Carpal Arthrodesis by BoneCure® Membrane
First reported cases with no use of bone graft by Itamar Tsur B.Sc.(Hons), B.V.Sc., MRCVS, DVM.
Shane: 6 years old Samoyed, that fell off the Barber's table and suffered from a torn carpal canal; Pan carpal arthrodesis was done in the normal manner (removing all cartilages from the radio carpal joint and intercarpal joints) and fixing with a hybrid 3.5/2.7 carpal arthrodesis DCP (Veterinary Instrumentation, Sheffield, UK). Instead of using autogenous cancellous bone graft, BoneCure® Membrane was placed under the plate, surrounding about 270 degrees of the circumference. The leg was supported with a plaster cast (3M) for 6 weeks, when the area felt very stable. (Surgeon: Itamar Tsur DVM - Radiographs not shown)
Dobby: 9 years old GSD, 35 kg; Pancarpal arthrodesis was carried out on the right carpus using a 3.5/2.7 Hybrid arthrodesis plate together with BoneCure® Membrane to stimulate osteogenesis across the joint surfaces. Dobby has been discharged with a 5 day course of Rilexine (600mg BID) and Rimadyl 50mg BID. After 10 days bandages and skin sutures were removed. Exercise was limited to 3 or 4 ten minute daily walks for 6 weeks , no jumping or stairs or playing with other dogs during this period. (Surgeon: Hamish R. Denny , MA, VetMB, PhD, DSAO, FRCVS)
Non-Union Case: Charlie
Adult cat suffering a distal tibialfracture which was repaired with External Fixation but did not unite for 6 months. After having used BoneCure® Membrane in the region, the fracture healed in 3 months.
The pre op radiographs performed did show that the distal end of the fracture had healed (as before), it was the proximal end where the non-union had formed. An oscillating saw was used to refresh the bone, then a minimum amount of soft tissue was stripped; the BoneCure® Membrane was wrapped 360 degrees along the fracture site leaving 2-3 cm of membrane proximal and distal to the ends of the fracture line (as it is oblique) on each side; 2x1.5 mm cortical screws were placed distal and proximal to the fracture site in order to fix the membrane. (Surgeon: Jesse DavicioniDVM, MRCVS, Anderson Veterinary Group, Orpington, Kent, UK)
Non-Union Case: Miyo
Miyo fell on 10.5.2012 from the 4th Floor and had a diaphysealtibialcomminuted fracture (left). On the 11.5.2012 the fracture was surgically treated with an external fixator type 2. On 20.6.2012 the radiographs did not show visible bone regrowth.
Also on 7.10.2012 (2 months post-op) no fracture healing was visible. The fracture area was crushed and reoperatedwith a spongiosaautograftand BoneCure® Membrane in cone form around the dorsal tibia.
Radiographs were taken on 30.7.2012, 21.8.2012, 25.9.2012 and 11.10.2012.
Due to the now visible bone healing capacity and the resilience of the leg, the external fixator was removed on 11.10.2012. (Freie Universität Berlin, Small Animal Clinic, Prof. Dr. Leo Brunnberg)
65 Kg St. Bernard female with a closed comminuted fracture of her Radius and Ulna; repaired with BoneCure® Membrane and with Type llconfiguration (Uniplanarbilateral) plus acrylic bars to support the frame; three pins external fixator. Showed almost complete healing by 3 weeks and complete healing by 6 weeks. (Surgeon: ItamarTsur, B.Sc. (Hons.), B.V.Sc., MRCVS, DVM)
4 years old DSH cat, that fell off the 4th floor (High Rise Syndrome); there was a comminuted fracture of the femur. No attempt was made to reduce the fragments with cerclagewires, rather the BoneCure® Membrane was wrapped around the whole area, after an IM pin was introduced into the bone. (Surgeon: ItamarTsur, B.Sc. (Hons.), B.V.Sc., MRCVS, DVM)
Babis fell on 10.7.2012 from the arm and had a diaphyseal radius fracture on the ulna (right). Treated on 11.7.2012 with a 2-0 DCP 8-hole plate and BoneCure® Membrane around the fracture. The first few days the leg was immobilized with a crepe bandage. On 10.8.2012 (4 weeks post-op) an X-ray was taken which showed that the fracture was almost completely healed. The dog was clinically normal, the leg was loaded normally. The further course of healing was uneventful; no additional radiographs. (FU Berlin, Small Animal Clinic, Prof. Dr. Leo Brunnberg)
4 years old Chinese Poodle, suffered a simple, distal third fracture of the Radius and Ulna. NOT a comminuted fracture, but as it appears in a size of dogs (breed) known to suffer from higher than average non unions, it was decided that in addition to a plate, the membrane will be used. A 2.7 mm DCP was used, with 7 screws. The expected time to healing under a plate in a mature skeleton is 5 months. The fracture in the radius (under the plate) seems to be totally healed in 6 weeks, while the ulnar fracture is completing the process albeit a little behind the radius. (Surgeon: ItamarTsur, B.Sc. (Hons.), B.V.Sc., MRCVS, DVM)
The Bussard is from the Berlin Zoo (Zoologischer Garten Berlin), the oldest and most visited zoo in Germany. The fracture was treated with with a plate and BoneCure® Membrane around the fracture. 2 weeks post-op an X-ray was taken which showed that the fracture was almost completely healed. 3 weeks post-op the plate was removed. The Bussard returned to the zoo. (Freie Universität Berlin, Small Animal Clinic, Prof. Dr. Leo Brunnberg).