Introduction
Avian traumatic fractures present distinct difficulties owing to the species’ specialized skeletal structure and functional characteristics. The joints of birds appear to be particularly susceptible to ankylosis as a result of implant-associated trauma. Avian fractures are often open and frequently comminuted, especially in wild birds and zoo specimens [1]. Traumatic wing injuries in birds were a common problem in clinics that treat wildlife [2] when compared to pelvic limb injuries in birds. Avian bones are inherently fragile. They can fragment easily in response to various natural events, such as midair collisions or fights with other birds. In addition, anthropogenic experiences like gunshot wounds, collisions with automobiles or fences, encounters with traps, and attacks by dogs or cats can also cause fragmentation [2,3]. In the case of the simple fractures involving tibiotarsus bone, retrograde intra-medullary pinning was done using small sized pin or K-wire (1.2 mm) as per the size of the bone and the wound was apposed by simple interrupted sutures using polyglactin 910 size 3/0 absorbable suture material [4]. Successful stifle disarticulation surgeries for amputation of the pelvic limb were reported in two avian patients; a northern cardinal (Cardinalis cardinalis) presented with soft tissue swelling and a traumatic fracture of the third digit of the left limb, accompanied by secondary bacterial infection and necrosis, and a 25-year-old cockatiel (Nymphicus hollandicus) diagnosed with distal extremity necrosis following a nonunion of a closed tibiotarsal fracture [5]. The successful outcome of these two cases suggests that stifle disarticulation may be used as an alternative to transfemoral amputation in birds where prolonged surgery, anesthesia, or patient size precludes traditional amputation techniques. While wing amputation has been reported in pigeons [6], there is a lack of documentation on pelvic limb amputation in this breed. This case report aims to address this gap by presenting a unique case of pelvic limb amputation in a pigeon. To the best of our knowledge, this is the first reported case of a comminuted tibial fracture in a pigeon successfully treated with stifle disarticulation.
Case Report
Signalment and history
A 1-year-old hen pigeon (Columba livia domestica) of 150 g body weight was presented to the Avian Clinic of the Veterinary Teaching Hospital, University of Jos, Nigeria, with the chief complaint of a broken right pelvic limb. History revealed that the fracture resulted from an attack by a young lad within the neighborhood about 30 minutes before the presentation. The pet bird is housed in a pigeon net but is seldom allowed to fly around the neighborhood.
Clinical observations
Clinical presentation revealed a lethargic pigeon (Fig. 1A) with a fractured right tibia and an open wound. Closer examination (Fig. 1B) disclosed extensive tissue damage at the proximal third of the right tibia, including; significantly severed soft tissue (yellow arrow), complete tibia fracture (white arrow), a bone fragment, hemorrhaging, regional tenderness and pale mucous membranes. Based on the clinical findings and history, the case was diagnosed as a right tibial proximal third open comminuted fracture and was managed by performing stifle disarticulation.
Presurgical preparation
Local anesthesia was achieved by infiltrating 1% lidocaine (PharmaX India Pvt. Ltd., Mumbai, India) around the stifle. The feathers proximal and distal to the stifle were manually plucked, and the site was prepared aseptically. The pigeon was restrained in left lateral recumbency, and the surgical site was then draped (Fig. 1B) before the procedure.
Surgical procedure
A stab skin incision was made just distal to the stifle, and the muscles were bluntly dissected to access the stifle joint. The tibiofemoral joint was then disarticulated using a scalpel blade. Approximately 5 mm of musculature distal to the stifle was transected. After arresting bleeders, the musculature was sutured with size 2/0 chromic catgut (Agarycryl®, Huaian Angel Med. Ins. Co., Ltd, Jiangsu, China) using a simple continuous pattern over the distal femur. The skin was closed (Fig. 1C) with a size 2/0 silk suture (Anhui Kangning Ind., Co., Ltd, Tiangchang, Anhui, China).
Post operative care
Post operatively, the pigeon received 150 mg/kg (0.1 ml) of 200 mg Amoxicillin Injection (Five-Amox.20® LA, Central Vet. Med., Hanoi, Vietnam) and 1 mg/kg (0.01 ml) of 10 mg Piroxicam Injection (Jiangxi Pharma., Co., Ltd, Jiangxi, China) intramuscularly (IM). These injections were repeated after 48 hours. In addition, 100 mg Iron dextran (0.3 ml) was administered IM. The wound was dressed every other day, and skin sutures were removed 8 days post-surgery. The pigeon showed remarkable recovery, regaining balance and flying comfortably.
Figure 1.
(A) The lethargic pigeon on the day of presentation during examination. (B) Closer view of the fractured limb; significantly severed soft tissue with hemorrhaging (white arrow) and complete tibial fracture at proximal third (yellow arrow). (C) The proposed surgical site is properly draped. (D) Skin closure with size 2/0 silk suture. (E) The surgical site after the procedure (red arrow). (F) The amputated portion of the right pelvic limb.
Discussion
The primary cause of the right tibial proximal third open comminuted fracture in the present case was likely the traumatic impact of the attack by the young individual, consistent with previous case reports [2,3] of avian traumatic fractures. This case bears similarity to previous reports of traumatic fractures involving the wing and tibiotarsus bones of pet birds, specifically pigeons, Columba livia domestica [4,5], but differs on the bases of the bone involved, i.e., the tibial bone. The comminuted nature of the tibial fracture in our case differs from the simple tibiotarsus fracture reported earlier [4]. Notably, retrograde intra-medullary pinning using small-sized pins or K-wires has been shown to be an effective treatment for uncomplicated tibiotarsus bone fractures. However, in the present case, the right tibial proximal third open comminuted fracture required a different approach. Stifle disarticulation surgery was performed, resulting in a remarkable outcome, which aligns with reports of successful management of comminuted fractures involving the pelvic limb in a Cockatiel and a Northern Cardinal [6]. General anesthesia using a Xylazine-Ketamine cocktail at 8 + 30 mg/kg, respectively, has been successfully employed in pigeons for limb amputation [5]. However, considering the patient’s compromised condition, characterized by blood loss, lethargy, and recumbency, local anesthesia with lidocaine hydrochloride was adopted for the disarticulation procedure. This approach enabled a swift and safe 15-minute surgery to be performed, avoiding the potential dangers of general anesthesia with xylazine and ketamine in a lethargic and recumbent patient. Several veterinarians have employed various standard orthopedic techniques for fracture management in pet and wild birds, including vultures and eagles with varying degrees of success [3,7,8]. Due to logistical constraints and the patient’s critical condition, pre-operative radiographic imaging was not feasible. A definitive diagnosis of right tibial proximal third open comminuted fracture was readily made based on the gross tissue damage. Therefore, surgical disarticulation of the right stifle was promptly undertaken to minimize pain, promote recovery, and for aesthetic purposes.
In conclusion, the successful outcome of this case proves to stifle disarticulation to be an effective treatment option for complex fractures in birds, underscoring the importance of innovative strategies and prompt surgical intervention. Furthermore, this case report addresses a significant gap in the literature, presenting the first documented case of a comminuted tibial fracture in a pigeon (Columba livia domestica) successfully treated with stifle disarticulation.
