Fracture Management in Avian Species

Surgical stabilization of a mandibular fracture in a pet African goose (Anser anser domesticus) with bilateral mandibular fractures

A 7-month-old, 3.8 kg, female intact African goose (Anser anser domesticus), was presented on emergency after being struck by a metal chair during a strong gust of wind. Physical examination revealed ventral displacement of rostral portion of the mandible. A cone beam computed tomography (CBCT) scan confirmed complete, comminuted, bilateral fractures on the rostral portion of the mandibular body. Surgical intervention involved applying external fixation using self-threading Thread Mate System (TMS) pins, orthodontic chains, and dental acrylics to stabilize the right mandible. Indirect reduction and inherent stability were achieved on the left side. An esophagostomy tube was placed to prevent manipulation of the bill during feeding and medication administration in the post operative period. The goose prematurely removed the esophagostomy tube and dental acrylics 10 days after surgery. At the two week post-operative recheck, the bill was stable on palpation and the goose was using it for eating and drinking without complications. At follow-up examination one month after surgery, the goose continued to clinically do well, but all fixations had been self-removed. A repeat CBCT scan revealed bony callus formation of the left fracture site and fibrous callus with incomplete osseous bridging of the right fracture site consistent with delayed union. At 8 months post-operatively, the goose was clinically normal without functional impairment to the bill.

Histologic characterization of fracture repair process in wild birds in association with gross appearance of the bone lesion

This study aims to provide an in-depth examination of the histological changes that occur during the repair of untreated bone fractures in avian species, correlating these microscopic alterations with gross anatomical characteristics observed during different tissue repair phases. A total of 93 bone fractures from different wild birds were analyzed and classified based on temporality (acute, subacute, and chronic) according to the color changes of the hematoma and morphology (open or closed; simple, comminuted, or greenstick fractures). From a microscopic standpoint, a strong correlation was observed between the temporal progression observed macroscopically and the histological changes evident in each temporal category. Microscopic variations were found to depend on the nature of the fracture. Lesional patterns directly related to the macroscopic appearance of the fracture were established. Acute fractures exhibited extensive hematomas and an intense inflammatory response; subacute fractures showed immature granulation tissue and early signs of soft callus formation; and finally, chronic fractures were characterized by prominent soft calluses and hard calluses in different stages of development. The possible factors influencing each phase of the healing process, such as the characteristics of the type of fracture, the stability of the fracture site, bacterial contamination, the chronicity of the fracture, and the potential differences in the progression of histological changes between different animal species, are discussed. This association may be of clinical utility in decision-making for the treatment and prognosis of bone fractures in birds.

Attitudes and opinions of Brazilian veterinarians towards the assessment and management of acute avian pain

BACKGROUND

Veterinarians' approaches to the management of avian pain have been poorly documented despite the rising number of pet birds seen in clinical settings.

METHODS

An online survey was advertised nationwide to recruit Brazilian veterinarians who had treated traumatic and surgical conditions in birds within the previous year. The survey comprised 25 closed or semi-closed questions divided into four sections (demographics, routinely performed medical procedures and pain recognition, drug choices for analgesia and challenges to pain treatment, and attitudes towards pain relief in birds). Survey results are expressed as a percentage of responses and a chi-squared test was used to compare proportions.

RESULTS

A total of 370 completed surveys were received. Approximately 72% of respondents worked exclusively in wild/exotic animal practice. Parrots and related species were the most commonly seen birds. The most frequently reported painful conditions were fractures (88.4%), feather plucking (73.0%) and limb amputation (65.1%). Although pain was diagnosed behaviourally by 97.6% of the respondents, 83.5% believed that the presence of an observer inhibited avian pain expression. NSAIDs and opioids, most commonly meloxicam and tramadol, were always provided perioperatively by 66.4% and 42.1% of respondents, respectively. Although nearly all respondents (95.4%) agreed that analgesics improve the quality of recovery after surgery, 80.3% stated that acute pain in birds is frequently undiagnosed in the clinical setting.

LIMITATIONS

Selection bias could have overestimated the attitudes concerning avian pain in relation to the wider veterinary population.

CONCLUSION

Practising veterinarians in Brazil revealed a positive attitude towards avian pain management. However, the lack of validated pain assessment methods makes avian pain relief highly challenging.

Retrospective Analysis of Pelvic Limb Fracture Management in Companion Psittacine Birds (60 Cases)

Pelvic limb fractures carry significant morbidity in avian patients, and although management options are well researched, published data on long-term complication rates and mortality outcomes are limited. Here, we present a cross-sectional study evaluating pelvic limb long bone fractures in companion psittacine birds presenting to an exotic-only veterinary hospital in the United Kingdom between 2005 and 2020, focusing on fixation techniques and long-term outcomes. Of the 60 cases that met the inclusion criteria, 22 separate species were represented, with an age range of 8 weeks to 25 years and an even distribution of sexes, among those that had been sexed. The majority of fractures (71.7%) were tibiotarsal; femoral (15%) and tarsometatarsal (13.3%) bones represented the other fracture sites. Several different fracture management methods were used, including external coaptation, surgery, or cage rest. Average time from fracture identification to healing was 33 days, with a median of 31 days and a range of 11-121 days. Satisfactory resolution of fracture repair was achieved in 85.5% (47/55) of cases that were able to be followed to conclusion. Complications were identified in 41.7% (25/60) of fractures of all pelvic long bones. Complications during fracture management were more common in cases treated with external coaptation. The most common complication reported was patient interference with bandages, splints, or both. This study provides an overview of pelvic limb long bone fracture management outcomes, which should prove useful for avian practitioners in clinical practice.

A RETROSPECTIVE STUDY OF FEMORAL FRACTURES IN WILD BIRDS OF PREY: 119 CASES

A retrospective study was performed to describe patient and fracture characteristics, treatments, complications, and outcomes associated with femoral fractures in free-ranging birds of prey. Cases were identified from the electronic database and included raptors admitted with femoral fractures at the Bird of Prey Clinic of the Université de Montréal, from 1986 to 2018. In total, 119 individuals from 24 species, with 123 femoral fractures, were included in the study. Twenty-seven birds (23%) were declared dead upon arrival. Ninety-two birds (77%) were admitted alive; 80 with acute fractures and 12 with a fracture that had already healed. A conservative treatment (cage rest) was used to manage eight fractures. Surgical repair was attempted on 34 femoral fractures in 33 birds. An intramedullary pin alone was used in 28 cases (82%), and an external skeletal fixator-intramedullary pin tie-in fixator was used in 6 cases (18%). For surgically treated fractures, 19 healed (in 18 birds), 4 did not heal, and 11 birds died or were euthanized before healing could be achieved. Of the 23/34 fractures where the healing process could be assessed, healing rate for comminuted fractures (11/23) was 91% (10/11). Surgical complications occurred in 10 cases (including 7 cases of migration and loosening of the pin, and 1 case of osteomyelitis), leading to euthanasia in 4 cases. Out of the 21 birds with acute femoral fracture upon presentation that were released, 14 had received a surgical treatment and 7 had received a conservative treatment. Nine of the 21 released birds (43%) had at least one other fractured bone. The majority of deaths and euthanasia occurred within 2 wk after admission (51/59; 86%). Thirteen birds were euthanized primarily because of their femoral fracture. Thirteen birds died in treatment and 33 were deemed nonreleasable and euthanized because of a comorbidity not related to the femoral fracture.

Masquelet-Induced Membrane Characteristics in Chicken Radii Bone Defects

This study evaluated the formation of a Masquelet-induced membrane created through the formation of segmental bone defects in the radii of 15 healthy domestic chickens. When the chickens were in a surgical plane of anesthesia, a 1.5-cm segmental bone defect was produced in the left radius, which was subsequently filled with a bone cement spacer during its pasty polymerization phase. The bone defects were evaluated through radiographic imaging immediately after surgery and at 7, 15, 21, and 30 days after the creation of the bone defect. Five birds were euthanatized at 15, 21, and 30 days postoperatively for histological evaluation of the bone defect site. Immediate postoperative radiographic examination of the radii showed the presence of bone cement, which occupied the segmental bone defect. Thirty days after the surgical procedure, the presence of new bone formation at the fractured extremities was evident in the 5 remaining chickens. Histologically, the induced-membrane had 3 distinct zones at 15 days postoperatively, including 1 cell layer in contact with the bone cement spacer, 1 layer with collagen fibers, and 1 layer in contact with muscle, which was composed of disorganized connective tissue, active fibroblasts, and blood vessels. Twenty-one days after surgery, the zones were less defined, and there were metaplastic areas comprising cartilage and bone. Postoperative, diffuse mineralization of the membrane was observed 30 days after the surgical procedure. Formation of the induced membrane was observed during all periods of evaluation. The best histological characteristics for the Masquelet-induced membrane were detected 15 days after the formation of the bone defect, suggesting this would be the optimal time for second-stage surgery for bone reconstruction.