Downloadable forms/information for clients for initial visit:
Client initial consultation history sheet
Fracture client education handout
Discharge instructions for fracture postop care
Downloadable forms/information for clients for 2-week recheck visits:
2-week fracture recheck (Telemed)
Downloadable forms/information for clients for 5 to 8-week recheck visits:
8 to 12-week fracture recheck (in hospital)
8 to 12-week fracture discharge instructions
Key Points
The I-loc system, developed by Dr. Loic Dejardin, provides a very stable construct for the repair of bone fractures
This method of repair is excellent for bones that have been shattered
It can also be used for minimally invasive fracture repair
Importantly, this method of fracture repair helps to preserve the blood supply to the bone, thus accelerating fracture healing and minimizing the risk for a nonhealing fracture
Introduction
Fracture repairs can be done with many methods, some are excellent and others are not so good. Keys to fracture repair include preservation of the biology of the bone (basically save all muscle/blood supply attachments to the bones, very sterile environment/technique, provision of an adequate size implant to provide a stable contstruct, and ensure that the pet is not too active in the postop period.
Anatomy
Bones have a marrow cavity and the outer shell called the cortex. Most long bones in the body have a rich blood supply from arteries that penetrate through small holes in the bone called nutrient foramen. The outer part of the bone is covered by periosteum which gets its blood supply from surrounding muscles.
Causes of fracture
Long bones are prone to fracture with traumatic events. These may included an external force such as a pet being hit by a car or other animal/person/object impacting the pet's limb. Some pets will sustain fractures from excessive forces from within the body that exert abnormal pressure on the bone, such as taking a sharp turn when playing. In some cases, a pet can develop a pathologic fracture from a cancer that has weakened the structure of the bone.
Preparation for surgery
The pet should be fasted prior to surgery, as instructed by the surgical team. Water is usually permitted up to the time of admission to the hospital. The surgical team should be informed of any medications that your pet is currently receiving. Just prior to surgery, your pet will receive a sedative, have an intravenous catheter placed for the administration of intravenous fluids and intravenous medications, be induced under general anesthesia with medication(s), and have a breathing tube (endotracheal tube) placed to allow delivery of oxygen and gaseous anesthesia. The surgical site will be clipped and cleansed with an anti-septic solution in preparation for surgery. While under general anesthesia, the pet’s breathing will be assisted with a ventilator and vital parameters such as heart rate, respiratory rate, core body temperature, blood pressure, oxygenation of the blood (pulse oximetry), exhaled carbon dioxide (capnography), and heart rhythm (EKG) will be monitored to ensure the pet’s well being. Pain will be controlled both during and after surgery with analgesics (pain-controlling medication). Please note that each surgical and anesthesia team may elect to chose a different, but effective analgesia protocol.
Surgical options for fracture repair
- Minimally displaced fracture – keep pet in cage until healed
-Minimally displaced fracture – support the fracture with a splint or cast
- Intramedullary pin – usually combined with other methods of support such as cerclage wiring, plating, or external fixator
- External fixator
- Bone plate and screws
- Interlocking nail – the system we use is called the I-loc (made by BioMedtrix) and we feel that at the time of this writing, this likely is the best system available for dogs and cats.
I-loc Method for Fracture Repair
The I-loc is a large pin (called a nail) that has four holes (two at the top and two at the bottom) that are threaded. Bolts are placed transversely through the top and bottom of the bone and through the holes in the nail. These bolts have threads on them and interlock with the threads of the holes of the nail. This method of fixation has a much less chance to fail during the bone healing process than metal bone plates and screws. Below is a video that shows how the I-loc is performed in a dog (animated video).
Aftercare
Prescribed medication to prevent infection and control pain are to be administered to your pet after surgery. Exercise should be restricted until the bone is deemed to be healed, based on x-rays. Passive range of motion exercises are important to achieve normal range of motion of the joint above and below the fractured bone. Your pet may also benefit from therapy from a professional rehabilitation therapist.
Success
In our experience, about 95% of the patients do very well after i-loc surgery with very good healing of the bone. Even dogs that were treated with the I-loc due to cancer have done very well with healing of the bone noted; these dogs eventually will succumb to their cancer, typically due to metastatic disease to the lungs or other areas of the body. It is imperative that the discharge instructions are closely followed to reduce postoperative complications that may have long-term devastating effects on the outcome.
