External Fixation Methods Research Articles

Surgical treatment of the aseptic femoral shaft nonunion

Femoral shaft nonunions is difficult complication and a big challenge for the orthopaedic surgeons. These complications occur after open femoral fractures, comminuted fractures, segmental fractures, the infection, after the inadequate fixed osteosynthesis, the systemic disease, and smokers. The paper presents the results of treatment aseptic femoral shaft nonunion in 18 patients. They were primarily operated by the method of internal compresive plate fixation and external fixation (open fractures). For fixation we used dinamic internal fixator by Mitkovic. All nonunions treated by this method are healed. In patients with atrophic femoral shaft nonunions in addition to fixation was performed and bone grafting. This implant has proved successful in the treatment of femoral shaft nonunion. During the fixation no periostal and intramedullary vascularization damage, which is an important prerequisite for bone healing. Implant enables biological and mechanical conditions for nonunion healing.

Dynamic and static external fixation for distal radius fractures—A systematic review

Introduction External fixation of distal radius fractures may be static (wrist-bridging) or dynamic (wrist-bridging with mobile hinge or non-bridging). The aim of this systematic review is to investigate the effectiveness of different methods of external fixation for unstable distal radius fractures. Methods A Medline database search was performed with strict eligibility criteria to obtain the highest quality evidence from meta-analyses, RCTs and comparative studies. Eligible studies were critically appraised using levels of evidence and RCTs were further appraised using a validated scoring tool. Results Fifty-four studies were identified of which eight were included. There were six RCTs and two retrospective comparative studies. Three RCTs compared non-bridging with static wrist-bridging fixation. Two RCTs compared dynamic wrist-bridging with static wrist-bridging fixation. One study compared dynamic wrist-bridging with non-bridging fixation. The RCTs varied in quality and scored between 12 and 23 out of a maximum of 33 points. The evidence suggests that there are no functional or radiological benefits for a dynamic wrist-bridging external fixator with a mobile hinge joint over a static wrist-bridging external fixator. The evidence also suggests that there are no benefits for non-bridging over static wrist-bridging external fixation in older patients but there do appear to be clear benefits both functionally and radiologically when considering patients of all ages. Conclusion Dynamic and static external fixators both achieve good outcomes for patients with unstable distal radius fractures with comparable complication rates. Non-bridging fixation may result in better functional and radiological results than static wrist-bridging fixation when considering patients of all ages with earlier return of function. This benefit does not seem apparent when considering older patients. Although a benefit was not seen in this group, the technique may have practical advantages over wrist-bridging fixation by allowing increased mobility and use of the limb during the fixation period and enabling such patients to maintain their independence. Cost effective analyses are required to assess whether this would be an economically viable option for this group of patients.

The Ilizarov Method of External Fixation: Current Intraoperative Concepts

The Ilizarov method of external fixation is used to treat fractures, complex lower extremity deformities, osteomyelitis, and soft tissue contractures and to lengthen limbs. Tremendous improvements in the Ilizarov method have occurred during the past 60 years, improving intraoperative care and limb salvage management concepts. Improved instrumentation has increased the quantity and complexity of the tray systems required for these procedures. Perioperative nurses must be well versed in optimal preparation and function of Ilizarov fixation systems to ensure safe patient care during Ilizarov external fixation procedures.

Charcot foot reconstruction with combined internal and external fixation: case report

Charcot neuroarthropathy is a destructive and often-limb threatening process that can affect patients with peripheral neuropathy of any etiology. Early recognition and appropriate management is crucial to prevention of catastrophic outcomes. Delayed diagnosis and subsequent pedal collapse often preclude successful conservative management of these deformities and necessitate surgical intervention for limb salvage. We review the current literature on surgical reconstruction of Charcot neuroarthropathy and present a case report of foot reconstruction with combined internal and external fixation methods.

Treatment of open tibial shaft fracture with soft tissue and bone defect caused by aircraft bomb: Case report

Aircraft bombs can cause severe orthopaedic injuries. Tibia shaft fractures caused by aircraft bombs are mostly comminuted and followed by bone defects, which makes the healing process extremely difficult and prone to numerous complications. The goal of this paper is to present the method of treatment and the end results of treatment of a serious open tibial fracture with soft and bone tissue defects resulting from aircraft bomb shrapnel wounds. A 26-year-old patient presented with a tibial fracture as the result of a cluster bomb shrapnel wound. He was treated applying the method of external bone fixation done two days after wounding, as well as of early coverage of the lower leg soft tissue defects done on the tenth day after the external fixation of the fracture. The external fixator was removed after five months, whereas the treatment was continued by means of functional plaster cast for another two months. The final functional result was good. Radical wound debridement, external bone fixation of the fracture, and early reconstruction of any soft tissue and bone defects are the main elements of the treatment of serious fractures.

Hybrid external fixation in treatment of proximal tibial fractures: a good outcome in AO/ASIF type-C fractures

The treatment of proximal tibial fractures is often challenging, and internal fixation is occasionally associated with problems in wound healing due to frequently co-existing soft tissue injuries. External fixation of these fractures have yielded satisfactory results, but some studies have reported problems in the achievement and maintenance of fracture reduction. The purpose of the present study was to evaluate the performance of a hybrid external fixator in the treatment of different types of proximal tibial fractures. Thirty-three proximal tibial fractures, of which 20 were high energetic, were treated with a hybrid external fixator (Tenxor Strker-Howmedica) in the acute phase. Fracture categorisation was done according to AO/ASIF, and the reduction was performed most often by closed means or through mini-open reduction (26/78.8%). The patients were followed up to an average of 12.7 months (range 10-22) and were evaluated with radiographs and clinical examinations. Five AO/ASIF type-C intraarticular fractures had a poor postoperative reduction, and were thus treated with internal fixation in a second operation. Of the remaining 28 patients, local and transient pin tract infection was observed in seven patients, and one had septic arthritis of the knee. All 13 C1 and five of six C2/C3 fractures united in mean time of 15.1 weeks, whereas three of nine type-A fractures failed to unite, albeit an adequate reduction, and needed a second operation (odds ratio 11.4, 95% CI 1.0-143, compared with type-C fractures). For the remaining six type-A fractures, the mean healing time was 24 weeks (mean difference 8.9, 95% CI 6-12 weeks compared with type-C fractures). Age over 48 and the presence of an open fracture, but not fracture type, gender, or the level of injury energy, correlated to a poor subjective outcome. The hybrid external fixation method we have used is safe, and type-C1 fractures are particularly suitable to be treated with this method. However, even C2/C3 fractures may be candidates for this method, but a meticulous fracture reduction should be performed. Type-A fractures are liable to healing problems when the fixator is used as a rigid complex.

Fixation of Dorsally Displaced Distal Radius Fractures With Volar Plate

The treatment of unstable fractures of the distal radius remains controversial between nonoperative and operative management and between different methods of internal and external fixation. The aim of the study is to evaluate the early functional and radiologic outcomes of using Association for the Study of Osteosynthesis (AO) (Synthes) distal radius volar locking plate for unstable dorsally displaced distal radius fractures. Seventeen consecutive fractures in 16 patients were included in the study. The average age of the patients was 46 years. There were 11 women and 5 men. Patients were selected according to the protocol; unstable dorsally displaced distal radius fractures in patients less than 65 years of age. Fractures were treated according to the protocol using AO volar locking plate. All patients have completed the study. The average follow-up period was 8.4 months (6-13 months). The functional and radiologic outcomes were rated using three scoring systems; the Disability of the Arm, Shoulder, and Hand scoring system, the Gartland and Werley score, and the Scoring system of Jakim et al. Eighty-eight percent of the fractures were rated as good or excellent according to the Disability of the Arm, Shoulder, and Hand scoring system, and the Gartland and Werley score, whereas 76.4% were rated as good or excellent according to the Scoring system of Jakim et al. This report supports the view of using volar plating for the unstable dorsally displaced distal radius fractures.

External fixation combined with minimal invasion internal fixation for complex diaphyses fracture combined with femur condyle fractures

Objective To discuss external fixation method for the complex diaphyses fracture involving condyles of femur and evaluate its clinical efficacy.Methods A retrospective study was done on 42 patietns with comminuted femur diaphyses fracture combined with distal intra-articular fractures treated surgically from January 2001 to Janurary 2007.There were 24 males and 18 females at mean age of 33 years (20-66 years).According to AO/ASIF classification,there were 18 patients with type C2 fractures and 24 with type C3 ones.Simple internal fixation plus external fixation was performed on patitents with C3 fractures but only external fixation on those with C2 fractures.Four patients were treated with intramedular fixation.Results All patients were followed up for 1-12 months.According to Kotmert's assessment standard on function of proximal femur,the knee function was satisfactory in 35 patients (83% ) ,good in six (14% ) and unsatisfactory in one (2% ).Conclusions Minimally invasive external fixation can utmostly restore relative length of the femur and regulate between articular face of the femur and longitudinal axis of femur shaft to reach a symmetrical relation with middle and inferior part of opposite femur.Postoperative exercise is important for maximal recovery of the knee function.Attention should be paid to reconstruction of tubiform structure of the femur. Key words: Femoral fractures; Fracture fixation; External fixators

Proposal of a new method for treating type II odontoid fractures: Odontoid process prosthetic (Ti)

A novel method for treating type II odontoid fractures is presented. The use of a sintered titanium odontoid prosthetic could eliminate long healing times associated with external fixation methods, and the neurological deficits associated with non-union events in odontoid fracture treatment. Finite element experiments provide early indications that the axis vertebral body could accommodate a titanium odontoid prosthetic. Strain of 3.5 % and stresses of up to 10.5 MPa on the reamed opening of the axis vertebral body are considered as the local maximums. Conventional and emerging implant fixation and non-fouling techniques are also discussed.

Review

Question: In patients with distal radial fractures, does external fixation give better results than conservative treatment? Data sources: Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (September 2006); the Cochrane Central Register of Controlled Trials (2006, Issue 3); MEDLINE (1966 to September 2006); EMBASE/ Excerpta Medica (1988 to September 2006); CINAHL (1982 to September 2006); Current Controlled Trials; the United Kingdom National Research Register; proceedings of orthopaedic meetings; hand-searching relevant journals; and reviewing reference lists of articles. Study selection and assessment: Randomized controlled trials (RCTs) or quasi-RCTs that compared external fixation with conservative treatment (e.g., plaster cast immobilization) in adults with distal radial fractures. Trials comparing different methods of external fixation or comparing external fixation with other methods of surgical fixation were included. Trials that included adults and children but did provide separate data for adults were also excluded. Study quality was assessed with use of a rating scheme covering 11 aspects of trial validity. Main outcome measures: Primary outcomes included patient functional assessment, return to work or activities of daily living, grip strength, pain, range of motion, complications, and cosmetic appearance. Main results: 15 RCTs (n = 1022 patients; mean age range, 36 to 72 y) met the inclusion criteria. Methodological quality of the trials was generally poor, and substantial heterogeneity existed among trials due to variation in patient characteristics, interventions, methods and timing of outcome assessments, and selection of reported outcomes. All trials compared external fixation with plaster cast. Follow-up ranged from 4 months to 10 years. Functional scoring systems, which were mainly unvalidated and which often rated other outcomes such as radiographic deformity, were used in 13 RCTs. Results of these composite outcomes could be pooled in 9 RCTs for a rating of not excellent and in 11 RCTs for a rating of fair or poor. With use of a fixed-effects model, external fixation was superior to plaster cast in both analyses (Table). Sensitivity analyses conducted in the review revealed, however, that these results were robust. Two RCTs that evaluated activities of daily living showed no difference between groups at I and 7 years, respectively. One trial showed no difference between groups at 6 months in the proportion of patients who changed jobs because of their injury. One trial reported similar times to return to work or normal activities (70 vs 75 d). Two RCTs showed greater grip strength in the external fixation group at 1 year; at the time of final follow-up, no significant difference was observed between groups in 7 RCTs. Of 5 RCTs reporting pain outcomes, 1 showed reduced pain in the external fixation group whereas 4 RCTs showed no difference. Range of motion results were variable and inconclusive. Redisplacement generally occurred in the plaster cast group; this often resulted in secondary treatment (9 RCTs; relative risk 0.17, 95% CI 0.09 to 0.32). Pin-site infections were more common in the external fixation group (11 RCTs; relative risk 12.02, CI 5.07 to 28.49), as were iatrogenic nerve injuries. Data from 2 trials showed no difference between groups in cosmetic appearance. One trial reported that pin-track scars in the external fixation group were accepted by patients. Conclusion: In patients with displaced distal radial fractures, weak evidence supports external fixation compared with conservative treatment. Although external fixation gives improved anatomical results, it is associated with an excess of mainly minor surgically related complications.

Different methods of external fixation for treating distal radial fractures in adults

Fracture of the distal radius is a common injury. A surgical treatment is external fixation, where metal pins inserted into bone on either side of the fracture are then fixed to an external frame. To evaluate the evidence from randomised controlled trials comparing different methods of external fixation for distal radial fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (June 2007), the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, conference proceedings and reference lists of articles. No language restrictions were applied. Randomised or quasi-randomised controlled clinical trials which compared different methods of external fixation in adults with a distal radial fracture. All review authors independently performed study selection. Two authors independently assessed the included trials and performed data extraction. Nine small trials involving 510 adults with potentially or evidently unstable fractures, were grouped into five comparisons. The interventional, clinical and methodological heterogeneity of trials precluded data pooling. Only one trial had secure allocation concealment. Two trials comparing a bridging (of the wrist) external fixator versus pins and plaster external fixation found no significant differences in function or deformity. One trial found tendencies for more serious complications but less subsequent discomfort and deformity in the fixator group. Three trials compared non-bridging versus bridging fixation. Of the two trials testing uni-planar non-bridging fixation, one found no significant differences in functional or clinical outcomes; the other found non-bridging fixation significantly improved grip strength, wrist flexion and anatomical outcome. The third trial found no significant findings in favour of multi-planar non-bridging fixation of complex intra-articular fractures. One trial using a bridging external fixator found that deploying an extra external fixator pin to fix the 'floating' distal fragment gave superior functional and anatomical results. One trial found no evidence of differences in clinical outcomes for hydroxyapatite coated pins compared with standard uncoated pins. Two trials compared dynamic versus static external fixation. One trial found no significant effects from early dynamism of an external fixator. The poor quality of the other trial undermines its findings of poorer functional and anatomical outcomes for dynamic fixation. There is insufficient robust evidence to determine the relative effects of different methods of external fixation. Adequately powered studies could provide better evidence.

A computer-controlled contracture correction device with low-load and continuous torque

The purpose of this study was to clarify the relationship between mechanical stress and tissue response of the contracted knee joint in rats and to propose a new design of contracture correction device for clinical use. Wistar rats were operated on to immobilize their knee joints with a procedure causing periarticular bleeding and were kept in flexed position for 40 days. At day 40, the immobilizing wire was removed, and after day 43, the contracted knee joint had been treated with tunable corrective devices secured by an external fixation method to the rear limb. These devices consisted of four types of motor-driving system which provided several different low-load and continuous stretch torques. Measuring the angle of maximum knee extension, its effectiveness was assessed comparing with a lower load and control group of natural recovery course. The device also had a cyclic joint movement within the acquired range of motion and an oval cam mechanism producing a small distraction force to the joint along its long axis. The results showed that an appropriate range of low-load continuous torque was more effective to correct joint contracture. On the basis of the animal experiment, a new computer-controlled, gas-driven contracture correction device was developed for clinical trial. It was concluded that mechanical application in a condition with low and continuous torque is a useful treatment for fixed joint contracture.

Long-term results of various therapy concepts in severe pilon fractures

Intra-articular fractures of the tibia plafond are among the most challenging of orthopaedic problems. This is a retrospective case-control study of surgically treated pilon fractures which was undertaken to compare the internal fixation with the two external fixation methods. This is a case-control study of 55 patients with 55 pilon fractures. There were 36 type C and 19 type B. Of these fractures, 24 were open and 31 closed. Three surgical protocols were used. In 20 patients, Group A, a half pin external fixator with ankle spanning was performed. The mean age of patients was 42.0 years (22.0-74.0), SD 14.1 and the mean follow-up was 77.7 months (38.0-132.0), SD 25.4. In 22 patients, Group B, a single ankle sparring ring hybrid external fixator under a small arthrotomy was performed. The mean age of patients was 48.4 years (28.0-76.0), SD 12.4 and mean follow-up was 67.9 months (36.0-132.0), SD 27.8. In 13 patients, Group C, a two-staged internal fixation was performed. The mean age was 45.6 years (30.0-66.0), SD 9.7 and the mean follow-up was 78.6 months (55.0-132.0), SD 25.4. We addressed the dissimilarity of the type of fracture in each group performing supplementary stratified analyses within each fracture type group. Group A had union in 6.9 months, group B in 5.6 months and group C in 5.1 months; P = 0.009. Six patients (Group A), two (Group B), and one (Group C) had limitation of ankle motion; P = 0.47. One patient from group C developed infection and the plate was removed. Four patients (Group A), one (Group B), and one (Group C) have developed posttraumatic arthritis (loss of joint space and pain); P = 0.25. Seven patients from Group A have reduced their activities; P = 0.004. In stratified statistical analysis by type of fracture, the associations noted for both fracture groups combined were also noted separately within each fracture group. In this long term follow-up study, the two-staged internal fixation and the hybrid fixation with small arthrotomy were equally efficacious in achieving bone union. Patients in external fixation with the ankle spanning had a significantly higher rate of delayed union. Also more patients in this group have reduced their activities.

Management of 49 antebrachial and crural fractures in dogs using circular external fixators‡

To evaluate frame constructs, postoperative fracture reduction, postoperative care, complications, treatment duration and outcome of circular external fixation for management of 49 antebrachial and crural fractures in dogs. Medical records of dogs that underwent surgery with circular external fixation were examined for fracture location, frame configuration, postoperative fracture reduction, treatment duration, complications and outcome. Forty-nine fractures in 48 dogs were stabilised using circular external fixation. Frame removal occurred on average 61 days after surgery (median+/-sd, 52+/-30 days). Minor complications were observed in 35 cases (71 per cent) and major complications in seven (14 per cent). Radiographic outcome at frame removal was judged as excellent in 18 cases (37 per cent), as good in 26 (53 per cent), as fair in four (8 per cent) and poor in one (2 per cent). After frame removal, one fracture was stabilised with a plate, and eight patients were lost to follow-up. Functional and cosmetic outcome at follow-up was judged as excellent in 32 cases (80 per cent), good in seven (18 per cent) and fair in one (2 per cent). Circular external fixation can effectively treat antebrachial and crural fractures in dogs, even geometrically complex fractures. Minor complications are frequent but easily managed in most instances. Healing time is comparable to that of other external fixation methods.

The Ilizarov Method for the Treatment of Resistant Clubfoot

The resistant clubfoot deformity presents a significant challenge. Several corrective procedures have been described, with the goal to provide a pain-free, plantigrade foot. The Ilizarov method of external fixation and gradual distraction has been reported as an alternative to conventional techniques. Previous reviews have concluded that this method can provide satisfactory correction and outcome. This study presents a review of 21 resistant clubfeet in 17 patients, who had undergone previous surgery, treated with Ilizarov external fixation and gradual distraction by 1 of 2 surgeons. Outcome measures were graded based on function and presence of residual deformity: (a) excellent (painless, plantigrade foot, with no functional limitations); (b) good (plantigrade foot in a patient able to ambulate long distances with mild pain; (c) fair (mild residual deformity, required bracing, and/or had some functional limitations but an active life); and (d) poor (significant residual deformity, pain, and activity limitations). Radiographic measures of the talocalcaneal and talo-first metatarsal angles were compared preoperatively and postoperatively. At an average follow-up of 6.64 years (range, 2.25-10.50 years), 9.5% (2) achieved an excellent result; 4.8% (1), good; 33.3% (7), fair; and 52.4% (11), poor. All 11 of the feet graded poor required revision surgery at an average of 5.63 years postoperatively (range, 2.67-10.2 years). Only the talo-first metatarsal angle displayed a clinically and statistically significant correction. We conclude that the Ilizarov method for treatment of resistant clubfoot deformities results in poor outcome associated with residual or recurrent deformity, often requiring revision surgery.

In vitro evaluation of five canine tibial plateau leveling methods

To compare application time, accuracy of tibial plateau slope (TPS) correction, presence and magnitude of rotational and angular deformities, and mechanical properties of 5 canine tibial plateau leveling methods. 27 canine tibial replicas created by rapid prototyping methods. The application time, accuracy of TPS correction, presence and magnitude of rotational and angular deformation, and construct axial stiffness of 3 internal fixation methods (tibial plateau leveling osteotomy, tibial wedge osteotomy, and chevron wedge osteotomy [CWO]) and 2 external skeletal fixation (ESF) methods (hinged hybrid circular external fixation and wedge osteotomy linear fixation [WOLF]) were assessed. Mean bone model axial stiffness did not differ among methods. Mean application time was more rapid for WOLF than for other methods. Mean TPSs did not differ from our 5 degrees target and were lower for ESF methods, compared with internal fixation methods. Mean postoperative rotational malalignment did not differ from our target or among groups. Mean postoperative medio-lateral angulation did not differ from our target, except for CWO. Internal fixation methods lead to axially stiffer constructs than ESF methods. Reuse of ESF frames did not lead to a decrease in axial stiffness. The 5 tibial plateau leveling methods had acceptable geometric and mechanical properties. External skeletal fixation methods were more accurate as a result of precise data available for determining the exact magnitude of correction required to achieve a 5 degrees TPS.

External Fixation and Infection of Soft Tissues Close to Fracture Localization

We evaluated the method of external fixation for stabilization of unstable closed and open first-degree diaphyseal fractures of long bones of lower extremities in 19 patients with infections of soft tissues close to the fracture location. The results are compared with those of another group (n = 392) of patients, with similar fractures without infections close to the fracture site, treated with inner stabilization methods. In the first group of patients, we noticed postoperative osteitis of the tibia in two cases (10%), but no pseudarthrosis or lesions of important blood vessels. In the second group of patients, the incidence of postoperative osteitis was 8.6% (n = 34) and the incidence of pseudarthrosis was 2% (n = 8). Among these patients, three lesions of important blood vessels were diagnosed. Our conclusion is that when the method of external fixation is used in combination with skillful operative techniques, the infection of soft tissues near the fracture location has no principal influence on the frequency of osteitis.

Fixation of Silicone Stents in the Subglottic Trachea: Preventing Stent Migration Using a Fixation Apparatus

Silicone stents are widely used to treat benign or malignant airway stenosis. However, since straight silicone stents placed into the subglottic trachea to treat stenosis display a high risk of migration, novel approaches are required. The present report outlines our method of external fixation for silicone stents in the subglottic trachea. This technique utilizes a fixation apparatus, is readily performed, and may help to overcome the hesitation seen in placing silicone stents for subglottic tracheal stenosis.

Management of intra-articular fractures of the proximal interphalangeal joint by internal fixation and bone grafting

Intra-articular fractures of the proximal interphalangeal joint are usually treated by one of many methods of external fixation, but this does not restore the articular surface. We describe a procedure where bone grafting and internal fixation are used to restore the articular surface. A prospective study was conducted in which three patients underwent surgical treatment for this fracture. We describe a surgical procedure where bone graft harvested from the distal radius is packed through a diaphyseal window to restore the articular surface. This is followed by internal fixation with mini-screws. The average follow-up was 61 months. At last follow-up the average arc of movement of the proximal interphalangeal joint was 100 deg and the average Disability of the Arm, Shoulder and Hand (DASH) Score was 2. Postoperative radiographs showed restoration of the articular contour in all three patients. The surgical technique described addresses the issues of restoration of the articular surface and permits early mobilisation. The results for our group are excellent and compare favourably with those achieved using external fixators described in the literature.

Tension band stabilization of fractures and luxations of the thoracolumbar vertebrae in dogs and cats: 38 cases (1993-2002).

To determine the outcome of dogs and cats in which a tension band technique was used to stabilize traumatic fractures and luxations of the thoracolumbar vertebrae. Retrospective study. 38 client-owned animals (22 dogs and 16 cats) weighing between 1.4 and 45 kg (3 and 99 lb). Medical records of cats and dogs that underwent tension band stabilization of thoracolumbar fractures and luxations at the University of Zurich between 1993 and 2002 were reviewed. The stabilization technique was a modification of a spinal stapling technique with a figure 8 hemicerclage wire placed in a tension band fashion across the lesion. Neurologic status, lesion location and type, and concomitant traumatic injuries were assessed from the medical records and preoperative radiographs. Clinical outcome and complications were determined through follow-up examinations or telephone conversations with the owners. Complete or satisfactory neurologic recovery was achieved in 30 (79%) patients. Seven patients were euthanatized (6 owing to poor neurologic recovery and 1 owing to implant failure), and 1 dog was managed at home despite paraplegia. Clinically, only 4 patients (11%) had evidence of implant or fixation failure; all were dogs weighing > 16 kg (35 lb). Results suggest that the tension band technique may be appropriate for stabilization of fractures and luxations of the thoracolumbar vertebrae in cats and small- or medium-sized dogs. In larger dogs, fixation strength may be insufficient to stabilize certain fracture types and ancillary external or internal fixation methods may be needed.