan.

8
b. Persiapan Operator dan Co-Operator
Dokter hewan selaku operator dan pembantu operator sebelum dan
selama pelaksanaan operasi harus melakukan serangkain proses operasi
dalam kondisi steril. Operator dan pembantu operator mempersiapkan diri
dengan mencuci tangan dari ujung tangan sampai batas siku sebelum
operasi, menggunakan air sabun di bawah air bersih yang mengalir,
kemudian didesinfektan. Operator dan asistennya juga harus mengenakan
masker, sarung tangan steril, dan pakaian khusus operasi.
c. Persiapan Alat
Meja operasi harus dibersihkan dan disterilkan. Alat-alat operasi
dipersiapkan dalam keadaan steril dan diletakkan secara urut dan rapi pada
meja yang berdekatan dengan meja operasi. Alat-alat yang disiapkan
adalah stetoskop, termometer, alat pencukur, tali (handling), instrument
pembedahan standar, elevator periosteal, 2-3 forcep bone holder, alat
fiksasi (plates dan screw, wire atau pin), bor, currete (untuk
menghilangkan callus), jarum, benang jahit, tampón dan plester.

Gambar 4. Sekrup dan Plate

(sumber : Maaruf, Adrin. 2015)

9
 Gambar 5. Pin intrameduler
(sumber : Maaruf, Adrin. 2015)

Gambar 6. Kirschner wire

(sumber : Maaruf, Adrin. 2015)

d. Persiapan Obat-Obatan
Premedikasi yang digunakan yaitu Atropin sulfat 0,025% dengan
dosis 0,04 mg/kg BB secara subcutan. Untuk anestesi digunakan campuran
Xylazine 2% dosis 2 mg/kg BB dengan Ketamin HCL 10% dosis 15
mg/kg BB yang diberikan secara intramuskuler. Ampicillin 10% dengan
dosis 10 mg/kg BB juga perlu dipersiapkan.Pada hewan besar, terutama
kuda, anestesi dilakukan dua tahap, tahap pertama adalah pre anestesi
mempergunakan Acepromazine 1%, dosis 5 mg/50 kg BB, kemudian
dibiarkan beberapa saat hingga kuda tampak tenang dan mengalami
relaksasi. Tahap kedua adalah anestesi umum dengan mempergunakan
Hydras Chlorali 10 % dengan dosis 100 mg/kg BB

10
4.1.2 Teknik Operasi Fraktur Humerus
a. Operasi Frakktur Proksimal Os Humerus Komplit
• Hewan diberi anastesi
• Cukur rambut disekitar site operasi
• Insisi bagian kulit hingga nampak musculus bagian superfisial.
• Kuakkan musculus deltoideus pars acromialis dan musculus
brachiocephalicus.
• Lakukan insisi dibagian periosteal agar tulang yang mengalami fraktur
nampak.
• Lakukan fiksasi dengan memasang pin intramedular pada dimulai dari
tuberositas mayor hingga bagian medial dari condyles
• Setalah itu, lakukan jahitan antar muskulus dengan muskulus dengan
benang cat gut chromic ukuran 2/0 dengan pola jahitan sederhana
tunggal.
• Lakukan penjahitan subkutan dengan jahitan sederhana menerus
dengan benang cat gut plain ukuran 3/0.
• Lakukan penjahitan kulit dengan benang katún dengan pola sederhana
tunggal.
• Berikan iodium tincture pada daerah jahitan.
• Berikan antibiotik secara injeksi intramuskuler

Gambar 7. Contoh Fraktur Proksimal Os Humerus

(sumber : Maaruf, Adrin. 2015)

11
 Gambar 8. Pendekatan insisi mencapai daerah proksimal Os Humerus
(sumber : Maaruf, Adrin. 2015)

Gambar 9. Pemasangan Intramedular Pin (IM Pin)

(sumber : Maaruf, Adrin. 2015)

b. Operasi Fraktur Dhiapyseal Os Humerus

• Hewan diberi anastesi
• Cukur rambut disekitar site operasi

12
• Insisi bagian kulit dan otot superfisial dan kuakkan musculus bíceps
brachii dan musculus brachiocephalicus.
• Pasang sekrup di bagian medial fraktur
• Pasang plate dibagian proksimal dan os humerus dan sekrup plate
tersebut.
• Setalah itu, lakukan jahitan antar muskulus dengan muskulus dengan
benang cat gut chromic ukuran 2/0 dengan pola jahitan sederhana
tunggal.
• Lakukan penjahitan subkutan dengan jahitan sederhana menerus
dengan benang cat gut plain ukuran 3/0.
• Lakukan penjahitan kulit dengan benang katún dengan pola sederhana
tunggal.
• Berikan iodium tincture pada daerah jahitan.
• Berikan antibiotik secara injeksi intramuskuler.

Gambar 10. Contoh Fraktur Diaphyseal Os Femur

(sumber : Maaruf, Adrin. 2015)

13
 Gambar 11. Pendekatan insisi mencapai bagian medial Os Humerus
(sumber : Maaruf, Adrin. 2015)

Gambar 12. Pemasangan sekrup dan plate

(sumber : Maaruf, Adrin. 2015)

c. Fraktur dibagian Medial Condylus Os Humerus

Dengan stabilisasi awal, prognosis fraktur condylar lateral dan medial
umumnya baik. Dalam tinjauan dari 15 fraktur condylar yang diikuti

14
dengan rata-rata 43 bulan, semua siku yang terpengaruh mengembangkan
osteoarthritis pasca trauma (Moores, 2006).
• Hewan diberi anastesi
• Cukur rambut disekitar site operasi
• Insisi kulit hingga menemukan bagian otot superfisial di daerah dekat
medial condylus.
• Insisi beberapa otot superfisial dan kuakkan otot-otot didaerah
tersebut dengan memperhatikan nervus medial dan ulnar
• Lakukan pemasangan sekrup tulang dibagian condyles
• Setalah itu, lakukan jahitan antar muskulus dengan muskulus dengan
benang cat gut chromic ukuran 2/0 dengan pola jahitan sederhana
tunggal.
• Lakukan penjahitan subkutan dengan jahitan sederhana menerus
dengan benang cat gut plain ukuran 3/0.
• Lakukan penjahitan kulit dengan benang katún dengan pola sederhana
tunggal.
• Berikan iodium tincture pada daerah jahitan.
• Berikan antibiotik secara injeksi intramuskuler.

Gambar 13. Fraktur di bagian condyles

(sumber : Maaruf, Adrin. 2015)

15
 Gambar 14. Pendekatan insisi mencapai bagian medial condyles
(sumber : Maaruf, Adrin. 2015)

Gambar 15. Pemasangan skrup tulang

(sumber : Maaruf, Adrin. 2015)

4.1.3 Pasca Operasi Fraktur Humerus

Setelah operasi dilakukan berikan antibiotik secara intramuskuler 2 kali
sehari selama 3 hari. Oleskan juga salep iodine dan bioplacenton setiap pagi
dan sore. Usahakan hewan dijaga jangan sampai menjilat insisi bekas
operasi sehingga pemasangan elizabeth collar sangatlahh dianjurkan.
Resepkan antiinflamasi pada hewan. Pastikan hewan tidak menggunakan
daerah kaki yang telah dioperasi secara berlebihan. Lakukan ronsen dua

16
bulan setelah operasi untuk melihat perkembangannya dan plate dapat
dilepas setahun kemudian pada hewan dewasa.

17
 BAB V
SIMPULAN DAN SARAN

5.1 Simpulan
Fraktur adalah gangguan kontinuitas tulang dengan atau tanpa
perubahan letak fragmen tulang yang mengakibatkan tulang yang menderita
tersebut kehilangan kontinuitasnya atau keseimbangannya. Fraktur tulang
Humerus atau patah tulang humerus adalah cedera yang sangatserius. Fraktur
ini dikaitkan dengan beberapa komplikasi dan bisa menjadi bencana jika tidak
dikelola dengan baik.Kadang-kadang juga disertai dengan dislokasi siku atau
sendi bahu. Metode pengobatan dalam penanganan fraktur dilakukan dengan
reposisi tanpa operasi, reposisi dengan operasi dan amputasi. Teknik dan
metode penangannya sangat tergantung dari tingkat kerusakan yang dialami
oleh tulang tersebut. Dalam penatalaksanaan operasi ortophedi fraktur dikenal
konsep 4 R yakni rekognisis, reposisi, retensi dan rehabilitasi. Setelah operasi
dilakukan berikan antibiotik secara intramuskuler 2 kali sehari selama 3 hari.
Oleskan juga salep iodine dan bioplacenton setiap pagi dan sore. Usahakan
hewan dijaga jangan sampai menjilat insisi bekas operasi sehingga pemasangan
elizabeth collar sangatlahh dianjurkan.

5.2 Saran
Praktek langsung sangat perlu kiranya dilakukan karena dalam hal ini jika
hanya sekedar membaca agak sulit untuk dibayangkan.

18
 DAFTAR PUSTAKA

German, Alexander J. 2003. The Growing Problem of Obesity in Dogs and Cats.
Liverpool: The Journal of Nutrition.

Maaruf, Adrin. 2015. Teknik Operasi Pharyngotomy pada Hewan (Bedah Sistem
Digesti). https://mydokterhewan.blogspot.com. Diakses pada tanggal 5
Oktober 2017

S. Saifzadeh., R, Hobbenaghi., Sh, Hodi. 2006. Elastic Cartilage Grafting in

Canine Radial Fracture. Iran: University of Shiraz.

Slatter, Douglas. 2003. Textbook of Small Animal Surgery Third Edition. USA:
Saunders Elsevier Science.

Sudisma, I.G.N., Putra Pemayun, I.G.A.G., Jaya Wardhita, A.A.G., dan Gorda,
I.W. 2006. Ilmu Bedah Veteriner dan Teknik Operasi. Denpasar: Pelawa
Sari.

Piermattei, Donald, Flo, Gretchen, DeCamp, Charles. 2006. Handbook of Small

Animal Orthopedic and Fracture Repair. Missouri: Saunder Elsevier.

19
Vet. Med. – Czech, 48, 2003 (5): 133–140 Original Paper

Treatment of extremity fractures in dogs using external

fixators with closed reduction and limited open
approach
S. ����1, K. A���������1
1
Surgery Department, Faculty of Veterinary Medicine, Istanbul University, Istanbul, Turkey

ABSTRACT: Humerus, tibia and antebrachium fractures determined in 30 dogs of different breed, age, weight and
gender were treated using Type I and II external fixators. Meynard and handcuff clamps were used in the external
fixators. Limited open approach was applied in 6 of the cases and closed reduction techniques in 24. In cases where
closed reduction and stabilisation was done, the patients were seen to use their leg within 3–10 days post-operatively
and that walking was reasonably good a�er 20 days. In cases to which a limited open approach had been applied,
use of leg was achieved in a period close to the closed method.

Keywords: dog; fracture; external skeletal fixation; closed reduction; limited open approach

The primary aim of fracture treatment is to achieve
the fastest possible healing and enable the patient
to function normally by allowing early walking
(Aron, 1998; Shahar, 2000). For this, the aim is to
produce anatomical unity between the joints above
and below the fractured bone and functioning of
the extremity (Piermatei and Flo, 1997). In the
treatment of radius and tibia fractures in dogs,
external fixation methods are primarily suggested
(Johnson et al., 1989; Font et al., 1997; Palmer, 1999).
External fixators are used either primarily or as a
support for internal fixation and are frequently
applied using a closed method (Foland and Egger,
1991; McLaughlin and Roush, 1999).
External fixators are used extensively in both
human and veterinary orthopaedics as a treatment
option in severely comminuted and open fractures,
infected non-union cases, arthrodesis, for bone-
lengthening and also correcting growth disorders
(Harari, 1992; Aron et al., 1995; Altunatmaz and
Yucel, 1999).
External fixators can be applied either with an
open approach or closed reduction. In the fracture
treatment with an open approach, manipulations
necessary during the operation will cause
secondary trauma in the injured region and the
blood circulation of the bone will be damaged,
causing a delay in the healing period (Dudley et
al., 1997; Lauer et al., 2000).
In severely comminuted and dislocated
diaphyseal fractures, reconstruction is known to
be very difficult. However, during surgery, priority
should be given to establishing anatomical structure
and protecting vascularisation of the bone rather
than to its reconstruction. This kind of an approach
is the basis of biological osteosynthesis (Aron et al.,
1995; Johnson et al., 1998; Palmer, 1999).
External fixation has advantages such as causing
minimal damage to the injured region, maintaining
bone length, minimising the atrophy forming
in the bone and so� tissues, allowing complete
weight-bearing on the healing bone and keeping
so� tissue trauma at the fracture line at the lowest
(Johnson and Decamp, 1992; Egger, 1998; Lewis et
al., 2001).
Healing in fractures treated using external
fixation occurs mainly via endostal callus rather
than a periostal one (Harari et al., 1996). Some cases
however, heal primarily. Researchers (Johnson et
al., 1989; Harari et al., 1996; Egger, 1998) report
that healing takes place in 3–12 weeks with this
application. As well as healing, delayed healing and
non-union cases have also been reported (Aron et
al., 1986; Carnmicheal, 1991; Harari, 1992; Rudd and

133
Original Paper
Whitehair, 1992). In fractures to which they applied
external fixation, Johnson et al. (1989) observed that,
bone healing or duration of union occurred at the
same time or earlier compared to those treated with
internal fixation.
In external fixation applications, complications
such as pin loosening, pin-base infection, pin
breaking, non-union or delayed union are frequently
encountered (Johnson et al., 1989; Anderson et al.,
1993; Lewis et al., 2001).
MATERIAL AND METHOD
The material for this study comprised of 30 dogs
of different breed, age, gender and body weight,
brought to the Istanbul University Veterinary
Faculty Surgery Department with a complaint of
lameness or inability to use the leg (Table 1).
In the clinical examination, cause of the fracture,
location of the fractured bone, whether the fracture
was open or closed and other injuries were deter-
mined. A 2-way (AP, ML) radiograph was taken of
the area and the reduction technique (limited open
or closed) to be applied was decided.
Patients were sedated and the operation site was
shaved and disinfected. Following this the animals
were put under general anaesthesia. A Type I exter-
nal fixator (unilateral-uniplanar) was used in cases
with a humerus fracture and a Type II external fixa-
tor (bilateral-biplanar) was used in cases with tibia-
fibula and radius-ulna fractures. Straight Steinmann
pins were used for fixation in all cases (Table 2).
Two different types of clamp (Meynard and
handcuff clamps) were used to a�ach the pins to
the fixator. Due to the small diameter of the bar,
the handcuff clamp was only used in dogs weigh-
ing under 10 kg.
The fixation procedure was carried out using
the limited open method in 6 fractures and via
closed approach in 24. In 1 case where an external
fixator was applied to the radius using the closed
method, an intramedullary pin was placed in the
ulna using an open approach. In 2 cases which had
open fractures in the distal diaphysis of the tibia-
fibula, the fixator was applied in transarticularly. In
1 case, which had been given an internal fixation
but in which complications had developed due to
osteomyelitis, an external fixator was applied us-
ing a closed approach. In one severely dislocated
case (No. 9), distraction was used to bring the
bone fragments closer together using the closed
134
Vet. Med. – Czech, 48, 2003 (5): 133–140
method. In one other case with an open fracture
in the distal diaphysis of the tibia-fibula, the fixator
was removed and plate osteosynthesis was carried
out due to non-union.
In the cases to which an external fixator was ap-
plied using the limited open approach, the incision
was kept minimal. The incision was closed a�er
the bone fragments were aligned and fixation was
complete.
In open and infected fractures, an external fixator
was applied a�er debridement and thorough irriga-
tion of the area using sterile saline solution.
Postoperative antibiotics were given to all cases.
The fixator was dressed using a large amount of
co�on-wool and the area was covered.
Immediately a�er fixation, the fractured bone was
radiographed and re-positioning was checked for
alignment. Distances between the bone fragments
were also recorded.
The condition of the callus was evaluated with
radiographs taken regularly during the postopera-
tive period. The fixator was removed in cases which
showed sufficient callus formation.
RESULTS
Treatment with external fixation and results a�er
the treatment were evaluated in a total of 30 dogs
in which, a�er clinical and radiological examina-
tion, radius-ulna fractures were determined in 6,
tibia-fibula fractures in 14 and humerus fractures
in 3 (Tables 1 and 2).
Fourteen of the dogs, which had been diagnosed
with a fracture and had been treated were adults
and 9 had not yet completed their growth. The
bodyweight of the cases ranged between 4–48 kg.
In the 6 cases with radius-ulna fractures, the frac-
ture was in the mid-diaphysis in 3 cases and in the
distal diaphysis in the remaining 3.
Of the tibia-fibula fractures 2 were located in the
proximal diaphysis, 2 in the mid-diaphysis, 9 in
the distal diaphysis and 1 in the distal epiphysis.
All of the humerus fractures were located in the
mid-diaphysis.
Of the fractures that were treated with external
fixation, 3 were open fractures (tibia-fibula frac-
tures). One of these cases (Case No. 11) was an old
fracture and necrosis was present in a 3 cm-long
part of the bone.
Type I external fixation was applied to cases with
humerus fractures (Figure 1) and Type II external
Vet. Med. – Czech, 48, 2003 (5): 133–140 Original Paper

Table 1. Findings of cases managed with external skeletal fixators

Case Weight Bone and type Fracture

Breed Age Gender Reduction technique
No. (kg) of fracture type

1 SiberianHusky 3 mo F 10 radius-ulna distal 1/3 close closed

2 Crossbred 3 mo M 13 humerus midsha� close limited open appr.
3 Crossbred 3 yrs M 15 tibia-fibula distal 1/3 close closed
4 Crossbred 2.5 mo F 9 tibia-fibula distal 1/3 open limited open appr.
5 Crossbred 2.5 mo F 7 humerus midsha� close limited open appr.
6 Cocker Spaniel 8 mo M 10 radius-ulna Midsha� close closed
7 Boxer 6 yrs M 26 tibia-fibula distal 1/3 close closed
8 Anatolian Shepherd 2 yrs F 36 radius-ulna midsha� close closed (i.m. pin to ulna)
9 German Shepherd 3 yrs M 27 radius-ulna midsha� close closed
10 Siberian Husky 6 mo M 18 tibia-fibula midsha� close closed
11 Crossbred 4 yrs M 22 tibia-fibula distal 1/3 open closed
12 Anatolian Shepherd 5 yrs F 32 tibia-fibula distal 1/3 close closed
13 Anatolian Shepherd 7 mo F 17 tibia-fibula distal 1/3 close closed
14 Crossbred 3.5 mo M 4 humerus midsha� close limited open appr.
15 Se�er 1 yrs F 15 tibia-fibula distal 1/3 close closed
16 Crossbred 3 yrs F 14 tibia-fibula distal 1/3 close closed
17 Doberman Pinscher 3 yrs M 23 radius-ulna distal 1/3 close closed
18 Napolitan Mastif 9 mo M 48 tibia-fibula proksimal 1/3 close closed
19 Boxer 8 yrs M 25 tibia-fibula midsha� close closed
20 Yorshire Terrier 11 yrs M 8 tibia-fibula distal 1/3 close closed
21 German Shepherd 2 yrs F 23 tibia-fibula distal 1/3 close limited open appr.
22 Crossbred 2 yrs M 15 radius-ulna distal 1/3 close closed
23 Crossbred 3 mo M 8 tibia-fibula proksimal 1/3 close closed
24 Doberman P. 9 mo M 27 tibia-fibula midsha� close closed
25 Colie 2 yrs F 19 radius-ulna distal 1/3 close closed
26 German Shepherd 8 mo M 24 tibia-fibula proksimal 1/3 close closed
27 German Shepherd 2 yrs M 28 tibia-fibula proksimal 1/3 close closed
28 German Shepherd 9 mo M 24 tibia-fibula proksimal 1/3 close closed
29 PitBull terrier 2 yrs M 25 tibia-fibula midsha� close closed
30 Crossbred 10 yrs M 15 tibia-fibula distal 1/3 close closed

fixation was used in those with radius-ulna and
tibia-fibula fractures (Figure 2).
A�er the fracture was stabilised using a fixator,
measurements showed the distance between the
bone fragments to differ between 0.5–1.5 mm.
In postoperative radiographic check-ups (obser-
vation of sufficient mineralised callus formation)
the fractures were observed to heal in between
16–40 days. Although there was no contact with
external surroundings, the healing period in
3 humerus mid-diaphyseal fractures treated using
a limited open approach was seen to be approxi-
mately the same as those treated using the closed
method.

135
Original Paper Vet. Med. – Czech, 48, 2003 (5): 133–140

Table 2. Results of cases managed with external fixator

Type of Distance Time of sufficient Time of fixator

Case Fracture Postoperative
external between the bone callus presence removel
No. type complications
fixator fragments (mm) (days) (days)
1 close Type II 1 21 21
2 close Type I 2 23 23
3 close Type II 15 40 40 pin loosening
4 open Type II 2 20 20
5 close Type I 1 16 21
6 close Type II 1 27 34
7 close Type II 0.5 21 36
8 close Type II 6 18 24 pin track discharge
9 close Type II 9 25 52 pin track discharge
10 close Type II 11 23 29
11 open Type II 5 – 33 non-union
12 close Type II 1 21 60 tarsal valgus
13 close Type II 1 27 27
14 close Type I 0.5 15 20
15 close Type II 3 21 31 tarsal valgus
16 close Type II 6 28 45
17 close Type II 2 26 39 pin loosening
18 close Type II 11 23 23
19 close Type II 14 40 40 pin track discharge
20 close Type II 3 36 42
21 open Type II 1 26 178 ankylosis
22 close Type II 2 22 22
23 close Type II 0.5 24 24
24 close Type II 9 28 40
25 close Type II 10 38 38
26 close Type II 4 35 35
27 close Type II 7 43 43
28 close Type II 4 35 40
29 close Type II 5 25 35
30 close Type II 6 35 44

All the cases that were treated (except case No. 11)
were seen to make slight ground contact with the
leg 3–10 days a�er external fixation and to function
close to normal within 20 days with full weight-
bearing on the fractured leg.
The fixator was removed in cases which had
sufficient mineralised callus formation and which
could bear weight on the leg. While this period
was approximately between 20–30 days, it was also
delayed due to the late appearance of the patient
owners (178 days).
In the radiographs taken 24 days later of case
No. 8, in which a fixator was applied to the radius
using the closed method and an intramedullary pin

136
Vet. Med. – Czech, 48, 2003 (5): 133–140
a c
was placed in the ulna using an open approach,
while there was sufficient healing in the radius, the
union in the ulna was seen to be insufficient.
Various complications were seen in the cases
included in our study which were; pin loosening
in 2, pin-base infection in 3, valgus deformation
in 2, non-union in 1 and ankylosis in 1 case. Pin
loosening and pin-base infection was usually seen
in pins placed in the proximal fragment. In a case
which had an open and infected fracture, the in-
fection was seen to disappear a�er application of
a fixator. However, as non-union was present, the
fixator was removed and treatment was carried out
with plate osteosynthesis.
DISCUSSION
When treating fractures in immature animals, it
is very important to protect the growth plates and
provide early return to function (Altunatmaz and
Yucel, 1999; Lewis et al., 2001). Ten cases, to which
we applied external fixation, had not yet completed
Original Paper
Figure 1. Radiographic view of midsha� humeral fracture
belonging to a crossbreed dog, to which limited open
approach was applied. a – radiographic view before
surgery, b – immediately a�er surgery, c – radiography
20 days a�er surgery and healing via endostal callus,
before removal of fixator
their development. During fixation utmost care was
taken not to damage the growth plates and in the
postoperative follow-ups no complications were
encountered relating to obstruction of growth in
these cases.
Type II external fixators can be applied to tibia-
fibula or radius-ulna fracture cases of all ages and
bodyweight (Aron et al., 1995; Aron, 1998; Kraus et
al., 1998; Lewis et al., 2001). Likewise in this study,
location of the fracture did not cause any problems
with respect to application of the fixator. The fact
that 6 radius-ulna and 11 tibia-fibula fracture cases,
to which a fixator was applied using the closed
method, and 3 humerus fracture cases fixed using
an open approach healed in a short period without
complication, once again proved the significance
of biological fixation (Toombs, 1992; Johnson et al.,
1998; Palmer, 1999).
The fact that the patients were able to walk by
touching the fractured leg on the ground within
3–10 days a�er application of the fixator and that
they could use their leg to a great extent within 20
days, are important developments with respect to
137
Original Paper Vet. Med. – Czech, 48, 2003 (5): 133–140

Figure 2. Radiography of mid-

sha� tibia-fibula fracture
belonging to a Siberian husky,
using external fixator with
closed reduction. a – before
surgery, b – immediately a�er
surgery, c – appearance 22 days
a�er surgery showing prob-
lem-free healing

138
Vet. Med. – Czech, 48, 2003 (5): 133–140
avoiding possible complications, such as bone and
muscle atrophy, by allowing early return to function
of the extremity. Also easy application of the fixator,
its low cost and re-useability are other significant
advantages (Carnmicheal, 1991; Aron et al., 1995).
It was not a problem during the healing process
that the bone fragments could not be aligned as
well as with internal fixation. This result is clear
proof that, when anatomical alignment is achieved
healing can take place in a short time without the
need for perfect positioning of the fragments.
External fixators can be removed a�er a postop-
erative period of approximately 3–5 weeks, when
the callus tissue has reached the point where it pre-
vents rotation of the bone fragments. However, in
intramedullary fixation the pins are removed only
a�er bone healing is completed. In a case to which
external fixation had been applied to the radius
and an intramedullary pin to the ulna, although
sufficient callus formation was observed in the ra-
diographs taken 24 days a�er fixation, union was
not yet complete in the ulna. This is a clear example
of early healing in closed treatment with external
fixation.
While it had been reported (Johnson et al., 1989;
Harari et al., 1996) that fractures treated with ex-
ternal fixators heal with endostal callus rather than
periostal callus, in the fractures that were fixed us-
ing closed and limited open approaches, healing
was observed to take place with the formation of
a large callus (both periostal and endostal callus
formation) (Figures 1 and 2).
In one clinical study (Aron et al., 1986), it was
reported that fixation done using smooth pins only
provided a trouble-free fixation for 2.2 months, that
this period was 4.3 months for fixation done using
smooth and threaded pins together and 4.8 months
for fixation with threaded pins alone. However, in
this study where only smooth pins were used, the
pins were seen not to provide stability for more than
40 days and that pin loosening occurred especially
in areas with a thick muscle layer.
Using the drill at high speed during the insertion
of pins produces heat related necrosis in the bone
and this in turn causes pin loosening and failure
in fixation. To avoid this, the process of pin insert-
ing should be done at low speed. A manual drill
may be preferred but the oscillation produced is
another cause of pin loosening (Anderson et al.,
1996; McLaughlin and Roush, 1999). In 2 cases
which showed pin loosening and 3 cases in which
pin-base infection had developed, the fact that
Original Paper
these complications occurred in the pins placed
in the proximal fragments suggests that this may
be a result of the area being covered with a thick
muscle layer.
In one of the cases with an open fracture, although
infection was treated, non-union was present, of
which the reason was excessive loss of bone.
Treating infection is one of the fields of use of ex-
ternal fixation (Harari, 1992; Lewis et al., 2001).
In this study, in which 2 different types of clamps
and external fixators were used with a closed or
limited open approach, very short healing period,
sufficient stability, early return to function in the
extremity, easy application and low cost conclude
that external fixation with closed or limited open
application should be preferred in appropriate
cases.
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Corresponding Author
Dr. Kemal Altunatmaz, Surgery Department, Faculty of Veterinary Medicine, Istanbul University, 34851-Avcilar,
Istanbul, Turkey
Tel. +90 212 591 69 84, fax +90 212 591 69 76, e-mail: altunatmaz@hotmail.com
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Received: 02–09–30
Accepted a�er corrections: 03–05–05
 COMPANION ANIMAL PR ACTICE
A five-year old springer
spaniel that was treated for
an intercondylar Y fracture

Humeral condylar fractures

and incomplete ossification of
the humeral condyle in dogs ANDY MOORES

HUMERAL condylar fractures are among the most common fractures seen in dogs and account
for approximately 20 per cent of the author’s canine fracture caseload, although this is a referral
population and probably does not represent the true incidence of these injuries. It has long been
recognised that spaniels are predisposed to humeral condylar fractures. It is now recognised that many
of these dogs have a condition known as incomplete ossification of the humeral condyle (IOHC) that
predisposes them to condylar fractures, often occurring during normal activity or associated with only
minor trauma. This article discusses the management of humeral condylar fractures and IOHC.

HUMERAL CONDYLAR FRACTURES the force from sudden impacts is primarily directed lat- Andy Moores
erally. Secondly, the lateral epicondylar ridge is smaller graduated from
Bristol in 1996. He
CLASSIFICATION and weaker than its medial counterpart. Lateral condylar spent five years in
Humeral condylar fractures can be divided into lateral fractures are most prevalent in skeletally immature dogs. small animal practice
condylar, medial condylar and intercondylar fractures. In one retrospective review, 67 per cent of cases were before returning to
Bristol to complete
Lateral and medial humeral condylar fractures involve less than one year of age, the most common age being a residency in small
only one epicondylar ridge of the condyle. Intercondylar four months (Denny 1983). Lateral and medial condylar animal surgery. In
2004, he joined the
fractures involve both the medial and lateral epicondylar fractures are often associated with a minor fall, although Royal Veterinary
ridges and are commonly described as ʻYʼ or ʻTʼ frac- in some dogs with IOHC they can occur during relative- College as a lecturer
in small animal
tures depending on the orientation of the fracture lines ly normal activity. Intercondylar fractures are usually, orthopaedics. He
through the epicondylar ridges. Intercondylar fractures but not exclusively, seen in skeletally mature dogs. They holds the RCVS
diploma in small
with supracondylar and/or condylar comminution are can also be caused by a fall but are generally associated animal surgery
also occasionally seen. with more severe trauma, such as road traffic accidents (orthopaedics),
(RTAs). and is a diplomate
of the European
SIGNALMENT AND PRESENTATION Dogs with a recent humeral condylar fracture present College of Veterinary
Humeral condylar fractures may be seen in any breed with non-weightbearing thoracic limb lameness. The Surgeons and an
RCVS specialist in
of dog although spaniels are commonly affected due to elbow feels thickened due to the separation of the two small animal surgery
their predisposition to IOHC. Lateral condylar fractures parts of the condyle and the associated haematoma and (orthopaedics).
are the most common condylar fracture seen. This is inflammation. Elbow pain and crepitus is evident if
thought to be due to two factors. First, the radius artic- elbow manipulation is attempted. The diagnosis is read-
ulates with the lateral part of the condyle and therefore ily made from orthogonal radiographs. It is important

Lateral condylar Medial condylar Y fracture T fracture

fracture fracture Classification of humeral In Practice (2006)
condylar fractures 28, 391-397

In Practice ● J U LY /A U G U S T 2 0 0 6 391

Craniocaudal radiograph of the elbow of a four-month-old
puppy. Note the size of the lateral epicondylar ridge in relation
to the medial ridge and the articulation between the radial head
and the lateral part of the condyle
that two views are taken: the fragments can be superim-
posed on a mediolateral view giving the appearance of a
relatively normal elbow to the inexperienced observer.
MANAGEMENT
If an animal has been involved in a major trauma (eg,
an RTA), life-threatening injuries should be evaluated
and addressed prior to assessing and treating the frac-
ture. Otherwise, initial treatment should concentrate
on the provision of suitable analgesia (generally non-
steroidal anti-inflammatory drugs [NSAIDs] in combi-
nation with injectable opiates) and confinement of the
patient to a kennel or cage. A support dressing is usually
not required. Indeed, dressings that only extend a short
way proximal to the elbow are counterproductive, serv-
ing only to increase the weight hanging from the frac-
ture site. The exception is the spica splint, which may be
useful in some situations. This extends around the thorax
and incorporates a lateral splint (a malleable bar or strips
of fibreglass casting material) that runs from the paw to
Mediolateral (above) and craniocaudal (right)
radiographs of a lateral condylar fracture in a
labrador
392
the dorsal midline and thus provides immobilisation of
the upper limb. Humeral condylar fractures are gener-
ally closed, but if the fracture is open, wound lavage and
intravenous broad spectrum antibiotics are indicated.
Humeral condylar fractures are articular fractures.
Therefore, in order to maximise joint function postop-
eratively the condylar fragments must be accurately
reduced and stabilised with rigid internal fixation. This
is achieved using a transcondylar lag screw to create
compression between the condylar fragments.
A partially threaded 4·0 mm cancellous screw can
be used as a transcondylar lag screw. Compression is
achieved if the screwʼs threads interface with the ʻfarʼ
fragment only (ie, the medial part of the condyle for a
lateral condylar fracture). However, the bending strength
of a 4·0 mm cancellous screw is only equivalent to a
2·7 mm cortical screw (both screws have the same core
diameter) and it is significantly inferior to the bending
strength of the larger cortical screws. Thus, in general,
an appropriately sized cortical screw is preferred. A can-
cellous screw may have some advantages in very young
dogs with softer epiphyseal and metaphyseal bone, but
even in these patients the use of a similarly sized corti-
cal screw is usually successful and preferred due to its
greater bending strength.
Lateral condylar fractures
Lateral condylar fractures are approached via a slightly
curved incision over the distal humerus, passing just cra-
nial to the point of the lateral epicondyle. The underly-
ing subcutaneous fascia is incised in the same line and
the deeper brachial fascia is incised along the cranial
border of the lateral head of the triceps, allowing cau-
dal retraction of this muscle and exposure of the lateral
epicondyle. Care must be taken to avoid the radial nerve
deep to the triceps at the proximal extent of the incision.
When a cortical screw is used as a lag screw, com-
pression is achieved by over-drilling the ʻnearʼ frag-
ment to create a glide hole. This glide hole can be cre-
ated either from the ʻinside-outʼ (the authorʼs preferred
approach), whereby the hole is started from the fracture
surface of the lateral fragment, and exits laterally, or the
ʻoutside-inʼ. To sufficiently expose the fracture surface,
the anconeus muscle is elevated from the caudal aspect of
the lateral fragment. Distal-to-proximal elevation of the
origin of the extensor carpi radialis muscle will expose
the cranial joint capsule, which can then also be incised
to free the cranial aspect of the fragment. This allows
the cranial articular surface to be inspected and also the
accuracy of fracture reduction to be assessed later. Once
the soft tissues have been sufficiently released the lateral
fragment can be rotated outwards on the lateral collat-
eral ligament and other distal soft tissues.
The inside-out approach ensures that the screw passes
through the midpoint of the condyle. It also ensures that
the glide hole includes all of the lateral fragment and
does not encroach on the medial fragment. The alterna-
tive, outside-in approach requires reduction of the frac-
ture, followed by drilling of a glide hole from the lateral
epicondyle through the lateral part of the condyle to the
fracture surface. Care must be taken to ensure that the
glide hole only includes the lateral fragment.
It is advisable to use a small drill bit first to check the
direction of the drilled hole. The aim is to place the drill
hole in the centre of the fractured surface of the condyle
and for it to exit the lateral surface slightly cranial and
In Practice ● J U LY /A U G U S T 2 0 0 6

Intraoperative view of a lateral condylar fracture in a six-month-
old English springer spaniel. The lateral fracture fragment has
been rotated outwards prior to drilling the glide hole. Note the
sclerotic bone at the fracture surface
slightly distal to the most lateral point of the lateral epi-
condyle. If the direction is satisfactory, larger drill bits
can be used to enlarge the glide hole, finishing with a
drill bit corresponding to the outside diameter of the
screw to be used (ie, a 3·5 mm drill for a 3·5 mm screw).
The drill is removed, replaced with a drill bit corre-
sponding to the core diameter of the screw (ie, a 2·5 mm
drill for a 3·5 mm screw), and then used to locate the
drill hole from the lateral (outer) aspect. The soft tissues
are elevated away from the hole so that when a screw is
placed it will sit on the bone rather than on the soft tis-
sues in that area. An appropriately sized insert sleeve is
guided over the tip of the smaller drill bit and into the
glide hole. With the sleeve in place it can be used as a
handle to manipulate the lateral fragment. It also serves
to prevent the tips of bone-reducing forceps from falling
into the glide hole.
The size of the screw chosen will depend on the size
of the humeral condyle and the aetiology of the frac-
ture. The outer diameter of the screw is generally 30 to
50 per cent of the diameter of the condyle at the frac-
ture surface. Fractures that are considered to be second-
ary to IOHC require the largest screw that can be safely
accommodated in the condyle. For most springer span-
iels this equates to a 4·5 mm cortical screw. A 5·5 mm
cortical screw is appropriate for larger dogs. Dogs with
fractures that are not thought to be secondary to IOHC
can be treated with relatively smaller screws.
Once the fracture surfaces have been cleared of any
soft tissues or haematoma that might prevent accu-
rate reduction, the fragments can be reduced. This is
achieved by applying distal traction on the limb and at
the same time digitally squeezing the medial and lateral
fragments together. Fine-tuning of the reduction can be
achieved by manipulating the lateral fragment via the
insert sleeve. Adequate reduction is achieved if the epi-
condylar ridge is perfectly aligned and if there is no step
evident in the cranial articular surface. Once obtained,
the reduction can be maintained with spiked bone reduc-
tion forceps placed across the condyle or simply by dig-
ital pressure. The core diameter drill bit is then passed
In Practice ● J U LY /A U G U S T 2 0 0 6
Postoperative craniocaudal
radiograph of a lateral
condylar fracture in a three-
month-old spaniel. A 3·5 mm
cortical screw and washer
have been used to stabilise
the condyle, with a K-wire
placed through the lateral
epicondylar ridge
through the insert sleeve and a hole is drilled through
the medial part of the condyle. The sleeve is removed
and the hole is measured and, if non-self-tapping screws
are being used, tapped. A screw sufficiently long for
its tip to be palpable medially should be chosen. This
ensures that the tip can be gripped with pliers and there-
fore easily removed should the screw break in the future.
In young dogs, the addition of a stainless steel washer is
advised to prevent the screw head sinking into the soft
bone of the epicondyle during tightening.
The transcondylar lag screw alone is not sufficient to
prevent the lateral fragment from rotating about the axis
of the screw. A second point of fixation is required to
counter rotational forces. In most cases this is achieved
by passing a Kirschner wire (K-wire) from the base of
the lateral epicondylar ridge distally, across the fracture
of the epicondylar ridge and into the diaphysis proxi-
mally. This wire should penetrate the medial cortex of
the humeral diaphysis. The wire is cut short, the wound
lavaged and the soft tissues closed in a standard man-
ner. Postoperative radiographs are of course essential
to assess fracture reduction, implant placement and to
allow comparison with follow-up radiographs taken at a
later date.
Medial condylar fractures
Medial condylar fractures are much less common than
lateral condylar fractures, but the principles of treat-
ment are the same. A transcondylar lag screw is placed
from the medial aspect and an additional anti-rotational
device is required. Medial condylar fractures often have
a longer medial epicondylar component that allows a
second lag screw, placed proximal to the supratrochlear
foramen, to be used as the anti-rotational device.
Intercondylar fractures
Y and T fractures present a challenge and their repair
should only be attempted by experienced surgeons. They
393

Preoperative radiographs of a Y fracture in an English springer spaniel
Postoperative radiographs of the fracture pictured at the top of the page. A bilateral approach has
allowed placement of a 3·5 mm lag screw across the condyle, a 2·7 mm dynamic compression plate
across the medial epicondylar ridge and a 2·0/2·7 mm Veterinary Cuttable Plate (Synthes) across the
lateral epicondylar ridge
can be approached in two ways. Some surgeons favour
a caudal approach. This can be performed by tenotomy
of the triceps tendon, although this is probably best
reserved for very small or very young patients. More
often an olecranon osteotomy is performed (see further
reading for specific details of this approach). Olecranon
osteotomy allows proximal retraction of the triceps mus-
cle and tendon, and exposure of the condylar fragments.
The condyle is reconstructed with a transcondylar lag
screw and the reconstructed condyle is then attached to
the shaft of the humerus. In very small patients, crossed
K-wires may be sufficient to achieve this but, in the
majority of patients, double plating is the preferred tech-
nique. One plate is applied along either the medial or the
caudal edge of the medial epicondylar ridge. A second,
smaller plate is applied along the caudal edge of the lat-
eral epicondylar ridge. It may also be possible to place a
plate along the lateral surface of the lateral epicondylar
ridge. Given the curved geometry of the lateral ridge, a
reconstruction plate is ideal for this purpose. Care must
be taken in placing screws to ensure they do not enter
the olecranon fossa and impinge on the anconeal process
during elbow extension.
The authorʼs preferred approach for intercondylar
fractures is a bilateral approach. This avoids osteotomy
394
of the olecranon and its potential complications but does
require that the medial part of the fracture can be accu-
rately reduced. The distal humerus is approached medi-
ally first, and the medial condylar fragment is reduced to
the humeral shaft and stabilised with a plate. By achiev-
ing this the fracture is essentially converted to a lateral
condylar fracture. The lateral condylar fragment is sub-
sequently reduced and stabilised with a transcondylar
lag screw and a lateral plate via a lateral approach. With
the bilateral approach, accurate reduction of the articular
surfaces of the condyle from the lateral side can only be
achieved if the medial part of the fragment is also per-
fectly reduced. Thus, intercondylar fractures that appear
to have some comminution of the medial epicondylar
ridge may be better managed using a caudal approach.
POSTOPERATIVE CARE
In the first 24 to 48 hours postoperatively a light, full
limb dressing may be used to limit swelling. Opiate
analgesia is provided during this period, but after 24 to
48 hours postoperatively NSAIDs are often sufficient
for analgesia and are generally continued for seven to 14
days.
Appropriate exercise restriction during the post-
operative period is essential to a good outcome. It is not
uncommon for inappropriate exercise during this time
to be associated with implant breakage and loss of frac-
ture reduction. The author advises that these patients
are either confined to a small room or are cage/kennel
rested. They should not be allowed to jump on or off
furniture and should be walked out to a garden on a lead
several times a day for toilet purposes only. This regi-
men should continue until fracture union is documented.
Strict rest in this fashion maximises the chances of suc-
cessful fracture healing and does not compromise elbow
range of motion. As long as a patient is using the affect-
ed limb well postoperatively, specific physiotherapy is
generally not required although gentle flexion–extension
exercises and hydrotherapy may be useful if restricted
mobility is a concern. The most important determinants
of good elbow range of motion postoperatively are accu-
rate fracture reduction, careful implant placement and
an atraumatic surgical technique, all of which allow
near-normal limb use in the postoperative period. If the
patient is dramatically lame or non-weightbearing on
the limb beyond the first few days postoperatively, frac-
ture instability, displacement of fragments or implants,
insufficient analgesia and infection must be ruled out as
possible reasons.
Follow-up radiographs are initially obtained four to
six weeks postoperatively depending on the age of the
patient. Implants are usually not removed unless they
are compromising elbow function, have loosened or are
associated with postoperative infection.
PROGNOSIS
With early stabilisation, the prognosis for lateral and
medial condylar fractures is generally good. The prog-
nosis is more guarded for fractures secondary to IOHC
(see later). In a review of 15 humeral condylar fractures
followed up for a mean of 43 months, all affected elbows
developed post-traumatic osteoarthritis (Gordon and
others 2003). This study revealed that the more accurate
the reduction, the lower the radiographic osteoarthritis
score. These dogs had a reduced range of elbow flexion
at follow-up, but elbow extension, which is more impor-
In Practice ● J U LY /A U G U S T 2 0 0 6
tant during the gait cycle, was unaffected. Although
radiographic evidence of osteoarthritis may develop, in
the authorʼs experience this is not associated with a clin-
ical problem in the majority of dogs.
The prognosis for intercondylar fractures is more
guarded, with approximately half of dogs having some
degree of persistent lameness in one study (Denny
1983). A more recent report of bilateral fixation showed
good or excellent short-term limb function in 27 out of
30 fractures (McKee and others 2005).
INCOMPLETE OSSIFICATION OF THE
HUMERAL CONDYLE
Although the high incidence of humeral condylar frac-
tures in spaniels had led to a suspicion that there was an
inherent weakness or conformational abnormality affect-
ing the humeral condyle of these dogs, the precise nature
of this abnormality has only come to light over the past
15 years or so. It is now recognised that some dogs have
a sagittal, radiolucent fissure present within the humer-
al condyle that separates the medial and lateral parts
of the condyle and extends from the articular surface
to, or towards, the supratrochlear foramen. A fissure is
frequently, but not invariably, found bilaterally. Biopsies
from fissures have demonstrated fibrous tissue with an
increased number of plasma cells and osteoclasts.
All long bones develop from a cartilaginous template
known as an anlage. During skeletal development, ossifi-
cation of the anlage commences at specific locations, or
so-called ossification centres. The humeral condyle devel-
ops from three such ossification centres: a medial ossifi-
cation centre, a lateral ossification centre and a smaller
ossification centre that forms the medial epicondyle. The
larger two ossification centres should fuse at between
eight and 12 weeks of age in dogs. The location of the
fissure in IOHC corresponds to the location of the carti-
laginous plate that separates these two ossification centres
prior to their fusion. This has led to the assumption that
IOHC is a developmental failure of fusion of these cen-
Radiograph of a distal humerus from the cadaver a seven-week-
old labrador. The medial (left) and lateral (right) ossification
centres of the humeral condyle are separated by a cartilaginous
septum that extends proximally to the distal humeral growth
plate
In Practice ● J U LY /A U G U S T 2 0 0 6
tres – hence the term ʻincomplete ossificationʼ. This carti-
laginous plate only extends as far proximally as the distal
humeral growth plate and yet often the fissures associated
with IOHC extend to the supratrochlear foramen proximal
to the growth plate. Presumably extension of the fissure
into the metaphysis occurs as a result of a stress fracture
initiated at the pre-existing weakness.
IOHC is most commonly seen in spaniel breeds. In
the USA, American cocker spaniels are often affected
while, in the UK, English springer spaniels are over-
represented. However, this condition does affect other
spaniel breeds and is also seen in a variety of non-
spaniel breeds including labradors and rottweilers. In
American cocker spaniels, pedigree analysis suggests
that the condition may be heritable with a recessive
mode of inheritance (Marcellin-Little and others 1994).
Dogs with IOHC may present in one of three ways:
■ With lameness;
■ With humeral condylar fractures secondary to IOHC;
■ Without clinical signs.
DOGS WITH LAMENESS
IOHC can cause elbow pain and lameness in its own
right. The lameness may be intermittent and mild, or
more persistent and severe. It is generally poorly respon-
sive to anti-inflammatory medication. Elbow pain is
often most noticeable on extension, but the range of joint
motion is not affected and these dogs usually do not
have elbow effusions. The exception to this is likely to
be dogs with concurrent fragmentation of the coronoid
process, which is reportedly common in American cock-
er spaniels with IOHC, but is a rare finding in the UK in
the authorʼs experience.
Diagnosis of IOHC requires demonstration of the
condylar fissure. This can usually be achieved with high
quality craniocaudal radiographs of the elbow, although
often the radiolucent fissure is not evident unless the
x-ray beam is directed exactly parallel to the fissure.
Several craniocaudal projections may be required, each
taken at slightly different angles of rotation. It has been
suggested that a 15° craniomedial-caudolateral oblique
projection is most likely to demonstrate the fissure.
The fissure may be partial, only extending partway
to the supratrochlear foramen, or it may be complete,
extending all the way. It is important that IOHC is not
mistakenly diagnosed on the basis of seeing a mach line
– a visual anomaly created by the superimposition of one
bone edge on another, which can appear as a radiolucent
line through the condyle. New bone, or a periosteal reac-
tion, along the lateral margin of the lateral epicondylar
ridge may be seen although, in the authorʼs experience,
this is an uncommon radiographic finding.
As it can be difficult to demonstrate a fissure with
standard radiography, computed tomography (CT) is the
preferred imaging technique. The fissure is readily evi-
dent on transverse slices through the condyle. CT addi-
tionally reveals areas of increased radiodensity (sclerosis)
adjacent to the fissure. Elbow arthroscopy may also be of
diagnostic use, revealing a linear fissure in the articular
cartilage of the humeral condyle in many affected dogs.
Dogs with IOHC and lameness, without fracture, are
treated with a transcondylar screw. A second point of
fixation is not required. It is unclear whether this screw
should be placed as a positional screw or as a lag screw,
although the author has had best results with the latter
technique. From a biomechanical perspective the use of
395
Craniocaudal radiograph of the non-fractured elbow
of the same dog as pictured at the bottom of page Craniocaudal radiograph of an elbow showing a
392, showing a partial condylar fissure (arrowhead) complete condylar fissure (arrowhead)
CT images of the elbow of an English springer spaniel demonstrating a humeral condylar
fissure (arrowheads). (left) Transverse slice, (middle) two-dimensional (2D) reconstruction in the
orthogonal plane, (right) three-dimensional reconstruction. Note the sclerosis of the humeral
condyle adjacent to the fissure evident on the two 2D slices
a lag screw would be expected to provide greater resist-
ance against micromovement between the medial and
lateral parts of the condyle. An adjustable drill aiming
guide is useful to facilitate accurate screw placement in
the intact condyle. If placing a lag screw, the depth of the
Radiograph showing the
placement of a 4·5 mm
transcondylar lag screw
in an English springer
spaniel with IOHC
396
Slightly oblique craniocaudal radiograph of an elbow
demonstrating a mach line (arrowhead)
glide hole should be judged from the CT scans or from a
craniocaudal radiograph.
Dogs with IOHC and lameness respond favourably
to the placement of a transcondylar screw. Thirteen out
of 18 dogs (72 per cent) recovered fully in the combined
results from two studies (Butterworth and Innes 2001,
Meyer-Lindenberg and others 2002).
DOGS WITH HUMERAL CONDYLAR
FRACTURES SECONDARY TO IOHC
Fractures due to IOHC are most commonly lateral con-
dylar fractures. A history of a humeral condylar fracture
occurring during relatively normal activity should arouse
suspicions of IOHC, particularly if the dog is a spaniel.
Affected cases may also have a history of a prodromal
lameness prior to fracture. Identification of a fissure in
the contralateral humerus further supports pre-existing
IOHC in the fractured humerus. If CT is available to
assess these fractures, the intracondylar margins of the
fracture will be sclerotic. Sclerosis of the fractured sur-
faces will also be apparent intraoperatively, and the bone
in the centre of the condyle will not be as soft as normal
epiphyseal or metaphyseal bone.
Three-dimensional CT reconstruction of a Y fracture in an
English springer spaniel, sectioned through the condylar
fragments. Note the sclerosis adjacent to the fracture
surface (arrowheads)
In Practice ● J U LY /A U G U S T 2 0 0 6
 The principles of fracture repair are the same as for
any humeral condylar fracture, except that there is a
greater risk of implant failure due to the reasons high-
lighted below, and thus the choice of implants may be
different to those used to stabilise a standard condylar
fracture.
Surgical treatment of condylar fractures secondary to
IOHC, and of IOHC in the absence of fracture, should
not be relied upon to result in bone union across the
fissure. Also, radiographic evidence showing the disap-
pearance of the fissure postoperatively is an unreliable
indicator of union. In dogs with apparent disappear-
ance of the fissure on follow-up radiographs, a persist-
ent fissure may be demonstrated on CT examination.
Bone union, confirmed with CT, is occasionally seen
but is not the norm. More often, follow-up radiographs
or CT show a persistent fissure despite transcondylar
screw placement. Drilling small bone tunnels across
Radiograph of the same fracture as pictured on
the condyle in an attempt to encourage vascular access Radiograph showing a broken 4·5 mm screw the left following revision surgery. A 5·5 mm
to the fissure and thus promote osseous union has been subsequent to the management of a lateral cortical screw and 2·7 mm dynamic compression
condylar fracture in an English springer spaniel plate have been placed
reported with (Butterworth and Innes 2001) and with-
out (Rovesti and others 2002) concurrent placement of
a transcondylar screw. Disappearance of the fissure on
follow-up radiographs was reported in three out of eight
dogs treated with tunnels and a screw. CT examination
following treatment with tunnels alone revealed the tun-
nels and the fissure to be devoid of bone 14 weeks post-
operatively. Due to these inconsistent results, the author
does not routinely drill tunnels across the condyle.
As the condyle frequently fails to unite following
treatment of IOHC or IOHC-associated fractures, there
is an increased risk of fatigue failure of the transcondy-
lar screw with subsequent condylar fracture, recurrence
of lameness or loss of fracture reduction. For this reason,
the largest transcondylar screw that can be safely placed
should be used. For most springer spaniels this requires
the placement of a 4·5 mm cortical bone screw. Fatigue
failure of 3·5 mm cortical screws is not an uncommon
finding following the treatment of simple IOHC and the (left and right) Radiographs showing the management of the fracture pictured at the bottom of
treatment of condylar fractures in springer spaniels. Less page 392 using a 4·5 mm lag screw and 2·7 mm reconstruction plate along the lateral epicondylar
commonly, 4·5 mm cortical screws may also break. In ridge

this situation, successful revision is often possible with a

5·5 mm cortical screw. Titanium is generally regarded as
having better fatigue resistance than stainless steel and
thus there may be an advantage in using titanium screws
to treat IOHC. Titanium implants should not be used in
combination with stainless steel implants.
Reinforcement of the lateral epicondylar ridge may
reduce the stress on the transcondylar implant in dogs
with lateral condylar fractures secondary to IOHC. With
this in mind, it may be appropriate to use a bone plate
along the lateral epicondylar ridge, rather than a single
K-wire, to counter rotational forces in these cases.
DOGS WITHOUT CLINICAL SIGNS
Occasionally, IOHC will be recognised in an asympto-
matic limb, usually following the screening of the ʻnor-
malʼ humerus of a dog with a humeral condylar fracture
or a dog with contralateral symptomatic IOHC. The
epidemiology of this disease is not currently well under-
stood and it is therefore unclear what the most appro-
priate course of action is in such situations. The true
prevalence of IOHC is unknown in the general canine
population, or indeed in spaniel populations, and thus it
is impossible to calculate the risk of an affected condyle
fracturing for any individual. Placement of a transcondy-
lar screw may reduce the risk of a future condylar frac-
ture in these dogs, but the risks associated with anaes-
thesia and surgery (eg, seroma, infection) should be
weighed against the perceived benefits of screw place-
ment. The relative merits of surgery should be consid-
ered in conjunction with the owners on an individual
basis for each dog.
References
BUTTERWORTH, S. J. & INNES, J. F. (2001) Incomplete humeral condylar fractures in the dog. Journal
of Small Animal Practice 42, 394-398
DENNY, H. R. (1983) Condylar fractures of the humerus in the dog – a review of 133 cases. Journal of
Small Animal Practice 24, 185-197
GORDON, W. J., BESANCON, M. F., CONZEMIUS, M. G., MILES, K. G., KAPATKIN, A. S. & CULP, W. T. N.
(2003) Frequency of post-traumatic osteoarthritis in dogs after repair of a humeral condylar fracture.
Veterinary and Comparative Orthopaedics and Traumatology 16, 1-5
McKEE, W. M., MACIAS, C. & INNES, J. F. (2005) Bilateral fixation of Y-T humeral condyle fractures via
medial and lateral approaches in 29 dogs. Journal of Small Animal Practice 46, 217-226
MARCELLIN-LITTLE, D. J., DEYOUNG, D. J., FERRIS, K. K. & BERRY, C. M. (1994) Incomplete ossification
of the humeral condyle in spaniels. Veterinary Surgery 23, 475-477
MEYER-LINDENBERG, A., HEINEN, V., FEHR, M. & NOLTE, I. (2002) Incomplete ossification of the
humeral condyle as the cause of lameness in dogs. Veterinary and Comparative Orthopaedics and
Traumatology 15, 187-194
ROVESTI, G. L., BIASIBETTI, M., SCHUMACHER, A. & FABIANI, M. (2002) The use of computed
tomography in the diagnostic protocol of the elbow in the dog: 24 joints. Veterinary and
Comparative Orthopaedics and Traumatology 15, 35-43
Further reading
PIERMATTEI, D. L. & JOHNSON, K. A. (2004) An Atlas of Surgical Approaches to the Bones and Joints
of the Dog and Cat, 4th edn. Philadelphia, W. B. Saunders

In Practice ● J U LY /A U G U S T 2 0 0 6 397
NOTE  Surgery

Outpatient Treatment for Humeral Fractures in Five Calves

Norio YAMAGISHI1)*, Bhuminand DEVKOTA1,2) and Masahiro TAKAHASHI1,3)

1)Cooperative Department of Veterinary Medicine, Iwate University, Morioka, Iwate 020–8550, Japan
2)Centerfor Biotechnology, Agriculture and Forestry University, Rampur, Chitwan, 44209, Nepal
3)Department of Advanced Pathobiology, Graduate School of Life and Environmental Sciences, Osaka Prefecture University, Izumisano,

Osaka 598–8531, Japan

(Received 31 March 2014/Accepted 4 July 2014/Published online in J-STAGE 24 July 2014)

ABSTRACT. Humeral fractures were treated in 5 calves using unilateral external fixation with epoxy putty fixator (type I). The surgeries were
performed under sedation and analgesia, and it involved application of ultrasound-guided brachial plexus block. The surgical procedures
were completed in 60 to 90 min, and each calf was returned to the farm on the same day. The fixation allowed each calf to remain with the
dam and suckle without strict stall rest and was removed 11 to 62 days post-surgery. The clinical sign of diminished radial nerve function
disappeared 40 days to 4 months post-surgery. These observations suggest that this repair technique represents a feasible outpatient treat-
ment for humeral fractures in calves.
KEY WORDS: calf, epoxy putty fixator, humeral fracture, outpatient treatment, unilateral external fixation

doi: 10.1292/jvms.14-0170; J. Vet. Med. Sci. 76(11): 1519–1522, 2014

Humeral fractures occur infrequently in cattle accounting
for less than 5% of all types of fracture and 18% of all long-
bone fractures [3, 8]. These fractures are typically spiral or
oblique through the diaphysis with different degrees of com-
munication [12]. They may occur close to the radial nerve,
which induces a considerable risk of permanent neurologic
damage [3]. Several treatment options have been proposed
for management of humeral fractures in cattle, including
strict stall rest or internal fixation using plates and intramed-
ullary pins [3, 8]. Treatment methods depend on the size, age,
temperament and economic value of the animals and past
experience of the surgeons [3, 8]. In this report, we describe
outpatient treatment for humeral fractures using external
fixation (EF) with the unilateral epoxy putty fixator (type I)
in 5 calves. The surgery was performed under sedation and
analgesia, and it involved application of ultrasound-guided
brachial plexus block (uBPB).
One Holstein and 4 Japanese Black calves (2 to 106 days
old and 38 to 83 kg) were referred to the Veterinary Teaching
Hospital of Iwate University to treatment suspected humeral
fractures (Table 1). All calves had demonstrated non-weight-
bearing forelimb lameness for 2 to 7 days before arrival.
Their clinical signs included the inability to fully extend the
elbow and a dropped elbow posture, indicating diminished
radial nerve function. Preoperative radiographs confirmed
oblique midshaft (calves A, C, D and E) or comminuted
supracondylar fractures (calf B) of the humerus (Fig. 1a).
Each calf was sedated by 0.1 mg/kg body weight (BW) of
*Correspondance to: Yamagishi, N., Cooperative Department of
Veterinary Medicine, Iwate University, 3–18–8 Ueda, Morioka
020–8550, Japan. e-mail: yamagisi@iwate-u.ac.jp
©2014 The Japanese Society of Veterinary Science
This is an open-access article distributed under the terms of the Creative
Commons Attribution Non-Commercial No Derivatives (by-nc-nd)
License <http://creativecommons.org/licenses/by-nc-nd/3.0/>.
xylazine (2% Seractal; Bayer, Osaka, Japan) intravenously
and administered 20 mg/kg BW of cefazolin (Cefazolin-
Chu; Fujita Pharmaceutical, Tokyo, Japan) and 1 mg/kg
BW of flunixin meglumine (FORVET-50, Nagase Medicals,
Itami, Japan) intravenously before surgery. The animals
were positioned in lateral recumbency, and the affected limb
was placed upward and prepared aseptically from the radius
to the scapula. A 10-ml lidocaine solution (2% Xylocaine;
AstraZeneca, Osaka, Japan) was administered to achieve an-
algesia by uBPB according to a method reported previously
[5]. Additional intramuscular administration of xylazine
(0.05 mg/kg BW) was done to maintain the sedation at 50 to
60 min after the first xylazine administration.
Four calves (A to D) underwent fracture repair by open re-
duction. A curvilinear craniolateral incision starting from the
point of the greater tubercle (calves A, C and D) or the distal
diaphysis near the lateral condyle (calf B) of the humerus
was extended distally to the lateral epicondyle or proximal
radius, respectively, to provide access to the fracture site.
The radial nerve was identified and reflected with the bra-
chialis muscle as needed. Two calves underwent fracture
repair by unilateral EF with percutaneous intramedullary pin
placement through the greater tubercle (calf A) or the lateral
and medial condyle of the humerus (calf B). The remaining
2 calves (C and D) were treated by unilateral EF alone. Calf
E underwent fracture repair by closed reduction and unilat-
eral EF. The EF was structured by 3 to 5 3.2- or 4.0-mm
pins [Steimann intramedually pin (Part No. 10180 or Part
No. 10532); IMEX Veterinary Inc., Longvew, TX, U.S.A.]
or 2.4-mm pins (Kirschner wire; Mizuho Ikakogyo, Tokyo,
Japan) using a Power Surgery Drill (Part No. 30010; IMEX
Veterinary Inc.). Briefly, 1 or 2 pins were inserted percuta-
neously across the fracture plane to stabilize the fragments,
and another 2 or 3 pins were percutaneously placed into both
the proximal and distal fragments (Fig. 1b). The pins for EF
were joined together with epoxy putty (Cemedine Epoxy
1520 N. YAMAGISHI, B. DEVKOTA AND M. TAKAHASHI

Table 1. Clinical information of 5 calves with humeral fractures treated by external fixation
Age in Duration of
Post-surgical
days (body the lameness Surgery Duration Post-surgical
Calves lameness
Breed Sex weight, kg) before the Preoperative radiography (reduction, of surgery pin removal
ID disappearance
on the treat- treatment fixation) (min) (days)
(days)
ment day day
A Holstein Female 106 (83) 3 Oblique midshaft fracture Open, EF plus IP 90 62 105
Friesian of right humerus
B Japanese Male 16 (45) 7 Comminuted supracondy- Open, EF plus IP 90 48 120
Black lar fracture of left humerus
C Japanese Male 7 (41) 7 Oblique midshaft fracture Open, EF 70 47 90
Black of right humerus
D Japanese Male 8 (45) 5 Oblique midshaft fracture Open, EF 90 50 110
Shorthorn of left humerus
E Japanese Female 2 (38) 2 Oblique midshaft fracture Closed, EF 60 11a) 40
Black of left humerus
EF: external fixation, IP: intramedullary pin placement. a) The pins of EF were dropped out on day 11 of post-surgery due to biting by the dam.

Putty [for metal]; Cemedine, Tokyo, Japan) unilaterally at
the extracorporeal position (Fig. 1c and 1d). Meanwhile,
percutaneous intramedullary pin placement was performed
in 2 calves (A and B) using two 2.4-mm Kirschner wires.
The surgeries were completed in 60 to 90 min (Table 1).
Each calf was returned to the farm on the same day as
surgery and administered the antibiotics for 4 to 6 days by
the referring veterinarians. One calf (A) was confined indi-
vidually to a small pen, and the remaining 4 (calves B to E)
were reared in large pens together with their dams to allow
for suckling. Follow-up information about postoperative
conditions and outcomes was obtained from interviews with
the owners or referring veterinarians, although 4 calves (A
to D) were brought to the Veterinary Teaching Hospital for
radiographic examination and removal of the EF under seda-
tion with xylazine. The fixations in 3 calves (A, C and D)
were removed 47 to 62 days post-surgery at the University
Hospital (Fig. 1e and 1f). In calf B, the intramedullary pins
were removed 2 weeks post-surgery by the referring veteri-
narian at the farm under sedation with xylazine, and the EF
was removed 48 days post-surgery at the Veterinary Teach-
ing Hospital under sedation with xylazine. In calf E, the EF
dropped out 11 days post-surgery due to biting by the dam.
The clinical sign of diminished radial nerve function disap-
peared within 40 days or within 3 to 4 months post-surgery
(Table 1). Pin tract infection was identified by serous dis-
charge from around the pin tracts at the time of EF removal
in 2 calves (A and E), but it resolved on treating with initial
systemic antibiotics and daily cleaning with sterile saline.
All animals remained in good condition without apparent
forelimb lameness for over 2 years, and all grew up normally
and accomplished their productivity.
The treatment of humeral fractures in calves has been
a challenge for the bovine orthopedic surgeons with little
information available to guide the surgeons in choosing the
most appropriate treatment plan [8]. In bovine medicine,
strict stall rest is the most commonly chosen nonsurgical
approach for management of humeral fractures, especially
in young calves, because it is not associated with any costs
or specific orthopedic skills [3, 8]. Fractures amenable to
this approach are those with minimal displacement or those
in which the proximal fragment impacts the distal fragment
providing some stability for healing [8]. Depending on the
age and weight of the animals and the degree of fracture
displacement, the animal should start to bear weight in 2 to
4 weeks with healing occurring in 2 to 3 months [8]. Pain
associated with prolonged healing of an unstable fracture is
undesirable. Carpal contracture in the injured limb, develop-
ment of angular limb deformity and stretched flexor tendons
in the opposite limb have been associated with prolonged
convalescent periods [8, 9]. Malunion with shortening of
the limb and persistent lameness may also occur [8, 9, 12].
Instability and displacement without contact of the proximal
and distal fragments decrease the chances of a favorable
outcome without reduction and internal fixation [8, 9]. At
least in Japan, this conservative management is often unfa-
vorable, since many farmers rear Japanese Black calves in
pens together with their dams to allow for suckling, making
it difficult to stabilize fractured limbs.
Internal fixation has been successful for the repair of
bovine humeral fractures [3, 8]. However, plate fixation is
not an optimal technique performed frequently in clinical
practice, because it requires expensive implants and equip-
ments, surgical facilities, and specialized experience and
anesthetic support for orthopaedic surgery [6]. Intramedu-
ally pin technique is another approach of internal fixation in
repair of humeral fractures. An advantage of this technique
over plating is that a surgical approach to the diaphysis of the
humerus may be avoided in favor of a more limited surgi-
cal approach to the diaphysis for debridement and fracture
reduction [8, 9, 11, 12]. Intramedually pins are best suited
to short oblique fractures or in combination with cerclage
wires for long oblique fractures with minimal comminution
[7], whereas this technique is not possible when there is ex-
tensive comminution [9].
In the present cases, the main request of the farmers was
to repair the fractures by inexpensive surgical approach and
to return the calves to the farms on the same day to rear
together with their dams. Inhalation anesthetic equipments
were not available in our hospital. Therefore, simple and
 TREATMENT FOR HUMERAL FRACTURES IN CALVES 1521

Fig. 1. Radiographs (a, c and e) and photographs (b, d and f) of a Japanese Black calf (calf C) with a right humeral fracture treated
by external fixation (EF). (a) Caudocranial view of the humerus before surgery. (b) The surgical area after percutaneous pin
placement for EF before joining 4 pins with epoxy resin. (c) Caudocranial view of the humerus after surgery. (d) Standing pos-
ture of the calf after surgery. (e) Caudocranial view of the humerus immediately after the removal of EF (47 days post-surgery).
(f) Standing posture of the calf on the day of EF removal (47 days post-surgery). Even though clinical signs of diminished radial
nerve function were still apparent, they disappeared by 90 days post-surgery.

feasible approach was required to effectively repair humeral
fractures without special orthopedic instruments or rigorous
effort to immobilize animals. In order to comply with those
demands, we adopted EF as a treatment for the repair of hu-
meral fractures. This EF was constructed by the pins inserted
in the humerus and the unilateral splintage of epoxy putty
(type I). This free-form external fixator has the advantage
that pin direction and pin diameter are not influenced by
direction of the connecting bar and size of the clamp, re-
spectively [10]. Another advantage of using the epoxy putty
1522 N. YAMAGISHI, B. DEVKOTA AND M. TAKAHASHI
is that it is inexpensive and readily available. The surgical
procedure was not complicated compared to the plate fixa-
tion, even while applying open reduction (calves A to D) and
percutaneous intramedullary pin placement (calves A and B)
methods. The short surgical time was also considered to be
an additional merit of the present approach for the repair of
humeral fracture in calves.
In general, advantages of the EF for the treatment of limb
fractures are early healing, preservation of local blood flow
to the fracture site, preservation of bone stimulatory proteins
that exude into the fracture site at the initial injury, diver-
sity in design for comminuted fractures and ease of implant
removal after clinical union of the fracture [1, 2, 6]. In the
present cases, the period from surgery to the disappearance
of diminished radial nerve function was shortest in the calf
that underwent fracture repair by closed reduction (calf E),
suggesting that this approach may be more beneficial than
open reduction method.
The most common clinical complications associated with
EF are instability at the fracture site and pin tract infections
[1, 2, 4, 6]. In feline medicine, many patients with the femo-
ral fractures treated with EF initially had a very slight serous
discharge from around the pins; this was generally not a
problem, and owners should be warned that it is likely to
occur [6]. More substantial discharge is caused by loosening
of the pin in the bone or continual damage to the soft tissue
around the pin [6]. In the present cases, 1 or 2 pins of EF
were inserted across the fracture plane to stabilize the frag-
ments. This may be an effective approach to overcome the
complication of instability at the fracture site associated with
EF. The pin tract infection was observed in 2 cases (calves
A and E), which was resolved by treating with systemic
antibiotics and daily lavage. In the current study, intramed-
ullary pin placement was performed only in 2 calves (A and
B); therefore further studies will be required to evaluate its
effectiveness for stabilization of the fracture site in combina-
tion with the present approach of EF.
To the best of our knowledge, this is the first reported
case series of outpatient treatment for humeral fractures in
calves repaired by EF with the unilateral epoxy putty fixator
under sedation and uBPB. The fixation allowed each calf to
remain with the dam and sucklings without strict stall rest,
suggesting that many owners are amenable to this treatment.
We believe that this repair technique represents a feasible
outpatient treatment for humeral fractures in calves and can
be applied in the field of bovine practice.
ACKNOWLEDGMENT. We thank all staff members of the
Veterinary Teaching Hospital of Iwate University for their
support and the referring veterinarians for introducing the
cases.
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