Avian Orthopedics.

In a Western town we find two men of sullen countenances discussing an unpleasant set of circumstances. "Maybe we should just put him out of his misery," moans an obviously distraught cowboy. "You can tell that the leg's broke by the way it hangs there."

"Maybe there's another way", counters the thoughtfully attentive figure in white. "How did it happen?"

"Well, Polly and me was practicing this new trick where he rollerskates backwards on top of a ball up a teeter-totter. Guess he teetered, then crash, he was on the floor! Think I could teach a macaw to skate on one leg?"

Fortunately, Polly and others like him have several options when suffering from broken bones. Some are simple, some are complex, but at least we are not routinely forced into choosing the ultimate option. A word of caution would seem to be in order as we look into the various options. Many of the procedures mentioned here can cause almost as many problems as they solve if done improperly or if they are not cared for properly after application. Encircling a bird's body with tape may aid in the mending of a broken wing bone but it is also an excellent way to prevent that bird from breathing. The too, while one might get the idea that we are outlining a series of steps to be followed in any case of a broken bone, in actuality, each type of fracture must be evaluated in regards to the particular set of problems peculiar to each case before an initial course of action is chosen. All too many times well meaning but misapplied techniques have left little chance that the doctor can repair either the original problem or the ensuing complications. Please, do not use this one article as a course text in avian orthopedics. It is meant merely to point out some of the options open to the owner or breeder.

A natural starting point is how to determine if a fracture, or dislocation has occurred. There is little doubt that our cowboy was correct in his diagnosis. If the leg seems to have an extra joint which permits it to move at right angles in a 360° range, one might surmise one or more bones are no longer intact. However some fractures are not so dramatic. A broken toe or crack in the radius (thinner of two bones between the elbow, at the wing web, and wrist, at the base of the long primary flight feathers) but not in the ulna might be detected as restlessness or a relatively slight posture change. The best advice we can give is to take Max the Moluccan into his doctor whenever an abnormal posture or activity persists for more than a few hours.

A bit of super sleuthing reveals a fracture but no external wounds. Now we shall attempt to repair the damage with the least inconvenience to the patient. This is appropriate since the less a bird is bothered by a device, the more likely it is to leave the fracture site alone and thus permit it to heal more readily and better aligned. Many repairs are accomplished with seemingly simple tape splints. Adhesive tape, elastic tape, masking tape, cellophane tape have all been used at one time or another. For most applications, regular adhesive tape seems to be a good compromise between durability and excessive weight. The fractured radius shown in figure 1. was repaired with a tape splint. This particular restraint went all the way around the body while the wings were folded. An additional piece of tape was applied to hold the wing tips together. A few weeks later and this fracture had healed, as seen in figure 2. While the bones may still look weak, I can assure you that this pigeon was quite capable of flying. Broken legs may also be repaired using tape splints. Fractures of the tibiotarsus bone, similar to our shin bone, often heal well if the foot is held 90° to the leg bone and a piece of tape is applied to span above the "knee" and below the angle formed at the "ankle". While this single layer of tape is sufficiently strong to support the weight of a canary or budgie, cockatiel-sized patients may need additional layers. Many times we apply cellophane tape as a slick outer wrap to help the actual splint weather the commonly encountered chewing by hooked or chiseled beak.

"Come on now. You mean to say all I need is a roll of tape and I can be Harry Hyacinth's orthopedic specialist? That's great!"

Well, not exactly. Some bones are just too strong to get enough support from any feasible amount of tape. Other fractures, called comminuted fractures, are comprised of too many pieces to be readily lined up by mere external means. These cases likely require surgical manipulation.

While bone grafts and similar procedures are used in avian patients, stainless steel pins are used more commonly to reduce, i.e., repair, the fracture site. The size of these metallic devices varies from sewing needle thickness to those with the diameter of a pencil lead or thicker.

Figure 3 shows a radiograph of a tibiotarsal fracture in a Scarlet Macaw. This angle has us looking at the leg from the side. One can immediately see that somehow the knee bone, top, is definitely not connected, via "shin bone", to the ankle bone. Now there are darn few bandages you can put on a bird with the talents of a macaw with much hope of their staying in one piece for long. Add to this the relatively large amount of weight placed on the splint and one starts to think that a Band-Aid is just not quite enough. So down the hollow center of this leg bone we surgically inserted a stainless steel pin. This can be seen as a solid white pointed fat line in figures 4 and 5. Figure 4 shows a head on view while figure 5 is taken from the same perspective as figure 3. On occasion this procedure can be accomplished closed, in other words, no incision is made except to permit introduction of the pin. Most cases, however, require that the surgeon delicately incise the skin then separate the muscle to expose the bone fragments. Throughout the entire procedure from initial cut, in through alignment and pinning of the fragments, and finally suturing the paper thin skin back together, the surgeon must avoid blood loss as much as possible since these tiny patients can measure their blood volume in drops. Then too, one must be certain the patient is sufficiently anesthetized to permit rapid progress in the surgery but not so deeply "asleep" that he dies from respiratory or cardiac failure or even hypothermia. We can realize that here are decided risks involved in such surgery but fortunately veterinary techniques have progressed to the point where the surgical risks can be minimized. Please, do not hesitate to question your doctor as to what the pros and cons or surgery might be. After the bone pinning your doctor may elect to place an external splint either for additional support or to protect the surgery site.

Birds heal remarkably fast so in a few weeks the splint will be removed of the pin pulled out (under an anesthetic). A measure of tender loving care from you and Polly will be back skating. Let me reemphasize that this article is not an in-depth text on every aspect of fracture repair in avaian species. Please discuss all your questions and expectations ("Will he soar with the eagles, Doc?") before choosing any options.