Femoral Fracture Repair Using a Locking Plate Technique in an Adult Captive Polar Bear (Ursus Maritimus)

Objective— To report successful femoral fracture repair in a polar bear. Study Design— Case report. Animals— Female polar bear (Ursus maritimus) 5 years and ～250 kg. Methods— A closed, complete, comminuted fracture of the distal midshaft femur was successfully reduced and stabilized using a compression plating technique with 2 specialized human femur plates offering axial, rotational, and bending support, and allowing the bone to share loads with the implant. Postoperative radiographs were obtained at 11.5 weeks, 11 months, and 24 months. Results— Bone healing characterized by marked periosteal reaction was evident at 11 months with extensive remodeling evident at 24 months. No complications were noted. Conclusions— Distal mid shaft femoral fracture was reduced, stabilized, and healed in an adult polar bear with a locking plate technique using 2 plates. Clinical Relevance— Previously, femoral fractures in polar bears were considered irreparable. Use of 2 plates applied with a locking plate technique can result in successful fracture repair despite large body weight and inability to restrict postoperative activity.     

Treatment of medial patellar luxation by femoral closing wedge ostectomy using a distal femoral plate in four dogs

This case report describes the treatment of recurrent medial patellar luxation associated with varus deformity of the distal femur by distal femoral ostectomy stabilised using a distal femoral plate. Four dogs (five affected limbs) were included in the study. All cases had received previous surgery for medial patellar luxation but remained significantly lame. All were treated by femoral ostectomy to correct distal femoral varus deformity with application of a distal femoral bone plate. All cases improved following surgery. An excellent outcome was recorded in four of five cases. Lameness persisted in one case despite satisfactory patellar stability as a result of concurrent cranial cruciate ligament deficiency. One case suffered implant failure. Femoral ostectomy is an effective treatment for medial patellar luxation associated with femoral varus deformity. The distal femoral plate provides a convenient method by which to stabilise the ostectomy. Care should be exercised when the 2 mm distal femoral plate is applied.     

Radiography of the distal extremity of the manus in the donkey foal: Normal images and quantitative characterization from birth to 2 years of age: A pilot study

This study describes a radiographic survey of the anatomical development of the distal extremity of the manus in the donkey from 0 to 2 years of age. The right distal limb of 10 donkey foals, born in the spring of 2012, underwent radiographs every month for the first 6 months of age and every 3 months during the following 18 months. Latero‐medial radiographs with and without barium marker at the coronary band and dorso‐palmar radiographs with both front feet in weight bearing were obtained. The distal physis of the third metacarpal bone and the proximal physis of the proximal phalanx (phalanx proximalis) were closed at the mean age of 18.6 months. The distal physis of the proximal phalanx appeared as a clear radiolucent line at 2 weeks of age and was still subtly visible in some donkeys at 24 months. The proximal physis of the middle phalanx (phalanx media) was closed at the mean age of 16.7 months. The distal physis of this phalanx was visible at birth, but closed at 4 days. The distal phalanx (phalanx distalis) was triangular at birth. At the age of 20–21 months, the palmar processes (processus palmares) were both developed. The navicular bone (os sesamoideum distalis) was developed at the mean age of 9 months. The proximal sesamoid bones (ossa sesamoidea proximalia) were seen in continuously development during the 24 months. It seems that the physes in the distal extremity of the manus in the donkey close at an older age than the physes in the horse.     

Multifocal Coccidioides immitis in a donkey (Equus asinus)

This case report discusses the clinical signs, diagnostic findings, treatment and outcome for a donkey (Equus asinus) diagnosed with coccidioidomycosis. At presentation, the donkey was lame, was in poor body condition, had a draining tract over the left femur and was hyporexic. Further investigation of the draining tract via radiography and ultrasonography showed a focal lesion of extensive bony proliferation and lysis on the mid-shaft of the left femur. There was also a soft tissue swelling over the fifth left rib. AGID titres were positive for Coccidioides immitis. Recommended treatment for C. immitis consists of two antifungal classes, the azoles and amphotericin B, with this donkey being prescribed daily fluconazole. A recheck 3 months from initial diagnosis showed marked improvement of clinical signs, but the C. immitis titre remained unchanged. The 18-month recheck showed improvement radiographically and significantly decreased titres. After 3 years of daily treatment of fluconazole, the C. immitis titre was decreased, but radiographs of the femur still showed persistent bony proliferation.     

Use of a condylar screw plate for repair of a Salter-Harris type-III fracture of the femur in a 2-year-old horse

A 2-year-old sexually intact male Paint horse weighing 427 kg (940 lb) was admitted for examination and treatment of intermittent non-weight-bearing lameness of the right hind limb of 1 week's duration. Radiography revealed a displaced Salter-Harris type-III fracture of the right femoral condyle with the sagittal component of the fracture line located in the intercondylar space and the transverse component exiting on the medial aspect of the femur. The fracture was repaired with a condylar screw plate designed for repair of femoral condylar fractures in humans. The owner reported by telephone 9 months after surgery that the horse was sound. To our knowledge, use of this particular implant system for fixation of a Salter-Harris type-III fracture on the medial side of the femur in a horse has not been described. Results in this horse suggest that this implant can be successfully used for repair of femoral condylar fractures in selected adult horses.     

Open reduction and internal fixation with a locking plate for the treatment of a femoral fracture in a ferret (Mustela putorius furo)

Long bone fractures in ferrets (Mustela putorius furo) are usually traumatic in etiology, and the femur is commonly affected [1]. A 4-year-old, castrated male ferret was examined for acute, non-weight-bearing lameness of the left pelvic limb after presumably falling from its elevated enclosure. Clinical and radiographic evaluation showed a complete, comminuted fracture of the proximal diaphyseal third of the left femur. Open reduction and internal fixation (ORIF) of the left femoral fracture was performed with cerclage wires and a 1.5 mm locking compression plate with associated locking screws. Anatomic reconstruction was achieved, and postoperative radiographs confirmed appropriate fracture fragment apposition, limb alignment, and implant placement. At 9 weeks postoperatively, the ferret was ambulatory with no evidence of lameness, and complete radiographic union was noted. This is the first published report of the use of a bone plate for femoral fracture stabilization in a ferret. Bone plates, including locking plates, could be considered for long bone fracture stabilization in ferrets as an alternative to other methods.     

Use of extensible internal device in the femur of young dogs.

An extensible internal device (EID) was developed to preserve growth plate during the treatment of fracture complications or segmental bone loss from tumour resection in children. Since this type of extensible, transphyseal, internal fixation device has only been used in a few paediatric cases; the aim of this study was to evaluate an in vivo canine study, a surgical application of this device, and its interference with longitudinal growth of the non-fractured distal femur. Ten clinically healthy two- to three-month-old poodles weighing 1.5-2.3 kg were used. Following a medial approach to the right distal femur, one extremity of the EID, similar to a T-plate, was fixed in the femoral condyle with two cortical screws placed below the growth plate. The other extremity, consisting of an adaptable brim with two screw holes and a plate guide, was fixed in the third distal of the femoral diaphysis with two cortical screws. The EID was removed 180 days after application. All of the dogs demonstrated full weight-bearing after surgery. The values of thigh and stifle circumferences, and stifle joint motion range did not show any difference between operated and control hindlimbs. The plate slid in the device according to longitudinal bone growth, in all but one dog. In this dog, a 10.5% shortening of the femoral shaft was observed due to a lack of EID sliding. The other dogs had the same longitudinal lengths in both femurs. The EID permits longitudinal bone growth without blocking the distal femur growth plate if appropriately placed.     

Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of 3-hole 4.5 mm locking compression plate and 3-hole 4.5 mm narrow dynamic compression plate, with two transarticular 5.5 mm cortex screws

Objectives: To compare the biomechanical characteristics of 2 arthrodesis techniques for the equine proximal interphalangeal joint (PIP) using either a 3‐hole 4.5 mm locking compression plate (LCP) or 3‐hole 4.5 mm narrow dynamic compression plate (DCP), both with 2 transarticular 5.5 mm cortex screws. Study Design: Experimental. Sample Population: Cadaveric adult equine forelimbs (^*n=6 pairs). Methods: For each forelimb pair, 1 limb was randomly assigned to 1 of 2 treatment groups and the contralateral limb by default to the other treatment group. Construct stiffness, gap formation across the PIP joint, and rotation about the PIP joint were determined for each construct before cyclic axial loading and after each of four, 5000 cycle loading regimens. After the 20,000 cycle axial loading regimen, each construct was loaded to failure. Results: There were no significant differences in construct stiffness, gap formation, or sagittal plane rotation between the LCP and DCP treatment groups at any of the measured time points. Conclusion: Biomechanically, fixation of the equine PIP joint with a 3‐hole 4.5 mm LCP is equivalent to fixation with a 3‐hole 4.5 mm narrow DCP under the test conditions used.     

Custom total knee replacement in a dog with femoral condylar bone loss

Objective— To report surgical planning, technique, and outcome of custom total knee replacement (TKR) performed to manage a medial femoral condylar nonunion in a dog.
Study Design— Clinical case report.
Animal— A 3-year-old, 20 kg Karelian Bear Hound.
Methods— Computed tomographic scan of the left pelvic limb was used to build a stereolithography model of the distal portion of the femur. The model was used to create a custom augment to replace the missing medial femoral condyle and a custom stem for intramedullary condylar cemented fixation. The augment and stem were adapted to femoral and tibial components already available. The model was used to rehearse the surgery and then the custom prosthesis was implanted.
Results— Weight bearing returned 8 hours after surgery and improved thereafter. Joint alignment was normal and prosthetic joint motion was 60–165° postoperatively. The dog resumed moose hunting 3 months after surgery. Peak vertical force and impulse of the operated limb measured 17 months after surgery were 65% and 47% of the normal, contralateral limb.
Conclusion— Based on short-term follow-up, cemented canine TKR was successfully achieved for management of a severely abnormal stifle joint.
Clinical Relevance— With further refinement and development of commercially available prostheses, TKR should be possible for canine patients.     

Mechanical Comparison of 3.5 mm Broad Dynamic Compression Plate,Broad Limited‐Contact Dynamic Compression Plate,and Narrow Locking Compression Plate Systems Using Interfragmentary Gap Models

Objectives— To compare (1) pullout properties between 3.5 mm cortical and locking screws, and (2) mechanical properties and gap displacements between the 3.5 mm broad limited‐contact dynamic compression plate (LC‐DCP), broad dynamic compression plate (DCP), and narrow locking compression plate (LCP), during axial loading of plate‐stabilized diaphyseal fragments with an interfragmentary gap. Study Design— In vitro mechanical testing of implanted polyurethane foam (PUF) hollow cylinders that simulated compact or osteopenic diaphyseal bone. Sample Population— (1) Five cortical and locking screws and (2) 4 PUF‐plate constructs for each plate type; using high‐ and low‐density (0.8 and 0.32 g/cm³) cylinders. Methods— (1) Screws were completely extracted at 5 mm/min. (2) Plated constructs were axially compressed at 300 N/s for 10 cycles from 5 to 355 N to determine gap displacement during physiologic loading, followed by single cycle increasing load to failure. Results— Pullout properties were not different between screw types. All plate constructs had yield loads over 3 times trotting loads. Gap closure occurred with LC‐DCP and DCP constructs, but not LCP constructs. LCP construct properties were most similar to LC‐DCP and DCP construct properties in the low‐density model. Conclusion— All plate systems sustained physiologic limb loads. Only LCP constructs maintained some gap integrity, although LC‐DCP and DCP screws were placed in neutral position. Clinical Relevance— The LCP system is more likely than LC‐DCP and DCP systems, with neutrally positioned screws, to maintain a planned interfragmentary gap, although gap strains range from 0% to 15% across the 2 mm gap during a trot load.     

Fixation of a complete scapular neck fracture in a foal using two 3.5 mm locking compression plates

This report describes the successful surgical repair of a transverse, displaced scapula fracture in a foal. A 3.5 mm locking compression plate (LCP) was used on either side of the spine of the scapula. The suprascapular nerve was apparent upon dissection as it passed directly over the fracture line and care was taken to leave it intact, although the fracture line itself caused some irritation. The foal recovered without long‐term nerve damage and is sound at 1.5 years post surgery.     

Total Hip Prosthesis for Revision of Unsuccessful Excision Arthroplasty

Two types of total hip prostheses were implanted in three dogs that had been previously treated by excision arthroplasty, two for degenerative joint disease secondary to hip dysplasia and one for removal of a fractured femoral neck. Complications occurred in one case when the femoral shaft was split during the reaming process for implantation of the prosthesis and at three weeks after surgery when an oblique fracture of the distal femur occurred. Both complications were treated successfully. The time since surgery varied between eight and 18 months. All three dogs had excellent functional results evidenced by increased joint mobility and freedom from pain.     

Femur fractures associated with canine total hip replacement

OBJECTIVE: To report femur fracture as a complication of canine total hip replacement (THR) and to report the incidence, predisposing factors, treatment options, and outcome. STUDY DESIGN: Prospective clinical study. ANIMALS: Twenty-two client-owned dogs with 24 femoral fractures occurring during or after THR. METHODS: Cemented THR (BioMedtrix, Boonton, NJ) was performed. Medical records and radiographs were used to identify dogs that had femur fracture and to identify risk factors. Follow-up was obtained until dog death or study end. RESULTS: The overall incidence of femur fracture after THR was 2.9%. Femoral fractures occurred intraoperatively, immediately postoperatively, and up to 2196 days after THR. In 17 dogs, fractures resulted from a traumatic event. Osteopathy was present at THR in 5 dogs; all developed femoral fissures during reaming. Three dogs had fractures associated with cortical thinning secondary to aseptic loosening. Fracture treatment included euthanasia (1 dog), strict confinement (3 dogs), full cerclage wires on long oblique fractures (3 dogs), or plate and screw fixation (10 with, and 7 without, cerclage wires). All fractures extended near the distal tip of the femoral stem and all aggressively treated fractures healed. CONCLUSIONS: Predisposing risk factors for femur fracture after THR include osteopathy and iatrogenic fissures created during reaming. Trauma, excessive load concentration, and increased torque can lead to mid-diaphyseal fracture near the end of the femoral stem. Fracture did not disrupt THR implants. Cement fracture exposing the tip of the femoral stem did not affect fracture healing or rehabilitation. Immediate plate and screw fixation resulted in the most favorable outcome; healing occurred in 6-10 weeks. CLINICAL RELEVANCE: Femur fractures that occur after THR should be repaired using plate and screw fixation augmented with cerclage wire when needed. Forces on fissures should be neutralized to prevent propagation and fracture. Owners of high-risk patients (old dogs with osteopathies or previous hip surgery) should be counseled before THR. The prognosis is excellent when fractures are treated correctly.     

In Vitro Biomechanical Comparison of a Modified 5.5 mm Locking Compression Plate Fixation with a 5.5 mm Locking Compression Plate Fixation of Osteotomized Equine Third Metacarpal Bones

Objectives: To compare number of cycles to failure for palmarodorsal 4‐point bending of a modified 5.5 mm broad locking compression plate (M5.5‐LCP) fixation with a 5.5 mm broad LCP (5.5‐LCP) fixation used to repair osteotomized equine third metacarpal (MC3) bones. Study Design: In vitro biomechanical testing. Animal Population: Adult equine cadaveric MC3 bones (n=6 pairs). Methods: An 8‐hole, M5.5‐LCP, obtained by having a 1.0 mm thickness removed from the bone contact portion of the 5.5‐LCP, was applied to the dorsal surface of 1 randomly selected MC3 from each pair, and an 8‐hole, 5.5‐LCP was applied dorsally to the contralateral bone from each pair using a combination of cortical and locking screws. Plates and screws were applied using standard ASIF techniques to MC3 bones with a mid‐diaphyseal osteotomy. MC3 constructs had palmarodorsal 4‐point bending cyclic fatigue testing. Mean cycles to failure for each method were compared using a paired t‐test within each group. Significance was set at P<.05. Results: Mean±SD cycles to failure of the M5.5‐LCP fixation (188,641±17,971) was significantly greater than that of the 5.5‐LCP fixation (166,497±15,539). Conclusion: M5.5‐LCP fixation was superior to 5.5‐LCP fixation of osteotomized equine MC3 bones in resisting cyclic fatigue under palmarodorsal 4‐point bending. Clinical Relevance: This suggests that biological plate fixation is not the ideal choice for osteotomized equine MC3 bones.     

Cryosurgical Epiphysiodesis in the Dog

Transphyseal freezing of the canine distal femur was evaluated to determine its effect on physeal growth and closure. A specially designed cryoprobe was used to freeze the distal right femoral physis in 17 immature dogs. The left distal femoral physis was sham operated to serve as a control. Dogs were radiographed weekly and euthanized from 2 days to 8 weeks following surgery. The rate of long bone growth decreased in all dogs, and the physis was closed at 6 to 8 weeks.
Histologic studies on the distal femoral physes revealed that immediately after freezing, there was extensive hemorrhage in the epiphysis and metaphysis with disruption of the physis. Inflammation and death of the physeal cartilage followed. Blood vessels invaded the physis, and eventually bone was formed between the epiphysis and metaphysis, resulting in complete and premature physeal closure.     

IMAGING DIAGNOSIS—NUCLEAR SCINTIGRAPHIC,RADIOLOGICAL, AND PATHOLOGIC CHARACTERISTICS OF METASTATIC PILOMATRICOMA IN A DOG

A 6‐year‐old castrated Goldendoodle dog was presented for left‐sided lameness of 3 weeks’ duration. Focal, moderate to marked increased ^99mTc‐methylene diphosphonate (^99mTc‐MDP) uptake was detected in the right caudal lung lobe, caudal angle of the left scapula, and the distal aspect of the left femur with whole body bone phase scintigraphy. Radiographs identified a well‐circumscribed, oval‐shaped soft tissue opaque mass in the right caudal lung lobe; a suspect oval‐shaped osteolytic lesion in the proximal third of the left scapula; and an osteolytic lesion in the distal aspect of the left femur. Metastatic pilomatricoma was confirmed histologically at all three sites.     

An In Vitro Biomechanical Comparison of a 5.5 mm Locking Compression Plate Fixation with a 4.5 mm Locking Compression Plate Fixation of Osteotomized Equine Third Metacarpal Bones

Objectives: To compare the monotonic biomechanical properties and fatigue life of a 5.5‐mm‐broad locking compression plate (5.5 LCP) fixation with a 4.5‐mm‐broad locking compression plate (4.5 LCP) fixation to repair osteotomized equine 3rd metacarpal (MC3) bones. Study Design: In vitro biomechanical testing of paired cadaveric equine MC3 with a middiaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. Animal Population: Fifteen pairs of adult equine cadaveric MC3 bones. Methods: Fifteen pairs of equine MC3 were divided into 3 test groups (5 pairs each) for (1) 4‐point bending single cycle to failure testing, (2) 4‐point bending cyclic fatigue testing, and (3) torsional single cycle to failure testing. An 8‐hole, 5.5 LCP was applied to the dorsal surface of 1 randomly selected bone from each pair and an 8‐hole, 4.5 LCP was applied dorsally to the contralateral bone from each pair using a combination of cortical and locking screws. All plates and screws were applied using standard ASIF techniques. All MC3 bones had middiaphyseal osteotomies. Mean test variable values for each method were compared using a paired t‐test within each group with significance set at P<.05. Results: Mean yield load, yield bending moment, composite rigidity, failure load, and failure bending moment, under 4‐point bending, single cycle to failure, of the 5.5 LCP fixation were significantly greater than those of the 4.5 LCP fixation. Mean cycles to failure in 4‐point bending of the 5.5 LCP fixation (170,535±19,166) was significantly greater than that of the 4.5 LCP fixation (129,629±14,054). Mean yield load, mean composite rigidity, and mean failure load under torsional testing, single cycle to failure was significantly greater for the broad 5.5 LCP fixation compared with the 4.5 LCP fixation. In single cycle to failure under torsion, the mean±SD values for the 5.5 LCP and the 4.5 LCP fixation techniques, respectively, were: yield load, 151.4±19.6 and 97.6±12.1 N m; composite rigidity, 790.3±58.1 and 412.3±28.1 N m/rad; and failure load: 162.1±20.2 and 117.9±14.6 N m. Conclusion: The 5.5 LCP was superior to the 4.5 LCP in resisting static overload forces (palmarodorsal 4‐point bending and torsional) and in resisting cyclic fatigue under palmarodorsal 4‐point bending. Clinical Relevance: These in vitro study results may provide information to aid in selection of an LCP for repair of equine long bone fractures.     

Repair of a proximal diaphyseal femoral fracture in a calf, using intramedullary pinning, cerclage wiring, and external fixation.

Repair of a comminuted, spiral oblique, proximal diaphyseal femoral fracture in a 7-day-old calf was achieved by use of an intramedullary pin, cerclage wires, and external fixator. Six stainless steel wires were used for full cerclage to secure a long butterfly fragment and multiple incomplete and complete nondisplaced fragments to the femur in order to create 2 principal fragments. Axial alignment and resistance to bending was provided by a round, double-pointed, end-threaded intramedullary pin (6.35 mm in diameter), which was inserted in a retrograde fashion. A type-1, double-connecting-bar external fixator, using 4 round pins (4.8 mm in diameter), was used to provide supplemental stabilization against shear and torsional forces. At 45 days after surgery, healing at the fracture site was seen on radiography of the limb, and the external fixator was removed. Eight months after surgery, the calf had a normal gait.     

Osteosarcoma of the proximal radius in a donkey

A mature donkey was presented for evaluation of a forelimb lameness and presence of a large mass on the left forelimb distal to the elbow joint. Clinical examination, radiographs and cytological examination of ultrasound‐guided fine needle aspirates of the mass led to a presumptive diagnosis of osteosarcoma. The donkey was subsequently subjected to euthanasia. Post mortem examination confirmed the diagnosis of osteosarcoma in the proximal radius with expansion of the mass through the ulnar cortex and metastases to liver and regional lymph nodes, areas of metastasis previously unreported in the equine literature.     

In vitro biomechanical comparison of locking compression plate fixation and limited-contact dynamic compression plate fixation of osteotomized equine third metacarpal bones

Objective— To compare monotonic biomechanical properties and fatigue life of a broad locking compression plate (LCP) fixation with a broad limited contact dynamic compression plate (LC‐DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. Study Design— In vitro biomechanical testing of paired cadaveric equine MC3 with a mid‐diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. Animal Population— Cadaveric adult equine MC3 bones (n=12 pairs). Methods— MC3 were divided into 3 groups (4 pairs each) for: (1) 4‐point bending single cycle to failure testing; (2) 4‐point bending cyclic fatigue testing; and (3) torsional single cycle to failure testing. The 8‐hole, 4.5 mm LCP was applied to the dorsal surface of 1 randomly selected bone from each pair. One 8‐hole, 4.5 mm LC‐DCP) was applied dorsally to the contralateral bone from each pair. All plates and screws were applied using standard ASIF techniques. All MC3 bones had mid‐diaphyseal osteotomies. Mean test variable values for each method were compared using a paired t‐test within each group. Significance was set at P<.05. Results— Mean yield load, yield bending moment, composite rigidity, failure load and failure bending moment, under 4‐point bending, single cycle to failure, of the LCP fixation were significantly greater than those of the LC‐DCP fixation. Mean cycles to failure for 4‐point bending was significantly greater for the LCP fixation compared with LC‐DCP fixation. Mean yield load, mean composite rigidity, and mean failure load under torsional testing, single cycle to failure was significantly greater for the broad LCP fixation compared with the LC‐DCP fixation. Conclusion— The 4.5 mm LCP was superior to the 4.5 mm LC‐DCP in resisting the static overload forces (palmarodorsal 4‐point bending and torsional) and in resisting cyclic fatigue under palmarodorsal 4‐point bending. Clinical Relevance— The results of this in vitro study may provide information to aid in the selection of a biological plate for the repair of equine long bone fractures.