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Dr. Orosz is an internationally known avian veterinarian and anatomist. She received her
PhD in human neuroanatomy from the University of Cincinnati Medical Center in 1980 and
her DVM degree from The Ohio State University in 1984. From 1986-2000, Dr. Orosz taught
avian medicine and surgery at The University of Tennessee, College of Veterinary Medicine
where she attained the rank of professor. During her tenure at the University, she advanced
the Avian and Exotic Animal Medicine Service at the Teaching Hospital as Service Chief
and developed the ABVP Avian Residency Program in Avian Medicine. She obtained board
certification in Avian Medicine through the American Board of Veterinary Practitioners and
the European College of Avian Medicine. Dr. Orosz authored the award-winning prede-
cessor to this text, Avian Surgical Anatomy: Thoracic and Pelvic Limbs, and co-authored
Manual of Avian Medicine with Dr. Glen Olsen. She has written on a variety of avian topics
for research publications, including avian anatomy, fungal diseases and their treatment, and neurology. Dr Orosz is a past
president of the Association of Avian Veterinarians (1995) and served as scientific editor for its journal, The Journal of Avian
Medicine and Surgery, from 2000-2003. She received the Merck Award for Creative Achievement in 1994 and was the
recipient of the Excellence in Avian Research from the AVMA in 1997. Dr Orosz was awarded the Dr. TJ Lafeber Avian Practi-
tioner Award in 2007. Dr. Orosz has served as a committee member to the Secretary of Agriculture’s Advisory Committee on
Foreign Animal and Poultry Diseases and as a consultant for the Lafeber Company. Dr. Orosz is owner of the Bird and Exotic
Pet Wellness Center in Toledo, OH.
Dr. M. Scott Echols is a boarded avian specialist veterinarian living in Salt Lake City,
Utah. Dr. Echols was the 2005 recipient of the T.J. Lafeber Avian Practitioner of the Year
Award, 2007 Texas Veterinary Medical Association Non-Traditional Species Practi-
tioner of the Year, 2007-2008 President of the Association of Avian Veterinarians and
Texas A&M 2018 Distinguished Alumnus. He is also the creator of several educational
DVDs including Captive Foraging and The Expert Companion Bird Care Series. Dr
Echols founded the Grey Parrot Anatomy Project to better define bird anatomy and
develop new diagnostic and therapeutic advances that apply to numerous branches
of medicine. Additionally, he creates innovative imaging technology for use with
animals and humans and is the founder of Scarlet Imaging where he works to help
science achieve better answers that change the world. His animal and anatomy
themed artworks have been featured on the cover of several journals, recognized for two Wellcome Image Awards
and displayed in numerous museums and galleries across the world. Dr Echols is a frequent author, lecturer and
visiting professor internationally covering topics relative to human and animal health. He lives with his wife Layle and
daughter Alaina who also enjoy animals and nature.
Dr. Patrick Redig DVM, PhD, is Professor Emeritus at the College of Veterinary Medicine,
University of Minnesota and founder and former director of The Raptor Center, a
world-renowned institution of raptor conservation and medicine. He obtained his DVM
from the University of Minnesota in 1974 and his PhD in physiology at the same insti-
tution in 1979. He assumed a position as an assistant professor in 1981 and rose to the
level of Full Professor in the Department of Small Animal Clinical Sciences. A falconer
since his early teens with a keen interest in raptor protection, he seized the opportunity
to initiate and develop a program designed to promote conservation of birds of prey
through the medium of veterinary medicine and public outreach. From this platform,
he nurtured, through research and practice, the nascent art of avian medicine and the
establishment of The Raptor Center. Responding to the need for an armamentarium of
tools to treat the hundreds of traumatically injured raptors presented annually, he developed unique and affordable
methods for orthopedic management that are a major component of this edition of the book. These methods have
been taught to thousands of students around the globe through residencies and internships at The Raptor Center as
well as workshops offered at many venues domestic and abroad. Dr. Redig is the author of numerous original research
articles on topics ranging from anesthesia and orthopedic surgery to West Nile virus disease, avian influenza, asper-
gillosis, and lead poisoning. In addition, he has authored numerous chapters in most contemporary avian medicine
books and convened two international symposia on raptor biomedicine. Beyond veterinary medicine, he also served
as the overall coordinator for restoration of the peregrine falcon in the Midwest United States and was appointed by
the U.S. Fish & Wildlife Service to the California Condor Recovery Team where he served as coordinator of outreach on
lead poisoning for 15 years. He served for six years on the Committee on the Environment of the American Veterinary
Medical Association and as Treasurer for the AAV. He is a recipient of the T.J. Lafeber Avian Practitioner of the Year
Award and the Minnesota Veterinary Medical Association’s Veterinarian of the Year. He retired in 2018 after forty-five
years of dedication to the cause of raptor conservation and continues to work on their behalf. The endowed Patrick T.
Redig Chair in Avian Medicine and Conservation at The Raptor Center ensures his legacy will endure.
PREFACE
Avian Surgical Anatomy: Thoracic and Pelvic Limbs by Orosz, Ensley and Haynes, was published in 1992 and has
served as a standard guide for those performing orthopedic surgery on birds. That foundational work is out of
print but the need for a concise source of avian surgical anatomy has not changed. Our objective in this edition
has been to recapture the musculoskeletal anatomy of the original work and to expand the scope to include
comprehensive coverage for the clinical management of common fractures of the long bones of birds, primarily
raptors. The procedures described have been honed over two decades of development and refinement by clini-
cians at the Raptor Center at the University of Minnesota. In addition, we have included details of the vascular
anatomy of the limbs, further informing the surgeon and clinician.
The class Aves includes thousands of species with countless anatomic variations. Although it is impractical to
represent every species, birds commonly encountered in private practice and rehabilitation medicine including
poultry, pigeons, parrots and birds of prey were chosen for this book. Details of the vascular anatomy of the
limbs were obtained by high resolution digital computed tomography imaging of the appendicular skeleton of
several diverse bird species. These images provide a unique comparative aspect that clinicians will find useful in
conducting surgical procedures. This new information is intended to help the reader better understand skeletal
and vascular anatomy, and thus improve interpretation, reporting of findings, treatment and teaching.
This new information is intended to help the reader better understand relationships between musculoskeletal
and vascular anatomy, helping the surgeon preserve vasculature during complex orthopedic procedures. It is
our hope that it will enrich the interpretation, reporting of findings, development of treatment methods and the
teaching of management procedures for orthopedic issues in birds.
Since publication of the first edition, numerous advances have been made and published relative to avian
orthopedics. In this edition, you will find comprehensive discussion of orthopedic conditions, and clinical
management that represents best treatment options and current practices. The title of the book has been
changed to reflect inclusion of that information.
As our knowledge of avian anatomy, health and disease progresses, so does the need for improved resources
that convey this valuable information. Over time the information contained herein will also need to be expanded
and updated. The authors humbly submit this work to the veterinary and scientific community for review and
scrutiny. We hope that it will contribute to the betterment of avian care.
Respectfully,
Drs. Susan E. Orosz, M. Scott Echols and Patrick T. Redig
ACKNOWLEDGEMENTS
PRIOR CONTRIBUTORS
We would like to acknowledge those individuals that made the first edition of Avian Surgical Anatomy: Thoracic
and Pelvic Limbs possible. Two of the previous authors, Carol Haynes, our illustrator and Dr Phil Ensley were
instrumental in providing illustrations of great quality and clarity and in getting the atlas off the ground. It started
with a small grant provided by Dr Werner Heuschle and the Zoological Society of San Diego. I was a veterinary
student at The Ohio State University seeking to better understand the surgical anatomy of the wings and legs, to
facilitate improved surgical support to injured California condors that were then precariously close to extinction.
The project morphed into a standalone surgical atlas that has been used around the world. Other individuals
were also acknowledged in the first edition and all were integral in making it happen. These included Eric
Bergman, who worked then, and now to help assemble and edit the work for production. My father, Julius Orosz,
was my (SEO) guiding light and drew the original thumbnail sketches, showing how we could turn these drawings
into a unique, practical, and beautiful atlas. The completed book won the book category at the highest level of
recognition (Distinguished) and was runner up for the Best of Show award at the Society of Technical Communi-
cation’s International Competition in 1993.
ANATOMICAL IMAGING ASSISTANCE
While we have included most of the original illustrations, new imaging technology has also been used to create
the second edition. We wanted to demonstrate anatomic variability and advance our understanding of anatomy
relative to commonly performed orthopedic procedures in birds. High resolution computed tomography (CT)
was used to create the detailed digital skeletal and vascular images found throughout the book. The Grey Parrot
Anatomy Project (www.avianstudios.com/the-grey-parrot-anatomy-project) has been established in part to
discover and report anatomy of avian (and other) species. Funds made available through generous donations
have been used to develop CT protocols and scanning time to create images in this book.
The images are standardized to include a minimum of four approximately orthogonal views per section: the
distal wing, humerus and leg. The shoulder was divided into three main views (dorsal, ventral and cranial) with
an additional dorsal oblique view. In some birds, these sections are further divided, and additional views are
provided to show greater detail such as the hip of the military macaw.
Most of the CT scans were created using the Siemens Inveon Preclinical Micro-PET/CT unit at the Preclinical
Imaging Facility, University of Utah HSC Cores in Salt Lake City, Utah (www.cores.utah.edu/preclinical-imaging).
The scans were conducted under the direction of Dr Ed Hsu and his students, Samer Merchant and Gavin Yeip,
at the University of Utah Department of Biomedical Engineering as a part of the Grey Parrot Anatomy Project.
This scanner produces ‘slices’ 100 µm or less creating incredibly detailed images. Because the CT unit bore is
small (about 5 inches), tissues that can be scanned are limited by their size. For many of the below listed birds,
the entire leg or wing could be placed in the scanner. However, for the golden eagle, the shoulder girdle was
simply too large to scan, which is why the shoulder girdle of that species is not included in this book. Because
of the exceptional detail and relatively large size, the golden eagle and military macaw images were made as
standard plus oblique views to create more ‘three dimensional’ views of the bones and joints than those done
with the other birds.
The domestic chicken and African goose were scanned using the Epica Vimago CT at Parrish Creek Veterinary
Hospital and Diagnostic Center in Centerville, Utah. The scans were conducted under the direction of Drs Scott
Echols and Doug Folland and staff including Crystal Wilcox, LVT and Jason Benzing, LVT also as part of the Grey
Parrot Anatomy Project. The Vimago’s large gantry allowed for scans of whole animals and thick tissues such as the
breast and shoulder girdle of the chicken that would otherwise not be suitable for the Inveon Preclinical Micro-PET/
CT scanner. At 200 µm slice thickness, the Vimago also produced high quality images required for this book.
SKELETAL ANATOMY INFORMATION
Common Name Scientific Name CT Image Slice Size Views
Budgerigar Melopsittacus undulatus 50 µm Standard
Domestic Chicken Gallus gallus domesticus 200 µm Standard
Golden Eagle Aquila chrysaetos 100 µm Standard plus obliques
Great Horned Owl Bubo virginianus 100 µm Standard
Military Macaw Ara militaris 100 µm Standard plus obliques
Orange Winged Amazon Amazona amazonica 100 µm Standard
Pigeon Columba livia 100 µm Standard
Red Tailed Hawk Buteo jamaicensis 100 µm Standard
Umbrella Cockatoo Cacatua alba 100 µm Standard
The vascular anatomy was created using a perfusion process and product (BriteVu®, www.ScarletImaging.
com) developed by Dr Scott Echols. Once the vascular system was properly perfused, the regions of interest
were then CT scanned. Drs Scott Echols and Nick Kirk and the Parrish Creek Veterinary Hospital staff (especially
Crystal Wilcox, LVT and Jason Benzing, LVT) performed the BriteVu® perfusions.
The arteriovenogram images were standardized to include four approximately orthogonal views per section: the
distal wing, proximal wing, hip and stifle, and foot. There are additional views of the pigeon and painted stork.
There are no distal limb images in the barn owl due to physical trauma to all extremities.
Understanding the location of the vasculature can prove quite useful during wound management, surgery and
other treatments. Vascular anatomy is complex and can be quite variable between breeds and individuals. The
images provided are not comprehensive and cannot be representative of all birds. However, the arteriovenograms
do provide a guide as some vascular features appear to be common to many studied bird species.
ARTERIOVENOGRAM INFORMATION
Common Name Scientific Name CT Image Slice Size Views
African Goose Anser anser domesticus 200 µm Standard
Barn Owl Tyto alba 100 µm Proximal wing and hip and
stifle only
Painted Stork Mycteria leucocephala 100 µm Standard plus
additional views
Pigeon Columba livia 100 µm Standard plus
additional view
None of these images would have been possible without the donations of terminally ill and deceased birds
by their loving caretakers. In common to all donors was the desire to learn and advance our knowledge about
these magnificent animals. Many birds were submitted through the Grey Parrot Anatomy Project while only a
handful were selected for this book. Criteria included acceptable bone density, normal anatomy (except for the
pigeon with a fractured coracoid), lack of vascular disease and more. Many of the birds listed above were family
members and beloved collections animals. Out of respect for the caretakers and their birds, personal details
have been omitted. Every effort has been made to respect the wishes of the caretakers and present the images
in a manner that can benefit the scientific community and those who care for birds.
Additionally, we would like to thank those that provided photographs to help explain principles like with our
Andean Condor and those that provided a similar feel to the wonder of birds as in the first edition. One of
those individuals we want to thank posthumously and his family for allowing us to use his photos. Some of
these exquisite photos were taken by Kevin Blaylock during several ecotours hosted by the Phoenix Landing
Foundation. Kevin was enamored by the elegance, ingenuity, grace, and joyful nature of wild parrots. Kevin was
also passionately dedicated to giving parrots better lives in captivity. He was on the Phoenix Landing Board of
Directors and was one of its most treasured volunteers. He facilitated the rehoming of many birds, and he inspired
people with his enthusiastic teaching skills. We lost Kevin at an early age, but his love for birds, as obvious
through his photos, will last long into the future. It (SEO) is my joy to honor his life and work in this book. Kevin
Wayne Blaylock, (October 8, 1972 - June 17, 2017)
The staff, board members and bird caretakers at Tracy Aviary in Salt Lake City assisted with coordinating and
establishing photo sessions and by providing some of the images found throughout the book. These contributors
include Darris Howe, Helen Dishaw, Lindsay Hooker, Michiko Berceau, Aron Smolley and Kate Lyngle-Cowand.
Brian Smyer, a professional photographer also provided images taken of birds residing at Tracy Aviary. Andy, Tracy
Aviary’s beloved Andean condor, posed beautifully to help create the topographical anatomy images.
The golden eagle on page 293 was taken by Dawn Scalise Giffard. Cover art by Dr. Scott Echols and Manu
Carrasco, artist, falconer and naturalist.
Finally, our families who have supported and endured our work must be recognized. Without their encour-
agement and tolerance of long hours pursuing this goal, this book would not be possible.
DEDICATION
We dedicate this text to our feathered patients and their health care.
FOREWORD
Paracelsus, a 16th century Swiss physician, was the first to describe medicine as both an art and a science. In
this long-awaited book, Avian Surgical Anatomy and Orthopedic Management, readers will find both parts to
this whole. While anatomy reflected in this book details important facts, the surgical section depicts decades of
creative problem-solving to ensure better outcomes for avian patients.
For over two decades, I have had the privilege of knowing and working with the authors of this book. I learned
the basics from Pat Redig, eventually taking over leadership of his brainchild, The Raptor Center at the University
of Minnesota; I have taught workshops and been friends with Susan Orosz for almost two decades; and Scott
Echols is a treasured colleague in the world of avian medicine. Each of these wonderful people is a brilliant,
passionate teacher. Combined, they bring over 100 years of experience and expertise to create an incomparable
team for writing this book.
The first edition of this book, Avian Surgical Anatomy, written by Dr. Orosz in 1992, has stood the test of time
as an invaluable reference. Those of us who own dog-eared and worn copies have carefully protected them
as they have become irreplaceable over the years. My own copy makes regular trips from its home on my
bookshelf to the surgical suite, where it is a mainstay as students make sense out of the altered anatomy of
trauma and sculpt a plan that gets a patient back on the wing.
In bringing the second edition to fruition, Dr. Orosz recruited the leading avian orthopedic surgeon in the world,
Dr. Redig, and one of the most innovative clinicians in avian medicine, Dr. Echols, to curate and present the
most up-to-date information available in avian orthopedics. Moving beyond the first book’s sections on surgical
approaches to avian bones, this edition has been expanded to include both surgical and non-surgical treatment
options for orthopedic patients, as well as post-operative management and care. Advanced diagnostic imaging
has also been included as new tools have built the knowledge base of anatomy far beyond the careful and
detailed dissections that were the foundation of the original book.
From start to finish, this book provides accessible information that is practical for a clinical setting. It starts by
presenting general principles and orthopedic techniques for avian orthopedic patients, then moves to detailed
drawings and explanations of relevant anatomy and surgical approaches. Clinicians can turn to this book for
step-by-step instructions on orthopedic methods, as well as the foundational information needed to extrapolate
the information to the many varied presentations seen in avian practice. The depth of anatomical detail enclosed
in this book is enhanced with cutting-edge diagnostic images that are both beautiful and revealing in ways not
seen before in avian medicine.
Like its predecessor, this book will quickly become a “must have” text for all veterinarians working with feathered
patients. I am certain that with its breadth of new information and presentation of tried-and-true methods,
readers will find this book to be a treasured resource for their practice of avian medicine and surgery. With its
superb illustrations, it is a masterpiece. And with its practical approach, clinicians have a definitive, scientific and
evidence-based tool for managing avian orthopedic cases.
Julia B. Ponder, DVM, MPH
Executive Director, The Raptor Center
Associate Professor, Veterinary Population Medicine
College of Veterinary Medicine, University of Minnesota
Chapter 1.
Scope of This Book ................................................................................................................................ 1
Chapter 2.
Anatomic Form and Function.........................................................................................3
Terms of Orientation and Direction .............................................................................................4
The Feathers of the Wing ..................................................................................................................7
Aerodynamics and Their Clinical Implications..................................................................10
Clinical Aspects.....................................................................................................................................20
Tail Region ................................................................................................................................................22
Pelvic Limb ..............................................................................................................................................22
Foot ...............................................................................................................................................................24
Chapter 3.
Overview of Fracture Management ....................................................................................29
Pre and Post-operative Management of the Orthopedic Patient ........................30
Examination and Assessment of the Orthopedic Patient ..........................................30
Management of Wounds Associated with a Fracture ...........................................31
Chapter 4.
General Considerations for Management of Fractures:
Methods and Materials ...................................................................................................................33
General Approaches to the Management of the
Avian Orthopedic Patient................................................................................................................34
Materials and Procedures for Coaptation ............................................................................34
Surgical Fracture Management ..................................................................................................47
Surgical Fracture Management: The Tie-In Fixator .......................................................53
Chapter 5.
Anatomy of the Shoulder Girdle and Wing..................................................................59
Shoulder Girdle and Skeleton .................................................................................................... 60
Vascular Contrast Images of the Shoulder Girdle and Wing.................................122
Dorsal Distal Wing .............................................................................................................................135
Vascular Contrast Images of the Distal Wing ................................................................. 170
Chapter 6.
Management of Wing Fractures ..........................................................................................177
Methods of Fixation for the Humerus .................................................................................. 178
Fixation of Fractures of the Ulna and/or Radius ..........................................................200
Management of Radial Fractures ........................................................................................... 228
Methods of Fixation for the Major Metacarpal ............................................................... 232
Metacarpal Fractures Managed with Coaptation ........................................................248
Chapter 7.
Anatomy of the Pelvic Girdle and Leg........................................................................... 255
Pelvic Girdle, Thigh, Leg and Pes ...........................................................................................256
Leg: CT Images ..................................................................................................................................260
Vascular Contrast Images of the Leg ...................................................................................331
Chapter 8.
Surgical Approaches to the Leg .........................................................................................359
Application of Tie-In-Fixation for Fractures of the Femur ......................................360
Stifle Dislocations and Luxations ............................................................................................371
Methods of Fixation for Fractures of the Tibiotarsus ................................................. 372
Post-operative Management of Femoral and Tibiotarsal Fractures................386
Methods of Stabilization and Fixation for Tarsometatarsal Fractures ..............387
Chapter 9.
Post-operative Management of the Orthopedic Patient .............................395
General Considerations with Emphasis on the Pectoral Limb ............................396
Longer Term Considerations .....................................................................................................398
Post-operative Issues of the Pelvic Limb..........................................................................399
Chapter 10.
Digital Radiographs of the Limbs....................................................................................... 401
Appendices .............................................................................................................................................409
I: Table of Guidelines of Pin Sizes for Long Bones of Various Species.................. 410
II: Table of Homologous Terms ........................................................................................................ 411
References .............................................................................................................................................. 416
Index ...............................................................................................................................................................417
CHAPTER
1
Scope of this Book
This book – from text to pictures – is designed to provide information that enhances the surgical and medical care
of the wings and legs of birds. It is based on the original text, Avian Surgical Anatomy: Thoracic and Pelvic Limbs,
published over 25 years ago. Unfortunately, the atlas had a limited press run and is out of print, so it is not generally
available for use. Realizing the book’s purpose remains vital, the authors wanted to provide the information in an
expanded manner and include the most tried and true surgical approaches developed by Dr. Patrick Redig at The
Raptor Center, University of Minnesota.
While many of the drawings from Avian Surgical Anatomy: Thoracic and Pelvic Limbs have been used in this
text, we have expanded our understanding of the anatomy by adding, for the first time, a large collection of
CT images of the wings and legs of a variety of bird species. We chose to provide a diverse group of species,
because avian veterinarians see a variety of birds in practice. This is an important distinction from dog and cat
veterinarians that see a diversity of breeds. The species of birds range from frugivorous parrots to carnivorous
condors. As you look at the CT images provided, it is important to remember that each is an individual bird of
that species. There may be variations within the species but since this technology is so new – particularly the
micro CT that was used on many of the smaller birds – the range of variations is not known at this time. However,
as you can see from looking at the CT images from each portion of a limb, there is considerable variation
between species.
The familiar anatomic drawings from the original book, in which we used the turkey vulture to document
basic anatomy of the wings and legs are included. We also provide CT scans for the readers to develop their
three-dimensional understanding of the same structures. CT scans are provided that first image the standard
anatomic positions, followed by oblique views. This is done to encourage readers to develop their ability to
visualize a three-dimensional image of the anatomic portion of the limb. Once they can visualize the basic
anatomy of the wing or leg, the reader is challenged to use the obliques of the CT images to better understand
that portion of the wing or leg by visualizing it in their head. Variations of the limbs among species can then be
studied using a variety of CT images including oblique views from diverse species. The concept of building
an anatomic image and being able to flip and see things in layers is important in understanding an individual
surgical or medical avian patient. This is particularly vital with traumatic wounds where one must quickly
determine anatomic landmarks.
We have provided arteriovenograms of portions of the limb or its entirety depending on the species and the
size of the bird. These provide an idea of the interspecies variations in birds of the circulatory system. They also
help the surgeon to know where important blood vessels lie, as well as gain an appreciation of the degree of
perfusion in surrounding tissues.
After developing an understanding of the anatomy of the wings and legs, additional chapters are provided with
information explaining concepts of avian orthopedics and post-operative patient management. This is critical
as avian patients are extreme athletes and require different care from mammals. After the anatomic chapter of
each limb, a chapter follows providing step-by-step information for repairing fractures relative to that region.
These approaches have stood the test of time with raptors and other bird species with fractures that have been
repaired by the veterinarians of The Raptor Center, University of Minnesota. The person that developed these
approaches is one of the authors of this text, Dr Patrick Redig, and his work, drawings and thoughts on repair are
well represented. These are the approaches that he and his colleagues at The Raptor Center have used to train
other veterinarians and veterinary students around the world with the goal of returning birds to function.
A table of homologous terms is provided and will be useful for comparing terms from older textbooks since the
names of the muscles have changed over time.
We are excited that this text provides under one cover the detailed anatomy and surgical protocols for fracture
repair of the wings and legs of birds. Its new depth and breadth with the inclusion of CT images of the bones
and joints and of arteriovenograms will allow those individuals working with a diverse group of species to have
the knowledge to do what is necessary to properly surgically manage the legs and wings of their avian patients.
