Fracture Healing Biological Plate Osteosynthesis

Fracture Healing Biological Plate Osteosynthesis-80
Radiographs obtained 3 weeks after implant removal necessitated by infection (e).

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The Minimally Invasive Reduction Instrumentation System (MIRIS) was utilized to facilitate minimally invasive plate osteosynthesis (MIPO) of distal limb diaphyseal comminuted fractures (2 crural, 1 antebrachial) in three dogs.

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Premedication consisted of intravenous dexmedetomidine (3–5 μg/kg) and methadone (0.1 mg/kg); induction was performed with propofol (4–6 mg/kg).

Dogs were maintained with inhalant (isoflurane 1.5–2%).

The time elapsed from when each dog sustained the fracture to initial surgical stabilization ranged from 2 to 3 days.

Dogs were given intermittent methadone (0.1–0.2 mg/kg) boluses every 4–6 hours for pain control prior to surgery.The dog that underwent revision surgery developed a surgical site infection 5 months following revision surgery, which necessitated implant removal.All three dogs had excellent limb function at the time of the final evaluation.Figure 3: Craniocaudal and mediolateral preoperative radiographs of dog #2’s right tibial and fibula fractures (a).Initial postoperative radiographs following primary surgical stabilization with a 12-hole, 2.7 mm locking compression plate and a 10-hole, 2.7 mm String of Pearls plate (b).The MIRIS facilitated efficient MIPO in all three fractures.Radial and tibial lengths were restored within 2% of the length of the intact bone and postoperative frontal and sagittal plane angulation were within 3° of the normal contralateral limb for each of the fractures.Iatrogenic soft tissue trauma and disturbance of the fracture environment are limited as implants are applied via small plate insertion incisions made remote to the fracture site [1–7].Purported advantages afforded by this technique include reduced operative times compared to open anatomic fracture reconstruction [2, 10], low infection rates due to the shorter duration of surgery and limited exposure of the fracture site [8, 11–14], and shorter times to union ascribed to maintenance of the fracture hematoma and preservation of periosteal blood supply [15–17].This system resulted in reductions that were near anatomic, with acceptable restoration of length and alignment and excellent limb function.Minimally invasive plate osteosynthesis (MIPO) is utilized in both human and veterinary orthopedics and embraces the principles of biological fracture stabilization [1–9].


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