# Orthopedic Implants and Fixation Devices: Principles and Selection


## Key Takeaways

- Fracture fixation success hinges on matching implant mechanics to the specific strain environment and vascular integrity of the fracture, rather than solely on implant strength.
- Bone plates can function as load-sharing or load-bearing devices, with locking plates offering fixed-angle stability that preserves periosteal blood supply, particularly beneficial in osteoporotic or metaphyseal bone.
- Intramedullary pins primarily resist bending but require adjunct fixation (e.g., plates, external fixators) for rotational and axial stability, while interlocking nails provide superior rotational and axial control for diaphyseal fractures.
- External fixators are minimally invasive and adjustable, making them ideal for open, infected, or severely comminuted fractures, with frame configuration dictating mechanical behavior.
- Implant-associated infection is a critical complication driven by biofilm formation, necessitating aggressive debridement and organism-specific antimicrobial therapy, often requiring implant removal.
- Patient factors such as size, bone quality, and owner compliance significantly influence implant selection, with smaller patients and compromised bone favoring locking constructs or external fixation.

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Fracture repair and corrective osteotomy in dogs and cats require the surgeon to match implant mechanics to bone biology, loading environment, and patient factors. This article compares the principal implant systems used in small animal orthopedics, including bone plates, intramedullary pins, external fixators, and interlocking nails, with emphasis on biomechanical principles, indications, and selection logic. It is written for practicing veterinarians who perform or plan fracture surgery and need a structured framework for choosing among fixation methods.

The central clinical question is not which implant is strongest, but which construct best controls the specific strain environment of a given fracture while preserving blood supply and allowing predictable healing. Implant selection therefore depends on fracture configuration, bone segment viability, soft tissue envelope integrity, patient size and temperament, and surgeon experience. This article provides the conceptual foundation for those decisions, with later sections addressing individual implant classes and their comparative performance.

## At a Glance

| Parameter | Consideration |
|---|---|
| Primary decision driver | Fracture strain environment and vascular integrity, not implant strength alone |
| Bone plate | Load-sharing or load-bearing, best for articular, metaphyseal, and comminuted fractures |
| Intramedullary pin | Neutralizes bending but not rotation or axial compression, best combined with adjunct fixation |
| External fixator | Minimally invasive, adjustable, ideal for open fractures and salvage of failed internal fixation |
| Interlocking nail | Superior rotational and axial stability versus plain pins, suited to diaphyseal fractures |
| Implant material | Titanium alloys offer osseointegration potential, stainless steel remains standard for cost and handling |
| Implant-associated infection | Biofilm formation mandates aggressive debridement and organizm-specific antimicrobial therapy |
| Patient factors | Body weight, activity, bone quality, and owner compliance alter construct choice |

## Biomechanical Foundations of Fracture Fixation

Fracture healing proceeds through endochondral or intramembranous ossification depending on the mechanical environment. Rigid constructs with minimal interfragmentary strain favor primary bone healing, while moderately unstable constructs permit callus formation. The surgeon selects a fixation method to produce the strain environment appropriate for the fracture type and the biologic capacity of the patient.

Load-sharing constructs, such as plates applied with screws engaging both cortices on a reducible fracture, transmit force through bone and implant together. Load-bearing constructs, including plates spanning comminuted zones or bridging plates, transmit the full load through the implant until bone consolidates. External fixators can function in either mode depending on frame configuration and pin number. The distinction matters clinically because load-bearing implants are at higher risk of fatigue failure if healing is delayed.

Bone quality modifies every biomechanical calculation. Osteopenic bone, whether from disuse, metabolic disease, or advanced age, provides poor screw purchase and pin anchorage. Research in sheep models of osteoporosis has shown that implant performance in compromised bone differs substantially from that in healthy bone, and this has driven development of surface treatments and alternative materials [Turner AS, the sheep as a model for osteoporosis in humans](https://pubmed.ncbi.nlm.nih.gov/12090765/). The surgeon should anticipate reduced holding power and consider augmenting fixation with polymethylmethacrylate, additional points of fixation, or locked constructs.

## Implant Materials and Surface Biology

Stainless steel and titanium alloys dominate veterinary implant manufacture. Stainless steel offers high stiffness, low cost, and well-documented mechanical behavior. Titanium alloys provide comparable strength with lower elastic modulus, which more closely approximates bone stiffness and may reduce stress shielding. Titanium also demonstrates superior biocompatibility and osseointegration potential. Experimental work in a canine femur model showed that alkali and heat treatment of titanium surfaces produced direct bone bonding with shear strengths of 2.4 to 4.5 MPa at four weeks, compared with 0.3 to 0.6 MPa for untreated controls [titanium metals form direct bonding to bone after alkali and heat treatments](https://pubmed.ncbi.nlm.nih.gov/11516085/). Untreated implants typically developed an intervening fibrous layer, whereas treated surfaces bonded directly to bone.

Surface microgeometry also influences osseointegration. Controlled porosity and specific channel designs can direct tissue migration and reduce fibrous encapsulation at the implant-bone interface [osseointegration on metallic implant surfaces, effects of microgeometry and growth factor treatment](https://pubmed.ncbi.nlm.nih.gov/12418014/). These findings have translated into commercially available roughened or coated implants, though clinical outcome data in veterinary patients remain limited.

Magnesium-based alloys represent an emerging class of biodegradable implants. They degrade gradually in vivo, potentially eliminating the need for implant removal and reducing stress shielding over time [magnesium-based alloys used in orthopedic surgery](https://pubmed.ncbi.nlm.nih.gov/35161092/). Their mechanical properties and degradation rates vary with alloy composition, and gas accumulation during corrosion remains a clinical concern. Use in veterinary patients is currently limited to investigational settings.

## Infection and Implant Failure

Implant-associated infection is a distinct clinical entity because bacteria adhere to metal surfaces and form biofilms that resist both host defenses and antimicrobial therapy. The diagnosis requires a high index of suspicion, and treatment without implant removal is possible only in selected cases. Rifampin-containing combination regimens are considered crucial for staphylococcal infections, with quinolones serving as suitable partners against susceptible strains [infections associated with orthopedic implants](https://pubmed.ncbi.nlm.nih.gov/16804382/). Increasing antimicrobial resistance has prompted evaluation of alternative agents, though clinical experience remains limited.

Prevention begins with perioperative antimicrobial prophylaxis timed 30 to 60 minutes before incision. Intraoperative technique, including minimization of soft tissue trauma and maintenance of strict asepsis, is equally important. When infection is confirmed, the surgeon must decide between suppressive therapy, implant removal after healing, or staged revision. Biofilm eradication from a retained implant is rarely achieved, and the decision to retain hardware should be made with owner counseling about the risks of persistent infection and delayed union.

## Construct Selection Logic

No single implant system is appropriate for all fractures. The selection process begins with fracture classification, proceeds through assessment of the soft tissue envelope and patient factors, and ends with a construct that the surgeon can apply competently. The American College of Veterinary Surgeons provides specialist-level summaries of surgical conditions and expected outcomes that can guide clinical decision making [ACVS animal health resources](https://www.acvs.org/small-animal/). General practice references from the MSD Veterinary Manual offer additional context on fracture classification and patient assessment [MSD Veterinary Manual, professional edition](https://www.msdvetmanual.com/).

The following sections examine each implant class in detail, comparing mechanical properties, indications, and common failure modes.

## Bone Plates: Application Modes and Mechanical Roles

Bone plates function as load-sharing or load-bearing devices depending on the fracture configuration and the plate's working mode. In a buttress mode, the plate bears the full load across a gap, which demands a plate of sufficient stiffness and screw purchase to resist cyclic bending. In a neutralization mode, the plate protects an interfragmentary compression construct from torsional and bending forces while the bone itself transmits axial load. In a bridging mode, the plate spans a comminuted zone without attempting anatomic reduction, preserving the soft tissue envelope and relying on the plate to maintain length, alignment, and rotation during secondary bone healing.

Locking plates alter the mechanics of the bone-plate interface. The screw head threads into the plate hole, creating a fixed-angle construct that does not depend on friction between the plate and bone for stability. This design preserves periosteal blood flow because the plate does not need to compress the bone surface, and it resists toggling in osteoporotic or metaphyseal bone where screw purchase is poor. Nonlocking plates require precise contouring and compression of the plate against bone to generate friction, and they lose stability if screws loosen or if the plate is not contoured accurately.

Plate selection begins with the patient's body weight, the bone involved, and the fracture location. A 2.0 mm plate in a 5 kg cat behaves differently from the same plate in a 20 kg dog. The surgeon must match plate stiffness to the expected loads, choosing a plate that is strong enough to avoid fatigue failure but not so stiff that it stress-shields the bone and delays remodeling. Locking plates are preferred for metaphyseal fractures, short juxta-articular segments, and revision cases where screw purchase is compromised. Nonlocking plates remain appropriate for simple diaphyseal fractures where anatomic reduction and interfragmentary compression are achievable.

## Intramedullary Pins and Interlocking Nails

Intramedullary pins resist bending in all planes but provide poor resistance to axial compression, rotation, and shear. A single pin alone is rarely sufficient for a weight-bearing long bone fracture in a dog or cat, it must be combined with a plate, an external fixator, or cerclage wire to control the forces the pin cannot resist. Pin diameter should not exceed approximately 40 percent of the medullary canal diameter at the isthmus, because larger pins disrupt endosteal blood supply and may impede healing.

Interlocking nails address the rotational and axial instability of plain pins by placing transverse bolts through the nail and bone. The nail is inserted normograde or retrograde, and the bolts lock the nail to the bone, converting the construct into a load-sharing device that controls length, alignment, and rotation. Interlocking nails are well suited to diaphyseal fractures of the femur, tibia, and humerus, particularly comminuted fractures where a plate would require extensive exposure. The nail preserves the periosteal blood supply and allows early weight bearing. The principal limitation is the need for accurate nail and bolt sizing, and the requirement for specialized instrumentation that may not be available in every practice.

## External Skeletal Fixation: Configurations and Clinical Use

External fixators consist of transosseous pins or wires connected to an external frame. They are versatile, minimally invasive, and adjustable, which makes them valuable for open fractures, infected fractures, and fractures with severe soft tissue injury. The frame configuration determines the mechanical behavior. An unilateral, uniplanar (Type I) fixator resists bending in one plane but is weaker in others. Adding a second bar or a second plane (Type II) increases stiffness. A bilateral, biplanar (Type III) frame provides the greatest stability and is used for the most unstable fractures or for arthrodesis.

The choice of pin type and size matters. Positive-profile threaded pins have a larger core diameter than the thread root, which reduces the risk of pin loosening and thermal necrosis during insertion. Negative-profile pins have threads cut into a uniform-diameter shaft, creating stress risers at the thread-shaft junction. Pins should engage at least two cortices, and the pin-bone interface should be monitored for drainage and loosening throughout the treatment period. The frame should be applied with the limb in a functional standing angle, and the patient should be able to bear weight on the limb within days of surgery.

External fixators are particularly useful in cats and small dogs where the bone is too small for a plate or nail, and in fractures with substantial soft tissue compromise where internal fixation would risk contamination. They also allow staged removal, with the frame destabilized progressively to encourage bone remodeling before complete removal.

## Comparative Selection Framework

| Implant | Primary Indications | Advantages | Disadvantages |
|--------|---------------------|------------|---------------|
| Nonlocking plate | Simple diaphyseal fractures, metaphyseal fractures with good bone stock | Low cost, familiar technique, allows interfragmentary compression | Requires precise contouring, depends on plate-bone friction, weaker in osteoporotic bone |
| Locking plate | Comminuted fractures, metaphyseal fractures, revision surgery, osteoporotic bone | Fixed-angle stability, preserves periosteal blood supply, no contouring required | Higher cost, requires specialized screws and drill guides, less forgiving of malreduction |
| Intramedullary pin | Femoral and humeral fractures as part of a composite construct | Cheap, quick to place, resists bending | Poor rotational and axial stability, must be combined with other fixation |
| Interlocking nail | Comminuted diaphyseal fractures of femur, tibia, humerus | Load sharing, controls rotation and length, preserves periosteum | Requires specialized instrumentation, limited sizes for small patients |
| External fixator | Open fractures, infected fractures, severe soft tissue injury, small patients | Minimally invasive, adjustable, allows staged destabilization | Pin tract infection, patient tolerance issues, frame management burden |

## Decision Points That Change the Choice

Patient size is the first filter. A 3 kg cat with a distal femoral fracture may be best served by a small locking plate or a Type I external fixator, whereas a 40 kg dog with the same fracture may require a 3.5 mm locking plate or an interlocking nail. Bone quality changes the decision: osteoporotic or metaphyseal bone favors locking constructs because they resist screw pullout better than nonlocking plates, as demonstrated in experimental models of implant fixation in compromised bone. Fracture location matters: articular fractures require anatomic reduction and rigid internal fixation, typically with plates and screws, while diaphyseal fractures can heal by secondary bone healing with bridging fixation.

Soft tissue status is decisive. Open fractures with contamination are better managed with external fixation to avoid placing hardware directly in a contaminated bed. Infected fractures or nonunions with prior hardware failure may require a staged approach, with initial external fixation and debridement followed by delayed internal fixation once the infection is controlled. The risk of biofilm formation on implanted hardware is well documented, and the presence of an implant changes both the diagnosis and treatment of infection.

Available equipment and surgeon experience are legitimate constraints. A practice without interlocking nail instrumentation should not attempt that technique, a plate applied with poor technique is worse than a well-applied external fixator. Referral to a surgical specialist should be considered when the required equipment or expertise is unavailable, and the [American College of Veterinary Surgeons resources](https://www.acvs.org/small-animal/) provide guidance on expected outcomes and postoperative care for common procedures.

## Postoperative Monitoring and Complication Detection

Radiographic monitoring at 4, 8, and 12 weeks is standard for most fractures, with the interval adjusted for the patient's age, fracture location, and fixation type. Callus formation should be assessed for volume and progression, and implant position should be checked for migration, bending, or breakage. Pin tract evaluation is essential for external fixators: serous discharge is common and manageable, but purulent discharge, progressive lucency around the pin, or pin loosening requires intervention.

Clinical monitoring includes weight-bearing status, limb swelling, and temperature. A patient that was bearing weight and then becomes non-weight-bearing may have implant failure, infection, or fracture disease. Serial examination findings should be documented in the medical record with a standardized format that includes the date, limb, fixation type, radiographic findings, and any changes to the treatment plan. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) provides species-specific guidance on fracture healing timelines and complications that can support client communication and clinical decision-making.

## Recognized Complications and Early Detection

Implant-associated infection remains the most consequential early complication. Biofilm formation on metallic surfaces protects microorganisms from both host defenses and systemically administered antimicrobials, and established biofilms frequently require implant removal for cure. Perioperative prophylaxis timing is critical, with administration recommended 60 to 30 minutes before incision. Early detection relies on serial clinical assessment: progressive weight-bearing lameness, incisional drainage, persistent seroma, or fever beyond the first 48 to 72 hours postoperatively warrant investigation. Serial radiography may reveal periosteal reaction, implant loosening, or osteolysis, though these changes lag clinical signs by days to weeks. Serum acute-phase proteins and synovial fluid analysis can support the diagnosis, but definitive confirmation often requires culture of deep tissue or implant sonication fluid.

Implant loosening without infection presents more insidiously. Radiolucent lines around screws, screw back-out, or migration of intramedullary pins on follow-up radiographs indicate loss of fixation. The clinician should compare immediate postoperative films with subsequent studies to distinguish settling from progressive loosening. Pain on manipulation, crepitus, or sudden change in limb use after a period of improvement all mandate radiographic reassessment.

Delayed union and nonunion are detected when the expected timeline for osseous healing passes without radiographic progression. Serial radiographs every 4 to 6 weeks should demonstrate increasing callus and progressive bridging. A nonunion with a persistent radiolucent fracture gap, sclerotic bone ends, or implant fatigue suggests mechanical instability or biologic failure.

## Common Errors and Corrective Action

The most frequent error in fracture fixation is under-sizing the implant relative to the loads the bone will experience. A plate applied in buttress mode must resist the full cyclic bending and torsional load of weight bearing, and choosing a plate too small for the patient's body weight invites fatigue failure. Corrective action is to template preoperatively using orthogonal radiographs and to select a plate that spans at least three cortices of purchase on each side of the fracture in the near cortex, with the plate length exceeding the fracture zone by a margin appropriate to the bone.

Failure to respect the soft tissue envelope is equally common. Excessive periosteal stripping during plate application devascularizes fracture fragments and converts a biologically favorable situation into one at high risk for delayed union. The corrective principle is to preserve fragment attachments and use indirect reduction techniques where possible.

A third recurring error is the inappropriate use of intramedullary pins as primary fixation in comminuted fractures. Pins resist bending but provide no rotational or axial stability, and their use as a sole implant in a comminuted diaphyseal fracture invites shortening and malrotation. The corrective action is to combine the pin with a plate, external fixator, or interlocking nail that controls rotation and length.

## Limitations of Current Evidence

The veterinary literature on implant selection is dominated by retrospective case series and biomechanical bench studies, with few prospective randomized trials comparing fixation methods for specific fracture configurations. Expert opinion therefore carries substantial weight, and differences persist on questions such as the optimal plate working length, the value of locking versus nonlocking screws in various bone qualities, and the threshold at which an external fixator should be converted to a plate.

Surface modification research, including alkali and heat treatments that produce direct bone bonding in canine models, and growth factor delivery systems that accelerate osseointegration, has not yet translated into commercially available veterinary implants. Similarly, magnesium-based biodegradable alloys remain under investigation, with clinical translation limited by degradation rate control and gas accumulation. The practitioner should interpret manufacturer claims about novel surfaces with appropriate skepticism until peer-reviewed clinical data in dogs and cats are available.

## Referral and Escalation Criteria

Referral to a board-certified surgeon is appropriate when the fracture configuration exceeds the clinician's experience, when revision of a failed fixation is required, when the patient has sustained polytrauma, or when the owner's expectations for return to function are high and the primary repair carries substantial risk of complication. Early consultation is preferable to attempted salvage of a failing construct.

Laboratory involvement is indicated when infection is suspected, including aerobic and anaerobic culture of deep samples, antimicrobial susceptibility testing, and histopathology of any resected tissue. Where regulatory reporting is required, such as for suspected implant-related adverse events or notifiable conditions, the practitioner should follow the relevant national authority and professional body guidance, including the standards published by the World Organization for Animal Health.

## Troubleshooting Guide

| Observation | Likely Cause | Discriminating Check |
|---|---|---|
| Progressive lameness after initial improvement | Implant loosening or infection | Radiographic comparison with postoperative films, deep culture if infection suspected |
| Incisional drainage or persistent seroma | Superficial infection or deep implant infection | Cytology, culture, and antimicrobial susceptibility |
| Screw back-out or plate migration | Insufficient screw purchase or premature weight bearing | Radiographic assessment of screw position relative to plate holes |
| Delayed callus formation at 8 weeks | Biologic failure, instability, or infection | Radiographic evaluation of fracture gap and implant integrity, consider culture |
| Implant fatigue fracture | Under-sized implant or excessive working length | Radiographic identification of implant failure, reassess load-sharing strategy |
| Pin migration through skin | Inadequate pin anchoring or poor soft tissue coverage | Physical examination and radiography, consider pin removal or replacement |

## Frequently Asked Questions

### How Do I Choose a Fixation Method When Only Basic Equipment Is Available?

When locked plating systems or interlocking nails are unavailable, prioritize stability using the equipment on hand. A plate applied in compression mode remains the most versatile option if standard plates and screws are available. If only pins and cerclage exist, select fractures amenable to load-sharing constructs, such as long oblique or spiral diaphyseal fractures, and avoid transverse fractures in weight-bearing bones. External fixators constructed from threaded pins and acrylic or connecting bars offer adjustable stability with minimal inventory. Consider referral when fracture geometry or patient size demands implants you cannot provide. Document the equipment limitation in the medical record and explain to the owner that the chosen construct may require stricter activity restriction than a locked alternative.

### What Are the Practical Cost Considerations When Recommending Implants?

Implant cost varies substantially between locking plates, conventional plates, interlocking nails, and external fixator components. Locking plates and interlocking nails generally carry higher acquisition costs, while external fixators allow reuse of some hardware after sterilization. Factor in the cost of a second surgery if implant failure or nonunion occurs, since a cheaper construct that fails is more expensive than a pricier one that heals. Discuss cost openly with owners before surgery, presenting the mechanical rationale for the recommended implant instead of only the price difference. The [ACVS animal health resources](https://www.acvs.org/small-animal/) provide owner-oriented summaries of fracture repair options and expected outcomes that can support these conversations. For financially constrained cases, an external fixator often provides adequate stability at lower initial cost, provided the owner can manage pin care.

### How Does Implant Selection Differ Between Cats and Dogs?

Feline bone is smaller in diameter and has thinner cortices than canine bone, which reduces screw purchase and increases the risk of iatrogenic fracture during drilling or tapping. Locking plates with 2.0 or 2.4 mm screws are often preferable in cats because the locked screw-plate interface does not rely on screw head compression against bone for stability. Intramedullary pins in cats should occupy a smaller fraction of the medullary canal than in dogs, typically less than 40 percent of canal diameter, to preserve endosteal blood supply. External fixator pin diameter should not exceed 20 to 25 percent of bone diameter in either species. Feline patients also tolerate external fixators poorly if the frame is bulky, so consider lighter connecting systems or a plate when compliance is uncertain.

### What Should I Document in the Medical Record Regarding Implant Selection?

Record the implant type, manufacturer, size, and lot number for every component implanted. Document the fracture classification, the biomechanical rationale for the chosen construct, and any deviation from the planned fixation. Note the reduction quality, screw lengths and positions, and whether the construct relies on load sharing or load bearing. Include intraoperative complications such as drill bit breakage, stripped screw threads, or inadvertent pin penetration of a joint. Postoperative radiographs should be described with specific parameters: implant position, fracture gap, alignment, and any lucency around screws or pins. The [AVMA practice resources](https://www.avma.org/resources-tools) offer guidance on medical record standards that support continuity of care and medicolegal defense. Serial radiographic findings at rechecks should be documented with the same specificity to allow early detection of loosening or migration.

### How Should I Explain Implant Failure Risk to an Owner Before Surgery?

Describe the mechanical goal of the repair in plain terms: the implant holds bone fragments aligned while the bone heals, and the implant eventually becomes unnecessary once union occurs. Explain that no implant is unbreakable and that the most common causes of failure are premature weight bearing, uncontrolled activity, and infection. State the expected healing timeline for the specific bone and fracture type, and specify the activity restrictions required during that period. The [MSD Veterinary Manual](https://www.msdvetmanual.com/) provides species-specific summaries of fracture healing and postoperative care that can be referenced when discussing expectations. If the fracture is comminuted or in a region with poor blood supply, be explicit that the risk of delayed union or nonunion is higher and that a second surgery may be needed. Offer a written postoperative care plan.

### When Should I Refer a Fracture Case instead of Attempt Fixation?

Refer when the fracture pattern exceeds your implant inventory or your experience with the required technique. Specific triggers include articular fractures requiring anatomic reduction, fractures in very small or very young patients, comminuted diaphyseal fractures needing locked constructs, and fractures associated with significant bone loss or infection. Refer also when previous fixation has failed and the bone is osteopenic or has screw holes that compromise new screw placement. The [WOAH terrestrial animal health standards](https://www.woah.org/en/what-we-do/standards/codes-and-manuals/terrestrial-code-online-access/) address professional responsibility in surgical decision-making, though they focus on international animal health instead of individual case referral. If you are uncertain whether your skills match the case, contact a boarded surgeon before surgery instead of after a complication. Stabilize the fracture temporarily with a splint or external coaptation and refer promptly.

## Related Clinical & Scientific Guides

* [Perioperative Antibiotic Prophylaxis: Timing and Selection](/knowledge/veterinary-medicine/veterinary-surgery/perioperative-antibiotic-prophylaxis-timing-selection)
* [Surgical Approaches to the Femur and Stifle](/knowledge/veterinary-medicine/veterinary-surgery/surgical-approaches-femur-stifle)
* [Fracture Healing Assessment: Radiographic and Clinical Evaluation](/knowledge/veterinary-medicine/veterinary-surgery/fracture-healing-assessment-radiographic-clinical)


## References and Further Reading

- [Infections associated with orthopedic implants.](https://pubmed.ncbi.nlm.nih.gov/16804382/). 2006.
- [Titanium metals form direct bonding to bone after alkali and heat treatments.](https://pubmed.ncbi.nlm.nih.gov/11516085/). 2001.
- [Osseointegration on metallic implant surfaces: effects of microgeometry and growth factor treatment.](https://pubmed.ncbi.nlm.nih.gov/12418014/). 2002.
- [Designer Dual Therapy Nanolayered Implant Coatings Eradicate Biofilms and Accelerate Bone Tissue Repair.](https://pubmed.ncbi.nlm.nih.gov/26923427/). 2016.
- [The sheep as a model for osteoporosis in humans.](https://pubmed.ncbi.nlm.nih.gov/12090765/). 2002.
- [Magnesium-Based Alloys Used in Orthopedic Surgery.](https://pubmed.ncbi.nlm.nih.gov/35161092/). 2022.
- [American College of Veterinary Surgeons Animal Health Resources](https://www.acvs.org/small-animal/). American College of Veterinary Surgeons.
- [MSD Veterinary Manual, Professional Edition](https://www.msdvetmanual.com/). MSD Veterinary Manual.
- [American Veterinary Medical Association Practice Resources](https://www.avma.org/resources-tools). American Veterinary Medical Association.

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> This article is educational professional reference material for veterinary audiences. It is not a substitute for veterinary diagnosis, individual clinical judgment, current product labeling, or applicable regulatory requirements.