Das et al. BJVAS, Vol. 8, No.

2, July – December 2020

Bangladesh Journal of Veterinary and Animal Sciences, Vol. 8, No. 2, July - December 2020

Bangladesh Journal of Veterinary and Animal Sciences ISSN 2227-6416

Journal homepage: www.bjvas.com eISSN 2709-2542
Case Report
Successful surgical management of radial and ulnar fracture by
dynamic compression plating technique in a dog
Bhajan Chandra Das*, Sabiha ZarinTasnim Bristi, Saroj Kumar Yadav, Tuli Dey , Monoar
Sayeed Pallab and Bibek Chandra Sutradhar
Department of Medicine and Surgery, Chattogram Veterinary and Animal Sciences University, Chattogram-
4225. Bangladesh
ARTICLEINFO ABSTRACT
Article history:
Radius and ulna are paired bone. Radius/ ulna or both radius and ulnar
Received: 23/09/2020 fractures are common in small and large animals. Small and toy breeds of dog
Accepted: 30/12/2020 are more prone to distal radial fractures and have a high rate of complications
even after surgical correction. The present case study was conducted for
Keywords:
management of right distal radial and ulnar diaphyseal overriding transverse
Functional limb outcome, fracture in an eight-month-old, 8.4 kgs bodyweight male intact Samoyed breed
lameness grade, implant, of dog. The case was corrected by using a 2.7mm 8-hole dynamic compression
dynamic compression plate plate applied in the cranial aspect of the radius. The patient was evaluated
(DCP), radial and ulnar postoperatively at a different interval by clinical and radiographic examination
fracture up to 72 days of operation. Clinically, lameness grade was improved gradually
*Corresponding author: and functional limb outcome was excellent on postoperatively day72.
Postoperative day1 to day 72, X-ray revealed implant (plate and screw) in
Cell: +01930370731 position and primary healing of the bone.
Email: bhajan@cvasu.ac.bd
To cite this paper: B. C. Das, S. Z. T. Bristi, S. K. Yadav, T. Dey , M. S. Pallab and B. C. Sutradhar, 2020.
Successful surgical management of radial and ulnar fracture by dynamic compression plating technique in a
dog. Bangladesh Journal of Veterinary and Animal Sciences, 8(2): 140-145.

1. INTRODUCTION 1997). The method is suggested principally for

Diaphyseal fracture of the radius and ulna are mature dogs with overriding transverse fractures,
common in dogs and cats. Fractures of the radius oblique or comminuted fractures. This method is
and ulna include about 1 in 6 of the fractures also recommended as the primary treatment in
perceived in small animal exercise (Harasen, the toy and miniature breed of dogs (Denny and
2003; Muir, 1997). Most of the cases, the Butterworth, 2000). Complications of diaphyseal
fracture occurs through the middle or distal third fractures of radius and ulna are not uncommon.
of the radius and ulna. Frequently, both bones are Most common complications are premature
fractured but infrequently a solitary fracture of closure of the distal ulnar growth plate, delayed
whichever the radius or the ulna is encountered union and non-union especially in toy and
(Ness and Armstrong, 1995). The common miniature breeds of dog and malunion especially
methods of fixation of radius and ulna fracture in distal fractures (Denny and Butterworth,
are external coaptation using casts or splints 2000). The distal radius and ulna fractures are
(Lappin et al., 1983), bone plating (Gibert et al., recognized as having a frequency of delayed
2015; Ramírez and Macías, 2016) and external union or nonunion as high as 80% (Muir, 1997;
skeletal fixation (McCartney et al., 2010; Piras et Welch et al, 1997; Lappin et al., 1983) when
al., 2011). Bone plating is generally accepted treated with external coaptation or intramedullary
which gives consistently good results in the pinning. Plate osteosynthesis with locking
treatment of fractures of the radius and ulna. The compression plates or conventional plates DCP
plate most frequently used is the dynamic (Gibert et al., 2015; Ramírez and Macías, 2016)
compression plate (DCP) (Permitted and Flo achieves good clinical outcomes with a major
complication rate of less than 6% (McCartney et

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al., 2010; Piras et al., 2011; Gibert et al., 2015; hydrochloride (G-Ketamine®, Gonoshasthaya
Ramírez and Macías, 2016). The objective of the Pharmaceutical Ltd.) @ 5.0 mg/kg body weight
study is to evaluate the efficacy of dynamic intravenously and anaesthesia was maintained by
compression plating technique in Samoyed dog monitoring the patient approximate half of the
at Shahedul Alam Quadery Teaching Veterinary induction dose. The patient was positioned in
Hospital (SAQTVH). lateral recumbency and the affected limb
downward (Figure 3). Through the craniomedial
2. CASE HISTORY AND OBSERVATION approach, a linear incision was done ( Figure 4),
The study was conducted at Surgery Unit, exposed both proximal and distal end of the
Sahedul Alam Quadery Teaching Veterinary fractured bone ( Figure 5) and removed all soft
Hospital (SAQTVH) in Chattogram Veterinary tissue attachment of the fractured end. The
and Animal Sciences University (CVASU), fracture was anatomically reduced by manual
Chattogram. An eight-month-old intact male and toggling technique and stabilized by
Samoyed dog weighing 8.4kg was carried to applying 2.7mm 8 holes DCP with cortical
SAQTVH for treatment with the history of screws in the cranial aspect of bone (Figure 6).
falling from a height and limping in right The surgical wound was closed like a standard
forelimb for past 11 days. A local veterinarian surgical procedure (Figure 7) and applied
has been treated the dog with a soft cotton Modified Robert Jones Bandage (Figure 8).
bandage immediately after fracture (Figure 1).
The dog was active and alert but reduced appetite
during clinical examination and orthopaedic
examination revealed non-weight-bearing
(Figure1), pain on palpation, swelling and
crepitation. Neurological examination showed
positive conscious proprioception and deep pain
reflex. The radiographic examination confirmed
the closed diaphyseal overriding transverse distal
third right radius and ulnar fracture (Figure 2).
Based on the fracture patient assessment score Figure 1: Non weight bearing after 1 week of
(FPAS), the case was decided for open reduction MRJ bandage applied ( left) and X-ray revealed
internal fixation (ORIF) by dynamic compression fractured fragments were not in alignment (right)
plating.
3. PATIENT PREPARATION, ANAESTHESIA
AND OPERATIVE TECHNIQUE

Under physical restraining, clipping and shaving

were done on affected limb proximally above the
elbow joint and distally below the carpal joint
and surgical areas were made aseptic by using
7% povidone-iodine and 70% alcohol (Figure 3).
The dog was sedated by using xylazine Figure 2: Lateral and craniocaudal radiograph of
hydrochloride (Xylaxin®, Indian Immunological affected and contralateral limb- Overriding
Ltd.) @ 1.0 mg/kg body weight intramuscularly diaphyseal radius and ulnar fracture in right
and induction was performed by ketamine forelimb.

Figure 3: Aseptic preparation of Figure 4: Craniomedial approach- Figure 5: Exposed the proximal
surgical site by using sterile drapes a linear incision was done and distal end of fractured bone

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Figure 6: Fixation of fractured bone by using 2.7mm 8- Figure 7: Closure of surgical wound
hole dynamic compression plate by using silk

removed. Radiographic examination was

performed on the same day which revealed
implant in position and there was a gap in
fracture fragments (Figure 10). On a
postoperative day 15 and day 28, clinically and
Figure 8: Applied MRJ bandage, immediate radiographically, improved weight-bearing
after surgery (Figure 11) and primary healing progress (Figure
4. POSTOPERATIVE CARE AND ADVICE 12) was observed respectively.

Postoperatively, antibiotics- Ceftriaxone Postoperatively 72 days, clinically functional

(Renacef vet®, Renata Ltd.) used for five days limb outcome was excellent (Figure 13) and
intramuscularly @ 50 mg/kg body weight, pain radiographic examination confirmed the implant
killer- Meloxicam (Melvet®, Acme Ltd.) used (plate and screws) in position and fracture gap
for three days subcutaneously @ 0.2mg/kg body was reduced and primary healing (Figure 14) was
weight and antihistaminic- Pheniramine maleate observed. Postoperatively from day 1 to day 72,
(Alerin®, SK+F Ltd. ) used for five days there were no complications in the wound, plate
intramuscularly @ 0.5mg/kg body weight. and screws but mild reduced carpal joint mobility
Advice was given to apply cold application in the was recorded during the flexion of the joint.
affected area for three days and restricted
movement for one week, keep the surgical area
dry, neat and clean until wound healing and
follow up checkup especially for radiographic
evaluation of bone healing. To evaluate the
surgical outcome of the dog, the following
parameters were analyzed at regular interval-
lameness grade, functional limb outcome,
fracture healing by radiographic examination. Figure 9: Lateral and craniocaudal radiograph-
immediate after surgery- implant in position
5. RESULTS AND DISCUSSIONS
Postoperatively, the results were evaluated by
clinical and radiographic examination.
Immediate after surgery, an X-ray was taken
which revealed implant (plate and screws) in
position (Figure 9). On a postoperative day 7,
mild weight-bearing was observed on the
affected limb (Figure 10) and wound healing was
also noticed on the same day and stitches were Figure 10: Mild weight bearing at 7thpostoperative
day ( left) and implant in position ( right)

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The present case study was reported on
successful surgical management of diaphyseal
radius and ulnar fracture in a Samoyed dog by
using dynamic compression plating technique.
The dog was intact male, 8 months and 8.4kgs
body weight and the aetiology of fracture was
fallowing from a height.

Diaphyseal distal third radius and ulnar fractures

are very common in small breed of dogs and
mostly the nature of fracture is an either
Figure 11: Improved weight bearing at
transverse or short oblique fracture which was
15thpost-operative day
reported by (Lappin et al., 1983; Eger 1990;
Muir, 1997; Larsen et al., 1999; Hamilton et al.,
2005; McCartney et al., 2010; Piraset al., 2011;
Gibertet al., 2015) as injuries resulting from falls
(Harsen, 2003). The occurrence of radius and
ulnar fracture varies in different studies - 30% of
all appendicular bone (Haaland et al., 2009),
10.6% (Cardoso et al., 2016), 36% (Roush,
2014), 5.1% (Eyarefe and Oyetayo, 2016), 5.8%
(181/3110) (Keosengthong, 2019). Similar
information like location and nature of the
fracture, small breed, causes of fracture also
Figure 12: Lateral radiograph- post operative
day 28- primary healing progressed found in the present case study.

Muller et al. (1970) reported the principles and

developed techniques for fracture fixation. The
original principles of the Arbeitsgemeinschaftfür
Osteosynthesefragen (AO) philosophy included
open precise reduction and rigid fixation of all
fracture fragments. The common methods of
fixation of radius and ulna fracture are external
coaptation using casts or splints (Lappin et al.,
1983), bone plating (Gibert et al., 2015; Ramírez
and Macías, 2016) and external skeletal fixation
(McCartney et al., 2010; Piras et al., 2011).
Figure 13: Normal weight bearing in Piermattei and Flo, 1997 stated that bone plating
posture at post-operative day 72 is widely accepted method which gives
consistently good results in the treatment of
fractures of the radius and ulna. Among different
plates, the dynamic compression plate (DCP) is
most frequently used because it has the built-in
potential of compression at the fracture site.
Denny and Butterworth 2000 recommended that
this method is suitable particularly for mature
dogs with overriding transverse fractures,
oblique or comminuted fractures. This method is
also suggested as the primary treatment in the toy
and miniature breed of dogs. In the present case
study, 2.7mm 8-hole dynamic compression plate
was used for the correction of radius and ulnar
Figure 14: Lateral and craniocaudal radiograph- fracture in a male dog which was supported by
implant in position and primary healing noticed the above findings.
at PO day 72

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Wallace et al. (1992) reported the plate interfragmentary strain, challenges in achieving
application either cranial or medial aspect of stability with external coaptation, variations in
radial fracture correction. The plate is usually blood supply. The biggest single reason why
applied to the cranial aspect of the radius and is small breed dogs have problems with the healing
the most widely used method for all diaphyseal of fractures in the distal third of the radius or
fractures because it is easily accessible and ulna is decreased density of the intraosseous
provides a broad and only slightly curved blood supply in this region in small compared
surface. This surface helps well for fractures of with larger dogs (Welch et al., 1997).
the proximal and middle regions of the radius Extraosseous blood supply is also limited due to
focus in the distal zone, the plate is the source of minimal overlying soft tissues (Denny and
some morbidity. Therefore, the plate can be Butterworth, 2000). Gibertet al. (2015); Ramírez
applied to the medial aspect in some cases and Macías (2016) stated that plate
particular distal radius fracture. Lappin et al., osteosynthesis achieves good clinical outcomes
1983 mentioned the ulnar fracture correction in with a major complication rate of less than 6%
small and large breeds of dog. Usually, the ulnar (McCartney et al., 2010; Piraset al., 2011; Gibert
fracture requires no fixation because the radius is et al., 2015; Ramírez and Macías, 2016).
the main weight-bearing bone in the forearm. It Postoperative swelling and pain are reduced by
acts as a splint for the ulna because of the the use of a Robert-Jones bandage for 3 to 5
interosseous attachments between the two bones. days. In the present case study, there was no
But this rule is not applicable in large and giant complication in soft tissues and bone healing
breeds of dog in which plate fixation of both the except mild reduces the carpal joint mobility
radius and ulna is suggested. Piermattei and Flo during the flexion of the joint.
(1997) described the difficulty of closing the
surgical site and plate application in the medial 6. CONCLUSIONS
or cranial aspect of the radial bone. Partition
and raise of the extensor tendons from their Radial fractures are most common in the distal
synovial sheaths in the middle groove of the one-third of the diaphysis of small and large
distal radius and the succeeding gliding of these breeds of dog and have a greater risk for
tendons over the plate surface produce a variable development of delayed union or nonunion. The
gradation of functional problem. In calculation to method selected for the repair of radial fractures
that difficulties are sometimes met in closing the influences the course of healing. In the present
scant soft tissues over a distal plate. However, case study, distal diaphyseal overriding
the majority of the problems can be eliminated transverse radial fracture was corrected by using
by medial plate placement for distal fractures. a 2.7mm 8-hole dynamic compression plate. This
Technically one problem in the medial plate study concluded that the DCP technique can be
application is that the medial surface is narrower successfully applied in field condition for distal
and the medial plate should be smaller (2.7 radial fracture management in small breed of
versus 3.5mm) than the cranial plate. In the dog.
present case study, the 2.7 mm DCP was applied ACKNOWLEDGEMENTS
in the cranial aspect of radius bone only which
suggests the above findings. Complications of The authors are grateful to the pet owner for well
diaphyseal fractures of radius and ulna are very cooperation by providing valuable information
common. Denny and Butterworth, 2000 stated and postoperative follow up. The authors also
that the most common complications are grateful to Director of clinics, CVASU for all
premature closure of the distal ulnar growth kinds of technical supports to successfully
plate, delayed union and non-union especially in perform this work.
the toy and miniature breeds of dog and
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