Use of a circular external skeletal fixator for stabilization of a comminuted diaphyseal metatarsal fracture in an alpaca

CASE DESCRIPTION: A 3-year-old male alpaca was evaluated because of non-weight-bearing lameness (grade 5/5) in the left hind limb. CLINICAL FINDINGS: Clinical and radiographic examination revealed a closed, comminuted, nonarticular, displaced diaphyseal fracture of the left third and fourth metatarsal bones. TREATMENT AND OUTCOME: Initial attempts at treatment via reduction of the fracture under traction and subsequent application of a cast were unsuccessful, and more stable fracture fixation was pursued. The alpaca underwent closed reduction of the fracture, which was stabilized by the application of a 3-ring circular external skeletal fixator (CESF). Improved weight bearing on the affected limb was evident soon after surgery and gradually increased; full weight bearing was evident by the seventh day after discharge from the hospital (day 20 after application of the CESF). Lameness was hardly noticeable during walking at that time. After 3 months, complete fracture healing was evident and the CESF was removed; mild outward rotation of the distal fragment and metatarsophalangeal joint was present. A Robert Jones bandage was applied to the limb, and the alpaca was kept in a stall for another 4 weeks. Eleven months after CESF application, the owners and referring veterinarian reported that the alpaca was healthy, not lame, and serving as a stallion without apparent impediment. CLINICAL RELEVANCE: Although mostly restricted to small animals, application of a CESF can be a viable alternative for management of long bone fractures in South American camelids.     

Bovine xenograft application for treatment of a metatarsal nonunion fracture in an alpaca (Vicugna pacos)

CASE HISTORY: A 15-year-old female huacaya alpaca (Vicugna pacos) was referred because of a non-weight-bearing lameness (4/4) in the left pelvic limb caused by a grade three open metatarsal fracture. The referring veterinarian treated the fracture with conservative management using bandages, but it progressively evolved to a non-union.

CLINICAL FINDINGS AND DIAGNOSIS: Clinical examination revealed external wounds on the medial and lateral surfaces of the metatarsus. Radiographs confirmed an open, nonarticular, displaced, diaphyseal fracture of the left metatarsus.

TREATMENT AND OUTCOME: Cancellous bone was sourced from bovine proximal and distal femur epiphyses, followed by a thermal shock procedure to achieve decellularisation, to produce a xenograft. Open reduction and internal fixation of the fracture using locking plates was performed. Alignment of the fracture fragments was corrected and the xenograft was placed at the debrided fracture site to stimulate and harness osteogenesis in situ. Clinical and radiographic follow-up was performed up to 40 weeks postoperatively. Clinical evaluations revealed that the alpaca gradually increased weight bearing following bandage removal 10 days after surgery. Serial radiographs showed correct alignment of the left metatarsus, progressive bone modelling and, complete bone union at 12 weeks. Ten months postoperatively the alpaca showed no signs of lameness and resumed normal activity.

CLINICAL RELEVANCE: For management of a metatarsal non-union, a combination of bovine xenograft application and angular stable internal fixation progressed toward an excellent long-term recovery.     

Surgical repair of a coxofemoral luxation in an alpaca

A female breeding alpaca with acute lameness of the left hindleg was diagnosed with a craniodorsal coxofemoral luxation. Repair was achieved using extracapsular stabilisation. Two nylon sutures were passed through a hole drilled in the femoral neck and anchored to the dorsal acetabulum using two screws and two spiked washers. A metal crimp was used to tighten and maintain the sutures. Postoperatively the alpaca was confined to a stall for 4 weeks before being returned to a paddock. At 6 months after surgery the alpaca was free of lameness and was successfully mated.     

Comparison of two caudolateral approaches to the scapulohumeral joint for treatment of osteochondritis dissecans in dogs

Two caudolateral approaches to the canine scapulohumeral joint that do not require myotomy, tenotomy, or osteotomy were used to expose the humeral heads of both scapulohumeral joints in 10 clinically normal dogs. One approach (method 1) was used on the left shoulder of 5 dogs and on the right shoulder of the other 5 dogs. The other approach (method 2) was used on the opposite joints. The amount of humeral head articular cartilage that could be exposed with each approach was measured. The amount of articular cartilage exposed with method 1 was significantly greater than that exposed with method 2 (P less than 0.0001). Method 1 also provided for exposure of the caudomedial aspect of the scapulohumeral joint. Method 1 was used unilaterally in 20 dogs with osteochondritis dissecans. This approach provided excellent exposure of the humeral head and osteochondritis dissecans lesion. Of the 16 dogs that were available for follow-up evaluation, 1 developed a seroma after surgery. Other complications were not observed or reported.     

Results of single-session bilateral triple pelvic osteotomy with an eight-hole iliac bone plate in dogs: 95 cases (1996-1999)

OBJECTIVE: To evaluate feasibility of single-session bilateral triple pelvic osteotomy with 8-hole iliac bone plates in dogs with bilateral hip dysplasia. DESIGN: Retrospective study. ANIMALS: 95 dogs with bilateral hip dysplasia. PROCEDURE: Medical records were reviewed, and information was obtained on signalment; body weight; angles of subluxation and reduction prior to surgery; durations of surgery and hospitalization; postoperative mobility; severity of lameness, radiographic grade of hip dysplasia, Norberg angle, and femoral head coverage before and after surgery; time required for radiographic evidence of iliac healing; change in pelvic diameter; implant integrity; and complications. RESULTS: Mean age at the time of surgery was 10.8 months, and mean weight was 35.2 kg (77.4 lb). Prior to surgery, mean angles of subluxation were 2.2 degrees on the right and 2.6 degrees on the left; mean angles of reduction were 25.9 degrees on the right and 27.3 degrees on the left. Mean surgical time was 95 minutes. All but 1 dog were able to walk on their own by the fourth day after surgery. Mean hospitalization time was 7.5 days. Clinical signs of lameness and radiographic grade of hip dysplasia were significantly improved during follow-up examinations. Mean time for radiographic iliac healing was 8 weeks. None of the plates and only 7 of the 1,520 (0.5%) screws loosened after surgery. Nineteen dogs had complications, but all complications were minor. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that single-session bilateral triple pelvic osteotomy with 8-hole iliac bone plates is effective for treatment of dogs with bilateral hip dysplasia.     

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.     

Arthrotomy for the treatment of chronic purulent septic gonitis with subchondral osteolysis in two calves

Abstract

CASE HISTORY: A 6-week-old German Holstein heifer calf (Case 1) and a 4-week-old Charolais bull calf (Case 2) were referred because of unilateral hind limb lameness. Both had been treated with systemic antibiotics by the referring veterinarian.

CLINICAL FINDINGS AND DIAGNOSIS: Based on the results of clinical, radiographic and ultrasonographic examination, a diagnosis of chronic purulent septic gonitis with subchondral osteolysis of the lateral femoral condyle was made in both calves. In Case 2 the lateral tibial condyle also showed osteolysis.

TREATMENT AND OUTCOME: Treatment consisted of arthrotomy with debridement of abnormal bone and cartilage via a craniolateral and a caudolateral approach. Case 1 was discharged from with grade 1/5 lameness 60 days after surgery. In a follow-up 15 months postoperatively, the owner reported that it had been bred at 14 months, was not lame and the affected stifle joint appeared normal. Case 2 had grade 2/5 lameness 52 days after surgery, but was sound at the time of slaughter at 22 months of age.

CLINICAL RELEVANCE: Arthrotomy via a caudolateral approach is a suitable method for the treatment of septic purulent gonitis with osteolysis of the lateral femoral and tibial condyles in calves. In these cases, this treatment resulted in the elimination of localised inflammation, prevented clinically relevant spread of infection to other organs, and restored normal joint function.     

Total Hip Replacement in an Alpaca Using a Cementless Implant

Objective— To report use of a cementless total hip prosthesis in an alpaca.
Study Design— Case report.
Animals— Alpaca (n=1) with chronic craniodorsal coxofemoral luxation.
Methods— A 2.5-year-old Suri alpaca, 3 months pregnant, was admitted for evaluation of acute onset severe left hind limb lameness (grade 4/5) of 6 weeks duration. After diagnosis of craniodorsal luxation of the left femoral head, total hip replacement (THR) using a cementless implant was performed because of the poor prognosis for reduction of a chronic luxation.
Results— A press-fit prosthesis was used and the alpaca delivered a live cria 8 months later. Persistent mild mechanical lameness remained after surgery, with moderate reduction in mobility of the coxofemoral joint. The prosthesis was stable and correctly positioned at 7 weeks and at 9 months. There was mild exostosis surrounding the proximal aspect of the femur at 9 months, and Steinmann pins used to repair the trochanteric osteotomy were removed because of migration. At 1 year, the alpaca has a slight gait abnormality, remains with the herd on pasture and has been re-bred.
Conclusion— Chronic coxofemoral luxation in an alpaca can be managed by THR.
Clinical Relevance— THR is a viable treatment option in alpacas with severe coxofemoral disease.     

A technique for internal fixation of scapulohumeral luxation using scapulohumeral tension sutures in three alpacas and one miniature steer

Objective— To report a technique for open reduction and internal fixation of scapulohumeral joint luxation in large animals, and outcome.
Study Design— Clinical case reports.
Animals— Mature alpacas (n=3) and immature miniature steer (1).
Methods— Shoulder joint luxation was diagnosed by physical examination and confirmed by radiography. Open reduction was performed with internal fixation using lateral tension band sutures.
Results— Animals maintained shoulder joint reduction and were sound with radiographically normal shoulder joints (n=2) and normal range of motion without appreciable gait abnormalities (4) at follow-up 8–36 months later.
Conclusions— In contrast to previous reports of open reduction with internal fixation of shoulder joint luxation in large animals, open reduction and use of lateral scapulohumeral tension sutures resulted in functionally normal shoulder joints.
Clinical Relevance— Stabilization of the shoulder joint with lateral scapulohumeral tension sutures after open reduction is effective, technically simple, and should be considered in large animal species weighing <100 kg.     

Diagnostic findings and prognosis following arthroscopic treatment of subtle osteochondral lesions in the shoulder joint of horses: 15 cases (1996-1999)

OBJECTIVE: To determine clinical, scintigraphic, radiographic, and arthroscopic findings and results of treatment in horses with lameness attributable to subtle osteochondral lesions of the shoulder joint. DESIGN: Retrospective study. ANIMALS: 15 horses. PROCEDURE: Medical records were reviewed, and results of physical examination, scintigraphy, radiography, arthroscopy, and treatment were recorded. RESULTS: Severity of lameness ranged from grade 1 to 4. Response to shoulder flexion or extension was variable. Twelve horses had a narrow upright foot. Intra-articular anesthesia of the shoulder joint localized the cause of the lameness to the shoulder joint in 9 of 10 horses. Scintigraphic abnormalities were detected in 4 of 6 horses. Radiographic lesions were subtle and included glenoid sclerosis, focal glenoid lysis, small glenoid cysts, and alterations in the humeral head contour. Arthroscopic evaluation confirmed clefts in the glenoid cartilage, glenoid cysts, a humeral head cyst, fibrillation of the humeral head cartilage, cartilage fragmentation, or a nondisplaced fracture of the humeral head. After treatment, 12 horses returned to their previous level of performance, 1 was sound for light riding, 1 remained lame, and 1 was euthanatized because of chronic lameness. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that a combination of physical examination, scintigraphy, and radiography is necessary to diagnose subtle osteochondral lesions of the shoulder joint in horses. Arthroscopy can be used to confirm the diagnosis and treat cartilage and subchondral bone lesions. Young and middle-aged horses with subtle osteochondral lesions of the shoulder joints have a good prognosis for return to performance following arthroscopic treatment.     

Diagnosis and surgical removal of brain abscesses in a juvenile alpaca

CASE DESCRIPTION: A 1-month-old female alpaca was examined because of progressive clinical signs consistent with an intracranial lesion. CLINICAL FINDINGS: Clinical signs included signs of depression, lethargy, tetraparesis, and neck weakness. Two large isointense intracranial masses could be seen on T1-weighted magnetic resonance images. On T2-weighted images, the masses contained concentric rings of hypointense and hyperintense material. TREATMENT AND OUTCOME: 2 abscesses were removed via a craniotomy that incorporated removal of the sagittal crest and surrounding skull and transection of the sagittal sinus. The bony deficit was replaced with polypropylene mesh. The alpaca recovered within 2 weeks and was fully integrated into the herd within 1 month after surgery. CLINICAL RELEVANCE: Findings indicated that surgical removal is a feasible means of successfully treating intracranial abscesses in juvenile alpacas.     

Scapulohumeral arthrodesis in miniature horses

OBJECTIVES: To describe surgical arthrodesis of the scapulohumeral joint and to evaluate its efficacy in reducing morbidity associated with severe shoulder dysfunction in miniature horses. STUDY DESIGN: Retrospective study. ANIMALS: Four miniature horses. METHODS: Medical records and radiographs were reviewed for history, physical examination findings, lameness evaluation, radiographic evaluation, surgical techniques, postoperative complications, and outcome. A 10- or 11-hole, 4.5-mm narrow dynamic compression plate and 4.5-mm cortical screws were applied to the cranial surface of the scapula and cranial surface of the humerus after osteotomy of the intermediate tubercle. In most horses, 1 or 2 screws were inserted in lag fashion across the joint, through holes in the plate. RESULTS: Scapulohumeral osteoarthritis was diagnosed radiographically in 4 horses, and 3 horses had concurrent shoulder luxation or subluxation. All horses had grade 3 or 4 lameness before surgery, and most improved by 1 to 2 grades after surgery. Despite complications of implant failure (2 horses), infection (2 horses), scapular fracture (1 horse), and atrophy of the shoulder muscles (1 horse), functional arthrodesis reduced morbidity in all horses. CONCLUSIONS: Scapulohumeral arthrodesis facilitates early return to weight bearing in miniature horses with severe scapulohumeral joint osteoarthrosis. Despite functional gait abnormality, the horses ambulated quite well after surgery. CLINICAL RELEVANCE: Scapulohumeral arthrodesis should be considered for debilitating conditions of the shoulder joint in miniature horses, especially when the intended outcome is breeding or pasture soundness.     

Evaluation of a method for experimental induction of osteoarthritis of the hip joints in dogs

OBJECTIVE: To evaluate a method for experimental induction of osteoarthritis in the hip joints of dogs. ANIMALS: 12 mixed-breed dogs. PROCEDURE: A unilateral triple pelvic osteotomy was performed. In 6 dogs, the iliac osteotomy was repaired with 45 degrees of internal rotation, reducing coverage of the femoral head by the acetabulum. In the other 6 dogs, the fragments were repaired in anatomic alignment. Radiography, force plate evaluations, and subjective lameness evaluations were performed before and after surgery. Dogs were euthanatized 7 months after surgery, and samples of cartilage and joint capsule were examined histologically. RESULTS: Subjective lameness scores, radiographic appearance of the hip joints, and Norberg angles were not significantly different between groups; however, force plate evaluations did reveal significant differences in vertical ground reaction forces. Femoral head coverage was significantly decreased with rotation of the acetabulum. Mild inflammatory changes were discernible in the joint capsule and articular cartilage of some dogs in both groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that 45 degrees internal rotation of the acetabulum does not consistently induce biologically important osteoarthritic changes in the hip joints of dogs.     

Surgical management of suspected congenital luxation of the radial head in three dogs

Abstract

CASE HISTORIES: Three dogs, aged between 11 and 20 weeks, were presented with unilateral forelimb lameness, with an associated bony prominence on the lateral elbow.

CLINICAL FINDINGS AND DIAGNOSIS: Radiographs revealed a caudolateral luxation of the radial head in all cases, consistent with a diagnosis of suspected congenital luxation of the radial head. Surgical reduction and stabilisation involved open reduction of the radial head, and in two cases the use of a trans articular pin.

CLINICAL RELEVANCE: Congenital luxation of the radial head is an uncommon condition that has conflicting reports in the literature regarding its cause, heritability, breed predisposition, treatment and prognosis. The three cases here occurred in young dogs of English Bull Terrier, Jack Russell Terrier, and Staffordshire Bull Terrier breeds. Surgical reduction and stabilisation provided successful outcomes, in all cases. Only six cases of congenital luxation of the radial head managed surgically have previously been reported in the literature.     

Repair of cranial cruciate ligament rupture in an alpaca

A mature male alpaca with acute lameness of the left handlimb was diagnosed as having a rupture of the cranial cruciate ligament. Repair was achieved using a combination of surgical techniques. A patellar ligament autograft was passed under the cranial meniscal ligament, through the joint and over the femoral condyle, and anchored using a screw and washer. Two nylon sutures were passed through a hole made in the tibial crest, and secured under the screw. The alpaca was confined in a stall for 3 months. Exercise was then increased progressively for 3 months. One year after surgery the alpaca is sound and has resumed breeding activity.     

A Comparison of Two Surgical Approaches to the Scapulohumeral Joint in Dogs

Two scapulohumeral arthrotomy techniques were evaluated and compared in 10 normal, young adult greyhounds. A caudolateral approach with craniodorsal retraction of the teres minor muscle (no-tenotomy) and a craniolateral approach with tenotomy of the infraspinatus tendon were each performed unilaterally in 5 dogs. The dogs were evaluated using force plate gait analysis, lameness evaluation, radiography, and goniometry for 5 weeks and then euthanatized. Tenotomy sites and sections of the humeral articular cartilage were collected from shoulder joints that had been operated on and examined microscopically. The same surgical approach was then performed on the contralateral shoulder in the cadavers and exposure of the humeral articular cartilage was measured using planimetry. Peak vertical force applied to the operated limbs in the tenotomy group was significantly less than preoperative levels on day 3 and significantly less than the no-tenotomy group on days 21 and 28. The peak vertical force applied to the operated limbs in the no-tenotomy group was not significantly different from preoperative levels during the study. Scapulohumeral arthrotomy by tenotomy of the infraspinatus resulted in decreased range-of-motion and joint extension compared with joints operated on without tenotomies, but provided significantly greater exposure to the articular surface. Scapulohumeral arthrotomy with craniodorsal retraction of the teres minor muscle did not significantly alter goniometric measurements compared with unoperated joints. Both techniques resulted in similar subjective lameness scores and caused no gross microscopic or radiographic evidence of articular cartilage damage.     

Hematuria and transitional cell papilloma of the renal pelvis treated via unilateral nephrectomy in an alpaca

CASE DESCRIPTION: An 11-year-old 72-kg (158-lb) sexually intact female alpaca was examined for diagnosis and treatment of hematuria of 4 months' duration. CLINICAL FINDINGS: Pigmenturia was detected by the owner when the alpaca was 8 months pregnant. Radiographic, ultrasonographic, vaginal speculum, and cystoscopic evaluation of the urinary tract revealed normal vaginal and urethral epithelia and increased bladder vessel tortuosity, with pulses of hemorrhage from the left ureter. Regenerative anemia and mild leukopenia were detected and serum urea nitrogen and creatinine concentrations were within reference ranges. TREATMENT AND OUTCOME: Chronic hematuria resolved after unilateral nephrectomy of the left kidney, and no dysfunction was detected in the remaining kidney. Histologic evaluation of the kidney revealed a transitional cell tumor in the renal pelvis. CLINICAL RELEVANCE: Although anemia is common in South American camelids, hematuria is an uncommon sign of this condition. Chronic urinary tract infection, toxin ingestion, and neoplasia causing hematuria or hemoglobinuria should be considered in South American camelids with pigmenturia. Thorough and systematic evaluation of the urinary tract should be performed to locate the site of hemorrhage to treat hematuria appropriately.     

Acquired cervical scoliosis attributed to Parelaphostrongylus tenuis infection in an alpaca

CASE DESCRIPTION: A 2-year-old alpaca was evaluated because of acute onset of cervical scoliosis. CLINICAL FINDINGS: Physical examination revealed severe scoliosis of the caudal portion of the cervical vertebral column with a C-shaped curvature to the right side. No gait deficits were observed. Cervical radiography confirmed severe curvature of C4 to C6 but did not reveal any bony changes. Cerebrospinal fluid had high total protein concentration and extremely high nucleated cell count with a high proportion of eosinophils, suggesting parasitic infection. TREATMENT AND OUTCOME: The alpaca was treated for suspected parelaphostrongylosis with ivermectin, fenbendazole, flunixin, vitamin E, thiamine, physical therapy, and a custom-made neck brace. The alpaca's condition continued to deteriorate, and it developed tetraparesis and ataxia and was euthanized after approximately 1 month. Microscopic evaluation of the cervical spinal cord revealed marked vacuolar changes in the left medial portion of the ventral funiculus, mild lymphoplasmacytic infiltration, and multifocal granulomas. The lesions were continuous from C1 to C7 and were compatible with parasite migration. CLINICAL RELEVANCE: To the authors' knowledge, this is the first report of acquired scoliosis in an alpaca, which appears to represent an unusual manifestation of parelaphostrongylosis that was reported in horses.     

Osteolysis of the radius and ulna induced by a circumferential foreign body in a cat

CASE DESCRIPTION: A 1-year-old neutered male cat was examined because of a 6-month history of recurrent swelling and draining wounds affecting the craniomedial aspect of the distal portion of the left forelimb. CLINICAL FINDINGS: No lameness or neurologic deficits were evident. Examination of craniocaudal and lateromedial radiographic views revealed nonprogressive circumferential osteolysis and a mildly radiopaque, ring-shaped foreign body surrounding the radius and ulna. TREATMENT AND OUTCOME: During surgery, a tight elastic band surrounded by a thick fibrous tissue capsule was found encircling the limb. Microbial culture yielded a Staphylococcus sp that was susceptible to clindamycin. Follow-up monitoring via telephone communication with the owners 1.5 years after removal of the foreign body indicated that the cat had healed with no recurrence of drainage. CLINICAL RELEVANCE: Pressure osteolysis of the bones of the forelimb can be caused by a circumferential foreign body without associated neurologic abnormalities or lameness.     

Arthropathy caused by a lead bullet in a dog

CASE DESCRIPTION: A 3-year-old spayed female Labrador Retriever was evaluated for progressive lameness of the left forelimb 21 months after being shot in the elbow with a lead bullet. CLINICAL FINDINGS: Physical examination findings were consistent with moderate osteoarthritis of the left elbow joint. Orthogonal radiographic views of the elbow revealed multiple metallic fragments in and around the joint space as well as signs of osteoarthritis. TREATMENT AND OUTCOME: The elbow joint was evaluated arthroscopically. A lead-based bullet fragment was seen in the lateral synovial compartment and removed in multiple pieces. Excess fibrin and synovium were removed, and microfractures were created in exposed subchondral bone to stimulate neovascularization and fibrocartilage formation. In a follow-up telephone conversation 4 months after surgery, the owner reported a marked improvement in the lameness. CLINICAL RELEVANCE: Removal of lead intra-articular foreign bodies may be indicated even if the material is not believed to mechanically interfere with joint motion.