Bone splinting techniques for long bone fractures in small ruminants: A review of six cases

Introduction

Orthopaedic conditions in small ruminants are common, with long bone fractures being the most frequently encountered. In goats, such fractures typically result from falls, road accidents, blunt trauma, or dog attacks (Gupta, 2015) [3] . Among young small ruminants aged 1-3 years, the metacarpal and metatarsal bones are most affected (50%), followed by the tibia (12%), radius and ulna (7%), and humerus (5%) (Awatif et al., 2006) [2] . The configuration and anatomical location of the fracture dictate the choice of fixation technique necessary for effective stabilization and healing (Fossum, 2019) [6] . Fracture management involves a spectrum of approaches tailored to the bone affected, fracture type, and species, including external coaptation (e.g., splints and casts), external skeletal fixation (ESF), and internal fixation using plates, screws, intramedullary pins, or interlocking nails. Treatment decisions are influenced by biomechanical demands, anatomical considerations, and the biological potential for fracture repair (Aithal et al., 2023; Kapler and Dycus, 2015) [1,4] . The present study underscores the clinical relevance and therapeutic diversity in managing long bone fractures in small ruminants, particularly goats, within a field-oriented veterinary surgical setting.

Materials and Methods

A total of six cases (table 1) presented to the Large Animal Surgery Unit, Veterinary Clinical Complex, Veterinary College and Research Institute, Namakkal, with a history of trauma and clinical signs suggestive of long bone fractures were included in the study. Animals were selected irrespective of age, breed, or sex. Each case underwent thorough clinical and radiographic evaluation.

Preoperative Planning

Each fracture case was thoroughly evaluated to rule out any underlying neurological abnormalities. Following clinical examination, two orthogonal radiographic views of the affected limb were obtained for all animals. These radiographs were used to identify the exact fracture location, number of fragments, and the orientation and position of longitudinal fissures. They also facilitated measurements of the medullary cavity diameter at the isthmus for selecting appropriate intramedullary pins, cortex-to-cortex width for determining ESF pin diameter and suitable dimensions for bone plates and screws. Based on these assessments, all implants, surgical instruments, and necessary accessories were selected and sterilized according to the specific requirements of each case. Preoperatively, all animals received 0.5 mL of tetanus toxoid administered deep intramuscular injection.

Anaesthesia

Animals were premedicated intramuscularly with xylazine hydrochloride at a dose of 0.05 mg/kg body weight and butorphanol at 0.1 mg/kg. General anesthesia was employed for the surgical procedure, with induction achieved via intravenous administration of ketamine (2.5 mg/kg) in combination with diazepam (0.5 mg/kg). Anesthesia was maintained through an intravenous administration of ketamine and diazepam in a 1:1 volume ratio, adjusted as needed throughout the operation.

Surgical procedures

The surgical site was prepared aseptically with povidone iodine. For overriding fractures, traction via the hanging limb method was applied for 30 minutes preoperatively. Sterile bandages covered the limb ends, tincture of iodine was applied, and the site was draped. a) For External Skeletal Fixation (ESF): Fracture reduction and stabilization were achieved via a closed approach using traction. Alignment was maintained intraoperatively with manual traction and countertraction, using either a hoof-secured bandage roll or the hanging limb method. Pins (20-30% of bone width) were inserted craniomedially to caudolaterally with a lowspeed drill, two per segment, perpendicular and parallel to the bone axis. Saline irrigation minimized heat during drilling. Pins were bent 1 cm from the skin with help of pin bender toward the fracture, taped temporarily, and stabilized permanently with M-seal. b) For intramedullary pinning: Intramedullary pinning was performed for tibial and humeral fractures using bone-specific approaches and techniques. For tibial fractures, a normograde method was employed, with closed pinning preferred in fresh, simple cases and open reduction indicated for delayed or comminuted fractures.

The pin was inserted at the craniomedial tibial margin, between the patellar and medial collateral ligaments, and advanced distally into the medullary canal under fluoroscopic or manual guidance. Humeral fractures were managed via a retrograde approach following a craniolateral incision from the greater tubercle to the lateral epicondyle. Layered dissection exposed the fracture site while preserving neurovascular structures, with dissection proceeding between the brachialis and brachiocephalicus muscles and careful retraction of the triceps and radial nerve. The pin was introduced into the proximal fragment and advanced distally.

c) For minimally invasive plate osteosynthesis (MIPO):

MIPO was performed via a medial approach with two small (2-4 cm) incisions at the distal and proximal ends of the tibial fracture. A subcutaneous and epiperiosteal tunnel was created using Metzenbaum scissors. A 3.5 mm LC-LCP was inserted through the distal incision and guided along the medial tibial surface. Holes were drilled with a 2.5 mm bit, and screws were placed distally and proximally to stabilize each major fragment. Surgical site closure was done according to standard protocol in all the cases.

Postoperative care

Postoperatively, pin entry sites in ESF cases were dressed with povidone-iodine-soaked sterile gauze and the fixation construct was securely bandaged. For intramedullary pinning and plating, a modified Robert Jones bandage was applied.

Postoperative care involved administering ceftriaxonetazobactam intravenously at 10 mg/kg body weight for five days, and meloxicam intramuscularly at 0.2 mg/kg body weight for three days. Wound dressing was performed on alternate days. Animals were kept on stall rest with restricted movement for two weeks, followed by gradual, supervised walking.

Results and Discussion

The six cases evaluated demonstrated a spectrum of fracture types and anatomical locations commonly encountered in clinical practice. These findings align with previous epidemiological reports indicating that metacarpal and metatarsal fractures are most prevalent in young goats, followed by tibial, radioulnar, and humeral fractures ( [2,7,8] . Automobile accidents accounted for the majority of fractures (4 cases, 66.67%), while blunt trauma and dog attacks contributed to one case each (16.67%), consistent with the observations of Kumaresan (2013) and Rani et al. (2025) [8] .

Effective fracture management relied on accurate diagnosis, biomechanical planning, and appropriate implant selection. Orthogonal radiographs (mediolateral and craniocaudal views) of the injured limb and adjacent joints were essential for evaluating fracture configuration and guiding fixation choices, in line with the principles described by Piermattei et al. (2006) [5] and Fossum (2019) [6] . Measurements of the medullary canal and cortical width facilitated precise implant sizing, while contralateral limb radiographs ensured optimal fit and alignment. Additionally, the anaesthetic protocol employed provided smooth induction, maintained a stable surgical plane, and resulted in uneventful recovery in all animals.

External skeletal fixation (ESF) was employed in three cases, two involving metacarpal fractures and one metatarsal fracture ( Wound healing was evident by the 15th postoperative day in all animals. ESF was removed on the 60th postoperative day, during which mild discharge and construct loosening were noted but resolved promptly without complications. Radiographically, initial periosteal proliferation was observed by day 30, followed by exuberant periosteal proliferation by day 45 (Fig 3 &5). Intramedullary pinning was employed in two cases involving humeral (Fig7) and tibial fractures. The surgical approaches provided feasible access and effective fracture realignment. Pins occupying 60-70% of the medullary canal diameter offered adequate stabilization (Fig10). In the tibial fracture, normograde pinning enabled partial weight bearing by day 15 and complete weight bearing by day 45 (Fig 9). In the humeral fracture, full weight bearing was achieved by day 30 (Fig 6 [4] and Redfern et al. (2004) [9] . In contrast, secondary healing was observed with intramedullary pinning, evidenced by exuberant callus and a persistent radiolucent gap by day 45, reflecting indirect healing stages as described by Aithal et al.

(2023) [1] and Piermattei et al. (2006) [5] . Gupta, 2015) [1,3] . MIPO enabled early mobilization and biological healing in a comminuted tibial fracture, as advocated by Redfern et al. (2004) [9] . Across all techniques, postoperative care and implant selection were critical to functional recovery.

Conflict of Interest

Financial Support

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