A technique for repair of femoral capital epiphyseal fractures in the dog

A new method for repair of femoral capital epiphyseal fractures in the immature dog is described. The technique employs two small AO/ASIF cortical screws inserted in lag fashion from the articular surface into the femoral neck. The screw heads are countersunk, so as not to project from the articular cartilage of the femoral epiphyseal fragment, While this is an early report it is hoped that it will prompt the use of the technique by others so that its long term assessment may be more rapidly determined than by one clinic working alone.     

Stabilization of coxo-femoral luxation using tenodesis of the deep gluteal muscle. Technique description and reluxation rate in 65 dogs and cats (1995-2008)

This retrospective study documents deep gluteal tenodesis (DGT) used to stabilize coxo- femoral 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. Re- luxation 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.     

Y-T humeral fractures with supracondylar comminution in five cats

Five cats with Y-T fractures of the humeral condyle were reviewed. Breeds presented included domestic shorthair (four cats) and Maine Coon (one cat). Age ranged from two to 16 years. All the cats were neutered males. A road traffic accident was suspected in all cases. Four of the fractures were severely comminuted and one fracture had four fragments. The fractures were repaired via combined medial and lateral approaches. Fixation of the epicondylar ridges was performed using buttress plates in four cases and neutralisation plates in one case. The intracondylar fracture was stabilised using a 2.7 mm lag screw in four cases and a 3.5 mm lag screw in the other. A corticocancellous bone graft was applied in two cases. The intracondylar fracture was accurately reduced in all cases. Complete radiographic healing was documented in two cases 6 and 11 weeks following surgery. Failure of the fixation occurred in the most severely comminuted fracture five days postoperatively. Surgical revision was not performed, and the limb was amputated. Three cats were free of lameness and had resumed outdoor activities at follow-up (five to eight months after surgery). Marked lameness due to loss of elbow movement was observed in the other case.     

Pantarsal arthrodesis with a customised medial or lateral bone plate in 13 dogs

Pantarsal arthrodesis was performed in 12 dogs using a customised medial bone plate, and in one using a lateral bone plate. The dogs' ages ranged from 14 months to 144 months (median 30 months) and their bodyweights ranged from 7 to 66 kg (median 32 kg). Before the surgery they had been lame on a pelvic limb for between one and 16 months (median eight months). In eight of the dogs the fixation of the plate was augmented with a calcaneotibial positional screw, and in one of them with a talocrural lag screw. A cranial half cast was applied to 12 of the dogs and an external skeletal fixator to the other for six to eight weeks. Five complications were recorded in four of the dogs. Between 29 and 156 weeks postoperatively the clinical outcome was graded as excellent in six dogs, good in six dogs and fair in the other.     

Traumatic craniolateral shoulder luxation and fracture of the lesser tubercle of the humerus in a dog

A five-year old, spayed female, Bearded Collie was presented with a 24-hour history of non-weight-bearing lameness of the right thoracic limb after sustaining vehicular trauma. Radiographs revealed a craniolateral scapulohumeral luxation and a distally and medially displaced fracture of the lesser tubercle of the humerus. Open reduction and internal fixation of the fracture was achieved with lag screw fixation and an anti-rotational Kirschner wire. Surgical repair resulted in compression across the fracture line, anatomic reduction of the articular surface, and a stable scapulohumeral joint following reduction of the humeral head in the glenoid. Six weeks postoperatively, the patient exhibited no evidence of pain or lameness on the right thoracic limb and radiographs revealed complete healing of the fracture and normal articulation of the scapulohumeral joint. This is the first report of a lesser tubercle fracture associated with a craniolateral shoulder luxation. Surgical intervention resulted in the return of full shoulder joint function in this dog.     

Use of Computed Tomography in Standing Position to Identify Guidelines for Screw Insertion in the Distal Phalanx of Horses: An Ex Vivo Study

Objectives— To compare the precision of radiography and computed tomography (CT) preoperatively in the standing position for identification of guidelines for screw insertion in the distal phalanx, and to identify whether standing CT might improve operative time compared with preoperative radiographic planning.
Study Design— Experimental ex vivo study.
Animals— Cadaveric equine thoracic limb pairs (n=10).
Methods— Insertion of a 4.5 mm cortex screw in lag fashion into an intact distal phalanx was evaluated in 2 groups (n=10) of cadaveric equine thoracic limbs. In 1 group, the site, direction, and length of the implant were determined by radiography, and in the other group, by CT. Accuracy of screw placement was verified by specimen dissection. Outcomes were (1) absence of penetration of the articular surface, the solar surface, or the semilunar canal (2) appropriate length and direction of the screw. Surgical time was also measured.
Results— No screw penetrated the articular surface, the solar surface, or the semilunar canal in either group. CT was more accurate to identify guidelines for screw insertion (U=23.50, P =.049). With CT, surgical time (mean, 7.7 minutes) was significantly shorter (U=0.000, P =.000) than with radiography (mean, 12.7 minutes).
Conclusion— Standing CT can be used to accurately determine anatomic landmarks for screw insertion in lag fashion in sagittal fractures of the distal phalanx.
Clinical Relevance— This study has a clear clinical relevance for improved internal fixation of sagittal fractures of the distal phalanx.     

Canine sacroiliac luxation: anatomic study of the craniocaudal articular surface angulation of the sacrum to define a safe corridor in the dorsal plane for placement of screws used for fixation in lag fashion

Objective: To define a safe corridor in the dorsal plane relative to the articular surface for placement of a single screw in lag fashion to achieve stabilization of sacroiliac luxation in the dog. Study Design: Cadaveric study. Methods: Dorsoventral radiographs of denuded canine sacra (n=49) were taken to determine the safe corridor in the craniocaudal plane, and the maximum, optimum and minimum angles were calculated that would allow a screw inserted in lag fashion to engage at least 60% of the width of the sacral body without cranial or caudal penetration through the bone. Results: The mean safe corridor in the dorsal plane is ～24° wide. Mean craniocaudal minimum, optimum and maximum drill angles from the drill start point were 88°, 100°, and 111° from the articular surface, respectively. No single angle will completely avoid risk of screw penetration beyond the safe corridor cranially and caudally. Conclusions: There is sufficient anatomic variation between different canine sacra that a single angle cannot be recommended for screw placement in the dorsal plane. Clinical Relevance: A standard angle cannot be recommended for screw placement in lag fashion within the canine sacrum in the dorsal plane. Because of the narrow width of the safe corridor, preoperative measurements on radiographs are recommended and a range of angled drill guides may be useful to decrease surgeon margin of error.     

Arthrodesis of the pastern joint in the horse

Arthrodesis of the pastern joint was performed in six horses with a history of acute trauma and in 10 horses with a history of chronic lameness of one to six months duration. Five surgical techniques were employed: curettage of the joint, lag screw compression and immobilisation in a plaster cast; curettage, compression using a T plate and immobilisation; drilling, lag screw compression and immobilisation; lag screw compression and immobilisation; and curettage and immobilisation. Pre- and postoperative clinical course are described together with significant radiographical findings. The best results were achieved by luxating the joint to curette the articular cartilage, followed by fixation and compression with either lag screws or a T plate and immobilisation in a plaster cast.     

Repair of femoral trochanteric osteotomy in the dog

The records and radiographs of 24 dogs that underwent femoral trochanteric osteotomy repair were reviewed. Osteotomy repair was performed with either a pin and tension band wire or a lag screw technique. Significant clinical complications associated with the osteotomy were identified in one dog (4 per cent) six weeks after surgery, although abnormal radiographic changes were evident in 15 dogs (62 per cent). The method of repair did not influence healing and there were comparable radiographic complication rates. It Is concluded that femoral trochanteric osteotomy Is not associated with significant clinical problems, despite a high incidence of abnormal radiographic findings.     

Resurfacing Canine Femoral Trochleoplasties with Free Autogenous Periosteal Grafts

Femoral trochleoplasties resurfaced with autogenous free periosteal grafts in six dogs were compared to femoral trochleoplasties performed without grafts in six dogs. The grafts produced cartilage as early as 4 weeks after surgery; however, it was fibrocartilage rather than normal hyaline articular cartilage. The trochleoplasties not resurfaced with periosteum also healed with fibrocartilage but not until 40 weeks postoperatively. The grafted stifles had less patellar cartilage damage when compared to trochleoplasties left to heal without resurfacing.     

Evaluation of Closed Reduction and Screw Fixation in Lag Fashion of Sacroiliac Fracture‐Luxations

Objective— To evaluate outcome by radiographic assessment after closed reduction and percutaneous screw fixation in lag fashion of sacroiliac fracture‐luxations in dogs. Study Design— Retrospective study. Animals— Dogs (n=24) with sacroiliac fracture‐luxations. Methods— Medical records (1999–2006) and radiographs of 24 dogs (29 fracture‐luxations) that had stabilization of sacroiliac fracture‐luxation by fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion were reviewed. Signalment, body weight, number, and location of all concurrent injuries and implants used for repair were recorded. Radiographs were used to evaluate the accuracy of screw placement in the sacral body, screw depth/sacral width ratio, reduction of the sacroiliac joint, pelvic canal diameter, and hemipelvic canal width. Radiographic re‐examination (range, 4 to >8 weeks postoperatively) was available for evaluation. Results— Mean screw depth/sacral width ratio on immediate postoperative and re‐examination radiographs was 64% and 61%, respectively. Mean percentage reduction of the sacroiliac joint on immediate postoperative and re‐examination radiographs were 91% and 87%, respectively. Pelvic canal diameter ratio demonstrated successful restoration of the pelvic canal. Hemipelvic canal width ratio documented successful closed reduction repair independent of concurrent pelvic injuries. Conclusion— Successful repair of sacroiliac fracture‐luxations, determined by radiographic assessment, can be achieved by fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion. Clinical Relevance— Fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion of sacroiliac fracture‐luxations is a minimally invasive technique that restores and maintains pelvic canal dimensions and should be considered as an alternative to open reduction or nonsurgical management of sacroiliac fracture‐luxations.     

Effect of Gelatin Hydrogel Sheet Containing Basic Fibroblast Growth Factor on Proximal Sesamoid Bone Transverse Fracture Healing in the Horse

Our objective in this study was to examine the effect of gelatin hydrogel (GH) sheets containing basic fibroblast growth factor (bFGF) on healing of proximal sesamoid bone transverse fractures in the horse. Ten healthy adult Thoroughbreds were used. The lateral proximal sesamoid bone of the left forelimb and the medial proximal sesamoid bone of the right forelimb were osteotomized, while the horses were under general anesthesia, and subsequently repaired by lag screw fixation using a single 4.5-mm cortical screw. A GH sheet containing 100 μg of bFGF was then sutured to the synovial membrane adjacent to the osteotomized proximal sesamoid bone. In the control group, the fracture was fixed with a lag screw, and the articular capsule was sutured. Fracture healing was assessed by radiographic examination once a week for 16 weeks after the operation. Radiographic examination of bone healing revealed significantly lower demineralization of the fracture line in the GH sheet-treated group than in the control group. The rate of demineralization of the fracture line in the GH sheet-treated group was significantly lower than that in the control group at 2, 4, and 8 weeks after the operation. In this study, we demonstrated that the use of a GH sheet containing bFGF promotes healing of proximal sesamoid bone fracture in the horse. Therefore, it is believed that this treatment strategy would be useful for quick recovery from bone fracture in the horse.     

Canine sacroiliac luxation: anatomic study of dorsoventral articular surface angulation and safe corridor for placement of screws used for lag fixation

OBJECTIVE: To define a safe corridor in the dorsoventral plane to facilitate placement of screws inserted in lag fashion within the sacral body for fixation of sacroiliac fracture-luxation injuries in dogs. STUDY DESIGN: Anatomic study. SAMPLE POPULATION: Cadaveric canine sacra. METHODS: Canine sacra (n=45) were used for a radiographic study to define a safe corridor in the dorsoventral plane for placement of screws inserted in lag fashion for fixation of sacroiliac luxation in the dog. The defined safe corridor allowed drilling to a depth of 65% of the sacral width to ensure screw purchase of > or =60%. Effects of positioning and measurement techniques were evaluated. RESULTS: Eighty-seven safe corridors were measured. The mean articular surface was 100+/-4.52 degrees from horizontal. Mean maximum, optimum, and minimum safe corridor drill angles were 111+/- 4.57 degrees, 100+/-4.70 degrees, and 89+/-5.17 degrees, respectively, from the articular surface. Predicted surgeon error of +/-4 degrees was used to define the safe corridor for use clinically. CONCLUSIONS: In 91% of sacra, a drill angle of 100+/-4 degrees would remain ventral to the vertebral canal. Twelve sacra (14%) were at risk of penetration of the pelvic canal. A drill angle of 97+/-4 degrees avoids penetration of the vertebral canal in all sacra measured but risks ventral exit from the body in 30% of sacra studied. CLINICAL RELEVANCE: A drill angle of 97 degrees from the articular surface is recommended for insertion of screws for lag fixation of canine sacroiliac luxation.     

Salter-Harris type III fractures of the distal humerus in two dogs

Salter-Harris type III fractures of the distal humerus in a four-month-old male Labrador Retriever and a male crossbreed dog (estimated to be 3.5-months-old) are reported. Both fractures were treated with open reduction and interfragmentary compression by lag screw fixation. Both fractures healed and full limb use was regained at four weeks postoperatively. The occurrence of this unusual fracture type may be related to the physeal closure pattern of the distal humeral physis, and a different mechanism of injury compared to the more common Salter-Harris type IV fracture seen in this region.     

Meniscal Release in Cruciate Ligament Intact Stifles Causes Lameness and Medial Compartment Cartilage Pathology in Dogs 12 Weeks Postoperatively

Objective— To evaluate after 12 weeks the effects of caudal medial meniscal release (MR) in the cranial cruciate ligament-intact canine stifle.
Study Design— Blinded, prospective in vivo study.
Animals— Purpose-bred hound dogs (n=10).
Methods— Either MR (n=5) or a sham (SH) surgery (n=5) was performed via arthroscopy. Orthopedic examination and subjective lameness evaluation were performed in each dog preoperatively and at 4, 8, and 12 weeks after surgery. Twelve weeks postoperatively, ultrasonographic, radiographic, and arthroscopic examinations were performed on the operated stifles. Gross pathology of the articular cartilage, cruciate ligaments, and menisci was assessed. India ink staining of the femoral and tibial articular surfaces was performed to determine the percent area of articular cartilage damage.
Results— At 8 and 12 weeks after surgery, MR dogs were lamer than SH dogs. At 12 weeks, the degree of radiographic OA was significantly higher in MR stifles than in SH stifles. Gross and sonographic meniscal pathology was more severe in MR stifles compared with SH stifles. MR stifles had significantly more severe articular cartilage pathology compared with SH stifles 12 weeks after surgery; pathology was most severe in the medial compartment.
Conclusions— MR alone is associated with articular cartilage loss, further meniscal pathology, degenerative joint disease, and lameness.
Clinical Relevance— Subsequent osteoarthritis and dysfunction of the stifle joint should be considered when making clinical decisions regarding MR in dogs.     

Arthroscopic removal of an intra-articular screw causing joint impingement after distal femoral fracture repair in a dog

The use of lag screws to treat femoral condyle fractures is common, and their placement in surgery is technically demanding. Intra-articular screw impingement is a serious complication that may occur during surgical treatment of femoral condyle fractures. Here, we describe the case of a 3-year-old 40-kg dog which experienced recurrent lameness 6 mo after successful surgical treatment of a comminuted medial femoral condyle fracture due to an intra-articular non-loosening screw causing joint impingement. Removal of the conflicting screw was performed arthroscopically, based on its ability to offer minimally invasive access to the stifle joint. Six months after removal of the screw, the dog had full recovery without limitations to range of motion or stifle pain. To our knowledge, this is the first report on the use of arthroscopy to remove an intra-articular screw causing joint impingement after distal femoral fracture repair in a dog.     

Lag Screw Fixation of a Patellar Fracture in a Horse

A vertical fracture involving the medial one-third of the patella of a yearling filly was successfully treated by lag screw fixation. Three months postoperatively the fracture was healed and the filly was clinically sound.     

Atlanto-axial subluxation in the dog: a review of thirty cases and an evaluation of treatment by lag screw fixation

The clinical and radiological features of atlanto-axial subluxation in the dog are described with reference to a series of 30 cases. Two methods of treatment were evaluated. In 13 dogs, a dorsal approach was used and the atlas and axis stabilised with a wire suture. Four cases had respiratory arrests during surgery; one of these and seven others made full recoveries after wiring. In 10 dogs treated by lag screw fixation of the ventral articular facets there were no complications during surgery and nine of these recovered within two months. Atlanto-axial subluxation was diagnosed in 30 dogs referred to the Department of Veterinary Surgery, University of Bristol between 1977 and 1986. The condition was encountered in six small breeds of dog and was seen most frequently in the Yorkshire     

Standing repair of an articular dorsal medial oblique fracture of the proximal third metacarpal bone in a racing Standardbred

The third metacarpal bone (McIII) is a common site of long bone fractures in racehorses. However, articular fractures of the dorsomedial aspect of McIII are a rare location of such injuries. This report describes the successful standing surgical repair of an articular fracture of the dorso-medial proximal McIII in a 4-year-old Standardbred racing mare using lag screw fixation.     

Reduction and stabilisation of a supraglenoid tuberosity avulsion under arthroscopic guidance in a dog

A supraglenoid tuberosity avulsion fracture was diagnosed in a five-month-old dog, which was presented with a non-weightbearing lameness of the right forelimb after being involved in a road traffic accident. Arthroscopy allowed associated cartilaginous, capsular and ligamentotendinous injuries to be ruled out. The fracture was reduced and stabilised under arthroscopic guidance using a Kirschner wire and a cortical bone screw. Video assistance significantly minimised the extent of the necessary craniomedial approach. The lameness was very mild 15 days after surgery and had disappeared after four weeks. Radiographs taken nine weeks postoperatively revealed complete bone healing and implants were removed. No lameness was reported during a follow-up period of 20 months. To the authors' knowledge, this is the first report describing shoulder osteosynthesis under arthroscopic guidance in the dog. The mildly invasive character of arthroscopy and video-assisted surgical procedures may allow a faster recovery and may limit complications following the treatment of articular fractures.