Conservative management of minimally displaced radial fractures in three horses
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Abstract:
Minimally displaced, spiral, radial fractures were diagnosed in three adult horses. Two horses had open fractures and in one horse the fracture was closed. A diagnosis was made on radiographs taken 24 h, 5, and 9 days after the fracture. There was minimal displacement of the fracture fragments despite the considerable time which had elapsed between fracture and diagnosis and an unfavourable prognosis with internal fixation, so conservative therapy was the preferred method of treatment. One horse developed a sequestrum and draining sinus, which was treated surgically under general anaesthesia 3 months after diagnosis of the fracture. Other complications were minimal and transient. Two horses were being used for pleasure riding 12 months after fracture and one horse was pasture sound at 8 months.Keywords:
Conservative Treatment
Sequestrum
A four‐year‐old Hereford bull was admitted to The Texas Veterinary Medical Center for evaluation of a left pelvic limb injury. In initial radiographs there was extensive soft tissue swelling but no significant osseous involvement. Additional radiographs made six weeks later identified a sequestrum on the cranial surface of the tibia and an area caudal to the tibia suggestive of an abscess. The sequestrum was removed surgically but did not communicate with the abscess in the adjacent soft tissue. Reports on bony sequestration in food animals are rare.
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To examine the morbidity, mortality and recurrence rate after a modified conservative operation in the treatment of hepatic hydatidosis.Prospective open study.University hospital, Greece.67 Consecutive patients with hepatic hydatidosis, operated on between 1985 and 1990.The liver was mobilised and abdominal cavity isolated with pads soaked in 15% saline solution. Hydatid fluid was aspirated from the cysts which were widely deroofed, sterilised with 15% saline, and then oversewn with a braided absorbable suture. Drains were left in place and a third of patients also had omentoplasty (n = 22).Morbidity, mortality and recurrence rate.One patient died (1%), 4 developed complications (6%), and there were 3 recurrences (6%). It made no difference whether an omentoplasty was added or not.Conservative surgery achieves satisfactory results in the treatment of hepatic hydatidosis.
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Cure rate
Hydatid cyst
Abdominal cavity
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Thirty-five horses that had bone sequestration as a consequence of limb wounds were examined clinically and radiographically. It is possible to diagnose bone sequestra as early as 10 to 15 days after injury. Periosteal defects and infection appear to be the basis for bone sequestrum formation. The early radiographic signs of bone sequestration and progress to mature sequestrum formation are described. Treatment is the surgical removal of the sequestrum. In the presence of equine limb wounds in which the periosteum may have been damaged, it is advisable to radiograph the limb at the initial examination and again in 10 to 15 days.
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Periosteum
Periosteal reaction
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Aim The localization of sequestrum in chronic osteomyelitis (COM) is crucial in preoperative planning. The identification of sequestrum on plain X-ray could be difficult. CT and MRI were reported to show the sequestrum. We aimed to analyze the sequestrum characteristics on 18F-FDG-PET-CT images. Methods A prospective study included all patients diagnosed with long-bone chronic osteomyelitis. All patients had preoperative 18F-FDG-PET-CT. Images were analyzed using RadiAnt DICOM Viewer. Axial cuts were used to measure the Standard Uptake Ratio (SUV)max in the Region of Interest (ROI) in the sequestrum, the surrounding area, and the normal bone in the same cut. Surgical debridement was done as standard; samples were taken for microbiology and histopathology, and the intraoperative finding was documented. Results Nineteen patients (17 males/2 females) were operated on in one center between October/2021 and Jan/2023 at a mean age of 32±18. There were 10 tibias, 7 femurs, one ulna, and one fibula. Ten had postoperative COM, six open fractures, and three hematogenous OM. They all showed sequestrum on PET-CT; the dead bone appeared void, surrounded by a halo of increased uptake. There was a trend of lower uptake in the sequestrum compared to the halo around. The mean SUVmax at the sequestrum was 4.18±3.16, compared to the surrounding halo, 7.08±5.81. The normal bone has a mean SUVmax of 1.61±1.42. Sequestrum was removed successfully in all cases. Conclusion 18F-FDG-PET-CT can precisely localize the sequestrum preoperatively, it has a lower uptake than tissues around it. This would facilitate planning and improve the quality of debridement.
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Objective To evalute the management methods of clinical treatment on hepatic trauma.Methods Among 75 patients with hepatic trauma there were 19 cases in grade Ⅰ to grade Ⅱ,32 cases in grade Ⅲ,22cases in grade Ⅳ,2 cases in grade Ⅴ,47 cases were complicated with other organ trauma.61 cases were operated,14 cases conservative treatment,1 case was operated because conservative treatment was not good,and debridement was performed on 3.Results Total 61 cases obtained successful surgery,2 cases died,among them 1 case died for chest complications,1 case died for cirrhosis,5 cases were biliary fistula,among them 4 cases were cured by conservative treatment,1 case were operated second time.Conclusion Patients with liver trauma Ⅰ~Ⅲ grade mainly to conservative treatment,surgery for debridement to suture repair and gauze packing.When necessary,feasible debridement of the liver resection,to avoid the clear liver resection.
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Debridement (dental)
Conservative Management
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Objective
To compare the clinical effects of open reduction and internal fixation and conservative treatment on ribs fracture.
Methods
Eighty patients with rib fractures were randomly divided into two groups. The patients in the internal fixation group were treated by open reduction and internal fixation. The conservative treatment group was treated by conservative treatment. The analgesic effects, the relevant monitoring indicators, analgesic application, hospital stay and complications were compared between the two groups.
Results
The visual analogue scale score, heart rate and respiratory rate of the internal fixation group were significantly lower than those of the conservative treatment group at 2 h, 1 d, 2 d and 3 d after treatment (P<0.01). The PaO2 level of the internal fixation group was significantly higher than that of the conservative treatment group (P<0.01). The frequency of use of analgesics, hospital stay and lung complication rates of the internal fixation group were significantly lower than those in conservative treatment group (P<0.01).
Conclusions
Compared with conservative treatment, the clinical effect of open reduction and internal fixation on rib fractures is more significant, with reference value.
Key words:
Rib fractures; Open reduction and internal fixation; Conservative treatment
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Conservative Management
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Metatarsal injuries with exposed bone are described in seven horses. Superficial osteitis and sequestrum formation occurred in six of the seven horses. The basic pathophysiology includes local vascular stasis leading to ischemic necrosis of osteocytes and establishment of bacterial infection within dead bone. Radiographic features of superficial osteitis and sequestrum formation include reactive periosteal new bone formation, an area of radiodense necrotic bone (sequestrum) surrounded by a radiolucent zone of granulation tissue, which in turn, is surrounded by an area of increased radiodensity (involucrum). The presence of a sequestrum may usually be confirmed radiographically by 12–14 days after injury. Surgical management included wound debridement, wound irrigation, bandaging or casting, sequestrectomy and skin grafting. Five of the seven patients required sequestrectomy, in one the sequestrum disappeared without removal. Mixed bacterial populations were commonly found in the wounds. No specific etiologic agent was associated with sequestrum formation.
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This is an ongoing retrospective study of 35 children treated from 1986 to 2001 for chronic osteomyelitis following acute haematogenous osteomyelitis. The purpose was to validate the use of a modified Cierny classification to predict behaviour, to assess the timing of sequestrectomy in relation to involucrum formation, and to evaluate the results of dealing with the resultant defect by conventional methods of bone grafting. The mean age of the patients was 7 years (1 to 12). All except 18, who were treated within five days of acute onset, were delayed presentations or transfers. In 14 children the tibia was involved, in 13 the femur, in five the humerus and in three the fibula. Monthly radiographs were taken and the size and location of the sequestrum and involucrum was documented. Our classification represents the size and location of the sequestrum. We divided the patients into cortical (one), medullary (three), corticomedullary (12) and structural (19) types. Fractures occurred in all the structural types, as well as in five of the 12 corticomedullary types. A sequestrum was apparent at a mean of 2.4 months (1 to 3). The mean length of the sequestrum at diagnosis was 8.5 cm and at surgery 5.8 cm, suggesting partial resorption. Involucrum formed in 69% of patients at a mean of 1.9 months (1 to 3) after sequestrum. In 31% of patients no involucrum formed from 4 to 12 months after surgery. This suggests that involucrum formation depends on viable periosteum and not on the sequestrum, and in the absence of involucrum early rather than late sequestrectomy is warranted. The resultant incomplete bone defects in the corticomedullary type ranged from 1 cm to 15 cm, but had an intact cortical bed on one or more sides. These and complete defects of less than 6 cm in the structural type united after autogenous cancellous bone grafting, with or without an exoskeleton. Four structural defects greater than 6 cm united after fibular strut grafting (humerus) or bone grafting from fibula to tibia via a posterolateral approach (tibia). Patients were followed up both clinically and radiologically for a mean of 2.9 years. Twenty patients (57%) had an excellent result and 15 (43%) a good result.
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Periosteum
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A case of a 10-year-old patient with a femur fracture treated with an external fixator who subsequently went on to develop a free-floating ring sequestrum is presented. The patient was largely asymptomatic throughout his course of treatment until seen emergently at 2 years postinjury with local and systemic signs of infection. He was successfully treated with intravenous and oral antibiotics as well as thorough irrigation and debridement. Ring sequestrum is the end point for pin tract infection that is left untreated. When it occurs, a course of antibiotics and thorough irrigation and debridement can lead to a successful outcome.
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Debridement (dental)
Open fracture
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Use of single photon emission computerized tomography (SPECT) with Tc 99m HDP for localization of an active sequestrum in a case of chronic head and neck osteomyelitis is described. Correlation with x-ray computed tomography (CT) for anatomy was helpful for surgical debridement. The potential of the complementary roles of SPECT and CT in chronic head and neck osteomyelitis for assessing sequestrum activity and anatomy prior to surgery is discussed.
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Planaria
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