Comparison of fixation methods for treatment of long bone fractures in llamas and alpacas

Objective: To determine outcome after repair of long bone fractures in llamas and alpacas. Study Design: Case series. Animals: Llamas (n=11) and alpacas (8). Methods: Medical records (1998–2008) of camelids with long bone fractures were reviewed for history, repair method, and complications. Outcome was also assessed by owner telephone questionnaire. Results: Mean age at repair was 39 months. There were 8 males and 11 females. Fracture distribution was tibia (n=6), metatarsus (5), metacarpus (4), radius and ulna (2), humerus (1), and femur (1), with 13 closed and 6 open fractures. Fracture repair was by internal fixation (n=11), external fixation with a transfixation pin cast (5), external coaptation (2), and cross‐pinning (1). In 1 llama, the limb was amputated to revise a failed external fixation repair. Seventeen animals (89%) were discharged, and 2 were euthanatized. Outcome was available for 13 animals: 9 were used for breeding and 4 as pets. Fewer major complications occurred with internal fixation than with external fixation with a transfixation pin cast (P<.005); however, there were no significant differences in minor complications between groups. Conclusions: Internal fixation with bone plates was associated with fewer major complications than external fixation with a transfixation pin cast.     

Long-bone fractures in llamas: six cases (1993-1998)

OBJECTIVE: To determine clinical and radiographic findings, treatment, and outcome for llamas with long-bone fractures. DESIGN: Retrospective study. ANIMALS: 6 llamas. PROCEDURE: Medical records of llamas admitted between 1993 and 1998 because of long-bone fractures were reviewed. Data collected included age, sex, type of fracture, method of fracture repair, and postoperative complications. The Fisher exact test was used to compare age and sex of the llamas with long-bone fractures with those of the hospital population of llamas. All owners were contacted by telephone to determine perceived postoperative problems and whether the llamas were able to perform as expected. RESULTS: Mean age was 160.8 days (range, 23 to 365 days). There was 1 male and 5 females. Fractures were more likely to occur in young llamas (< or = 1 year old) than in adults. Five of the fractures were attributed to traumatic episodes. Long bones affected included the tibia (n = 2), radius (2), femur (1), and humerus (1). Internal fixation with lag screws, plating, or both was performed on fractures of all llamas except 1; that llama was treated by use of confinement to a stall. None of the llamas had intraoperative complications, but postoperative complications were reported in 2 llamas. All fractures healed eventually, and clients were pleased with outcomes. CONCLUSIONS AND CLINICAL RELEVANCE: Long-bone fractures in llamas are uncommon. Several types of long bone fractures can be successfully repaired by use of internal fixation, resulting in few complications and minimal convalescent time.     

Treatment of long bone fractures in South American camelids: 5 cases

An adult llama and four alpacas were referred with long bone fractures. The llama presented with a closed, comminuted fracture of the right metatarsal bones. Two of the alpacas presented with comminuted fractures of the proximal radius. One fracture was closed and one was open. One alpaca had a closed, comminuted fracture of the distal radius, and the final alpaca had a closed, oblique fracture of the metatarsus. A diagnosis was made in each animal on the basis of clinical examination and radiographs. All fractures were managed by open reduction and internal fixation using selective placement of lag screws and dynamic compression plates. Four animals made uneventful recoveries and no long-term complications were encountered. One alpaca was re-admitted for plate failure and non-union of the fracture 5 weeks after surgery. The plate and screws were removed and a transfixation cast was applied. The fracture healed, however the alpaca showed signs of radial nerve paralysis after the cast was removed. With confinement in a small yard, full function gradually returned to the leg over the ensuing 4 months. Using techniques recommended in other species, South American camelids are suitable candidates for long bone fracture repair using open reduction and internal fixation.     

Surgical repair of femoral fractures in New World camelids: five cases (1996-2003)

Five New World camelids were admitted to the Western College of Veterinary Medicine between 1996 and 2003 for evaluation of femoral fractures. There were three alpacas and two llamas. Four of the animals were female and three were less than 3 months of age. Fracture configurations consisted of distal physeal fractures (three), a comminuted diaphyseal/metaphyseal fracture, and a transverse diaphyseal fracture. Fractures were diagnosed with a combination of physical examination and radiographs in all cases. All five fractures were repaired with internal fixation and three animals were discharged from the hospital with fractures that healed. One cria underwent successful internal fixation but died from pulmonary oedema during recovery from anaesthesia. Postoperative complications were rare and limited to inadequate fracture stability in one alpaca and prolonged recovery to weight bearing in another. One llama with a comminuted metaphyseal fracture, repaired with a 4.5 mm dynamic compression plate, subsequently had catastrophic failure of the bone 17 days after surgery. Overall the clients were pleased with the outcome of discharged animals. Although femoral fractures are considered rare, they pose a unique opportunity for the large animal veterinarian to successfully achieve fracture union with the aid of internal fixation.     

Complications after orthopedic surgery in alpacas and llamas: 24 cases (2000-2006)

Objective— To report complications associated with orthopedic surgery in alpacas and llamas.
Study Design— Retrospective study.
Animals— Alpacas (n=18) and llamas (n=6) that orthopedic surgery using internal or external fixation.
Methods— Medical records (January 2000–December 2006) and radiographs were reviewed and owners contacted for follow-up information for alpacas and llamas that had orthopedic surgery involving internal or external fixation. Fourteen camelids had internal fixation, 7 had external fixation, and 3 had a combination of internal and external fixation.
Results— Twenty-two animals (92%) were discharged after surgery (mean hospitalization, 15 days). Of 20 animals with ≥1 year follow-up information, 18 were alive (82%). Postoperative complications related to fracture healing, infection, soft tissue structures, or joints occurred in 21 camelids (87%). Thirteen animals returned to their intended use, 4 animals returned to breeding but not their intended use, 4 were euthanatized, and 3 were only able to be used as pets.
Conclusions— Fixation type (internal, external) did not have any significant effect on complications involving fracture healing, infection, soft tissue structures, or chronic lameness. Camelids with open fractures were more likely to have complications associated with fracture healing, repair, and infection than closed fractures.
Clinical Relevance— Complications after orthopedic surgery in alpacas and llamas are more common than previously reported and may result in chronic lameness or prevent return to their intended use.     

Prevalence of neoplasia in llamas and alpacas (Oregon State University, 2001-2006).

Prevalence and type of neoplastic disease were determined in 551 camelid submissions (368 alpacas [Lama pacos], 180 llamas [Lama glama], and 3 cases in which species was not identified) over a 5-year period. Forty neoplasms were identified in 38 animals (6.9%). Prevalence of neoplasia in llamas was higher (11%) than in alpacas (4.9%). Mean age of camelids with neoplasia was 9.42 +/- 4.9 years. Mean age of alpacas with neoplasia (5.48 +/- 3.7 years) was significantly less than of llamas with neoplasia (12.53 +/- 3.2 years; P < 0.001). Cutaneous and mucocutaneous fibroma/fibropapilloma was most common (10 animals), followed by cutaneous and mucocutaneous squamous cell carcinoma (6 animals), disseminated lymphoma (5 animals), and fibrosarcoma (4 animals). Four of 5 animals with lymphoma were alpacas, aged 0.21 to 4 years. Lymphoma occurred in 1 aged llama (15 years). Disseminated carcinoma and adenocarcinoma occurred in 4 llamas and 2 alpacas, and included biliary (2), gastrointestinal (2), mammary gland (1), and unknown (1) origin. Mean age of camelids with any type of carcinoma or adenocarcinoma (12.36 +/- 2.8 years) was significantly greater than that of camelids with lymphoma (4.24 +/- 6.2 years; P = 0.02). Results indicate that neoplasia is relatively common in camelids and that there are differences between llamas and alpacas as regards prevalence of neoplasia, tumor types, and age at diagnosis.     

Repair of femoral capital physeal fractures in 12 cattle

OBJECTIVE: To document signalment, clinical signs, and long-term outcome of surgical treatment for femoral capital physeal fractures in cattle. STUDY DESIGN: Retrospective study. Animals-Twelve cattle with femoral capital physeal fractures. METHODS: Cases were identified by a search of radiographic records. Historical, diagnostic, surgical, and outcome data were collected from the medical records. Owners were contacted for follow-up information by telephone. RESULTS: Fractures were repaired by screws inserted in lag fashion in 4 animals and by use of multiple intramedullary pins in 8 animals. Six of 12 animals required repeat surgery to reposition screws or pins. Nine animals were considered successfully treated at discharge. Six months after surgery, 6 of 11 animals for which follow-up was obtained were still sound. At 12 months, 4 of 4 animals alive were still sound. Animals that bore weight earliest postoperatively were more likely to have a successful outcome. Animals <12 months of age had better outcomes than animals >12 months of age. CONCLUSIONS: Prognosis for serviceable soundness is good in cattle <12 months of age and fair in animals >12 months of age after surgical repair of femoral capital physeal fracture by stacking intramedullary pins or by screws inserted in lag fashion. CLINICAL RELEVANCE: Surgical repair of femoral capital physeal fracture is most successful in younger cattle and can result in productive animals.     

Evaluation of intraocular pressure in eyes of clinically normal llamas and alpacas

OBJECTIVE: To estimate intraocular pressure (IOP) in eyes of healthy camelids, using applanation tonometry. ANIMALS: The eyes of 34 camelids (16 llamas [Lama glamal and 18 alpacas [L. pacos]) that did not have major abnormalities of the ocular surface or intraocular abnormalities. PROCEDURE: Tonometry measurements were obtained from each eye 3 times during a 24-hour period. Each measurement was the mean of several corneal applanations obtained by use of an applanation tonometer. Data were analyzed, using an ANOVA for a repeated-measures design. RESULTS: Mean (+/- SEM) IOP of llamas and alpacas was 13.10+/-0.35 and 14.85+/-0.45 mm Hg, respectively. Range of IOP was 7 to 18 mm Hg for llamas and 11 to 21 mm Hg for alpacas. Mean IOP of llamas was significantly less than the mean IOP of alpacas. Significant differences in IOP were not detected between the right and left eye of animals. Significant differences in IOP were not attributed to sex, age, or time of measurement within llamas or alpacas. CONCLUSIONS AND CLINICAL RELEVANCE: Establishing the mean and range of IOP of clinically normal llamas and alpacas provides a frame of reference that is important for use in a complete ophthalmic examination of camelids, which can assist clinicians in the diagnosis of glaucoma and uveitis. Reasons for the difference in mean IOP between llamas and alpacas are unknown. Although the difference may be unimportant clinically, this finding reiterates the fact that caution must be used when extrapolating IOP among species.     

A Lateral Approach for Screw Repair in Lag Fashion of Spiral Third Metacarpal and Metatarsal Medial Condylar Fractures in Horses

Objective— To describe a lateral approach for screw fixation in lag fashion of simple spiral medial condylar fractures of the third metacarpus/metatarsus (MC3/MT3).
Study Design— Case series.
Animals— Thoroughbred racehorses (n=9).
Methods— Nondisplaced medial MC3/MT3 condylar fractures (3 thoracic, 6 pelvic limbs), with mean length 126 mm (range, 91–151 mm) were repaired by internal fixation, under general anesthesia, using multiple 4.5 mm cortical screws inserted in lag fashion from the lateral aspect of the limb, using radiographic or fluoroscopic guidance. Horses were recovered from anesthesia in half-limb casts; 7 unassisted and 2 using a rope-recovery system. Horses had 2 months box rest, 1 month in-hand walking, and follow-up radiographic examination at 3 months.
Results— Horses recovered uneventfully from anesthesia. Five horses raced; 1 returned to training, was persistently lame, and was retired to stud; 2 were retired directly to stud; and 1 horse was lost to follow-up.
Conclusions— MC3/MT3 medial condylar fractures were successfully repaired by screws inserted n lag fashion form the lateral aspect.
Clinical Relevance— Use of a lateral approach to medial condylar MC3/MT3 fractures allows screw insertion perpendicular to the fracture plane without interference with palmar/plantar soft tissue structures or from the splint bones. Although repair was performed under general anesthesia, the technique should be adaptable to application in standing horses.     

Genotypic characterization of Chilean llama (Lama glama) and alpaca (Vicugna pacos) pestivirus isolates

Llamas and alpacas are domesticated South American camelids (SACs) important to ancestral population in the Altiplano region, and to different communities worldwide where they have been introduced. These ungulates have shown to be susceptible to several livestock viral pathogens such as members of the Pestivirus genus, in particular Bovine Viral Diarrhea (BVDV), but there is little data available on Pestivirus infections in SACs. In this study we aimed to detect and identify Pestivirus genotypes and subgroups infecting SACs in both wild and confined environments. Samples were collected from 136 llamas and 30 alpacas from different areas in the Chilean Altiplano (wild animals), and from 22 llamas and 26 alpacas diagnosed as Pestivirus positive from the Metropolitana region in Chile (confined animals). Seroneutralization tests showed titers lower than 2 in all 166 samples from Chilean Altiplano. These samples were also negative to BVDV isolation, indicating that these animals have not been exposed to Pestivirus. After reactivation of positive samples from the Metropolitana region, the 5′ non-codifying region (5′NCR) and E2 glycoprotein were amplified by RT-PCR from the Pestivirus genome. Viral sequences were pairwise compared and phylogenetic trees were constructed. The 5′NCR analysis showed that all 12 sequenced isolates belonged to BVDV-1. Of particular interest, isolates from eight llama and two alpaca were BVDV-1j and two alpacas were BVDV-1b. In agreement with these results, E2 phylogenetic analysis rendered a similar grouping indicating that all 16 isolates belong to BVDV-1. However, the lower availability of E2 sequences determines the creation of a smaller number of sub-groups than the 5′NCR sequences. Based on the E2 sequences, the 5′NCR BVDV 1j group consisting of all the llamas and 3 alpacas are completely included in the E2 BVDV 1e group. Due to the universal availability of the 5′NCR segment, we propose the classification of these Chilean llamas and alpacas Pestivirus isolates as BVDV 1j and BVDV 1b respectively. Thus, this is the first time BVDV-1j is obtained in SACs. In addition, these results indicate Pestivirus infection in llamas and alpacas is associated with bovine population as genotypes and sub-groups are the same as those affecting Chilean livestock.     

What is your diagnosis? Esophageal hiatal hernia.

A 14-month-old Arabian colt was admitted for treatment of an articular fracture of the supraglenoid tubercle of the right forelimb. Successful repair was achieved by use of three 5.5-mm cortical screws placed in lag fashion across the fracture line. In other reports of supraglenoid tubercle fractures in horses, investigators have preferred conservative management or surgical removal of the fragment, because of limited success with internal fixation. Use of three 5.5-mm screws placed in lag fashion may offer an alternative method of treatment in selected cases of supraglenoid tubercle fractures.     

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.     

Short incomplete sagittal fractures of the proximal phalanx in ten horses not used for racing

Objective— To describe short incomplete sagittal fractures of the proximal phalanx (type Ia P1 fractures) in horses not used for racing and report outcome.
Study Design— Retrospective study.
Animals— Horses (n=10) with type Ia P1 fractures.
Methods— Retrieved data of horses with type Ia P1 fractures were signalment, history and results of orthopedic examination. Radiographs were re-evaluated for position and length of the fracture line, presence of osteoarthritis or subchondral cystic lesions (SCL), periosteal new bone formation and subchondral sclerosis. Conservative treatment (n=4) included box confinement for 2 months followed by 1 month of hand walking. Surgical therapy (n=6) consisted of internal fixation by screws inserted in lag fashion in 5 horses. Concurrent SCL were debrided by curettage via a transcortical drilling approach. In 1 horse, only SCL curettage but not internal fixation was performed. Outcome was assessed on a clinical and radiographic follow-up examination in all horses.
Results— Mean follow-up time was 27 months (median, 13.5 months; range, 9 months to 9 years). All horses treated with internal fixation were sound at follow-up and had radiographic fracture healing. Of the 4 horses managed conservatively, 3 remained lame and only 1 horse had radiographic evidence of fracture healing. Catastrophic fracture propagation occurred in 2 horses not treated by internal fixation, 20 and 30 months after diagnosis, respectively.
Conclusions— Horses with a type Ia P1 fracture treated surgically had a better outcome than those managed conservatively and lack of fracture healing seemingly increases the risk of later catastrophic fracture.
Clinical Relevance— Surgical repair of type Ia P1 fractures should be considered to optimize healing and return to athletic use.     

Long-bone fractures in llamas and alpacas: 28 cases (1998–2008)

Treatment and outcome of camelids with long-bone fractures are described. Medical records (1998–2008) of camelids (n = 28) with long-bone fractures were reviewed for signalment, time to presentation, fracture type, method of repair, duration of hospitalization, and post-operative complications. Follow-up information was obtained via telephone interviews with owners. Mean age and weight at presentation were 3.4 years and 56.3 kg, respectively. Twenty-six fractures were treated with internal fixation (n = 11), external fixation (n = 10), combination of internal and external fixation (n = 3), amputation (n = 1), and external fixation followed by amputation (n = 1). Long-term follow-up information was obtained for 19 of the 26 animals. The post-operative complication rate was 23% and owner satisfaction was high. Animals with open fractures were more likely to experience complications. Internal fixation was associated with superior alignment and outcome. Internal fixation techniques should be recommended for camelids.     

Determination of electrocardiographic parameters in healthy llamas and alpacas

OBJECTIVE: To determine electrocardiographic parameters in healthy llamas and alpacas. ANIMALS: 23 llamas and 12 alpacas. PROCEDURE: Electrocardiography was performed in nonsedated standing llamas and alpacas by use of multiple simultaneous lead recording (bipolar limb, unipolar augmented limb, and unipolar precordial leads). RESULTS: Common features of ECGs of llamas and alpacas included low voltage of QRS complexes, variable morphology of QRS complexes among camelids, and mean depolarization vectors (mean electrical axes) that were directed dorsocranially and to the right. Durations of the QT interval and ST segment were negatively correlated with heart rate. CONCLUSIONS AND CLINICAL RELEVANCE: ECGs of acceptable quality can be consistently recorded in nonsedated standing llamas and alpacas. Features of ECGs in llamas and alpacas are similar to those of other ruminants. Changes in the morphology of the QRS complexes and mean electrical axis are unlikely to be sensitive indicators of ventricular enlargement in llamas and alpacas.     

Antibody responses in New World camelids with tuberculosis caused by Mycobacterium microti

Antibody responses in New World camelids (NWC) infected with Mycobacterium microti were studied by two serological methods, multiantigen print immunoassay (MAPIA) and lateral-flow-based rapid test (RT). Serum samples were collected during 2004-2006 from 87 animals including 1 alpaca and 7 llamas with confirmed or suspected M. microti infection, 33 potentially exposed but clinically healthy animals from known infected herds, and 46 control NWC from herds where infection had not been previously diagnosed. The serological assays correctly identified infection status in 97% (MAPIA) or 87% (RT) cases. In three llamas with confirmed M. microti infection and one llama with gross pathology suggestive of disease, for which multiple serum samples collected over time were available, the antibody-based tests showed positive results 1-2 years prior to the onset of clinical signs or being found dead. In MAPIA, MPB83 protein was identified to be an immunodominant serological target antigen recognized in NWC infected with M. microti. With the limited number of animals tested in this study, the serological assays demonstrated the potential for convenient, rapid, and accurate diagnosis of M. microti infection in live llamas and alpacas.     

Camelid mucoutaneous fibropapillomas: clinicopathologic findings and association with papillomavirus

Five camelid mucocutaneous fibropapillomas with histologic features similar to equine sarcoids were diagnosed. They were characterized by a dermal fibroblastic proliferation and overlying, often ulcerated hyperplastic epidermis with thin rete pegs extending down into the dermis. Two of the tumors came from llamas and three from alpacas. Four of the animals were 6-year-old females. The fifth was a 6-year-old castrated male. The fibropapillomas were located on the nose, lip, and cheeks. One of the llama tumors waxed and waned before surgery and recurred and spread after surgery. None of the other tumors recurred. All five tumors were positive for papillomavirus (PV) DNA by polymerase chain reaction testing. Nucleotide sequence analysis of the PCR product from one of the llama fibropapillomas confirmed a unique PV. This report provides the microscopic and clinical features of fibropapillomas in camelids as well as evidence for a PV etiology.     

Fracture repair with transfixation pins and fiberglass cast in llamas and small ruminants

Transfixation pinning with fiberglass casting is an effective and adaptable method of longbone fracture fixation in llamas and small ruminants. Treatment of fractures in 7 limbs of 4 llamas and 2 small ruminants with this technique are described. Steinmann pins are placed transcortically proximal, and if necessary, distal to the fracture. The pin ends and limb are encased in fiberglass cast material. The cast is strong enough in animals of this size to eliminate the need for external frames or connecting bars. Severely comminuted fractures and fractures near joints are especially suited to fixation with this technique. Complications encountered in these cases included loosening of pins and one delayed union. All fractures healed to permit full use of the limb.     

Density of corneal endothelial cells, corneal thickness, and corneal diameters in normal eyes of llamas and alpacas

OBJECTIVE: To determine density of corneal endothelial cells, corneal thickness, and corneal diameters in normal eyes of llamas and alpacas. ANIMALS: 36 llamas and 20 alpacas. PROCEDURE: Both eyes were examined in each camelid. Noncontact specular microscopy was used to determine density of corneal endothelial cells. Corneal thickness was measured, using ultrasonographic pachymetry. Vertical and horizontal corneal diameters were measured, using Jameson calipers. RESULTS: Values did not differ significantly between the right and left eyes from the same camelid. There was no significant effect of sex on density of corneal endothelial cells or corneal thickness in either species. Mean density of endothelial cells was 2,669 cells/mm2 in llamas and 2,275 cells/mm2 in alpacas. Density of endothelial cells decreased with age in llamas. Polymegathism was observed frequently in both species. Mean corneal thickness was 608 microm for llamas and 595 microm for alpacas. Corneal thickness and density of endothelial cells were negatively correlated in llamas. Older (> 36 months old) llamas had significantly larger horizontal and vertical corneal diameters than younger llamas, and older alpacas had a significantly larger vertical corneal diameter than younger alpacas. CONCLUSIONS AND CLINICAL RELEVANCE: Density of corneal endothelial cells is only slightly lower in camelids than other domestic species. Density of endothelial cells decreases with age in llamas. Age or sex does not significantly affect corneal thickness in normal eyes of llamas and alpacas. Specular microscopy is useful for determining density of corneal endothelial cells in normal eyes of camelids.