Minimally invasive osteosynthesis of a distal humeral Salter‐Harris type II fracture by percutaneous pinning

Surgical repair of Salter-Harris type II fracture of the distal humerus: short and long-term outcomes in a case series of three dogs and one cat

CASE HISTORIES

Three dogs and one cat sustained forelimb trauma and were presented to a university veterinary clinic (Liège, Belgium) and a private veterinary hospital (Beacouzé, France). All four animals were referred for surgery.

CLINICAL FINDINGS

Two dogs and the cat were ambulatory on admission but unable to bear weight on the affected limb. One dog was non-ambulatory and lacked voluntary movement and sensation in one forelimb. Salter-Harris type II fractures of the distal humerus were diagnosed by radiography in all cases; avulsion of the brachial plexus and pelvic fractures were also present in the non-ambulatory dog.

TREATMENT AND OUTCOME

All Salter-Harris type II fractures were stabilised by open reduction and internal fixation with cross pins. One minor complication (seroma) and three major complications (implant migration) developed after surgery. The pins were completely removed in one case and partially removed in two cases to resolve these complications. At the final follow-up examination (12-31 months after surgery), owners reported no lameness in three of the four cases and grade 2/5 left forelimb lameness in one case.

CLINICAL RELEVANCE

This type of fracture is rarely described in the literature; however, it should be included in the differential diagnoses of traumatic humeral fractures in growing dogs and cats. In this case series, we achieved fair-to-excellent short-term and long-term outcomes after osteosynthesis of Salter-Harris type II fractures by cross pinning.

A review of minimally invasive fracture stabilization in dogs and cats

OBJECTIVE

To summarize and discuss peer-reviewed studies on minimally invasive osteosynthesis (MIO) of long bone, physeal, and articular fractures in dogs and cats.

STUDY DESIGN

Invited review.

METHODS

A critique of literature was performed to assess MIO feasibility, outcomes, and complications through PubMed, Scopus, and CAB abstracts research databases (2000-2020).

RESULTS

More than 40 MIO articles have been published in the last 15 years, but most studies had small numbers, lacked control groups, and used limited outcome measures. Studies generally showed that MIO was feasible in dogs and cats with low complication rates. The current evidence does not demonstrate superior bone healing or functional outcomes with MIO when compared to standard methods. Although treatment principles, case selection, and techniques varied depending on the anatomical location, there were no salient differences in complication rates among long bones, physeal, and articular fractures treated by MIO.

CONCLUSION

The current available evidence and the personal experience of the authors support MIO as a promising fracture management modality. MIO can yield excellent outcomes when applied in carefully selected cases, performed by surgeons experienced in the technique. We cannot, however, conclude that MIO is superior to open fracture stabilization based on the available evidence in veterinary literature. Randomized controlled studies are warranted to prospectively compare MIO with other osteosynthesis techniques and thereby validate its role in fracture management for dogs and cats.