Evaluation of a 3D-Printed Reduction Guide for Minimally Invasive Plate Osteosynthesis of Short Oblique Radial Diaphyseal Fracture in Dogs: A Cadaveric Study

This study aims to evaluate the clinical application of three-dimensional (3D)-printed custom reduction guides (3DRG) for minimally invasive plate osteosynthesis (MIPO) of short oblique radial diaphyseal fractures. Canine forelimb specimens (n = 24) were prepared and a diaphyseal short oblique fracture was simulated in the distal radius and ulna. Bone fragments were stabilized with the MIPO technique using a 3DRG (Group A), open reduction (Group B), or closed reduction with circular external skeletal fixation (ESF) (Group C). The diaphyseal short oblique fractures were created in each radius at one-third of the radial length from the distal radial articular surface. Surgical stabilization of the fractures was performed in each group. Pre and postoperative radiographic images were obtained to measure frontal angulation (FA), sagittal angulation (SA), frontal joint reference line angulation (fJRLA), sagittal joint reference line angulation (sJRLA), translational malalignment and fracture gap width. Surgical time was also measured. In the homogeneity test, differences in SA, sJRLA, craniocaudal translation and fracture gap before and after surgery had no significant difference among the three groups. On the other hand, differences in FA, fJRLA, mediolateral translation and surgical time before and after surgery had significant differences among the three groups. In the post hoc test, only surgical time showed a significant difference between the three groups, and group A showed the shortest surgical time. The use of 3DRG for MIPO of short oblique radial diaphyseal fractures in dogs is reliable for the alignment and apposition of fractures and reduces surgical time.

Delayed union, non-union and mal-union in 442 dogs

OBJECTIVES

(1) To estimate the prevalence of delayed union, non-union and mal-union in canine fractures; (2) to describe fracture, demographic, and treatment characteristics for these outcomes; (3) to identify risk factors for delayed or non-union.

STUDY DESIGN

Retrospective study.

SAMPLE POPULATION

Four hundred and forty two dogs (461 fractures).

METHODS

A review was conducted of clinical records and radiographs from 2 teaching hospitals. "Union," "delayed union," "non-union" and "mal-union" were defined, and fracture, demographic, treatment, and outcome variables described. Differences in proportions or medians between "union," "delayed union" and "non-union" were tested using χ² and Mann-Whitney U-tests for categorical and continuous variables respectively. Potential explanatory variables for "delayed or non-union" were tested using logistic regression to identify risk factors.

RESULTS

Median radiographic follow up was 53 days (14-282). Delayed union occurred in 13.9% of fractures (64/461), non-union in 4.6% (21/461), and mal-union in 0.7% (3/461). Risk factors for delayed or non-union were age (OR 1.21, 95% CI 1.12-1.31); comminuted fracture (OR 4.24, 95% CI 2.4-7.5); treatment with bone graft (all types) (OR 3.32, 95% CI 1.3-8.5); surgical site infection (OR 3.24, 95% CI 1.17-8.97), and major implant failure (OR 12.94, 95% CI 5.06-33.1).

CONCLUSION

Older dogs, dogs with comminuted fractures, surgical site infection, or major implant failure were at increased odds of delayed or non-union. Radius and ulna fractures in toy breed dogs were not at increased odds of delayed or non-union.

CLINICAL SIGNIFICANCE

The identified risk factors should inform fracture planning and prognosticating. The prognosis for radial fractures in toy breeds appears better than historically believed.

Clinical outcomes of orthogonal plating to treat radial and ulnar fractures in toy-breed dogs

OBJECTIVES

To describe the results of orthogonal plating (OP) as a treatment for fractures of the radius and ulna in toy-breed dogs.

MATERIALS AND METHODS

The medical records (June 2011 to April 2019) of toy-breeds in which the OP technique using non-locking cuttable plates was employed to treat radial and ulnar fractures were reviewed. The inclusion criteria included a bodyweight of 3.5 kg or less, fracture of the diaphysis of the radius and ulna of one or both forelimbs, and the availability of follow-up radiographs. Revision surgeries were also included.

RESULTS

Fifteen limbs that underwent initial fracture repair and five that underwent revision surgery met the inclusion criteria. The radial and ulnar fractures healed in 19 limbs at the final follow-up. Synostosis of the radius and ulna at the fracture sites was observed in one limb. Re-fracture after cranial plate removal was observed in one case. All dogs exhibited successful return of normal limb function at the final clinical and radiographic follow-up (mean, 104.7 ± 67.1 days; median, 79.5 days; range: 35 to 248 days). Long-term follow-up data obtained via telephone interviews to owners or referring veterinarians were available for 15 cases and confirmed maintenance of normal limb function in all dogs (mean, 32.5 ± 17.6 months; median, 26 months; range: 11 to 69 months).

CLINICAL SIGNIFICANCE

OP allowed the successful open reduction of radial and ulnar fractures, facilitating bone union in both the radius and ulna and a return to normal limb function in a series of toy-breed dogs.

Comparative microcomputed tomographic structural analysis of the trabecular and cortical bone architecture of radius and ulna in toy dog breeds

Radius and ulna fractures can be detected in dogs with an incidence of 18.0% and occur more frequently in toy breeds with increased complication rates. The reasons for the predisposition and the increased complication rate of antebrachial fractures in toy breeds are not yet fully understood. The aim of this study was to research the associated mechanisms by investigating the trabecular structure parameters (BV/TV (%), Tb.N (mm^-1), Tb.Th (mm), Tb.Sp (mm), Conn. D (mm^-3), DA) and the cortical bone density (Mean Density (mg HA/ccm)) for toy breeds and small dogs of other breeds using microcomputed tomography and to identify the differences between both groups. A total of 70 forearms, originating from toy breeds (n = 36) and small dogs of other breeds (n = 34) were evaluated by microcomputed tomography. The results of this study showed a lower bone volume fraction (BV/TV), more (Tb.N) but thinner trabeculae (Tb.Th) with greater separation (Tb.Sp) and decreased diaphyseal cortical density (Mean Density) in toy breed dogs. This could thus contribute to the increased risk of antebrachial fractures in toy breeds. Within the group of toy breeds inhomogeneous results were observed, whereby the values of the Chihuahuas deviated. This breed had significantly thinner trabeculae (Tb.Th) with a greater trabecular separation (Tb.Sp), lower bone volume fraction (BV/TV) and significantly lower diaphyseal cortical density (Mean Density). These parameters could therefore indicate an increased antebrachial fracture and complication risk, especially in Chihuahuas.

SUCCESSFUL REPAIR OF ANTEBRACHIAL FRACTURES WITH EXTERNAL SKELETAL FIXATION IN THREE MACROPODS

Three captive macropods comprising three different species sustained unilateral antebrachial fractures. All fractures were assumed to be trauma related, although the specific circumstances surrounding each case was unknown. Each fracture was surgically repaired with type Ia (unilateral, monoplanar) external skeletal fixators, which were all removed approximately 3 mo postoperatively. Although each animal experienced at least one complication, all animals showed adequate bridging and remodeling at the fracture sites and had good-to-excellent return to normal function after fixator removal. This case series is the first to describe the successful repair of antebrachial fractures using external skeletal fixation in captive macropods and details some of the complications that can occur with postoperative management of captive animals.

Use of three-dimensionally printed β-tricalcium phosphate synthetic bone graft combined with recombinant human bone morphogenic protein-2 to treat a severe radial atrophic nonunion in a Yorkshire terrier

OBJECTIVE

To describe a novel surgical approach to treat a critical-sized bone defect due to severe, radial atrophic nonunion in a miniature dog.

STUDY DESIGN

Case report ANIMAL: A 1-year-old Yorkshire terrier with a critical-sized left radial defect after failed internal fixation of a transverse radial fracture.

METHODS

Computed tomographic (CT) images of the radius were imported for three-dimensional (3D) printing of a custom-designed synthetic 3D-printed β-tricalcium phosphate (β-TCP) scaffold. The radius was exposed, and the β-TCP scaffold was press-fitted in the bone gap underneath the plate. Recombinant human bone morphogenic protein-2 (RhBMP-2) collagen sponges were squeezed to soak the scaffold with growth factor and then placed on both sides of the synthetic graft. Two additional cortical screws were also placed prior to routine closure of the surgical site.

RESULTS

Radiographic examination was consistent with complete healing of the radius defect 4 months after surgery. The bone plate was removed 10 months after surgery. According to CT examination 18 months after surgery, there was no evidence of the synthetic graft; instead, complete corticalization of the affected area was noted. Complete functional recovery was observed until the last clinical follow-up 36 months postoperatively.

CONCLUSION

Screw fixation and use of a 3D-printed ceramic scaffold augmented with rhBMP-2 resulted in excellent bone regeneration of the nonunion and full recovery of a miniature breed dog.

CLINICAL SIGNIFICANCE

The therapeutic approach used in this dog could be considered as an option for treatment of large-bone defects in veterinary orthopedics, especially for defects affecting the distal radius of miniature dogs.

Surgical Ectrodactyly Repair Using Limb-lengthening and Bone Tissue Engineering Techniques in a Toy Dog Breed

BACKGROUND/AIM

Bone tissue engineering is an emerging field of regenerative medicine that holds promise for the restoration of bones affected by trauma, neoplastic diseases, and congenital deformity. During the past decade, bone tissue engineering has evolved from the use of biomaterials that can only replace small areas of damaged bone, to the use of scaffolds in which grafts can be seeded before implantation. This case report proposes an alternative option for a veterinary patient suffering from ectrodactyly, which is one of several congenital deformities in dogs. A 2-month-old male toy poodle dog with ectrodactyly was treated using several stages of surgery involving pancarpal arthrodesis, limb lengthening, and bone tissue engineering techniques.

RESULTS AND CONCLUSION

Over a period of 2 years, the operated limb gained almost the same function as the contralateral limb. Bone tissue engineering techniques can be used for the treatment of congenital deformities in dogs.

Clinical outcomes of 119 miniature- and toy-breed dogs with 140 distal radial and ulnar fractures repaired with free-form multiplanar type II external skeletal fixation

OBJECTIVE

To report the clinical outcomes of miniature- and toy-breed dogs with primary and previously treated distal radial and ulnar fractures (RUF) treated with a free-form multiplanar type II external skeletal fixation (ESF).

STUDY DESIGN

Retrospective study.

ANIMALS

One hundred nineteen dogs with 140 distal RUF.

METHODS

Medical records (2003-2017) were reviewed for dogs weighing up to 7 kg that had been treated for distal RUF with a free-form multiplanar type II ESF. Data collected included signalment, fracture location and configuration, fracture reduction, intraoperative realignment, time to bone union and implant removal, duration of destabilization and postoperative splint, complications, and outcomes. Follow-up consisted of clinical and radiographic evaluation or telephone interview.

RESULTS

All fractures healed, with a median time of 60 days, and entire ESF was removed, with a median time of 89 days. Major complications occurred in four fractures: premature pin loosening, elbow subluxation, osteomyelitis, and delayed union. Minor complications occurred in 52 fractures (61 events). All dogs had a successful return to normal limb function at final follow-up (median, seven months; range, 2-97).

CONCLUSION

All primary and previously treated distal RUF in miniature- and toy-breed dogs healed and allowed return to normal function after fixation with a free-form multiplanar type II ESF.

CLINICAL SIGNIFICANCE

The free-form multiplanar type II ESF provides an alternative for minimally invasive fixation of distal RUF in miniature- and toy-breed dogs that facilitates fracture reduction, intraoperative realignment, adequate initial fixation stability, destabilization, and implant removal.

Breed susceptibility for common surgically treated orthopaedic diseases in 12 dog breeds

Background

A retrospective case–control study was conducted to estimate breed predisposition for common orthopaedic conditions in 12 popular dog breeds in Norway and Sweden. Orthopaedic conditions investigated were elbow dysplasia (ED); cranial cruciate ligament disease (CCLD); medial patellar luxation (MPL); and fractures of the radius and ulna. Dogs surgically treated for the conditions above at the Swedish and Norwegian University Animal Hospitals between the years 2011 and 2015 were compared with a geographically adjusted control group calculated from the national ID-registries. Logistic regression analyses (stratified for clinic and combined) were used to calculate odds ratios (OR) and 95% confidence intervals. Mixed breed dogs were used as reference.

Results

Breeds found at-risk for ED were the Labrador retriever (OR = 5.73), the Rottweiler (OR = 5.63), the German shepherd dog (OR = 3.31) and the Staffordshire bull terrier (OR = 3.08). The Chihuahua was the only breed where an increased risk for MPL (OR = 2.80) was identified. While the Rottweiler was the only breed predisposed for CCLD (OR = 3.96), the results were conflicting for the Labrador retriever (OR = 0.44 in Sweden, 2.85 in Norway); the overall risk was identical to mixed-breed dogs.

Conclusions

Most results are in concordance with earlier studies. However, an increased risk of CCLD was not identified for the Labrador retriever, the Staffordshire bull terrier was found to have an increased risk of ED and some country-specific differences were noted. These results highlight the importance of utilising large caseloads and appropriate control groups when breed susceptibility is reported.

Electronic supplementary material

The online version of this article (10.1186/s13028-019-0454-4) contains supplementary material, which is available to authorized users.

Management of feline tibial diaphyseal fractures using orthogonal plates performed via minimally invasive plate osteosynthesis

Objectives The objective was to assess the medium- and long-term outcomes (radiographic and owner questionnaire) of feline tibial diaphyseal fractures with orthogonal plate fixation via a minimally invasive plate osteosynthesis (MIPO) approach. Methods Medical records and radiographs of cats that had tibial diaphyseal fractures stabilised with orthogonal plates were obtained (2012-2016). Immediate postoperative radiographs were reviewed to assess the construct configuration and follow-up radiographs (where available) were used to assess bone healing and implant-related complications. An owner-completed questionnaire (feline musculoskeletal pain index [FMPI]) was used at a minimum of 6 months following surgery to assess the cats' ability to perform normal activities. Results Eight feline tibial diaphyseal fractures met the inclusion criteria. One major complication was observed, most likely due to an operative technical error. There were no further complications following revision surgery. Six of the eight cases that had radiographic follow-up either had clinical bone union or showed evidence of bone healing. All cases were classified as successful according to FMPI. Conclusions and relevance Orthogonal plating of feline tibial diaphyseal fractures via an MIPO approach resulted in successful outcomes and a lower complication rate compared with previously reported techniques.

Augmentation of diaphyseal fractures of the radius and ulna in toy breed dogs using a free autogenous omental graft and bone plating

Objectives: Evaluation of the short-term outcome, duration of bone healing, and complications following bone plate fixation in dogs weighing [uni2264]6 kg, with and without the use of a free autogenous greater omental graft (OG).

Materials and methods: A retrospective clinical study reviewed the medical records of 25 dogs of body weight <6 kg with mid to distal diaphyseal fractures of the radius and ulna (29 fractures) treated with open reduction bone plate fixation. Thirteen out of 29 fractures were implanted with an additional 2–3 cm3 OG lateral, cranial, and medial to the fracture site, adjacent to the bone plate.

Results: Median time to radiographic healing in OG fractures (n = 11) was 70 days (range 28–98) compared to 106 days (range: 56–144) in non-OG grafted fractures (n = 14). The OG dogs had no major complications; minor complications included oedema, erythema, and mild osteopenia. Six of the eight non-OG dogs for which follow-up could be obtained developed osteopenia necessitating implant removal, four of which re-fractured the radius one to five months after implant removal, with one dog re-fracturing the limb a second time and resulting in amputation. Telephone follow-up of owners of OG dogs (n = 11) three to 15 months (median 10) post-surgery did not identify any signs of lameness or other complications. Owners of the non-OG dogs (n = 8) reported that there were not any signs of lameness six to 48 months (median 36) post-surgery.

Clinical relevance: Free autogenous omen-tal grafting of diaphyseal fractures of the radius and ulna was associated with radial and ulnar healing with minimal complications in dogs weighing less than 6 kg.

In vitro biomechanical testing of a micro external skeletal fixator

Objective: To biomechanically test the properties of three different Universal Micro External Fixator (UMEX™) configurations with regard to their use in very small animals (<5kg) and compare the UMEX system to the widely used IMEX External Skeletal Fixation (SK™) system in terms of stiffness, space needed for pin placement and weight.

Methods: Three different UMEX configurations (type Ia, type Ib, and type II modified) and one SK configuration type Ia were used to stabilize Delrin plastic rods in a 1 cm fracture gap model. These constructs were tested in axial compression, craniocaudal bending, mediolateral bending, and torsion. Testing was conducted within the elastic range and mean stiffness in each mode was determined from the slope of the linear portion of the load-deformation curve. A Kruskal Wallis one-way analysis of variance on ranks test was utilized to assess differences between constructs (p <0.05).

Results: The UMEX type II modified configuration was significantly stiffer than the other UMEX configurations and the SK type Ia, except in craniocaudal bending, where the SK type Ia configuration was stiffer than all UMEX constructs. The UMEX type Ia configuration was significantly the weakest of those frames. The UMEX constructs were lighter and smaller than the SK, thus facilitating closer pin placement.

Conclusions: Results supported previous reports concerning the superiority of more complex constructs regarding stiffness. The UMEX system appears to be a valid alternative for the treatment of long-bone fractures in very small animals.

Locking compression plate stabilization of 20 distal radial and ulnar fractures in toy and miniature breed dogs

Objective: To evaluate retrospectively the effectiveness of the Locking Compression Plate® (LCP), in the form of either a straight or notched head T-plate, for the treatment of fractures of the distal radius and ulna in a series of 20 toy and miniature breed dogs.

Methods: The medical records of toy and miniature breed dogs (<6 kg), greater than six months of age, with fractures of the distal radius and ulna from two veterinary hospitals were reviewed. The inclusion criteria included: fractures of the distal 1/3 of the radius and ulna and repair with open reduction and internal fixation utilizing an LCP (straight or notched head T-plate).

Results: Twenty fractures (20 dogs) satisfied the inclusion criteria; eight straight and 12 notched head T-plates were used, either 2.0 mm (n = 13) or 2.4 mm (n = 7). Hybrid fixation was performed in all dogs in one or both fragments. Mean time to radiographic union was 6.9 ± 2.5 weeks (range: 4–12 weeks) in 18/20 dogs with radiographic follow-up. One complication was observed: infection that resolved with antibiotic medication and implant removal. No other major complications occurred by the time of last follow-up. In all cases (mean follow-up: 15 ± 7 months), the reported limb function as evaluated by the referring veterinarian or owner was excellent.

Clinical significance: The LCP, used as a hybrid construct for the treatment of distal radial and ulnar fractures was shown to yield excellent clinical results with both uncomplicated healing and excellent functional outcomes in this series of toy and miniature breed dogs.

Clinical evaluation of a mini locking plate system for fracture repair of the radius and ulna in miniature breed dogs

Objectives: To retrospectively evaluate the effectiveness of a novel 1.2 mm mini locking plate system in treating fractures of the radius and ulna in miniature breed dogs.

Methods: Medical records and radiographs of miniature breed dogs with fractures treated with a 1.2 mm mini locking plate system were reviewed. The inclusion criteria were: body weight of 2.5 kg or less, trans-verse or short oblique fracture of the radius and ulna, and treatment with a mini locking plate system as the sole method of fixation. For each patient, data including signalment, time to radiographic union, use of bone graft or other agents, and previous repair attempts were recorded. The outcome and complications were determined from clinical and radiographic follow-up examinations.

Results: Fourteen cases with a mean radial width of 4.5 mm (± 0.8 mm) were included into this study. The fractures healed without failure of fixation in all cases. Mean time to adequate radiographic union was 8.4 weeks (± 2.6 weeks). Major complications were not seen in any of the cases, and minor complications occurred in three of the cases. Limb function was graded as ‘normal’ in 10 cases and ‘occasional lameness’ in four cases.

Clinical significance: The mini locking system evaluated in this study was an effective treatment method for radial and ulnar fractures in miniature breed dogs with a radial width smaller than 5.5 mm.

Supplementary Material to this article is available online at http://dx.doi.org/10.3415/VCOT-16-01-0014.

Radial and ulnar fracture treatment with paraosseous clamp-cerclage stabilisation technique in 17 toy breed dogs

Objective

Description of surgical technique, complications and outcome of radius/ulna fractures in toy and miniature breed dogs treated with the paraosseous clamp-cerclage stabilisation (PCCS) method.

Study design

Retrospective study.

Methods

Clinical records of small breed dogs with fractures of the radius and ulna were reviewed between January 2011 and January 2016. Inclusion criteria were bodyweight of ≤3.5 kg, fracture of the radius and ulna of one or two limbs without previous repair attempts, available follow-up information, and the use of PCCS for repair of the fracture as the sole method of fixation.

Results

Seventeen fractures in 17 dogs were included in the study. Radiographic union was documented in 13/17 cases. Median time to radiographic union was 13 weeks (range: 5–53 weeks). Major complications occurred in 24 per cent (4/17) due to implant failure, and for revision surgery the PCCS method was chosen in all four cases. Three of four revised fractures healed radiographically. One of the four dogs was lost for radiographic follow-up, but the owner could be contacted for a telephone questionnaire. Eleven of 17 dogs achieved an excellent return to function without any lameness during clinical examination, but 5/17 dogs showed an intermittent mild lameness despite full radiographic union. Routine implant removal was performed in 9/17 dogs. The owners of 15/17 dogs could be contacted for a telephone questionnaire for a long-term follow-up. No further complications were reported.

Conclusions

PCCS is a feasible low-cost internal fixation technique for repairing radial and ulnar fractures in toy breed dogs. Further biomechanical and clinical studies are needed for better evaluation of the PCCS method.

Mechanics of Supplemental Drop Wire and Half-Pin Fixation Elements in Single Ring Circular External Fixator Constructs

OBJECTIVE

Evaluate the effects of supplemental fixation elements on the mechanical properties of a single ring circular fixator construct.

STUDY DESIGN

In vitro mechanical testing.

SAMPLE POPULATION

Five construct configurations (six replicates of each configuration) were used to stabilize a 1.6 cm diameter Delrin rod bone model.

METHODS

Constructs were assembled using 66 mm complete rings, 1.6 mm olive wires, and 3.2 mm diameter half-pins. Construct configurations tested were a base single ring construct, constructs with 1 supplemental drop wire or constructs with 1, 2, or 3 supplemental half-pins. Constructs were loaded in axial compression, caudocranial and mediolateral bending, and torsion. Strain was measured in individual fixation elements during axial loading.

RESULTS

A supplemental drop wire or half-pin significantly increased bending and torsional stiffness. The supplemental half-pin increased caudocranial stiffness significantly more than placing a drop wire. Placing a 2nd or 3rd pin afforded significantly greater increases in construct stiffness in all modes of loading, with 3 half-pin constructs having significantly greater axial and caudocranial stiffness than 2 half-pin constructs. Placing a single supplemental pin induced cantilever bending resulting in angular displacement of the Delrin rod during axial loading and high strain in both the fixation wire secured distal to the ring and the pin. Supplemental half-pins incrementally reduced strain in all fixation elements and resulted in linear displacement of the Delrin rod during axial loading.

CONCLUSION

If using supplemental half-pins as fixation elements, insertion of 2 or 3 pins is preferred over a single pin.

Successful use of autogenous bone graft for the treatment of a radius-ulna nonunion in an amputee dog

Fracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of São Paulo State University, with a right radius-ulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks.

Treatment of antebrachial and crural septic nonunion fractures in dogs using circular external skeletal fixation: a retrospective study

OBJECTIVE

To evaluate the outcome of treatment of antebrachial and crural septic non-union fractures in dogs using circular external skeletal fixation (CESF), and to document the type and frequency of complications associated with this technique.

METHODS

The medical records of all dogs with infected antebrachial and crural non-union fractures treated using the methods of Ilizarov at the Department of Animal Pathology of the University of Turin between 2006 and 2011 were retrospectively reviewed. Only dogs in which radiographic and clinical assessment were available at the time of CESF removal were included in the study.

RESULTS

Twenty-three dogs met the inclusion criteria. Twenty nonunion fractures treated with CESF healed and three did not. The latter three cases underwent amputation of the affected limb. In the 20 dogs that achieved bone union, six had minor complications and five had major complications. The mid-term outcome was judged to be excellent (n = 11), good (n = 6), fair (n = 2), or poor (n = 4).

CONCLUSIONS

The results of this study support the use of CESF for the management of antebrachial and crural septic nonunion fractures in dogs. Union was achieved in the majority of dogs and the complication rate was acceptable, considering the severity of the nonunion fractures that were managed in this fashion.