Abstract

The incidence of complications secondary to fracture stabilization, particularly osteolytic lesions and bony tumor formation, has long been difficult to evaluate. The objective of this study was to describe the long-term incidence of aggressive bony changes developing in dogs with long bone diaphyseal fractures stabilized by metallic bone plates compared to a breed-, sex-, and age-matched control group. The medical records of a tertiary referral center were retrospectively reviewed for dogs that matched each respective criterion. Signalment, history, cause of death (if applicable), and aggressive bony changes at previous fracture sites were recorded. Ninety dogs met the criteria for inclusion in the fracture group and were matched with appropriate control dogs. Four of the dogs in the fracture group developed aggressive bony changes at the site of previous fracture repairs most consistent with osseous neoplasia. One lesion was confirmed with cytology as neoplastic. The population of dogs was mixed with regard to breed and body weight, but all dogs with aggressive bony lesions were male. Incidence of aggressive bony lesion formation in the fracture group was 4 (4.4%) and was 0 (0%) in the control group; three (75%) of the affected dogs in the fracture group included cerclage as a component of their primary fracture stabilizations. Incidence of aggressive bony lesions in the fracture group compared to the control group was determined to be statistically significant (p = 0.0455), as was the incidence of cerclage among dogs affected by aggressive bony lesions compared to the rest of the fracture group (p = 0.0499). Development of aggressive bony lesions is an uncommon complication of fracture fixation. Additional research is needed to further identify and elucidate the long-term effects of metallic implants in dogs.

Highlights

  • Premalignant inflammatory changes and tumor formation in association with metallic hardware and fracture stabilization are a well-recognized, though uncommonly reported, occurrence in veterinary and human patients [1,2,3]

  • Implant- or fracture-associated osteosarcomas have distinctly different biological behavior compared to spontaneously forming osteosarcomas, as they are primarily reported to arise from the diaphyseal region of long bones rather than the metaphyses and are predominantly found in the femur and tibia rather than the radius or humerus [1, 2, 6, 8, 9]

  • The results of this study indicate a greater than expected incidence (4.4%) of late aggressive bony lesion development in dogs that have undergone internal fixation of diaphyseal long bone fractures with bone plates

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Summary

Introduction

Premalignant inflammatory changes and tumor formation in association with metallic hardware and fracture stabilization are a well-recognized, though uncommonly reported, occurrence in veterinary and human patients [1,2,3]. Implant or fractureassociated tumors are neoplasms that develop in close proximity to a previous fracture or implant, develop after a considerable time delay between the inciting injury and implant placement, and lack other known predisposing factors in the vicinity including chronic infection or prior radiotherapy [2, 4,5,6]. Previous reports of dogs afflicted with implant or fracture-associated tumors have identified primarily older patients, with an implantto-tumor formation time range from 1 to 12 years [2, 4,5,6]. The purpose of this study was to determine the incidence of aggressive bony lesions that may be implant-associated tumors in a population of dogs following open reduction and repair of long bone, diaphyseal fractures with metallic bone plates. Our hypothesis was that there would be a significantly higher incidence of aggressive bony lesions in dogs with fractures repaired with plates compared to a case-matched control group

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