Postoperative complications associated with external skeletal fixators in cats.

Lee Beever,Kirsty Giles,Richard Meeson

doi:10.1177/1098612x17699466

Lee Beever, Kirsty Giles + Show 1 more

Open Access

https://doi.org/10.1177/1098612x17699466

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Abstract

The objective of this study was to quantify complications associated with external skeletal fixators (ESFs) in cats and to identify potential risk factors. A retrospective review of medical records and radiographs following ESF placement was performed. Case records of 140 cats were reviewed; fixator-associated complications (FACs) occurred in 19% of cats. The region of ESF placement was significantly associated with complication development. Complications developed most frequently in the femur (50%), tarsus (35%) and radius/ulna (33%). Superficial pin tract infection (SPTI) and implant failure accounted for 45% and 41% of all FACs, respectively. SPTI occurred more frequently in the femur, humerus and tibia, with implant failure more frequent in the tarsus. No association between breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, degree of fracture load sharing, and the incidence or type of FAC was identified. No association between region of placement, breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, fracture load sharing and the time to complication development was identified. Complication development is not uncommon in cats following ESF placement. The higher complication rate in the femur, tarsus and radius/ulna should be considered when reviewing options for fracture management. However, cats appear to have a lower rate of pin tract infections than dogs.

Highlights

External skeletal fixators (ESF) are used for numerous orthopaedic conditions including fracture stabilisation, joint immobilisation, angular limb deformity and shear injury management
superficial pin tract infection (SPTI) accounted for 45% of all fixator associated complication (FAC), similar to a previous study investigating feline tibial fixation with 41%. 6 While results of our study showed no significant regional association with FAC type, the low levels of tibial SPTIs and high levels of femoral SPTIs, are suggestive of a true or surrogate influence of anatomic region
The type and size of pins placed was not consistently available for analysis and due to the referral nature of the caseload, under reporting of minor complications could have occurred. This is the largest study to date, reviewing ESF placement and fixator complications in cats

Summary

Introduction

External skeletal fixators (ESF) are used for numerous orthopaedic conditions including fracture stabilisation, joint immobilisation, angular limb deformity and shear injury management. 1-4 Whilst ESFs remain a versatile and useful tool in orthopaedics, reservations regarding their use are based on high reported fixator associated complication (FAC) rates, implant failure and pin tract infection (PTI). PTIs occur most commonly when there has been significant penetration and disruption to the adjacent soft tissues. This allows bacterial contamination of the skin to pin interface, leading to superficial pin tract infection (SPTI), which can progress to deep pin tract infection (DPTI), with associated bone lysis and osteomyelitis.[9,10,11] Implant failures include pin loosening, breakage or bending; clamp loosening and connecting bar breakage leading to construct failure.

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