체중 23kg, 나이 6세된 수캐 잡종 사냥개가 왼쪽 주관절에 총상을 입어 전북대학교 수의과대학 동물병원에 내원하였다. 방사선 사진에서 요골척골 근위부에 복잡골절과 주관절 돌기 후방에 금속성 탄환이 발견되었다. 첫 번째 외과처치는 탄환을 제거하고 bone plate, bone screw, K-wire등을 이용하여 정복 고정하였으나 실패하였다. 두 번째 시도는 주관철 고정술과 13번째 늑골로부터 얻은 자가골을 이용하여 결손부를 충진 하였다. 결과가 만족스럽지 못하여 자가골 재이식과 3번째 수술을 실시하여 주관절의 안정된 고정상태를 유지 할 수 있었다. 60주가 지난 현재 평상시 활동에는 커다란 문제점이 없지만 속보 혹은 뛰는 경우 관절 고정술을 실시한 다리를 들고 세 다리만 사용하는 아쉬움이 있다.
체중 23kg, 나이 6세된 수캐 잡종 사냥개가 왼쪽 주관절에 총상을 입어 전북대학교 수의과대학 동물병원에 내원하였다. 방사선 사진에서 요골 척골 근위부에 복잡골절과 주관절 돌기 후방에 금속성 탄환이 발견되었다. 첫 번째 외과처치는 탄환을 제거하고 bone plate, bone screw, K-wire등을 이용하여 정복 고정하였으나 실패하였다. 두 번째 시도는 주관철 고정술과 13번째 늑골로부터 얻은 자가골을 이용하여 결손부를 충진 하였다. 결과가 만족스럽지 못하여 자가골 재이식과 3번째 수술을 실시하여 주관절의 안정된 고정상태를 유지 할 수 있었다. 60주가 지난 현재 평상시 활동에는 커다란 문제점이 없지만 속보 혹은 뛰는 경우 관절 고정술을 실시한 다리를 들고 세 다리만 사용하는 아쉬움이 있다.
A 6year-old intact male hound cross dog, weighing 23 kg, was presented to the Teaching Animal Hospital, Chonbuk National University with the history of gunshot wound at the left elbow joint. Survey radiographs of the affected elbow revealed the presence of a metallic bullet caudal to the olecranon p...
A 6year-old intact male hound cross dog, weighing 23 kg, was presented to the Teaching Animal Hospital, Chonbuk National University with the history of gunshot wound at the left elbow joint. Survey radiographs of the affected elbow revealed the presence of a metallic bullet caudal to the olecranon processes and comminuted fracture of the proximal radius and ulna. The first treatment strategy included removal of the bullet and fixation of the radius and ulna using separate bone plates, bone screw, K-wire and surgical wire, was failed. The second treatment strategy included olecranon osteotomy and rigid immobilization of the elbow joint with a bone plate applied to the caudal aspect of the humerus and ulna along with autogenous bone grafts collected from the 13th rib. The optimal angle of the joint following arthrodesis of this case appeared to be 130°. This resulted in improving the case but after 60 weeks the plate was bent and there was exudation from the wound. The third treatment strategy was the same with the second except for that the bone autografts were collected from the proximal metaphyses of the ipsilateral humerus. This resulted in a successful arthrodesis 6 weeks after the surgery. Elbow arthrodesis with bone autograft resulted in acceptable function, but abnormal gait remained in the dog due to mechanical interference with the movement of the joint.
A 6year-old intact male hound cross dog, weighing 23 kg, was presented to the Teaching Animal Hospital, Chonbuk National University with the history of gunshot wound at the left elbow joint. Survey radiographs of the affected elbow revealed the presence of a metallic bullet caudal to the olecranon processes and comminuted fracture of the proximal radius and ulna. The first treatment strategy included removal of the bullet and fixation of the radius and ulna using separate bone plates, bone screw, K-wire and surgical wire, was failed. The second treatment strategy included olecranon osteotomy and rigid immobilization of the elbow joint with a bone plate applied to the caudal aspect of the humerus and ulna along with autogenous bone grafts collected from the 13th rib. The optimal angle of the joint following arthrodesis of this case appeared to be 130°. This resulted in improving the case but after 60 weeks the plate was bent and there was exudation from the wound. The third treatment strategy was the same with the second except for that the bone autografts were collected from the proximal metaphyses of the ipsilateral humerus. This resulted in a successful arthrodesis 6 weeks after the surgery. Elbow arthrodesis with bone autograft resulted in acceptable function, but abnormal gait remained in the dog due to mechanical interference with the movement of the joint.
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문제 정의
However, this study found that autogenous bone grafts stimulated osseous union in the fracture ends. This case study reported a successful elbow arthrodesis using complete immobilization of the joint with autogenous bone grafts.
제안 방법
However, 60 weeks after arthrodesis, suddenly the bone plate bent and there was exudation from the wound. A third surgery was performed; the plate was replaced with a new one and rearthrodesis was done along with bone autografts at the fracture site. The radiographs taken at 2 and 3 weeks after the surgery revealed osteogenesis and heeling at the fracture site and the prognosis seemed to be good.
Diagnosis was made as comminuted fracture of the proximal radius and ulna on the basis of the clinical findings and radiographic examinations.
After the second surgery (arthrodesis along with autograft) the condition was gradually improving but the progression was very slow. Radiograph of the elbow taken immediately after the surgery was compared with the subsequent radiographs taken at 1, 5, 10, 20, 30, 40, and 50 weeks after the surgery for evaluating healing process and monitoring the angle of the joint. However, all of these radiographs revealed gradual progress and osteogenesis at the fracture sites and the angle appeared to be 130°.
To our knowledge, clinical reports of elbow arthrodesis with autogenous bone grafts after gunshot fracture of the radius and ulna have not been published. The purpose of this study was to evaluate the surgical technique, complications and final functional outcome of elbow arthrodesis with bone autograft for the management of comminuted fracture of the radius and ulna in a dog.
To correct this problem, the third surgery was performed using replacement of the bone plate and re-arthrodesis of the elbow (Fig 5).
대상 데이터
A 6 year-old intact male hound cross dog, weighing 23 kg, was presented to the Teaching Animal Hospital, Chonbuk National University with the finical history of gunshot wound at the left elbow. Severe lameness was noticed on left fore limb with bleeding from the lesion.
성능/효과
A third surgery was performed; the plate was replaced with a new one and rearthrodesis was done along with bone autografts at the fracture site. The radiographs taken at 2 and 3 weeks after the surgery revealed osteogenesis and heeling at the fracture site and the prognosis seemed to be good. Radiographs taken at 4 weeks after the surgery revealed a complete healing and arthrodesis (Fig.
참고문헌 (15)
Amato JJ, Rich NM, Billy LJ, Gruber RP, Lawson NS. High-velocity arterial injury: A study of the mechanism of injury. J Trauma 1971; 11: 412-416
Johnson KA. A radiographic study of the effects of auto-logous cancellous bone grafts on bone healing after carpal arthrodesis in the dog. Vet Rdiol 1981; 22: 177-183
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