Update on the Use of the Tubular External Fixator (F.E.S.S.A.) in the Treatment of Fractures and Luxations in Birds
Clinic for Zoo Animals, Exotic Pets and Wildlife, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
This presentation summarizes the developments in the use of the tubular external fixator (Fixateur Externe du Service de Santé des Armées; F.E.S.S.A.) in avian surgery since its first presentation in 2003.1 Special emphasis is given to the different applications and practical experiences.
In addition to the company Medical Solution (Hünenberg, Switzerland) the system is now also marketed by two additional companies (Jorgensen Laboratories, Loveland, USA and Veterinary Instrumentation, Sheffield, UK). The original set of stainless-steel connection bars (Diameter 6, 8, and 12 mm; length range 31 to 118 mm) has been expanded with bars up to 200 mm in length.
Different publications have documented the successful use of the F.E.S.S.A. system in variety of captive and wild birds including psittacines, pigeons, and birds of prey with a body weight range from 100 to 2000 grams.2-4 The system has been used as a type 1, type 2, and tie-in external skeletal fixator to treat fractures of the humerus, radius and ulna, femur, tibiotarsus, and tarsometatarsus. In addition, the connection of two bars with a hinge to form a hinged linear external fixator (HLESF) has allowed the treatment of luxations in pigeons. Of special interest over current systems used in avian surgery was the possibility to perform early controlled physical therapy without removing the fixator.
Days from first pin removal until removal of last pin have been reported in a range from day 28 post-surgery until day 42.4 In a study involving hunting falcons that had been treated for tibiotarsal fractures, four out of five falcons were sent back to intensive training and were used successfully for hunting within 2–3 months post-surgery.4
In psittacine birds it has been recommended to cover the screws of the fixator with a drop of tissue glue, as it was observed that these birds tend to play with the screw and might loosen them.3
The authors have found the light weight, easy application, early return to normal limb function, re-usability, and cost effectiveness to be significant advantages of the F.E.S.S.A. system. The flexibility of the system allows removal of pins during the healing process without disturbing other, remaining pins. It was also found that the potential to insert up to six pins over a distance of 15 mm offers advantages in the treatment of fractures in small birds (e.g., <500 g body weight). Moreover, the use of the hinge to perform physical therapy did not lead to any side effects (e.g., pin loosening, hinge centre disorientation, increased skin/muscle trauma, or swelling around the pin insertion entrances).
In conclusion, the system continues to find increasing interest due to its different advantages and offers a viable alternative to currently used external skeletal fixation techniques.
1. Hatt J-M, Sandmeier P. Clinical application of the F.E.S.S.A. tubular external skeletal fixator in fracture repair of birds. In: Proceedings of the 5th ECAMS Scientific Meeting. Tenerife, Spain. 2003:4–5.
2. Hatt J-M, Christen C, Sandmeier P. The tubular external skeletal fixator (F.E.S.S.A): Clinical application in fracture repair in 28 birds. Vet Rec. 2007;160:188–194.
3. Hernandez-Divers SJ, Gladden J, Christian M, Hatt J-M. Application of F.E.S.S.A. external fixation for long bone fractures in birds. In: Proceedings of the Association of Avian Veterinarians Annual Meeting. 2007:43–47.
4. Muller MG, Nafeez JM. Use of the FixEx Tubulaire Type F.E.S.S.A. system for tibiotarsal fractures in falcons. Falco. 2007;29:25–28.