Incidence, classification and management of appendicular Bone fractures in dogs in nairobi county, kenya. A retrospective study

Abstract

Dogs and cats constitute the majority of domestic pets worldwide, Kenya included. These pets are prone to sustain appendicular bone fractures, which are frequently caused by traumatic injuries, or bone pathology. A retrospective study was carried out with the objectives of determining the incidence and associated risk factors of appendicular bone fractures; establishing the types and frequency of occurrence of fractures of appendicular skeleton; determining existing protocols for the management of appendicular fractures, and the associated complications and challenges, in small animal practices, in Nairobi County. The incidence and associated risk factors of appendicular bone fractures and the types of fractures and their frequency of occurrence were determined by retriving all records of cases diagnosed with appendicular skeletal bone fractures in the practices between April 2007 and December 2013. Data on each case which included the diagnosis, date, month and year of occurrence, breed, gender, age, type of fracture, limb affected, bone affected and the description of the fracture, were obtained and recorded. Protocols for management of appendicular bone fractures, associated complications and challenges were determined by analyzing data collected through structured questionnaires and review of patient records in participating practices. A total of 402 cases of fractures were retrived at the practices surveyed in this study. Out of these, 59 were appendicular fractures, giving an incidence of 14.7%. The incidence of hind limb fractures was higher than that for the forelimbs. Ninety percent (90%) of appendicular fractures affected entire males and females. The age of affected dogs ranged from 4 months to 10 years. The German shepherd breed of dogs and its crosses were the most affected. Male dogs (69%) were more affected than their female counterparts (31%). In the forelimb, the radius-ulna had the highest incidence of fractures (22%) followed by humeral fractures (13.6%). In the hind limb, femoral fractures had the highest incidence (30.5%), followed by tibia-fibula fractures (18.6%). Overall, diagnosis of fractures was achieved through physical examination of dogs and confirmation by radiography. Unknown trauma was the principal cause of fractures; followed by motor traffic accidents, human abuse, animal bites, falls and indoor trauma. The most common types of fractures encountered were complete simple transverse fractures (65%), followed by oblique (15%) and comminuted (5%) fractures. Fracture management comprised external and internal fixation techniques. The most common internal fixation technique employed was intramedullary fixation of long bone fractures. Other devices used included orthopedic wires, bone plates and bone screws. Cast bandage was used largely for external coaptation. These were no complications following appendicular fracture management in 22% of the cases. However, complications were encountered in 44% of the cases. Delayed union, non union and implant failure were the most encountered complications. Osteomyelitis, implant migration, arthritis and wound infection were usually seen in cases with unstable comminuted fractures. The challenges of managing appendicular bone fractures were non-compliance by the owners, limitations of resources and lack of appropriate surgical instrument, equipment and expertise. Record keeping was also noted as a major challenge in a number of practices. The study concluded that the incidence of appendicular bone fractures in dogs in Nairobi County is low, male dogs were affected more than female dogs and hind limb fractures were more common than fore limb fractures. Unknown trauma and motor traffic accidents were the two most common causes of fractures. Furthermore, the outcomes of managed appendicular fractures were largely not satisfactory and post-management complications were not uncommon. Whereas the necessary materials for fracture management may be readily available, their use is constrained by high cost, limited surgical skills and lack of appropriate surgical equipment. There is need to improve surgical skills in orthopaedics for better surgical outcomes in fracture cases. Also there is a need to keep proper records in small animal practices in Nairobi County. These can be achieved through targeted training.