TUGAS MATA KULIAH

ILMU BEDAH KHUSUS VETERINER

TEKNIK OPERASI FRAKTUR FEMUR

Disusun oleh :

Erwin Danareka Putra (1309005027)

I Kadek Toto Sugita (1509005097)

Archie Leander Maslim (1509005098)

Putu Ayutia Areningrat (1509005105)

Reydanisa Noor Madania (1509005106)

Kelas : C

LABORATORIUM BEDAH VETERINER

FAKULTAS KEDOKTERAN HEWAN

UNIVERSITAS UDAYANA

TAHUN 2018

i
 RINGKASAN

Fraktur femur adalah rusaknya kontinuitas tulang femoral yang dapat

disebabkan oleh trauma langsung, kelelahan otot, kondisi-kondisi tertentu
seperti degenerasi tulang/osteoporosis. Pre operasi fraktur femur terdiri dari
pemeriksaan sinyalemen, sejarah, pemeriksaan fisik, dan radiografi. Anastesi
yang digunakan adalah anastesi umum inhalasi. Teknik operasi melalui 3 cara,
yaitu teknik operasi fraktur diaphyseal dan supracondylar femur, teknik operasi
fraktur metaphyseal dan artikuler femur, dan teknik operasi fraktur femoral
physeal. Pasca operasi frakturos femur tediri dari radiografi, pemakaian e-
collar, pemberian anti inflamasi dan antibiotik, juga pengangkatan pin IM dan
fiksasi skeletal ketika sudah sembuh.

Kata Kunci : Fraktur Femur, Operasi

SUMMARY
Femoral fractures are damage to femoral bone continuity which can be caused by
direct trauma, muscle fatigue, certain conditions such as bone degeneration or
osteoporosis. Preoperative femoral fracture consists of signal examination, history,
physical examination, and radiography. The anesthesia used is general inhalation
anesthesia. The operating technique is through 3 ways, the first is diaphyseal and
supracondylar femur fracture, the second is metaphyseal and articular fracture surgery,
and the third is physeal femoral fracture surgery technique. Postoperative femoral
frakturos from radiography, use of e-collar, anti-inflammatory administration and
antibiotics, also removal of IM pins and skeletal fixation when healed.
Keywords: Femur fracture, surgery

ii
 KATA PENGANTAR
Puji syukur kami panjatkan kehadirat Tuhan Yang Maha Esa atas segala
rahmat dan hidayah-Nya sehingga karya tulis yang berjudul “Teknik Operasi Fraktur
Femur” ini dapat diselesaikan tepat pada waktunya.

Karya tulis ini dibuat dalam rangka menyelesaikan tugas yang akan dijadikan
landasan dalam pemberian nilai pada proses pembelajaran mata kuliah Bedah Khusus
Veteriner Fakultas Kedokteran Hewan Universitas Udayana. Tidak lupa penulis juga
mengucapkan terima kasih kepada semua pihak yang telah membantu dan
memberikan dukungan pada kami. Kami menyadari bahwa tulisan ini masih banyak
kekurangan baik dari segi materi, ilustrasi, dan contoh. Oleh karena itu, saran dan
kritik dari para pembaca yang bersifat membangun sangat kami harapkan. Semoga
karya tulis yang dibuat dapat membantu dan bermanfaat bagi semua kalangan.

Denpasar, 12 November 2018

Hormat kami,

Penulis

iii
 DAFTAR ISI
Halaman Judul .......................................................................................... i
Ringkasan ................................................................................................. ii
Summary ................................................................................................. iii
Kata Pengantar ......................................................................................... iv
Daftar Isi .................................................................................................. v
Daftar Gambar .......................................................................................... vi
Daftar Lampiran ...................................................................................... vii
Bab I Pendahuluan
1.1 Latar Belakang .................................................................................... 1
1.2 Rumusan Masalah ............................................................................... 2
1.3 Tujuan Penulisan ................................................................................ 2
1.4 Manfaat Penulisan............................................................................... 2
Bab II Tinjauan Pustaka
2.1 Pre Operasi ........................................................................................ 3
2.2 Teknik Operasi Fraktur Femur ............................................................ 5
2.3 Pasca Operasi Fraktur Femur .............................................................. 14
Bab III Pembahasan
3.1 Pengertian Fraktur Femur.................................................................... 17
3.2 Indikasi Fraktur Femur........................................................................ 19
Bab IV Simpulan dan Saran
4.1 Kesimpulan......................................................................................... 21
4.2 Saran .................................................................................................. 21
Daftar Pustaka .......................................................................................... 22
Lampiran Jurnal ........................................................................................ 23

iv
 DAFTAR GAMBAR

Gambar 1. Insisi musculus sampai tulang femur terekspos ........................ …5

Gambar 2. Teknik operasi dengan pemasangan Intramedullari Pin………..6

Gambar 3. Teknik operasi dengan pemasangan Intramedullari Pin……......7

Gambar 4. Penempatan interlocking nail pada tulang femur………….…....7
Gambar 5. Plat ditempatkan pada permukaan lateral femur....................... 8

Gambar 6. Insisi musculus ........................................................................ .....8

Gambar 7. Insisi Musculus........................................................................ ….9

Gambar 8. Teknik Operasi Fraktur dengan Kabel Kirschner Triangulasi...10

Gambar 9. Fraktur Bicondylar dengan Sekrup Lag dan Pin Steimann…….. .11
Gambar 10. Kawat Triangulasi Kirschner……………………………….…12
Gambar 11. Sekrup Lag dan Kawat Kirschner .......................................... ...13

Gambar 12 Pin Steintmann………………………………………………… 14

Gambar 13. Obat Anti-inflamasi Nonsteroid ............................................. ...15

Gambar 14. Radiografi pasca operasi ........................................................ ...15

Gambar 15. Radiografi pasca operasi ........................................................ ...16

Gambar 16. Perban Robert Jones .............................................................. ...16

v
 DAFTAR LAMPIRAN

Lampiran 1. Altunatmaz, K., Karabagli, M., Kaya, D.A., Guzel, O., Yalin, E.E.,
Ugurlu, U., Sadalak, D.J., Ekici, H. 2017. The
treatment of supracondylar and diaphyseal femoral
fractures in cats using intramedullary two-way stacked
Kirschner wire application. Turk J Vet Anim Sci
(2017) 41: 282-287.

Lampiran 2. Libardino, R.D.N., Costa, D.D., Menezes, F.B., Cavalli, L.G.,

Pedrotti, L.P., Kohlrausch, P.R., Minto, B.W., Silva,
M.A.A. 2018. Classification, fixation techniques,
complications and outcomes of femur fractures in dogs
and cats: 61 cases (2015-2016). Ciencia Rural, Santa
Maria, v 48:06, e20170028.

Lampiran 3. Uddin, Karim MD et al. 2017. Internal fixation of fracture of femur

of dog using intramedullary pinning. Veterinary and
Animal Sciences University, Bangladesh
*Corresponding author: Md. Zakir Hassan, Scientific
Officer, Animal Health Research Division, Bangladesh.
Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3), 243-
246. ISSN 2414-1283 (Print) 2414-6293 (Online)

vi
 BAB I

PENDAHULUAN

1.1 Latar Belakang

Tulang membentuk rangka penunjang dan pelindung bagi tubuh dan
merupakan tempat untuk melekatnya otot yang menggerakan kerangka tubuh. Pada
bagian tengah tulang juga terdapat rongga yang berisi jaringan hematopoetik yang
membentuk sel-sel darah. Komponen utama jaringan tulang adalah mineral-mineral
dan jaringan organik (kolagen dan proteoglikan). Kalsium dan fosfat membentuk
suatu kristal garam (hidrosiapatit), yang tertimbun pada matriks kolagen dan
proteoglikan. Matriks organik tulang (osteoid) sekitar 70% terdiri dari kolagen tipe I,
yang sifatnya kaku dan memberikan kekuatan pada tulang. Bahan organik lain yang
menyusun tulang berupa proteoglikan seperti asam hialuronat.
Fraktur femur atau patah tulang adalah terputusnya hubungan normal suatu
tulang / tulang rawan yang disebabkan oleh kekerasan batang femur dapat mengalami
fraktur trauma tidak langsung, putiran (twisting) atau pukulan pada bagian depan lutut
yang berada dalam posisi fleksi pada kecelakaan jalan raya / jatuh dari ketinggian
yang mengakibatkan penderita jatuh dalam shock. Trauma tidak langsung atau karena
adanya kelainan dalam tulang tersebut. Dapat berupa kanker tulang (primer /
sekunder) radang tulang yang berat atau karena kelainan metabolisme yang
menyebabkan zat kapur dalam tulang menjadi sangat berkurang. Sebagian besar patah
tulang disebabkan oleh trauma, sisanya diakibatkan oleh penyebab-penyebab yang
tidak langsung.seperti tumor ganas tulang,dan radang tulang yang berat.Sebelah atas
tulang femur dibatasi oleh artikulasi coxae yang merupakan hubungan antara kaput
femoris dengan acetabulum. Sebelah distal tulang femur dibatasi oleh articulasio genu
terdiri dari articulasio femuro patellaris dan articulasio tibialis dan batang femur pada
hewan dewasa sangat kuat. Dengan demikian trauma langsung yang keras, seperti
yang dialami pada kecelakaan automobile, diperlukan untuk menimbulkan fraktur
batang femur.Salah satu cara untuk mengobati kejadian fraktur os femur ini adalah
melalui pembedahan. Pada paper ini penulis akan membahas mengenai bagaimana
teknik dalam melakukan operasi fraktur pada os femur.

1
1.2 Rumusan Masalah
1.2.1 Bagaimana prosedur pre-operasi fraktur os femur hewan.
1.2.2 Bagaimana prosedur teknik operasi fraktur os femur hewan.
1.2.3 Bagaimana hasil dan pasca operasi fraktur os femur hewan.

1.3 Tujuan
1.3.1 Untuk mengetahui prosedur pre-operasi fraktur os femur hewan.
1.3.2 Untuk mengetahui prosedur teknik operasifraktur os femur hewan.
1.3.3 Untuk mengetahui hasil dan pasca operasi fraktur os femur hewan.

1.4 Manfaat Tulisan

Manfaat dari penulisan paper ini yaitu agar mahasiswa dapat mengetahui
bagaimana prosedur pre-operasi, prosedur teknik operasi, hingga hasil dan pasca
operasi fraktur os femurhewandilakukan, dan juga pembuatan paper ini untuk
melengkapi tugas Ilmu Bedah Khusus Veteriner tentang teknik operasi fraktur os
femurhewan.

2
 BAB II

TINJAUAN PUSTAKA

2.1 Pre Operasi

Karena fraktur ini terjadi akibat trauma, semua hewan yang terkena harus
diperiksa untuk cedera bersamaan dan distabilkan jika diperlukan sebelum operasi.
Kontraksi otot paha membantu melumpuhkan fragmen tulang, tetapi pasien harus
terbatas pada daerah kecil sampai operasi.

2.1.1 Sinyalemen

Segala usia, jenis, atau jenis kelamin anjing atau kucing mungkin terpengaruh,
tetapi anjing jantan muda kemungkinan besar mengalami patah tulang femur yang
diinduksi trauma. Pada fraktur femoral physeal sebagian besar hewan yang terkena
dampak lebih muda dari 10 bulan. Anjing jantan muda lebih mungkin untuk
mempertahankan trauma yang mengakibatkan fraktur femoral phyesal, mungkin
karena kecenderungan mereka untuk menjelajah. Kucing jantan muda berat yang telah
dikebiri sebelum usia 6 bulan juga berisiko

2.1.2 Sejarah

Trauma mungkin atau mungkin tidak teramati. Kecelakaan kendaraan

bermotor menyebabkan sebagian besar kasus fraktur diaphyseal femoralis. Penyebab
cedera lainnya termasuk tembakan dan terjatuh.

2.1.3 Pemeriksaan Fisik

Pasien dengan fraktur diaphyseal femoralis biasanya memiliki berbagai derajat

pembengkakan anggota badan. Nyeri dan krepitasi sering dapat ditimbulkan dengan
manipulasi ekstremitas. Proprioception mungkin tampak abnormal karena hewan
tersebut tidak dapat mengangkat telapak kakinya ketika diletakkan di dorsumnya.
Keengganan hewan untuk menggerakkan anggota tubuh mungkin disebabkan oleh
rasa sakit.

2.1.4 Radiografi

Kedua craniocaudal dan radiografi lateral dari tulang paha diperlukan untuk
menilai tingkat kerusakan tulang dan jaringan lunak. Radiografi ekstremitas
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 kontralateral berguna dalam menilai panjang dan bentuk tulang normal. Radiografi ini
dapat digunakan untuk membentuk plat tulang lebih tepat sebelum operasi,
mengurangi waktu operasi. Radiografi juga digunakan sebagai referensi untuk
memilih implan berukuran tepat.

2.1.5 Penemuan Laboratorium

Kelainan laboratorium yang konsisten tidak ada. Hewan yang menderita patah
tulang sekunder akibat trauma harus memiliki cukup kerja darah yang dilakukan
untuk menentukan regimen anestesi yang tepat dan penyakit bersamaan.

2.1.6 Peralatan Operasi

Peralatan yang diperlukan untuk penempatan pin dan kawat termasuk

retraktor, pointed reduction forsep, Kern bone holding forsep, reduction forceps,
chuck pin akob, pin IM, pin Steintmann, kabel Kirschner, kawat ortopedi, pemotong
kawat, dan pemotong pin. Peralatan tambahan yang diperlukan untuk fiksasi eksternal
termasuk mata bor, panduan bor, bor daya rpm rendah, dan klem fiksasi eksternal dan
plat. Peralatan plat dan bor berkecepatan tinggi diperlukan untuk aplikasi plat dan
sekrup.

2.1.7 Anestesi

a. Premedikasi
 Midazolam (0.2 mg/kg IV, IM)
 Diazepam (0.2 mg/kg IV)
b. Induksi
 Jika terpremedikasi berikan,
1. Propofol (2-4 mg/kg, IV), atau
 Jika tidak terpremedikasi berikan,
1. Propofol (4-8 mg/kg, IV), atau
2. Ketamine (5,5 mg/kg IV) dengan diazepam (0.28 mg/kg IV)
c. Maintenance
a. Isoflurane atau sevoflurane
d. Blok
Epidural :
b. Jika terjadi paralisis pada anggota tubuh bagian belakang maka diperlukan,
4
 1. Bupivacaine (0,5 % 0,22 ml/kg), lamanya 2-5 jam, atau
2. Ropivacaine (0,5 % 0,22 ml/kg), lamanya 2-5 jam, atau
3. Lidocaine (2% 1 ml per 4,5 kg dari berat badan), lamanya 1-2 jam
c. Jika paralisis yang tidak diinginkan maka diperlukan,
1. Morphine (0,1 mg/kg tanpa bahan pengawet), atau
2. Buprenorphine (0,003-0,005 mg/kg dienecerkan pada larutan saline).

2.2 Teknik Operasi Fraktur Femur

2.2.1 Teknik Operasi Fraktur Diaphyseal dan Supracondylar Femur

Pasien diposisikan dalam posisi lateral recumbency. Kaki diset dari garis
tengah dorsal ke sendi tarsal. Adalah menguntungkan untuk menggunakan persiapan
kaki-gantung untuk memungkinkan manipulasi ekstremitas selama operasi. Lokasi
donor untuk penebangan cangkok tulang cancellous disiapkan di humerus proksimal
ipsilateral. Alternatifnya, sayap iliaka ipsilateral atau tibia proksimal digunakan.

Gambar 1. Insisi musculus sampai tulang femur terekspos

A. Buat sayatan di sepanjang perbatasan craniolateral paha. Pastikan bahwa sayatan

dibuat sedikit lebih kranial daripada lateral karena bidang paparan akan berada di
perbatasan kranial bisep. Panjang sayatan tergantung pada jenis implan yang
digunakan untuk stabilisasi dan konfigurasi fraktur. Secara umum, penyisipan plat
tulang dan pola fraktur comminuted memerlukan insisi yang lebih panjang.
B. Insisi musculus superficial fascia latae sepanjang batas kranial musculus bisep
femoris.
C. Tarik musculus bisep femoris untuk melihat musculus vastus lateralis.

5
 D. Insisi septum fasia dari m. vastus lateralis saat insersi pada batas lateral kaudal
femur. Membuka m. vastus lateralis dari permukaan femur untuk mengekspos
diaphysis femoralis.

2.2.2 Aplikasi Intramedullary (IM) pin

1. Untuk normograde pin IM, buat sayatan kulit kecil di titik masuk pin di atas tulang
trokanter mayor.
2. Dorong ujung pin melalui jaringan lunak sampai menyentuh tonjolan trochanteric
paling proksimal. Jalani titik pin dari tepi medial trokanter mayor yang lebih besar
sampai jatuh ke fossa trochanteric. Amankan segmen proksimal dengan forsep Kern
bone holding forceps, dan dorong pin melalui tulang proximal metaphyseal
cancellous dalam arah sedikit caudomedial. Ketika pin point muncul dari rongga
sumsum di tempat fraktur, mengurangi fraktur dan dorong pin ke segmen distal.
Gunakan pin kedua yang sama panjangnya dengan yang ditempatkan di rongga
sumsum untuk titik acuan untuk memperkirakan penetrasi pin yang tepat ke dalam
segmen tulang distal. Lepaskan pin berlebihan proksimal dengan mendorong kulit
ke bawah dan memotong pin di bawah tingkat kulit. Jahit kulit dengan pola
sederhana terputus di atas pin.

Gambar 2. Teknik operasi dengan

pemasangan Intramedullari Pin

6
 Gambar 3. Teknik operasi dengan pemasangan Intramedullari Pin

2.2.3 Aplikasi Interlocking Nails

Masukkan sekrup yang saling mengunci dengan cara normograde dimulai di

fosa trokanterika. Buat pendekatan terbatas pada trokanter untuk mengekspos titik
penyisipan. Sedikit overreduce femur distal untuk memasukkan sekrup jarak yang
tepat ke segmen distal

Gambar 4. Penempatan
interlocking nail pada tulang
femur

7
 2.2.4 Aplikasi Plat Tulang dan Sekrup

1. Tempatkan plat berukuran dan berkontur tepat di permukaan lateral tulang femur.
2. Gabungkan plat dengan pin IM berukuran 40% hingga 50% dari lebar saluran
meduler untuk stabilitas tambahan untuk fraktur comminuted.
3. Plat pengunci yang digunakan sebagai fixator internal untuk menstabilkan fraktur
femur tidak perlu secara anatomis sesuai dengan bentuk tulang selama tulang sejajar
ketika pelat diterapkan. Namun, dengan fraktur kominutif, akan membantu kontur
plat ke bentuk normal tulang paha dan mengamankan segmen tulang ke plat dengan
forceps pengurangan sebelum memasukkan sekrup pengunci.

Gambar 5. Plat ditempatkan pada permukaan lateral femur dapat berfungsi sebagai (A) plat
kompresi untuk fraktur transversal, (B) pelat netralisasi untuk mendukung fraktur oblique
panjang direkonstruksi dengan sekrup lag, atau (C) plat penghubung dikombinasikan dengan IM
pin untuk menjangkau fraktur yang tidak dapat direduksi.

2.2.5 Teknik Operasi Fraktur Metaphyseal dan Artikuler Femur

Gambar 6. Insisi musculus untuk melakukan eksposur craniolateral sendi panggul

8
 Hewan biasanya diposisikan dalam posisi lateral recumbency dengan kaki
yang diangkat. Persiapan kaki yang digantung akan memfasilitasi manipulasi
anggota badan selama operasi. Memposisikan hewan dalam posisi berbaring
punggung memfasilitasi eksposur bagian medial stille.

A. Insisi kulit sepanjang 5 cm proksimal ke trokanter mayor.

B. Refleksikan musculus tensor fasciae latae secara kranial dan musculus femoris
gluteal dan biceps superfisial ke kaudal. Insisi tendon gluteal dalam untuk sepertiga
sampai setengah dari lebarnya pada titik insersinya ke trokanter mayor.

Gambar 7. Insisi musculus untuk mengekspos distal femur

C. Insisi kapsul sendi dan asal otot vastus lateralis untuk mengekspos sendi pinggul
D. Insisi pada permukaan kraniolateral sendi kaku yang berpusat diatas tulang femur
setelah dipalpasi.
E. Buat arthrotomy parapatellar melalui musculus fasia latae distal dan kapsul sendi.
F. Refelksikan otot paha depan, patella, dan tendon patella medial untuk mengekspos
permukaan artikular dari kondilus femoralis.

2.2.6 Aplikasi Fraktur Leher Femoralis dengan Sebagian Lag Sekrup dan Kawat
Kirscher

1. Tempatkan dua kawat Kirschner sehingga mereka terletak di tingkat paling atas dan
distal dari permukaan fraktur.
2. Arahkan kawat dari medial ke lateral, mulai dari permukaan fraktur, atau dari
permukaan lateral medial untuk keluar di permukaan fraktur. Kurangi fraktur, dan
9
 arahkan kawat Kirschner ke kepala femoral. Berhati-hatilah agar tidak menembus
permukaan artikular.
3. Bor lubang melalui epiphysis femoralis dengan mata bor ukuran yang sesuai sejajar
dengan dan berpusat di antara kawat Kirschner.
4. Masukkan sekrup cancellous berulir sebagian 2 mm lebih pendek dari panjang yang
diukur sehingga semua benang melintasi bidang fraktur dan duduk ke kepala
femoral.
5. Tinggalkan satu atau kedua kabel di tempat untuk berfungsi sebagai perangkat
antirotasi.
6. Untuk menstabilkan fraktur leher femur dengan sekrup tulang korteks digunakan
sebagai sekrup lag, bor lubang glide melalui leher femoralis dengan mata bor sama
dengan diameter sekrup.

2.2.7 Aplikasi Fraktur Leher Femoralis dengan Kawat Kirschner Triangulasi

1. Masukkan tiga kabel Kirschner dari permukaan fraktur dengan kabel sejajar satu
sama lain untuk membentuk segitiga.
2. Retrograde kabel untuk keluar dari tulang dekat trokanter ketiga. Atau, normograde
kabel sehingga mereka memasuki tulang di trochanter ketiga dan keluar di situs
fraktur.
3. Kurangi fraktur, dan dorong kawat ke epiphysis femoralis. Hati-hati jangan sampai
menembus permukaan artikular.

Gambar 8. Teknik Operasi Fraktur Leher

Femoralis dengan Kabel Kirschner
Triangulasi

10
2.2.8 Aplikasi Fraktur Unicondylar dengan Sekrup Lag

1. Kurangi fraktur dan stabilkan sementara dengan pointed reduction forsep tajam dan
kawat Kirschner.
2. Mempersiapkan dan memasukkan sekrup lag mulai hanya proksimal ke tepi
trochlear pada sisi yang sama atau berlawanan dari tulang paha tergantung pada
orientasi garis fraktur.
3. Mengorientasikan sekrup tegak lurus dengan garis fraktur untuk kompresi optimal
dan mencegah fragmen bergeser karena sekrup dikencangkan.
4. Kawat Kirschner dapat dilepaskan atau dibiarkan di tempat untuk stabilitas rotasi.

Gambar 3. Aplikasi Fraktur

Unicondylar dengan Sekrup
Lag

2.2.9 Aplikasi Fraktur Bicondylar dengan Sekrup Lag dan Pin Steimann

1. Kurangi fraktur kondilus femoralis, dan menerapkan kompresi dengan sekrup lag
yang ditempatkan di seluruh fraktur.
2. Setelah pengurangan fraktur kondilus dan stabilisasi, masukkan dua pin Steinmann
kecil seperti yang dijelaskan untuk stabilisasi fraktur.

Gambar 9. Aplikasi Fraktur Bicondylar

dengan Sekrup Lag dan Pin Steimann

11
2.2.10 Teknik Operasi Fraktur Femoral Physeal

Hewan diposisikan dalam posisi lateral recumbency. Anggota badan harus

dipotong secara melingkar dari garis tengah dorsal ke tibia distal (fraktur physeal
distal) dan dibungkus dari posisi menggantung untuk memungkinkan manipulasi
maksimal selama pembedahan. Insisi kulit sampai terekspos tulang femur sama
seperti Gambar 5.

2.2.11 Aplikasi Fraktur Proxymal Physeal dengan Kawat Triangulasi Kirschner

1. Tempatkan tiga kawat Kirschner sejajar satu sama lain dan diposisikan di leher
femoralis sehingga mereka berada dalam segitiga. Dua kawat cukup untuk kucing.
2. Masukkan kawat dari aspek lateral femur sejajar dengan sudut leher femur; titik-
titik dari kabel seharusnya hanya terlihat pada permukaan fraktur.
3. Kurangi fraktur dengan mengamankan femur proksimal dengan reduction forsep
dan manuver ke posisinya.
4. Tahan pengurangannya dengan menekan fragmen di acetabulum, dan dorong
kawat ke dalam epiphisis femoralis

Gambar 10. Teknik Operasi Fraktur

Proxymal Physeal dengan Kawat
Triangulasi Kirschner

2.2.12 Aplikasi Fraktur Proxymal Physeal dengan Sekrup Lag dan Kawat
Kirschner

1. Untuk menstabilkan fraktur physeal femoral dengan sekrup pada tulang korteks
yang digunakan sebagai sekrup lag, letakkan dua kawat Kirschner (satu superior
dan satu inferior) di leher femoralis, tegak lurus dengan permukaan fraktur. Bor
lubang luncur antara kawat Kirschner.

12
 2. Mengurangi fraktur, dan arahkan kabel Kirschner ke epiphysis femoralis. Bor
lubang luncur di epiphysis, ukur untuk menentukan panjang sekrup.
3. Masukkan sekrup lag tersebut.

Gambar 11. Teknik Operasi Fraktur Proxymal Physeal Femoral

dengan Sekrup Lag dan Kawat Kirschner

2.2.13 Aplikasi Fraktur Distal Physeal Femoral dengan Pin Steintmann

Ketika menggunakan pin Steintmann :

1. Masukkan pin melalui cranial tulang rawan artikular ke asal ligamentum

cruciatum kaudal.
2. Arahkan pin dalam mode normograde melintasi fraktur, secara proksimal ke
tulang paha, untuk keluar di fosa trochanteric
3. Potong bagian distal pin dan hitung kembali di bawah tingkat kartilago artikular;
potong pin yang berlebihan di bawah kulit di atas fosa trokanterika.
4. Gunakan pin berdiameter kecil sehingga bisa menekuk dengan kelengkungan
saluran femoral saat melewati proksimal. Pertimbangkan untuk menambahkan pin
bersilang kecil pada fraktur untuk membentuk stabilitas rotasi, yang diperlukan.

Ketika menggunakan pin Steintmann yang disilangkan :

1. Posisikan pin tersebut sehingga mereka memasuki epiphysis pada titik kranial ke
epikondilateral medial dan lateral, dan dorong secara proksimal ke titik di mana
mereka hanya terlihat di permukaan fraktur.
2. Lebih mengurangi fraktur, dan mendorong pin ke dalam metafisis femoral dan
melalui korteks.
3. Sesuaikan kapsul sendi menggunakan pola jahitan terputus. Tutup jaringan
subkutan dan kulit secara rutin.

13
 Gambar 12. Teknik Operasi Aplikasi Fraktur
Distal Physeal Femoral dengan Pin
Steintmann

2.3 Pasca Operasi Fraktur Femur

Radiografi pasca operasi diambil untuk mengevaluasi pengurangan fraktur dan

lokasi implan. Radiografi harus diambil dan dievaluasi dalam 6 minggu. Aktivitas
hewan dibatasi dengan cara dikandangkan dan dibeirkan Elizabethan Collar. Obat
anti-inflamasi nonsteroid (NSAID) dianjurkan untuk mengontrol rasa sakit pada
pasien ortopedi. Pada kucing dapat diberikan 30 mg / kg IM ceftriaxone satu kali
sehari selama 5 hari pasca operasi dan 0,2 mg / kg meloxicam IM selama 3 hari untuk
menghilangkan rasa sakit. Antibiotik profilaksis efektif dalam mencegah infeksi situs
bedah pada pasien ortopedi. Cefazolin, 22 mg / kg IV, diberikan setelah induksi
anestesi dan diulangi setiap 2 hingga 4 jam selama prosedur, adalah protokol pilihan
untuk sebagian besar pasien ortopedi. Pin IM dan fiksasi skeletal eksternal harus
dihapus ketika penyembuhan terjadi; kawat cerclage, sekrup lag, sekrup interlocking,
dan lempengan tulang umumnya tidak dihilangkan kecuali masalah dikaitkan dengan
kehadiran mereka. Perban Robert Jones dan modifikasi mereka adalah splint eksternal
yang paling sering digunakan pada pasien hewan. Pembungkus besar kapas-kasa ini
biasanya digunakan sebelum atau sesudah pembedahan untuk splotting ekstremitas
sementara.

14
 Gambar 13. Obat Anti-inflamasi Nonsteroid
Digunakan untuk Mengobati Anjing dengan
Masalah Ortopedi.

Gambar 14. Radiografi pasca operasi. (A) Fraktur femur

comminuted dalam dengan plat pengunci menjembatani fraktur. (B)
Penyembuhan Fraktur 5 minggu kemudian

15
 Gambar 15. Radiografi pasca operasi. (A) Fraktur physeal femoralis
distal distabilkan dengan pin intramedulla (IM) dan pin silang. (B)
Penyembuhan fraktur 6 minggu kemudian

Gambar 16. A, Saat mengaplikasikan perban Robert Jones, letakkan

selotip adhesif pada permukaan cranial dan kaudal kaki dari carpus
(tarsus) hingga 6 inci di luar jari kaki. Tutupi luka dengan bantalan non-
ester. B, Kemudian bungkus 3 hingga 6 inci kapas di sekitar ekstremitas.
C, Setelah mengaplikasikan pita sanggurdi dan kapas di dahan, bungkus
kasa elastis dengan kuat di atas kapas untuk menekannya. D, Kemudian
aplikasikan pita elastis ke permukaan luar perban.

16
 BAB III

PEMBAHASAN

3.1 Pengertian Fraktur Os Femur

Os Femur merupakan tulang terbesar dalam tubuh yang berbentuk silinder

kecuali bagian ujung. Sebelah proksimal os femur dibatasi oleh artikulasi coxae yang
merupakan hubungan antara kaput femoris dengan acetabulum. Sebelah distal os
femur dibatasi oleh articulasio genu terdiri dari articulasio femuro patellaris dan
articulasio tibialis serta corpus femur pada hewan dewasa sangat kuat. Dengan
demikian trauma langsung yang keras, seperti yang dialami pada kecelakaan, dapat
untuk menimbulkan fraktur corpus femur. Perdarahan interna yang masif dapat
menimbulkan renjatan berat.

Fraktur adalah pemecahan suatu bagian, terutama pada tulang atau terputusnya
kontinuitas tulang atau tulang rawan. Sedangkan pada fraktur femur adalah rusaknya
kontinuitas tulang femoral yang dapat disebabkan oleh trauma langsung, kelelahan
otot, kondisi-kondisi tertentu seperti degenerasi tulang/osteoporosis. Klasifikasi
fraktur corpus femur dibagi berdasarkan adanya luka yang berhubungan dengan
daerah yang patah. Pada umumnya bentuk penanggulangan fraktur terbuka dilakukan
tindakan debridement, sebaiknya penanggulangan untuk tulangnya sendiri, dilakukan
tindakan yang sama seperti pada penanggulangan fraktur tertutup. Klasifikasi fraktur
femur dibagi menjadi :

1. Fraktur collum femur

Fraktur collum femur dapat disebabkan oleh trauma langsung yaitu hewan
terjatuh dengan posisi miring dimana daerah trochanter mayor langsung terbentur
dengan benda keras (jalanan) ataupun disebabkan oleh trauma tidak langsung yaitu
karena gerakan exorotasi yang mendadak dari tungkai bawah. terbagi dalam :

a. Fraktur intrakapsuler (Fraktur collum femur)

b. Fraktur extrakapsuler (Fraktur intertrochanter femur)

17
2. Fraktur subtrochanter femur dan Fraktur supracondyler femur
Fraktur supracondyler fragment bagian distal selalu terjadi dislokasi ke
posterior, hal ini biasanya disebabkan karena adanya tarikan dari otot – otot
gastrocnemius, biasanya fraktur supracondyler ini disebabkan oleh trauma langsung
karena kecepatan tinggi sehingga terjadi gaya axial dan stress valgus atau varus dan
disertai gaya rotasi. fraktur dimana garis patahnya berada 5 cm distal dari trochanter
minor, dibagi dalam beberapa klasifikasi yaitu :

a. Tipe 1 : garis fraktur satu level dengan trochanter minor

b. Tipe 2 : garis patah berada 1 -2 inch di bawah dari batas atas trochanter minor

c. Tipe 3 : garis patah berada 2 -3 inch di distal dari batas atas trochanter minor

3. Fraktur corpus femur

Fraktur corpus femur biasanya terjadi karena trauma langsung akibat
kecelakaan lalu lintas atau jatuh dari ketinggian, patah pada daerah ini dapat
menimbulkan perdarahan yang cukup banyak, mengakibatkan hewan menjadi shock,
salah satu klasifikasi fraktur corpus femur dibagi berdasarkan adanya luka yang
berhubungan dengan daerah yang patah yaitu :

a. Tertutup
b. Terbuka, ketentuan fraktur femur terbuka bila terdapat hubungan antara tulang patah
dengan dunia luar yang dibagi menjadi tiga derajat yaitu :

 Derajat I : Bila terdapat hubungan dengan dunia luar dan timbul luka kecil, biasanya
diakibatkan tusukan fragmen tulang dari dalam menembus keluar.
 Derajat II : Lukanya lebih besar (>1cm) luka ini disebabkan karena benturan dari
luar.
 Derajat III : Lukanya lebih luas dari derajat II, lebih kotor, jaringan lunak banyak
yang ikut rusak (otot, saraf, pembuluh darah)

4. Fraktur intercondylair
Biasanya fraktur intercondular diikuti oleh fraktur supracondular, sehingga
umumnya terjadi bentuk T fraktur atau Y fraktur.

18
5. Fraktur condyler femur
Mekanisme traumanya biasa kombinasi dari gaya hiperabduksi dan adduksi
disertai dengan tekanan pada sumbu femur keatas.

3.2 Indikasi Fraktur Os Femur

Indikasi fraktur femur pada prinsipnya adalah dapat disebabkan oleh traumatik
termasuk kecelakaan, jatuh dari ketinggian, tembakan, berkelahi dengan binatang lain
serta karena suatu penyakit seperti tumor tulang ganas dan radang tulang yang berat.
Fraktur femur lebih sering terjadi disebabkan oleh trauma, maka sebaiknya hewan
harus diperiksa untuk menentukan keparahan luka serta luka sekunder lainnya.
Fraktur karena trauma dapat dibagi menjadi dua yaitu :

1. Fraktura os femur directa yaitu fraktur yang terjadi tepat di tempat trauma tersebut

2. Fraktura os femur indirect yaitu fraktur yang terjadi tidak tepat di tempat trauma
tersebut.

Secara umum fraktura dapat dibagi menjadi dua yaitu :

1. Penyebab ekstrinsik

a. Gangguan langsung : trauma yang merupakan penyebab utama terjadinya fraktur.

Misalnya, tertabrak atau jatuh dari ketinggian

b. Gangguan tidak langsung : bending, perputaran dan kompresi

2. Penyebab intrinsik

a. Kontraksi dari otot yang menyebabkan avulsion fraktur, seperti fraktur yang sering
terjadi pada hewan yang belum dewasa

b. Fraktur patologis : penyakit sistemik,seperti neoplasia, cyste tulang, osteoporosis,

hyperparathyroidism dan osteomalacia

c. Tekanan berulang yang dapat menyebabkan fraktur

19
 Adapun faktor-faktor yang menunjang terjadinya fraktur os femur yaitu :

a. Umur

Hewan yang berumur muda lebih mudah mengalami faktur dibandingkan

hewan tua. Hal ini disebabkan tulang hewan muda lebih lunak konsistensinya dan
masih banyak mengandung zat perekat. Sedangkan hewan tua mempunyai zat perekat
sedikit sehingga konsistensi tulangnya menjadi keras.

b. Gizi

Hewan yang kurang bergizi akan lebih mudah mengalami fraktur

dibandingkan hewan yang bergizi baik. Hal ini dikarenakan hewan yang memiliki gizi
yang baik dalam pembentukan urat daging baik dari karbohidrat, protein dan lemak
serta pertumbuhan tulangnya juga akan lebih baik dengan cukupnya meneral dan
vitamin yang dikonsumsinya. Hewan yang kekurangan mineral, terutama yang
berfungsi untuk komponen tulang seperti kalsium dan fosfor, maka tulangnya akan
menjadi rapuh.

20
 BAB IV

PENUTUP

4.1 Kesimpulan
Fraktur femur merupakan jenis fraktur yang sering terjadi pada anjing
terutama akibat kecelakaan lalu lintas. Patah pada tulang femur dapat disebabkan oleh
trauma. Trauma tidak langsung atau karena adanya kelainan dalam tulang tersebut.
Dapat berupa kanker tulang (primer / sekunder) radang tulang yang berat atau karena
kelainan metabolisme yang menyebabkan zat kapur dalam tulang menjadi sangat
berkurang. Sebagian besar patah tulang disebabkan oleh trauma, sisanya diakibatkan
oleh penyebab-penyebab yang tidak langsung.seperti tumor ganas tulang,dan radang
tulang yang berat.
Pre operasi fraktur femur terdiri dari pemeriksaan sinyalemen, sejarah,
pemeriksaan fisik, dan radiografi. Anastesi yang digunakan adalah anastesi umum
inhalasi. Teknik operasi melalui 3 cara, yaitu teknik operasi fraktur diaphyseal dan
supracondylar femur, teknik operasi fraktur metaphyseal dan artikuler femur, dan
teknik operasi fraktur femoral physeal. Pasca operasi frakturos femur tediri dari
radiografi, pemakaian e-collar, pemberian anti inflamasi dan antibiotik, juga
pengangkatan pin IM dan fiksasi skeletal ketika sudah sembuh.

4.2 Saran
Pada kasus fraktur femur tingkat kesulitan pembedahan cukup tinggi. Sebagai
dokter hewan di harapkan memiliki keterampilan yang baik. Selain itu, ketersediaan
alat sangat menentukan keberhasilan operasi. Pemilik hewan diharapkan memberikan
perhatian khusus kepada hewan pasca operasi guna untuk mempercepat kesembuhan
hewan.

21
 Daftar Pustaka

Altunatmaz, K., Karabagli, M., Kaya, D.A., Guzel, O., Yalin, E.E., Ugurlu, U., Sadalak,
D.J., Ekici, H. 2017. The treatment of supracondylar and diaphyseal femoral
fractures in cats using intramedullary two-way stacked Kirschner wire
application. Turk J Vet Anim Sci (2017) 41: 282-287.

Fossum, T.W. Dewey, C.W. Horn, C.V. Johnson, A.L. MacPhail, C.M. Radlinsky, M.G.
Schulz, K.S. Willard, M.D. 2013. Small Animal Surgery. 4th Edition. Elsevier:
Missouri.

Libardino, R.D.N., Costa, D.D., Menezes, F.B., Cavalli, L.G., Pedrotti, L.P., Kohlrausch,
P.R., Minto, B.W., Silva, M.A.A. 2018. Classification, fixation techniques,
complications and outcomes of femur fractures in dogs and cats: 61 cases
(2015-2016). Ciencia Rural, Santa Maria, v 48:06, e20170028.

Uddin, Karim MD et al. 2017. Internal fixation of fracture of femur of dog using
intramedullary pinning. Veterinary and Animal Sciences University,
Bangladesh *Corresponding author: Md. Zakir Hassan, Scientific Officer,
Animal Health Research Division, Bangladesh. Asian Australas. J. Biosci.
Biotechnol. 2017, 2 (3), 243-246. ISSN 2414-1283 (Print) 2414-6293 (Online)

22
LAMPIRAN

23
 Turkish Journal of Veterinary and Animal Sciences Turk J Vet Anim Sci
(2017) 41: 282-287
http://journals.tubitak.gov.tr/veterinary/
© TÜBİTAK
Research Article doi:10.3906/vet-1606-12

The treatment of supracondylar and diaphyseal femoral fractures in

cats using intramedullary two-way stacked Kirschner wire application
1 1 1, 1
Kemal ALTUNATMAZ , Murat KARABAĞLI , Didar AYDIN KAYA *, Özlem GÜZEL ,
1 1 2 1
Ebru ERAVCI YALIN , Ümit UĞURLU , Defne Joan ŞADALAK , Himmet EKİCİ
1
Department of Surgery, Faculty of Veterinary Medicine, İstanbul University, İstanbul, Turkey
2
32 Sion Hill, Both, BA1, 2UW, United Kingdom

Received: 01.01.2016 Accepted/Published Online: 01.01.2016 Final Version: 19.04.2017

Abstract: Femoral fractures in cats are treated using pin and wires, lag screws, Rush pins, intramedullary threaded pins, interlocking
pins, clamp rod internal fixators, and plates or plate-rods. In this study, 14 cats brought to the surgery clinic between the years 2010
and 2015 for fracture, due to either a road traffic accident or falling from a height, were evaluated. Following clinical and radiological
examination of the cases, the type and location of the fracture, details of the applied fixation method, and postoperative clinical and
radiological results were assessed. Localization of the fractures was as follows: 4 comminuted diaphyseal (1 segmental), 6 comminuted
distal, and 4 uncomplicated distal transversal fractures. All fractures were closed. Following intramedullary positioning of the pins, rigid
stabilization was observed in the fracture line. In the case of the segmental fracture, better stabilization was achieved when the medullary
canal was completely filled. The patients were able to use their extremities 3–5 days after surgery and started walking normally from
postoperative day 10. Functional healing was seen to improve gradually. Radiographic examination revealed sufficient calli to have
formed between days 32 and 44. Complete healing and return to function with no complications was recorded in all the cases.

Key words: Cat, femur, fracture, treatment, intramedullary fixation

1. Introduction function of the injured leg, and prevent damage to soft

Femoral fractures are common in cats and constitute
20%–26% of total fractures (1). Most of these occur in
the femoral shaft and are usually in the form of closed
fractures (2,3). While femoral fractures are seen mostly in
the proximal or distal physis in young cats, they are mostly
metaphyseal or diaphyseal fractures in adults. According
to the Salter–Harris classification, distal femoral fractures
of cats that have not yet completed their development are
called metaphyseal, physeal, or epiphyseal, while fractures
of the distal metaphysis are described as supracondylar
(4–6). The most common fractures of adult cats are
supracondylar fractures. These fractures occur in the distal
metaphyseal region of the femur together with condylar
fractures, either as an isolated or a comminuted fracture
(7). The important factors in the treatment of femoral
fractures are appropriate surgical approach, minimal
dissection, protection of soft tissue and bones in the area,
anatomical or indirect reduction, sufficient stabilization,
suitable material selection and application, and appropriate
postoperative care (2).
The ultimate aim of fracture treatment is to achieve
rapid bone healing, provide fast return to complete
* Correspondence: didaraydin@hotmail.com
282
tissues and the bone (8,9). If pin application principles are
adhered to, intramedullary pin application is a relatively
easy method (8).
Distal femoral fractures in cats are successfully treated
using pin and wires, Rush pins, intramedullary threaded
pins, interlocking pins, clamp rod internal fixators, and
plates or plate-rods (2,4,6,7,10–15). In addition to these
methods, intramedullary pins are used in combination
with external fixators (tie-in) (7,16–18). However, they are
not highly advised due to the dense soft tissue mass in the
region (2).
The aim of this study is to present to veterinary
practice the successful treatment of distal diaphyseal and
supracondylar femoral fractures seen commonly in cats,
with the easily applicable two-way (normograde and
retrograde) intramedullary stacked pin application, which
provides good stability and requires minimal dissection.
2. Materials and methods
The study material comprised 14 cats of different breed,
age, and sex brought to the İstanbul University Veterinary
Faculty Surgery Department between the years 2010
 ALTUNATMAZ et al. / Turk J Vet Anim Sci

and 2015. Physical and radiological examination of
the patients (Figures 1–4) led to fracture diagnosis and
surgical treatment. The appropriate surgical approach was
employed and the fracture site was reached via a lateral
femur incision.
Following exposure of the fracture fragments,
Kirschner pins were first inserted into the medulla of the
proximal fragment in a retrograde fashion so that the pin
exited the intertrochanteric fossa (Figure 1). The numbers
of Kirschner pins used were three 1.5-mm pins in 1 case,
two 1.5-mm pins in 4 cases, and two 2-mm pins in 9
cases. An approximately 1-cm incision was made at the
pin exit site. The pins were pulled proximally towards the
cancellous region in order to vacate the medullary canal
(Figure 1).
The stifle joint was then opened and the condyles
exposed. Two Kirschner wires each (1.2-mm wires in 5
cases and 1.5-mm wires in 9 cases) were inserted into the
medulla in a normograde fashion through the fracture
line and these exited the medial and lateral sides of
the condyles (Figure 1). Following repositioning of the
fracture, the distal pins were advanced until they entered
the cancellous bone of the proximal fragment. The pins
inserted into the proximal fragment were then advanced
until they reached the cancellous bone and the free tips
were bent and cut. Metal cerclage wire was used to aid
fixation in some oblique, spiral, and comminuted fractures
and polydioxanone cerclage was used in other fractures.
The tips of the pins inserted distally were bent and left
on both sides of the condyles in 9 cats (Figures 1, 2, and

Figure 1. (a) Preoperative mediolateral and ventrodorsal view of distal diaphyseal femur fracture in a 6-month-old mixed breed cat; (b)
radiographic view of retracted pins inserted in a retrograde fashion into the proximal fragment before intraoperative repositioning and
that of pins inserted lateral to the condyle; (c) intraoperative view of pins inserted in a normograde fashion lateral to the condyle; (d)
postoperative mediolateral and ventrodorsal view.

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 ALTUNATMAZ et al. / Turk J Vet Anim Sci

Figure 2. (a) Preoperative mediolateral and ventrodorsal view of segmental comminuted femur fracture in a 7-month-old mixed breed
cat; (b) postoperative mediolateral and ventrodorsal view; (c) 2 months after operation, a mediolateral and ventrodorsal view before
removal of pins; (d) mediolateral view after removal of pins.

4), while in 5 cats the pins were retracted until the tips
disappeared within the joint and then bent over the major
trochanter (Figure 3). To prevent soft tissue and ischiatic
nerve damage the tips of the bent pins were directed
laterally and cranially (Figures 1–4). On completion of the
fixation procedure, the operation site was closed routinely.
Postoperative radiographs of the cases were obtained.
All cats were administered 30 mg/kg IM ceftriaxone once
daily for 5 postoperative days and 0.2 mg/kg IM meloxicam
for 3 days for pain relief. When there was sufficient
functional healing and radiographic callus formation, the
proximally bent pins were removed in all cases and the
distally bent pin in one case (Figure 2). No problems were
observed with the bent pin tips within the stifle joint in 8
cases; therefore, these were not removed.
3. Results
Intramedullary two-way stacked Kirschner wire
application was used to treat femoral fractures in 14 cats.
Among these cats, 11 were mixed breed, 2 were Siamese,
and 1 was a Sphynx cat. There were 11 male and 3 female
cats. Bodyweight ranged between 1.5 and 6 kg and the cats
were aged between 5 months and 2 years (7 cats were 11
months old or younger). The fractures had been caused by
falling from a height in 5 cases, road traffic accidents in 8
cases, and as a result of being hit in 1 case. The location of
the fractures were: diaphyseal comminuted (1 segmental)
in 4 cases, distal comminuted in 6 cases, and distal
transversal simple fractures in 4 cases. All were closed
fractures. Following insertion of intramedullary pins,
there was reasonably rigid stability in the fracture line. In
the case of the segmental fracture, better stabilization was

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 ALTUNATMAZ et al. / Turk J Vet Anim Sci

Figure 3. Preoperative (a) mediolateral and (b) ventrodorsal view of distal diaphyseal femur fracture in a 9-month-old Sphynx cat;
postoperative (c) mediolateral (d) and ventrodorsal view.

achieved when the medullary canal was completely filled.
The patients were seen to begin using their extremities
3–5 days after surgery and were walking normally from
postoperative day 10. Functional healing was determined
to improve gradually. In radiographic controls, total
healing (sufficient callus) was seen to occur between days
32 and 44. Full recovery and return to function with no
complications was observed in all cases.
4. Discussion
Due to the variable medullary canal diameters of the
bones, the application of just one intramedullary pin
usually does not provide sufficient fixation. Insertion of
multiple pins increases pin and bone contact and gives
better stabilization (9,14,19). Traditional intramedullary
pin or stacked pin application is used mostly for the
fixation of simple diaphyseal fractures of the femur and
humerus (14,19). The majority of the cases in this study
had distal diaphyseal or supracondylar fractures. The
diaphyseal fractures were comminuted. Since two-way
stacked pins provide sufficient stabilization, in the authors’
opinion, this method can be used without any problems in
all femoral fractures in cats.
Retrograde application of the interlocking pin is
used successfully in supracondylar or diaphyseal femoral
fractures in cats (6). Retrograde and normograde two-
way pin application causes less trauma and removal of
the material is easier. Also, it may not be possible in every

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 ALTUNATMAZ et al. / Turk J Vet Anim Sci

Figure 4. (a) Preoperative mediolateral and ventrodorsal view, (b) postoperative mediolateral and ventrodorsal view, and (c) mediolateral
and ventrodorsal view 40 days after operation of supracondylar femur fracture in a 6-month old mix breed cat.

veterinary practice to acquire an interlocking pin and set
for cats. However, Kirschner wires are easy to obtain and
this method is easily applicable.
Distal femoral fractures can also be treated using plate-
rod constructs and adjunctive external fixators (2,20).
The authors reached the conclusion that, compared to the
methods mentioned above, the two-way intramedullary
pin application is quicker and more easily applicable,
removal of the osteosynthesis material following healing is
easy, and it is a more cost-effective technique.
In fracture treatment using plate-rod constructs, Reems
et al. (21) reported that they encountered complications
such as pin migration, soft tissue irritation, and serum
production. None of these complications were observed in
the present study.
In patients that have not yet completed their physical
development, plate application in metaphyseal fractures
has a negative effect on growth (22). Among the cases
of this study, neither premature growth plate closure nor
problems associated with this were encountered.
In a study carried out by Stigen (23), supracondylar
femoral fractures were treated using fixation with
normograde pin application via the stifle joint. However,
it was reported that removal of the pins following fracture
repair was difficult and therefore this method was not
advised (23). In the present study, pin removal was seen
to be reasonably easy and uncomplicated in the two-way
pin application, particularly in cases where the pin tip was
bent over the major trochanter.
Iatrogenic sciatic nerve damage may occur following
intramedullary pin application in femoral fractures (24).
This may be particularly because during the bending of the
intramedullary pins, the bent tips can also cause damage to
the nerve. During retrograde application, holding the hip
joint in slight extension and adducting the leg minimizes
soft tissue penetration and prevents the exposed pin from
damaging the sciatic nerve (9). It has been reported that
an appropriate tie-in technique in external fixation and
intramedullary pin combinations may prevent sciatic
nerve damage and soft tissue irritation that may be caused

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by intramedullary pin application (20). In this study, no
nerve damage or soft tissue irritation was encountered
either during two-way stacked pin application or removal.
In the authors’ opinion, this damage can be avoided by
cranial and lateral bending of the pin tips over the major
trochanter. In the tie-in technique, since the intramedullary
pin was bent laterally, this problem did not occur. Also in
patients where all the pins were bent upwards, the fact that
pin removal could be performed under sedation and local
analgesia was considered to be an advantage.
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Acknowledgments
The authors would like to thank Dr Klaus Zahn for his idea
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287
Ciência Classification,
Rural, Santafixation
Maria, v.48:06,complications
techniques, e20170028, and2018
outcomes of femur fractures in dogs and cats: 61 cases (2015-2016).
http://dx.doi.org/10.1590/0103-8478cr20170028
ISSNe 1678-4596
CLINIC AND SURGERY

Classification, fixation techniques, complications and outcomes of femur

fractures in dogs and cats: 61 cases (2015-2016)

Renato do Nascimento Libardoni 1 Diego da Costa 2 Felipe Barretos Menezes 2

Lucas Geraldo Cavalli Luís Fernando Pedrotti 2 Patrícia Regina Kohlrausch 2
2

Bruno Watanabe Minto 3 Marco Augusto Machado Silva 4*

1
Curso de Medicina Veterinária, Universidade de Passo Fundo (UPF), Campus Passo Fundo, Hospital Veterinário, Passo Fundo, RS, Brasil.
2
Programa de Residência Integrada em Medicina Veterinária, Universidade de Passo Fundo (UPF), Campus Passo Fundo, Hospital Veterinário,
Passo Fundo, RS, Brasil.
3
Departamento de Clínica e Cirurgia Veterinária, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Campus
Jaboticabal, Jaboticabal, SP, Brasil.
4
Escola de Veterinária e Zootecnia, Universidade Federal de Goiás (UFG), 74690-900, Goiás, GO, Brasil. E-mail: silvamam@gmail.com.
*Corresponding author.

ABSTRACT: The aim of this study was to retrospectively evaluate the frequency of femur fractures in dogs and cats in the routine of a
school hospital, determining their classification, fixation methods, complications, and outcomes. A total of 61 animals, 50 (82.0%) dogs and
11 (18.0%) cats, had femoral fractures that were submitted to osteosynthesis. Sixty-two femoral fractures were evaluated. Single fractures
in the distal epiphysis (n=25) were the most frequent (P=0.0001). Intramedullary pins were used in association with cerclage and tension
band for osteosynthesis in proximal fractures. In diaphyseal fractures, bone plates and screws, two intramedullary pins (insulated or with
cerclage) and Tie-In configuration were used. In distal fractures, modified Rush intramedullary pins, cross pins and Tie-In configuration
were used. Comparing complication frequencies at fracture sites that required reintervention after osteosynthesis, a significant difference was
observed (P=0.0253) between the diaphyseal (31.25%) and distal (7.14%) fractures independent of the technique used. We concluded that
distal epiphyseal fractures were the most frequent in the routine of a school hospital. Distal epiphyseal fractures presented a lower frequency
of complications for consolidation when treated with modified Rush intramedullary pins or crossed pins.
Key words: small animals, casuistry, retrospective study, distal fractures.

Classificação, métodos de fixação, complicações e desfecho das fraturas

de fêmur em cães e gatos: 61 casos (2015-2016)

RESUMO: O objetivo deste estudo foi avaliar, retrospectivamente, a frequência das fraturas de fêmur em cães e gatos, na rotina de um
hospital escola, determinando a classificação, métodos de fixação, complicações e desfecho. No total, 61 animais, 50 (82,0%) cães e 11
(18,0%) gatos, apresentaram fraturas de fêmur submetidas a osteossíntese. Sessenta e duas fraturas de fêmur foram avaliadas neste estudo.
As fraturas simples localizadas na epífise distal (n=25) foram as mais frequentes (P=0,0001). Para osteossíntese das fraturas proximais,
foram utilizados pinos intramedulares em associação a cerclagem e banda de tensão. Nas fraturas diafisárias, foram utilizadas placas ósseas
e parafusos, dois pinos intramedulares (isolados ou com cerclagem) e fixador externo Tie-In e, nas fraturas distais, pinos intramedulares de
Rush modificados, pinos cruzados e fixador externo Tie-In. Comparando-se a frequência de complicações que necessitaram reintervenção
após osteossíntese, entre as localizações das fraturas, independente da técnica empregada, houve uma diferença significativa (P=0,0253)
entre as diafisárias (31,25%) e distais (7,14%). Conclui-se que as fraturas epifisárias distais foram as mais frequentes na rotina de um hospital
escola e, quando tratadas com pinos intramedulares de Rush modificados ou pinos cruzados, apresentaram menor frequência de complicações
para a consolidação.
Palavras-chave: pequenos animais, casuística, estudo retrospectivo, fraturas distais.

INTRODUCTION femoral neck, trochanteric, subtrochanteric, diaphyseasl,

suprachondillary, or condylar, and distal (JOHNSON,
Femur fractures are common in dogs and 2013), and they are mostly closed due to the supra-
cats, accounting for 20-25% of all fractures in these skeletal muscles (BEALE, 2004). None of them allows
animals. These fractures can be classified in many a conservative treatment with external coaptation, due to
bases, and the classification system adopted by the AO the anatomical peculiarities of the femur and surrounding
Vet allows alphanumeric evaluation and coding for soft tissues (BEALE, 2004; DeCAMP et al., 2016).
location, morphology, and severity (DeCAMP et al., Thus, a complete understanding of the forces
2016). Femur fractures are classified as femoral head, acting on the fracture focus to which implants will be
Received 01.16.17 Approved 05.03.18 Returned by the author 06.03.18
CR-2017-0028.R1
Ciência Rural, v.48, n.6, 2018.
2 Libardoni et al.
submitted is essential to select the implant and fixation
technique (BEALE, 2004; JOHNSON, 2013). Treatments
are often successful when basic principles of repair are
used (BEALE, 2004; DeCAMP et al., 2016). Suitable
implants include bone plates and screws, intramedullary
pins and cerclages, blocked intramedullary nails and
external skeletal fixator, using anatomical reduction and
rigid fixation, or biological osteosynthesis. Complications
included pin migration, sciatic nerve block, infection,
non-union, late union, implant failure, quadriceps muscle
contracture, and premature physeal closure, leading to
limb shortening or angular deformity (BEALE, 2004;
ROUSH, 2005). Therefore, the objective of the present
study was to retrospectively evaluate the classification,
fixation methods, complications, and outcome of femoral
fractures in dogs and cats in the routine of a school hospital.
MATERIALS AND METHODS
Records of orthopedic services, which
were carried out at the Veterinary Hospital (HV),
Universidade de Passo Fundo (UPF), in the period
Jan 2015 to Dec 2016, were reviewed. Dogs and cats
with femur fracture(s) confirmed by previous history,
clinical, orthopedic, and radiographic examination, and
submitted to osteosynthesis surgical treatment were
included in this study. Information about the species,
race, age, gender, weight, and causative agent were
recorded, and the animals were distributed into four
age groups: puppies (less than 1 year), young adult
(1-3 years), mature adult (3-10 years), and elderly
(over 10 years old), according to the methodology used
in another case study (SHEARER, 2011). Regarding
size (weight), the dogs were categorized in: less than
6kg, 6-15kg, 15-25kg, and more than 25kg. Cats were
categorized in: less than 2kg, 2-3kg, 3-4kg, and 4-5kg.
Regarding location, morphology, and
severity of fractures in long bones, the fractures were
classified based on the classification system adopted by
the AO Vet (DeCAMP et al., 2016). Fracture site was
obtained assigning number 3 to each femur bone, and
dividing it into the 1 (proximal), 2 (diaphyseal), and 3
(distal) zones. For severity, each fracture was classified
as A (simple fracture), B (multiple fracture/reducible
wedge), and C (comminuted fracture/non-reducible
wedge). Subsequently, each evaluation was grouped into
1 (slight), 2 (moderate), or 3 (severe), depending on the
type and extent of bone fragmentation. For fractures in
the proximal and distal bone zones, a second individual
description was performed to designate the specific
morphology. The fixation methods were evaluated
through the classification and severity of the cases. Data
on the evaluations performed in the post-surgical period
were collected, with emphasis on the complications
reported, reinterventions, and final outcome.
Complications were categorized into minor,
major, and catastrophic. Catastrophic complications
were those that resulted in an unacceptable permanent
functioning of the limb, resulting in amputation. Major
complications required surgical treatment for resolution.
Minor complications did not require additional surgical
or medical treatment for resolution (COOK et al., 2010).
Frequencies of bone consolidation and
major complications were compared using the Fisher’s
exact test, with view to the osteosynthesis techniques
and anatomical (proximal, diaphyseal, and distal)
locations, independent of the technique used. The
G-Test was used for comparison between fracture types
as a function of their location. Other epidemiological
data were analyzed using descriptive statistics. For
all tests, the 5% significance level was adopted.
RESULTS AND DISCUSSION
A total of 61 animals, 50 (82.0%) dogs and
11 (18.0%) cats, presented fractures in the femur bone,
which underwent osteosynthesis. In our sample, part of
dogs (48.0%) and cats (90.9%) had an undefined breed.
Dogs had defined breeds such as Australian Cattle Dogs
(2; 4.0%), Border Collies (2; 4.0%), Boxers (2; 4.0%),
Poodles (2; 4.0%), Pinschers (3; 6.0%), Shih Tzus (4;
8.0%), and other breeds (11; 22.0%). Only one (9.1%)
cat was of the Siamese breed. Regarding age group,
dogs were pups (28; 48.0%), young adults (12; 24.0%),
mature adults (7; 14.0%), and old dogs (3; 6.0%). Cats
were puppies (8; 72.7%) and young adults (3; 27.3%).
As for gender, femoral fractures in male dogs (30; 60%)
were more frequent than in female dogs (20; 40.0%);
similarly, such fractures in male cats (8; 72.7%) were
also more frequent than in female cats (3; 27.3%).
In this study, puppies were most affected
by femoral fractures due to low bone density in their
development (osteogenesis) phase. At this stage, these
bones are fragile even for minor trauma (MINAR,
2013) and due to lack of ability of the puppies to avoid
trauma (VIDANE, 2014). Such fractures occur more
frequently in the proximal or distal physes, whereas
metaphyseal and diaphyseal fractures are more common
in mature patients (BEALE, 2004; KIM et al., 2012).
Regarding animal size, dog weights were less
than 6kg (21; 42.0%), between 6-15kg (20; 40.0%), and
15-25kg (8; 16.0%), and greater than 25kg (1; 2.0%). Cat
weights were less than 2kg (2; 18.2%), between 2-3kg (3;
27.3%), 3-4kg (5; 45.4%), and 4-5kg (1; 9.1%). As for
etiology, car accidents were the main cause (45 dogs; 3
cats), followed by falls (2 dogs; 4 cats), dog bite (1 dog;
Ciência Rural, v.48, n.6, 2018.
 Classification, fixation techniques, complications and outcomes of femur fractures in dogs and cats: 61 cases (2015-2016).

3 cats), treadmill (1 cat), human aggression (1 dog), and
ballistic projectile (1 dog). In this study, car accidents and
falls were the most frequent causes of femoral fractures in
dogs and cats, respectively. Traumatic events are the main
cause of orthopedic disorders in dogs and cats (STREETER
et al., 2009; ELZOMOR et al., 2014), and fractures result
mainly from car accidents (VIDANE, 2014), ballistic
projectiles, fights, and falls (KUMAR, 2007). High
incidence of car accidents was due to the high number of
both animals with access to public roads, and owners who
suppress the containment and protection measures in their
homes and during outings (LIBARDONI et al., 2016).
In this study, 62 femoral fractures were
evaluated (Table 1). The simpler and more complex
proximal, diaphyseal, and distal fractures were “3
1 A1” (n=1), “3 1 C1” (n=1), “3 2 A1” (n=11), “3
2 C3” (n=1), “3 3 A1” (n=24), and “3 3 C2” (n=2),
respectively. In the comparison between fracture
morphology and bone zone (Table 2)simple fractures
in the distal epiphysis (n=25) were most frequent
(P=0.0001). Distal fractures were individually
described as Salter-Harris type I (n=7), Salter-Harris
type II (n=13), Salter-Harris type III (n=1), metaphyseal
extra-articular fracture (n=6), and partial joint fracture
(n=1). We emphasized that fragment exposure occurred
in three of the fractures mentioned above. Only two
proximal fractures occurred (major trochanter avulsion
and metaphyseal extra joint fracture), both in dogs.
A careful evaluation of femoral fractures
is of paramount importance in order to adequately
plan the treatment (BEALE, 2004; ROUSH,
2005). In the present study, the classification
system adopted by the AO Vet (DeCAMP et al.,
2016) allowed to evaluate and alphanumerically
codify fractures in terms of location, morphology,
and severity, thus facilitating fracture complexity
determination and its subsequent evaluation
regarding appropriate treatment and prognosis.
In this study, nine internal fixation methods
were used for primary bone repair (Table 3) Lateral
access to the thigh was performed to reduce the
proximal and diaphyseal fractures, with separation
of the biceps femoris and vastus lateralis quadriceps
muscles from each other. Lateral arthrotomy was
performed in dogs (weight ≤15kg) and cats, and
medial arthrotomy was performed in dogs (weight
>15kg) to reduce distal fractures. Intramedullary pins
were used in proximal fractures in association with
cerclage (n=1) for reduction of the subtrochanteric
fracture, and tension band (n=1) for avulsion of the
greater trochanter. Bone plates and screws were used
for treatment of diaphyseal fractures (compressive
function, n=1; neutral function after interfragmentary
compression, with cerclage, n=1; and, bridge function,
associated with the use of intramedullary pin, n=6),
two intramedullary pins to fill 85% of the medullary

Table 1 - Alphanumeric morphological classification of fractures, according to location, morphology, and severity, in dogs and cats
attended in a hospital school (January 2015 to December 2016).

-----------------------------------------------------------Alphanumeric morphological classification---------------------------------------------------

----------Location------- --------------------Morphology---------------- Dogs Cats Total
Bone Zones Severity Complexity n (%) n (%) n (%)
3 1 A 1 1 (1.6) 0 (0) 1 (1.6)
3 1 C 1 1 (1.6) 0 (0) 1 (1.6)
----------------------------------------Subtotal--------------------------------- 2 (3.2) 0 (0) 2 (3.2)
3 2 A 1 9 (14.5) 2 (3.2) 11 (17.7)
3 2 B 1 10 (16.1) 1 (1.6) 11 (17.7)
3 2 B 2 2 (3.2) 2 (3.2) 4 (6.4)
3 2 C 1 2 (3.2) 0 (0) 2 (3.2)
3 2 C 2 1 (1.6) 2 (3.2) 3 (4.8)
3 2 C 3 1 (1.6) 0 (0) 1 (1.6)
----------------------------------------Subtotal--------------------------------- 25 (40.3) 7 (11.3) 32 (51.6)
3 3 A 1 21 (33.9) 3 (4.8) 24 (38.7)
3 3 A 2 0 (0) 1 (1.6) 1 (1.6)
3 3 C 1 1 (1.6) 0 (0) 1 (1.6)
3 3 C 2 2 (3.2) 0 (0) 2 (3.2)
---------------------------------------Subtotal---------------------------------- 24 (38.7) 4 (6.4) 28 (45.2)
-----------------------------------------Total----------------------------------- 51 (82.3) 11 (17.7) 62 (100)

Ciência Rural, v.48, n.6, 2018.

4 Libardoni et al.

Table 2 - Comparison between fracture morphology and the bone zone using the G Test (P<0.05) in dogs and cats attended in a hospital
school (January 2015 to December 2016).

---------------------------------------------Fracture morphology----------------------------------
Bone areas Total n (%)
Simplen (%) Multiplen (%) Cominutiven (%)
Proximal 1 (1.6) 0 () 1 (1.6) 2 (3.2)
Diaphyseal 11 (17.7) 15 (24.2) 6 (9.7) 32 (51.6)
Distal 25 (40.3) 0 (0) 3 (4.8) 28 (45.2)
Total 37 (59.7) 15 (24.2) 10 (16.1) 62 (100)
Value GL P
G-Test
28.1 4 0.0001

canal (isolated, n=5; or associated with the use of
cerclage, n=14) and external skeletal fixator Tie-In
configuration (n=5) (association of an intramedullary
pin and type-IA external skeletal fixator). Animals
with distal fractures were treated using the modified
Rush intramedullary pin technique (n=11), cross-pin
technique (n=14), and Tie-In configuration (n=3).
In relation to the internal fixation methods used
in this study, each implant was evaluated in terms of its
advantages and disadvantages. However, determining the
“best” fixation method was impossible, due to variability
in patients, injuries, expertise, equipment, and finance.
Nevertheless, his selection was based on age, weight, and
characteristics of fracture. The fixation combinations were
considered, being an intramedullary pin with external
skeletal fastener, an intramedullary pin with bone plate,
and modified or crossed Rush pins (HARARI, 2002;
BEALE, 2004; ROUSH, 2005; DeCAMP et al., 2016).
Complications (n=14) were observed
(Table 4) and categorized into minor (n=4)
and major (n=10) complications. Catastrophic
complications were not observed. Complication
frequencies for fracture sites that required
reintervention after osteosynthesis were
compared and a significant difference (P=0.0253)
was observed between the diaphyseal (31.25%)
and distal (7.14%) fractures independent of
the technique employed. In addition, a low
frequency (n=2) of proximal fractures was
observed in this study. One of them (50%) was
treated with tension band and resulted in bone
consolidation without complication; the other
(50%), which was treated with osteosynthesis,
intramedullary pin, and cerclage, resulted in
pin migration and need for reintervention for
consolidation where the pins were cut and buried.

Table 3 - Frequency of osteosynthesis methods in relation to fracture morphology in dogs and cats attended in a hospital school (January
2015 to December 2016).

-------------------------------Fracture morphology---------------------------
Osteosynthesis methods Total n (%)
Simple n (%) Multiple n (%) Cominutive n (%)
Tension band 1 (1.6) 0 (0) 0 (0) 1 (1.6)
DCP 1 (1.6) 0 (0) 0 (0) 1 (1.6)
Tie-In configuration 1 (1.6) 2 (3.2) 5 (8.1) 8 (12.9)
IMP 5 (8.1) 0 (0) 0 (0) 5 (8.1)
IMP + cerclage 5 (8.1) 8 (12.9) 2 (3.2) 15 (24.2)
Cross pins 14 (22.6) 0 (0) 0 (0) 14 (22.6)
Modified Rush pins 10 (16.1) 1* (1.6) 0 (0) 11 (17.7)
NP + cerclage 0 (0) 1 (1.6) 0 (0) 1 (1.6)
BP + IMP 0 (0) 3 (4.8) 3 (4.8) 6 (9.7)
Total 37 (54.2) 15 (18.1) 10 (8.3) 62 (100)

DCP: Dynamic compression plate; IMP: Intramedullary pin; NP: Neutral plate; BP: Bridge plate. *Modified Rush pins associated with
cerclage.

Ciência Rural, v.48, n.6, 2018.

 Classification, fixation techniques, complications and outcomes of femur fractures in dogs and cats: 61 cases (2015-2016).

Table 4 - Frequency of complications in relation to osteosynthesis methods in dogs and cats attended in a hospital school (January 2015
to December 2016).

Total
---------------------------------------------------Complications----------------------------------------------------------------
Osteosynthesis methods n (%)
Minor n (%) Major n (%) Catastrophic n (%) Absent n (%)
Tension band 0 (0) 0 (0) 0 (0) 1 (1.6) 1 (1.6)
DCP 0 (0) 0 (0) 0 (0) 1 (1.6) 1 (1.6)
Tie-In configuration 4 (6.4) 2 (3.2) 0 (0) 2 (3.2) 8 (12.8)
IMP 0 (0) 2 (3.2) 0 (0) 3 (4.8) 5 (8.1)
IMP + cerclage 0 (0) 2 (3.2) 0 (0) 13 (21.0) 15 (24.2)
Cross pins 0 (0) 0 (0) 0 (0) 14 (22.6) 14 (22.6)
Modified Rush pins 0 (0) 2 (3.2) 0 (0) 9 (14.5) 11 (17.7)
NP + cerclage 0 (0) 1 (1.6) 0 (0) 0 (0) 1 (1.6)
BP + IMP 0 (0) 1 (1.6) 0 (0) 5 (8.1) 6 (9.7)
Total 4 (6.4) 10 (16.1) 0 (0) 48 (77.4) 62 (100)

DCP: Dynamic compression plate; IMP: Intramedullary pin; NP: Neutral plate; BP: Bridge plate.

Migration of intramedullary pins was
observed in diaphyseal fractures (n=4), causing
fragmentation in the fracture focus and requiring
surgical reintervention for consolidation. Migration
of modified Rush intramedullary pins occurred in two
cases, being related to a delayed union in one of the
cases. Loosening of pins in the external skeletal fixator
and secretion drainage through the path of the pins were
observed in four cases. This was attributed to the choice
of an inadequate pin diameter (n​=2), exuberant muscular
mass of the thigh (n=1), and rapid growth of the puppy
(n=1). Due to small pin diameter, a case of non-union
and another of delayed union occurred. In one case,
migration of fixation screws was observed in the bridging
plate due to fall of a female patient in the postoperative
period. Another case of folding of the plate in neutral
function was also observed, causing fragmentation in the
fracture focus, due to the occurrence of a new trauma.
In our opinion; however, most of these complications
could have been prevented by better surgical planning,
use of the basic repair principles, appropriate
selection of implants, and differentiated postoperative
management, thus confirming previous observations
(BEALE, 2004; ROUSH, 2005; McCARTNEY
& MacDONALD, 2006; VALLEFUOCO, 2016).
In general, the use of modified Rush
intramedullary pins and crossed pins in this study were
the most successful methods for the consolidation
of femoral fractures. However, the most fragmented
fractures were repaired with the use of bridging
plate associated with the intramedullary pin, external
skeletal fixator Tie-In configuration, and association of
intramedullary pins with cerclage. Therefore, stating that
the complication rate is due to the attachment method,
fracture, and patient characteristics is impossible
(JACKSON & PACCHIANA, 2004; KÖNNING, 2013).
However, it was observed that fractures
treated with the external skeletal fixator Tie-
In configuration presented a greater number of
complications. In addition, given the low number
of cases per fixation method employed, statistical
comparison between different types of implants
did not allow us to support this perception.
In this study, a positive correlation
was observed between juvenility and rate of
consolidation without complications, because
distal fractures consolidated with a lower index of
complication after osteosynthesis independent of
the technique used. Bones of young animals tend to
heal faster than those of older animals (STRUBE,
2008) because many arteries perforate the newly
formed appositional bone, running longitudinally
over the periosteal surface (JOHNSON, 2013).
CONCLUSION
Distal epiphyseal fractures of the femur
were the most frequent in the routine of a school
hospital. These fractures presented a lower frequency
of complications for consolidation when treated with
either modified Rush intramedullary pins or cross pins.
ACKNOWLEDGEMENTS
The authors are grateful to the Integrated Residency
Program in Veterinary Medicine of the University of Passo
Fundo, RS, Brazil.

Ciência Rural, v.48, n.6, 2018.

6 Libardoni et al.
DECLARATION OF CONFLICTS OF
INTEREST
The authors declared no potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article.
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Internal fixation of fracture of femur of dog using intramedullary pinning

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Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3), 243-246

Asian-Australasian Journal of
Bioscience and Biotechnology
ISSN 2414-1283 (Print) 2414-6293 (Online)
www.ebupress.com/journal/aajbb

Article
Internal fixation of fracture of femur of dog using intramedullary pinning
Md. Karim Uddin1, M. M. Mafizul Islam2, Md. Zakir Hassan3*, Md. Mamunur Rahman4, Md. Rafiqul islam5,
Md Fazlul Hoque6 and Bhajan Chandra Das7
1
Infectious Disease Division, International Center for Diarrheal Disease Research, Bangladesh
2
Department of Microbiology, Hajee Mohammad Danesh Science and Technology University, Dinajpur,
Bangladesh
3
Animal Health Research Division, Bangladesh Livestock Research Institute, Savar, Dhaka, Bangladesh
4
Conservation and Improvement of Native Sheep through Community & Commercial Farming Project,
Bangladesh Livestock Research Institute, Savar, Dhaka, Bangladesh
5
Livestock Division, Bangladesh Agricultural Research Council, Dhaka, Bangladesh
6
Department of Medicine, Surgery and Obstetrics, Hajee Mohammad Danesh Science and Technology
University, Dinajpur, Bangladesh
7
Department of Medicine & Surgery, Chittagong Veterinary and Animal Sciences University, Bangladesh

*Corresponding author: Md. Zakir Hassan, Scientific Officer, Animal Health Research Division, Bangladesh
Livestock Research Institute, Savar, Dhaka, Bangladesh. Phone: +8801737840328; E-mail: zhtitas@gmail.com

Received: 07 December 2017/Accepted: 24 December 2017/ Published: 31 December 2017

Abstract: The study was conducted at S A Quadery Teaching Veterinary Hospital (SAQTVH) in Chittagong
Veterinary and Animal Sciences University (CVASU), Bangladesh from January, 2014 to June 2014 to conduct
about the surgical management of internal fixation of fracture of femur of local dog using intramedullary
pinning. A total number of 10 dogs of different ages were used for surgical management based on history and
presenting clinical sings. Fractures of femur commonly occur in dogs following different kind of trauma, road
accident and jumping from top place. In the small animal internal fracture fixation, many improvements have
been developed, including improved fixation techniques and a more diverse selection of implants. To treat this
fractures intramedullary pin are used for internal surgical fixation with clinical and radiological procedure
established. After successful surgical repair bone healing was occurred without any complications and the dog
discharged one month after surgery bearing weight on the limb.

Keywords: fracture; femur; dog; surgical management

1. Introduction
Femoral fractures normally arise in puppies following one-of-a-kind form of trauma. Traffic coincidence is the
major cause of femoral fractures in Canines (Tercanlioglu and Sarierler, 2009). While metaphyseal and
diaphyseal fractures were more common in mature dogs, proximal or distal physeal fractures were more
common in young dogs (Simon et al., 2011). Maximum femur fractures are determined as closed fractures due
to the heavy overlying muscle (Beale, 2004). The aim of fracture repair is to establish best alignment and firm
fixation of the bone to allow both well timed and maximized return to function of the affected area. Within the
small animal internal fracture fixation, many enhancements had been advanced, consisting of progressed
fixation techniques and more diverse selection of implants (Tercanlioglu and Sarierler, 2009). Stability in
orthopedics is described as the degree of displacement among the fragments concerned in a fracture and
stiffness as the capacity of the implant to oppose deformation (Wagner and Frigg, 2006). Femur fractures are
generally no longer amenable to conservative repair, and a few form of internal fixation is generally required
(Beale, 2004). Intramedullary pinning acts usually as internal splint of medullary canal of long bone that shares
Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3) 244
loading with bones keep axial alignment of the fracture and resists bending forces in all directions applied to the
bone (Beale, 2004). Critical factors taken into consideration in repair of femur fracture include suitable surgical
technique, preservation of regional soft tissues and their attachments to bone fragments, either anatomic or
indirect reduction, adequate stabilization, appropriate preference and application of implant device and proper
postoperative care (Stiffler, 2004). The rationale of this report is to explain the medical and radiographic
examination of femoral fracture in a dog in addition to a successful reduction of the fracture intermedullary
pinning.

2. Materials and Methods

2.1. Case history
The study was conducted at S A Quadery Teaching Veterinary Hospital (SAQTVH) in Chittagong Veterinary
and Animal Sciences University (CVASU), Bangladesh from January, 2014 to June 2014 to conduct about the
surgical management of internal fixation of fracture of femur of local dog using intramedullary pinning. A total
number of 10 dogs of different ages were used for surgical management based on history and presenting clinical
sings.

2.2. Control and anaesthesia

Animal was positioned in lateral recumbency with the affected limb up and general anaesthesia was
administered after proper premedication. The femoral area was prepared for aseptic surgery.

2.3. Surgical management

The femoral bone was covered and supported by the two major muscles, vastus lateralis and biceps femoris. The
superficial fascia and the tensor fascia lata covers these two muscles. The femoral diaphysis and metaphysis was
approached via a craniolateral pores and skin incision made at the lateral thing, extending from barely caudal to
the more trochanter to the lateral condyle of the femur. The subcutaneous tissue and superficial fascia are
incised without delay below the skin incision. Fascia later was incised to the entire duration of the pores and
skin incision along the cranial border of the biceps femoris muscle aponeurosis. Biceps femoris and vastus
lateralis are pondered caudally and cranially respectively after excising the inter-muscular septum between those
muscular tissues to reveal the shaft of femur. After finding the site of fracture, the proximal bone fragment
was accelerated and an intramedullary pin which almost fills the diameter of the medullary canal was inserted
into the proximal fragment and the pin was withdrawn thru the pores and skin after making stab incision at
the trochanteric fossa. The fracture was decreased and the proximal and distal bone fragments are aligned and
the pin was then inserted within the distal fracgment and anchored at the distal extremity thus immobilizing the
fracture. After conducting the open reduction, the muscle tissues were apposed and the fascia later was sutured
and eventually the skin was sutured in habitual way. The pores and skin around the sticking out pin at
trochanteric fossa was depressed and the pin was reduced as short as viable to bury subcutaneously.
An easy interrupted suture was carried out on the pores and skin to close the hollow (Figure 1). Osteosynthesis
was performed under general anesthesia effect, allowed good muscle relaxation and a satisfied analgesia
throughout the procedure. The average time for setting up an intramedullary pinning fixation was 1hour and 15
minutes. In dog the sequence of intervention revealed no complications, and the awakening took place quietly.

2.4. Post-operative care

A course of antibiotics and analgesics were administered for 7 days, the wound was cleaned daily by antiseptic
solution. Skin sutures had been removed at 8-10th post-operative day. Intra-medullary pin was removed after
complete fracture healing as evidenced by clinical and radiographic evaluation. Dog was clinically observed
daily during the study period for recording any postoperative complications. Recovery of consciousness and
return to function of dogs treated with intramedullary pinning took place gradually.

2.5. Radiographic examination

A radiograph was made room immediately after surgery to enjoy a good quality of osteotomy, the correct
position of the implants and the absence of intraoperative fractures. Exercise limited for 3-4 weeks period and
limb was immobilized. Careful clinical and radiographic evaluation of fracture healing process has done.

3. Results and Discussion

Out of 10 surgical cases of dog, the injury was occured frequently caused by trauma (50%), road accident
(40%), and jumping from top places (10%). So this study was revealed that trauma was the most common cause
Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3) 245
of fracture in femur of dog that shown in Table 1. The dog up to 1 year of age was shown higher percentage
(70%) of fracture in femur than other ages (30%) which was shown in Table 2. This result revealed that fracture
of femur was most common in young dog than adult. Fractured femur repaired by intamedullary pinning dog
showed gradual dense periosteal reaction at the 2nd week. At the 5th week, the periosteal reactions were getting
denser in dog with the beginning of periosteal callus bridging formation from the third week, of full training
callus generally after one month follow up. These study was indicated the usefulness with purposeful
augmentation, multiplied consolidation ratio and mechanical solidarity in the use of intramedullary pinning. In a
research by (Inas et al., 2012) argue that the intramedullary pinning offers high-quality balance for long bones,
so it offers an great biomechanical surroundings for fracture recovery. Intramedullary pinning favors charging
member, and permits by law of Wolff accelerate callus strength and impede muscle atrophy and joint ankylosis
(Mills and Jackson, 2003). The migration of the pin before complete consolidation confirmed an angulations of
the bone within the dog. This problem was the crucial illness of intramedullary pinning recorded at some point
of our take a look at in line with (Fossum, 2007), micro motion of the pin , because of inequality among the
diameter of the pin and the medullary canal, are liable for the migration of a pin . The damage to the periosteal
blood supply was considerable and often restricts the formation of periosteal callus (Baron, 2010). Unlike the
installation of the plate, the insertion of intramedullary pinning does not harm the periosteal blood operating
time was reduced by half of (Daglar et al., 2007). Most complications recorded in the presence of infection, this
results in a diffused readability on the radiography, causing migration of the pin. It has been mentioned that
intramedullary pins are supreme for shaft fractures of the femur in small dogs and cats (Phillips, 1979). As Boyd
was said, an intramedullary pinning was justified simplest in situations whilst its mechanical advantages from
the stand factor of the stress involved outweigh the biological negative aspects and when rotation can
be managed. From a biomechanical point of view, the callus decreases the lever arm which tends to stretch the
fracture, that's why the callus might be even larger than the house was unstable (Piermattei, 2006). Implants
failure from fatigue fracture isn't common with intramedullary pinning due to the fact the area of an
intramedullary pin within the centre of the shaft has a tendency to spare some of the bending forces responsible
for fatigue failure and the effect of the law of wolf which could be very favorable by way of the intramedullary
pinning.

Table 1. Causes of fracture of femur in dog.

Causes of fracture of femur Number of injured dog Percentage of occurrence (%)

Trauma 5 50

Road Accident 4 40

Jumping from Top Level 1 10

Table 2. Age of occurrence of fracture of femur in dog.

Age of occurrence in dog Number of injured dog Percentage of occurrence (%)

Up to 1 Year 7 70

Above 1 Year 3 30
Asian Australas. J. Biosci. Biotechnol. 2017, 2 (3) 246

Preparing for Make incision Separate muscle of Locating fractured Intramedullary

operation thigh bone drilling

Drilling with pins Bone Suturing Bandaging Radiograph

Immobilization

Figure 1. Showing the technique of surgical management of femur in dog.

4. Conclusions
The study reveal that the fixation of femoral fractures with intramedullary pinning was an economical and
efficient method and provides good stability with minimal complications. The intramedullary pinning offers a
perfect alignment and rigid fixation of the fractured bone. Finally, we had concluded that applications of
intramedullary pins were safe, economical and successful treatment method if basic principles of repair were
used.

Acknowledgments
The authors are thankful to the Department of Medicine, Surgery and Obstetrics, Hajee Mohammad Danesh
Science and Technology University, Dinajpur, Bangladesh.

Conflict of interest
None to declare.

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