When did comics enter the progressive era?


The aim of the retrospective study was to analyze the treatment of diaphyseal and distal metaphyseal forearm fractures with angle-stable and non-angle-stable osteosynthesis procedures, their healing and possible complications, taking into account patient and fracture-dependent influencing factors. A total of 88 dogs with 91 diaphyseal or distal metaphyseal radius / ulna fractures (3 dogs with bilateral fractures) were evaluated. The fractures were stabilized in the Clinic for Small Pets at the Free University of Berlin with plate fixation or external fixator from 2009-2015. The 88 dogs belonged to 39 different breeds or mixed breeds of these breeds. The age of the dogs varied between 2 and 186 months and corresponded to an average age of 3.17 years. 52.3% of the dogs were female and 47.7% were male. Lightweight breeds (<5 kg; toy breeds) were with 31.8%, low (5-15 kg) with 23.9%, medium (> 15-30 kg) with 26.1% and heavy (> 30 kg) ) represented with 18.2%. The causes of fractures were traffic accidents (42.9%), falls from a low height (24.2%), minor trauma (getting stuck, trapping or playing, kicking; 9.9% each), dog bite (5.5%) or wild boar injuries (2 , 2%). The cause was unknown in 5.5% of the dogs. In 96.7% both the radius and ulna were fractured, in 3.3% only the radius. 74.7% of the fractures involved the diaphysis and 25.3% the distal metaphysis. The distal metaphysis was ruptured more frequently (46.7%) in the light-weight dogs (<5 kg) than in the heavier dogs (6.3-18.2%). Overall, the transverse (79.1%), before splinter (12.1%) and oblique (8.8%) fractures were the most common types of fracture. Even if the localization was considered separately, transverse fractures made up the largest proportion in each case (diaphysis: 77.9%; distal metaphysis: 82.6%). 14.3% of the fractures were open. The fractures were treated after an average of 1.07 days. The operating time averaged 67.7 minutes. 46.2% of the operations were performed by very experienced and 53.8% by less experienced surgeons. 83.5% of the fractures were angle-stable (73.6% NCP; 9.9% external fixator) and 16.5% were non-angle-stable (DCP). Plates (90.1%) were overall more common than external fixation fixations (9.9%). In the distal metaphyseal area, the external fixator was used more frequently (17.4%) than in the diaphyseal area (7.4%). 78% of the fractures were x-rayed at least once in the clinic after the day of the operation. The radiologically proven healing of 52 fractures averaged 15.58 ± 7.9 weeks. Patient (age, gender, body weight) and fracture-dependent (fracture location, type, open vs. closed) factors did not significantly influence the healing time. Fractures treated with an external fixator tended to heal faster (11.33 ± 7.89 weeks) than after plate fixation (16.13 ± 7.87 weeks); this difference was not significant. No significantly different healing times were found between the fractures treated with non-angle-stable (DCP) and angle-stable plate fixation (NCP). This was also the case when comparing non-angle-stable osteosyntheses (DCP) with angle-stable (NCP and external fixator). The implants were removed at the clinic in 54 fractures. The implant dwell times calculated from this were significantly shorter for external fixation osteosynthesis (10.88 ± 5.08 weeks; p = 0.036) than for plate fixation (16.69 ± 8.58 weeks). The detailed analyzes of non-angle-stable vs. angle-stable plate osteosynthesis and non-angle-stable vs. angle-stable osteosynthesis did not reveal any significant differences in implant dwell times. The healing process was checked in the clinic in 84 dogs (95.5%) with 84 fractures (92.3%). In 33 (39.3%) fractures (= patients) the healing (in some multiple) was fraught with complications (57 complications). The most common complications were osteomyelitis and bone resorption (13.1% each; n = 11), followed by fracture healing disorders (Malunion, Nonunion, Delayed Union; 10.7%; n = 9), implant failure (8.3%; n = 7) , Ankylosis of the carpal joint (2.4%; n = 2) and transient radial paralysis (1.2%; n = 1). Patients with osteomyelitis were treated with antibiotics (n = 11), loosened implants were removed (n = 2), autologous cancellous bone attached and / or the assembly changed (n = 1). For the treatment of bone resorption and non- or delayed union, the fractures were dynamized (n = 6), the assembly was changed (n = 1) and / or a cast bandage was applied after the implant was removed (n = 2). Wound infections were treated with antibiotics. In the event of implant failure, the assembly was changed (n = 3), loosened implants removed (n = 2) or reattached (n = 1). In the case of refractures, a reosteosynthesis was carried out with a change in the osteosynthesis method (n = 6). The ankylosis in the carpal joint and the radial paralysis were treated with physiotherapy. Malunions (all of them minor axis errors) were not corrected osteotomized and synostoses were not resected, as they did not cause any functional impairment. No significant correlations could be found between patient-dependent influencing variables (race, age, gender, body weight) and the general risk of complications. However, the patient's weight had a significant effect on the risk of developing osteomyelitis (p = <0.001). Fracture-dependent factors (fracture location, type, open vs. closed), as well as treatment-dependent factors (time interval between accident and osteosynthesis, duration of surgery, level of experience of the surgeon), were not significantly correlated with the complication rate. In the analysis of the osteosynthesis method (plate vs. external fixator; DCP vs. NCP; DCP vs. NCP / external fixator), no significant differences in the risk of complications could be found either. This was also the case for dogs <5 kg with distal metaphyseal fractures, described in the literature as particularly at risk of complications. The functional treatment result could be evaluated for 88.6% of the dogs with 85.7% of the fractures. The limb function was rated as good (93.6%), satisfactory (5.1%) or unsatisfactory (1.3%) according to the degree of lameness (free from lameness, slightly, moderately, extremely lame). A good functional therapy result was achieved in 92.8% of the plate osteosyntheses and in 100% of the external fixator osteosynthesis. In conclusion, angle-stable (NCP / external fixator) and non-angle-stable (DCP) osteosynthesis are ideally suited for the treatment of diaphyseal and distal metaphyseal radius / ulna fractures. The selection of the most suitable procedure must be made individually on the basis of the recommendations already available in the literature and the results of the present study, taking into account as many influencing factors as possible (patient, fracture, surgeon, owner compliance, costs) and any complications recognized and treated as early as possible.

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