Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report

Chronic septic bone nonunion requires a well-designed therapeutic planning, demanding a multimodal treatment to achieve bone consolidation and elimination of infection. A successful case of an association of the major omentum flap with surgical stabilization with an interlocking nail for treatment of a femoral septic nonunion in dog is reported. The patient had partial functional return of the limb 30 days after surgery, negative bacterial culture with radiographic signs of bone healing and total functional return of the limb at 90^th days after the surgical procedure.

Keywords:
complication; orthopaedics; osteomyelitis; planning

Authorship

M.P. Menezes

Universidade Estadual Paulista “Júlio de Mesquita Filho” ˗ Jaboticabal, SPUniversidade Estadual PaulistaBrazilJaboticabal, SP, BrazilUniversidade Estadual Paulista “Júlio de Mesquita Filho” ˗ Jaboticabal, SP

http://orcid.org/0000-0002-0294-5126

R.C. Costa

http://orcid.org/0000-0001-6404-2603

M.E.B.A.M. Conceição

http://orcid.org/0000-0002-6939-2183

B.W. Minto

http://orcid.org/0000-0002-8808-4127

L.G.G.G. Dias ^**Autor para correspondência (corresponding author) E-mail: gustavogosuen@gmail.com

http://orcid.org/0000-0003-3993-1649

*Autor para correspondência (corresponding author) E-mail: gustavogosuen@gmail.com

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (3)

Thumbnail

Figure 1
Photographic images of dog’s right femur nonunion osteosynthesis. The yellow asterisk illustrates the cranial direction of the limb and the black asterisks indicate the proximal direction. (A) Fistula (black arrow) in the caudo-lateral aspect of the right limb; (B) fistulous path in the medial face of the right limb; (C) evidence of devitalized bone fragments (yellow arrow) and large amount of fibrous tissue (white arrow); (D) Bone defect (blue arrow) after surgical debridement; (E) the greater omentum (purple arrow), collected after caudal laparotomy, at the 13th right rib, passed through the subcutaneous space (grey arrow) to the fracture site; (F) Placement of the Corticospongious bone autograft at the fracture site (light green arrow). Green arrow indicates the locking screw used on the interlocking nail; (G) femoral diaphysis overlapped with the omentum flap. (H) The patient, after thirty days, exhibiting adaptive support by hyperextension of the tibiotarsal joint (red arrow) and stifle joint.

Thumbnail

Figure 2
Preoperative radiographic images in the (A) mediolateral and (B) craniocaudal projections, illustrating a complete comminuted fracture of the middle third of a canine right femur, with irregular and sharp fragment edges, and edema of the adjacent soft tissue. The radiographic signs are compatible with a septic nonunion.

Thumbnail

Figure 3
(A, B) Postoperative radiographic images of canine right femur, immediately after osteosynthesis as treatment of a bone septic nonunion, in medio-lateral (A) and cranio-caudal (B) projections, focusing on the implant used, an interlocking nail (black arrow) with 4 locking screws and on the presence of a radiolucent line indicating the fracture site (red arrow). (C, D) Radiographic images of the same patient, at 30 days after surgery, showing the onset of bone consolidation, in the medio-lateral (C), and cranio-caudal (D) projections. (E, F) Radiographic images in the medio-lateral (E) and cranio-caudal (F) projections, at 100 days after osteosynthesis, note the implant dynamization by the removal of the locking screws, closer to the focus of the fracture (blue arrows), showing bone consolidation (yellow arrows). (G, H) Radiographic images at 170 days after the first surgery, immediately after the second dynamization, in which the two remaining screws were removed, in medio-lateral (G) and cranio-caudal (H) projections.

Figure 1 Photographic images of dog’s right femur nonunion osteosynthesis. The yellow asterisk illustrates the cranial direction of the limb and the black asterisks indicate the proximal direction. (A) Fistula (black arrow) in the caudo-lateral aspect of the right limb; (B) fistulous path in the medial face of the right limb; (C) evidence of devitalized bone fragments (yellow arrow) and large amount of fibrous tissue (white arrow); (D) Bone defect (blue arrow) after surgical debridement; (E) the greater omentum (purple arrow), collected after caudal laparotomy, at the 13th right rib, passed through the subcutaneous space (grey arrow) to the fracture site; (F) Placement of the Corticospongious bone autograft at the fracture site (light green arrow). Green arrow indicates the locking screw used on the interlocking nail; (G) femoral diaphysis overlapped with the omentum flap. (H) The patient, after thirty days, exhibiting adaptive support by hyperextension of the tibiotarsal joint (red arrow) and stifle joint.

Figure 2 Preoperative radiographic images in the (A) mediolateral and (B) craniocaudal projections, illustrating a complete comminuted fracture of the middle third of a canine right femur, with irregular and sharp fragment edges, and edema of the adjacent soft tissue. The radiographic signs are compatible with a septic nonunion.

Figure 3 (A, B) Postoperative radiographic images of canine right femur, immediately after osteosynthesis as treatment of a bone septic nonunion, in medio-lateral (A) and cranio-caudal (B) projections, focusing on the implant used, an interlocking nail (black arrow) with 4 locking screws and on the presence of a radiolucent line indicating the fracture site (red arrow). (C, D) Radiographic images of the same patient, at 30 days after surgery, showing the onset of bone consolidation, in the medio-lateral (C), and cranio-caudal (D) projections. (E, F) Radiographic images in the medio-lateral (E) and cranio-caudal (F) projections, at 100 days after osteosynthesis, note the implant dynamization by the removal of the locking screws, closer to the focus of the fracture (blue arrows), showing bone consolidation (yellow arrows). (G, H) Radiographic images at 170 days after the first surgery, immediately after the second dynamization, in which the two remaining screws were removed, in medio-lateral (G) and cranio-caudal (H) projections.

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Universidade Federal de Minas Gerais, Escola de Veterinária Caixa Postal 567, 30123-970 Belo Horizonte MG - Brazil, Tel.: (55 31) 3409-2041, Tel.: (55 31) 3409-2042 - Belo Horizonte - MG - Brazil
E-mail: abmvz.artigo@gmail.com

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Treatment of a femoral septic nonunion in a dog with interlocking nail stabilization associated to corticospongious bone autograft and greater omentum flap: case report

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[1] *Autor para correspondência (corresponding author) E-mail: gustavogosuen@gmail.com