Augmentation of diaphyseal fractures of the radius and ulna in toy breed dogs using a free autogenous omental graft and bone plating

Baltzer, Wendy I.; Cooley, Stacy D.; Warnock, Jennifer J.; Nemanic, Sarah; Stieger‐Vanegas, Susanne M.

doi:10.3415/vcot-14-02-0020

Cited by 14 publications

(3 citation statements)

References 25 publications

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“… 8 However, our study is similar to others that show a higher percentage of fractures in the distal diaphysis in cats and small dog breeds. 2 , 20 – 22 It is important to note that the prevalence of antebrachial fractures in cats is much lower than in dogs: 2–8% and 18%, respectively. 2 , 23 This has previously been hypothesised to be due to higher cortical bone density, thicker trabeculae and increased anisotropy in cats compared with dogs.…”

Section: Discussionmentioning

confidence: 99%

Feline radial and ulnar diaphyseal fractures: a retrospective study of 49 cases comparing single bone fixation and dual bone fixation

Makar,

Lai,

Simcock

et al. 2024

Journal of Feline Medicine and Surgery

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Objectives The objectives of this study were to report the complications in radial and ulnar diaphyseal fractures in cats and to compare the differences in outcome between single and dual bone internal fixation. Methods Medical records between 2004 and 2022 were searched retrospectively for cats with antebrachial diaphyseal fractures treated with internal bone-plate fixation. In total, 49 cases were included from six referral hospitals, including one teaching hospital. Patient information was collated, including fracture configuration, location, repair method and clinical outcome as assessed by veterinary physical examination, radiography and owner questionnaire. Results A total of 47 cats (mean age 4.2 years) were included. Fractures were located distally (24/49, 49%), proximally (13/49, 26.5%) and mid-diaphyseally (12/49, 24.5%). Dual bone fixation was used in 13/49 (26.5%) cases, with only 1/13 (7.7%) having major complications. By comparison, 4/36 (11.1%) of single plated fractures had major complications. Single bone fixation was 14.25 times more likely (95% confidence interval [CI] 2.07–97.99) to have a successful outcome (veterinarian-assigned score of 0) compared with dual bone fixation ( P = 0.007). When evaluating owner-assessed outcomes, single bone fixation was 9.4 times more likely (95% CI 1.4–61.96) to have a successful outcome (owner score of 0) compared with dual bone fixation ( P = 0.019). Conclusions and relevance Fractures that were repaired with single bone fixation had a greater chance of a better outcome. Although the difference was not significant, there was a higher major complication rate and a lower minor complication rate for cases treated with single bone fixation compared with dual bone fixation. The majority of fractures were located in the distal diaphysis. Comminution of the fracture and concurrent orthopaedic issues did not significantly affect the outcome. Further prospective studies with standardised follow-up, radiographic assessment, surgeon and implants are required to truly assess the difference between dual and single bone fixation.

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Section: Discussionmentioning

confidence: 99%

Feline radial and ulnar diaphyseal fractures: a retrospective study of 49 cases comparing single bone fixation and dual bone fixation

Makar,

Lai,

Simcock

et al. 2024

Journal of Feline Medicine and Surgery

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“…Three papers answered the PICO question, with two studies being experimental case control studies, (Bigham-Sadegh et al, 2012;and Karimi et al, 2013) and one being a retrospective clinical trial (Baltzer et al, 2015). All three studies had a small sample size, and none were randomised.…”

Section: The Evidencementioning

confidence: 99%

“…Perhaps the most significant is the difference in the type of studies -it is difficult to properly compare a retrospective study with experimental case control studies. The retrospective study (Baltzer et al, 2015) also used different surgical repair techniques, as well as different stabilisation methods. These may have affected healing, so it is best to look at this study separately to the experimental studies.…”

Section: Appraisal Application and Reflectionmentioning

confidence: 99%

Efficacy of omental graft to facilitate canine radial fracture repair

Dietrich

2023

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PICO Question In dogs with a displaced radial fracture, does the use of a free autologous greater omental graft, combined with other standard fracture repair methods, compared to not using a greater omental graft, reduce fracture healing time? Clinical bottom line Category of research Treatment. Number and type of study designs reviewed Three papers were critically reviewed: one retrospective clinical study and two experimental case control studies. All three papers answered the PICO question. Each of the three papers had a very small sample size, with two having a sample size of 16 (n = 4 in the relevant experimental group, and n = 4 for the control). The third had an initial sample of 25 that was later reduced to 19, as six dogs were excluded from the study. Strength of evidence Weak. Outcomes reported Two papers were experimental case control studies, which looked at radial fracture healing of dogs that had undergone an osteotomy, followed by bone plate and screw fixation, as well as either with a free autologous greater omental graft (OG) or without. Healing was measured in both studies via radiographical analysis using a modified Lane and Sandhu scoring system, and histopathological analysis post euthanasia with Heiple’s histopathological scoring system. Both studies found higher radiographic and higher histopathological scores in the OG group, though there was a large overlap between group scores. There was no mention of randomisation or power analysis in either of these studies, and blinding was only mentioned regarding histopathological analysis. The other was a retrospective study, looking at the outcomes of radial and ulna fractures in small breed dogs, after being surgically treated with a plate and screw, and either with or without OG. They found that dogs with omental grafts healed faster than those without, and had no major complications (whereas the non-OG group did). Note that this study was not (and could not) be randomised due to its nature, and it made no mention of blinding. Conclusion All three studies concluded that the use of OG assisted healing in canine radial fractures. However, care must be taken when applying these results to practice, as the studies lack robustness. While two of the studies had a good study design, both had very small sample sizes and neither mentioned randomisation. Blinding was only mentioned in the histopathological analysis, not radiographical analysis, and while both studies reported significant differences between their respective OG and control groups, they failed to account for multiple comparisons in statistical analysis, which likely skewed the results. The third study also represents a weak level of evidence, due to its retrospective nature and other limitations. Its small sample size, and the fact that 4/8 control (non-OG) dogs received a different type of graft, contributed to this. Due to the small number of animals in each study and the poor-quality design, it is concluded that there is weak evidence to support the PICO question. Further randomised blinded clinical trials with larger samples sizes are recommended, to increase the strength of the evidence before the routine clinical use of greater omentum grafts for aiding fracture repair can be recommended, considering that this means an additional abdominal surgical procedure. How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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Forelimb Examination, Lameness Assessment, and Kinetic and Kinematic Gait Analysis

Millis

Janas

2021

Veterinary Clinics of North America: Small Animal Practice

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Augmentation of diaphyseal fractures of the radius and ulna in toy breed dogs using a free autogenous omental graft and bone plating

Abstract: Free autogenous omental grafting of diaphyseal fractures of the radius and ulna was associated with radial and ulnar healing with minimal complications in dogs weighing less than 6 kg.

Cited by 14 publications

References 25 publications

Feline radial and ulnar diaphyseal fractures: a retrospective study of 49 cases comparing single bone fixation and dual bone fixation

Feline radial and ulnar diaphyseal fractures: a retrospective study of 49 cases comparing single bone fixation and dual bone fixation

Efficacy of omental graft to facilitate canine radial fracture repair

Forelimb Examination, Lameness Assessment, and Kinetic and Kinematic Gait Analysis

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