# Fracture non-union: when do you give up?



## Teresa (Jul 10, 2005)

My rescue Halo has two fractures of the tibiotarsus, very close together.
She was so frail and thin when I got her that I suspected the injury must be several days old, but the fractures weren't exposed, so at least there was no necrotic tissue to worry about.
Knowing I was out of my league, I took her to my avian vet, who X-rayed her and bound the leg. After 2 weeks of treatment (which included a course of Flagyl for the scary poops, an anti-inflammatory and Baytril) she was X-rayed again yesterday.
The bone hasn't knit together. The vet says perhaps we got to her too late, past the point where the bone would mend itself. The proposed course of action is to persevere until either the bone knits or we have to give up and have her leg amputated. 
I have another rescue, Hercules, who had the same problem, but there was only one fracture, so after 2 months the vet (+ two surgeons) performed a remarkable operation that saved his leg, though he walks with a pronounced limp. But in Halo's case that isn't possible, as the bone can't take it.

I would appreciate any advice from those of you who have had experience of this kind of problem, namely when will we know if it's just not going to happen?


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## Reti (Jul 20, 2003)

Can you tell from the x-rays if the bone fragments are in contact? If they are not, most likely they won't fuse together and start healing. In that case she will need surgery, to cut a little bit form each bone margin and fixate it together with screws. 
I had it done in one of my rescues and it had worked great. She ended up with the leg shorter than the other but you could harldy tell as she walked fine.

Reti


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## Dobato (Jul 3, 2008)

Teresa, I thought I would mention, although not exactly the same, a situation where a leg break would not heal. It seems because of the location and type of break even putting small amounts of weight on it, although the leg was splinted was interfering with the bones joining. Only after putting this particular bird into a sling for a few weeks did it heal and with a very good outcome, no limp and just a slight turn in on the leg.

Good luck with him,

Karyn


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## boneyrajan.k (Jul 15, 2010)

The medical vets may not be able to advise u on this,try to take her to a vet who specializes in bones (orthopaedics),i think,if its not too late,then he may be able to re-unite the bones with surgery and make it functional to a certain limit


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## Teresa (Jul 10, 2005)

Thank you for your advice, it is much appreciated.

Reti, the bone fragments are not in contact. Also, it wasn't clear from the X-ray, but it's very possible that the bone fragments are themselves fissured/cracked.
The procedure you described seems different from what was suggested to me, and I will mention it to my vet. I had no idea it would be possible to join the fragments into a shorter length that will allow the pigeon to still lead a normal life. Thanks again! 

Karyn, I asked my vet if it would be a good idea to put Halo on a sling, but she said it wouldn't help with the bad leg, though it would be good to help take the strain out of the good leg.
I've got some pictures of bird sling designs and I'm going to see what would work best. Meanwhile she's on a soft surface with a rolled-up towel to snuggle up to for support.

Boneyrajan, fortunately my avian vet is one of a team at a veterinary hospital which is headed by an orthopaedic surgeon (so good in fact, he's a prof at our most prestigious university) and he will naturally be involved soon if Halo's leg doesn't set by itself. He was the one who, together with a specialist in animal microsurgery, operated on my Hercules before.
My avian vet said today that they will try surgery first, and only go for amputation if the bones shatter.


This was the procedure on Hercules's leg:










One metal pin was placed inside the bone, and three smaller ones were secured across it, and were held in place by resin (the black stuff). The operation was complicated by the fact that the fracture had been exposed for days and there was a lot of necrotic tissue. In fact, when I found him, his toes were so discoloured they were almost black -- and yet he was fighting the others for food... hence the name!!


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## Teresa (Jul 10, 2005)

P.S. The big problem in Portugal is the lack of training of even the best vets in dealing with pigeons. Bird surgery, so far, has been for expensive large exotics... Hercules may well be the first Portuguese pigeon who didn't get euthanised for his horrific injury. 
I will ring them on Monday, as it seems clear from what you said that the sooner the surgery is done, the better.


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## Dobato (Jul 3, 2008)

Teresa, he sounds like he is, and will be receiving the very best of care. The only other suggestion I have right now, and you may have already tried it, is trying him in a donut, instead of just leaning against a towel for support.

http://www.pigeons.biz/forums/showpost.php?p=467722&postcount=6

Good luck with him,

Karyn


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## Teresa (Jul 10, 2005)

I'll do that, Karyn, thanks a lot!


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## Larry_Cologne (Jul 6, 2004)

Okay, this post may not be worth paying any attention to, since I am going on memory, and I think Pidgey would be a better source of info,

but ... 

you mention giving her Baytril, which, if I remember correctly, is the animal equivalent to the human version of Ciprobay (from Bayer) or _ciprofloxacin_, which interacts with calcium.

From Wikipedia (on ciprofloxacin):


> Concurrent administration of ciprofloxacin with magnesium or aluminum antacids, sucralfate or products containing calcium, iron, or zinc (including multivitamins or other dietary supplements) may substantially decrease the absorption of ciprofloxacin, resulting in serum and urine levels considerably lower than desired.


Would the Baytril deprive the healing process of calcium?

If I am wrong, we can delete this post, to avoid misinformation and confusion. This is just something that caught my eye, and I am not up-to-date on all the medication details and contraindications and dosages. (I feel a bit stupid making this comment, when your pidge has been seen by a vet.)

----

Amazing picture of the bone-pinning process on Hercules' leg!

Larry


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## John_D (Jan 24, 2002)

The problem of interaction is that calcium can 'bind' the medication and prevent, or at least hinder, proper absorption. Grit, pickstone, calcium syrups and other sources of calcium should be witheld for at least a few hours before and after administering Baytril.


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## Teresa (Jul 10, 2005)

Larry_Cologne said:


> Okay, this post may not be worth paying any attention to, since I am going on memory, and I think Pidgey would be a better source of info,
> 
> but ...
> 
> ...


Hi there, Larry! 

Of course I value your opinion, even when the bird's been seen by a vet! Vets in Portugal are not accustomed to treating pigeons, and even my avian vet says her specialist training was inadequate, and mostly about parrots. But, as I said to her, 'give me another couple of years and another 50 rescues, and you will be an authority on pigeons!'

About the Baytril, it's enrofloxacine rather than ciprofloxacine, but going by the name it will be a close relative and may have the same effect. At the moment she doesn't have grit available, just vitamins+calcium twice a week, a few hours after the Baytril, so I hope that's okay.

P.S. Lawrence the Cat says hello!


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## Teresa (Jul 10, 2005)

John_D said:


> The problem of interaction is that calcium can 'bind' the medication and prevent, or at least hinder, proper absorption. Grit, pickstone, calcium syrups and other sources of calcium should be witheld for at least a few hours before and after administering Baytril.


Hi, John! 

Halo doesn't have grit or pickstone available at the moment. Twice a week she gets a couple of drops of multivitamins and 0.03 ml calcium gluconate, at least 4 hours after the Baytril. That should be alright, shouldn't it?


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## Teresa (Jul 10, 2005)

Dobato said:


> Teresa, he sounds like he is, and will be receiving the very best of care. The only other suggestion I have right now, and you may have already tried it, is trying him in a donut, instead of just leaning against a towel for support.
> 
> http://www.pigeons.biz/forums/showpost.php?p=467722&postcount=6
> 
> ...


When it was time to give Halo her med and change her bedding I provided her with a donut made from a very soft old T-shirt. (I never liked that T-shirt, anyway!)
At first, she hopped out of it and went to the back of her basket grumbling (translation: 'Who does this human think she is to tell me what to do?') but after a few moments she went and settled down in it. She looks very comfortable. 
As I write this, she's preening.


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## Jaye (Mar 13, 2008)

Would there be any chance that scar tissue would just form and "bridge" the gaps of the breaks/fractures ? I had a rescue one, Betsy Red, who had a break of the tibiotarsus and her muscles had contracted enough that it was impossible to get the bones realigned w/o surgery. They had slid laterally to one another, like taking 2 pencils and laying one atop the other, just overlapping at their ends.

Her leg was splinted for 6 weeks while she was on antibiotics and Medacam for the first two, and the developing scar tissue actually "bound" one side of the break to the other. After the cast came off, and after 2 weeks of slowly beginning to use it, she was actually walking quite well and it was very stable, so she was released soonafter.

I know, not the same sorta fracture/break you are talking about.....

BTW, that Hercules solution is quite amazing.....


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## Teresa (Jul 10, 2005)

That's very interesting, Jaye!

I'd have to say none of the pigeons with broken legs that I've treated before healed in less than 5 weeks, so that must be why the vet wants to wait and continue the treatment while there's hope the bones will set.
But she seemed quite disappointed that there was no sign of a union yet. So there's the big question: how much ossification is normal after 2 weeks?

About Hercules, I understand that operation was a first here in Portugal. The surgeon had actually tried to source a titanium pin for the tibiotarsus, but none that thin was available.
There followed another operation to remove the three transversal pins, and later another to try to remove the longer pin. This last one was unsuccessful, because the bone had fused with it, and it couldn't be removed without damaging the bone. He still has that pin, which makes him a bionic pigeon, I suppose...


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## Teresa (Jul 10, 2005)

Halo when she was found:










The left leg was dangling lifeless and discoloured. My guess is whoever put that stupid bit of plastic-coated wire on her right leg broke the other one, as even now Madam doesn't like being handled.
She had horrible 'oil paint' poops and a soiled vent, and she was so thin that her keel was very prominent.

Her first splint:










She's a very lively little hen, bright and curious, and I hope she will be able to have her freedom back some day.

Geting confident:


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## Reti (Jul 20, 2003)

Teresa said:


> Thank you for your advice, it is much appreciated.
> 
> Reti, the bone fragments are not in contact. Also, it wasn't clear from the X-ray, but it's very possible that the bone fragments are themselves fissured/cracked.
> The procedure you described seems different from what was suggested to me, and I will mention it to my vet. I had no idea it would be possible to join the fragments into a shorter length that will allow the pigeon to still lead a normal life. Thanks again!
> ...



This is what Gia's leg looked like after the surgery. My vet had cut off some of the margins of the of bones as they were necrotic (one was exposed). After he had put in the pins he took an x-ray and noticed that the bones were not in contact, so he did a second surgery to bring the bones closer to each other. It took a long time for callus to form but did eventually after about three weeks. Then he kept the pins in for another four weeks.
So, it took about two months for the fracture to heal.

Reti


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## Reti (Jul 20, 2003)

Teresa said:


> Hi there, Larry!
> 
> Of course I value your opinion, even when the bird's been seen by a vet! Vets in Portugal are not accustomed to treating pigeons, and even my avian vet says her specialist training was inadequate, and mostly about parrots. But, as I said to her, 'give me another couple of years and another 50 rescues, and you will be an authority on pigeons!'
> 
> ...



Cipro and Baytril are form the same family of antibiotics. My vet recently told me that Baytril is converted into Cirpo by metabolism.

Reti


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## Pidgey (May 20, 2005)

It's not uncommon to get a non-union when there's an infection in the injured area. Sometimes, you have to cure that osteomyelitis before you can get the fracture to mend.

Pidgey


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## Teresa (Jul 10, 2005)

Reti said:


> This is what Gia's leg looked like after the surgery. My vet had cut off some of the margins of the of bones as they were necrotic (one was exposed). After he had put in the pins he took an x-ray and noticed that the bones were not in contact, so he did a second surgery to bring the bones closer to each other. It took a long time for callus to form but did eventually after about three weeks. Then he kept the pins in for another four weeks.
> So, it took about two months for the fracture to heal.
> 
> Reti


Thanks, Reti, I was in fact wondering whether Gia had undergone a different procedure.
My vet does intend to try that method on Halo too, if no callus forms, but she told me that there was an uncomfortably high probability that her bone fragments might shatter, in which case they'd amputate.
Did Gia have another pin inside her bone too?


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## Teresa (Jul 10, 2005)

Pidgey said:


> It's not uncommon to get a non-union when there's an infection in the injured area. Sometimes, you have to cure that osteomyelitis before you can get the fracture to mend.
> 
> Pidgey


Thanks, Pidgey.
She's been on Baytril for just over 2 weeks. Is Baytril good to combat osteomyelitis?


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## Reti (Jul 20, 2003)

Teresa said:


> Thanks, Reti, I was in fact wondering whether Gia had undergone a different procedure.
> My vet does intend to try that method on Halo too, if no callus forms, but she told me that there was an uncomfortably high probability that her bone fragments might shatter, in which case they'd amputate.
> Did Gia have another pin inside her bone too?


No, she didn't, just the ones you could see on the outside.
Baytril should work. Gia was on Baytril as she had one fragment exposed and it worked fine.

Reti


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## Teresa (Jul 10, 2005)

Thanks, Reti!


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## Teresa (Jul 10, 2005)

*Good news!*

Halo had another X-ray today, and it showed that the uppermost fracture has formed a callus and it's almost set, and the other fracture shows signs of progress.
I'm just over the moon!!!


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## Dobato (Jul 3, 2008)

Teresa, thanks for posting this very positive update. Glad you hung in there with him and there are now signs of real progress. Please do keep us updated of how things continue to go for this little guy.

Good job,

Karyn


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## Reti (Jul 20, 2003)

That is wonderful news Teresa. I am thrilled.

Reti


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## Teresa (Jul 10, 2005)

*THE SPLINT IS OFF!!!!!*









Halo went back to the vet's today for her follow-up X-ray and *the fractures have healed!*
But she has lost a lot of mobility to the joint, because of the long period of time with her leg fixed in the healing position.

She's to take it easy for a week, to give the new bone tissue time to harden up a bit more, and so she can get used to start using that leg. After that, there will be physio to see if we can get some mobility back.

I was so worried that her leg wouldn't set... this really is the best of news!


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## Reti (Jul 20, 2003)

He must feel so much better now with the splint off. That is so great. I am sure he will gain some mobility back if not all of it. 
You did a great job Teresa.

Reti


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## Dobato (Jul 3, 2008)

Teresa, you really have brought this little guy along, very well done. I agree with Reti, in time, and with some physio care, his use of the leg should improve as it gets use. Do please keep us updated of his progress in the future.

Karyn


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## Pidgey (May 20, 2005)

Pigeons seem to do their own physical therapy pretty well. I'm guessing that's mostly because they've never been taught how to use the buttons on TV remote controls...

Pidgey


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## Teresa (Jul 10, 2005)

Pidgey said:


> Pigeons seem to do their own physical therapy prett well. I'm guessing that's mostly because they've never been taught how to use the buttons on TV remote controls...
> 
> Pidgey


LOL, Don't give them ideas! They're demanding enough as it is, they're not having the remotes as well... I'd want to watch something else besides NatGeo Wild!


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## Teresa (Jul 10, 2005)

Thank you, Reti and Karyn!

She hasn't attempted to put any weight on that leg yet, in so much as I've seen, but she was preening it earlier on.
I'll keep you posted.


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## Teresa (Jul 10, 2005)

Here she is, without the splint, after her bath, eyeing the camera with suspicion! 
*Two toes on the ground, that's a good beginning!*










Bath time is perfect for a little hydrotherapy! I put in enough water so her feet barely touched the bottom and supported her throughout. She enjoyed wiggling both legs, as she didn't have to put any weight on them.


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## Reti (Jul 20, 2003)

can she walk on that leg? I am sure in time it'll straighten out more.

Reti


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## Teresa (Jul 10, 2005)

No, she hasn't walked on it yet, the best so far was a limp without bending the knee.


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## Reti (Jul 20, 2003)

She'll get better. Her muscles are still weak cause of the cast and keeping the leg immobile for so long. In a few days you should see some improvement.

Reti


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## Teresa (Jul 10, 2005)

*You were so right, Reti!*

Halo can now stand on both legs!  She always shows a little improvement after her hydrotherapy sessions.










And she's managed a few steps too, though she doesn't bend her 'knee'.

But I'm still concerned about that lower fracture. The vet did say that it wasn't as well lined up as the other one, and that the splint had caused a little wound from rubbing (now totally healed), but I don't like the colour of the joint, and it looks swollen (but doesn't feel warm to the touch), so I'm wondering if she should have a new course of Baytril. What do you think?


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## Dobato (Jul 3, 2008)

Teresa said:


> But I'm still concerned about that lower fracture. The vet did say that it wasn't as well lined up as the other one, and that the splint had caused a little wound from rubbing (now totally healed), but I don't like the colour of the joint, and it looks swollen (but doesn't feel warm to the touch), so I'm wondering if she should have a new course of Baytril. What do you think?


Teresa, I am going to PM Pidgey to have a look at that joint, is there some give to the swelling, is it a bit soft, or is it hard feeling, more bone like?

Karyn


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## Pidgey (May 20, 2005)

Hmm... can you take a few more pictures (like close-ups or zoom-ins), front and side? Yeah, I see a little yellowing that may or may not indicate a slight infection. It's usually better to play it safe and medicate. No, the bird's not going to free that up too fast, considering how long it took to mend in the first place. The alignment reminds one more of a splay-legged pigeon, but we'll just have to see how it gets on in that respect--hardly anything we can do about that at this point anyhow.

Pidgey


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## Reti (Jul 20, 2003)

You can try a course of Baytril, see if the swelling goes down. But Gia and Brian have something very similar from old fractures. That happenes sometimes when the joints are not properly aligned. Brian's legs (he had them both fractured) look misaligned and they are kinda stiff, but he walks fine.

Reti


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## Teresa (Jul 10, 2005)

Thank you Karyn, Pidgey and Reti.

The swelling is hard and bone-like, and it doesn't feel warm to the touch -- that's why I hesitated. The vet did say the alignment on the lowermost fracture wasn't perfect, there's a little overlap.

I haven't managed to take any decent close-ups as she doesn't much like being handled and fidgets, and there goes the focus... However the colour has improved in the last few days, so perhaps it was because of the abrasion caused by the splint.
I'll keep a close eye on it, and I'll ask my daughter to take some pics while I hold little Miss Fidget.

Thanks again.


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## Teresa (Jul 10, 2005)

Just a quick update, to let you know that *Halo is now walking very well!* 
Her toes still point sideways a bit, but she has a lot more movement on her leg, and the joint is looking much better.

In this picture, she's third from the camera, and you can see her using her bad leg to grip the edge of the plant pot.










PS. Don't be alarmed by the one in the foreground. That's Sammy, a PMV survivor, and after 2 years she still stargazes sometimes when she gets excited.


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## Reti (Jul 20, 2003)

As long as he can walk alright it doesn't matter what it looks like I see he has a good grip. I am so glad he recovered so wondeful. You did a great job, Teresa.
Your pijies look so happy and healthy 

Reti


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## Teresa (Jul 10, 2005)

Thank you, Reti! They've got me well trained, lol!


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## Reti (Jul 20, 2003)

Teresa said:


> Thank you, Reti! They've got me well trained, lol!


Yeah, they are experts in doing that 

Reti


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## Libis (Oct 8, 2010)

Teresa said:


> Just a quick update, to let you know that *Halo is now walking very well!*
> Her toes still point sideways a bit, but she has a lot more movement on her leg, and the joint is looking much better.
> 
> In this picture, she's third from the camera, and you can see her using her bad leg to grip the edge of the plant pot.
> ...


Glad that she's recovering so well! 

Is that a sunroom that you keep your birds in? I've always dreamed of making a sunroom for my doves. If I'm looking at it right, what's your setup like?


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