Use of reconstruction plates for repair of acetabular fractures in 16 dogs

Acetabular fractures in 16 dogs were repaired using reconstruction plates. Notches cut into the plate permitted contouring in three planes to facilitate accurate articular reconstruction. There were three cranial, seven central, one caudal and five comminuted acetabular fractures. These acetabular fractures were invariably associated with multiple pelvic fractures. Repair of nonacetabular fracture/luxation was indicated in 10 cases. Follow-up information was available for 15 dogs, of which 12 (80 per cent) had an excellent or good outcome. Fracture configuration and the presence of multiple fractures did not influence prognosis. Two dogs died suddenly, late in convalescence, but the cause of death was not established.     

Augmentation of the transverse acetabular ligament in canine caudoventral hip luxation.

Open surgical fixation was performed on four hip joints in three dogs who were suffering from caudoventral hip luxations for which closed reduction had previously failed. Stabilization of the joint was achieved with a ventral coxofemoral approach, which augmented the function of the transverse acetabular ligament using a sling implant through a bone tunnel (n = 1), a sling implant around two pelvic screws (n = 1), or an internal fixator plate (n = 2). Transverse acetabular ligament augmentation resulted in successful joint stabilization in all cases, and should be considered for the surgical reduction of caudoventral hip luxations in dogs. The use of an internal fixator plate, while preserving soft-tissue blood supply and resulting in minimal to no long-term arthritic changes, may provide an optimal outcome.     

Retrospective evaluation of fixation complications of 49 pelvic osteotomies in 36 dogs

Thirty-six dogs undergoing 49 pelvic osteotomies (POs) stabilised either by manually twisted dynamic compression plates (DCPS; n= 29) or canine pelvic osteotomy plates (CPOPS; n = 20) were retrospectively reviewed. Postoperative radiographs were available for all POs and 36 had additional radiographic follow-up. Pelvic osteotomies with CPOPs were more likely to have three screws placed in the sacrum while DCPs were associated with none, one or two screws in the sacrum. There was no difference in the postoperative sagittal alignment of the acetabular segments for POs with DCPs or CPOPs. Screw loosening was the most common complication (n = 13/36, 36 per cent), usually involving screws in the ilial segment. On follow-up radiographs, medial displacement of the acetabular segment was most frequently associated with screw loosening and plate bending. Medial displacement of the acetabular segment caused apparent pelvic narrowing on radiographs, more pronounced in dogs with bilateral POs, but clinical problems were not reported.     

Results of Screw/Wire/Polymethylmethacrylate Composite Fixation for Acetabular Fracture Repair in 14 Dogs

Objective- To assess the clinical results in dogs with acetabular fractures stabilized using a screw-wire-polymethylmethacrylate (SWP) composite fixation.
Study Design- A retrospective study of client-owned dogs with acetabular fractures.
Animals- Fourteen dogs ranging in age from 4 to 95 months (mean, 34 ±25 months; median, 25 months) and body weight from 8 to 39 kg (mean, 25 ±6 kg; median, 27 kg).
Methods- Medical records and radiographs were retrospectively evaluated to determine location of the fracture, presence of preexisting degenerative joint disease, accuracy of fracture reduction and complications associated with surgery. Long-term results were evaluated by subjective assessment of lameness, elicitation of pain and/or crepitus on manipulation of the coxofemoral joint, measurements of pelvic limb circumference, coxofemoral joint goniometric measurements, and radiographic evaluation.
Results- Fracture reduction was considered anatomic in 13 dogs. At the time of the last follow-up evaluation (mean, 347 ±261 days; median, 380 days) 10 dogs were sound on the affected limb, three dogs had a subtle weight-bearing lameness of the affected limb, and the remaining dog had a consistent non-weight-bearing lameness of the affected limb. Mild (n = 10) or moderate (n = 1) degenerative changes of the affected coxofemoral joint attributed to the acetabular fracture and its repair were noted on the follow-up radiographs in 11 dogs. Limb circumference of the affected limb ranged from -8.2% to +10.8% (mean, -0.8 ±4.2%; median, -0.7%) of the contralateral limb.
Conclusions- The SWP composite fixation consistently maintained anatomic reduction, was associated with few complications, and yielded satisfactory clinical results.
Clinical Relevance- The SWP composite fixation technique would seem to be an acceptable means of stabilizing acetabular fractures in dogs.     

Reduction and temporary stabilization of acetabular fractures using ASIF mandibular reduction forceps: technique and results using plate fixation in 25 dogs

OBJECTIVE: To report the results of acetabular fracture fixation in 25 dogs in which a specialized forceps (ASIF mandibular reduction forceps, Synthes USA, Paoli, PA) was used to obtain fracture reduction and stabilization. STUDY DESIGN: A retrospective clinical study. ANIMAL POPULATION: Twenty-five client-owned dogs with traumatic acetabular fractures. METHODS: The mandibular reduction forceps (MRF) use a screw on each side of the fracture to attach the clamp directly to the bone and permit direct manipulation of the fragments. Medical records from 25 dogs with acetabular fractures were reviewed to determine the effectiveness of this technique in obtaining, and then maintaining, fracture reduction while a plate was being applied. RESULTS: Clinical results were considered successful in 24 of 25 dogs; the small size of 1 dog prevented application of the MRF. The final reduction and fixation of the fractures was evaluated as anatomic in 17 dogs, near-anatomic in 6 dogs, and nonanatomic in 1 dog. CONCLUSIONS AND CLINICAL RELEVANCE: Application of the MRF is an effective technique for aiding the reduction of acetabular fractures in dogs. It maintains reduction while simultaneously permitting unimpeded access to the dorsal acetabular rim, thus facilitating accurate contouring of a plate. Accurate reduction and rigid fixation of articular fractures is essential to prevent secondary osteoarthritis.     

The Effects of Plate Type, Angle of Ilial Osteotomy, and Degree of Axial Rotation on the Structural Anatomy of the Pelvis

Unilateral triple pelvic osteotomy was performed with three variations in technique on canine cadaver pelves. The following variables were studied: the angle of the ilial osteotomy (perpendicular to the long axis of the ilium and 10d?, 20d?, and 30d? off perpendicular); the degree of axial rotation (20d?, 30d?, and 45d?); and the type of fixation (canine pelvic osteotomy plate [CPOP] or a 2.7-mm dynamic compression plate [DCP]). Structural changes measured were the pelvic inlet and acetabular area, interischiatic tuberosity distance, and degree of acetabular version. Means and standard error of the means were determined for all pelvic measurements and were analyzed by three-way analysis of variance (P < .05). As the axial rotation increased from 20d? to 45d? an ilial osteotomy angled 10d?, 20d?, or 30d? resulted in a significantly greater decrease in the pelvic inlet area and significantly less deviation of the interischiatic tuberosity distance and degree of acetabular version from normal than an osteotomy directed perpendicular to the long axis of the ilium. Compared with the CPOP, as the axial rotation increased from 20d? to 45d?, the DCP resulted in a significantly greater decrease in the pelvic inlet area, an increase in the interischiatic tuberosity distance and degree of acetabular version, and less of an increase in the acetabular area. The results of this study suggest that to maximize dorsal acetabular coverage, while minimizing disruption of normal pelvic architecture, a CPOP and an ilial osteotomy angled 10d? to 30d? are preferred for all degrees of axial rotation.     

Comparison of the Diagnostic Value of Ultrasonography and Standing Radiography for Pelvic–Femoral Disorders in Horses

Objective— To assess agreement between ultrasonography (transcutaneous and transrectal) and standing radiography in horses with fractures in the pelvic region and disorders of the coxofemoral joint.
Study Design— Case series.
Animals— Warmblood horses (n=23) and 2 ponies.
Methods— Medical records (1999–2008) of equids with pelvic or coxofemoral disorders that had pelvic radiography and ultrasonography were retrieved and results of both techniques compared.
Results— Radiography and ultrasonography each identified equal numbers of fractures of the tuber coxa (n=4), ilial shaft (2), ischium (3), femoral neck (2), and osteoarthritis/osis of the coxofemoral joint (6). Fractures of the ilial wing (4) were only identified by ultrasonography not by standing radiography. Of 9 acetabular fractures, 3 were identified on radiographs only, 5 were identified with both modalities. One pubic fracture was identified using ultrasonography and radiography. One acetabular and 1 pubic fracture were only diagnosed on necropsy.
Conclusions— We found reasonable agreement (73%; 24/33) between ultrasonography and standing radiography for diagnosis of pelvic–femoral disorders. Ultrasonography was more useful for ilial wing fractures and radiography for acetabular fractures.
Clinical Relevance— Ultrasonography is a rapid, safe imaging technique for detecting disorders of the pelvic region with a high diagnostic yield and is a preferred initial approach in horses with severe hindlimb lameness.     

Feline Ilial Fractures: A Prospective Study of Dorsal Plating and Comparison with Lateral Plating

Objective— To (1) report a technique for repair of feline ilial fractures using a dorsally applied bone plate and (2) compare outcome with cats treated by a lateral plate.
Study Design— Prospective study.
Animals— Cats (n=10) with iliac fractures.
Methods— Cats with ilial fractures (January 2005–December 2006) were treated by application of a dorsally applied bone plate. Immediate postoperative radiographs were compared with those taken 4–6 weeks later to assess screw loosening, screw purchase, and pelvic canal narrowing. Owners were contacted for medium-term (>3 month) follow-up. Data were compared with a report of outcome after lateral plating (LP) in 21 cats.
Results— Mean (± SD) screw purchase (89 ± 11 mm) was significantly greater ( P <.01) with a dorsal plate compared with a lateral plate (33 ± 8 mm). Significantly more screws ( P <.01) were used with a dorsal plate (median, 7) compared with a lateral plate (median, 6). Significantly less postoperative pelvic canal narrowing developed in the dorsal plating group between postoperative and 4–6-week follow-up radiography compared with the LP group (2% versus 15%, P <.01).
Conclusion— Dorsal plating of feline ilial fractures results in significantly less screw loosening and pelvic canal narrowing at 4–6 weeks after surgery compared with LP.
Clinical Relevance— Dorsal plating of feline iliac fractures may reduce complications associated with pelvic canal narrowing such as constipation and megacolon.     

普通T形骨板治疗玩具犬桡尺骨远端骨折的手术效果

旨在评估普通T形骨板内固定治疗玩具犬桡尺骨远端骨折的临床效果及并发症。回顾了在中国农业大学动物医院采用开放式复位和普通T形骨板内固定治疗桡尺骨远端骨折的玩具犬的病历记录,并对这些病例进行回访。入选病例满足：体重不超过7 kg;骨折位置位于前臂远端(远端骨段与桡骨长度比值<0.25);回访时间>12个月;病例信息记录完整。结果表明：共纳入29只犬的29例桡尺骨远端骨折,26例(89.7%)术后无跛行,3例(10.3%)术后勉强可见跛行。未发生严重并发症,轻微并发症的发生率是20.7%(n=6)。普通T形骨板内固定能有效治疗玩具犬桡尺骨远端骨折,临床效果良好,无严重并发症。     

Early detection and treatment of screw loosening in triple pelvic osteotomy

OBJECTIVE: To detect early screw loosening in triple pelvic osteotomy (TPO) and to evaluate the efficacy of retightening using fluoroscopic guidance and minimally invasive surgery to maintain acetabular alignment and achieve bone healing. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Sixteen dogs that had TPO. METHODS: Dogs (16) had TPO (21) by using pre-angled plates secured with 3.5 and 4.0 mm screws, with ischiatic or iliac cerclage, for osteosynthesis. In all but 1 TPO at least 1 screw was inserted into the sacral body (43 screws). The mean radiographic screw length inserted in the sacrum was 10.2 mm, and the mean percent sacral engagement was 22%. Dogs were examined clinically and radiographically immediately postoperatively, and at 10, 30, 60, and 90 days to evaluate screw position. Loose screws were retightened through stab incisions using fluoroscopy to locate the screw. RESULTS: TPO was performed without operative complications. At 10 days, 12 TPOs (57%; 11 dogs) had loose screws primarily located in the cranial aspect of the plate. This represented 20% (25) of the inserted screws. In 5 dogs, screw loosening resulted in medial rotation of the acetabular segment. All loose screws were retightened; 3 screws loosened again in 2 dogs and were detected at 60 days. However, the osteotomies healed with the planned acetabular rotation without further intervention. Screw tightening corrected the acetabular segment displacement. Screws correctly seated at 10 days did not subsequently loosen. Clinical and radiographic outcome was judged excellent in all dogs. CONCLUSION: Loose screws in TPO plates can be identified by 10 days postoperatively and retightened using fluoroscopic guidance to achieve acetabular realignment and healing without need for further surgery. CLINICAL RELEVANCE: Postoperative radiographic evaluation of screw position at 10 days after TPO is recommended to detect loose screws. Retightening loose screws should be considered as an alternative to TPO revision or confinement, especially in immature dogs.     

Composite fixation of comminuted ilial wing fractures in cats: three cases

CLINICAL SUMMARY: The surgical repair of comminuted ilial wing fractures (comprising a long oblique fracture with ventral multiple fragmentation) in three cats using composite internal fixation is reported. The technique comprised the use of pins, screws, wire and polymethylmethacrylate. All cases had an excellent outcome with uneventful bone healing. One case had a very mild reduction in pelvic canal diameter postoperatively. There was no evidence of implant loosening or migration in any cat on follow-up radiographs. PRACTICAL RELEVANCE: This technique provided a quick and highly adaptable means of stabilising this fracture configuration, as well as restoring pelvic symmetry, when limited buttressing support and bone stock were available cranial and ventral to the acetabulum. This method of fixation may have biomechanical advantages over lateral or dorsal plating techniques for this particular type of fracture configuration.     

Open reduction and internal fixation with a locking plate for the treatment of a femoral fracture in a ferret (Mustela putorius furo)

Long bone fractures in ferrets (Mustela putorius furo) are usually traumatic in etiology, and the femur is commonly affected [1]. A 4-year-old, castrated male ferret was examined for acute, non-weight-bearing lameness of the left pelvic limb after presumably falling from its elevated enclosure. Clinical and radiographic evaluation showed a complete, comminuted fracture of the proximal diaphyseal third of the left femur. Open reduction and internal fixation (ORIF) of the left femoral fracture was performed with cerclage wires and a 1.5 mm locking compression plate with associated locking screws. Anatomic reconstruction was achieved, and postoperative radiographs confirmed appropriate fracture fragment apposition, limb alignment, and implant placement. At 9 weeks postoperatively, the ferret was ambulatory with no evidence of lameness, and complete radiographic union was noted. This is the first published report of the use of a bone plate for femoral fracture stabilization in a ferret. Bone plates, including locking plates, could be considered for long bone fracture stabilization in ferrets as an alternative to other methods.     

Treatment of severely comminuted diaphyseal fractures in the dog, using standard bone plates and autogenous cancellous bone graft to span fracture gaps: 11 cases (1979-1983)

Severely comminuted diaphyseal fractures in 11 dogs were repaired with standard bone plates that spanned a fracture gap filled with autogenous cancellous bone graft. Five dogs had closed injuries, 4 dogs had open fractures, and 2 dogs had infected nonunion fractures for which previous attempts at internal pin fixation had failed. A second autogenous cancellous bone graft was performed in 3 of the dogs during the healing period. The technique was successful in all dogs. The technique was considered a versatile and relatively simple alternative, compared with meticulous small fragment reconstruction and cortical bone allografts.     

普通骨板内固定治疗玩具犬桡尺骨骨折的回顾性分析

本试验旨在评估普通骨板内固定治疗玩具犬桡尺骨骨折的临床效果及并发症。回顾了中国农业大学动物医院使用普通骨板（圆洞骨板或兽医可剪裁骨板）开放式复位和内固定治疗桡尺骨骨折的玩具犬的病历记录，并对这些病例进行回访。入选病例满足以下条件：体重不超过7 kg；回访时间大于12个月；病例信息记录完整。结果显示：共纳入63只犬的64例桡尺骨骨折，49例（76.6%）术后无跛行，7例（10.9%）术后勉强可见到跛行，6例（9.3%）存在轻度跛行，2例（3.1%）存在中度跛行。严重并发症的发生率是6.3%，轻微并发症的发生率是27%。试验表明，普通骨板内固定能有效治疗玩具犬桡尺骨骨折，该方法临床效果良好，且严重并发症发生率低。     

Use of T-plates for the stabilisation of supra-cotyloid ilial fractures in 18 cats and five dogs.

The use of the AO (Arbeitgemeinschaft für Osteosynthesenfragen) veterinary T-plates (1.5/2 mm and 2.7/3.5 mm) for stabilisation of supracotyloid ilial fractures in 18 cats and five dogs was evaluated in a retrospective study. The distal fragment from the coxofemoral joint ranged from 0.5 cm to 1 cm with a mean distance of 0.85 cm. Twenty out of 23 (87%) ilial fractures healed in original alignment. Three out of 23 (13%) animals had two loosened screws of the distal fragment with fracture malunion and minor medial displacement of the acetabular fragment. Screw or plate breakage was not observed and the implants were not removed. The clinical result was 'excellent' for 18 animals (78%), 'good' for four animals (17%), and 'poor' for one animal (5%). The use of T-plates permits good correction of supracotylo?d fractures with minimal approach and minimizes post-operative complications.     

Fluoroscopically Guided Closed Reduction and Internal Fixation of Fractures of the Lateral Portion of the Humeral Condyle: Prospective Clinical Study of the Technique and Results in Ten Dogs

OBJECTIVE: To report a technique for fluoroscopically guided closed reduction with internal fixation of fractures of the lateral portion of the humeral condyle (FLHC) and determine the long-term results in 10 clinical cases. STUDY DESIGN: Prospective clinical case study. ANIMALS: Ten dogs with 11 fractures. METHODS: Fractures of the lateral portion of the humeral condyle were stabilized with transcondylar screws and Kirschner wires. Closed reduction and implant placement were achieved using intraoperative fluoroscopic guidance. After fracture repair, postoperative radiographs were evaluated for articular alignment and implant placement. Dogs were evaluated after surgery by means of lameness scores, elbow range of motion (ROM), radiographic assessment, and owner evaluation of function. RESULTS: Postoperative reduction was considered anatomic in 6 fractures with all other fractures having <1.5 mm of malreduction. Follow-up was available for 9 patients from 9 to 21 months after surgery. All of the fractures had healed. One minor (wire migration) and one major (implant failure) complication occurred. Mean lameness scores were 0 (n = 6), 0.5 (n = 2), and 1 (n = 1) at the time of final follow-up. No significant differences were found in follow-up ROM values between affected and unaffected elbows. All of the dogs in this study regained 90-100% of full function, based on owner assessment. CONCLUSIONS AND CLINICAL RELEVANCE: Fluoroscopic guidance for closed reduction and internal fixation of FLHC in dogs is an effective technique.     

Vertebral stabilisation and selective decompression for the management of triple thoracolumbar disc protrusions

Triple adjacent thoracolumbar disc protrusions causing moderate to severe spinal cord compression were diagnosed by magnetic resonance imaging in two German shepherd dogs with marked paraparesis and pelvic limb ataxia. Both cases were managed by selective hemilaminectomy, partial annulectomy and bilateral quadruple vertebral body stabilisation using novel canine locking fixation plates (SOP). The stabilisation of multiple vertebrae in the thoracolumbar spine was possible because the plates could be contoured with six degrees of freedom. Spinal pain resolved and neurological function improved in both dogs. Screw breakage was evident in one dog five months following surgery.     

Increased sacral screw purchase minimizes screw loosening in canine triple pelvic osteotomy

OBJECTIVE: To determine if screw loosening in triple pelvic osteotomies (TPO) is minimized when screws cranial to the ilial osteotomy had maximal sacral purchase. STUDY DESIGN: Prospective study. ANIMALS: Forty-six dogs with decreased acetabular coverage of the femoral head and minimal degenerative joint changes. METHODS: TPOs were performed where screws cranial to the ilial osteotomy were inserted to maximally engage sacral bone. Data collected were: use of ilial and ischial cerclage wire, screw length, ventrodorsal radiographic sacral width (most caudal aspect), pelvic canal diameter, and sacral penetration of the 3 cranial screws. On all subsequent radiographs, changes in screw position, pelvic canal diameter, and sacral purchase were noted. RESULTS: For 69 TPOs, 414 screws were used. Mean radiographic cranial screw length was 34.54 mm. Combined sacral depth of all 3 screws was 93.3% of sacral width. All osteotomies healed uneventfully. Twenty-four screws (6%) loosened with 12 being in the most cranial positions. Use of ischial or ilial cerclage wires did not statistically influence screw loosening. Pelvic diameter decreased by a mean of 7.79% from postoperative radiographs to the last radiographic recheck. CONCLUSIONS: By sufficiently engaging the sacrum with screws cranial to the ilial osteotomy, implant failures can be avoided and screw loosening minimized when a 6-hole TPO plate is used. CLINICAL RELEVANCE: To minimize screw-loosening in TPO, screws inserted cranial to the ilial osteotomy should be inserted to maximum sacral depth without penetrating the vertebral canal.     

Repair of radial fractures in toy breed dogs with self-reinforced biodegradable bone plates, metal screws, and light-weight external coaptation

OBJECTIVE: To describe a surgical technique for, and outcome after, treatment of radial fractures with biodegradable self-reinforced polylactide plates and metal screws, and external coaptation. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Eleven Toy breed dogs. METHODS: Radial fractures were repaired by application of a single or 2 stacked biodegradable self-reinforced polylactide plates (poly-L/D, L-lactide, stereocopolymer [LL-and DL-lactide ratio 70/30]; SR-PLA (70/30) implants) secured with metal screws, and light-weight external coaptation. Healing was evaluated clinically and by radiography at 2, 4, 6, 8, 9, 12, 24-26 weeks, and at 1 and 2 years. Owners were interviewed 3 years after surgery. RESULTS: Radial fracture lines disappeared within 4-14 weeks in 10 dogs; an implant failed in 1 dog. Ambulation was excellent for healed fractures. Excessive skin tension led to removal of implants in 1 dog and suture repair in another dog. No foreign body reaction from implant degradation was observed and the plate was usually no longer palpable at 2 years. One dog had a fracture through a screw hole at 1 year. CONCLUSION: Healing and complication rates after repair of radial fractures with SR-PLA (70/30) plates were considered similar or better than reported after repair with metallic plates or external fixation in Toy breed dogs. No radiographic signs of osteopenia were identified under the plate during follow-up. CLINICAL RELEVANCE: Biodegradable polylactide plates could be considered as an alternative to metal plates for radial fracture repair in Toy breed dogs, however available plates are likely not strong enough when used as a single plate. Implant removal is usually not needed.     

Open reduction of sacral fractures using transarticular implants at the articular facets of L7-S1: 8 consecutive canine patients (1995-1999)

OBJECTIVE: To describe and evaluate facet stabilization as an aid for open reduction and fixation of sacral fractures. STUDY DESIGN: A clinical case series. STUDY POPULATION: Eight consecutive client-owned dogs with sacral fractures. METHODS: A combination of a standard lateral approach to the ilium and a dorsal approach to the articular facets of L7-S1 was performed. The articular facets were reduced and stabilized with a Kirschner wire or a combination of a Kirschner wire and a cortical screw. Primary stabilization of the sacrum was then accomplished using a cortical screw inserted from the lateral aspect of the ilium, through the sacral fracture into the body of the sacrum. Accuracy of reduction, position of the implants, percent screw depth/sacral width, pelvic canal diameter ratio, and complications were assessed using radiographs and physical examination. RESULTS: Mean sacral fracture reduction was 91% immediately after surgery, and was 87% when measured at follow-up examinations. Mean screw depth/sacral width was 66%. Mean pelvic canal diameter ratio was 1.12 postoperatively and 1.03 at the 4- to 6-week reevaluation. Six of the 8 dogs were using the leg well 10 to 12 days after surgery; none had clinically detectable neurologic deficits. The long-term (mean, 2.7 years) outcome for these dogs was good (normal to grade I lameness). CONCLUSION: Fixation of the L7-S1 facet joints facilitates repair of sacral fractures.