Antebrachial Fractures Research Articles

Characteristics of Nonunion Fractures in Patients with Antebrachial Fractures at dr. Mohamad Soewandhie General Hospital Surabaya 2021-2022: A Retrospective Study

Background: Nonunion, a complication of fracture healing, can lead to patient morbidity. Contributing factors include age, gender, fracture type, multiple fractures, infection, prolonged nonsteroidal anti-inflammatory drug (NSAID) use, smoking, nutritional status, and history of chronic disease. This study aims to determine the prevalence and characteristics of nonunion antebrachial fractures at dr. Mohamad Soewandhie General Hospital Surabaya. Methods: This retrospective descriptive study involved 111 patients. Data was gathered from medical records treated at dr. Mohamad Soewandhie General Hospital Surabaya for antebrachial fracture during 2021-2022. The study protocol obtained approvals from two local ethical committees. Data included demographics, fracture characteristics, fracture type, multiple fractures, infection, NSAID use, hypertension and diabetes history, smoking habits, and nutritional status by BMI calculation. Results: This study found a 24.3% prevalence of antebrachial nonunion fractures at dr. Mohamad Soewandhie General Hospital Surabaya in 2021-2022, mostly in males (66.7%) aged 17-25 years (22.2%). Nonunion in antebrachial fractures is marked by high rates in closed (92.6%) and single fractures (92.6%). Notably, infections (22.2%), smoking (7.4%), and hypertension history (7.4%) are common contributors. Despite ideal BMI in many cases (44.4%), nonunion still occurred. Conclusions: The study conducted at Dr. Mohamad Soewandhie General Hospital in Surabaya revealed a high prevalence of antebrachial nonunion fractures at 24.3%, particularly among young males. It was found that closed, single fractures were the most common type, with infections, smoking, and a history of hypertension being significant contributing factors. Interestingly, even individuals with an ideal BMI were still at risk for nonunion.

Comparison of exposure of the radius afforded by the craniomedial and craniolateral open surgical approaches in dog cadavers.

Management of antebrachial fractures in dogs typically involves open reduction and bone plate stabilisation of the radius performed using either a craniomedial approach (CMA) or craniolateral approach (CLA). The aim of this cadaveric study was to compare radial exposure afforded via the craniomedial and craniolateral approaches, without and with releasing the abductor digiti I longus (ADIL) muscle. The CMA and CLA were performed on alternate paired cadaver forelimbs with the subsequent release (CMA) or elevation (CLA) of the ADIL muscle (n = 12). The percent area of exposure was calculated in defined longitudinal radial segments (LRSs) and hemi-circumferential radial segments (HRSs) using digitally uploaded images. A non-parametric rank sum test was used for statistical analysis (p < 0.05). While both the CMA and CLA provided sufficient exposure for radial cranial plate placement in the mid-to-distal diaphyseal region (50-80% LRSs), the CMA afforded greater exposure to the distal metaphysis (80-90% LRS). The CLA was advantageous in exposing the proximal diaphysis (20-50% LRSs) and distal epiphysis (90-100% LRS). Exposure of the distal diaphyseal, metaphyseal, and epiphyseal regions (80-100% LRSs) was impeded by the ADIL muscle. A tenotomy of the tendon of insertion of the ADIL muscle increased exposure afforded by the CMA in the distal metaphyseal and epiphyseal regions. The exposure afforded by the CLA in the distal diaphyseal and metaphyseal regions was significantly improved by elevating the origin of the ADIL muscle. The results of this study provide useful clinical information when surgeons are deciding which approach to use for cranial radial plating.

THE EFFECT OF LAVENDER AROMATHERAPY TO ANXIETY LEVELS PATIENT PREOPERATIVE ORIF ANTEBRACHII FRACTURE

Surgery is a potential or actual threat to a person's integrity and can subsequently cause a psychological reaction, namely anxiety. One alternative in overcoming anxiety is with lavender aromatherapy. Lavender aromatherapy has advantages compared to other types of aromatherapy, namely it is economical, easy to obtain, safe to use, does not take long and is practical because it does not require complicated equipment). Lavender has a chemical content, namely Linalyl acetate and linalool. These molecules have sedative and antidepressant effects that can affect a person's feelings and emotions. The purpose of this study was to determine the effect of lavender aromatherapy on the anxiety level of preoperative ORIF antebrachii Fracture patients. The study used a pre-experimental design with a One-group pre-post test design which was carried out on March 9 - April 9 2023. The population in this study were all preoperative ORIF Antebrachial Fracture patients for 1 month as many as 14 people in the bougenvile room at Kertosono Hospital. A sample of 14 respondents with total sampling sampling technique. Measurement of anxiety levels before and after being given lavender aromatherapy with Hamilton Rating Scale for Anxiety (HARS). Provision of lavender aromatherapy for 15 minutes. Data analysis used the Wilcoxon sign rank statistical test. The results of the Wilcoxon sign rank statistical test showed P value = 0.001 &lt;α = 0.05 so that there was an effect of lavender aromatherapy on the anxiety level of preoperative ORIF Antebrachii Fracture patients. Lavender aromatherapy can be applied as an alternative solution in overcoming the anxiety of preoperative ORIF Antebrachii Fracture patients.

Load-bearing composite fracture-fixation devices with tailored fibre placement for toy-breed dogs

Fibre reinforced composites are attractive materials for hard tissue reconstructions, due to the high strength and low flexural modulus. However, lack of contourability in the operation theatre inhibits their clinical applications.The study presents a novel in situ contourable composite implant system for load-bearing conditions. The implant system consists of a thin bioresorbable shell with several cavities, much like bubble-wrap. The central cavity contains a semi-flexible glass fibre preform prepared using Tailored Fibre Placement method. The preform is either pre-impregnated with a light curable resin, or the resin is injected into the cavity during the surgical procedure, followed by light curing. The semi-flexible glass fibre preforms were also examined as separate devices, “miniplates”. Two types of miniplates were scrutinized, a simplified pilot design and a spatially refined, “optimized” design. The optimized miniplates were implemented as biostable and bioresorbable versions.The feasibility of the in situ contourable composite implant system was demonstrated. The potential of Tailored Fibre Placement for the semi-flexible glass fibre preforms and miniplates was confirmed in a series of biomechanical tests. However, structural optimization is required. Antebrachial fractures in toy-breeds of dogs are exemplar veterinary applications of the devices; further applications in veterinary and human patients are foreseen.

Comparison of cranial versus medial minimally invasive plate osteosynthesis applications for the stabilization of simulated radius and ulna fractures in dog cadavers.

Minimally invasive plate osteosynthesis (MIPO) is an emerging fracture management modality in small animal orthopedics. Although cranial plate application has been consistently advocated when performing radial MIPO, medial plating affords several purported advantages including improved screw purchase through the wider medial-to-lateral dimension of the radius, the potential to use smaller plates allowing more screws per unit length, and avoidance of extensor tendons which can complicate cranial plate placement in distal diaphyseal or metaphyseal fractures. To compare cranial versus medial MIPO applications for the stabilization of diaphyseal radius and ulna fractures in dog cadavers. Simulated bilateral antebrachial fractures were stabilized with cranial MIPO on one forelimb and medial MIPO on the contralateral limb, facilitated by a two-ring circular fixator construct. Procedure times and ease, number of fluoroscopic images obtained, and post-procedural frontal and sagittal alignment and radial length were compared between plating groups. The ease of construct placement, fracture reduction, radial approach, and plate application, were subjectively scored 1-5 for each procedure. Paired t-tests were performed to identify significant differences (p < 0.05) between the two plating groups. There was no difference in total or incremental procedural times, subjective ease scores, or the number of fluoroscopic images obtained between plating groups. Both plating groups had comparable post-procedural frontal and sagittal plane alignment. There was a significant difference between plating groups for final radial length (p = 0.004) and change in radial length compared to the intact radii, (p = 0.002). Medial-plated radii measured longer than cranial-plated radii. The only outcome measure significantly different between plating groups was the post-procedural radial length. The change in length compared to intact radii was <1%, regardless of the plating group, and unlikely to be clinically relevant.

Assessment of 2 Treatment Methods for Ulna Fractures With an Intact Radius in Raptors: Conservative Management and Surgical Fixation With a Type I External Skeletal Fixator Intramedullary Pin Tie-in.

Several methods have been reported for treating avian antebrachial fractures, yet the quantitative information regarding their success is limited. This retrospective study applied data from raptors admitted to a wildlife rehabilitation center to provide metrics associated with the treatment of ulna fractures with an intact radius by either conservative management or a single surgical method: a type I external skeletal fixator tied in to an intramedullary pin (ESF IMP tie-in). Postfledging wild raptors with an ulna fracture admitted to The Raptor Center at the University of Minnesota College of Veterinary Medicine (St Paul, MN, USA) between January 1, 2007, and December 31, 2017, that survived for at least 7 days after admission were included in the study. Information regarding signalment, fracture characteristics, treatment method, outcome, and complications were recorded. The study included 110 raptors representing 15 species. The majority of birds (69%, 76/110) were treated with conservative management. Conservative management was used more often in cases of chronic (P = .02) and closed (P = .02) fractures, whereas fractures with poor alignment at the time of admission were frequently treated through surgical means (P=.001). Alignment was more likely to improve with an ESF IMP tie-in (P=1.01 ×10-9). The majority of cases (65%, 72/110) had a successful outcome. Birds with closed fractures were more likely to have a successful outcome (P=.03). Birds in which fracture alignment became exacerbated with either treatment method were more likely to have a poor outcome (P=.002). The results of this retrospective study found that conservative management and surgical fixation by the ESF IMP tie-in technique are both viable treatment options for ulna fractures with an intact radius in raptors. The choice of treatment method is dependent on the clinician's assessment of the fracture characteristics and individual patient.

The cat as a small dog?—Comparison of trabecular and cortical bone microarchitecture of radius and ulna in cats and small dogs using microcomputed tomography

The forearms of dogs and cats do not only differ anatomically from each other, but there are also differences in prevalence of radius and ulna fractures between the two species. The prevalence of antebrachial fractures is 18.0% in dogs and 2.0–8.0% in cats. Many studies focus solely on the trabecular and cortical bone structure of dogs and the characteristics of the cat are often disregarded.The aim of this study was to evaluate the trabecular structure parameters [bone volume fraction per total volume (BV/TV), bone surface per total volume (BS/BV), trabecular number (Tb.N), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), connectivity density (Conn. D), degree of anisotropy (DA)] and the diaphyseal cortical bone density (Mean Density) of the antebrachium in cats and small dogs to visualise their differences.For this purpose, a total of 32 forearms of cats (n = 8) and small dogs (n = 8) were evaluated using microcomputed tomography and the findings were compared.The results of the study showed that cats had higher values for BV/TV, Tb.Th, Tb.Sp, DA and Mean Density and lower values for BS/BV, Tb.N and Conn.D at radius and ulna compared to dogs.According to the results of this study, the higher bone volume fraction (BV/TV), thicker trabeculae (Tb.Th), increased anisotropy (DA) and significantly higher diaphyseal cortical density (Mean Density) could contribute to the lower fracture risk of the antebrachium in cats compared to small dogs.

A Retrospective Study of Postoperative Development of Implant-Induced Osteoporosis in Radial-Ulnar Fractures in Toy Breed Dogs Treated with Plate Fixation.

This study aimed to evaluate implant-induced osteoporosis (IIO) development in toy breed dogs treated using internal fixation with digital radiographs as the index of pixel values. There were 226 cases (236 limbs) of toy breed dogs with radial-ulnar fractures. Pixel values were measured on radiographs immediately, 2 weeks and 1 to 12 months after surgery. The ratio of pixel values (PVR) represented the bone mineral areal density based on the humeral condyle in the same image. The dogs were grouped based on the fixation methods, age and status of destabilization. There was a significant decrease in the PVR at 1 to 12 months postoperatively for all cases. There were not any significant differences in PVR of antebrachial fractures between those repaired with plates using locking head screws, cortex screws or a combination of locking and cortex screws. Implant-induced osteoporosis persisted at 1 to 12 months postoperatively in dogs aged ≧6 months, while the PVR increased after 3 months in dogs aged <6 months. Based on the destabilization method, there was a significant increase in the PVR at 3 months in the plate removal group. This study suggests that IIO occurs in small dogs treated with plates and screws. Moreover, patients aged < 6 months showed an early postoperative recovery of bone mineral areal density. Further, screw and plate removal could contribute to the recovery of bone mineral areal density.

Comparative microcomputed tomographic structural analysis of the trabecular and cortical bone architecture of radius and ulna in toy dog breeds

Radius and ulna fractures can be detected in dogs with an incidence of 18.0% and occur more frequently in toy breeds with increased complication rates. The reasons for the predisposition and the increased complication rate of antebrachial fractures in toy breeds are not yet fully understood.The aim of this study was to research the associated mechanisms by investigating the trabecular structure parameters (BV/TV (%), Tb.N (mm−1), Tb.Th (mm), Tb.Sp (mm), Conn. D (mm−3), DA) and the cortical bone density (Mean Density (mg HA/ccm)) for toy breeds and small dogs of other breeds using microcomputed tomography and to identify the differences between both groups.A total of 70 forearms, originating from toy breeds (n = 36) and small dogs of other breeds (n = 34) were evaluated by microcomputed tomography.The results of this study showed a lower bone volume fraction (BV/TV), more (Tb.N) but thinner trabeculae (Tb.Th) with greater separation (Tb.Sp) and decreased diaphyseal cortical density (Mean Density) in toy breed dogs. This could thus contribute to the increased risk of antebrachial fractures in toy breeds. Within the group of toy breeds inhomogeneous results were observed, whereby the values of the Chihuahuas deviated. This breed had significantly thinner trabeculae (Tb.Th) with a greater trabecular separation (Tb.Sp), lower bone volume fraction (BV/TV) and significantly lower diaphyseal cortical density (Mean Density). These parameters could therefore indicate an increased antebrachial fracture and complication risk, especially in Chihuahuas.

Human placenta‐derived matrix with cancellous autograft and demineralized bone matrix for large segmental long‐bone defects in two dogs with septic nonunion

To report the successful treatment of septic nonunion in two dogs with large segmental defects secondary to long-bone fractures by using a novel human placenta-derived matrix (hPM) as adjunct to fixation. One 3-kg 9-year-old neutered male Yorkshire terrier with a distal antebrachial fracture and one 6-kg 4-year-old spayed female miniature pinscher with a distal humeral fracture. Short case series. Both dogs presented for septic nonunion after internal fixation of Gustilo type II open diaphyseal fractures from dog bite injuries. During revision, debridement of nonviable bone resulted in segmental defects of 32% and 20% of the bone length for the antebrachial and humeral fractures, respectively. The antebrachial fracture was stabilized with a circular external fixator, and the humeral fracture was stabilized with biaxial bone plating. The fracture sites were not collapsed, and full length was maintained with the fixation. Autogenous cancellous bone graft and canine demineralized bone allograft were packed into the defects, and hPM was injected into the graft sites after closure. Radiographic union was documented at 8 weeks and 6 weeks for the antebrachial and humeral fractures, respectively. Both dogs became fully weight bearing on the affected limbs and returned to full activity. Augmenting fixation with grafts and hPM led to a relatively rapid union in both dogs reported here.

Characteristics of antebrachial fractures associated with a successful outcome among free-ranging birds of prey that received treatment in a rehabilitation program.

To identify characteristics of antebrachial fractures associated with a successful outcome (ie, bird released back into the wild after regaining normal flight ability, without being returned to the rehabilitation program within 1 month afterward) for free-ranging birds of prey admitted to a rehabilitation program. 620 birds of prey (representing 24 species) with antebrachial fractures admitted alive to a rehabilitation program from August 1986 through December 2015. The medical record of each bird was reviewed to obtain information on species, age, sex, year of admission, fracture characteristics, and treatments administered. Outcome was classified as successful or unsuccessful on the basis of available data. Multivariable logistic regression was used to identify fracture characteristics associated with outcome. 519 of 620 (84%) birds received treatment, and a successful outcome was recorded for 245 (47%) treated birds. Birds with closed (vs open) fractures were significantly more likely to have a successful outcome. Birds with concomitant radial and ulnar fractures involving the same third of the antebrachium (vs other types of antebrachial fractures) were significantly less likely to have a successful outcome, although birds with this type of fracture were significantly more likely to have a successful outcome when the fracture was localized to the middle or distal (vs proximal) third of the antebrachium. The characteristics of antebrachial fractures associated with a successful or unsuccessful outcome in this study may be useful in the development of triage protocols for birds of prey in other rehabilitation centers.

Release Rates and Complications for Birds of Prey With Antebrachial Fractures at a Veterinary Teaching Hospital.

A retrospective case series that included 253 free-ranging birds of prey admitted to a rehabilitation center was conducted to describe the treatment and outcome of antebrachial fractures. Medical records from birds of prey belonging to 21 species admitted with antebrachial fracture between 1989 and 2015 at the University of California, Davis, were reviewed. Species distribution on admission, treatment, outcome, and complications were described by fracture category and species. Among 134 birds treated after initial triage on the day of admission, 4 bone/ wing categories were identified: 83 birds had an ulnar fracture only; 18 birds had a radial fracture only; 28 birds had a concomitant fracture of the radius and ulna on the same wing; and 5 birds had bilateral antebrachial fractures. Logistic regressions were performed to determine which factors were associated with a positive outcome within each of these 4 categories. Among birds having only an ulnar fracture, those with a closed fracture were significantly more likely to be released than birds with open fractures (P = .03; odds ratio = 5.43, 95% confidence interval: 1.29-28.12). In addition, birds with a fracture of the middle third of the ulna were significantly more likely to be released than birds diagnosed with a single fracture of the proximal third of the ulna (P = .02; odds ratio = 4.54, 95% confidence interval: 1.35-16.64). No significant prognostic factor was detected in other fracture categories.

Long bone fractures in cattle: A retrospective study of treatment and outcome in 194 cases

The present retrospective study investigated the localization, cause, treatment and healing of long bone fractures in cattle. Over a period of ten years, medical records of 194 cattle of all ages with a long bone fracture, presented at the Clinic for Ruminants with Ambulatory and Herd Health Services at LMU Munich, were evaluated. The majority of patients (n = 131, 67.5%) were younger than two weeks of age. Of these, 118 calves sustained the fracture on the day of birth (60.8%). An obstetrical assistance was found in 57.4% (n = 58) of birth-related cases as a fracture cause. The femur was most frequently affected in calves aged up to two weeks (n = 35; 26.7%). The second most frequent fractures occurred in the metacarpus (n = 31; 22.9%) in this age group, followed by metatarsus (n = 28; 21.4%) and tibia (n = 27; 20.6%). Fractures of the antebrachium (n = 9; 6.9%) and the humerus were rare (n = 1; 0.8%). A total of 194 patients were diagnosed with 50 femur fractures (25.8%), 53 metacarpal fractures (27.3%), 43 metatarsal fractures (22.2%), 30 tibial fractures (15.5%), 11 antebrachial fractures (5.7%) and 7 humeral fractures (3.6%). Of the 194 animals, 78 (40.2%) had to be euthanized, 42 of them (53.8%) without treatment. In 150 patients, treatment was initiated, of which 110 patients (73.3%) were dismissed healthy from the clinic. Among the conservative treatment methods were stall rest, casts, casts combined with a U-shaped metal rail (walking casts) and the Thomas splint. Surgical therapy (internal fixation with plates or screws, transfixation pin casts) was used to treat 65 animals (33.5%). While 86.9% (74 out of 85) of the conservatively treated animals left the clinic alive, it were only 58.1% (36 out of 65) animals after surgical treatment. In the newborn calves, colostrum supply had a significant effect on the success of the treatment. If the gamma-glutamyl transferase concentration was below 200IU/L in the calves aged under 4 days, the healing rate was significantly different from the cure rate of sufficiently immunized patients (26.9% (7 out of 26) vs. 65.3% (47 out of 72), P = 0.001).

Treatment of Long Bone Fractures in Calves with Ilizarov External Fixator.

In this study, the advantages and disadvantages of Ilizarov external fixator in the treatment of long bone fractures in calves were investigated. For this purpose, 26 calves of different breeds, ages and genders, having metacarpal (n = 12), metatarsal (n = 5) and antebrachial (n = 9) fractures underwent surgery under general anaesthesia. Frames, which were prepared before surgery in accordance with the radiographic findings, were applied under open reduction in 18 cases, and under closed reduction in eight cases. In the postoperative period, all calves except one started to bear some weigh on the injured limb on the first day, while the remaining calf did the same on the second day. The consolidation started in the first 2 weeks for 24 of the calves and was completed by the day 55. In the two remaining cases, it started in the third week and was completed on day 71 and day 90, respectively.The soft tissue wounds were completely healed in all calves and no complications occurred. In five calves that were not kept in our clinic pin tract infections formed. They were controlled rapidly, and there was no change in the fracture reduction or healing duration.In conclusion, in our study, the Ilizarov external fixator system was applied to long bone fractures in cattle calves, in cases where the fragments were not large enough to apply pins and plates, and which became open and infected after defective bandage practices or unsuitable treatment. Fractures completely healed in all cases, without any complications. These results show that many of the long bone fractures experienced by calves, that were considered for amputation due to the anticipated inability to treat them successfully, could be treated with the use of the Ilizarov system.

Randomized, controlled, prospective clinical trial of autologous greater omentum free graft versus autogenous cancellous bone graft in radial and ulnar fractures in miniature breed dogs.

To determine the rate of radiographic healing, complications, vascularization, and bone density after repair of radial and ulnar fractures in dogs <6 kg that were treated with an autogenous cancellous bone graft (BG) or free autologous omentum graft (OG). Prospective, randomized, controlled clinical trial with owners/radiologists blinded to treatment. 25 dogs with naturally occurring traumatic radial/ulnar fractures. Fractures underwent plate fixation with OG or BG. Power Doppler ultrasonographic, computed tomographic (CT), and radiographic examinations of the affected antebrachium were performed preoperatively and every 3 weeks postoperatively until healed. Pressure-sensitive walkway gait analysis and owner and veterinarian assessments were obtained preoperatively (0 weeks) and 3, 6, 9, 12, and 24 weeks postoperatively. Owner/veterinarian assessments improved postoperatively but did not differ significantly between groups. The improvement in peak vertical force/vertical impulse was greater in dogs with OG than in those with BG, beginning 3 weeks postoperatively. Radiographic healing occurred earlier in bones treated with OG (median, 9 weeks) than in those treated with BG (12 weeks). Cortical bone density derived from CT of the distal ulna was higher in bones with BG compared with bones with OG. Signal intensity and the number of vessels in the fracture callus declined over time in both groups, according to results of ultrasonography. However, bones retained more vessels and greater signal intensity when treated with OG compared with treatment with BG, according to multiple views at 6 and 9 weeks postoperatively. Omental grafting was not associated with major complications, and it accelerated bone healing and return to weight bearing in dogs. Omental grafting should be considered as an adjunct to stabilization of antebrachial fractures in toy and small breed dogs.

Fractures of the radius and ulna

Fractures of the radius and ulna are commonly encountered in dogs and cats and they are often stated to be simple to repair. While the surgical approaches to both the radius and ulna are certainly easier than to the proximal limb, the paired bone system predisposes individuals with these injuries to a unique set of complications. Skeletally immature animals are at risk for development of angular limb deformity following these injuries and frequent monitoring with early investigation and intervention where necessary is advised. In any dog, and particularly cats, with antebrachial fractures, every effort must be made to maintain the natural motion that occurs between the radius and ulna; failure to do so may precipitate implant failure and/or lead to impaired quality of life. Toy-breed dogs suffer fractures of the radius and ulna frequently and pose a unique challenge for management, with high complication rates associated with inappropriate methods of stabilisation such as external coaptation. This article details the types of antebrachial fracture that are commonly encountered and provides guidance on how to choose between the various types of stabilisation available, with the aim being to minimise complications and improve prognoses for these patients.

Risk Factors for Post-treatment Complex Regional Pain Syndrome (CRPS): An Analysis of 647 Cases of CRPS from the Danish Patient Compensation Association.

Complex regional pain syndrome is a challenging condition that includes a broad spectrum of sensory, autonomic, and motor features predominantly in extremities recovering from a trauma. Few large-scale studies have addressed occurrence of and factors associated with complex regional pain syndrome (CRPS) following orthopedic treatment. The present study aimed to identify factors associated with post-treatment development of CRPS. Using the Danish Patient Compensation Association's database, we identified 647 patients claiming post-treatment CRPS between 1992 and 2015. Age, gender, initial diagnosis, treatment, and amount of compensation were extracted. Multivariate logistic regressions were performed to identify variables associated with approval of the claim. For carpal tunnel syndrome (CTS) patients, we registered whether symptoms were bilateral or unilateral and if neurophysiology prior to treatment was pathologic. The following ratios were found: women:men was 4:1, primary diagnosis to the upper limb:lower limb was 2.5:1, and surgical:nonsurgical treatment was 3:1. Mean age was 47.5 ± 13.7 years, and no intergender difference was detected. Antebrachial fracture (23%) and CTS (9%) were the most common primary conditions. Surgical treatment was associated with approval of the claim (odds ratio 3.5, 95% confidence interval 2.3 to 5.3; P < 0.001). Half of CTS patients had normal neurophysiology prior to surgery; among patients with unilateral symptoms, 71.4% had normal neurophysiology. Female gender, surgical treatment, and treatment to the upper limb were risk factors. Elective surgery accounted for a large number of post-treatment CRPS patients. In CTS patients developing CRPS, normal neurophysiological examination findings were common, and it could be suspected that these patients were suffering from an pre-clinical stage of CRPS, not CTS.

Comparison of two external fixator systems for fracture reduction during minimally invasive plate osteosynthesis in simulated antebrachial fractures.

To compare the Minimally Invasive Reduction Instrumentation System (MIRIS) to a two-ring circular fixator construct (CFC) for indirect reduction during minimally invasive plate osteosynthesis. Cadaveric antebrachial fracture model. Ten skeletally mature dog cadavers. Simulated bilateral antebrachial fractures were reduced and stabilized with the MIRIS on one limb, and a CFC on the contralateral limb, prior to placing a 10 hole Locking Compression Plate. Time to satisfactory reduction and implant placement were compared. Difficulty of fracture reduction and plate application was subjectively scored (1 to 5) for each procedure. Prefracture and postoperative orthogonal antebrachial radiographs were compared to assess restoration of radial length and angulation in sagittal and frontal planes. A paired t test (P ≤ .05) was used to compare parameters between the two reduction techniques. Reduction was faster (P = .0191) and plate application was subjectively easier (P = .047) when using the MIRIS compared to the CFC. There were no differences in subjective difficulty of reduction or plate application time between techniques. Mean postoperative radial length was reduced by approximately 4-mm, and procurvatum were decreased by approximately 7° compared to prefracture measurements, regardless of reduction technique. The MIRIS allowed for faster fracture reduction, and simplified plate placement compared to a temporary application of a CFC in our simulated antebrachial fracture model.

Dual Bone Fixation: A Biomechanical Comparison of 3 Implant Constructs in a Mid-Diaphyseal Fracture Model of the Feline Radius and Ulna.

To compare the biomechanical properties of dual bone fixation (DBF) constructs to radial locking compression plating (LCP) in an ex vivo feline antebrachial fracture gap model. Ex vivo study. Cadaveric feline antebrachii (n=12 pairs). Antebrachii were radiographed to confirm normal skeletal appearance and maturity. After creation of a 5 mm radial and ulnar ostectomy, each antebrachium received 1 of 3 constructs using an incomplete randomized block design (n=8 per group). All groups received a 10 hole 2.0 mm radial LCP. DBF groups received either a 1.2 mm ulnar intramedullary pin (LCP with pin) or an 8 hole 2.0 mm ulnar LCP in addition to the radial LCP. Biomechanical testing was performed in axial compression and caudocranial and mediolateral 4-point bending before destruction in axial compression. DBF constructs (LCP with pin and dual LCP) were significantly stiffer than radial LCP alone in axial compression and caudocranial bending. There were no differences between LCP with pin and dual LCP constructs in axial compression and caudocranial bending or between any constructs in mediolateral bending. Failure load was significantly greater for dual LCP than LCP with pin or LCP alone constructs. Failure loads were not different between LCP with pin and LCP alone. DBF significantly increased construct stiffness and strength. Given the high complication rate reported in cat antebrachial fractures when only the radius is stabilized, surgeons should consider DBF.

Highly Comminuted, Articular Fractures of the Distal Antebrachium Managed by Pancarpal Arthrodesis in 8 Dogs.

To describe the surgical management by pancarpal arthrodesis for highly comminuted articular fractures of the distal antebrachium in 8 dogs. Retrospective clinical case series. Eight dogs. Medical records (2001-2014) of dogs with antebrachial fractures were reviewed and dogs with highly comminuted distal antebrachial fractures were identified. The nature of the injury, surgical management by pancarpal arthrodesis, outcome, and complications were recorded. Nine fractures occurred in 8 dogs. Seven dogs were ex-racing greyhounds (8 fractures) and of these, 6/7 dogs had fractures of the right thoracic limb. Compared with the hospital population of dogs with antebrachial fractures, greyhounds were over-represented for the antebrachial injury (odds ratio 117, 95% confidence interval 13-1022). Five dogs sustained injury during exertional exercise or with relatively minor trauma. Submitted bone samples (n = 4) showed no evidence of underlying neoplasia. Mean followup was 15.5 months with 11 complications recorded in 7/8 dogs, including 1 catastrophic, 5 major, and 5 minor complications. Pancarpal arthrodesis allowed a full functional outcome in 3 dogs and an acceptable outcome in 3. Comminuted articular fractures of the distal radius and ulna are complex injuries and have a similar presentation to pathologic fractures. Surgical management by pancarpal arthrodesis is associated with a high risk of complication and a guarded prognosis for a full functional outcome.