In order to look for phenotypic correlation between hip (HD) and elbow (ED) dysplasia, we used radiographic scoring obtained from 1,411 dogs of different breeds, which were evaluated for authoritative grading of both conditions. In this population, we found that the risk ratio for an animal to be simultaneously affected by HD and ED is 1.67. For a dog with ED, the risk ratio to be affected by HD increases as the ED grade increases. Similarly, for a dog affected by HD, the risk ratio to be affected by ED increases as the HD grade increases. In a dog affected by HD or ED, the clinician should look for the second condition in the same animal. Due to the low, yet positive correlation, selection against one trait will not affect the other trait sufficiently. Therefore selection has to be conducted at reduction of HD as well as reduction of ED.
The objective of this study was to describe the use of a titanium 1.5 mm locking plate in the stabilization of atlantoaxial pathology in three toy breed dogs. Two dogs with atlantoaxial subluxation and another dog with an axial fracture, confirmed by diagnostic imaging, were stabilized via a ventral approach with a 1.5 mm titanium 5-hole locking butterfly-plate. Surgical reduction and stabilization were assessed by computed tomography and radiography after surgery. Follow-up evaluation for resolution of neurological signs and possible complications was performed in all three dogs. For long-term assessment, a telephone follow-up was performed. A considerable improvement of neurological signs occurred within two to four weeks after surgery. An excellent clinical outcome was identified in all three patients. Adequate stabilization and resolution of neurological signs in all three dogs was achieved. The stabilization of atlantoaxial surgical conditions in toy breeds with the 1.5 mm titanium 5-hole butterfly locking plate appears to be an effective means of surgical treatment.
To determine patient factors and fracture morphology of dogs presented with mandibular fractures to a small animal referral centre in South Africa.
Patient data on age, sex, breed and aetiology of dogs with mandibular fractures were recorded. The fractures were classified according to the anatomical location, displacement, fracture type, fracture line direction, periodontal pathology, and whether there were teeth in the fracture line or not by evaluation of preoperative radiographs. Clinical observations indicated whether these fractures were open or closed.
In total, 109 dogs with 135 mandibular fractures were included in the study. Small breed dogs and dogs less than eight months of age predominated (102/109). Dog fights were the most common aetiology in this study (68/109). The molar region was the most commonly affected region (56/135). Evaluation of the radiographs revealed that transverse (73/135), relatively unstable (116/135), and displaced (112/135) fractures were the most common. The majority of fractures involved teeth in the fracture line (100/135), with the first molar frequently involved (54/135). The majority of fractures were open (104/135).
The results obtained from this study may be used to guide patient and fracture morphology selection in biomechanical studies of mandibular fracture repair techniques. Screening of this patient population may inspire the search for new treatment options for mandibular fracture repair in South Africa.
Metacarpal and metatarsal fractures in 11 patients were treated 'closed' with a specially designed External Skeletal Fixation (ESF) frame with a walking bar and traction applied to the digits. Mediolateral angulation had improved postoperatively in 10 of the 11 patients. Craniocaudal angulation had improved in eight patients and could not be evaluated in three due to ESF frame superimposition. At follow-up, eight patients had a good clinical function, whereas three patients were still slightly lame. Only minor ESF-related complications were seen (pin loosening, pin tract infection, cerclage wire breakage and bending of the frame), which resolved without intervention after frame removal.
Traumatic patellar fracture in cats mainly occurred in male neutered cats with an average age of four years, six months and a mean weight of 4.8 kg. Patellar fractures were concurrent with long bone fractures and cruciate ligament rupture or occurred after gunshot. The patella luxated medially or laterally in four cats. Fracture fragments were usually small, either from the proximal pole (base) or distal pole (apex) or longitudinal fragments. Treatment was by fragment excision when the fragment was small or by reconstruction with pins and wires when fractures were comminuted. The outcome in six cats was reported as 'good' to 'normal' and three cats were 'improving' or had 'mild' intermittent lameness at the last follow up.
To describe the diagnostic findings, surgical technique and outcome in dogs with thoracolumbar intervertebral disc-associated dynamic compression.
Retrospective case series.
Client owned dogs (n = 11).
Medical records (2005-2010) of dogs with a stress myelographic diagnosis of spinal cord injury due to thoracolumbar intervertebral disc-associated dynamic compression with inconclusive compression in the neutral myelographic views that had hemilaminectomy and vertebral stabilization were reviewed. Data on pre- and postoperative neurologic status, diagnostic findings, surgical techniques and outcomes were retrieved. Follow-up clinical and radiographic evaluations were performed immediately, and at approximately one, two, and six months postoperatively as well as at annual follow-up examinations.
The stress myelography demonstrated distinct ventral dynamic compression due to bulging of the disc and additional dorsal compression due to infolding of the ligamentum flavum in some cases. The median percentage of post-stress reduction in spinal cord height on the lateral view was 18.0% (9.8-27.2%). All dogs recovered after surgery and at follow-up examinations were still ambulatory (median: 45 months, range: 7 to 94 months).
Conclusions and clinical relevance:
Thoracolumbar intervertebral disc degeneration may result in disc-associated dynamic compression. Stress myelography was an effective means of diagnosing this condition and hemilaminectomy with vertebral stabilization was an effective treatment resulting in long-term neurological improvement in all dogs.
To assess the management of traumatic urethral ruptures using a systematic attempt at urethral catheterisation.
Eleven cats that had been diagnosed with a traumatic urethral rupture over a five-year period were included in this study. Rupture was assessed by positive-contrast retrograde urethrography. An attempt was made to manage these ruptures by placing an indwelling urethral catheter.
The placement of an indwelling urethral catheter, could be performed in 10 out of 11 cats, which indicated a partial rupture. In one cat, catheterisation was not possible because of complete urethral rupture. A urethral catheter was placed into the urinary bladder via the urethra in five animals. In the other five animals, urethral catheterization required cystotomy using a modified 'inside to outside' technique. Urethral catheter removal occurred between five and 14 days after placement. Urethral healing was accomplished in all cases of catheterisation with a good outcome in eight of the 10 cats. Two cats showed clinical signs related to stricture formation during the follow-up period (seven to 72 months). Retrograde urethrography provided a definitive diagnosis of partial rupture in only six of the 10 cases of partial rupture.
Results suggested that primary alignment with the placement of a urethral catheter should be attempted for the management of traumatic urethral ruptures in cats. Gentle urethral catheterisation seems to be an effective procedure for diagnosing and dealing with partial urethral rupture in cats. Clinical stricture formation can occur, but the risk does not seem to be high. Further studies are warranted in order to define the ideal duration for maintenance of an indwelling urethral catheter in cases of traumatic partial urethral rupture.
The objective of the present study was to determine clinical and arthroscopic characteristics associated with dorsoproximal proximal phalanx (P1) fragments in Warmblood horses, as well as to examine their histopathological appearance. One hundred sixty-eight fragments were removed from 150 fetlocks of 117 Warmblood horses. Details of signalment and results of clinical examination were collected prior to surgery. After arthroscopic fragment removal and joint evaluation for synovial and/or cartilage abnormalities, the fragments were measured and evaluated histopathologically. The vast majority of the fragments (95.2%) were found medially, without predilection for front or hind limbs. In 10% of the joints, more than one fragment was present. The mean size of the fragments was 6.8 +/- 2.6 mm. Only eight horses presented fetlock-related lameness. Horses of seven years of age and older (OR = 13.32; p = 0.033) and the presence of more than one fragment (OR = 11.12; p = 0.016) were significantly associated with lameness. Arthroscopic evaluation revealed one or more abnormalities in 50.7% of the joints. On histopathology, osteochondral fragments presented as a bony center covered with smooth hyaline cartilage on one side and some fibrous tissue on the other side. No clear histopathological signs were indicating precisely their origin. In Warmblood horses with dorsoproximal P1 fragments, the age (seven years and older) and the presence of more than one fragment in a fetlock significantly increased the risk of lameness. The osteochondral dorsoproximal P1 fragments could be defined as a developmental orthopaedic disease.
Dogs treated for congenital medial patellar luxation were reviewed for the purpose of determining the incidence of postoperative major complications requiring surgical revision and the risk factors for their occurrence. Major complications occurred in 18.5% of the patellar luxation stabilization procedures with implant associated complications being the most frequent, patellar reluxation the second, and tibial tuberosity avulsion the third most common major complication. Other complications included patellar ligament rupture and trochlear wedge displacement. When recession trochleoplasty was performed in addition to tibial tuberosity transposition, a 5.1-fold reduction in the rate of patellar reluxation was observed. Release of the cranial belly of the sartorius muscle further reduced the incidence of patellar reluxation, while patella alta (pre- or postoperative) and patellar luxation grade were not found to influence the rate of reluxation. Tibial tuberosity avulsion was 11.1-times more likely when using a single Kirschner wire to stabilize a transposition, compared with two Kirschner wires. Independent to the number of Kirschner wires used, the more caudodistally the Kirschner wires were directed, the higher the risk for tibial tuberosity avulsion. Tension bands were used in 24.4% of the transpositions with no tuberosity avulsion occurring in stifles stabilized with a tension band. Overall, grade 1 luxations had a significantly lower incidence of major complications than other grades, while body weight, age, sex, and bilateral patellar stabilization were not associated with risk of major complication development.
Osteochondritis dissecans of the shoulder joint was treated by arthroscopy in 126 dogs. Twenty-four dogs had bilateral surgery, making a total of 150 joints treated. The OCD flaps were removed in small pieces through the cannula or in a single piece through a stab incision. The lameness resolved completely within seven-60 days following arthroscopy in 137 out of 150 affected limbs. Within a subset of 47 dogs with unilateral OCD, it was found that lesions located on the caudo-medial region of the humeral head had a better functional outcome than those lesions located in the caudo-central region of the humeral head.
To evaluate a cohort of dogs undergoing tibial plateau levelling osteotomy (TPLO) implant removal to determine key clinical features, prevalence, and indications for implant removal.
Medical records of dogs undergoing TPLO implant removal at a private referral practice (Dallas Veterinary Surgical Center) between 2004-2008 were reviewed. Patient signalment, implant type, presence of concurrent medical disease, surgeon, antibiotic use, aerobic bacterial culture result, and operative findings were recorded. Data were analyzed using paired t-test, Fisher's exact test, and Wilcoxon-rank sum test. Statistical significance was set at p <0.05.
The TPLO implants were removed from 126 dogs (n = 129, 4.8% of TPLO procedures) during the study period. Average time interval from TPLO to implant removal was 16.0 ± 17.8 months. The most common clinical signs were the presence of an open wound (n = 80), draining tract (n = 64), and lameness (n = 59). Culture of tissue or fluid from the implant bed or implants was positive for bacterial growth in 95/115 cases. A significantly greater proportion of the implants removed were Slocum TPLO plates (n = 109; 6.1%) when compared to other TPLO plate types (n = 20; 2.3%) (p <0.0001). No association was identified between a positive bacterial culture and measured variables.
Local bacterial infection and clinical signs of inflammation were the most common reasons for TPLO implant removal. There may be an increased implant-associated complication rate for Slocum TPLO plates in the study population.
The clinical use of beta-tricalcium phosphate (beta-TCP) as a synthetic cancellous bone graft in veterinary orthopaedics is herein reported. The retrospective study was based on 13 clinical cases belonging to 11 dogs and one cat. The weights of the dogs ranged from 3.4 to 48 kg. One female cat weighing 3.5 kg completed the study. The clinical cases were six arthrodeses (four carpal, two tarsal), one hypertrophic non-union (femur), one atrophic non-union (metacarpal bones) and five long-bone fractures (two femurs, one tibia, two radii) possessing subcritical-sized bone defects. The beta-TCP used in this study was presented as irregular interconnected- porous granules and was placed in the bone defects after mixing it with fresh blood. Bone healing was achieved at between eight and 12 weeks in all clinical cases except for the case of the chronic atrophic nonunion in which only one of the four metacarpal bones healed. In the 12 successful cases, the bone defect grafted with beta-TCP showed a radiological bone ingrowth of 100% (10 cases), 90% (one case) and 75% (one case). The complete lack of tissue adverse effects in our series, and the good defect healing, allows us to hypothesise that beta-TCP can be successfully used as a synthetic bone graft in bone defects with good local biological conditions and where osteoconduction is especially needed for assuring a structural scaffold for new-bone ingrowth. When, in addition to osteoconduction, osteoinduction and osteogenesis are necessary for defect healing, the fresh cancellous bone graft remains the gold standard in veterinary orthopaedics.
The objective of this study was to evaluate the accuracy of ultrasonographic diagnosis of lesions in the canine stifle associated with cranial cruciate ligament rupture. Thirteen dogs that had a diagnosis of cranial cruciate ligament rupture were included in this prospective clinical study. Two ultrasonographers who were unaware of specific historical and clinical data performed the sonography with a high frequency (8-16 MHz) linear transducer. Surgical treatment of the affected stifle was performed within two days of ultrasonography by a surgeon who was unaware of the ultrasonographic findings. The lesions observed during ultrasonography and arthrotomy were compared at the completion of the study. Visualisation of the superficial tendons (quadriceps and long digital extensor) and ligaments (patellar ligament, collateral ligaments) of the stifle using ultrasonography was excellent. However, the detection of deep stifle ligaments (cranial cruciate ligament and caudal cruciate ligament) was extremely difficult to perform using ultrasonography. For cranial cruciate ligament rupture, the sensitivity for ultrasonographic diagnosis was 15.4%. For meniscal lesions, the sensitivity, specificity, positive and negative predictive values for ultrasonographic diagnosis were 82%, 93%, 90% and 88% respectively. High frequency ultrasonography is a non-invasive method for accurately and efficiently detecting superficial ligaments, tendons and meniscal lesions associated with cranial cruciate ligament rupture in the stifle of non-sedated dogs.
This study investigated the frequency and distribution of patellar luxation in the dogs presented to the Chonbuk National University Animal Medical Centre during January 2000 to September 2005. Patellar luxations were classified as medial or lateral, and unilateral or bilateral, were graded I to IV, and were subdivided according to age, sex and size of the dogs. The incidence of medial patellar luxation (MPL) was greater than the incidence of lateral patellar luxation (LPL) in both small and large dogs. Small-breed dogs were admitted almost exclusively with MPL. LPL was found uncommon; however it was observed more often in larger-breed dogs. Surgical correction was performed primarily in the dogs (165 stifles in 111 dogs) with grade II, III and IV patellar luxations following different surgical techniques. The combination of the surgical techniques was found to be more effective for the management of the disease. The prognosis was found to be favourable, because when the grade was low, the dog was younger, without cruciate ligament rupture, and as the surgical correction was performed with combination of more techniques.
Fourteen Spaniels that presented with an intercondylar fracture of the distal humerus were managed using a lateral plate and an additional pin in twelve cases. Fixation of the fracture was achieved using a plate applied laterally which incorporated the transcondylar lag screw in the most distal hole. Of the 14 cases, two had poor results, one of which was a bilateral case, whilst the remaining 12 cases had good or very good results with only occasional stiffness or lameness. Finite element (FE) modelling of a distal humerus was generated, and loading of fracture repairs using a lateral plate and caudal plate was completed in a comparative study to determine which fixation method resisted micro-motion most effectively. Finite element analysis revealed that the lateral plate fixation provided significantly more resistance to micro movement at the fracture site that the caudal plate fixation, with 40% more micro-motion in the latter.
A 14-month-old male Quarter horse was presented for evaluation of a grade 3 out of 5 (grade 0 = sound; grade 5 = non-weight bearing) right rear lameness. A firm, 8 x 16 cm mass was palpable at the caudal medial aspect of the distal tibia and proximal tarsal region of the right hind limb. A percutaneous needle aspirate contained mesenchymal cells that were moderate to large in size with single, oblong nuclei. Differential diagnoses included fibrous hyperplasia, fibroma, or well-differentiated fibrosarcoma. Excisional biopsy for both definitive diagnosis and treatment was offered and selected by the owner. A fibrosarcoma was confirmed by histological examination of the mass. One and a half years after resection signs of lameness or evidence of regrowth of the mass were not evident.
The objectives of this study were to determine the frequency of incomplete ossification of the contralateral humeral condyle (IOHC) in mature dogs with unilateral, atraumatic humeral condylar fracture (HCF), and to determine the sensitivity of radiographs as a diagnostic tool for IOHC.
Computed tomography and radiographs were obtained for both elbows of 14 dogs with unilateral HCF. The images were evaluated by two boarded radiologists and the prevalence of IOHC in the limb contralateral to the HCF was identified. Sensitivity and specificity of the radiographic diagnosis of IOHC were determined.
Incomplete ossification of the humeral condyle was present in six of 14 dogs, however IOHC was incomplete in three of the six affected dogs. Plain radiographs had a sensitivity of 0.83 (CI 95%: 0.36 to 0.99) and specificity of 1 (CI 95%: 0.60 to1). The Kappa coefficient between radiologists for radiographic examination was 0.714. Of the Spaniel breeds, four out of eight had IOHC in the limb contralateral to the HCF.
Computed tomography evaluation is more sensitive than radiographs for diagnosis of IOHC, particularly when assessing partial or incomplete IOHC. However, sensitivity of radiographic diagnosis is good and should be adequate in most cases. Clinical suspicion of IOHC in the contralateral limb to the unilateral HCF should be present; however overall frequency may not be as high as previously reported.
The medical records of 156 dogs with degenerative lumbosacral stenosis (DLS) that underwent decompressive surgery were reviewed for signalment, history, clinical signs, imaging and surgical findings. The German Shepherd Dog (GSD) was most commonly affected (40/156, 25.6%). Pelvic limb lameness, caudal lumbar pain and pain evoked by lumbosacral pressure were the most frequent clinical findings. Radiography showed lumbosacral step formation in 78.8% (93/118) of the dogs which was associated with elongation of the sacral lamina in 18.6% (22/118). Compression of the cauda equina was diagnosed by imaging (epidurography, CT, or MRI) in 94.2% (147/156) of the dogs. Loss of the bright nucleus pulposus signal of the L7-S1 disc was found on T2-weighted MR images in 73.5% (25/34) of the dogs. The facet joint angle at L7-S1 was significantly smaller, and the tropism greater in GSD than in the other dog breeds. The smaller facet joint angle and higher incidence of tropism seen in the GSD may predispose this breed to DLS. Epidurography, CT, and MRI allow adequate visualization of cauda equina compression. During surgery, disc protrusion was found in 70.5% (110/156) of the dogs. Overall improvement after surgery was recorded in the medical records in 79.0% (83/105) of the dogs. Of the 38 owners that responded to questionnaires up to five years after surgery, 29 (76%) perceived an improvement.
Distal limb lacerations are common injuries in horses, with a better prognosis reported for extensor tendons lacerations compared to flexor tendons lacerations. The objective of the present study was to determine the influence of type and location of injury, modalities of treatment and post surgical complications on the outcome of extensor tendon lacerations. The medical records of 156 horses surgically treated for extensor tendon lacerations over a 10-year period were analysed retrospectively. Information was obtained for 124 horses with a minimum of 18 months follow-up. Statistical analysis was performed on 129 horses (five horses were euthanatized during hospitalization) in order to determine factors affecting outcome. Seventy-four percent of the horses returned to soundness, 17% had moderate gait impairment and 9% remained lame. Approximately 60% of the sports horses returned to an equal or higher level of performance, and 17.5% returned to a lower level. In the multivariate statistical analysis, the only significant factor that favourably influenced outcome was complete suture of the wound. A significant association could not be detected between outcome and absence of a functional extensor tendon, The most important post-surgical complication was extensive scarring of the wound. The present results report outcome of extensor tendon lacerations in a large number of horses and outline the importance of primary wound healing in order to avoid major scarring with potential functional consequences.
The objective of this retrospective study was to assess radiographical and surgical findings, surgical management and outcome of penetrating injuries in dogs and cats by evaluating patient records. Sixteen patients were identified (15 dogs and one cat), four with gunshot wounds, and 12 with fight wounds (11 with bite wounds, one struck by a claw). The thoracic cavity was affected in six patients, the abdominal cavity in three cases. Both cavities were affected in five dogs and the trachea in two cases. All of the patients with fight wounds were small breed dogs. Multiple injuries to internal organs that required intervention were found surgically after gunshot wounds and a high amount of soft tissue trauma requiring reconstruction was present after fight wounds. Radiography diagnosed body wall disruption in two cases. All of the affected thoracic body walls in the fight group had intercostal muscle disruptions which was diagnosed surgically. Fourteen patients survived until discharge and had a good outcome. In conclusion, penetrating injuries should be explored as they are usually accompanied by severe damage to either the internal organs or to the body wall. A high level of awareness is required to properly determine the degree of trauma of intercostal muscle disruption in thoracic fight wounds.
Cementless total hip implants are relatively new to the veterinary market and therefore complication rates and prognostic indicators associated with the procedure have not been thoroughly documented. The objective of this study was to determine the prevalence of complications and identify prognostic indicators of success or failure for the Zurich cementless total hip replacement (THR). Medical records of 163 dogs that underwent Zurich cementless-THR were reviewed; continuous and categorical variables, clinical outcomes and complications were recorded. Complications were separated into intra-operative (IOC), short-term (STC), and long-term (LTC). Bivariate and multivariate statistical analysis was used to compare complications. The clinical significance of this study was to provide surgeons with prognostic indicators of success or failure when evaluating prospective Zurich cementless-THR patients, and to report the complication rate of Zurich cementless-THR. The complication rates of Zurich cementless-THR were then compared to previously-reported complication rates of cemented-THR and other cementless-THR systems. Short-term complications, LTC, and IOC rates of Zurich cementless-THR were found to be 6.75%, 10.4%, and 11.0% respectively. The most common complications were intra-operative femoral fracture, luxation of the implant, and septic loosening of the implant. Increased body weight and prior cemented-THR or femoral head and neck ostectomy of the contra-lateral hip were identified as negative prognostic indicators. The overall complication rate identified was greater than those previously reported for other cementless- and cemented-THR systems.
Seventeen cases of feline cranial cruciate ligament rupture are presented. The cases are divided into two groups: those with traumatic multiligamentous damage, and those with isolated cranial cruciate ligament rupture without a history of trauma. The cats that had suffered cruciate ligament rupture were heavier than the general population of cats and there is evidence reported that this injury parallels the degenerative cranial cruciate ruptures seen in overweight small breed dogs. The limited literature on this subject is reviewed including approaches to treatment.
Seventeen puppies, two to four months old, with a femoral (n = 12) or tibial (n = 5) diaphyseal fracture were treated by elastic plate osteosynthesis with a Veterinary Cuttable Plate (VCP) or straight plate. In one case of femoral fracture treated with a VCP, plate bending due to an excessive elasticity of the implant was observed three days after the osteosynthesis and surgical revision was required. Two cases of femoral overgrowth and one case of slight femoral head and neck retroversion were identified during the radiographic follow-up but without any clinical consequences. Bone healing was obtained for all fractures four to eight weeks (5.64 +/- 0.88 weeks) after the surgical procedure, and functional results were excellent in all cases. Our study confirms that elastic plate osteosynthesis with either a VCP or straight plate can be used to treat femoral diaphyseal fractures in medium and large breed puppies less than four months old, but that modification of implant elasticity or rigid osteosynthesis use is required when such puppies reach four months. The same technique can also be used successfully to treat tibial fractures in puppies younger than four months old.
To compare the stiffness and strength of AO bone plates (DCP, LC-DCP, VCP, RCP, and LP) and the Clamp-Rod Internal Fixation System (CRIF). Study design: In vitro. Sample size: 12 individual implants of 18 plate dimensions and four sizes of CRIF, each corresponding to 2.0, 2.4/2.7, 3.5, or 4.5 mm screw sizes.
Implant-constructs of each plate and CRIF were created using Canevasit rods as a bone substitute in an unstable gap fracture model. Six implant-constructs of each type were tested under single cycle four-point bending loading, and six were tested under single cycle torsional loading until permanent plastic deformation occurred.
Torsional stiffness and yield load of the DCP were always significantly greater than the CRIF within the same group. Bending properties of the 2.0 DCP were not significantly different to the 2.0 CRIF. The 2.7 DCP had significantly higher bending values than the 2.7 CRIF. The bending stiffness of the 3.5 DCP and 4.5 DCP was significantly less than their CRIF counterparts. While the bending yield load of the 3.5 DCP was significantly greater than the 3.5 CRIF, the bending yield load of the 4.5 DCP was significantly less than the 4.5 CRIF.
A weakness was found in the torsional resistance of the CRIF constructs compared to the DCP constructs.
Bone holding power and applied screw torque should be considered when using the CRIF system in clinical application.
The use of the AO (Arbeitgemeinschaft für Osteosynthesenfragen) veterinary T-plates (1.5/2 mm and 2.7/3.5 mm) for stabilisation of supracotyloid ilial fractures in 18 cats and five dogs was evaluated in a retrospective study. The distal fragment from the coxofemoral joint ranged from 0.5 cm to 1 cm with a mean distance of 0.85 cm. Twenty out of 23 (87%) ilial fractures healed in original alignment. Three out of 23 (13%) animals had two loosened screws of the distal fragment with fracture malunion and minor medial displacement of the acetabular fragment. Screw or plate breakage was not observed and the implants were not removed. The clinical result was 'excellent' for 18 animals (78%), 'good' for four animals (17%), and 'poor' for one animal (5%). The use of T-plates permits good correction of supracotyloîd fractures with minimal approach and minimizes post-operative complications.
This article is reprinted by kind permission of Veterinary History where it first appeared in Vol. 14, No. 2 (2008), pgs. 119–136. The paper is the text of an invited lecture that was given by the late Professor Leslie Vaughan. It has not been peer-reviewed, but is reprinted for readers of VCOT. An obituary to Professor Vaughan was published in VCOT 2009 22(3): IX-X.
This study evaluates 76 cases of shoulder instability in dogs, functional outcome after treatment, and the effectiveness of medial biceps tendon transposition using a metallic staple. Clinical examinations of the shoulder were performed and radiographs were taken. Conservative treatment or surgery (biceps tendon transposition or arthrodesis) was then opted for on the basis of type of instability, associated lesions and dog (age, weight, behaviour). Long-term functional outcome was categorized as 'excellent', 'good', 'average' or 'poor'. In our series, the most frequently affected breed was the Poodle (13%). Humeral head intermittent displacement was either medial (80%), lateral (19%) or cranial (1%). On clinical examination, 97% of the animals experienced pain. In anaesthetised dogs, shoulder instability was observed in 90% of the population. Muscle atrophy (33%) and associated radiographic lesions (34%) were less frequent. Ninety-five percent of the dogs were treated surgically, either by bicipital tendon transposition (81%) or by shoulder arthrodesis (19%). Results were 'good' to 'excellent' in 25% of the animals treated conservatively, and in 84.5% and 87.5%, respectively, in those treated by tendon transposition and arthrodesis. Complications did not arise from the use of a metallic staple to anchor the tendon during medial transposition. Tendon transposition or arthrodesis resulted in a good functional outcome in more than 80% of the dogs with shoulder instability. During the medial transposition, the biceps tendon was easily and effectively stabilized using a metallic staple.
This retrospective study documents deep gluteal tenodesis (DGT) used to stabilize coxofemoral luxation (CFL) in dogs and cats, and to report reluxation rate and clinical outcome after DGT.
Medical records (1995–2008) of 65 dogs and cats with traumatic CFL treated by capsulorrhaphy and DGT were reviewed. Animals with radiographic evidence of pre-existing hip dysplasia or articular fractures had been excluded. Reluxation rate and outcome were assessed by clinical examination, performed two and ten weeks postoperatively.
Surgical treatment was performed between one and 20 days after the initiating event. No perioperative complications occurred. All hip joints were correctly reduced and stabilized immediately after DGT completion. Except for five patients, placement of the screw was considered correct. In two of these patients, the screws were too long and were protruding into the pelvic canal. In two dogs, the screws were not tightened adequately, and in one dog the screw was too short. Twenty-six dogs and eight cats were re-examined between eight and 13 weeks postoperatively. Reluxation did not occur in any of them. Outcomes were good in two cases and excellent in 32 cases; all but two had a normal range-of-motion of the reconstructed hip, and were free of lameness and did not show any signs of pain.
Traumatic CFL can be stabilized safely and effectively by DGT in dogs and cats. This technique should be considered among other capsular reinforcement techniques in the presence of an intact deep gluteal muscle.
Presented in part at the 19th Annual Scientific Meeting ECVS, Helsinki, Finland, July 1–3, 2010
A retrospective study between 1995 and 2004 of fracture repair in cats (n = 46) using interlocking nails (ILN) was made. Only the cases in which clinical and radiographic examination of bone healing were available are included. Five humeral and twenty eight femoral fractures were reviewed. Multiple-hole interlocking nails (MH-ILN) were used in 22 fractures, with the four-hole model (FH-ILN) in the remaining cases. In three of the cases, the FH-ILN was transformed to a three-hole model by cutting the nail between the two most distal holes. The average length of humeral ILN was 78.8 mm, and the femoral ILN was 97.2 mm. Static fixation was performed in 27 cases, with dynamic fixation in the remaining. The medullary canal filling was 100% in both radiographic views in 16 cases. Intra-operative complications were encountered in two cases. A total number of 76 screws were inserted, with 5.26% of them being malpositioned. Malunion, in a deformed femur, and partial unscrewing of one screw were the only radiographic complications observed at the time of follow-up. The clinical outcome, as well as fracture healing, were excellent in all of the cases. The results of this study indicate that the 4.0 and 5.0 mm MH-ILN and FH-ILN can be used to repair simple or comminuted humeral and femoral fractures in cats.
Modifications of a Type 1a external skeletal fixator (ESF) frame were evaluated by alternately placing transfixation pins on opposite sides of the connecting rod (Type 1a-MOD) or by placing additional connecting rods on either of the two inside (Type 1a-INSIDE) or two outside (Type 1a-OUTSIDE) transfixation pins. The objective of this study was to evaluate the stiffness of these modifications in terms of axial compression (AC), cranial-caudal bending (CCB), and medial-lateral bending (MLB). We hypothesized that these designs would allow significant increase in unilateral frame stiffness, over Type 1a, without proportional increase in frame complexity or technical difficulty of application. All of the ESF frames were constructed using large IMEX SKtrade mark clamps, 3.2 mm threaded fixation pins, 9.5 mm carbon fibre connecting rods and Delrin rods as bone models. Nine, eight pin frames of each design were constructed, and subjected to repetitive non-destructive loading forces (AC, CCB, MLB) using a materials testing machine. Frame construct stiffness for each force (AC, CCB, MLB) was derived from load-deformation curve analysis and displayed in N/mm. Data revealed the 1a-MOD and 1a-OUTSIDE constructs had significantly increased stiffness in CCB and AC as compared to the Type 1a constructs while all of the modified constructs were significantly stiffer in MLB than the Type 1a constructs.
To describe acute correction of antebrachial angular and rotational limb deformities (ARLD) using a new external skeletal fixator (ESF).
Dogs that were presented with lameness caused by ARLD were treated by radial and ulnar osteotomies and acute realignment. A modified type-1b ESF incorporating double arches (DA-ESF) and a novel connecting configuration facilitated alignment with six degrees of freedom. Bilateral deformities were corrected surgically in the same session. Aseptic preparation of both antebrachii allowed comparison of limb alignment. Radiographic evaluation was performed using centre of rotation of angulation (CORA) methodology.
Thirty-five antebrachii (22 dogs) underwent surgery. Postoperative limb function was graded as good (n = 31), fair (n = 2), or poor (n = 2). Persistent medial carpal instability was associated with a suboptimal outcome. Postoperative radiographic images of the frontal and sagittal plane joint angles and elbow-to-carpus translation were compared with values that were reported in previous studies, and were within published reference ranges in most cases. Complications included delayed radial osteotomy union (n = 5), delayed ulnar osteotomy union (n = 2) and implant-associated morbidity (n = 3).
A practical technique for acute correction of complex antebrachial ARLD is suggested, incorporating a new configuration of ESF. Putative limitations of radiographic planning using CORA may be compensated by careful attention to intra-operative visual and palpatory assessment.
This study describes the titanium ComPact UniLock 2.0/2.4 locking plate system (Stratec Medical, Oberdorf, Switzerland) and reports its application in nine selected clinical cases. The system was found useful for a variety of indications. Three categories of clinical applications are illustrated. They include (a) long bone fractures, (b) cervical spinal fractures and instabilities and (c) joint instabilities and luxations. A brief introduction to the system has already been published
The medical records of three cats that were presented with severe carpal injury requiring radiocarpal arthrodesis were reviewed. Medial plating using the Compact 2.0 LOCK™ system was performed in all three cases. Although screw positioning may be difficult because of the large distance between the holes of the plate and the relatively large size of screws, plate loosening or metacarpal fractures did not occur. Long-term clinical and radiographic follow-up (6 months to 4.5 years) revealed excellent outcome in two cats. In the third cat, the radiocarpal joint did not undergo complete fusion. At four and a half years following surgery, recurrence of forelimb lameness was associated with breakage of the plate.
Use of stacked veterinary cuttable plates (VCP) increases the construct stiffness, but it also increases the stress protection and concentrates the stress at the extremities of the implants. We hypothesized that by shortening the superficial plate, it would not reduce the stiffness of the construct, but that it would reduce the stress concentration at the plate ends.
A 3 mm fracture gap model was created with copolymer acetal rods, stacked 2.0-2.7 VCP and 2.7 screws. The constructs consisted of an 11-hole VCP bottom plate and a 5-, 7-, 9- or 11-hole VCP superficial plate. Five of each construct were randomly tested for failure in four-point bending and axial loading. Stiffness, load at yield, and area under the curve until contact (AUC) were measured. Strains were recorded during elastic deformation for each configuration.
During both testing methods, stiffness, load at yield and AUC progressively decreased when decreasing the length of the superficial plate. No statistically significant differences were obtained for load at yield in four-point bending and AUC in axial loading. The strain within the implant over the gap increased as the length of the superficial plate decreased.
Shortening the superficial plate reduces the stiffness and strength of the construct, and decreases stress concentration at the implants ends. As the cross section of the implant covering the gap remained constant, friction between the plates may play a role in the mechanical properties of stacked VCP.
To compare the mechanical properties of locking compression plate (LCP) and limited contact dynamic compression plate (LC-DCP) constructs in an experimental model of comminuted fracture of the canine femur during eccentric cyclic loading.
A 20 mm mid-diaphyseal gap was created in eighteen canine femora. A 10-hole, 2.4 mm stainless steel plate (LCP or LC-DCP) was applied with three bicortical screws in each bone fragment. Eccentric cyclic loadings were applied at 10 Hertz for 610,000 cycles. Quasistatic loading / unloading cycles were applied at 0 and 10,000 cycles, and then every 50,000 cycles. Structural stiffness was calculated as the slope of the linear portion of the load-displacement curves during quasistatic loading / unloading cycles.
No bone failure or screw loosening occurred. Two of the nine LCP constructs failed by plate breakage during fatigue testing, whereas no gross failure occurred with the LC-DCP constructs. The mean first stiffness of the LCP constructs over the course of testing was 24.0% lower than that of constructs stabilized by LC-DCP. Construct stiffness increased in some specimens during testing, presumably due to changes in bone-plate contact. The first stiffness of LC-DCP constructs decreased by 19.4% and that of locked constructs by 34.3% during the cycling period. A biphasic stiffness profile was observed: the second stiffness was significantly greater than the first stiffness in both groups, which allowed progressive stabilization at elevated load levels.
Because LCP are not compressed to the bone, they may have a longer working length across a fracture, and thus be less stiff. However, this may cause them to be more susceptible to fatigue failure if healing is delayed.
To describe fluoroscopically assisted percutaneous placement of 2.4 mm cannulated screws for fixation of artificially induced sacroiliac luxations in cats, and to evaluate the success of this technique in restoration of normal pelvic anatomy.
Fluoroscopically assisted closed reduction and percutaneous fixation of sacro-iliac luxations using 2.4 mm cannulated screws was performed in cadavers of 12 cats. Pre- and postoperative radiographs and postoperative computed tomographic scans were used to evaluate screw placement, screw purchase within the sacral body, reduction of the sacroiliac joint, pelvic canal diameter ratio, and hemipelvic canal width ratio.
Mean total surgical time was 6 minutes and 10 seconds ± 53 seconds and mean total time of fluoroscopic screening for each procedure was 44 seconds ± 6 seconds. Mean percent of reduction was 98.33% and mean screw purchase within the sacral body was 73%. Eleven out of 12 screws were placed in a satisfactory location in the sacral body. Pelvic canal diameter ratio and hemipelvic canal width ratio indicated successful restoration of the pelvic anatomy.
Our results confirm that fluoroscopically assisted percutaneous placement of 2.4 mm cannulated screws is a feasible technique for fixation of sacroiliac luxations in cats. Mechanical properties of this fixation technique need to be evaluated before the use in clinical patients.
To evaluate the acetabular ventroversion obtained with a modified triple pelvic osteotomy (2.5 PO) compared with that resulting from standard double pelvic osteo-tomy (DPO).
Ex vivo study.
Seven pelves obtained from skeletally mature dogs with a total body weight ranging from 26-41 kg were used.
Unilateral DPO technique and dorsal ischial mono-cortical osteotomy were performed on every right hemipelvis. Angular ventral rotation was measured by determining the relative orientation of two Kirschner wires placed in the ilial wing and in the dorsal acetabular rim.
The mean angle of ventroversion was 9.5 ± 5.2 degrees for the DPO group (range 2.1-18.1) and 10.9 ± 4.8 degrees for the 2.5 PO group (range 4.1-19.5). The mean difference between the 2.5 PO and DPO was 1.5 ± 0.6 degrees (range 0.5-2.1).
The 2.5 PO technique increased acetabular ventroversion versus DPO.
Several techniques have been described for canine pancarpal arthrodesis (PCA) with dorsal plating becoming the most accepted method for ease of placement despite the proposed biomechanical disadvantages. The aim of this study was to compare the biomechanical effects of the addition of crossed K-wires to a standard 2.7/3.5 mm hybrid PCA plate. A 2.7/3.5 mm hybrid PCA plate, alone and combined with crossed K-wires were tested. Six pairs of cadaver forelimbs were collected from medium-sized dogs with an average weight of 24 kg by elbow disarticulation. The limbs were potted and fixed in an Instron load cell (Instron, High Wycombe, UK) and axially loaded to failure. Load displacement data and mode of failure were recorded and stiffness, yield load and ultimate load at failure were calculated. The yield load (kN) of the plate and K-wire construct (1.278+/-0.11) was significantly higher than for the plate construct alone (1.002+/-0.07) (p=0.00056). However, the differences between the two constructs in stiffness and failure loads were not significant.
Objectives: To determine the frequency and radiographic aspect of medial humeral epicondylar lesions as a primary or concomitant finding and to evaluate the association with osteoarthritis.
Methods: Medical records of dogs diagnosed with elbow lameness were reviewed. Inclusion criteria for this study were a complete clinical examination, a complete set of digital radiographs and a final diagnosis made by computed tomography or magnetic resonance imaging and arthroscopy. Changes of the medial humeral epicondyle were recorded and correlated with the radiographic osteoarthritis and final diagnosis.
Results: Eighty of the 200 elbows showed changes of the medial humeral epicondyle. In 12 of these 80 elbows, changes of the medial epicondyle were the only findings within the joint, and these elbows were diagnosed with primary flexor enthesopathy. In the remaining 68 elbows, other concomitant elbow pathologies were found. In those cases of concomitant epicondylar changes, high grades of osteoarthritis were recorded, while most elbows with primary flexor enthesopathy showed a low grade of osteoarthritis.
Clinical significance: Changes of the medial humeral epicondyle are often considered clinically unimportant and are regarded as an expression of osteoarthritis. This study showed the relatively frequent presence of epicondylar changes of which the majority were considered concomitant to a primary elbow problem. If changes of the medial humeral epicondyle are the only pathologic finding (primary flexor enthesopathy) they should be considered as the cause of lameness and not as a sign of osteoarthritis.
Patellar tendon thickening (PTT) and patellar tendinosis (PTS) have been discussed in the veterinary literature as a post-operative complication of tibial plateau leveling osteotomy (TPLO). The purpose of this study was to define radiographic PTT, determine the frequency of and risk factors for PTT and PTS, and describe the clinical and histopathological findings of PTS after TPLO. We hypothesized that the location of the osteotomy alters forces placed on the patelloar tendon resulting in PTT or PTS. Radiographs and medical records from 83 dogs undergoing 94 TPLO procedures were retrospectively evaluated. Two months post-operatively, 19 dogs (20.2%) had a normal patellar tendon or mild PTT, 51 (54.3%) had moderate PTT, and 24 (25.5%) had severe PTT. Seven of the 24 dogs (7.4%) with severe PTT had clinical signs consistent with PTS. Only dogs with severe PTT developed PTS (p < 0.0001). The risk factors for the development of PTT include: a cranial osteotomy, a partially intact cranial cruciate ligament (CCL) in conjunction with a cranial osteotomy, and post-operative tibial tuberosity fracture. The only risk factor identified for the development of PTS was a partially intact CCL. Four dogs with PTS improved with conservative therapy and one improved with surgical treatment. Two dogs had tendon biopsies with histopothological review that showed tendon degeneration with lack of inflammation. As only the dogs with severe PTT develop PTS, a caudal osteotomy for the prevention of PTT and subsequent PTS is recommended.
This prospective study describes a series of 18 olecranon fractures in 16 horses that were treated with locking compression plates (LCP). Twelve of the 18 fractures were simple (type 2), whereas six were comminuted (type 4). Six fractures were open and 12 were closed. Each horse underwent LCP osteosynthesis consisting of open reduction and application of one or two LCP. Complete fracture healing was achieved in 13 horses. Three horses had to be euthanatized: two because of severe infection and one because of a comminuted radial fracture 11 days after fixation of the olecranon fracture. Complications encountered after discharge of the horses from the Equine Hospital at the Vetsuisse Faculty (University of Zurich) included implant infection (n=2) and lameness (n=3), which were successfully treated with implant removal. Despite being easier to use, LCP osteosynthesis resulted in a clinical outcome similar to DCP osteosynthesis.
To determine relationships between seasonality and lunar cycle and the frequency of maxillomandibular (MM) and non-maxillomandibular (non-MM) injury in canine and feline trauma patients.
A medical records database was searched to identify all MM trauma patients (n = 67) and a random sample of non-MM trauma patients (n = 129) according to search criteria. Season of injury, moon phase, and moon luminosity were calculated for the date of injury.
Maxillomandibular injury occurred predominately in the spring and decreased through winter while non-MM injury occurred more frequently in the summer and fall. The difference in the frequency of MM and non-MM injuries during different seasons was not significant (p = 0.071). When comparing the amount of moon illuminated when injuries occurred during the quarters before or after the full moon, a difference (p = 0.007) was noted with a greater number of injuries occurring immediately following the full moon.
These results may guide clinicians to closely evaluate trauma patients that are presented on emergency during a particular season or lunar phase. Based on the season at the time of injury, close evaluation for MM versus non-MM trauma may be appropriate.
To determine differences in signalment between maxillomandibular (MM) and non-maxillomandibular (non-MM) trauma patients to help predict the type of injury sustained.
A medical records database was searched from December 2003 to September 2012 to identify all MM trauma patients. A random sample of non-MM trauma patients was generated for comparison. Patient species, age, sex, weight, and injury aetiology were recorded for both populations.
Sixty-seven MM trauma patients and 129 non-MM trauma patients were identified. Feline patients were almost twice as likely to be presented for MM trauma compared with non-MM trauma. The median weight of canine patients suffering MM injury was significantly less than that of non-MM patients (p = 0.025). A significant association existed between the causes of injuries associated with MM and non-MM trauma populations (p = 0.000023). The MM trauma patients were more likely to sustain injury as a result of an animal altercation (Bonferroni p = 0.001) while non-MM injuries were more likely to result from motor vehicle accidents (Bonferroni p = 0.001). Overall, animals that were less than one year of age with traumatic injuries were overrepresented (65/196) in comparison to the entire patient population.
The results of this study may help guide clinicians in the evaluation and screening of trauma patients that are presented as an emergency. Cats, small dogs and animals suffering from animal altercations should all be closely evaluated for MM injury.
The aim of this paper was to record the types of injuries and causes of lameness exhibited by dogs involved in game shooting. The study investigated gundogs that worked in the seasons 2005/2006 and 2006/2007. Information was acquired by owner questionnaires. The dogs were classified as working in the beating line, as peg dogs or as picking up dogs. A further group comprised Setters and Pointers that worked the grouse moors. A secondary objective was to assess the incidence of injuries that were treated by owners without seeking the assistance of their veterinarian, and to identify those that may have been underestimated. Depending on whether a dog was injured or went lame, and, if so, the nature of the injury, was correlated with the number of days worked, where it worked, its breed and the type of work it did. A mildly positive association between the Spaniel breed group and injuries was seen in 2005/2006 but not in 2006/2007. However, the relationship between the type of work and injuries was very significant for both seasons with dogs working in the beating line being at greatest risk and Setters and Pointers having the least number of injuries. The dogs in the beating line were also at a significantly greater risk of injury in both years when the type of injury was investigated. Fifty-three percent of all injuries were deemed to be sufficiently minor, that veterinary attention was not sought. However, those dogs with proximal thoracic limb lameness may have been under-investigated. There was a highly significant association between tail injuries and undocked Springer and Cocker Spaniels.