Treatment of a Large Defect Induced by Atrophic Nonunion of Femoral Fracture in a Dog with Autogenous Coccygeal Bone Grafting

SIMPLE SUMMARY: This study addressed the complexities of nonunion in small animal orthopedics and highlighted the potential of autogenous corticocancellous bone grafts to facilitate bone healing. Autogenous cancellous bone grafting has proven to be the most effective means of stimulating fracture healing in orthopedics; however, filling large bone defects with cancellous bone can be challenging. In these cases, cortical bone grafts may provide mechanical stability to the defective area. This case study investigated the use of the coccygeal bone as an autogenous bone graft to fill a large femoral defect. To prevent fixation failure, rigid fixation was achieved between the coccygeal and femoral bone fragments using orthogonal locking plates and screws, strengthening the mechanical structure. Harvesting was performed immediately before transplantation to increase the viability of the grafted bone. Various methods can be employed to enhance osteoinductivity and osteoconductivity to promote successful engraftment, including the use of platelet-rich plasma and active rehabilitation to improve the blood supply and increase biological activity. Although coccygeal bone grafting has been reported in the radius and tibia, this is the first instance of the coccygeal bone being used as an autogenous bone graft in femoral fracture nonunion. ABSTRACT: An 11-month-old castrated male Pomeranian presented with nonunion following a femoral fracture that occurred after femoral head and neck osteotomy. Radiography and computed tomography revealed severe atrophy of the proximal bone fragment and retardation of the ipsilateral distal fragment and tibia. An autogenous bone graft using coccygeal bone was performed, in which three and a half coccyges were placed in succession and fixed using an orthogonal locking plate. To promote bone healing and facilitate proper weight bearing and ambulation, bone morphogenetic proteins, biphasic calcium phosphate, platelet-rich plasma, passive-range-of-motion exercises, transcutaneous electrical nerve stimulation, neuromuscular electrical stimulation, and low-level laser therapy were applied. During the four-year follow-up, it was observed that the previously engrafted bone healed well and maintained stability over a prolonged period, resulting in the patient being able to walk comfortably with good outcomes. However, some degree of lameness was noted in the dog when running owing to limb shortening and joint contracture.