Efficacy of omental graft to facilitate canine radial fracture repair

Abstract

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.