Leczenie braku zrostu septycznych złamań kości przedramienia i kości podudzia u psów

Treatment of antebrachial and crural septic nonunion fractures in
dogs using circular external skeletal fixation: a retrospective study.
Part I

Nonunion is an interruption of the fracture healing process, which negates the possibility of fracture union without further surgical intervention. Nonunion fractures are characterized by formation of fibrous or cartilaginous tissue between fragments (1, 2). Nonunion fractures are often the result of failed surgical treatment that can often be attributed to intra-operative technical errors and they may also be accompanied by chronic infection (1-6).

When assessing an infected nonunion fracture, factors such as local blood supply, mechanical stability and regenerative ability of the involved tissues must be considered when formulating a therapeutic plan (15). The surgical treatment of nonunion fractures remains a therapeutic challenge for orthopaedic surgeons, especially in the presence of infection, bone loss or both together (7).

One of the primary objectives in treating septic nonunion fractures is adequate debridement to reduce bacterial load and to remove necrotic tissue and sequestra (8). The debrided fracture must be restabilized with appropriate internal or external fixation (7-16).

The methods of Ilizarov using circular fixator constructs have been shown to be an effective treatment modality for managing nonunion fractures in both humans and dogs (7-11, 13, 15, 16). Circular external skeletal fixation (CESF) not only allows for initial compression of the fracture segments but also for mechanical modulation of the fracture environment during the healing process (17-19). Circular constructs can be applied using a monofocal or bifocal approach. With the monofocal approach, the two major bone segments adjacent to the fracture defect are moved toward each other resulting in bone shortening. Shortening can be done acutely during the surgical procedure or sequentially in the postoperative period. The bif...