HISTORY OF SMALL ANIMAL ORTHOPAEDICS
WAYNE H. RISER
Perrin, a small animal practitioner from Nebraska, apologized for presenting a subject as dreary as fracture repair and stated that improved methods had not been introduced in over 30 years.(23) He depicted people in his part of America as being frequently indifferent about their pets, especially when it came to fractures, since dogs had little monetary or sentimental value. The exception may have been the greyhound-Airdale hybrid used on ranches to chase coyotes. Perrin considered cage rest to be the best treatment for canine fractures, since "this allowed nature to take care of the bone repair very nicely when assisted by the immobility of the part."(23) He further recommended keeping the animal quiet and applying artificial immobilization to support the limb, namely, splints and casts. His experience with splints and casts, however, led him to believe that they were usually bunglesome, unnecessary, and impractical.(26)
Other articles of that era that describe the application of splints and casts reveal that a variety of materials were used, such as plaster of paris, sodium silicate (glass water), tripolith dressing (mixture of plaster of paris and soot), fish glue, pitch, and cornstarch paste. Each of these substances, when mixed with water, made a paste that was used to saturate bandages of gauze, muslin, cheesecloth, or crinoline. The saturated bandages were then wrapped over cotton padding and supported splints that were made from a wide range of materials, including wood, tongue depressors, gutta-percha, wire gauze and screen, cardboard shirt backs, mailing tubes, flexible wooden strips from market baskets, yucca board, and corset stays. For further protection after the cast had dried, waterproof adhesive tape or electrical tape was often wound around the Cast.(6-8,18,20,23)
The first advancement in veterinary orthopaedics came in 1920 when fluoroscopy of the skeleton was introduced. Watching bone images move on the screen of the fluoroscope made orthopaedics an exciting and challenging subject. Observing the bones by fluoroscopy was so fascinating that radiographs were seldom made except for permanent records. Both fluoroscopy and radiography generated new insights into orthopaedic problems never before considered. New methods of fracture reduction were developed.
Most long-bone fractures of humans, especially those of children, were set and repaired by the local family doctor. A fluoroscopic view of the fractured bones was just what was needed to aid the family physician with fracture reduction. In response to this need, low-priced, small, light-weight and portable x-ray machines and hand-operated fluoroscopes were made available to the medical profession. Physicians who reduced fractures either purchased such equipment or shared it with a colleague.
A number of veterinarians with busy small animal practices copied the physician's procedures and used fluoroscopy extensively to reduce fractures. The increasing number of automobiles and the lack of leash laws resulted in the injury of many dogs and cats. When sodium pentobarbital, a new anesthetic that lasted for several hours, was introduced, the fluoroscope was an ideal instrument to assist in bringing about proper fracture reduction. Sometimes this reduction procedure, when difficult, required as long as an hour under the fluoroscope.
Fluoroscopy was accompanied by unanticipated hazards. Both veterinarians and physicians, after using the fluoroscope for a few years with their hands unprotected from the x-ray beam, developed permanent radiation injury of the skin of their hands: dehydration, irritation, and ulceration, with some ulcers so severe that they did not heal. Skin grafts and even amputations of fingers were occasionally necessary. In rare instances squamous cell carcinoma occurred on the hands of the most severely affected.
FIG. 1-1 This veterinarian's hands demonstrate radiation dermatitis.
Radiographs made it apparent that leather, wood, and metal commonly applied with or without starch, adhesive, and plaster of paris were not as effective as they were once thought to be.(3,6-9,21,22)
Overriding of fractured bones, especially of the femur and the humerus, was a major unsolved problem in fracture reduction. Muscle spasms were ever-present, causing fractured bone ends to overlap, and correction was extremely difficult. In humans, tongs and traction applied to the distal fragment of the bone brought encouraging results. In 1931 Dibbell reported the use of small tongs applied to the distal fragment of the dog's femur, with traction applied by means of a cast.(6) This sometimes corrected the overriding, but osteomyelitis often developed at the point at which the points of the tongs were inserted into the bone.(6,7)
In 1933 Schroeder,(35) having been inspired at Massachusetts General Hospital, wrote
"Having made use of x-rays before and after reduction especially in fractures of the humerus and femur, we have become convinced that reduction and fixation without incorporating some form of traction is ineffective in most cases. Gross displacement of the fractured bone is always to be expected in complete fractures. The overriding is due to unapposed muscular contraction and spasm. Without continuous traction to offset the unapposed muscular action in these fractures, reduction cannot be maintained." (35,36)
Thomas in 1875 and Jones in 1913 introduced to human orthopaedics a splint to correct overriding.(19,40) It was made by bending a metal rod in such a fashion as to apply traction to both the proximal and distal ends of the fracture. To a considerable extent this overcame the muscle spasm and corrected the overriding. In 1933 Schroeder (Fig.%20I-2)adapted the concept of this splint to canine practice and applied traction to the proximal end of the fracture by padded wire rings applied to the body and adhesive tape attached to the skin after the hair has been removed.(35,33) Gauze wraps were also used, and in difficult cases tongs or Kirschner pins were applied to the distal end of the fractured bone. The Schroeder splint was made with a metal rod, bending a ring at the proximal end through which the limb was placed. The padded ring rested against the body, the latter serving as countertraction while the joint and the foot below were attached under tension to the other end of the splint. The limb was also fastened to the side bars of the splint to further align the bone fragments. This arrangement permitted movement of the splint at the joint next to the body while the limb was secured inside the splint. The animal could remain ambulatory.(35,36)
This splint, the Schroeder-Thomas splint, could be fashioned from various materials. For cats and toy dogs, coat hangers and steel brace wire from fences were used.For larger dogs, light, pliable, and inexpensive rods of aluminum alloy were used.(35,36)
FIG. 1-2 Erwin F. Schroeder, DVM. 188:3 December 26, 1952
Rigid aseptic or sterile technique in which all instruments, solutions, drapes, and towels were subjected to sterilization by live steam pressure and in which the operators were covered by sterile gowns and rubber gloves with hair and mouth covered by clean caps and masks had been used for some time in human medicine.(10,41) Schlotthauer and Man of the Mayo Clinic,(32) Riser of Des Moines,(21) Farquehanson of Colorado State,(10) Gadd of Baltimore(11) and Stader of Philadelphia (38,39) were among the first to adopt sterile techniques in veterinary surgical procedures. It was found that if aseptic technique could be maintained, a closed fracture could be invaded for approximately 20 minutes and still heal by first intention without infection or drainage. The chances of a complicated infection increased rapidly after 25 minutes. However, results obtained using aseptic technique were sufficiently encouraging to prove that pin insertion, even multiple pin insertion in which the pins were allowed to extend beyond the skin, was a procedure that usually elicited a favorable response.
In 1940 a third breakthrough occurred that added confidence to successful fracture repair: the introduction of antibiotics to minimize infections. Penicillin and a number of sulfa derivatives were the first agents used. Initially these were quite crude and complicated to use. Veterinarians, armed with radiography, sterile technique, and antibiotics, made rapid progress in fracture repair and reconstruction.
One of the best-known contributors to fracture reconstruction was Stader,(33,39) a one-time Wisconsin and Illinois bovine sterility specialist turned small animal practitioner (Fig. 1-3). Fracture repair was fascinating to Stader because of the mechanics involved. His father, a trained machinist, had developed and patented instruments for sterility treatment.(39)
Stader was enthralled by the work of Gadvilli, a Swiss surgeon who introduced the Steinmann pin to America.(39) This pin was inserted transversely through the fractured end of the bone and surrounding soft tissues. Pins above and below the fracture could be used to bring the fractured bone ends together and hold them in apposition. The ends of the pins were then incorporated in a cast until the bone healed. Although this technique had been used with success in humans, when applied to animals, especially the dog, the results were unsatisfactory because it was impossible to keep the cast free of moisture, contamination from urine and feces, and damage from chewing.
FIG. 1-3 Otto Stader, VMD. April 4, 1984-September 10, 1962
These unsatisfactory experiences led Stader to draw on his mechanical imagination and youthful training to invent a new splint using the feature of the inserted pins. He employed four short Steinmann pins pointed on one end. Two pins were inserted through a tailored block as a guide in a V-shaped direction to add strength and to prevent them from being pulled out. A set of pins and block was placed in the proximal and distal fracture fragments in a similar manner. Each pin was inserted on the lateral side of the limb through the skin, soft tissue, lateral bone cortex, and medullary cavity, with the points of the pins emerging slightly through the medial cortex. The ends of the pins that protruded through the proximal and distal blocks on the side of the limb were maneuvered into position and secured. The metal parts of the splint were rigid and stable. The apparatus was easy to clean and offered immediate patient mobility.|
FIG. 1-4 Jacques Jenny, Dr. med. vet. October 19, 1917-November 20, 1971
FIG. 1-5 Gerry B. Schnelle, VMD. July 20, 1904 May 4, 1976
By the mid 1940s, many other skeletal diseases of the dog were being recognized and characterized. Among these were medial patella subluxation and malalignment of the stifle in the toy proportionate dwarf, intervertebral disk disease in the chondrodystrophic breeds,(12-14) osteochondrosis dissecans of the shoulder in large and giant breed dogs,2 ununited anconeal process,(4) cranial bowing of the radius in the giant breed dog,(29) lateral deviation of the front foot,(3,10) and retained cartilage of the ulnar metaphysis in the rapidly growing giant dog.(29)
Veterinary orthopaedics, which began as fracture repair and enlarged into orthopaedic diseases of animals, now includes contributions in genetics, electron microscopy, histochemistry, biomechanics, computer sciences, and other specialized disciplines. The future should continue to expand the horizons of veterinary orthopaedics. Our humble beginnings can be traced to three major steps made by the medical community: radiography, sterile technique, and antibiotics.
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