Prospective evaluation of minimally invasive plate osteosynthesis in 36 nonarticular tibial fractures in dogs and cats

Objective: To evaluate the clinical outcome of minimally invasive plate osteosynthesis (MIPO) for nonarticular tibial fractures stabilized using bone plates with or without an intramedullary rod (IMR). Study Design: Prospective study. Animals: Dogs (n=28) and 8 cats. Methods: After closed reduction, fracture fixation was achieved using an epiperiosteal plate inserted percutaneously through epiphyseal small incisions. In some fractures, an IMR was inserted via medial parapatellar arthrotomy. Radiographs were recommended every 3 weeks until clinical union. Postoperative tibial length and alignment were compared with contralateral measurements (P<.05). Time to clinical union and complications were recorded. Results: An IMR was used in 30.5% of the cases. Repaired tibiae were 1% shorter than contralateral tibiae (P<.05). Frontal and sagittal alignment were similar between repaired and contralateral tibiae (P>.05). Six dogs were lost for follow‐up; owners indicated normal function. In 30 cases for which bone healing was documented, mean±SD healing time was 45±20.8 days; however, when considering the 23 cases, which completed preestablished scheduled follow‐ups, healing time was 36±11.6 days. Minor complications occurred in 4 cases (11%). One major complication (3%) consisting of a plate fracture was successfully revised using MIPO with a larger plate. Conclusions: Consistent restoration of alignment was accomplished using MIPO techniques. Furthermore, MIPO appeared to yield faster healing times and lower complication rates than those reported with conventional plate osteosynthesis.     

Retrospective comparison between minimally invasive plate osteosynthesis and open plating for tibial fractures in dogs

Objectives: To compare fracture healing in diaphyseal tibial fractures stabilized using either minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF). Methods: Dogs in each group were matched for type of fracture, age and body weight. Stage of healing was measured blindly every four weeks postoperatively until complete healing. Outcome variables including fracture length, plate length, plate bridging ratio, plate working length, healing grading, and fracture reduction were compared between groups using the Mann-Whitney test. Significant difference was set at p <0.05. Results: Based on the definition of clinical union, at 30 days five out of eight dogs managed with MIPO had healed, while two of the eight of dogs managed with ORIF had healed. We did not find any significant differences in the other outcome measures. No complications were reported in the MIPO group whereas one major complication was reported in the ORIF group. Clinical significance: All dogs treated by MIPO healed rapidly without any complications, nevertheless the difference in radiographic healing between the two groups was not significant.     

Thymic lymphosarcoma in three heifers

Three heifers with the thymic form of lymphosarcoma were examined. In each of the 3 cases, fever, bloat, and jugular venous distention had developed. Detectable antibody to bovine leukosis virus was not found on agar gel immunodiffusion testing in any of the cases. Thymic lymphosarcoma was confirmed by necropsy and histologic examination. Thymic lymphosarcoma must be considered in the differential diagnosis in heifers with fever, bloat, and jugular venous distention.     

Ulnar osteotomy for treatment of cubital subluxation,following locking compression plate osteosynthesis of a radius fracture in a foal

A closed mid‐diaphyseal fracture in a one‐day‐old foal was treated using a 3.5 mm locking compression plate on the cranial aspect of the radius. The foal showed good fracture healing, but a radio‐ulnar synostosis developed despite the absence of transfixation by any implant into the ulna. Four months after surgery the radiographs revealed a cubital subluxation, which was managed by an osteotomy of the ulna at the time of plate removal, allowing the ulna to adjust into a normal position. One year after surgery the foal was clinically sound; the radiographs showed good healing of the osteotomy gap as well as good remodelling of the radius; however, a slight elbow subluxation was present.     

Pathophysiology of humeral fractures in a sample of dairy heifers

AIMS: To investigate the pathophysiology of humeral fractures in first-lactation dairy heifers in the North Island of New Zealand.

METHODS: Ten 2-year-old dairy heifers with humeral fractures were subject to euthanasia and the fractured and non-fractured contralateral humeri were collected. Humeri were also collected from 10 unaffected 2-year-old dairy heifers sent for slaughter. Humeri from heifers with and without fractures were examined using computed tomography (CT), and four slices of the diaphysis and lower metaphysis (D1–4) were analysed using the Bone J plug-in for Image J. The humeri were sectioned sagittally and 5?mm bone slabs were processed for histopathology.

RESULTS: There were no differences in bone length between the humeri from heifers with or without fractures (p=0.31). Median cortical bone mineral density at D1 was increased in humeri from affected compared with unaffected heifers (810 vs. 783?mg/cm³; p=0.03), cortical area at D1 was reduced (816 vs. 1,037?mm²; p=0.04), the median stress strain index, a calculated theoretical measure of bone strength, at D1 was decreased (7,288 vs. 9,072?mm³; p<0.01), and the median ratio of overall bone volume (BV) to total volume (TV) was decreased (0.32 vs. 0.38; p<0.01). The median periosteal circumference at D1 was also reduced in humeri from affected compared with unaffected heifers (151 vs. 173?mm; p<0.01). Using a binary logistic regression model, BV/TV was the only variable associated with humeral fractures (p=0.03).In nine of 10 fractured humeri the fracture appeared to have started just distal to the head of the humerus and spiralled distally down the diaphysis to end just above the humeral condyles. Histopathological findings included a reduction in the number, and thickness, of trabeculae in the metaphysis; metaphyseal growth arrest lines, and osteoclastic resorption in fractured humeri. Concentrations of copper in serum from four of five animals with fractures were within, and one was below, normal reference ranges, while concentration of copper in the livers of three heifers with fractures were below adequate ranges.

CONCLUSIONS: The CT and histological findings were consistent with a diagnosis of osteoporosis. We propose that humeral fractures in dairy heifers are associated with osteoporosis, possibly as a result of insufficient deposition of bone during growth because of protein-calorie malnutrition. Increased osteoclastic resorption of bone associated with calcium mobilisation for lactation, and periods of copper deficiency may contribute to bone weakening.     

Comparison of limited-contact dynamic compression plate and locking compression plate constructs for proximal interphalangeal joint arthrodesis in the horse

This study compared in vitro monotonic and cyclic mechanical properties of equine proximal interphalangeal joint arthrodeses stabilized using an open or closed technique combined with axial 4.5 mm narrow limited-contact dynamic compression plate (LC-DCP) or 4.5 mm narrow locking compression plate (LCP). Ten forelimb pairs were randomly assigned to LCP or LC-DCP groups. One limb in each pair was assigned to either open or closed technique. Limbs were tested for cyclic fatigue at 20 000 cycles and then single-cycle to failure under 3-point dorsopalmar bending. There was no significant difference in stiffness of constructs during cyclic fatigue testing or on force or stiffness at failure in single cycle to failure testing between open and closed techniques or between plate types. Both implants, surgical technique, or combinations thereof are suitable for clinical use. More work is necessary to define the interaction between implant type and surgical technique.     

Assessment of fracture healing after minimally invasive plate osteosynthesis or open reduction and internal fixation of coexisting radius and ulna fractures in dogs via ultrasonography and radiography

Objective-To evaluate fracture healing after minimally invasive plate osteosynthesis (MIPO) or open reduction and internal fixation (ORIF) of coexisting radius and ulna fractures in dogs via ultrasonography and radiography. Design-Prospective cohort study. Animals-16 dogs with radius-ulna fractures that underwent MIPO (n = 9; 2 dogs were subsequently not included in the analyses because of incomplete follow-up information) or ORIF (7). Procedures-Dogs in the 2 treatment groups were matched by age, body weight, and configuration of the fractures. Fracture healing was evaluated with ultrasonography, power Doppler ultrasonography, and radiography every 3 to 4 weeks until healing was complete; a semiquantitative score based on the number of Doppler signals was used to characterize neovascularization, and subjective B-mode ultrasonographic and radiographic scores were assigned to classify healing. Results-Fractures in dogs that underwent MIPO healed in significantly less time than did fractures in dogs that underwent ORIF (mean ± SD; 30 ± 10.5 days and 64 ± 10.1 days, respectively). Radiography revealed that fractures in dogs that underwent MIPO healed with significantly more callus formation than did fractures in dogs that underwent ORIF. Although Doppler ultrasonography revealed abundant vascularization in fractures that were healing following MIPO, no significant difference in neovascularization scores was found between groups. Conclusions and Clinical Relevance-For dogs with radius-ulna fractures, data indicated that bridging osteosynthesis combined with a minimally invasive approach contributed to rapid healing after MIPO. The MIPO technique may offer some clinical advantage over ORIF, given that complete radius-ulna fracture healing was achieved in a shorter time with MIPO.     

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.