Comparison of surgical treatment options for cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle

Objective— To identify surgical techniques performed by veterinary surgeons for the treatment of cranial cruciate ligament disease in large-breed dogs with excessive tibial plateau angle (eTPA), compare their outcomes, identify risk factors for postoperative complications, and compare outcome and complication rate with tibial plateau leveling osteotomy (TPLO) in dogs without eTPA.
Study Design— Multicenter, case–control study.
Animals— eTPA group (TPA≥35°)=58 dogs (78 stifles); control group (TPA≤30°)=58 dogs (72 stifles).
Methods— Control and eTPA group dogs were identified. Medical records, radiographic reviews, and pet-owner interviews were used to identify surgical treatments performed, their complications, and outcome. Odds ratios with 95% confidence intervals, χ² tests, and t-tests were calculated to discern differences between eTPA and control-group dogs.
Results— TPLO was the most common treatment for eTPA. Owner-perceived outcome was superior for eTPA group dogs when TPLO resulted in TPA≤14° compared with those with postoperative TPA>14°. Loss of tibial plateau leveling during convalescence was the most commonly observed major complication; addition of ancillary implants to TPLO significantly reduced its incidence. Postoperative complications were more common in dogs with eTPA than in dogs without eTPA; however, no difference in owner-perceived outcome was identified.
Conclusions— Surgical treatment of dogs with eTPA has a higher complication rate, but comparable outcome to that of dogs without eTPA.
Clinical Relevance— Postoperative TPA≤14° and addition of ancillary implants are recommended when using TPLO to treat dogs with eTPA.     

Complications associated with tibial plateau leveling osteotomy: A retrospective of 1519 procedures

This retrospective study identified complications associated with tibial plateau leveling osteotomy (TPLO) and predisposing factors for these complications in a large population of dogs from a metropolitan area with cruciate ligament deficiency. There were 943 dogs that underwent unilateral TPLO and 288 with staged bilateral TPLO for a total of 1519 procedures. There were 47 cases with at least 1 major complication and 126 cases with at least 1 minor complication but no major complications. The total complication rate (major or minor) was 11.4% [95% confidence interval (CI) estimate: 9.8%, 13.2%]; the major complication rate was 3.1% (95% CI: 2.3%, 4.1%); and the minor complication rate was 8.3% (95% CI: 7.0%, 9.8%). Factors associated with development of complications included being a German shepherd dog [odds ratio (OR): 3.2], tibial plateau angle > 30° (OR: 1.6), and heavier weights (for every 4.5 kg increase in body weight the OR increased by 1.10). Tibial plateau leveling osteotomy is a common treatment for dogs with cruciate ligament deficiency and has a low complication rate.     

Risk factors for tibial tuberosity fracture after tibial plateau leveling osteotomy in dogs

Objective— To evaluate factors that predispose to tibial tuberosity (TT) fracture after tibial plateau leveling osteotomy (TPLO) in dogs.
Study Design— Retrospective study.
Animals— Dogs (n=182) with cranial cruciate ligament (CCL) rupture undergoing 213 TPLO surgeries.
Methods— Medical records and radiographs of 2 groups of dogs that had TPLO surgery (2000–2001, 2004–2005) were evaluated to determine the effect of operative technique and surgeon experience on TT fracture.
Results— TT fracture was diagnosed in 8 dogs (9 TPLO, 4.2% of surgical procedures). Four fractures occurred after unilateral TPLO in 167 dogs (2.4%), 4 fractures occurred after simultaneous bilateral TPLO in 5 dogs (40%), and 1 fracture occurred after staged bilateral TPLO in 36 dogs (2.8%). Simultaneous bilateral TPLO resulted in a 12.4 times higher odds of TT fracture versus unilateral TPLO ( P =.046). The mean absolute thickness of the TT after TPLO was less in dogs sustaining TT fractures (7.2 ± 2.2 mm) than those that did not (10.8 ± 2.7 mm, P <.0001). The odds of fracture decreased by 37% when the absolute TT width postosteotomy increased by 1 mm ( P <.0001). An increase in tibial plateau angle at follow-up versus immediately postoperative was associated with TT fracture ( P =.025). Surgeon experience was not associated with TT fracture.
Conclusion— A combination of surgical decision-making and surgical technique play a role in the occurrence of TT fracture after TPLO. Simultaneous bilateral TPLO was associated with a high percentage of TT fracture.
Clinical Relevance— Careful planning of osteotomy positioning is advised while performing TPLO surgery.     

Complications associated with 696 tibial plateau leveling osteotomies (2001-2003)

A total of 696 tibial plateau leveling osteotomy (TPLO) procedures were performed over a 30-month period following TPLO training. The overall complication rate was 18.8%. Complications were classified as perioperative (1%), short-term (9.3%), and long-term (8.5%). Examples of complications encountered during the study were hemorrhage, swelling at the incision site, premature staple removal by the dog, tibial tuberosity fracture, patella tendon swelling, and implant complications. Based on the rate of complications observed, clinical outcomes of TPLO procedures within 30 months of TPLO training were considered good.     

Risk Factors Associated with Fibular Fracture After Tibial Plateau Leveling Osteotomy

Objective— To determine the incidence of, and risk factors for, fibular fracture after tibial plateau leveling osteotomy (TPLO) in dogs.
Study Design— Case series.
Sample Population— TPLO (n=168) on 142 dogs.
Methods— Medical records (January 2006–September 2007) and radiographs of all dogs that had TPLO were reviewed. Data retrieved were breed, sex, age, weight, type of plate, use of a jig, time to recheck, preoperative tibial plateau angle (TPA), immediate postoperative TPA, and presence or absence of fibular fracture.
Results— Fibular fractures occurred in 5.4% TPLOs. Body weight, change in TPA, and preoperative TPA were significantly higher in dogs with fibular fracture. TPLO without use of a jig was significantly associated with fibular fracture. Age, postoperative TPA, and plate type were not significantly associated with fibular fracture.
Conclusions— Fibular fracture is uncommon after TPLO. Risk factors are increased body weight, greater preoperative TPA, greater change in TPA, and TPLO performed without a jig. All fractures occurred during convalescence.
Clinical Relevance— Owners should be warned of potential complications and risk factors associated for fibular fracture after TPLO.     

Tibial Plateau Leveling Osteotomy or Tibial Tuberosity Advancement?

Objective— To review the proposed biomechanical basis of the tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) and recommendations for these techniques.
Study Design— Literature review.
Methods— Literature search through Ovid Medline Plus, Pub Med, CAB Abstracts, and conference proceedings abstracts (August 1983 to March 2008).
Results— TPLO and TTA stabilize the cranial cruciate ligament (CrCL) deficient stifle joint neutralizing tibiofemoral shear forces by altering the geometry of the proximal aspect of the tibia. Stability is attained by placing the joint in a functionally greater flexion angle so that the patellar tendon angle (PTA) remains ≤90°. Both procedures target slightly differing endpoints, the significance of which is unknown. Many of the biomechanical variables investigated appear to favor the TTA; however, TPLO appears to have more clinical versatility. The clinical ramifications of these differences remain to be determined but the reported results for both procedures are comparable. Only the early results of these techniques have been reported, which is reflected in the relatively high number of complications associated with the early learning curve for both procedures.
Conclusions— There are many similarities between TPLO and TTA although it remains to be fully elucidated if either procedure is superior and under what conditions.
Clinical Relevance— TPLO and TTA are effective at returning dogs with a CrCL-deficient stifle joint to good limb function. Surgeon discretion and case selection drive selection of TPLO or TTA based mostly on anecdotal evidence and personal experience.     

Complications with and owner assessment of the outcome of tibial plateau leveling osteotomy for treatment of cranial cruciate ligament rupture in dogs: 193 cases (1997-2001)

OBJECTIVE: To identify complications associated with tibial plateau leveling osteotomy (TPLO) for treatment of cranial cruciate ligament rupture in dogs and assess owner perceptions of outcome. DESIGN: Retrospective study. ANIMALS: 193 dogs that underwent unilateral or bilateral TPLO (253 TPLOs total) between November 1997 and March 2001. PROCEDURE: Complications associated with the surgical procedure were recorded. A questionnaire was sent to owners of all dogs to assess their perceptions of outcome. RESULTS: Complications were identified in 47 of the 193 (24.4%) dogs and in association with 52 of the 253 (20.6%) TPLOs. Dogs that underwent bilateral TPLOs during a single anesthetic episode had a higher complication rate than did dogs that underwent unilateral TPLO and dogs that underwent bilateral TPLOs during separate anesthetic episodes. Body weight, surgery time, whether a meniscal release or meniscectomy was performed, and extent of cruciate ligament damage were not associated with whether complications occurred. One hundred forty-one of 151 (93%) owners who responded to the questionnaire were satisfied with the outcome of the surgery. Assessments of outcome were not significantly different between owners of dogs that had complications and owners of dogs that did not. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that complications developed in approximately 25% of dogs undergoing TPLO for treatment of a cranial cruciate ligament injury but that most complications responded to appropriate treatment, and development of complications did not affect owner assessments of outcome. There was a higher incidence of complications when bilateral TPLOs were performed during a single anesthetic episode.     

A comparison of outcomes following tibial plateau levelling osteotomy and cranial tibial wedge osteotomy procedures.

The objective of this study was to determine whether clinical outcomes were superior and complication rates were lower in dogs that had had a cranial cruciate ligament rupture treated by tibial plateau levelling osteotomy (TPLO), compared to those dogs that had been treated using the original cranial tibial wedge osteotomy (CTWO) procedure. Thirty-seven client-owned dogs with cranial cruciate ligament rupture were included in the study: 19 dogs underwent a TPLO procedure, and 18 dogs underwent a CTWO procedure. The study was retrospective, with the data being obtained from medical records and a review of radiographs. The long-term outcome was assessed by means of an owner questionnaire using a visual analogue scale. For the majority of factors that were reviewed, there was not a significant difference in outcome between the dogs that had a TPLO or those that had undergone a CTWO. All of the dogs showed a rapid return to weight bearing after surgery, and at the six week re-examination, the majority of the dogs did not have any pain on stifle palpation. They displayed a good stifle range of motion and significantly lower lameness scores than those prior to surgery. The complication rates did not differ between the procedures, however, within this small sample of dogs, complications following a CTWO were more likely to require revision surgery.     

Clinical Applications of Demineralized Bone Matrix: A Retrospective and Case‐Matched Study of Seventy‐Five Dogs

Objectives— To evaluate the outcome in dogs treated with demineralized bone matrix (DBM) as an adjunct to orthopedic procedures. Study Design— Retrospective and case‐match study. Animals— Dogs (n=75). Methods— Medical records (1999–2006) and radiographs of dogs that had orthopedic procedures (comminuted fractures, tibial plateau leveling osteotomy [TPLO] where correction for tibial rotation created an osteotomy gap, arthrodeses, open corrective osteotomies) where DBM was used were reviewed for signalment, quantity of DBM implanted, duration of exercise restriction, radiographic healing, and complications. Dogs that had TPLO and correction of tibial torsion (n=15), or arthrodesis (n=16) were compared with case‐matched controls. Data were analyzed using Kruskal–Wallis test, ANOVA, Tukey's HSD test, and logistic regression analysis. Results— Mean (±SD) healing time for orthopedic surgeries with DBM augmentation were 15±6.97 (weeks) and complication rate was 19% (14 dogs). Dogs with a TPLO gap filled with DBM were allowed to return to normal exercise 2 weeks earlier than dogs with a well‐apposed TPLO site. Radiographic healing, duration of exercise restriction, and timing of destabilization were similar in dogs undergoing carpal and tarsal arthrodesis whether they received DBM, autogenous graft, or both. Conclusions— DBM can be used to treat uncomplicated bone defects associated with comminuted fracture repairs, open osteotomies, and arthrodeses in dogs. Under these circumstances, clinicians might expect similar clinical outcomes without the possibility of side effects associated with the harvest of autogenous cancellous bone. Clinical Relevance— DBM is safe for use in dogs.     

Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle

OBJECTIVE: To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). STUDY DESIGN: Retrospective clinical study. ANIMALS: Fifteen client-owned dogs (18 stifle joints). METHODS: Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. RESULTS: Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. CONCLUSIONS: Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. CLINICAL RELEVANCE: TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.     

Radiographic and clinical changes of the tibial tuberosity after tibial plateau leveling osteotomy

OBJECTIVE: To investigate radiographic changes of the tibial tuberosity after tibial plateau leveling osteotomy (TPLO) surgery and identify clinical findings and risk factors associated with such changes. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Hundred and eighty-six client-owned dogs (219 stifles) that had TPLO surgery. METHODS: Patient data retrieved included radiographic changes of the tibial tuberosity during re-examination, age, body weight, whether unilateral or single-session bilateral surgery had been performed, location of the anti-rotational pin, approximate tibial tuberosity area, and approximate average tibial tuberosity width. RESULTS: Fracture with resulting caudal displacement of the proximal tibial tuberosity (1.4%; 3 of 219) occurred less frequently than non-displaced tibial tuberosity fractures (7.3%; 16 of 219). Age, weight, average tibial tuberosity width, location of the anti-rotational pin, and single session bilateral surgery were identified as risks factors for non-displaced fracture. Weight divided by the square of the average tibial tuberosity width may be a stronger risk factor than either weight or average tibial tuberosity width alone. CONCLUSIONS: Dogs undergoing single session bilateral TPLO surgery are at greater risk for developing non-displaced tibial tuberosity fractures. The non-displaced tibial tuberosity fracture does not appear to adversely affect outcome or lead to tibial tuberosity avulsion. Significant risk factors for fracture of the proximal tibial tuberosity with caudal displacement were not identified. CLINICAL RELEVANCE: Factors including age, weight, tibial tuberosity thickness, and conditions that may enhance strain on the tibial tuberosity, such as single-session bilateral procedures, may increase risk of fracture.     

Outcome of and postoperative complications in dogs undergoing surgical treatment of laryngeal paralysis: 140 cases (1985-1998).

OBJECTIVE: To compare outcomes of various surgical techniques for treatment of laryngeal paralysis in dogs and determine incidence and risk factors for development of postoperative complications. DESIGN: Retrospective study. ANIMALS: 140 dogs undergoing surgical treatment for laryngeal paralysis at a veterinary teaching hospital between 1985 and 1998. PROCEDURE: Data were analyzed to determine outcome and factors influencing outcome and development of complications. Kaplan-Meier curves were constructed for survival analysis. RESULTS: Postoperative complications were documented in 48 (34.3%) dogs; 20 (14.3%) dogs died of related causes. Aspiration pneumonia was the most common complication (33; 23.6%). Seven dogs died of aspiration pneumonia > 1 year after surgery. Dogs that underwent bilateral arytenoid lateralization were significantly more likely to develop complications and significantly less likely to survive than were dogs that underwent unilateral arytenoid lateralization or partial laryngectomy. Factors that were significantly associated with a higher risk of dying or of developing complications included age, temporary tracheostomy placement, concurrent respiratory tract abnormalities, concurrent esophageal disease, postoperative megaesophagus, concurrent neoplastic disease, and concurrent neurologic disease. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that surgical repair of laryngeal paralysis may be associated with high postoperative complication and mortality rates. Surgical technique and concurrent problems or diseases increased the risk of complications. Dogs appeared to have a life-long risk of developing respiratory tract complications following surgical correction.     

Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs

Objective: To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy. Study Design: Cases series. Animals: Dogs (n=12; 19 stifle joints). Methods: Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed. Pre‐ and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective osteotomy technique, method of fixation, and complications were recorded. In hospital re‐evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long‐term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. Results: Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre‐ and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88–96°) and 96.1° (range, 94–101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In‐hospital re‐evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long‐term follow‐up was obtained. Conclusions: Long‐term clinical outcome of combination TPLO and transverse corrective osteotomy was excellent, and had a high owner satisfaction. Healing times were comparable to standard TPLO with a similar complication rate.     

Risk factors for fibular fracture after TPLO

Objective: To determine (1) risk factors for fibular fracture after tibial plateau leveling osteotomy (TPLO) and (2) if a single postoperative radiographic measurement or measurement ratio of the proximal tibial fragment can be used as a predictor for fibular fracture. Study Design: Multivariate retrospective clinical study. Animals: Dogs (n=326) with cranial cruciate ligament rupture that had TPLO (n=355). Methods: Medical records (January 2004–November 2007) and radiographs of dogs that had TPLO were reviewed. TPLO plate type, distance between tibial plateau and proximal screw, proximodistal tibial plateau fragment length, tibial plateau width, the presence of a fibular drill hole filled with a screw or not, and fibular fractures were recorded. Results: The odds of having a fibular fracture were 10 times greater in dogs with a fibular drill hole than in dogs without a drill hole. The odds of having a fibular fracture were 1.46 times greater for every 4.5 kg increase in body weight. Tibial plateau angle (TPA) at the time of reevaluation was larger than the postoperative TPA and TPA increase was larger in dogs with fibular drill holes than without (P<.01) and in dogs with fibular fractures than without (P<.01). Conclusion: An unfilled fibular drill hole and increased body weight are risk factors for fibular fracture.     

Tolerance of cutaneous or mucosal flaps placed into a radiation therapy field in dogs

OBJECTIVE: To determine the clinical outcome and factors affecting cutaneous or mucosal flaps in dogs treated with radiation therapy (RT). STUDY DESIGN: Longitudinal clinical study. ANIMALS: Twenty-six client-owned dogs. METHODS: Dogs entered in the study had a flapping procedure and RT as part of their treatment. The sequence of flapping and RT included: (1) planned preoperative RT, (2) postoperative RT, and (3) flapping as a salvage procedure for management of complications or local tumor recurrence after RT. Flap complications were defined as necrosis, local infection, dehiscence, and ulceration. The risk and severity of flap complication were analyzed independently. RESULTS: Twenty (77%) dogs had a complication; 6 dogs required an additional flapping procedure; and 4 dogs had an unresolved complication. Flapping procedures performed to correct a complication, or failure of RT, had a significantly greater risk for complication; however, postoperative RT decreased the severity of complication. A dose per fraction of 4 Gy compared with 3 Gy was prognostic for increased severity of complications, whereas the head and neck location was prognostic for decreased severity of complication. CONCLUSIONS: Although morbidity was substantial, cutaneous or mucosal flaps were used successfully in an RT field in 85% of the dogs. Flaps that were part of the planned therapy as opposed to those used to correct a complication or failure of RT had a better clinical outcome. CLINICAL RELEVANCE: Cutaneous or mucosal flaps can be part of the treatment of dogs with tumor when adjuvant or neoadjuvant RT is to be used.     

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 3: Long-term complications and survival

REASONS FOR PERFORMING STUDY: Few studies have evaluated long-term survival and complication rates in horses following surgical treatment of colic, making it difficult to offer realistic advice concerning long-term prognosis. OBJECTIVE: To review the complications occurring after discharge from hospital and survival to >12 months after surgery of 300 horses undergoing exploratory laparotomy for acute colic. Pre-, intra- and post operative factors that affected long-term complications and long-term survival were assessed. METHODS: History, clinical findings, surgical findings and procedures and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Long-term follow-up information was retrieved from case records and telephone enquiries from owners. RESULTS: The long-term (>12 months) survival rate for 204 horses discharged after colic surgery and for which follow-up information was available was 84%. The most common complication after discharge was colic, affecting 35.1% of horses following a single laparotomy. Colic was most common in horses that had had small intestinal obstructions, bowel resection or post operative ileus. Abdominal adhesions were most common in horses that presented with severe colic due to strangulation of small intestine. Ventral hernia formation occurred in 8% of horses, and was most common in horses that had had post operative wound drainage or infection. CONCLUSIONS: This study identified various factors that appear to predispose horses to long-term complications after colic surgery. POTENTIAL RELEVANCE: Further evaluation of strategies that might reduce the incidence of such complications are needed; in particular, the value of intraperitoneal heparin should be evaluated, and procedures designed to reduce the rates of wound drainage and infection assessed.     

Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 2: Short-term complications

REASONS FOR PERFORMING STUDY: Few studies have assessed short- and long-term complication rates of horses following surgical treatment of colic, a potentially fatal condition. Complications can lead to patient discomfort and increased costs; knowledge of predisposing factors may help to reduce complication rates. OBJECTIVES: To document and analyse short-term complications in 300 horses undergoing colic surgery, and to assess some of the possible predisposing factors. METHODS: History, clinical findings, surgical findings and procedures, and post operative treatments of 300 consecutive surgical colic cases (1994-2001) were reviewed. Comparisons among groups of discrete data were made using chi-squared or Student's t tests as appropriate. RESULTS: Short-term complications in 227 horses following a single laparotomy included colic/pain (28.2%), incisional drainage or infection (26.9%), post operative ileus (13.7%), severe endotoxaemic shock (12.3%), jugular thrombophlebitis (7.5%), septic peritonitis (3.1%) and colitis/diarrhoea (2.2%). Horses with small bowel obstruction had a higher rate of post operative ileus than those with large bowel obstruction. Rates of post operative pain and shock were higher in horses with small colon rather than large colon obstruction, and in those that had an ischaemic rather than a simple obstruction. The rate of wound complications increased with increasing total plasma protein concentration at admission. Horses that had a repeat laparotomy had a higher rate of wound complications compared to those that had a single laparotomy. Application of a stent bandage was associated with a higher rate of wound complications than if no stent was applied; however, application of an incise drape over the wound for recovery was associated with a lower rate of wound complications than for horses that had no protective covering of the wound. CONCLUSIONS: The most common short-term post operative complications following colic surgery were pain, incisional drainage, ileus, endotoxaemiac shock and jugular thrombophlebitis. Some factors that appeared to predispose to these complications were identified. Although many of these factors related to the underlying disease process, a number of factors, including surgical techniques, were identified that might be amenable to modification. POTENTIAL RELEVANCE: Prospective studies to assess the effects of modifying these factors on survival rates should be performed.     

Proximal tibial intraarticular ostectomy for treatment of canine cranial cruciate ligament injury

OBJECTIVE: To report a technique for surgical alteration of the slope of the tibial plateau by a proximal tibial intraarticular ostectomy (PTIO) after injury to the canine cranial cruciate ligament (CCL) and to determine the outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Dogs (n=52) with CCL injury in 60 stifle joints. METHODS: CCL injury was treated by lateral stifle arthrotomy, removal of CCL remnants, and appropriate meniscal surgery. PTIO was performed to remove a wedge of bone from the proximal aspect of the tibia. The ostectomy site was reduced and stabilized using a bone plate and screws applied to the medial surface of the tibia as well as a craniocaudal positional screw. Dogs were evaluated at 6 weeks, 6, and 12 months by complication assessment, lameness scores, stifle range of motion (ROM), thigh circumference, radiographic assessment, degenerative joint disease (DJD) scores, and surgeon and owner evaluation of function. RESULTS: Lameness scores improved by 6 and 12 months in all but 1 dog. Thigh circumference and DJD were increased at 6 and 12 months. Complications occurred in 20% of dogs with all but 1 occurring perioperatively or within 6 weeks; most common were injury to the long digital extensor tendon (4 dogs) and plate failure (3); 2 other dogs required surgery to treat complications. Most owners (98%) reported that lameness had improved by 12 months; 90% were extremely or very satisfied with the procedure and 90% would have the same procedure performed on another dog. CONCLUSION: PTIO to level the tibial plateau provided a satisfactory clinical outcome in dogs >20 kg with CCL injury and the complication rate was similar to tibial plateau levelling osteotomy (TPLO). Stifle osteoarthritis continued to progress radiographically. CLINICAL RELEVANCE: PTIO represents an alternative to TPLO that does not require specialized surgical equipment.     

Routine castration in 568 draught colts: incidence of evisceration and omental herniation

REASONS FOR PERFORMING STUDY: Castration is one of the most common routine surgical procedures performed in the horse, from which a number of potential complications can arise. We undertook a prospective evaluation of short-term complications associated with castration of draught colts over a 3-year period (1998-2000). OBJECTIVES: To compare castration complications in a large number of draught foals with previously published literature. METHODS: Five hundred and sixty-eight draught colts, age 4 or 5 months, were castrated in field conditions. Foals were observed for complications for 24 h post operatively. RESULTS: There was no significant difference in complication rates between open and closed surgical techniques. Inguinal/scrotal hernia rate was 4.6% (26/568) prior to surgery, and evisceration of the small intestine occurred in 4.8% (27/568). Foals observed to eviscerate underwent immediate surgical correction with an overall survival rate of 72.2% (13/18). Omental herniation was seen in 2.8% (16/568) of colts. CONCLUSIONS: This study showed no difference between the closed and open techniques of castration and the rate of omental herniation or evisceration. The evisceration rate in combination with the omental and presurgical herniation rates approached 12.2%, which is high enough to warrant further examination. POTENTIAL RELEVANCE: Future investigation should help to assess predisposing factors for evisceration. Regardless of the technique employed, herniation appears to pose a significant risk to draught foals undergoing castration.     

Effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament in dogs

OBJECTIVE: To determine the outcome and effect of surgical technique on limb function after surgery for rupture of the cranial cruciate ligament (RCCL) and injury to the medial meniscus in Labrador Retrievers. STUDY DESIGN: Prospective clinical study. ANIMALS: 131 Labrador Retrievers with unilateral RCCL and injury to the medial meniscus and 17 clinically normal Labrador Retrievers. PROCEDURE: Affected dogs had partial or complete medial meniscectomy and lateral suture stabilization (LSS), intracapsular stabilization (ICS), or tibial plateau leveling osteotomy (TPLO). Limb function was measured before surgery and 2 and 6 months after surgery. Treated dogs were evaluated to determine the probability that they could be differentiated from clinically normal dogs and tested to determine the likelihood that they achieved improvement. RESULTS: No difference was found between LSS or TPLO groups, but dogs treated with ICS had significantly lower ground reaction forces at 2 and 6 months. Compared with clinically normal dogs only, 14.9% of LSS-, 15% of ICS-, and 10.9% of TPLO-treated dogs had normal limb function. Improvement was seen in only 15% of dogs treated via ICS, 34% treated via TPLO, and 40% treated via LSS. CONCLUSIONS AND CLINICAL RELEVANCE: Surgical technique can influence limb function after surgery. Labrador Retrievers treated via LSS, ICS, or TPLO for repair for of RCCL and medial meniscal injury managed with partial or complete meniscectomy infrequently achieve normal function. Results of LSS and TPLO are similar and superior to ICS.