Tenorrhaphy and modified immobilization technique for the management of transected tendons in a bullock.
Tendons are elongated extension of muscles which allow minimal size and maximal strength for insertion to bone (Oehme and Prier, 1974; Tyagi and Singh, 2010). The main function of a tendon is to transfer muscle contraction for skeletal movement (Tyagi and Singh, 2010). Injury to the tendon includes large part of orthopedic activities in animals and disruption of tendon occurs usually as a result of direct trauma (Assal et al., 2002; Mazzone and Mc Cue, 2002) or following tendonitis treated with steroids (Kleinman and Gross, 1983; Hersh and Heath, 2002). The nature of trauma influences the type of tendon injury and may result in acute rupture of the tendon with partial or complete loss of integrity of the structure, sometimes with exposure of tendon ends. During post-operative management after tenorrhaphy, primarily in the early stages of healing, limb immobilization is essential. Movement can produce a significant space between the tendon ends decreasing the local blood supply and increasing fibrosis, which can compromise healing and final functional outcome (Clark, 2001).
History and Diagnosis
A non-descript bullock aged eight years was presented with history of cutting forearm in posterior aspect above the accessory carpal bone (Fig.1). Advancement of limb was not free and there was inability to keep the foot in its normal position. On close examination, the tendon of flexor carpi ulnaris and superficial digital flexor were found to be transected about one inch above the accessory carpal bone (Fig. 2). Hence repair of tendon was considered at the door step of owner in order to avoid loosening of post-operative immobilizing device.
The animal was fasted for 24 hours before it sedation with Xylazine hydrochloride @ 0.1 mg/ kg body weight intramuscularly. The the animal was restrained in lateral recumbency over soft bedding keeping the left forelimb upward. The skin around the wound was shaved properly and a surgical debridement with proper dressing of the wound was performed. After isolating the individual tendon ends from the surrounding tissue, the margins were debrided and the site was thoroughly flushed with normal saline followed by povidone iodine solution. Tenorrhaphy of individual tendon with its counterpart was performed by Bunnel mayer technique with black braided silk no. 4. Another few interrupted sutures were placed transverse to the apposition line. Fascia was closed with chromic catgut no. 2. Finally the skin gap was reduced by placement of two vertical mattress sutures passed through both the tendon and skin. The wound was covered with thick padded antiseptic absorbent bandage (Fig. 3).
For immobilization of limb after tendon repair and keeping the carpal joint with mild flexon an angular frame device was fabricated (Fig. 4). Along with the angular frame device, a modified Thomas splint was prepared for the support of the body in standing position. The limb was retained properly in flexed knee position inside the angular frame. The hoof was positioned in flexed condition over a cup shaped rubber padding fitted initially at the bottom of the frame (Fig. 5). In the second attempt the entire limb along with the angulated frame was immobilized with additional Thomas splint. For the post-operative care the animal was housed within a 10 ft. by 10 ft. enclosure area for 1% months (Fig. 6). Antibiotics Ceftriaxone @ 10 mg/kg body weight (Intacef (a)) and Meloxicam @ 0.2 mg/kg body weight (Melonex (a)) were given intramuscularly for 7 days. Local dressing was continued through the window for 7 days. The protective bandage cover was removed without disturbing the immobilizer after 7 days. The sutures and the immobilizer were removed after one month. Again the animal was housed within the enclosure for a period of 15 days. The tendon healing was perfect (Fig. 7). The pressure wounds created by the immobilizers were dressed by fly repellants and antiseptics till healing. The bullock had a perfect healing and was cured from the condition (Fig. 8).
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Result and Discussion
The healing process of a tendon injury is usually difficult and uncertain because the prognosis varies widely depending on the amount of trauma and the time that elapses between trauma and treatment. Moreover complicated recoveries are mainly due to low vascularization of the tendon structure, adhesion of tendons to surrounding tissues and diastasis of tendon ends due to tension and active load (Spinella et al., 2010). Like that of fracture immobilization, immobilization of the limb plays a vital role for the successful healing of a repaired tendon. During postoperative management, primarily in the early stages of tendon healing, perfect limb immobilization is very much essential. Movement may create a significant space between the tendon ends, decreasing the local blood supply and increasing fibrosis, which can compromise healing and final functional outcome (Clark, 2001). For tendon healing the portion of the limb needs to be immobilized in flexed position. For immobilization of limb in flexed position the use of angulated frame has a very beneficial effect as the suture site is kept undisturbed which is essential for tendon repair. The operated limb was immobilized in such a way that, the carpal joint was slightly flexed and the hoof was kept flexed over the angulated frame at the bottom to reduce tension of the tendon. However use of angulated frame along with Thomas splint was found to be effective as it maintains the limb length. Animal reaction for the application of immobilizers was found to be co-operative. There was no non-weight bearing lameness after splint removal, only mild lameness was observed for 3-4 days which vanished after mild exercise. The animal was again kept inside the enclosure for another 15 days with mild exercise. Complete recovery with workable condition of the bullock was observed after 1% months.
Assal, M., Stern, R. and Peter, R. (2002). Fracture of the ankle associated with rupture of the Achilles tendon: case report and review of literature. J Orthop Trauma. 16: 385-61.
Clark, D.M. (2001). Tendon lesion and its treatment. In: Bojrab M J (ed.): Disease Mechanisms in Small Animal. Giraldi, Bologna. pp: 1414-18.
Hersh, B.L. and Heath, N.S. (2002). Achilles tendon rupture as a result of oral steroid therapy. J Am Podiatr Med Assoc. 92: 355-58.
Kleinman, M.D. and Gross, A.E. (1983). Achilles tendon rupture following steroid injection. J Bone Joint Surg. 65-A: 1345-47.
Mazzone, M.F. and McCue, T. (2002). Common conditions of the Achilles tendon. Am Fam Physician. 65: 1805-10.
Oehme, F.W. and Prier (1974). Textbook of Large Animal Surgery. The Williams and Wilkins Company. Baltimore. pp: 245-60.
Spinella, G., Tamburro, R., Loprete, G., Villar, J.M. and Valentini, S. (2010). Surgical repair of Achilles tendon rupture in dogs: a review of the literature, a case report and new perspectives. Veterinarni Medicina 55: 303-10.
Tyagi, R.P.S. and Singh, Jit. (2010). Ruminant Surgery, CBS publications, New Delhi. pp: 304-13.
Sadananda Nayak (1), Sidhartha Sankar Behera (2), Prasanta Kumar Sika (2)
Department of Veterinary Surgery and Radiology College of Veterinary Science and Animal Husbandry Odisha University of Agriculture and Technology Bhubaneswar--751003 (Odisha)
(1) Professor/Head and Corresponding Author E-mail: email@example.com
(2) Post Graduate Scholar
(a)--Brand of Intas Animal Health, Ahmedabad
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|Title Annotation:||Short Communication|
|Author:||Nayak, Sadananda; Behera, Sidhartha Sankar; Sika, Prasanta Kumar|
|Date:||Jul 1, 2012|
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