Implantation of a Titanium Partial Limb Prosthesis in a White-Naped Crane (Grus

vipio)
Author(s): E. Marie Rush, DVM, Thomas M. Turner, DVM, Ronald Montgomery, DVM, MS, Dipl
ACVS, Anna L. Ogburn, DVM, Robert M. Urban, Chris Sidebothum, BSME, and Andrew LaVasser,
DVM
Source: Journal of Avian Medicine and Surgery, 26(3):167-175. 2012.
Published By: Association of Avian Veterinarians
URL: http://www.bioone.org/doi/full/10.1647/2009-012R2.1

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Journal of Avian Medicine and Surgery 26(3):167175, 2012

2012 by the Association of Avian Veterinarians

Clinical Reports

Implantation of a Titanium Partial Limb Prosthesis in a

White-Naped Crane (Grus vipio)
E. Marie Rush, DVM, Thomas M. Turner, DVM,
Ronald Montgomery, DVM, MS, Dipl ACVS, Anna L. Ogburn, DVM,
Robert M. Urban, Chris Sidebothum, BSME, and Andrew LaVasser, DVM
Abstract: A female white-naped crane (Grus vipio) was presented with an open, oblique fracture
of the distal right tarsometatarsus and concomitant vascular and nerve damage. Conventional
fracture xation repairs failed, which led to implantation of a custom titanium limb prosthesis.
After subsequent revisions with 2 different prosthetic devices, limb function was ultimately
restored but a later yolk embolism caused a circulatory compromise in the opposite leg, which
necessitated euthanasia. Histopathologic results revealed limited ingrowth of bone into the porous
coated implant, which indicated that a limb prosthesis may provide salvage for long-legged, heavybodied birds with fractures of the tarsometatarsus.
Key words: tarsometatarsus, fracture, prosthesis, implant, bone, avian, white-naped crane, Grus
vipio

which indicated vascular compromise. Full neurologic function of the limb could not be determined,
but deep pain recognition was present for all digits.
The limb and wound were thoroughly cleaned with
chlorhexidine (2% scrub and 1% dilute solution)
and irrigated with sterile saline solution, and a
temporary supportive soft splint was applied. A
single dose of dexamethasone sodium phosphate
(2.8 mg/kg IM) and lactated Ringers solution (120
mL SC) were administered. After 2 hours, perfusion of the foot was visibly improved.
For the initial fracture repair, the crane was
anesthetized with isourane and was monitored
routinely during surgery. An external skeletal
xation (ESF) device was placed by using 2
positive-threaded pins above and below the fracture site with methylmethacrylate cement connecting bars. A cerclage plastic cable tie was used for
additional rotational stability. Moderate damage
of the common extensor tendon was evident, and
viability of the distal limb was questionable.
Postoperative radiographs conrmed good reduction and alignment of the tarsometatarsus. Enrooxacin (15 mg/kg q12h IV; Bayer Health Care
LLC, Animal Health Division, Shawnee, KS,
USA), clindamycin (300 mg/kg IV q24h; Abbott
Labs, N. Chicago, IL, USA), and ketoprofen (1

Clinical Report
A 17-year-old, 5.5 kg, female white-naped crane
(Grus vipio), part of a valuable breeding pair, was
presented with severe trauma to its right leg from
entanglement in outdoor enclosure fencing. Physical and radiographic examination identied an
open, comminuted, oblique fracture of the distal
one-third of the right tarsometatarsus diaphysis.
No other health abnormalities were detected. The
limb distal to the fracture was rotated more than
1808, and all vascular and neurologic structures
were severely compromised. After detorsion of the
limb, the wound had only moderate hemorrhage,
From the Birmingham Zoo Inc, 2630 Cahaba Rd, Birmingham, AL 35223, USA (Rush, Ogburn, LaVasser); the Rush
University Medical Center, 1653 W Congress Pkwy, Chicago, IL
60612, USA (Turner, Urban); the Department of Small Animal
Medicine and Surgery, College of Veterinary Medicine, Auburn
University, AL 36849, USA (Montgomery); the VCA Berwyn
Animal Hospital, 2845 S Harlem, Berwyn, IL 60402, USA
(Turner); and Biomedtrix, 50 Intervale Rd, Ste 5, Boonton, NJ
07005, USA (Sidebothum). Present address: the Department of
Small Animal Medicine and Surgery, School of Veterinary
Medicine, St Georges University, True Blue, St Georges,
Grenada, West Indies, and the Environmental Institute/Alabama
Heritage Project, Auburn University, Auburn, AL 36849, USA
(Rush); 120 Kinsler Rd, Blythewood, SC 29016, USA (Ogburn).

167

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JOURNAL OF AVIAN MEDICINE AND SURGERY

Figure 1. The initial prosthesis implanted in a white-naped crane after amputation of the distal tibiotarsus and foot
after failed fracture repair. The dimensions and a diagram of the implantation protocol for the original prosthetic
device, including images, measurements, and dimensions of the prosthetic with respect to radiographic comparison of
the limb, are given.

mg/kg IM initially, then PO in q24h food; Fort

Dodge Laboratories, Fort Dodge, IA, USA) were
administered until the prosthesis surgery. The
crane was weight bearing after surgery, with
minimal lameness the following week. Daily
wound irrigations and bandage changes were
performed; however, the limb distal to the fracture
site became progressively necrotic, which necessitated amputation 16 days after the original
surgery. At the time of amputation, a wood block
was attached to the proximal ESF pins by
methylmethacrylate connecting bars, which provided a temporary weight-bearing device while
awaiting a prosthesis.
Initial Implantation of Prosthesis
After the failure of the ESF, a custom limb
prosthesis with a distal foot was designed (BioMedtrix, Boontown, NJ, USA), by using radiographs of the remaining tarsometatarsus and
templates for implant sizing (Fig 1).
The implant consisted of a titanium core with the
proximal end that incorporated a 4.5-mm screw
shank to allow for initial press-t xation. The
center portion of the implant was a porous tantalum
sleeve over the titanium core that provided porosity
for bone ingrowth for long-term xation and skin

ingrowth to seal the implant interface. The distal

end consisted of a tapered titanium segment with a
terminal rubber foot (Fig 1).
Surgery was performed by using special instrumentation (BioMedtrix) to press-t the implant
into the bone (Fig 1). The crane was anesthetized
as in the previous surgery. The scar was minimally
debrided, and soft tissues were proximally elevated
1 cm from the bone. A 22-mm section of distal
bone was resected transversely to provide a at
surface perpendicular to the long axis of the bone
and soft tissue closure. The gure shown (Fig. 1)
demonstrates the recommended surgical approach
based on original radiographic images and implant
design. However, it did not account for fracture
compression, soft tissue allowance, for actual
balance with the opposite limb once placed, or
the addition of the articial foot (which is shown in
the diagram and adds 2 mm to the physical length
of the limb). This is allowed for the 1 mm margin
of error that remained and was measured as actual
diffrence and was taken during planning of the
bone surface in surgery to allow for symmetry with
the opposing limb on ambulation. The medullary
canal was opened, drilled, and reamed, and the
prosthesis was inserted to abut the distal cut bone
surface (Fig 2). The remaining soft tissue was

RUSH ET ALPARTIAL LIMB PROSTHESIS IN A WHITE-NAPED CRANE

169

Figure 2. Postoperative radiograph (left), demonstrating the initial implanted prosthesis and a radiograph (right) of the
rst prosthesis implanted with kryolite cement after 10 days in the crane described in Figure 1. A marked periosteal
reaction is present circumferentially along the implanted bone length. Prominent radiolucencies surround the
intramedullary rod at the bone-cement and stem-cement interfaces.

closed against the porous implant surface in 2

layers with 3-0 polydioxanone (PDS, Ethicon,
Somerville, NJ, USA) suture in a pursestring
pattern. A sterile bandage was applied, and a
rubber stopper was attached to the bottom of the
implant. After recovery, the crane immediately
began placing full weight on the implant, which
was allowed to promote vascular and bone growth
into the implant. However, implant motion at the
bone-implant interface resulted in implant instability. Butorphanol tartrate (2.5 mg/kg PO q1224h) and haloperidol (0.5 mg/kg PO q12h; McNeill
Pharmaceutical Inc, Spring House, PA, USA) were
used for postoperative analgesia and sedation.
After 2 weeks and failed attempts to stabilize the
implant with stents and external support, a new
implant was developed.

implant, suggestive of infection, and bone resorption (Fig 2). The implant was removed, and the
bone was minimally resected proximal to the
apparent infected area. A sample of bone was
obtained and submitted for aerobic and anaerobic
culture. Results conrmed infection with Serratia
marcescens and Escherichia coli, and the bird was
treated systemically with culture sensitive cephalexin (40 mg/kg PO q8h) and chloramphenicol (50
mg/kg PO q8h). The medullary cavity was ushed
daily with sterile saline solution and bandaged
until the replacement implant arrived.

Incorporation of Bone Cement into

Prosthetic Stabilization
Implant instability required implant removal at
2 weeks after surgery, and the medullary canal was
debrided and reamed. Absorbable, sterile, calcied
triglyceride bone cement (Kryptonite, Doctors
Research Group Inc, Plymouth, CT, USA) was
inserted into the canal, and the implant was
replaced. The crane was maintained under isourane anesthesia for 1 hour for initial cure of the
cement (2448 hours for complete cure). Parenteral
uids, ketoprofen, enrooxacin, clindamycin, and
butorphanol were continued at previous treatment
regimens after surgery. The crane was then placed
into a custom standing sling. After 48 hours, the
bird was allowed to ambulate and bear weight on
the prosthesis, which it did readily. However, the
implant became unstable, and the skin did not
cover the porous surface, which allowed environmental contaminants into the interface. Radiographs revealed radiolucent lines around the

Figure 3. Photograph, showing the second prosthesis

and appropriate dimensions used in the crane described
in Figure 1. This surgery required a crescent wrench
placed over 2 ats at the foot that were 12.7 mm
apart. Skin was closed over the porous portion of the
implant and a recess in the implant allowed for a purse
string suture to secure the skin over the porous material.
A small rubber shoe was applied during the initial 46
weeks of bone integration into the tantalum material.
Evidence of ingrowth was evaluated with radiographs.

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JOURNAL OF AVIAN MEDICINE AND SURGERY

Implantation of Second Custom Prosthesis

The second implant design incorporated the
same concepts as the initial implant but was longer
and had a slightly larger diameter to accommodate
the higher bone resection. The new implant was
cylindrical and measured approximately 24 cm in
length. The proximal 8 cm was conically tapered
from 8 to 5 mm and had circumferential threading.
A tantalum porous coated sleeve, 5.2-cm length by
7-mm diameter, overlaid the central section, and
the remaining distal 11.4-mm portion of the device
was noncoated, with a female Morris taper
receptacle (Fig 3).
Three weeks after implant replacement with the
bone cement, a second implant surgery was
performed with the same technique as used in the
initial prosthesis placement, with the addition of an
outer chamfered cut to the end of the bone to
improve lateral stability of the bone-implant
interface (Fig 3). Intravenous uids, clindamycin
(300 mg IV q24h), enrooxacin (15 mg/kg IV
q12h), and cefazolin (30 mg/kg IV q8h) were
administered during surgery. Additional distal
bone resection was done based on limb length
measurements on radiographs and implant length
specications with respect to the animals postsurgical limb length. Intravenous administration of all
antibiotics was continued for 3 days after surgery,
followed for 6 weeks by oral administration of
enrooxacin and clindamycin at previous dosages.
Recovery was uneventful, and the bird immediately began using the implant for weight bearing
(which encouraged bone and vascular ingrowth)
and continued to improve daily, with the bird
bearing full weight on the implant within 72 hours
after surgery. The sling was used occasionally to
allow the patient to rest and as a restraint when
offering medicated food items.
Clinically, the crane responded well, continued
to eat, and became more active after surgery.
Acetylsalicylic acid (8 mg/kg PO q24h) was given
daily as an anti-inammatory and analgesic.
Progressive weight bearing and functional use of
the limb was exhibited. Unfortunately, abnormal
use of the opposite leg was observed in the third
week after surgery. On examination, vascular
compromise was apparent on the proximal medial
one-third of the tibiotarsus, and, subsequently, the
normal leg became progressively devitalized. Aggressive treatments, which consisted of physical
therapy, warm compresses, and application of
dimethyl sulfoxide (q6-8h; Med-Vet International,
Mettawa, IL, USA) were attempted but were
unsuccessful. Although the bird was using the

prosthetic leg normally, euthanasia was elected 3

weeks after the second implant surgery because of
the poor prognosis for the normal limb and quality
of life considerations.
Histologic Evaluation
The implanted limb was disarticulated at the
tarsal joint and xed in neutral buffered formalin
and orthogonal contact radiographs were obtained. The bone with the prosthetic device in situ
was sequentially sectioned transversely into 5-mmthick sections to within 5 mm of the porous coated
sleeve. A 1-cm transverse block, including the
porous coatingthread stem junction was cut
sagittally into 2-mm sections. Cut sections were
radiographed, ground down, and stained with

Figure 4. Contact radiograph with the partial limb

prothesis in situ from the crane and implant described in
Figure 3. The resected bone abuts the porous coating
sleeve of the prosthesis. The only bone ingrowth was
found at this site (white arrows).

RUSH ET ALPARTIAL LIMB PROSTHESIS IN A WHITE-NAPED CRANE

basic fuchsin and toluidine blue for light microscopy.

Contact radiographs of the limb with the
prosthesis in situ revealed the conically tapered
section to be well seated into most of the proximal
medullary canal. A section of bone overlaid the
porous coating along one side and extended
distally 3.5 cm. Scalloping was present along the
endosteal surface of the tarsometatarsal bone
adjacent to the threaded stem. A marked periosteal
reaction was also present, which extended proximally to the joint. The porous coating abutted the
resected portion of the tarsometatarsal bone with
no radiolucency evident. A continuous radiolucency was evident along the interface between the
intramedullary-threaded portion of the stem and
the endosteal bone surface except for the distal 4
mm of bone, which appeared to be in contact with
the threaded portion of the stem (Fig 4).
Radiographs of the cut sections revealed radiolucent areas between the threaded stem and the
cortex. Proximally, the stem was grossly loose
within the medullary canal. A marked 36-mmthick, circumferential, periosteal reaction was
present in all sections, which extended to and
included the level adjacent to the porous coating
and over the proximal edge of the porous coating
(Fig 5). At the porous sleeve-stem junction, bone

Figure 5. Contact radiograph of a histologic section that

contains the medullary rod from the crane and implant
described in Figure 3. The exuberant periosteal reaction
surrounds the entire cortical surface (white arrows).
Minimally displaced cortical fractures have lled with
abundant new bone by direct bone healing. Larger
vertical fractures have also healed with some new bone
formation on the fracture surfaces but are bridged with
extensive periosteal bone (black arrows).

171

Figure 6. Contact radiograph of a histiologic section

through the proximal porous sleeve, showing no bone
on or within the porous coating from the crane and
implant described in Figure 3.

was present between the threaded stem and the

porous sleeve in intimate contact with the internal
aspect of the porous sleeve and abutting the
threaded stem, and covering approximately onehalf of the circumferential porous-coating surface.
Bone was found in intimate contact abutting the
external surface of the porous coating (at the most
proximal aspect) and covering approximately
three-fourths of the circumferential surface. A 1
2-mm separation in the cortex was present, which
extended proximal to the level of the stem tip and
represented a nondisplaced fracture that was
bridged with periosteal new bone (Fig 5). No bone
was present on the porous coating surface or
within the tantalum porous material void spaces
beyond the resected bone surface (Fig 6).
Stained histologic sections focused on the
cortex, medullary tissue, and implant-bone interface, and, when present, the porous coating. In
general, proliferative and resorptive bone changes
were present, and a prominent brous membrane
surrounded the intramedullary stem of the device.
At the junction of the bone and porous coating,
there were limited sites of bone on the porous
coating surface and foci of bone in the porous void
spaces. Predominately, the device appeared to be
xed by the brous tissue membrane along the
length of the medullary stem and at the cortical
bone-implant junction.
On histologic examination of cortical bone in
the implanted leg, exuberant and extensive periosteal new bone formation, which measured 13
times the cortical thickness, was present circum-

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JOURNAL OF AVIAN MEDICINE AND SURGERY

Figure 7. A photomicrograph of a transverse cortical

section of bone from the crane and implant described in
Figure 3 reveals a nondisplaced fracture, which has lled
with abundant new bone (black arrows) (375). Osteonal
remodeling has also occurred with new bone seen
centrally in the osteons and a few resorptive cavities
undergoing remodeling. All histopathology were images
stained with basic fuchsin and toluidine blue.

ferentially along the entire length of the tarsometatarsal bone. Several nondisplaced vertical
cortical fractures, 23 per section, were seen with
varying extents of bone formation. Many of the
minimally displaced fractures were completely
lled with new woven and lamellar bone (Fig 7).
Fractures with wide separation between fragments
were bridged by the thick periosteal reaction but
had minimal bone in the fracture gap (Fig 5).

Figure 8. A photomicrograph of the bone-implant

interface membrane of the crane and implant
described in Figure 3, showing a very vascular brous
tissue membrane with an extensive mononuclear cellular
inltrate within a loose to moderately organized brous
structure (3154). All histopathology were images stained
with basic fuchsin and toluidine blue.

Figure 9. A photomicrograph of a sagittal section at the

porous coatingbone interface of the crane and implant
described in Figure 3, showing new woven bone in
contact to the tantalum bers of the porous coating
surface and bone ingrowth within the void spaces of the
porous material (3154). All histopathology were images
stained with basic fuchsin and toluidine blue.

Active cortical remodeling was present, with the

osteons lled with new bone centrally as evidenced
by the darker histologic staining. The endosteal
surface had some areas of new bone formation but
numerous sites of osteoclastic resorption. Thus,
overall the cortical bone appeared viable and
capable of repair and production of new bone.
The bone-implant interface membrane was the
predominant structure that surrounded the device
stem, at the bone-porous coating interface, and
within the porous coating. The structure of the
membrane varied from a densely organized layer
adjacent to the endosteum, progressing to a more
loosely organized layer closer to the implant and
highly vascular (Fig 8). A large population of
mononuclear cells inltrated the membrane with
occasional multinucleated cells.
Bone was present along the intramedullary
section of porous coating and on the external
surface of the porous coating segment of the
prosthesis only immediately adjacent to the resected bone-implant junction. Although the cylindrical
porous-coated device abutted the cut cortical bone
surface, there was limited bone ingrowth present
within the porous coating. At this junction, small
foci of new bone were within the void spaces of the
porous-coating, some of which were undergoing
osteoclastic resorption (Fig 9). No bone ingrowth
was within the porous coating sleeve distal to the
implant bone interface (Fig 6).

RUSH ET ALPARTIAL LIMB PROSTHESIS IN A WHITE-NAPED CRANE

Histologic examination of the nonimplanted leg

revealed apparent thrombosis in all sampled
sections of the tarsometatarsus, with complete
infarction of the bone and associated soft tissues
of the associated foot. Many of the blood vessels
contained brinocellular thrombi, some of which
contained yolk-like globules of proteinaceous
material. The yolk embolism of the blood vessels
likely resulted in circulatory compromise to the leg.
Discussion
Distal leg (tarsometatarsal) fractures are common in captive Gruiformes because of their heavy
bodies and long legs.1 These injuries often occur
with manual restraint for procedures or from ght
or ight responses that lead to secondary trauma.
These fractures may be open and highly comminuted, and are reported to have high xation
failure rates (up to 90%).14 In this report, we
described a successful salvage treatment of a failed
tarsometatarsal fracture repair by using a titanium
limb prosthesis.
The overall positive clinical response to limb
implantation demonstrates the clinical function of
a prosthetic limb in a long-legged avian species.
However, various factors were critical to achieve
proper implant xation and stability. These factors
are implant design, xation method, viability of the
remaining proximal implanted bone, the potential
for contamination, and the biology of avian bone.
The original implant was simplistic and did not
achieve initial mechanical stability within the
medullary canal or sufcient intimate bone contact. These are crucial to achieve bone xation.
Intimate contact of bone to a porous coating and
immediate rigid stability of the implant must be
achieved to provide an interface conducive to bone
development within the coating and at the
interface. The lack of complete stability is reected
in the loose proximal rod, endosteal scalloping,
and prominent periosteal reaction. A device with
closer tolerances to the medullary canal, as
achieved by the second implant, and additional
supplemental xation may have improved and
facilitated initial bone xation. A custom implant,
which has been successful in bilateral tibial
implants in a dog, can be achieved with computed
tomography imaging and 3-dimensional stereolithographic models.5 These detailed images and
models can be used to design both custom implants
and instruments, and provide a more precise t.
Also, multiple-sized implants could be provided to
appropriately select at surgery.

173

Fixation of prosthetic devices to bone can be

successfully achieved by cement xation, bone
ingrowth into a porous coating, bone ongrowth
onto a textured surface, and screw xation.6
Fixation of a device by a porous coating applied
to that device is well established in orthopedics.
Development of bone within a porous coating or
onto a textured surface has been successfully
demonstrated in animals. This method can provide
long-term xation and prosthetic function over the
life of the implant.716 The tantalum porous
material used in this crane has been documented
to achieve secure xation by bone ingrowth in
canine models, and these devices have been
successful in various species, including humans.
However, the use of porous coating for xation in
an avian species is not well documented.5,12,16 Use
of a porous coating avoids the involvement of bone
cement, which may cause thermal effects on bone
and production of particulate debris, and may
impede an additional interface for ingrowth. In this
case, use of conventional bone cement as a xation
method was challenging because of the inability to
interdigitate cement into avian bone, which is
devoid of substantial trabecular structure.
Environmental exposure of the bone implant
interface was problematic in this case. The poor
elasticity of avian skin and subsequent skin loss
from the original trauma allowed the introduction
of environmental contaminants into the medullary
cavity of the bone because of the inability to cover
the porous implant section. Particulate debris has
been shown to migrate along the bone prosthetic
interface, stimulate an inammatory response, and
result in osteolysis and subsequent device loosening from the bone, with eventual loss of prosthetic
xation. Loosening of the implant was observed
grossly, radiographically, and histologically in this
crane, and was likely a result of infection but could
also be related to early mechanical loosening.
Further analysis over long-term implantation is
required before conclusions can be made about the
mechanical stability of this device type. In a report
in a dog, bilateral tibial implants used a surface
treatment on a revised implant after the original
implant had aseptic loosening.5 This surface
treatment has been shown to act as an antiinammatory and to aid physiologic implant
acceptance, tissue growth promotion and osseointegration, platelet activation and adhesion reduction, and prevention of bacterial infection and
thrombosis.17,18 This treatment is currently used in
implants in humans and may be a valuable tool
toward creating successful transcutaneous implants in a variety of species.

174

JOURNAL OF AVIAN MEDICINE AND SURGERY

A stable bone-implant interface is critical to

achieving long-term successful xation of any
device.14,16 In this unusual application, the interface was potentially inuenced by a bone decient
medullary canal and by the viability of this bone.
Application of this prosthetic device was because
of ischemic necrosis of the distal limb, which also
may have impaired the viability of the remaining
proximal tarsometatarsal bone. Viability impairment appears unlikely because radiographs revealed an exuberant periosteal reaction, which
indicated vascularization and potential to respond
to an insult. Marked periosteal new bone in this
case was compatible with chronic irritation,
possibly from repeated surgical trauma, aseptic
or septic implant loosening, infection, aggressive
cell-based osteolysis, or a combination of these
factors. Bone viability was also supported by the
osteogenesis at the interface of the porous sleeve to
the adjacent bone, complete healing of the cortical
fractures, osteonal remodeling, and the development of bone ingrowth noted on histopathologic
examination.
Repeated surgeries with the original implant,
which was revised to the current prosthesis, caused
trauma and injury to the cortical and medullary
bone. This may have led to further injury to the
endosteal surface, a decrease in bone formation
ability, and thus decreased bone xation compared
with primary implantation of a porous-coated
device.19 The extent of these effects is unknown.
Finally, avian bone consists of thin cortices, has
a sparsity of trabecular bone, and has minimal
tissue in the diaphyseal medullary canal. Collateral
circulation to the distal limb is poor, with limited
soft tissue for wound coverage. These factors could
have impeded xation in this case.
Although this device was implanted for only a
limited time, it established the functional clinical
success of a partial limb prosthesis in this crane.
This case also demonstrates the feasibility of
having porous implant ingrowth and ongrowth in
avian bone. Factors that must be considered for
future implants are rening prosthetic design and
achieving a greater degree of initial bone implant
stability. Long-term survivability of a bone prosthetic interface that is partially exposed to the
external environment needs prolonged monitoring
and evaluation. This appears to be critical to
tissue-implant interface and a major limiting factor
in implant success and longevity. Dental implants
have been successfully anchored to maxillary and
mandibular bone long term, with exposure to the
oral cavity and bone environments, and, in a
report of long-term successful bilateral tibial

implants when using porous tantalum in a dog,

this porous surface was postulated to help prevent
complications at the skin-implant interface.5 The
successes and failures seen in both of these cases
illustrate the need for further development of this
technology but allow postulation for long-term
feasibility of this procedure. The successful implantation of limb prosthetics in these 2 species
highlights the potential for future use of this
technology for animal patients with limb amputations. Consideration for use of such implants
should be given when long-legged birds experience
fractures of the distal limb.
Acknowledgments: We thank BioMedtrix for their
donation of time and expertise in designing and
providing the implant for this crane, and to Leon
Roitburg, owner of National Precision Tool Company
Inc, Faireld, NJ, who donated his time in getting the
custom implants and instruments made and for supplying the calcium triglyceride bio-absorbable bone cement
used in this case.

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