the improper placement of implant (e.g. a screw that
is too short) or the placement of inappropriately sized
implant. The latter can lead to implant failure if the im-
plants are too small, or predispose to fracture of the
bone if too large (even in the face of being applied
appropriately)
Critical Review of Postoperative Radiographs
When assessing a fracture repair, detailed attention
needs to be paid to the fracture alignment, apposition
and placement of the surgical implants. To be able to
assess the alignment one needs to consider the angu-
lar and torsional displacement relative to normal anat-
omy. This is best done by evaluating the joint above
and below the fracture and it is thus of cardinal im-
portance that these joints be included in the postop-
erative radiographs. Contralateral radiographs can be
used to assess the normal joint angles.
A certain degree of apposition between the fracture
fragments are necessary in order for bone healing to
occur. Granted that in certain scenarios, like the open
but do not touch procedures, or the minimally invasive
plate osteosynthesis (if done in severely comminuted
fractures) one can expect the fracture haematoma to
reabsorb and the fracture fragment to move clos-
er to the central axis of the long bone with time.
Along with the bone the implants it is also necessary
to assess whether the implants will maintain stabil-
ity of the fracture until healed. Critical review of the
placement of the implants is necessary to determine
whether the standard protocols have been followed
for the placement of that specific implant.
Dealing with implant failures can be frustrating as
failure can result in the loss of proper bone stock
for implant placement, significant soft tissue trau-
ma, additional costs, prolonged time to healing and
increased patient morbidity. Adequate preoperative
planning, good surgical technique and critical review
of the osteosyntehsis will decrease the incidence of
implant failure.
Source Material
Johnson, AL. Implant failure IN: Griffon D, Hamaide
A Eds. Complications in Small Animal Surgery, Black-
well Wiley 2016, p641-668
Johnson AL, Houlton JE, Vannini R. AO Principles of
Fracture Management in the Dog and Cat, Thieme,
2005
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