At first glance, fracture treatment in human and veterinary patients seems very similar. The problem and solution are the same: treat a broken bone by restoring the anatomy and supporting the fracture by external three-point fixation with a cast or splint or by internal fixation with plates and screws. Despite the two fields of medicine having much in common, experts in human and veterinary medicine rarely exchange knowledge and experiences. In this article, we discuss key differences and similarities in fracture treatment in both medical fields and argue that a closer collaboration between them would benefit both medical professionals and their patients.
Common fracture types
The typical human fracture patient is an elderly woman who suffers a distal radius fracture after a low-energy fall. Other common human fractures are hip, ankle, shoulder and various hand fractures (Bergh et al., 2020). In comparison, the most common companion animal fractures are femoral, pelvic and tibial fractures (Abd El Raouf et al., 2019; Minar et al., 2013). In humans, high-energy fractures are rare and often due to traffic accidents or falls from heights. Companion animals, unfortunately, often suffer trauma caused by high energy secondary to motor vehicle accidents or falls from heights. This often leads to more severe and difficult-to-treat fractures in animals.
Fracture treatment methods
Treatment options are largely the same for animals and humans: internal and external fixation, casting and splinting. The key difference is the amount of surgery performed. In human orthopaedics, recent research findings seem to show a shift towards less rigid casting, shorter casting times and casting instead of surgery (Dias et al., 2020). In veterinary practice, almost the opposite is still true: many veterinarians prefer surgery simply out of a desire to avoid pressure sores. Surgery gives veterinarians a feeling of control over potential complications. In veterinary orthopaedics, it is often enough to stabilise the fracture with internal fixation. In contrast, for human patients, a cast is needed despite surgery, because the thin metal plates are not strong enough to withstand forces posed by the human body weight.
Many veterinarians prefer surgery simply out of a desire to avoid pressure sores. Surgery gives veterinarians a feeling of control over potential complications
Human medicine aims to offer the best treatment to everyone. There are financial support networks around the world to help people access the care they need. On the veterinary side, the pet owners’ financial status impacts treatment choices more heavily. Recent surveys show an increasing number of pet parents are unable to afford the rising costs of care (Harding, 2018; Giocanetti and Galvis, 2020; Zimlich, 2019). Surgery is expensive, which may lead to more owners looking for alternative treatment options within their financial means. In some cases, owners may have to resort to surrendering their pets to a rescue organisation or even opting for euthanasia.
A reduction in surgery lowers both the costs and resources required in fracture treatment substantially. Fewer operations will also help reduce complications such as infection and nerve damage. Shorter casting times are more convenient for the patient and lead to less stiffness and muscle atrophy.
Surgery is expensive, which may lead to more owners looking for alternative treatment options within their financial means
There is not yet enough evidence to say that less rigid casting and fewer surgeries would bring similar benefits to veterinary medicine as they do human medicine. However, we believe it would certainly be worth further research. The trend towards fewer surgeries and less rigid casting is positive in many ways – provided treatment results are similar, of course.
Causes of complications
The difference in fracture types and the larger proportion of high-energy fractures seen in animals puts them at a higher risk for complications. While human casting complications occur in approximately 1 to 10 percent of cases, veterinary casting complications often occur in more than 50 percent of cases. A retrospective study reported that more than 60 percent of cast-treated animals developed complications (Meeson et al., 2011). We argue that there are several reasons for the large difference in complication rates: compliance, anatomical differences and the ability to express discomfort.
There are several reasons for the large difference in complication rates: compliance, anatomical differences and the ability to express discomfort
Patient compliance is vastly different in human and animal patients. In humans, we see complications mostly in non-compliant patient groups such as small children. On the veterinary side, poor compliance is a problem for almost all patients. Animals are not careful with their injured limb; they chew on the cast and run through mud with it. Animals also hide pain well, which makes it difficult to detect complications early. As a result, cast injuries in companion animals are often more severe than in humans.
Differences in human and animal anatomy also impact complication rates. While humans tend to have an abundance of subcutaneous padding, most animals have little fatty tissue and many bony prominences. This is an issue for veterinarians making casts; add too much padding and the cast will get loose and fall off. Add too little padding and you will have a cast sore in no time.
Sharing knowledge across fields of expertise
When we started sharing our experiences and knowledge of human and veterinary medicine, we had a realisation: veterinary casting needs a device tailored completely for animal patients. Even if it works well enough for humans, the tube-shaped common cast is not ideal for animals. So, we started working with human medical and veterinary professionals to create a new veterinary cast. The result of this collaboration is a new type of external coaptation device for companion animals. The cast-splint hybrid is made from a novel heat-mouldable and eco-friendly material. While additional testing and refinements are underway, preliminary testing shows the device causes significantly fewer complications than a standard cast.
Traditionally, most advances in animal care have their origins in human medicine, which will also likely be the case in the future
Based on our experiences of interdisciplinary working, we would encourage more cooperation between human and veterinary practice. We are certain there are many lessons to be learned from both sides. For example, the invention of our new cast device would never have been possible if we did not combine state-of-the-art knowledge from human orthopaedics with rigorous veterinary experience. Traditionally, most advances in animal care have their origins in human medicine, which will also likely be the case in the future. Instead of just blindly trying to adopt the same practices, we encourage cross-disciplinary cooperation to try to better tailor human treatments to animals. We believe this is best done with experts from both sides present.
