Fractures of the radius and ulna

Abstract

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.

Feline radial and ulnar diaphyseal fractures: a retrospective study of 49 cases comparing single bone fixation and dual bone fixation

“… 14 In human surgery, it is commonplace to plate both the radius and ulna separately in antebrachial fractures due to concerns of increased strain on the fracture site increasing the risk of complications. 5 , 7 In this study, there were seven (14.3%) cases of delayed union, which is within the reported range of previous studies; however, this may be higher due to the fact that only 63% of the cases in the present study had follow-up radiographs after the fracture repair. 11 , 12…”

“…The majority of previous studies assessing complications associated with antebrachial fractures have been based on dogs or have a mixed population of predominantly dogs and fewer cats. 5 – 7 To the authors’ knowledge, the largest study of feline antebrachial fractures is that of 28 cats; however, this included multiple methods of repair, including bone plates, external skeletal fixators and external coaptation. 8 Currently, internal fixation is more commonly used to treat feline antebrachial fractures, and its advantages include low morbidity, minimal maintenance and allowing cats to weight bear immediately after surgery.…”

Feline Diaphyseal Fractures: Management and treatment options

“…Dual bone fixation with, in addition to radial fixation, ulnar fixation, involving placement of either a plate (Figure 4) or an IM pin (Figure 5) to provide additional mechanical support, is, in the authors' opinion, the surgical treatment of choice. [26][27][28] The application of a plate or ESF to the radius in conjunction with adjunctive stabilisation of the ulna Surgical approach A medial approach to the distal radius was taken for open reduction and plate application. The abductor pollicis longus muscle was sacrificed to allow adequate exposure.…”

“…Cats have a pliable and extensive inter-osseous membrane, which facilitates approximately double the range of pronation (90–128°) and supination (40–50°) 26 compared with dogs. Due to this movement of the paired bones, fixation of the radius or ulna alone has a higher risk of complications as it is less likely to result in stable fixation of the adjacent bone.…”

“…Dual bone fixation with, in addition to radial fixation, ulnar fixation, involving placement of either a plate (Figure 4) or an IM pin (Figure 5) to provide additional mechanical support, is, in the authors’ opinion, the surgical treatment of choice. 26–28 The application of a plate or ESF to the radius in conjunction with adjunctive stabilisation of the ulna (typically an IM pin) has been shown to be an effective repair method. 25 The use of external skeletal fixation may provide benefits for higher grade open fractures (see ‘open fractures’ box on page 665) as this method of repair can facilitate wound management while stabilising the fracture and provides the advantage of being easily removable, helping to avoid the perpetuation of implant-associated infection.…”