A lag-screw technique for bridging of the medial aspect of the distal tibial physis in horses

A lag-screw technique for transphyseal bridging of the medial aspect of the distal tibial physis in foals with tarsal valgus deformities and results of the technique in 11 foals (6 with bilateral tarsal valgus deformities and 5 with unilateral tarsal valgus deformities) are described. Briefly, horses were anesthetized, and a single stab incision was made through the skin to the underlying bone over the most distal aspect of the medial malleolus. A 20-gauge needle was placed in the incision to guide screw placement, and a lag screw was inserted parallel to the medial cortex of the tibia under radiographic guidance. Screws were removed when the tarsal valgus deformity was clinically assessed to have improved by at least 80%. Clinically, all horses had evidence of a tarsal valgus deformity of > 7 degrees prior to surgery. Mean age at the time of lag-screw implanation was 220 days (range, 116 to 364 days). Mean time the implant was in place was 62 days (range, 39 to 89 days). The tarsal valgus deformity resolved in all 11 horses with excellent cosmetic results.     

Pes varus correction in Dachshunds using a hybrid external fixator

Objective— To describe surgical correction of pes varus deformity in Dachshunds by acute medial opening wedge osteotomy of the distal aspect of the tibia stabilized with a hybrid external skeletal fixator (HESF), and report clinical and radiographic outcomes.
Study Design— Multicenter, retrospective clinical study.
Animals— Immature Dachshunds (n=13) with pes varus deformity.
Methods— Limb function and lameness scores were assigned before and after surgery, and correction was determined visually at surgery. Tibiotarsal joint orientation (TTJO) and medial and lateral tibial cortex lengths, measured on radiographs of deformed and normal (when available) limbs, were compared before correction and after fixator removal.
Results— Pes varus deformities (n=14) were corrected; 93% had good to excellent clinical outcome. None of the dogs had a normal preoperative gait. Mean TTJO of abnormal and normal tibiae before surgery were 29° varus (median, 28°), and 12° valgus (median, 12°). Angular correction ranged from 20° to 51° (mean, 36±8°; median, 36°). M e an TTJO after fixator removal was 7° valgus (median, 7°). Two dogs had minor transient postoperative complications whereas 3 had major complications; only 1 of which was resolved.
Conclusions— Pes varus deformity in Dachshunds can be corrected by acute medial opening wedge osteotomy of the distal aspect of the tibia stabilized by HESF. Technique modifications are needed to improve correction precision.
Clinical Relevance— Visual inspection of limb alignment during surgery resulted in good to excellent clinical outcomes; however, 91% of tibiae were under- or overcorrected (mean, 6°; median, 5°). Limb alignment should be based on evaluation of immediate postoperative TTJO measurements, not solely on intraoperative visual assessment.     

Treatment of Forelimb Growth Plate Deformity in 11 Dogs by Radial Dome Osteotomy and External Coaptation

Radial dome osteotomy and external coaptation were used to correct forelimb growth deformities with carpal valgus angles of 15 to 43 degrees in 11 dogs (12 forelimbs). Osteotomy sites were clinically healed by week 4. Appearance and function in 10 limbs was good to excellent. The angular deformity recurred in one dog by week 4 due to partial closure of the distal radial growth plate. Carpal valgus recurred in one dog by week 2 because the ulnar osteotomy healed before radial growth ceased.     

Corrective Osteotomy for Pes Varus in the Dachshund

Five dachshunds were treated for a distal varus deformity of one tibia. Angulations of 20 degrees to 30 degrees resulted from shortening of the medial tibial length with the maximum curvature at the distal metaphysis. Comparison with the contralateral limbs was required to determine the amount of correction necessary for functional and cosmetic results. Open wedge osteotomies stabilized with a modified type II external fixator resulted in correction of the deformities, early return of limb function, and healing of the osteotomies.     

Use of hinged circular fixator constructs for the correction of crural deformities in three dogs

Background Hinged circular external skeletal fixator constructs are used to perform sequential correction of angular limb deformities, often with resultant limb segment lengthening, via distraction osteogenesis. Although there are several reports describing the use of these constructs for correction of antebrachial deformities in dogs, there is little information regarding their use on other limb segments. This report describes the use of hinged circular fixator constructs for the correction of acquired crural deformities in three skeletally immature dogs. Case reports Two dogs had purely frontal plane deformities (one valgus, one varus) and the third dog had frontal (valgus) and sagittal (recurvatum) components to its deformity. At the time of long‐term evaluation, frontal plane angulation relative to the contralateral limb improved from 40° to 22° of valgus, 30° to 5° of valgus, and 20° to 1° of varus in the three individual dogs. Tibial length discrepancies of 12% and 22% that were initially present in two dogs were improved to 6% and 10%, respectively, of the contralateral tibial length at the time of final evaluation; both dogs had compensatory growth of the ipsilateral femur and all dogs had an excellent functional outcome. Conclusion These cases illustrate the value of using hinged circular fixator constructs for correction of crural angular deformities, particularly when length discrepancies of the tibia are present.     

Realignment of the radius in canine antebrachial growth deformities treated with corrective osteotomy and bilateral (type II) external fixation

OBJECTIVE: To identify factors affecting radial alignment after oblique corrective osteotomy stabilized with a type II external fixator and to evaluate the results of this treatment for antebrachial growth deformities. STUDY DESIGN: Retrospective study SAMPLE POPULATION: Twenty-eight dogs with unilateral antebrachial growth deformities treated with acute corrective osteotomy stabilized with a type II external fixator. METHODS: Medical records and preoperative and postoperative radiographs of the affected and contralateral limb were reviewed. Cause of deformity, age, weight, and gender were recorded. Radial length, varus/valgus angulation, and cranial/caudal angulation were measured from radiographs of the treated and contralateral limbs. Preoperative and postoperative angulation and length discrepancy were compared between affected and contralateral limbs. RESULTS: Correction of varus/valgus angle discrepancy was achieved by using acute corrective osteotomy stabilized with type II external skeletal fixation. No significant change was noted for correction of cranial/caudal angle discrepancy or length discrepancy between the affected and control limb. CLINICAL RELEVANCE: Varus/valgus angle deformities can be treated successfully with type III external fixation after oblique corrective osteotomy. Patients with significant length or cranial/caudal angle discrepancies or both that negatively impact function may require the use of hinged circular fixators or other dynamic techniques to achieve adequate correction.     

MORPHOMETRIC ASSESSMENT OF THE PROXIMAL PORTION OF THE TIBIA IN DOGS WITH AND WITHOUT CRANIAL CRUCIATE LIGAMENT RUPTURE

Based on the clinical observation that dogs with a steep tibial plateau slope had variable tibial morphology, we hypothesized that these dogs could be further characterized using measurements developed by examining computer generated models of specific proximal tibial malformations. A 3D tibial model was created from a normal canine tibia. The model was manipulated to reproduce two specific proximal tibial anomalies representing deformities originating from the tibial plateau or the proximal tibial shaft. Data from these models were used to create specific measurements that would characterize the shape of these anomalies. These measurements included the diaphyseal tibial axis (DTA)/proximal tibial axis (PTA) angle, which defined the orientation of the proximal portion of the shaft in relation to the tibial mid-shaft. These measurements were then made on radiographs of dogs with and without cranial cruciate ligament (CCL) rupture. Models with tibial plateau and proximal shaft deformities had a steep tibial plateau slope (TPS). Models with proximal shaft deformity had a markedly increased DTA/PTA angle. The model with a 10 degree proximal shaft deformity had a DTA/PTA angle of 11.23 degrees. Six dogs (9.0%) had a DTA/PTA angle larger than 11.23 degrees (range, 11.4-13.9 degrees). Dogs in this group had ruptured CCL and a steep TPS. Dogs with CCL rupture had higher TPS (mean, 31.8 +/- 4.1 degrees) and DTA/PTA angle (mean, 6.0 +/- 3.3 degrees) than dogs without CCL rupture (means, 23.6 +/- 3.4 degrees and 4.1 +/- 2.2 degrees, respectively). Dogs with proximal shaft deformity represented a distinct group, which could not be identified using the magnitude of the TPS alone. Characterizing more precisely the shape of the proximal portion of the tibia in dogs contributes to our understanding of the pathogenesis of steep TPS and may facilitate the optimization of the surgical management of dogs with CCL rupture.     

In vitro effects of osteotomy angle and osteotomy reduction on tibial angulation and rotation during the tibial plateau-leveling osteotomy procedure

OBJECTIVE: To determine the effect of osteotomy angle, reduction technique, and tibial plateau rotation angle on angular and rotational limb deformities. STUDY DESIGN: Geometric comparison using bone models. METHODS: Rotational osteotomies were made in the proximal metaphysis of artificial tibias at 0 degrees, 10 degrees, 20 degrees, -10 degrees, and -20 degrees from perpendicular with respect to either the proximodistal and craniocaudal tibial axes. Negative-numbered angles represented osteotomies made from distal to proximal or caudal to cranial. Changes in tibial angulation and torsion were measured using a 3-dimensional digitizing instrument at tibial plateau rotation angles from 0 degrees to 30 degrees at 5 degrees increments. Two osteotomy reduction techniques were used: complete osteotomy reduction and alignment of the medial cortex. The mean of 5 measurements of torsional and angular tibial deformity for each of the 9 osteotomy orientations in each reduction technique group was obtained. RESULTS: All had increasing angular and rotational deformity as tibial plateau rotation angle increased. In the medially aligned cortex group, all tibias had valgus deformity, and 8 of 9 tibias were internally rotated. In the reduced osteotomy group, minimal angular deformity was seen in tibias with osteotomy variation along the proximodistal axis; however, tibias with osteotomy variation along the craniocaudal axis had angular deformity ranging from 6.0 degrees of varus deformity to 14.3 degrees of valgus deformity. Rotational deformity was affected similarly by osteotomy variation along either axis. Reduction technique had greater affect on angular and rotational deformity than osteotomy angle variation. CLINICAL RELEVANCE: These results suggest that osteotomy reduction may play a greater role in angular and rotational deformity than osteotomy angle, although extreme osteotomy angles should be avoided. To decrease the severity of deformity, we recommend that the osteotomy be made perpendicular to the craniocaudal and proximodistal axes and be completely reduced with less regard for alignment of the medial cortex.     

Fracture of the proximal tibial epiphysis and tuberosity in 10 dogs

Ten dogs were presented with fractures of the proximal tibial epiphysis and tuberosity. All dogs had a cranioproximal-caudodistal angulation of the tibial plateau. Six dogs had marked caudal displacement of the proximal tibial epiphysis, five of which had also sustained fractures of the proximal fibula. The estimated mean angle of inclination of the tibial plateau of affected limbs was 45.8 +/- 9.6 degrees, which was significantly greater (P<0.0005) than the estimated mean angle of the normal contralateral limb 26.2 +/- 6.6 degrees. The mean angle of inclination of the tibial plateau of dogs with fibular fractures (n=5) was not significantly different from dogs without fibular fractures (n=5) (P>0.25). Five dogs were treated conservatively and five were treated by three different methods of surgical repair. Surgically treated dogs had significantly greater preoperative tibial plateau angles (P<0.05). All dogs regained full limb usage, regardless of the method of treatment chosen.     

Vertical position of the patella in the stifle joint of clinically normal large-breed dogs

OBJECTIVE: To define the vertical position of the patella in clinically normal large-breed dogs. SAMPLE POPULATION: Cadavers of 13 clinically normal large-breed dog. PROCEDURE: Both hind limbs were harvested with intact stifle joints and mounted on a positioning device that allowed full range of motion of the stifle joint. Lateral radiographic views were obtained with the stifle joints positioned at each of 5 angles (148 degrees, 130 degrees, 113 degrees, 96 degrees, and 75 degrees). Vertical position of the patella through a range of motion was depicted on a graph of mean stifle angle versus corresponding mean proximal patellar position (PPP) and distal patellar position (DPP) relative to the femoral trochlea for each dog. Ratio of length of the patellar ligament to length of the patella (L:P) was determined for each dog. Overall mean, SD, and 95% confidence intervals for L:P were calculated for all dogs. RESULTS: Evaluation of vertical position of the patella through a range of motion revealed a nearly linear relationship between joint angle and PPP and joint angle and DPPF Evaluation of L:P results did not reveal significant differences between limbs (left or right) or among joint angles. Overall mean +/- SD L:P for all dogs was 1.68 +/- 0.18 (95% confidence interval, 1.33 to 2.03). CONCLUSIONS AND CLINICAL RELEVANCE: The L:P proved to be a repeatable measurement of vertical patellar position, which is independent of stifle angles from 75 degrees to 148 degrees.This measurement could be used as a quantitative method for diagnosing patella alta and patella baja in large-breed dogs.     

Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs

OBJECTIVE: To describe the normal anatomic axis of the canine radius in 2 planes (frontal, sagittal), and report the use and efficacy of dome osteotomies for acute correction of canine antebrachial deformities. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Normal antebrachii (n = 20) radiographs were used as a reference, and 7 dogs with 9 radial angular limb deformities that were corrected by use of dome osteotomies. METHODS: Orthogonal radiographs of 20 normal antebrachii were used to determine normal ranges of frontal (FPA) and sagittal plane anatomic axes (SPA). Pre and postoperative radiographs of 7 dogs (9 radii) that had surgical correction of radial angular limb deformities by dome osteotomies were reviewed. Success at deformity correction into established normal ranges and to the normal contralateral side, if present, was determined. RESULTS: Normal ranges were FPA, 0-8 degrees and SPA, 8-35 degrees . There were 4 biapical and 5 uniapical deformities. FPA and SPA were corrected into normal range in 66% and 78% of affected limbs, respectively; however, only 44% of radii were corrected into normal ranges in both planes. CONCLUSIONS: Ranges for normal canine radial axes can be used as goals for angular limb correction when there is bilateral angular deformity. The dome osteotomy technique is advantageous in certain conditions for biplanar deformity correction. CLINICAL RELEVANCE: Dome osteotomies can be used to correct radial deformities in the frontal and sagittal planes, with certain advantages, but are heavily reliant on appropriate preoperative planning.     

Determination of Pelvic Limb Alignment in the Large‐Breed Dog: A Cadaveric Radiographic Study in the Frontal Plane

Objectives— To report a method for radiographic determination of the mechanical axis of the canine pelvic limb and its relationship to the joints and bone axes. To report reference ranges for the relationships between the axes of the pelvic limb and for joint position relative to the pelvic limb axis. Study Design— Cadaveric radiographic anatomic study. Animals— Pelvic limbs (n=101) from normal midsized to large breed dogs; tibiae (n=105) from dogs with cranial cruciate ligament disease (previous study). Methods— Extended full‐limb radiography was performed and images analyzed to determine: mechanical joint reference angles (femur, tibia), pelvic limb axis, tibiofemoral and metatarsotibial angle, mechanical axis—femur/metatarsus angle, and mechanical axis deviation (MAD) of the stifle/tarsus. Results— Mean mechanical angles were: lateral proximal femoral (103.7°±5.4°), lateral distal femoral (98.6°±2.5°), medial proximal tibial (92.2°±1.8°), medial distal tibial (95.9°±2.2°), tibiofemoral (9.1° varus ±2.8°), metatarsotibial (0.6° valgus ±2.1°). Mean mechanical axis—femur and—metatarsus angles were 5.6° (±1.7°) and 2.9° (±1.5°), respectively. Mean MAD of the stifle and tarsus were 3.6% (±1.1%) and 1.2% (±0.6%), respectively. Tibial angles were not different between dogs with and without cranial cruciate ligament disease. Conclusions— Mechanical axes of the canine pelvic limb and their relationship to the joints can be determined by full‐limb radiography. Clinical Relevance— Techniques and reference ranges may be useful for diagnosis, surgical planning, and postoperative assessment of pelvic limb deformities.     

Comparison of computed tomographic and standard radiographic determination of tibial torsion in the dog

OBJECTIVE: To compare the effect of internal tibial rotation on the computed tomographic (CT) and standard radiographic assessment of tibial torsion (TT) in dogs. STUDY DESIGN: In vitro study. SAMPLE POPULATION: Cadaveric canine hind limbs (6 pairs). METHODS: The cranial cruciate ligament was transected, and caudo-cranial radiographic and transverse CT images were obtained with the femur and tibiae in a neutral position, and after 15 degrees internal tibial rotation. Radiographic TT was determined by measuring the distance (d) between the calcaneus and the sulcus of the talus. CT determination of TT was performed using the proximal transcondylar and the distal cranial tibial axes. The distance (d) in the 2 groups and the difference in the CT determination of TT between groups were compared with a hypothetical mean value of 0 mm and 0 degrees, respectively. RESULTS: The mean distance (d) for the neutral radiographic group was not significantly different from 0 (P=.473); however, for the 15 degree group it was significantly different (P<.0001). The difference in the CT determination of TT did not differ from 0 (P=.317). CONCLUSION: The standard radiographic technique does not discriminate between internal TT and internal rotation of the tibia. Thus, dogs with normal tibial conformation can be depicted by radiography as torsed, whereas dogs with TT may be misinterpreted as normal because of arbitrary positioning. CLINICAL RELEVANCE: Lateral displacement of the medial border of the calcaneus on a caudo-cranial radiograph should not be used as the sole arbiter of TT before surgical correction.     

Periosteal transection and stripping for treatment of angular limb deformities in foals: clinical observations

Correction was attempted in 27 foals (41 limbs) with angular deformities at the carpal region (35 limbs), metatarsophalangeal region (5 limbs) and distal end of the tibia (1 limb) by hemicircumferential transection of the periosteum (HCTP) and periosteal stripping (PS). Successful outcome was determined by straight limbs and soundness, which was achieved in 81.5% of the cases, with 60% of the horses in performance training. Follow-up evaluation for all foals was completed at various times after physiologic closure of the physes. In none of the limbs was the deformity overcorrected. Owners of foals with carpal region deviations corrected by means of HCTP and PS were satisfied with the result. The cosmetic appearance of the surgical site was excellent. The HCTP and PS adequately corrected greater degrees of carpal region deformity and greater degrees of deformity in older foals than previously reported with this or other surgical techniques.     

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.     

Treatment of segmental tibial defects using acute bone shortening followed by gradual lengthening with circular external fixator

The aim of this study was to clinically and radiographically evaluate acute bone shortening followed by gradual lengthening in the treatment of large segmental tibia defects induced in seven clinically normal dogs. A circular external fixator was assembled with one proximal 5/8-circle ring, one middle ring and one distal ring connected with three rods. Thirty per cent of the tibia and fibula were removed in the middle and distal parts of the diaphyses, between the middle and distal rings. Acute bone shortening with compression of proximal and distal segments was performed. A subperiosteal osteotomy was performed between the half-ring and middle ring. Bone distraction started 7 days after surgery; after lengthening, the apparatus was left in place for 14 weeks for consolidation of regenerated bone. The frame was removed at the end of this period, and the dogs observed for four more weeks. Functional results were considered excellent in two, good in three and fair in the other two dogs. Bone regeneration within the distraction gap was obtained 14 weeks after neutral fixation period. We concluded that acute bone shortening followed by gradual lengthening by Ilizarov method can be used to treat extensive tibial defects in dogs, although it presents limb temporary abnormal limb shape and unequal length as early disadvantages.     

Proximodistal alignment of the canine patella: radiographic evaluation and association with medial and lateral patellar luxation

Objectives— To evaluate the contribution of proximodistal alignment of the patella to patellar luxation, and to evaluate the structures contributing to proximodistal alignment of the patella relative to the femoral trochlea.
Study Design— Retrospective study using a convenience sample.
Animals— Medium to giant breed dogs (n=106).
Methods— Medical records and stifle radiographs of 106 dogs were reviewed. Radiographic measurements evaluated the proximodistal alignment of the patella with respect to the femoral trochlea, distal aspect of the femur, and proximal aspect of the tibia. Measurements were compared between dogs with clinically normal stifles (controls; n=51 dogs, 66 stifles), and dogs with a clinical diagnosis of medial patellar luxation (MPL, n=46 dogs, 65 stifles) or lateral patellar luxation (LPL, n=9 dogs, 11 stifles) using ANOVA.
Results— In dogs with MPL, the ratio of patellar ligament length (PLL) to patellar length (PL) was increased, as was the ratio of the distance from the proximal aspect of the patella to the femoral condyle (A) to PL ( P <.0001). Dogs with LPL had a decreased A:PL ( P =.003) and an increased ratio of the proximal tibial length (PTL) to distal tibial width (DTW; P =.009).
Conclusions— MPL is associated with a relatively long patellar ligament and patella alta in medium to giant breed dogs. LPL is associated with a relatively long proximal tibia and patella baja. Values for PLL:PL>2.06 and A:PL>2.03 are suggestive of the presence of patella alta, whereas a value for A:PL<1.92 is suggestive of patella baja.
Clinical Relevance— Measurements of both PLL:PL and A:PL are recommended in dogs with patellar luxation, and surgical correction should be considered in those with abnormal values.     

Surgical correction of carpal valgus deformity in three alpacas

Two alpaca crias and one 14-month-old alpaca were referred for treatment of bilateral carpal valgus. In one cria, hemi-circumferential periosteal transection and elevation combined with an ulna osteotomy was performed initially without success, however transphyseal bridging with screws and wires was used successfully in both crias to straighten the limbs. As the distal radial and ulna growth plates had closed in the 14-month-old alpaca, bilateral wedge ostectomies of the distal radius and transfixation casts were used to straighten and stabilise the limbs. The ostectomy sites healed and the alpaca is ambulatory, although carpal flexion is significantly reduced. Until the relationship between the growth rate of crias and the success of hemicircumferential periosteal transection and elevation and ulna osteotomy is established, transphyseal bridging may provide a more reliable result in crias with carpal valgus deformity and open physes. Wedge ostectomy and application of a transfixation cast can be used to correct severe carpal valgus deformities in alpacas with closed physes.     

Effect of hemi-circumferential periosteal transection and elevation in foals with experimentally induced angular limb deformities

OBJECTIVE: To evaluate the effect of hemi-circumferential periosteal transection and elevation (HCPTE) in foals with, experimentally induced angular limb deformities. DESIGN: Prospective study. ANIMALS: 10 healthy foals. PROCEDURE: When foals were 30 days old, transphyseal bridge implants were placed on the lateral aspects of both distal radial physes. At 90 days of age (or when 15 degrees of angulation had developed), implants were removed, and HCPTE was performed on 1 limb. Foals were confined in small pens after surgery; the front feet of the foals were rasped weekly to maintain medial-to-lateral hoof wall balance. Dorsopalmar radiographic projections of the carpi were obtained before HCPTE and 2, 4, 6, 8, and 48 weeks later. RESULTS: At the time of transphyseal bridge removal and HCPTE, both treated and control limbs were observed to have a significantly greater carpal valgus, compared with the initial degree of angulation at 30 days of age. Following HCPTE or sham surgery, all limbs straightened over the subsequent 2 months of the study. Median angulation was not significantly different between treated and control limbs at any time during the study. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that in foals with experimentally induced limb deformities, HCPTE was no more effective than stall confinement and hoof trimming alone for correction of the deformity.     

In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig

OBJECTIVE: To evaluate the influence of a tibial plateau leveling jig on osteotomy orientation, fragment reduction, and postoperative tibial plateau angle (TPA) during tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: In vitro experimental study. ANIMALS: Large-breed canine cadavers (n=20). METHODS: TPLO was performed on 40 hindlimbs using 4 methods. Group 1: Jig; dogs in dorsal recumbency with the osteotomy parallel to the distal jig pin. Groups 2-4: No jig; dogs in lateral recumbency with the osteotomy in a vertical orientation (group 2: tibia parallel to the table top; group 3: controlled superimposition of the femoral condyles; group 4: internal rotation of the tibia). Postoperative TPA, fragment reduction, and osteotomy orientation relative to the tibial plateau were compared. Positive or negative values denoted deviation from parallel relative to the tibial plateau. RESULTS: Postoperative TPA, fragment reduction, and proximodistal osteotomy orientation were not significantly different between groups. Craniocaudal osteotomy orientation was significantly different (P<.005) from the tibial plateau. Median deviations were -4.0 degrees (group 1), 11.8 degrees (group 2), 11.2 degrees (group 3), and 0.2 degrees (group 4). Group 1 was not significantly different from group 4. CONCLUSIONS: A jig is not essential for osteotomy orientation, tibial plateau rotation, or fragment reduction. Comparable results were achieved performing a vertical osteotomy with the tibia slightly internally rotated (10 degrees -15 degrees) and parallel to the table surface. CLINICAL RELEVANCE: TPLO without use of a jig reduces surgical trauma, is less time consuming, and reduces cost.