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ABSTRACT: To describe medial humeral epicondylitis in cats based on radiographic, anatomic, and histologic observations.
Prospective cohort study.
Feline cadavers (n = 60).
Extended craniocaudal, and extended and flexed mediolateral radiographic projections were taken of both elbows of 60 consecutive European shorthair cats that died or were euthanatized. Elbows with new bone formation at the medial epicondyle were dissected and embedded in methyl-methacrylate (MMA). For comparison, both elbows of a cat with no radiographic changes were prepared in a similar manner. Sections of the MMA blocks were Giemsa stained and examined with light microscopy.
Bilateral new bone formation was identified radiographically at the medial aspect of the humeral epicondyle in 6 cats (10%). All of these cats had mineral deposition in the humeral head of the flexor carpi ulnaris muscle. Other findings were cartilage damage (n = 3 cats), an additional loose medial joint body (1), and tendinosis (3). The ulnar nerve was flattened and displaced caudally, and signs of chronic epineural fibrosis were present in 2 severely affected cats.
Ten percent of this feline population had radiographic evidence of medial humeral epicondylitis with chronic degeneration, mineralization, and metaplastic bone formation in damaged fibrillar matrix involving the origin of the humeral head of the flexor carpi ulnaris muscle. New bone formation caused displacement and compression of the ulnar nerve in severely affected elbows. Based on our findings, medial humeral epicondylitis appears to be a common disorder in cats with potential clinical sequelae.
Veterinary Surgery 08/2012; 41(7):795-802. · 1.26 Impact Factor
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ABSTRACT: To determine angles of insertion for laminar vertebral fixation of L1 and L2 by use of a locking plate in dogs and to confirm screw placement by use of computed tomography (CT).
Vertebral specimens harvested from 8 canine cadavers.
The point of insertion and minimum and maximum insertion angles for laminar and facet screws for laminar vertebral stabilization were determined by use of CT. A precontoured locking plate was then placed by use of 1 locking screw in the lamina of each lumbar vertebra and 1 nonlocking screw in the facet joint. The position and angle of the screws were examined by use of CT, and penetration into the vertebral canal was recorded.
Mean ± SD insertion angles for L1 and L2 were 18 ± 4° and 21 ± 5° toward the vertebral canal and 11 ± 4.4° and 10 ± 3° in a dorsal direction, respectively. Insertion angles for the facet joint were between 24 ± 4° ventrally and 12 ± 2° dorsally. Insertion of the screw did not penetrate the vertebral canal for 23 of 24 (96%) screws. For 23 of 24 inserted screws, the previously determined angle was maintained and purchase of bone and cortices was satisfactory.
Placement of laminar and facet screws in canine vertebrae was possible and can be performed safely if angles of insertion determined pre-operatively via CT are maintained.
American Journal of Veterinary Research 12/2011; 72(12):1674-80. · 1.27 Impact Factor
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ABSTRACT: To compare biomechanical characteristics of vertebral segments after vertebral body plating or laminar stabilization following complete incision of the annulus fibrosus.
Vertebral segments from T13 through L3 obtained from 18 canine cadavers.
A 4-point bending moment was applied in flexion and extension to the intact vertebral segments to determine a baseline range of motion (ROM) and neutral zone (NZ). Vertebral columns were then destabilized by creating a defect in the intervertebral disk via complete incision of the ventral aspect of the annulus fibrosus. The bending moment was applied again after stabilization was accomplished via vertebral body plating or with laminar stabilization (n = 9 vertebral segments/stabilization technique). The ROM and NZ were compared with their baseline values and among treatment groups. Finally, load-to-failure testing was performed in flexion.
Mean relative ROM and NZ for segments treated with laminar stabilization were significantly lower than those for segments treated with vertebral plates.
Analysis of in vitro results suggested that laminar stabilization of vertebral segments provided greater stiffness than did vertebral body plating.
American Journal of Veterinary Research 12/2011; 72(12):1681-6. · 1.27 Impact Factor
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ABSTRACT: OBJECTIVE: To (1) determine suction tip (intermittent and continuous mode) contamination rate in orthopedic surgery in dogs and cats; (2) examine the effect of surgical time on contamination; and (3) report bacteria isolated. STUDY DESIGN: Clinical study. SAMPLE POPULATION: Clean orthopedic surgeries (n = 50). METHODS: Surgical procedures were assigned to 1 of 2 groups: (1) continuous (n = 25) or (2) intermittent suction (n = 25). A control suction was operated in each surgery. Samples for aerobic and anaerobic bacteriologic examination were collected from the surgical suction at 0, 20, 60 minutes, and at the end of surgery, and from the control suction at the end of the surgery only. Comparison of continuous and intermittent suction data, and the effect of surgical time on contamination rate were analyzed using a Kaplan-Meier survival analysis followed by a Cox proportional hazards model. P < .05 was considered significant. RESULTS: Aerobic contamination occurred in 22 of 50 surgical procedures and there was no anaerobic growth. There was no significant difference between continuous and intermittent suction mode groups (P = .40). Surgical time did not influence the contamination rate (P = .79). Bacterial cultures mainly revealed coagulase-negative Staphylococci, however multiresistant bacteria were isolated. CONCLUSIONS: We failed to find superiority of the intermittent operation mode of the suction tip over the continuous mode. A safe time frame before contamination of the suction tip occurs that could not be defined.
Veterinary Surgery 09/2011; · 1.26 Impact Factor
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ABSTRACT: To evaluate the effect of tibial tuberosity advancement (TTA) on patellofemoral (PF) contact mechanics, and alignment of the PF and femorotibial (FT) joints in cranial cruciate ligament (CrCL)-deficient stifles of dogs.
Ex vivo biomechanical study.
Unpaired cadaveric hind limbs (n=9).
Digital pressure sensors placed in the PF joint were used to measure contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. The FT and PF poses were obtained using a 2-dimensional computer digitization technique. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Data was normalized and analyzed, after testing for normality by Wilk-Shapiro, using 1 sample T-test, paired T-test, and ANOVA; P≤.05 was considered significant. Bonferroni's correction was used when needed.
A significant cranioproximal tibial displacement and increase in patellar tilt were found in the CrCL-deficient joints. Both FT and PF alignments were restored after TTA. Contact areas and peak pressure did not vary between conditions. Peak pressure location displaced proximally from intact to CrCL-deficient condition and returned to normal after TTA. Total force measured in the CrCL-deficient stifle and TTA conditions were significantly lower than in the control.
TTA restored the normal FT and PF alignment, and reduced the retropatellar force by about 20%.
Veterinary Surgery 08/2011; 40(7):839-48. · 1.26 Impact Factor
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Veterinary Surgery 07/2011; 40(5):643. · 1.26 Impact Factor
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ABSTRACT: To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA).
Prospective study and case series. Animals: Dogs treated with TTA (n=67).
Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). Case series: nongrafted TTA (4-25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t-tests and ANOVA. Significance was set at P≤.05.
Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2-4). No healing related complications were observed.
The osteotomy gap created during TTA healed within expected time regardless of bone graft use.
Veterinary Surgery 01/2011; 40(1):27-33. · 1.26 Impact Factor
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Diplomate ECVS Tomás G. Guerrero Dr med vet,
Diplomate ECVDI Mariano A. Makara Dr med vet,
Kristine Katiofsky Dr med vet,
Diplomate ECVDI Mark A. Fluckiger Prof Dr med vet,
Joe P. Morgan Prof, DVM, Diplomate ACVR,
Michael Haessig Prof Dr med vet, Diplomate ECVPH, & ECBHM,
Pierre M. Montavon Prof Dr med vet,
Tomás G. Guerrero,
Mariano A. Makara,
Kristine Katiofsky,
Mark A. Fluckiger,
Joe P. Morgan,
Michael Haessig, Pierre M. Montavon
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ABSTRACT: Objective: To evaluate and compare healing, with and without the use of bone graft, of the gap created during tibial tuberosity advancement (TTA).Study Design: Prospective study and case series.Animals: Dogs treated with TTA (n=67).Methods: Prospective study: Mediolateral radiographic projections (6 weeks and 4 months) after TTA without use of bone graft (group I, n=14) were compared with radiographs of consecutive TTA in which the gap was filled with autologous cancellous bone graft (group II, n=14). Two scoring techniques (A, B) were used. Score A was used to grade the overall osteotomy healing (0=no healing, 4=healed osteotomy). Score B evaluated, independently of each other, healing in 3 sites: proximal to the cage (B1), between cage and plate (B2), and distal to the plate (B3). Case series: nongrafted TTA (4–25 weeks, n=39) were evaluated for healing (Score A). Data was analyzed using t-tests and ANOVA. Significance was set at P≤.05.Results: Prospective study: Score A, B2, and B3 showed no difference in healing between groups at 6.8 weeks and 4.2 months. Score B1 revealed, in both rechecks, a significantly higher density in group II. Case series: Radiographs at 11.59±5.99 weeks scored 3.3 (2–4). No healing related complications were observed.Conclusion: The osteotomy gap created during TTA healed within expected time regardless of bone graft use.
Veterinary Surgery 12/2010; 40(1):27 - 33. · 1.26 Impact Factor
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ABSTRACT: To evaluate the relationship of body weight (BW) and size, dog velocity, and vertical ground reaction forces (GRF) from a large number of dogs of various sizes.
Clinical research.
Orthopedically healthy dogs (n=129)
BW and dog size, represented as height at the withers (WH), were obtained. Stance times (ST), vertical impulses (VI), and peak vertical forces (PVF) of thoracic and pelvic limbs were measured on a force plate at controlled trotting speed. They were evaluated against BW and WH using linear regression analysis in absolute (nonnormalized) values, and when normalized to BW and/or body size according to the theory of dynamic similarity. Relative velocities were calculated for each dog.
Absolute ST, VI, and PVF showed strong positive correlations with BW and/or body size. When GRFs were normalized to BW, correlations with body size were markedly reduced, but remained positive for VI, and turned negative for PVF. Normalizing the time-dependent variables (ST and VI) also to WH eliminated most size influence. A small dependency of fully normalized GRF on body size remained that was because of differences in relative velocity between dogs of different sizes. Reference values for the fully normalized data are given.
The inherent relationship between BW, body size, dog velocity, and vertical GRF was demonstrated.
BW, body size, and relative dog velocity must be accounted for when wanting to obtain GRF variables that are comparable between different dogs.
Veterinary Surgery 10/2010; 39(7):863-9. · 1.26 Impact Factor
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ABSTRACT: To (1) evaluate radiographic changes associated with osteoarthrosis (OA) before and after tibial tuberosity advancement (TTA) and (2) determine if these changes are indicative of limb function as determined by kinetic gait analysis.
Prospective clinical study.
Dogs (n=35) with cranial cruciate ligament (CCL) deficient stifles (38).
Variables recorded were: complete or partial CCL rupture, meniscal lesions, arthroscopically graded cartilage lesions, complications, and revision surgeries. Radiographic evaluation and kinetic gait analysis (vertical ground reaction forces [GRFs]) were conducted pre- and 4-16 months postoperatively (mean, 5.9 months). Radiographs were evaluated without knowledge of operative findings and functional outcome. A score (0-3) based on new bone production at 11 specific sites was used to grade OA. Soft tissue changes were classified separately as normal or excessive. Preoperative scores were correlated with clinical variables. Postoperative scores and progression of OA scores were correlated with clinical variables and GRFs.
OA remained unchanged in 17 joints and progressed in 21 (55%). Dogs with meniscal lesions had higher OA scores preoperatively, but not at follow-up. Dogs with severe cartilage lesions at surgery had more progression of OA. GRFs improved after surgery and were not correlated with any of the radiographic OA scores.
Progression of OA was greater in the presence of severe cartilage lesions at surgery. OA scores were not correlated with GRFs.
Progression of OA is generally expected to occur after TTA despite improvement of limb function.
Veterinary Surgery 03/2010; 39(4):425-32. · 1.26 Impact Factor
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ABSTRACT: To evaluate the results of application, and identify complications, of the 2nd generation of Zurich Cementless Total Hip Replacement (ZCTHR).
Case series.
Client-owned dogs (n=60) that had ZCTHR (n=65).
Dogs with ZCTHR (2001-2003) with a minimum follow-up > or =6 months were evaluated. Data included signalment, cup position, longest follow-up, complications, management of complications and outcome.
Mean follow-up was 22.68 months. Eleven cases (17%) had postoperative complications: femoral fracture (n=1; 1.5%), prosthesis luxation (7; 11%), cup loosening (2; 3%), and implant failure (1; 1.5%); 9 cases were successfully revised. Explantation of implants was performed in 1 case because of infection, and 1 dog was euthanatized after reluxation.
ZCTHR can restore function in dogs affected by disabling diseases of the coxofemoral joint. The press-fit fixation of the cup allowed for corrections in cases of incorrect positioning. Cases with aseptic loosening were revised successfully by impacting larger cups. Newer stems of this generation are shot peening treated to increase their resistance to breakage. In our cases, infection is a disastrous event, leading to implant removal. After resolution of complications, a successful final outcome was achieved in 97% of THR.
ZCTHR offers a reliable alternative for treating dogs with disabling diseases of the hip joints.
Veterinary Surgery 01/2009; 38(1):70-80. · 1.26 Impact Factor
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ABSTRACT: To investigate a technique for repair of sacroiliac luxation with positional screw insertion from the ventral surface of the sacral wing via a ventral abdominal approach.
Hemipelvis specimens from cadavers of 5 small- to large-breed dogs and 9 European shorthair cats.
An optimal entry point and a safe drill corridor for implant placement were determined (4 hemipelvis specimens). Anatomic landmarks were identified, and the surgical technique for a ventral abdominal approach was described. Single positional screw placement was performed across the sacroiliac joint in 23 hemipelvis specimens. Screws were aimed at 25 degrees (n=2), 35 degrees (2), and 45 degrees (19) angles to the vertical axis in a transverse plane (alpha angles) and at a 90 degrees angle to the longitudinal axis in a dorsal plane (beta angle). Implant placement was assessed by radiographic evaluation of the cadavers and of the hemipelvis specimens devoid of soft tissue.
By use of alpha angles of 35 degrees and 45 degrees, 20 of 21 implants were placed adequately; screws crossed the sacroiliac joint and penetrated the wing of the ilium without damaging adjacent nerves. The measured median alpha angle was 38 degrees , and the median beta angle was 88 degrees. One complication was recorded.
Cortical positional screw placement from the ventral aspect of the sacral wing by use of a ventral abdominal approach could be an alternative to conventional techniques. This novel technique may be useful for repair of bilateral sacroiliac luxation, treatment of concomitant soft tissue injuries of the caudal portion of the abdominal cavity or abdominal wall, and repair of pelvic floor fractures in a single approach.
American Journal of Veterinary Research 05/2008; 69(4):542-8. · 1.27 Impact Factor
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ABSTRACT: To investigate sacroiliac luxation repair with positional screw insertion from the ventral surface of the sacral wing via a ventral abdominal approach in cats.
18 European shorthair cats.
All cats underwent clinical examination including orthopedic and neurologic examination and assessment of lameness and pain before and immediately after surgery and 6 and 16 weeks after surgery. All sacroiliac luxations were stabilized with a single positional 2.4-mm cortical titanium self-tapping screw. The pelvic floor was also repaired in selected cats. Screw entry points and angles determined in a prior study of cadavers were used. Radiographs were taken before surgery and during follow-up evaluations to assess postoperative sacroiliac luxation reduction, implant placement, and repair stability.
All implants were placed correctly. Iatrogenic sciatic nerve injuries occurred in 2 cats. Median time to ambulation was 1.5 days for cats with sacroiliac luxation as the sole injury. Radiographic outcome of sacroiliac luxation repair was excellent in 15 of 17 repairs, good in 1 of 17 repairs, and poor in 1 of 17 repairs. Clinical outcome was excellent in 11 of 15 cats and good in 4 of 15 cats.
Insertion of a positional screw across the sacroiliac joint via a ventral abdominal approached can be an alternative to conventional techniques of sacroiliac luxation repair in cats. This novel technique allowed repair of bilateral sacroiliac luxation, repair of pelvic floor fractures, and treatment of soft tissue injuries of the abdominal cavity or abdominal organs with a single approach.
American Journal of Veterinary Research 05/2008; 69(4):549-56. · 1.27 Impact Factor
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ABSTRACT: To evaluate mediolateral radiographic views of stifle joints to identify conformational differences between athletically sound dogs and dogs with cranial cruciate ligament disease (CCLD).
Radiographic images of 50 stifle joints of 43 dogs with surgically confirmed CCLD and 50 stifle joints of 38 dogs without clinical signs of stifle joint disease.
Mediolateral radiographic views of stifle joints were obtained, and long axes of the femur, tibia, and femoral condyles were measured. Angles between long axes of the femur and femoral condyle and between long axes of the femur and tibia were measured. Circles were drawn representing the joint surface of femoral condyles (circle 1), area of contact on the tibial plateau (circle 2), and femoral trochlea (circle 3). Radii of circles 1, 2 (line F), and 3 were measured. Distances between midpoints of circles 1 and 2 (line K) and between midpoint of circle 2 and most cranial aspect of the tibial tuberosity (line G) were measured. To evaluate differences in conformation that could lead to CCLD, quotients derived from measurements were created for comparison; angles were compared between dog groups.
Significant differences were found in the quotients created by the lengths of lines G and F and lines G and K between dogs with and without CCLD.
No anatomic differences were detected in the distal portion of the femur between dogs with and without CCLD. Development of the tibial tuberosity and shape (convexity) of tibial condyles may be relevant in the pathogenesis of CCLD.
American Journal of Veterinary Research 01/2008; 68(12):1332-7. · 1.27 Impact Factor
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ABSTRACT: To measure the angles between the patellar ligament and the tibial plateau and between the patellar ligament and the common tangent at the tibiofemoral contact point (TFCP) throughout the full range of motion of the stifle joint in dogs and determine the flexion angles at which the patellar ligament is perpendicular to the tibial plateau or to the common tangent.
16 hind limbs from cadavers of 9 adult dogs without radiographically detectable degenerative joint disease.
Mediolateral radiographic views of the stifle joints from full extension through full flexion were obtained (10 degrees increments). Angles between the tibial and femoral long axes (beta), between the patellar ligament and the tibial plateau gamma), and between the patellar ligament and the common tangent at TFCP (alpha) were measured. Data were analyzed via simple linear regression.
In canine stifle joints, angles gamma and alpha decreased linearly with increasing flexion (angle beta). The patellar ligament was perpendicular to the tibial plateau and perpendicular to the common tangent at the TFCP at 90 degrees and 110 degrees of flexion, respectively.
By use of the conventionally defined tibial plateau, data suggest that at approximately 90 degrees of flexion in stifle joints of dogs, shear force in the sagittal plane exerted on the proximal portion of the tibia shifts the loading from the cranial to the caudal cruciate ligament. Analyses involving the common tangent at the TFCP (a more anatomically representative reference point) identified this crossover point at approximately 110 degrees of joint flexion.
American Journal of Veterinary Research 12/2006; 67(11):1849-54. · 1.27 Impact Factor
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ABSTRACT: To measure the angles between the patellar ligament and the tibial plateau and between the patellar ligament and the common tangent at the tibiofemoral contact point (TFCP) in stifle joints of dogs with partial rupture of the cranial cruciate ligament (CrCL) for comparison with data obtained for stifle joints in dogs with intact CrCLs.
60 stifle joints of 54 dogs with surgically confirmed partial CrCL rupture.
Mediolateral radiographic views of the stifle joints were obtained, and the angles between the patellar ligament and the conventionally defined tibial plateau (angle gamma) and between the patellar ligament and the common tangent to the TFCP (angle alpha) were measured at incidental stifle joint flexion (angle beta) by 2 independent observers. Data underwent linear regression analysis and were compared with findings in joints of dogs without degenerative joint disease.
In stifle joints of dogs with a partial rupture of the CrCL, angles gamma and alpha were 5 degrees and 2 degrees larger than each corresponding angle in healthy canine joints. At 100 degrees of flexion, the patellar ligament was perpendicular to the conventionally defined tibial plateau. At 110 degrees of flexion, the patellar ligament was perpendicular to the common tangent at the TFCP.
In dogs, stifle joints with partially ruptured CrCLs have marginally larger angles between the patellar ligament and the tibial plateau, compared with joints with intact CrCLs; at equivalent angles of flexion, comparatively greater shear force affects the CrCLs in stifle joints with partial CrCL ruptures.
American Journal of Veterinary Research 12/2006; 67(11):1855-60. · 1.27 Impact Factor
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ABSTRACT: To determine the outcome of dogs and cats in which a tension band technique was used to stabilize traumatic fractures and luxations of the thoracolumbar vertebrae.
Retrospective study.
38 client-owned animals (22 dogs and 16 cats) weighing between 1.4 and 45 kg (3 and 99 lb).
Medical records of cats and dogs that underwent tension band stabilization of thoracolumbar fractures and luxations at the University of Zurich between 1993 and 2002 were reviewed. The stabilization technique was a modification of a spinal stapling technique with a figure 8 hemicerclage wire placed in a tension band fashion across the lesion. Neurologic status, lesion location and type, and concomitant traumatic injuries were assessed from the medical records and preoperative radiographs. Clinical outcome and complications were determined through follow-up examinations or telephone conversations with the owners.
Complete or satisfactory neurologic recovery was achieved in 30 (79%) patients. Seven patients were euthanatized (6 owing to poor neurologic recovery and 1 owing to implant failure), and 1 dog was managed at home despite paraplegia. Clinically, only 4 patients (11%) had evidence of implant or fixation failure; all were dogs weighing > 16 kg (35 lb).
Results suggest that the tension band technique may be appropriate for stabilization of fractures and luxations of the thoracolumbar vertebrae in cats and small- or medium-sized dogs. In larger dogs, fixation strength may be insufficient to stabilize certain fracture types and ancillary external or internal fixation methods may be needed.
Journal of the American Veterinary Medical Association 08/2004; 225(1):78-83. · 1.79 Impact Factor
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ABSTRACT: To describe a technique for carpal panarthrodesis using a medially applied dynamic compression plate (DCP) and to evaluate outcome.
Retrospective study.
Nine dogs with 10 carpal joint injuries.
Medical records of dogs that had carpal panarthrodesis by medial application of a DCP were reviewed. Signalment, cause and type of injury, preoperative treatment, operative technique, and postoperative clinical and radiographic outcome were retrieved.
Screw loosening in the metacarpal bones required surgical revision in 3 dogs. The plate was removed because of lick dermatitis in another dog. No complications were observed in 6 arthrodeses. All dogs were subsequently sound.
Medial application of a DCP is a reliable, reproducible method for carpal panarthrodesis. The load on the edge of the plate provides an increased area moment of inertia of the plate, enhancing it resistance to bending forces. Because of the valgus standing position of the canine carpus, dynamic compression is achieved. The DCP is secured to 1-3 metacarpal bones and loosening of the implant and bone fractures are expected to occur less frequently.
Medial plating for carpal panarthrodesis is a valid alternative method that can be used in dogs with injuries to the carpus for which panarthrodesis of the carpal joint is indicated.
Veterinary Surgery 34(2):153-8. · 1.26 Impact Factor
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To As,
G Guerrero,
Dr Med Vet,
Diplomate Ecvs,
Antonio Pozzi,
Diplomate Acvs,
Nicholas Dunbar,
Nicolas Kipfer,
Michael Haessig,
Diplomate Ecvph,
Ecbhm,
Mary Beth Horodyski, Pierre M Montavon
