JKAU: Met., Env. & Arid Land Agric. Sci., Vol. 23, No. 1, pp: 3-17 (2012 A.D./1433 A.H.)

DOI: 10.4197/Met. 23-1.1

3

Fractures in Single-humped Camels: A retrospective Study

of 220 Cases (2008-2009)

Ahmed Fathi Mohamed

Department of Veterinary Medicine, College of Agriculture and

Veterinary Medicine, Qassim University, Buraydah Al-Qassim,

Kingdom of Saudi Arabia.

Abstract. The objective of this paper was to study the etiology and

classification of fractures in dromedary camels and to evaluate their

response to different treatment approaches. Two hundred and twenty

cases of fractures in single-humped camels were admitted during the

period from August 2008 to December 2009. On admission, special

interest was given to record the cause, site, classification, radiography

and outcome of treatment. Factors affecting fracture healing were

studied and analyzed. Trauma was the main cause of fractures in

camels. Sixty percent of fractured camels were males and 40% were

females. The camel ages ranged from 1 day to 20 years old. Simple

fractures were less common than compound ones (34.1% vs. 65.9%,

P=0.001). Single fractures were 168 (76.4%) while multiple and

comminuted fractures were 52 (23.6%) cases. Appendicular fractures

were treated by external fixation using Plaster of Paris bandage alone

or in combination with polyvenylchloride (PVC) splints. Interdental

wiring, using U-shaped aluminum bar and wire suturing treated

mandibular fractures. Healing was recorded in 79.3% of treated

fractures. Mandibular fracture was the most common followed by

tibial fracture. External fixation by different techniques was a

successful method for treating fractures in camels. Freshness of the

fracture significantly affected the efficiency of healing (P= 0.0001).

Introduction

Although fractures are common affections in large animals (Singh, et al.,

1983, and Jennings, 1984), available literature lack detailed data about

the etiology and classification of such fractures in camels. Special

attention has been drawn to mandibular fractures and their treatments in

4 Ahmed Fathi Mohamed

camels, but other bone fractures have been cited briefly especially in

young camels (Ramadan, 1994, Gahlot, 2000, and Al-Sobayil and

Ahmed, 2010). Long bone fractures in the South American camelids

have also been reported (Johnson et al., 2000, Newman and Anderson,

2007, and Shoemaker and Wilson, 2007). Fractures in camelids are

caused by the same types of trauma reported in other animals (Fowler,

2010).

Camel orthopedics is poorly understood so far because of lack of

comprehensive studies on fracture healing (Gahlot, 2000). Moreover,

constrains of camel orthopedics are numerous, hence the principles of

bovine and equine orthopedics cannot be applied on camels in absolute

term (Gahlot and Chouhan, 1994). Theoretically, any of the fixation

techniques practiced in other domestic animals are applicable in

appropriate situations in camelids (Fowler, 2010). However, the animal

body weight plays an important role in the healing success. Members of

family Camelidae vary greatly in their body weight and accordingly,

different methods of fracture fixation have been reported.

External fixation has been discussed as more suitable and

applicable in the camels whereas internal fixation is best in the camelids

(Tee et al., 2005). Fiberglass casts and Thomas splint have been used in

repair of a displaced comminuted radial fracture in a juvenile camel

(Squire and Boehm, 1991). Plaster of Paris bandage with 4 wooden or

metal splints were used for treatment of fractures of metacarpus,

metatarsus, radius and ulna of young camels (Ramadan, 1992). In South

American camelids, fractures have been managed by open reduction and

internal fixation using selective placement of lag screws and dynamic

compression plates (Tee et al., 2005). Fowler (2010) used dynamic

compression plate in repair of a comminuted fracture of the proximal

portion of the radius and ulna in a 4-month-old llama. Fixation by screws

inserted in lag fashion, intramedullary pinning, rush pinning, and bone

plating has been also mentioned (Semevolos et al., 2008). A Velpeau

sling has been used for additional support in llamas and alpacas

(Newman and Anderson, 2007).

The objectives of this study were to investigate the etiology and

classification of fractures in camels and to evaluate the clinical relevance

of external fixations as methods of treatment. Effect of some factors

Fractures in Single-humped Camels: A retrospective Study of … 5

including age, sex, history, cause, type of fracture, fractured bone, and

method of treatment on fracture healing were investigated and analyzed.

Materials and Methods

Animals

A total number of 220 cases of bone fractures in single-humped-

camels were presented to the Veterinary Teaching Hospital, College of

Agriculture and Veterinary Medicine, Qassim University, during the

period from August, 2008 to December, 2009.

Data Collection

On admission, special attention was given to record the camel

breed, age and sex as well as cause of fracture. Camels were categorized

according to age: 1-180 days (n=56), 181-365 days (n=14), 366-600 days

(n=5), and more than 600 days (n=145). Freshness of fracture (time

elapsed between the occurrence of fracture and presentation to the

clinic): was categorized into 1-3 days (n=104), 4-7 days (n=64) and

7days (n=52). Types of fractures were described according to clinical and

radiological examinations.

Procedures

Methods of treatment (when indicated) were external fixation by

Plaster of Paris bandage alone or in combination with splints of

Polyvinylchloride (PVC) when relatively heavy camels were fractured in

the appendicular skeleton. Interdental wiring and U-shaped aluminum bar

were used in cases of mandibular fracture. Immobilization was

performed after closed reduction.

Closed reduction was performed after deep sedation of the camel

by xylazine HCl (0.3 mg/kg body weight, intravenously, Bomazine 10%,

BOMAC Laboratories Ltd, New Zealand). The camel was positioned in a

lateral recumbency with the fractured limb upward. Traction and counter

traction was then applied using a cotton rope around the axilla (in the

forelimb) or groin (in the hindlimb) medial to the thigh and tied in a fixed

object. The counter traction was then applied by tying a rope around the

pastern region while keeping the knot of the rope on the posterior aspect

of foot. The foot region was well padded using cotton before application

of counter traction. The free end of rope was kept pulled by using

6 Ahmed Fathi Mohamed

Ratchet Tie Down. Manual handling at the fracture site helped in

reduction.

After reduction, a layer of cotton as soft padding was applied

around the fractured bone including the joint above and the joint below.

A layer of gauze bandage was then applied followed by 7 to 10 layers of

Plaster of Paris bandages. When 2 PVC splints were used, they were cut

at suitable lengths and placed parallel to each other, over the cotton layer.

Compound fractures were treated with local and systemic

antibiotics (penicillin-streptomycin at a dose rate of 30,000 IU/kg body

weight for the penicillin and 10 mg/kg body weight streptomycin for 5

days, Norbrook Laboratories, UK) with a window on the wound through

the cast. The cast was re-inspected after 2 weeks. The cast was removed

after fracture healing.

In cases of mandibular fractures, two methods of fixation were

used while deep sedated camels were at sternal position. Interdental

wiring was applied by inserting a 0.8 mm diameter stainless steel wire

between first and second mandibular cheek teeth or occasionally between

second and third mandibular cheek teeth. The wire was then passed

between the central incisors and the two branches of the wire were tied

together using pliers. The excess wires were cut using wire cutter. The

same technique was repeated at the other side of the mandibular fracture.

In 10 cases, a 5 mm diameter aluminum bar was used as a method of

fixation. The bar was flattened at the seats of contacts with incisors and

mandibular cheek teeth and curved to suit the contour of the fractured

mandible. The U-bar was then fixed with first and second mandibular

cheek teeth by a 0.8 mm diameter stainless steel wire. The rostral

fragment of the mandibular fracture was then reduced and aligned before

tightening of the wires by using pliers. The incisors were then fixed with

U-bar by using the same wire and tightened by pliers. The excess wires

were cut using wire cutter. The wound in the oral mucosa was sutured if

recent or left open if old and infected but washed by Povidone Iodine

solution.

Healed fracture was defined as clinically acceptable fracture union

without deformity (mandibular and appendicular bone fractures) and

effect on gate (appendicular bone fractures), while no healing was

defined as unacceptable fracture union with deformity (mandibular and

Fractures in Single-humped Camels: A retrospective Study of … 7

appendicular bone fractures) affecting the gate (appendicular bone

fractures) or no union at all (Gangl et al., 2006).

Statistical Analysis

Data were analyzed for the effect of camel breed, age, sex and

history, cause, type of fracture, and method of treatment as well as their

interaction on fracture healing. The differences in percentages were

evaluated by Chi-Square test. The level of significance was tested at

P<0.05. A statistical program (SPSS, 2007) was used to perform the

statistical analysis.

Results

Camels with fractures were 132 (60%) males and 88 (40%)

females. Camel breeds were Maghateer (Wodh) (white-colored camels,

n=108, 49.1%), Majaheem (brown to black-colored camels, n=59,

26.8%), Asfar (light brown-colored camels, n=27, 12.3%), and Ashaal

(reddish brown-colored camels, n=26, 11.8%).

Causes of fractures were trauma by another camel (n=91, 41.4%),

camel bites (n=80, 36.4%), being stepped over by the mother or other

camels (n=33, 15 %), falling down a hill (n=5, 2.3%), car accidents (n=5,

2.3%), trapping of a limb in a rope (n=4, 1.8%), and stick trauma (n=2,

0.9%).

According to location, left and right side fractures were 56 (57.1%)

and 42 (42.9%), respectively. Fractures were the head and neck 122

(55.4%), forelimbs 29 (13.2%), hind limbs 69 (31.4%). Fractured bones

were mandible (n=117, 53.1%, Fig. 1A, B), tibia (n=36, 16.3%, Fig. 2A-

C), metatarsal bones (n=22, 10%, Fig. 2D-F), radius (n=16, 7.3%, Fig.

2G, H), metacarpal bones (n=9, 4.1%), femur (n=6, 2.7%), first phalanx

(n=5, 2.3%, Fig. 2I), cervical vertebrae (n=3, 1.4%), humerus (n=2,

0.9%), maxilla (n=2, 0.9%), calcanean tuberosity (n=1, 0.5%) and

olecranon tubersoity (n=1, 0.5%). Simple fractures were 75 (34.1%)

while compound fractures were 145 (65.9%). Single fractures were 168

(76.4%) and multiple and comminuted fractures were 52 (23.6%) cases.

8 Ahmed Fathi Mohamed

Fig. 1. Mandibular fracture (A) and its lateral radiograph (B) in a male Majaheem camel,

external fixation by interdental wiring (C) and its lateral radiograph (D), external

fixation by U-shaped aluminum bar (E) and its lateral radiograph (F), an abscess

(arrow) developed at the fracture site (G), and healed mandibular fracture after

using a U-bar (H).

Fractures in Single-humped Camels: A retrospective Study of … 9

Fig. 2. Tibial fracture (arrows) in young Wodh camel (A), its lateral radiograph (B), a

lateral radiograph of tibial fracture after application of Plaster of Paris bandage (C),

Metatarsal fracture (arrow) in an adult Asfar camel (D), a lateral radiograph of

metatarsal fracture in adult camel (E) and in a young camel (F), radial fracture in a

young Ashaal camel (G) note the Ratchet Tie Down used for reduction, a lateral

radiograph of a radial fracture in a young camel (H), and a dorso-palmar

radiograph of a fractured medial first phalanx in an adult camel (I).

10 Ahmed Fathi Mohamed

Long bone fractures (n=88) were classified according to site of

fractures into diaphyseal (n=58, 65.9%) and metaphyseal (n=30, 34.1%)

fractures (Table 1).

Amputation of the fractured limb was performed as a temporary

treatment in 7 young camels (3.2%). Thirty-four cases (15.5%) were not

treated and recommended to be slaughtered. These two categories were

considered no treatment group (n=41, 18.6%). Treatment was performed

on the remaining 179 (81.4%) cases by either a Plaster of Paris bandage

cast alone (n=34, 18.9%) or together with Polyvinylchloride (PVC)

splints (n=29, 16.1%), by interdental wiring (n=103, 57.3%), U-shaped

aluminum bar (n=10, 5.5%), wire sutures (n=2, 1.1%), and with two

Steinmann pins (n=1, 0.6%) (Table 1).

Satisfactory healing was recorded in 142 cases (79.3%) and no

healing was recorded in 37 (20.7%) cases. Plaster of Paris bandage alone

resulted in healing of 28 (82.5%) out of 34 cases. Plaster of Paris

bandage together with splints of PVC resulted in healing of 18 (62.1%)

out of 29 cases. Interdental wiring (Fig. 1C, D) resulted in healing of

mandibular fractures in 85 (82.5%) out of 103 cases. U-bar (Fig. 1E, F,

H) resulted in healing of 9 (90%) out of 10 cases. Healing time was 6 –

11 weeks. Fixation by two Steinmann pins for the mandibular fracture

resulted in healing of the treated case (Table 1).

The freshness of fracture significantly affected its healing

(P=0.0001). There was a tendency of single fracture to heal more than

multiple and comminuted fractures (P=0.1). In addition, there was a

tendency of some fractured bones such as mandible (95/114), metatarsus

(11/15), metacarpus (7/8), and first phalanx (4/5) to heal more than others

(P=0.1). There were no significant effects of camel breed, sex, age,

cause, site of fracture, and treatment method on the fracture healing

(Table 1).

Discussion

The present study showed that the incidence of mandibular

fractures in camels is high followed by tibial fractures. In addition,

interdental wiring, U-bar, Plaster of Paris bandage alone or in

combination with PVC splints as methods of external fixation are

successful methods for treatment of fractures in camels. Among the

Fractures in Single-humped Camels: A retrospective Study of … 11

parameters evaluated, it seemed that the freshness of the fracture has

significant effect on fracture healing.

Table 1. Some factors affecting fracture healing in camels (n=179).

Factor Item Total Healed

n (%) P value

Breed

Maghateer 86 69 (80.0)

0.5 Majaheem 51 40 (78.4)

Ashaal 22 15 (68.2)

Asfar 20 18 (90)

Sex Male 116 93 (80.2)

0.42 Female 63 49 (77.8)

Age

(days)

1-180 38 31 (81.6)

0.95 181-365 12 10 (83.3)

366-600 4 3 (75)

>600 125 98 (78.4)

Freshness of

fracture

(days)

1-3 94 82 (87.2)a

0.0001 4-7 54 47 (87)a

>7 31 13 (41.9)b

Cause

of fracture

Trauma 64 44 (68.8)

0.19

Stepped 23 20 (87)

Fall down 5 4 (75)

Trapped in rope 3 3 (100)

Car accident 4 4 (100)

Bite 78 66 (84.7)

Stick hit 2 1 (50)

Fractured

bone

Mandible 114 95 (83.3)

0.1

Tibia 24 18 (75)

Metatarsus 15 11 (73.3)

Metacarpus 8 7 (87.5)

Radius 8 6 (75)

Femur 2 0 (0)

1st Phalanx 5 4 (80)

Neck 1 0 (0)

Maxilla 2 1 (50)

Site of

fracture

Diaphyseal 38 29 (76.3) 0.3

Metaphyseal 17 11 (64.7)

Single/

Multiple

Single 142 116 (81.7) 0.1

Multiple 37 26 (70.3)

Closed/

Open

Closed 60 45 (75) 0.2

Open 119 97 (81.5)

Treatment

Method

Appendicular

skeleton

Plaster of Paris cast 34 28 (82.4)

0.4

Plaster of Paris+PVC 29 18 (62.1)

Mandible and

maxilla

IDW 103 85 (82.5)

U-bar 10 9 (90)

Wire Sutures 2 1 (50)

Two Steinmann Pins 1 1 (100) a , bValues with different superscripts in the same column are significant (P <0.05). n=number

In the current study, mandibular fracture was found to be the most

common fractures in camels especially those camels older than 600 days.

These results support those in other studies (Purohit et al., 1984; Gahlot,

12 Ahmed Fathi Mohamed

1990 and Ramadan and Abdin-Bey, 1990). On the other hand, fractures

of the appendicular skeleton have been recorded to be higher in camels

under four-years-old (Ramadan, 1992).

Moreover, fractures of the head and neck were more common than

the appendicular skeleton fractures in adult camels which were similar to

the results obtained by another study (Ramadan, 1992). The reason of

increasing the incidence of head and neck fractures was due to the higher

proportions of the mandibular fractures, which were the most common in

adult and aged camels. Camel bulls are sexually excited during the

rutting season that they usually bite other camels and hard objects

resulting in fracture of their mandibles (Gahlot, 2000). Left side fractures

were relatively higher than the right side in the current study. This

finding contradicts with that stated elsewhere by Ramadan (1992).

In this study, trauma was the most common cause of fractures.

Causes of fractures in similar study have attributed to faulty steps due to

uneven soil or stepping on holes in the ground (Gahlot, 2000). Stepping

over the young camels, while sleeping, by their dams or other camels was

also an important cause of fracture. Raising camel calves with adult

camels in the free-range desert is a predisposing factor (Al-Ani, 2004). In

addition, camels have relatively longer bones than other domestic

animals (Smuts et al., 1987) that make them highly subjected to fractures

as a result of trauma. Moreover, the anatomical location of bones could

be fracture predisposing factors (Singh and Nigam, 1982). Camel bites

were the second common cause of fracture in camels. Adult camel

usually bites other camels and hard objects during the breeding season

leading to fracture of its own mandible. The anatomical weakest point of

the mandible is just rostral to canines (tusks or tushes) (Gahlot, 2000).

This is due to the relatively small cross sectional diameter of the

mandible at this point and the presence of the alveoli of canines that

weakens the mandible more. On the other hand, the current study showed

that mandibular fractures in young camels were due to bites by another

camel.

Camelids are known to tolerate well the orthopedic surgery and the

application of various orthopedic devices (Fowler, 1998). However, lack

of availability and sustainability of suitable implants for internal fixation

of fractured long bones of long-legged animal is an analogue constraint

of camel orthopedics as compared to bovine orthopedics (Gahlot, 2000).

Fractures in Single-humped Camels: A retrospective Study of … 13

Therefore selection of a particular procedure should be dependent upon

the bone involved and the nature of the fracture, available anesthesia,

equipment, instrumentation, and the skill and experience of the surgeon

(Fowler, 1998). Accordingly, external fixation techniques were used in

the present study. Moreover, the techniques were feasible and suitable for

field situations.

Two different techniques were used for the treatment of mandibular

fractures. The first method was interdental wiring. The technique was

simple, cheap and consumed less time. Stable fractures were good

candidates for the treatment by interdental wiring. On the other hand, this

technique was not suitable for all types of mandibular fractures. Another

disadvantage of the interdental wiring was the development of intraoral

ulceration at the pass ways of the wires. The second technique used in the

treatment of mandibular fractures was the U-shaped aluminum bar. The

technique was also simple and cheap but consumed more time than the

interdental wiring. It offered good stability for the fracture site and was

suitable for stable and unstable mandibular fractures. In addition,

intraoral ulceration did not develop with the U-bar. An abscess (Fig. 1G)

developed at the site of compound mandibular fracture after one week,

which needed opening and drainage. Two Steinmann pins were used for

the treatment of mandibular fracture in a camel calf. The calf had no long

enough incisors to use the interdental wiring.

Plaster of Paris bandage alone or in combination with two PVC

splints resulted in healing of most treated cases of appendicular fractures

in the current study. Plaster of Paris bandage with 4 wooden or metal

splints were used for treatment of fractures of metacarpus, metatarsus,

radius and ulna of young camels (Ramadan, 1992). It was reported that

the prognosis of fractures is favorable in most young camels where

fusion of epiphyseal plate has not taken place as compared to adult

camels (Gahlot, 2000). Moreover, fixation type did not have any

significant effect on complications involving fracture healing, infection,

soft tissue structures, or chronic lameness (Semevolos et al., 2008).

Camelids with open fractures were more likely to have complications

associated with fracture healing, repair, and infection (Semevolos et al.,

2008). In the present study, fractured heavy weight camels over the

carpal and tarsal joints and old infected compound fractures were not

treated and were recommended to be slaughtered.

14 Ahmed Fathi Mohamed

In regards to the outcomes of treatment, statistics showed no

significance of breed, sex or age, contrary to what was found in another

study (Ramadan, 1992). Also, there were no significant effects of

fractured bone, type of fracture, and treatment method on the outcome of

treatment. However, there was a significant effect of the fracture

freshness on the outcome of treatment.

Conclusions

Incidence of mandibular fractures in camels is high followed by

tibial fractures. External fixation of mandibular fractures was achieved

by means of interdental wiring and U-bar. Plaster of Paris bandage alone

or in combination with PVC splints were successful methods of long

bone fracture treatment in camels. Among the parameters selected in the

current study, the only factor that has significant effect on healing was

the freshness of the fracture at the time of admission.

Acknowledgement

The current study was funded by the Scientific Research Deanship,

Qassim University, Kingdom of Saudi Arabia, Project Number SR-D-

008-046. The author thanks Dr. Al-Sobayil F.A for his valuable

assistance.

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16 Ahmed Fathi Mohamed

222دراسة بأثر رجعي على : الكسور في اإلبل وحيدة السنام (م2222-2222)حالة

أحمد فتحي محمد ،كلية الزراعة والطب البيطري ،البيطريقسم الطب ،المستشفي البيطري التعليمي

المملكة العربية السعودية –القصيم ، 15412بريدة ،جامعة القصيم

ساباب وتصانيم الكساور أكاا الدادم ما البحاا دراساة . المستخلصفااي اإلباال وحياادة الساانام، وتقياايم اسااتجابة تلااا الكسااور لطاار العاا

مااا اإلبااال مصاااابة بكساااور فاااي 222أجريااال الدراساااة علاااى . المختلفاااةالعظاااااام والتاااااي تااااام اساااااتقبالدا بالمستشااااافى البيطاااااري أثناااااا الفتااااارة مااااا

، وعنااااد اسااااتقبال الحااااا ل تاااام م2222ديساااامبر إلااااى 2222أغسااااط ،وع جاه ،شاعاعياإوتصاوير ،وتصنيفه ،ومكانه ،بب الكسرتسجيل س

والمتابعة بعد الع لتقييم المخرجال لكل طريقة ع جية، وتم تحليال أأظدارل النتااي . حصاايياإالعوامل المؤثرة في عملية شافا الكساور

٪02 الاككور مثلال أالرض هو السابب الاريي للكساور فاي اإلبال، و الحاا ل المصاابة بالكساور، تاراور عمار اإلبال ما ٪42بينما اإلنااا

عامااا، وكاناال الكسااور البساايطة أقاال شاايوعا 22ماا يااوم واحااد وحتااى ، أماااا (علاااى التاااوالي ٪0142و ٪،1445بنساااب )مااا الكساااور المركباااة

بينماااا مثلااال الكساااور ( ٪4044)حالاااة 502الكساااور ادحادياااة فمثلااال كساااااور القاااااوايم ، تااااام عااااا (٪2140)حالاااااة 12المتعاااااددة والساااااحقية

بالتثبياال الخااارجي بواسااطة جبياارة جااب باااري منفااردة أو تلااا الجبياارة ، أماااا كساااور الفاااا السااافلي فاااتم (ب ساااتيا)ماااب جبااااير البوليفينيلكلورياااد

ع جدا باستخدام السلا بي ادسنا ، قضيب ادلومنيوم بشاكل حارم Uلقاااد تااام تساااجيل الشااافا الكامااال .، وخياطاااة العظااام بالسااالا المعااادني

Fractures in Single-humped Camels: A retrospective Study of … 17

خلصال الدراساة إلاى أ .م الحا ل التي تم ع جداا ٪4241بنسبة يليدااا كسااور عظاام ،كسااور الفااا الساافلي هااي ادكثاار شاايوعا فااي اإلباال

ة لعا تعتبار طار التثبيال الخاارجي المختلفاة طرقاا ناجحاو القصابة، كا لنضارة الكسر تأثيرا معنويا علي معادل كسور العظام في اإلبل، و

.الشفا