Transverse ulnar bone transport osteogenesis: a new technique for limb salvage for the treatment of distal radial osteosarcoma in dogs

Objective— To develop instrumentation and a technique for transverse ulnar bone transport osteogenesis in dogs.
Study Design— Cadaveric study and in vivo validation (1 dog).
Sample Population— Paired cadaveric antebrachii (n=10 dogs) and 1 live dog.
Methods— Circular fixator constructs were applied and fitted with reeling or linear motors designed to transport an ulnar segment transversely into a defect created by excising the distal 50% of the ipsilateral radius. A longitudinal osteotomy of the adjacent ulna was created and the segment was transported across the radial defect. Pre- and post-distraction CT scans were used to compare the efficacy of each construct. The procedure was performed unilaterally in a live dog using the reeling motor (RM) construct.
Results— Both constructs effectively transported the ulnar segment into the defect. Subjectively, the RMs were easier to apply and operate. No significant differences were observed in the objective measures of efficacy between the 2 construct types. The live dog produced viable regenerate bone after transverse ulnar bone transport.
Conclusions— Transverse ulnar bone transport should be considered a potential method for limb salvage in dogs with osteosarcoma (OSA) of the distal radius. The RMs were effective and clinically applicable.
Clinical Relevance— Transverse ulnar bone transport osteogenesis affords the benefits of longitudinal radial bone transport osteogenesis, allowing resolution of large longitudinal radial defects in a substantially less time as a result of shortening the transport distance. This would be beneficial when treating conditions such as OSA where minimizing convalescence and maximizing quality of life is a priority.     

Management of antebrachial deformity and shortening secondary to a synostosis in a dog

A nine-week-old labrador was presented with a deformed left forelimb causing obvious lameness. Radiographs suggested that the dog had suffered a fracture involving the radius and ulna which had healed resulting in a synostosis. There was a concurrent radial physeal injury. The dog was treated initially by osteotomy of the radius and ulna stabilised using a static external skeletal fixator. At a subsequent surgery lengthening of the limb was achieved by using an Ilizarov apparatus. Worsening carpal hyperflexion was managed by bandaging in forced extension. A successful outcome was achieved with a final result of a 24 per cent discrepancy in length between the two radii at 17 months of age. An increase in length of the ipsilateral humerus was seen in association with the shortened forelimb.     

In vitro comparison of proximal ulnar osteotomy and distal ulnar osteotomy with release of the interosseous ligament in a canine model

Objective: To determine the effect of proximal ulnar osteotomy (PUO), distal ulnar osteotomy (DUO), and DUO with release of the interosseous ligament (DOLR) on displacement of the proximal ulna at the radioulnar joint. Study Design: Experimental mechanical study. Sample Population: Cadaveric, skeletally mature canine thoracic limb pairs (n=11). Methods: Thoracic limbs disarticulated at the elbow were randomly assigned to 1 of 2 groups: (A) limbs were tested with no treatment (NOTX), then with PUO; (B) limbs were tested with DUO followed by DOLR. A distraction force was applied to the proximal ulna with the distal limb secured in a frame, and displacement of the proximal ulnar segment at the radioulnar joint was recorded. Results: Mean displacement was 0.36 mm (95% confidence interval [CI]: 0?1.12 mm) in the NOTX group, 4.68 mm (95% CI: 3.82–5.55 mm) for PUO limbs, 0.95 mm (95% CI: 0.52–1.39 mm) for the DUO group, and 4.36 mm (95% CI: 3.71–5.02 mm) for the DOLR group. Mean ulnar displacement of the DOLR group was significantly different compared with the DUO group, but there was no significant difference between the PUO and DOLR groups. Conclusions: No significant difference was observed in displacement of the proximal ulnar segment after DOLR compared with PUO.     

Use of a circular external skeletal fixator for stifle arthrodesis in a dog

Arthrodesis of the right stifle was performed in a 21 kg German shepherd dog that had sustained a comminuted fracture of the lateral femoral condyle as a result of a gunshot wound. The arthrodesis was stabilised with a circular external skeletal fixator. A simplified technique to facilitate creation of the osteotomies of the femur and tibia, and positioning of the stifle at the desired angle, is described. Compression of the subchondral bone surfaces of the distal femur and proximal tibia was achieved using tensioned coiled transarticular Kirschner wires. Arthrodesis of the stifle was confirmed radiographically 21 weeks following surgery, and the fixator was removed. After union of the arthrodesis and removal of the fixator, the dog was fully weightbearing when standing or walking, and intermittently weightbearing or non-weightbearing at faster gaits.     

Ulnocarpal arthrodesis and limb lengthening for the management of radial agenesis in a dog

Radial agenesis was diagnosed in a nine-week-old boxer. An ulnocarpal arthrodesis was performed when six months of age to improve limb alignment and enable weight bearing. When the dog was 10 months old, a hinged circular fixator was applied to the limb to gradually lengthen the ulna and correct angular and rotational deformity. The fixator was removed at 16 months of age. At this time, there was 1·7 cm (6 per cent) shortening of the affected antebrachium-metacarpus and 2·6 cm (15 per cent) compensatory overgrowth of the humerus compared with the contralateral limb. Inability to extend the digits was a complication that improved with physiotherapy. Follow-up at 23 months of age showed good limb use when walking and running. Radiographs of the elbow showed periarticular osteophytes and subcoronoid sclerosis of the ulna.     

Management of fractures near the carpal joint of two calves by transarticular fixation with a circular external fixator

A four-ring circular external skeletal fixation device was evaluated for transcarpal fixation of compound fractures in two calves. Case 1 was an eight-month-old female Holstein-Friesian x indigenous breed calf weighing 72 kg, which had a Salter-Harris type II fracture at the distal metaphysis of the right radius/ulna with an open contaminated wound on the medial aspect of the carpus. Case 2 was an 18-month-old crossbred Haryana heifer weighing 105 kg, which had a comminuted fracture at the proximal end of its left metacarpus with severe soft tissue trauma and an open wound on the medial aspect. In both cases, the fractures were repaired with four-ring circular fixators by fixing the proximal two rings in the distal radius/ulna and the distal two rings in the metacarpus. Postoperatively, both calves were treated with analgesic and anti-inflammatory drugs and antibiotic, and the pin-bone interfaces and the open wound were cleaned regularly with povidone-iodine solution. In both animals weight bearing was good to excellent in the immediate postoperative period. The fixator was well maintained and tolerated by the animals until the fractures healed after 45 to 60 days. The movement of the carpal joint was slightly affected when the fixator was removed on day 60, but a follow-up examination after one year showed that both calves had normal functional usage of the limbs.     

Radiographic changes in elbow dysplasia following ulnar osteotomy--a case report and review of the literature

This case report describes the results of bilateral elbow arthrotomy and a unilateral ulnar osteotomy in a 10-month-old dog with bilateral elbow dysplasia. Fragmented coronoid processes were removed from both joints via bilateral medial arthrotomies. On the right side an ulnar osteotomy was also performed using a caudolateral approach. Bilateral flexed lateral elbow radiographs taken before surgery and 5 months postoperatively were assessed for changes in osteophyte size on the anconeal process, caudal epicondylar ridge and radial head. Osteophytes on the anconeal process and caudal epicondylar ridge disappeared over the postoperative period in the joint that received an ulnar osteotomy. In the contralateral joint the size of the oesteophytes on the anconeal process and caudal epicondylar ridge increased in size during the same period.     

Use of a hybrid external skeletal fixator for repair of a periarticular tibial fracture in a Patagonian cavy

An 8-week-old female Patagonian cavy was examined because of acute right hind limb lameness; radiography revealed a moderately displaced, comminuted fracture of the proximal third of the tibia. The fracture was stabilized with a hybrid external skeletal fixator. Two Kirschner wires were placed in the main proximal fragment, parallel to the tibial plateau and at right angles to each other. These wires were connected to a partial circular external fixator ring. Three half pins were placed in the distal fragment, and a straight connecting rod positioned on the medial side of the limb was connected to these pins and the fixator ring. A second connecting rod was positioned on the craniomedial side of the limb and was connected to the fixator ring and a fourth half pin in the distal fragment. The fracture healed without complications, and the fixator was removed 3 weeks after surgery. Hybrid external skeletal fixators combine the benefits of circular and linear external skeletal fixation methods, enabling rigid fixation of periarticular long bone fractures without adversely affecting mobility of the adjacent joint.     

Flexible External Fixation for Craniodorsal Coxofemoral Luxations in Dogs

An external fixator consisting of two Ellis pins connected by a flexible band was developed and evaluated as a treatment for craniodorsal coxofemoral luxations in dogs. The technique for closed application of the fixator without injury to the coxofemoral joint or sciatic nerve was developed in six dog cadavers. The coxofemoral joints were then surgically destabilized and the limbs were manipulated through a full range of motion to assess the efficacy of the fixator in maintaining joint reduction. The fixator maintained joint reduction and stability after a surgically created craniodorsal luxation except when the femur was externally rotated 90d?. A flexible external fixator was then applied unilaterally in four healthy dogs. The dogs tolerated the fixator well and were bearing weight on the limb within 2 days after surgery; the range of motion was not limited by the fixator. The efficacy of a flexible external fixator in maintaining joint reduction after craniodorsal coxofemoral luxation was then evaluated in eight large dogs. The right coxofemoral joint in each dog was luxated surgically by removal of the dorsal joint capsule and transection of the ligament of the head of the femur and deep gluteal muscle. The joint was reduced and the fixator pins were applied in a closed fashion. In four dogs, a flexible external band was applied to the pins. Luxation did not reccur in these four dogs. The bands were not applied initially in four control dogs. Luxation occurred in three of the four control dogs within 24 hours of surgery. The joints that luxated were reduced and the flexible bands applied. Luxation did not recur after the bands were in place. The dogs tolerated the external fixators well, were bearing weight within 2 days of surgery, and walking with only minimal lameness 5 days after surgery. Luxation of the coxofemoral joints did not occur during the 2-week period in which the fixators were in place. The joints remained stable 1 week after removal of the fixators, at which time the dogs were euthanatized. Necropsy evaluation identified inflammation surrounding the pins and fibrous thickening of the dorsal joint capsule. The flexible external fixators were applied closed, maintained reduction of the coxofemoral joint after replacement of a craniodorsal luxation, and allowed weight bearing and limb usage soon after surgery. The flexible external fixator has several advantages over other methods of treating craniodorsal coxofemoral luxations. Complications noted in this study included pin tract drainage, pin loosening, and disruption of the flexible bands.     

Arthroscopy of the antebrachiocarpal joint in dogs

A technique for arthroscopy of the antebrachiocarpal joint in dogs is described. Both antebrachiocarpal joints in 9 dog cadavers were examined arthroscopically and grossly to refine the technique and determine structures that could be seen. Two arthroscope portals were evaluated in each joint. The antebrachiocarpal synovium, ulnar carpal bone, distal portion of the ulna, medial and lateral collateral ligaments, accessory carpal bone, intercarpal ligament of the radial and ulnar carpal bone, distal portion of the radius, radial carpal bone, palmar process of the radial carpal bone, ligaments of the accessory carpal bone, palmar radiocarpal ligament, and palmar ulnocarpal ligament were visible and accessible to instruments. Arthroscopy was also performed in 5 client-owned dogs, allowing diagnosis of hyperextension injuries (n = 2), septic arthritis (2), and immune-mediated arthropathy (1). Arthroscopy of the antebrachiocarpal joint was found to be a useful adjunct to standard diagnostic modalities.     

Evaluation of delayed-image bone scintigraphy to assess bone formation after distraction osteogenesis in dogs

OBJECTIVE: To quantitatively assess distraction-induced bone formation in a crural lengthening model in dogs by use of delayed-image bone scintigraphy. ANIMALS: 12 mature Labrador Retrievers. PROCEDURE: Dogs were randomly allocated to 1 of 3 groups. A circular external skeletal fixation system was mounted on the right crus of each dog. Osteotomy of the distal portion of the tibia and fibula was performed in groups 1 and 2 and was followed by a lengthening procedure of 10 mm in the first group only. The third group served as sham-operated controls. Delayed-image bone scintigraphy with technetium-99m hydroxy methylene diphosphonate was performed 2, 4, and 6 weeks after surgery. Delayed-image-to-region-of-interest, delayed-image-to-crural, and delayed-image-to-femoral scintigraphic activity ratios were calculated. New bone formation was quantified by use of densitometric image analysis, and values for the scintigraphic ratios were compared. RESULTS: In the distraction and osteotomy groups, delayed-image-to-region-of-interest and delayed-image-to-crural ratios increased significantly. Although densitometric image analysis revealed increased bone formation after distraction, the region-of-interest ratios and crural ratios were similar in both groups. All dogs had increased delayed-image-to-femoral ratios. CONCLUSIONS AND CLINICAL RELEVANCE: Delayed-image bone scintigraphy ratios were not effective at differentiating between the amounts of distraction-induced bone and osteotomy-induced bone. Metabolic bone activity in the adjacent femur was increased as a consequence of circular external skeletal fixator placement. Delayed-image bone scintigraphy was not adequately sensitive to quantitatively monitor bone formation but may be useful as an early predictor of bone healing.     

Use of the Wagner apparatus to lengthen the antebrachium of a growing dog

A six-month-old male golden retriever was presented with a shortened radius and ulna and valgus deformity of the carpus secondary to premature closure of the distal radial and ulnar physes. Osteotomies of the radius and ulna were performed and the antebrachium was lengthened over eight weeks using a Wagner apparatus. This external fixation distractor is used in humans for limb-lengthening procedures. In this case, it was used to correct the angular deformity and to lengthen the limb.     

Trauma-induced growth abnormalities of the distal radius in three cats

Three immature cats with growth abnormalities of the distal radius secondary to trauma were presented between July 2001 and July 2003. Initial injuries included a Salter-Harris type II fracture of the distal radial physis in one cat, fractures of the styloid process of the ulna in two cats, and metacarpal fractures in one cat. The cats were between 3.5 and 4.5 months of age at the time of injury. Damage to the distal radial physis resulted in a variable degree of shortening of the radius in all cats. Asymmetrical closure caused widening of the lateral aspect of the radiocarpal joint space in two cats. Elbow incongruity was not observed. One cat was treated with osteotomies of the radius and ulna and realignment of the radius, stabilised with external skeletal fixation. Another was treated by ulnar ostectomy alone. Radius and ulna osteotomies and distraction osteogenesis of the radius were performed in the third cat. Clinical outcome was satisfactory in all three cases.     

Malignant transformation of an aneurysmal bone cyst in a dog

OBJECTIVE: To report malignant transformation of an aneurysmal bone cyst in a dog. STUDY DESIGN: Case report. SAMPLE POPULATION: Client-owned dog. RESULTS: A 5-year-old male Labrador retriever was diagnosed with an aneurysmal bone cyst of the distal aspect of the right ulna. Surgical curettage resulted in remission of clinical signs for 33 months. Because of recurrence of clinical signs, a distal ulnar ostectomy was performed. Histopathologic examination of the excised specimen revealed a moderately differentiated chondrosarcoma at the level of the bone cyst. Limb function was normal for 17 months until a subcutaneous mass, determined to be a chondrosarcoma, occurred at the level of the shoulder. A right forequarter amputation was performed. CONCLUSIONS: Aneurysmal bone cysts are benign but may be transformed into a malignancy after surgical manipulation. Complete surgical excision should be attempted where possible. In this case, distal ulnar ostectomy was an effective means of preserving limb function and preventing local recurrence of chondrosarcoma.     

Treatment of Humeroulnar Subluxation with a Dynamic Proximal Ulnar Osteotomy A Review of 13 Cases

Humeroulnar subluxation was treated surgically in 13 dogs with 18 affected elbows using a proximal osteotomy of the ulna that allowed the ulna to elongate dynamically. Distal humeroulnar subluxation was secondary to premature closure of the distal ulnar physis in 16 elbows. One distal subluxation was secondary to a radioulnar synostosis, and one proximal subluxation developed after premature closure of the distal radial physis. The mean follow-up time was 22 months. Twenty-eight percent of the elbows were judged to have excellent results, 22% good results, 50% fair results, and none was judged to have a poor outcome. The presenting lameness grade and the severity of preoperative and postoperative humeroulnar subluxation had significant correlations with the prognosis. Associated orthopedic abnormalities and complications of concurrent surgical procedures affected the outcome in several dogs. Overall, the dynamic proximal ulnar osteotomy was a simple and effective technique for the treatment of uncomplicated humeroulnar subluxation.     

A novel surgical treatment of type 3 congenital elbow luxation in a dog

Congenital luxation of the ulnar and radius is a rare orthopaedic condition in the dog. This case report describes a novel surgical treatment for congenital elbow luxation in a medium-breed dog. A 6-week-old Kelpie presented for left forelimb lameness and deformity. Radiographs and computed tomography (CT) confirmed the diagnosis of unilateral ulnar and radius luxation. The surgical repair involved open reduction followed by fixation with an extraarticular pin and a transarticular external fixator. The outcome of surgery was improved leg function and weight-bearing, however, reluxation of the radial head was diagnosed 7 weeks following surgery. This technique may offer an alternative surgical option to improve clinical signs, as well as insight into improving the management of this condition.     

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.     

Premature closure of the proximal physis of the humerus in a dog as a result of harvesting a cancellous bone graft

A 5-month-old castrated male mixed-breed dog was evaluated because of lameness of the right forelimb. Physical examination revealed pain on manipulation of the right elbow joint, and radiography revealed premature closure of the distal physis of the radius with subluxation of the right elbow joint. Corrective osteotomy of the radius was performed to increase the length of the radius and establish congruity of the elbow joint. Cancellous bone was obtained from the proximal portion of the humerus and used as a graft at the osteotomy site. The dog did well after surgery. Four months after surgery, the dog again was lame on the right forelimb. Physical examination revealed instability of the right shoulder, and manipulation of that area elicited signs of pain. Radiography revealed caudomedial subluxation of the right shoulder as well as deformity of the humeral head and hypoplasia of the greater tubercle. It was presumed that these changes were associated with collection of the cancellous bone graft during the initial surgery, which resulted in premature closure of the proximal physis of the humerus. To our knowledge, this is the first report of premature closure of the proximal physis of the humerus as a result of procurement of a bone graft.     

Large segmental radius and ulna defect treated by bone transportation with the Ilizarov technique

An 8-year-old male Boxer with a severely contaminated open fracture of the left radius and ulna fracture, produced by a helicopter propeller, was treated using bone transport by the Ilizarov method. Extensive diaphyseal bone loss and soft-tissue vascular damage were present. The radius and ulna were stabilised with an Ilizarov ring external fixator. The bone defect was partially shortened and restored by gradual transport of a bone segment created from proximal segments of the radius and ulna. The external fixator was removed 4 fi months after the beginning of the latency period, due to instability caused by osteolysis around the wires. A cast was placed for 3 weeks. Although the bone transport had resulted in formation of approximately 4 cm of bone, the antebrachium showed approximately 50% shortening when compared to the contralateral limb. The infection was eradicated, and the dog was able to bear weight on the operated limb when walking.     

Distraction osteogenesis to treat premature distal radial growth plate closure in a dog

A 4-month-old Labrador was presented for forelimb lameness and elbow pain. Radiography revealed asymmetric premature closure of the distal radial physis resulting in humeroradial and humero-ulnar subluxation. A four-ring circular external fixator applied to the antebrachium was used to perform distraction osteogenesis. After a 4 day latency period, varying rates of linear distraction were used to lengthen the radius by 50% of its original length, which is significantly longer than has been previously reported. By 69 days after performing the radial osteotomy, the distraction callus had achieved clinical union and the fixator was removed. One year postoperatively, mild lameness was present after exercise and minimal elbow osteo-arthritis was evident radiographically. Complications observed included pin tract drainage, transient carpal contracture and radio-ulnar synostosis.