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

Surgical technique

Methadone (Eptadone: Molteni, Scandicci, Italy) (0.2 mg/kg, IM) was administered for premedication. General anaesthesia was induced with propofol (Rapinovet: Schering-Plough S.a.S, Wicklow, Ireland) (1-4 mg/kg, IV) and maintained with 1.5-2% isofluorane (Isoflo: Schering-Plough S.a.S, Wicklow, Ireland) in oxygen.

The limb was prepared for aseptic surgery in a routine fashion. Cefazolin sodium (Cefazolina Dorom: Teva Pharma Italia, Milano, Italy) (20 mg/kg, IV) was administered to all dogs 30 minutes before surgery. Dogs were positioned in dorsal recumbency and a standard hanging limb preparation was used for both antebrachial and crural nonunion fractures. A sterile snaphook system was secured to the paw allowing the surgeon to disconnect the limb during the procedure.

Nonunion sites were managed in either a closed or an open fashion depending on the perceived viability of the ends of the fracture fragments, the presence of im-plants or sequestra, and the perceived need for bone grafting. Closed procedures were performed at the surgeon’s discretion in selected cases of vascular nonunion fractures previously stabilized with a linear fixator, when the underlying problem was ascribed to instability at the nonunion fracture site. In these cases, a fine needle aspirate of the nonunion site was obtained for aerobic and anaerobic culture (9).

In open procedures, the nonunion site was exposed through a standard approach and all implants were removed. Debridement of the nonunion site was achieved with one of two techniques. The first technique (traditional technique) involved excision of necrotic and infected tissue, and the reopening of the medullary canal with a highspeed burr (Pen Drive: Synthes, Opera Milan, Italy) or smooth pin driven by a drill (CADII: Synthes, Opera Milan, Italy). The second technique (en bloc ostectomy) was performed by the creation of two parallel surfaces by means of two limited ostectomies, that allowed complet...