Surgical management of large segmental femoral and radial bone defects in a dog

Summary

In this case report, we describe the use of a cylindrical titanium mesh cage combined with cancellous bone graft to surgically manage large segmental bone defects in a dog. A seven-year-old, neutered male cross-breed dog, with highly comminuted fractures of the right femur and the left radius and ulna, was referred for treatment. Previous open reduction and internal fixation of these fractures had failed. Following implant removal and debridement of each bone, a 71 mm segmental femoral defect and a 27 mm segmental radial defect were present. A commercially available cylindrical titanium mesh cage was filled with ß-tricalcium phosphate crystals mixed with an equal volume of autogenous cancellous bone graft. The mesh cage was aligned with the proximal and distal parts of each bone using an intramedullary pin passing through the cage, and a locking plate was applied to the proximal and distal fracture fragments to produce compression against the titanium cage. The dog had a successful long-term clinical outcome, and radiographic examination at 22 and 63 weeks after surgery showed the formation of remodelling bridging callus that was continuous across the titanium cage in each of the fractures. Due to the relative simplicity of the technique and the favourable outcome in this case, it should be considered an option when managing comminuted fractures with large bone defects.

Keywords

Titanium mesh cage - long segmental defect - cancellous bone graft

• References

• 1 Johnson KD, August A, Sciadini MF. et al. Evaluation of ground cortical autograft as a bone graft material in a new canine bilateral segmental long bone defect model. J Orthop Trauma 1996; 10: 28-36.
• 2 Johnson AL, Eurell JA, Schaeffer DJ.. Evaluation of canine cortical bone graft remodeling. Vet Surg 1992; 21: 293-298.
• 3 Kerwin SC, Lewis DD, Elkins AD. et al. Deep-frozen allogeneic cancellous bone grafts in 10 dogs: a case series. Vet Surg 1996; 25: 18-28.
• 4 Yanoff SR, Hulse DA, Palmer RH. et al. Distraction osteogenesis using modified external fixation devices in five dogs. Vet Surg 1992; 21: 480-487.
• 5 Seguin B, Walsh PJ, Mason DR. et al. Use of an ipsi-lateral vascularized ulnar transposition autograft for limb-sparing surgery of the distal radius in dogs: an anatomic and clinical study. Vet Surg 2003; 32: 69-79.
• 6 Hoffer MJ, Griffon DJ, Schaeffer DJ. et al. Clinical applications of demineralized bone matrix: a retrospective and case-matched study of seventy-five dogs. Vet Surg 2008; 37: 639-647.
• 7 Kawcak CE, Trotter GW, Powers BE, et al... Comparison of bone healing by demineralized bone matrix and autogenous cancellous bone in horses. Vet Surg 2000; 29: 218-226.
• 8 Toombs JP, Wallace LJ.. Evaluation of autogeneic and allogeneic cortical chip grafting in a feline tibial nonunion model. Am J Vet Res 1985; 46: 519-528.
• 9 Attias N, Lehman RE, Bodell LS. et al. Surgical management of a long segmental defect of the humerus using a cylindrical titanium mesh cage and plates: a case report. J Orthop Trauma 2005; 19: 211-216.
• 10 Ostermann PA, Haase N, Rubberdt A. et al. Management of a long segmental defect at the proximal meta-diaphyseal junction of the tibia using a cylindrical titanium mesh cage. J Orthop Trauma 2002; 16: 597-601.
• 11 Whitecloud 3rd TS, Castro Jr FP, Brinker MR. et al. Degenerative conditions of the lumbar spine treated with intervertebral titanium cages and posterior instrumentation for circumferential fusion. J Spinal Disord 1998; 11: 479-486.
• 12 Lindsey RW, Gugala Z, Milne E. et al. The efficacy of cylindrical titanium mesh cage for the reconstruction of a critical-size canine segmental femoral diaphyseal defect. J Orthop Res 2006; 24: 1438-1453.
• 13 Southwood LL, Frisbie DD, Kawcak CE. et al. Delivery of growth factors using gene therapy to enhance bone healing. Vet Surg 2004; 33: 565-578.
• 14 Teixeira CR, Rahal SC, Volpi RS. et al. Tibial segmental bone defect treated with bone plate and cage filled with either xenogeneic composite or auto-logous cortical bone graft. An experimental study in sheep. Vet Comp Orthop Traumatol 2007; 20: 269-276.
• 15 Attias N, Lindsey RW.. Case reports: management of large segmental tibial defects using a cylindrical mesh cage. Clin Orthop Relat Res 2006; 450: 259-266.