The present study was conducted on six cases of long bone fracture presented to BSPCA Hospital, Parel. Preoperative, intraoperative, postoperative findings regarding hemato-biochemical parameters, weight bearing on operated limb, functional limb usage and gait were noted.
Pre-operative evaluation
Most of the animals were young fell below age group of 12-18months (n=5) (Table 1). Young dogs were more prevalent as they were under development, with low-density bones in osteogenesis phase, which can be fragile even for injuries of lower intensities
(Minar et al., 2013) and also the young ones are more active and are not learned to cope up with hazards unlike their older counterparts
(Aithal et al., 1999 and
Eyerefe and Oyetayo, 2016).
Males (66.66%) (Table 1), in search of females in heat get exposed to accidents or to be involved in fights with other males
(Kumar et al., 2007and Libardoni et al., 2016).
Most of the animal breeds included in the present study were non-descript (n=5, 83.33%) breeds (Table 1). More number of non-descriptive breed dogs which are usually let loose to roam outside freely and thus more likely to succumb to road accidents (
Maala and Celo, 1975), Similar results were observed by
(Jain et al., 2018) and
(Sran et al., 2016) who reported highest occurrence of fracture in non-descript dogs. Most of the animals included in the study had history of automobile accidents (83.33%), one being fallen from height (16.66%) (Table 1).
(Aithal et al., 1999); (
Harasen, 2003). (
Ali 2013),
(Singh et al., 2015), (
Eyerefe and Oyetayo, 2016), also recorded high incidence of fractures due to automobile accidents.
In present study hind limbs (83.33%) found to be more affected than fore limbs (16.66%) (Table 1). In automobile accidents, animals were likely to be hit from behind, as the animals were slow to react from their hind quarters, might be the cause of more fracture in hind limb (
Harasan, 2003). Similarly the incidence was found in pelvic limbs (63.69%) followed by pectoral limbs (38.22%)
(Kumar et al., 2007and Aithal et al., 1999).
Lack of guidance by the local practitioners and the treatment given by quacks at the field level might have led to the delayed presentation of cases (n=4) (Table 1). Similar observations were also made by (
Singh, 2015) who reported that the socio-economic status, carelessness of the owner and treatment by the nearby veterinarians had contributed to the delayed presentation of cases. The animals included in the present study were evaluated based on mention, mucous membrane and health condition into excellent, good, fair, poor (Table no.3).
All of the animals included in the study had non weight bearing lameness on affected limb at the time of presentation. All the animals underwent physical examination to examine skin condition and extent of swelling at fracture site (Table 1). Orthopedic examination was carried out to evaluate bone and joint involvement. Amongst all cases studied the tibia fibula (66.66%) found to be mostly affected followed by radius ulna (16.66%) and femur (16.66%) (Table 1). Amongst the total cases studied, no joint involvement in any of the cases noted Similar observations were also made by (
Varshneya, 2011). Animals tend to either carry the affected limb or simply touch the toe on the ground due to the pain associated with the inflammation and injury to the surrounding soft tissue from the movement of the fracture fragments. Non weight bearing and varying degree of limb swelling are observed in patients with diaphyseal fractures, (
Fossum, 2007).
Two radiographs
viz. cranio-caudal view and medio-lateral view were taken preoperatively to evaluate status of bone fracture, number of fracture fragments, direction of fracture fragments, diameter of medullary cavity, length of fracture fragments to predict the size of bone plate and screw, similar findings were given by (
Langley- Hobbs, 2003).
Intraoperative findings
Fracture gap and Amount of bio glass putty applied at fracture site
The gap between fracture fragments after anatomical reduction and internal fixation was recorded and analyzed. The fracture gap ranged between 2-6 mm, mean average being 3.5±0.66 mm (Table 2).
The bio glass putty was applied at fracture site under aseptic and sterile conditions. The amount of bio glass putty applied ranged from 2-5ml (Table no.2). The amount required was more in oblique overriding fractures.
(Valimaki et al., 2005) stated that, the bioactive glasses result in significant intramedullary new bone formation and high local bone turnover.
(Guth et al., 2011) reported that the soluble silicon has notably demonstrated its role in the up-regulation of collagen synthesis, osteoblastic metabolism, promotion of osteo-inductive gene expressionand therefore faster bone formation.
Postoperative evaluation
Range of motion of the joints
On the 60
th day post operatively, the operated animals were examined to evaluate the range of motion of the proximal and distal joints to the affected bone. Scores were given as described by
(McCartney et al., 2010) (Table 3). Stiffness of the stifle joint reducing the range of motion after intramedullary pinning have been reported as a result of direct damage to the joint due to pin penetration during the operation or its migration in the later stage.
Time required to attain normal gait
Minimal exposure of fractured fragments together with gentle manipulation of bone fragments during surgery led to early weight bearing (Table no.3). The mean time required to attain normal gait in group I was 23.66±1.55 days, (
Bhalerao, 2010) recorded period to attain normal gaits as 22±0.672 days, (
Coutinho, 2012) reported it as 32.12±6.32 days
Post operative clinical examination
The postoperatively animals were evaluated for weight bearing on 7
th, 14
th ,30
th, 60
th day as per system given by
(Sahu et al., 2017). Weight bearing while standing was graded on score (0-3) and weight bearing while walking graded on score (0-4).
The better weight bearing while standing and walking was observed in cases was may be due to the osteo-inductive properties and compatibility of bio glass bone cement (Table 4) (Fig 4). These findings were in correlate with findings of
(Singh et al., 2015and Kumar et al., 2007) who also reported a gradual increase in weight bearing with partial weight bearing from 7
th day onwards and complete weight bearing from 6th week interval.
Post operative functional limb usage
The postoperative functional limb usage based on the degree of lameness was evaluated and graded based on the system given by
(Fox et al., 1995) on 60
th day (Fig 5). Better functional limb usage observed due to osteo-stimulative property of bio glass bone cement and its components
viz. Calcium phosphate, Hydroxyapatiteand Tricalcium phosphate which are osteoconductive in nature (Table no.3). (
Mathew, 2019) in their study reported the comparison between two groups, the functional limb usage was found good in three cases (50%) and poor in three cases (50%) of group I whereas excellent functional limb usage was evident in two cases (33.33%), good in three cases (50%) and poor in one case (16.66%o) of group II. (
Larsson, 2006) reported that, better functional limb usage, attributed to the augmentation of the fractures with polymethylmethacrylate bone cement that provided more stability with reduced overall movement, less distal displacement and less varus angulation when compared with fractures fixed with metal devices alone.
Post operative radiographic examination
The radiographic examination was performed immediately after the surgery, on 15
th day, 30
th day, 60
th day postoperatively to assess the position of implants, fracture fragments and callus formation. The bone formation score (BFS) and the bone union score (BUS) were given on the system given by (
Lane and Sandhu, 1987). The system given by
(Hammer et al., 1985) was used to score stage of union (SOU) (Table 5).
Bone formation and bone union scores were found to be better, which might be attributed to the osteo-stimulative and osteoconductive properties of bio glass bone cement, leading to early migration of mesenchymal cells resulting in to callus and bone formation. (
Schwandt and Montavon, 2005) reported that complete bridging and callus remodeling was observed at 53 days after surgery.
(Haaland et al., 2009) found that mean healing time using LCP in dogs in appendicular fractures was 7 weeks.
(Egol et al., 2004) opined that in the absence of anatomic reduction and interfragmentary compression, locked plating constructs rely on secondary bone healing which was induced by interfragmentary motion in millimeter range. The bone union was achieved at and around day 30
th-60
th post-operatively.
Complications
(
McLaughlin, 1999) described the complications following bone plating such as loosening of plate, breakage of screws, delay in fracture healing, non-union, infection, osteopenia and rarely implant induced osteosarcoma.
In present study no as such complications were noted due to, proper sterilization of surgical site and asepsis followed during surgical procedure, most of wounds healed by first intentionand also due to early presentation of the case where there was less soft tissue damage and also due to washing of wound with diluted amikacin in normal saline (1 ml+500 ml) prior to suturing of the wound reduced infection at fracture site. (
Bhalerao, 2010) observed a wide range of activity of amikacin against gram positive and gram-negative bacterial infections in orthopedic surgeries. It was also observed independently in the studies by, (
Coutinho, 2012).
