Management of Tibial Fractures Using a Circular External Fixator in Two Calves

Objectives: To report the repair of tibial diaphyseal fractures in 2 calves using a circular external skeletal fixator (CEF). Study Design: Clinical report. Animals: Crossbred calves (n=2; age: 6 months; weight: 55 and 60 kg). Methods: Mid‐diaphyseal tibial fractures were repaired by the use of a 4‐ring CEF (made of aluminum rings with 2 mm K‐wires) alone in 1 calf and in combination with hemicerclage wiring in 1 calf. Results: Both calves had good weight bearing with moderate lameness postoperatively. Fracture healing occurred by day 60 in 1 calf and by day 30 in calf 2. The CEF was well maintained and tolerated by both calves through fracture healing. Joint mobility and limb usage improved gradually after CEF removal. Conclusions: CEF provided a stable fixation of tibial fractures and healing within 60 days and functional recovery within 90 days. Clinical Relevance: CEF can be safely and successfully used for the management of selected tibial fractures in calves.     

Treatment of a Periarticular Tibial Fracture in a Foal with a Hybrid External Fixator

Objective— To report repair of a right proximal tibial Salter-Harris type II fracture in a foal with a hybrid external fixator (HEF).
Study Design— Case report.
Animals— A 5-month-old male foal.
Methods— After open surgical reduction, an HEF built with wires, 2 half-rings, 3 half-threaded connecting rods, and Schanz pins was used to stabilize the fracture.
Results— Immediately after surgery, the foal had relatively good weight bearing. The HEF was removed at 60 days after radiographic confirmation of healing.
Conclusions— HEF can be used to stabilize a proximal tibial Salter-Harris type II fracture in a 5-month-old foal.
Clinical Relevance— HEF should be considered as another option for repair of proximal tibial Salter-Harris type II fractures in foals.     

A Novel Combined Method of Osteosynthesis in Treatment of Tibial Fractures: A Comparative Study on Sheep with Application of Rod‐Through‐Plate Fixator and Bone Plating

The study compares the efficiency of a new bone fixator combining periostal and intramedullary osteosynthesis to bone plating in treatment of tibial fractures in sheep. Experimental osteotomies were performed in the middle third of the left tibia. Animals were divided into two groups: in one group (four animals) combined osteosynthesis (rod‐through‐plate fixator, RTP fixator) was applied, and in the other group (three animals) bone plating was used. The experiments lasted for 10 weeks during which fracture union was followed by radiography, and the healing process was studied by blood serum markers reflecting bone turnover and by histological and immunohistochemical investigations. In the RTP fixator group, animals started to load body weight on the operated limbs the next day after the surgery, while in the bone plating group, this happened only on the seventh day. In the RTP fixator group, consolidation of fractures was also faster, as demonstrated by radiographical, histological, and immunohistochemical investigations and in part by blood serum markers for bone formation. It can be concluded that application of RTP fixation is more efficient than plate fixation in the treatment of experimental osteotomies of long bones in sheep.     

In Vitro Comparison of a Novel External Fixator and Traditional Full‐Limb Transfixation Pin Cast in Horses

Objective: To compare the mechanical properties and failure modes of a standardized short oblique distal radial metaphyseal osteotomy stabilized using either a transfixation pin cast (TPC), a modular‐sidebar external skeletal fixator (ESF), or a solid‐sidebar ESF (modular‐ or solid‐ESF, respectively) using static or cyclic axial loading to failure. Study Design: In vitro study. Animals: Equine cadaver forelimbs. Methods: A 30° oblique distal radial osteotomy was created and stabilized using 1 of the 3 fixation methods: (1) TPC, (2) modular‐ESF, or (3) solid‐ESF. Limbs were tested using static (TPC, modular‐ESF, and solid‐ESF) or cyclic (TPC and solid‐ESF) axial loading to failure. The stiffness, yield load, yield displacement, failure load, and failure displacement for static loading and the cycles to failure for cyclic loading at 75% failure load were obtained. Data were analyzed using a Kruskal–Wallis test. Level of significance was P<.05. Results: The solid‐ESF had a greater stiffness, higher yield and failure load and a lower yield and failure displacement than the TPC (P=.01) and the modular‐ESF (P=.02). TPC had a higher yield load, failure load, and yield displacement than the modular‐ESF (P=.01). Mean cycles to failure for TPC was 2996±657 at a load of 16,000 N and for solid‐ESF 6560±90 cycles at a load of 25,000 N. Conclusions: The solid‐ESF was stiffer and stronger than the TPC and modular‐ESF and failed at a greater number of cycles in axial loading compared with the TPC. Clinical Relevance: This study is an initial step in evaluating the solid‐ESF. Further testing needs to be performed, but this fixation may offer a viable alternative to the traditional TPC for stabilization of long bone fractures in adult horses.     

In Vitro Mechanical Evaluation of a Novel Pin–Sleeve System for External Fixation of Distal Limb Fractures in Horses: A Proof of Concept Study

Objective: To evaluate the efficacy of a novel pin–sleeve cast (PSC) system for external fixation of distal limb fractures in horses and to compare it with the transfixation pin cast (TPC) system. Study Design: Experimental. Sample Population: One bone substitute each was used for the TPC and PSC systems. The PSC was tested in 4 configurations characterized by different pin preloads. Methods: Specimens were loaded in axial compression in the elastic range. Variables compared statistically were: bone substitute axial displacement and axial strain measured above implants with strain gauges. Pin preload was correlated with the variables investigated. Load to failure and a fatigue tests supplemented the investigation. Results: The PSC configuration with the highest pin preload showed a significantly lower axial displacement compared with the TPC. No significant differences were observed between all other PSC configurations and the TPC. All PSC systems had a significant decrease in recorded strain compared with the TPC system. Pin axial preload inversely correlated with axial displacement but had no effect on axial strain. In the failure test, the PSC encountered plastic deformation earlier than the TPC. In the fatigue test, the PSC ran >200,000 cycles. Conclusions: Preliminary in vitro tests showed that the PSC system significantly reduced peri‐implant strain while concurrently having comparable axial displacement to the TPC system. Clinical Relevance: The PSC system has the potential to reduce the risk of pin loosening in horses.     

Comparison of Multistage Versus One-Stage Destabilization of a Type II External Fixator Used to Stabilize an Oblique Tibial Osteotomy in Dogs

OBJECTIVE: To compare the biomechanical effects of multistage versus one-stage destabilization of a type II external skeletal fixator (ESF) used to stabilize an oblique unstable tibial osteotomy in dogs. STUDY DESIGN: In vitro, in vivo, and ex vivo experimental study. ANIMAL POPULATION: Twelve healthy adult dogs. METHODS: The biomechanical characteristics of the type II ESF used in this study were determined. This fixator was applied to both tibiae of two groups of 6 dogs to stabilize a 2-mm-wide oblique osteotomy. One fixator on each dog remained unchanged throughout the 11-week study (control group). The fixator on the opposite limb was destabilized late and acutely in one group of dogs (single-stage) and early and progressively in the other (multistage). Clinical examination, radiographic examination, and force-plate analysis were used to evaluate the results. All dogs were euthanatized at 11 weeks. All tibiae were scanned to determine the cross-sectional area of the callus in the center of the osteotomy and subjected to biomechanical tests to determine mean pull-out strength of pins and callus strength and stiffness. RESULTS: Stiffness of the type II ESF used in this study was 578 N/mm in axial compression, 0.767 Nm/deg in torsion, 261 N/mm in medio-lateral bending, and 25 N/mm in cranio-caudal bending. Peak vertical forces of the hindlimbs were significantly lower at 2.5 and 5 weeks than before surgery. Peak vertical forces of the hindlimbs did not change before and after destabilization. No significant differences could be detected between the two destabilization sequences or between all control tibiae and pooled destabilized tibiae with regards to radiographic evaluation of the healing osteotomy, cross-sectional periosteal callus area, mean pull-out strength of transfixation pins, callus strength, and callus stiffness. CONCLUSIONS AND CLINICAL RELEVANCE: Bone healing of unstable osteotomies stabilized with a type II ESF is not significantly enhanced by staged destabilization of the fixation as performed in this study.     

Limb Sparing Using a Double Bone-Transport Technique for Treatment of a Distal Tibial Osteosarcoma in a Dog

OBJECTIVE: To evaluate the treatment of a spontaneously occurring osteosarcoma in a dog by means of tumor resection and bone regeneration of a 12-cm defect using double bone transport. STUDY DESIGN: Case report. ANIMALS OR SAMPLE POPULATION: An 11 year-old client-owned German shepherd. METHODS: After tumor resection, a preassambled Ilizarov frame was secured to the proximal tibia and to the tarso-metatarsal region. Two osteotomies were performed in the proximal metaphysis. The two bone segments were transfixed with 1.5-mm-diameter wires, each secured to a ring, and bone transport was performed until the distal segment reached the talar surface. Cisplatin was administered 14, 35, and 59 days after surgery. RESULTS: Bone regenerate was first visible radiographically 4 weeks after surgery. The frame was removed 162 days after surgery. The hock was protected with a plaster cast because the tarsal arthrodesis was not complete. The dog underwent tibiotarsal arthrodesis 201 days after osteosarcoma resection. The dog died of metastatic disease 239 days after the initial surgery. CONCLUSIONS: Even though this dog died of systemic metastases, local recurrence did not develop. Cisplatin chemotherapy did not appear to negatively affect bone regeneration. CLINICAL RELEVANCE: To our knowledge, the double transport technique has not been previously described in the veterinary literature. In this dog, this technique decreased the duration of treatment compared with a conventional single-segment transport technique.     

Determination of Safe Depth of Pin Penetration for Repair of Distal Femoral Physeal Fractures in Immature Dogs: A Comparison of Normograde and Retrograde Pin Placement

Objective —The purpose of this study was to determine the depth that implants may be safely placed into the distal femoral epiphysis (DFE) for the repair of distal femoral physeal fractures.
Study Design —The depth of the DFE was related to the radiographic thickness of the patella in this experimental study.
Animals or Sample Population —Twenty immature canine cadavers.
Methods —Patella thicknesses were measured from lateral radiographs. Actual DFE depths were determined for pins driven in normograde fashion and for pins driven retrograde from the central depression between the metaphyseal pegs and from the cranial pegs. The association of DFE depth and patella thickness was evaluated using linear regression analysis. Using 95% confidence intervals, rules for estimating the safe depth of implant placement into the DFE were determined.
Results —DFE depth had significant correlation with patella thickness for pins placed in retrograde fashion from the central depression between the metaphyseal pegs (r²= .83) and from the cranial pegs (r²= .82) and for pins placed in normograde fashion (r²= .65).
Conclusions —Based on 95% confidence intervals, pins placed in retrograde fashion from the central depression between the metaphyseal pegs may be safely driven into the DFE a distance equal to 140% of patella thickness. Pins placed from the cranial metaphyseal pegs may be driven to a depth equal to 80% of patella thickness, and pins placed in normograde fashion may be driven to a depth equal to 30% of patella thickness.
Clinical Relevance —Measurement of patella thickness assists the surgeon in determining the approximate depth that pins may be driven into the DFE without penetrating the articular surface of the stifle joint.     

Comparison of Short‐ and Long‐term Function and Radiographic Osteoarthrosis in Dogs After Postoperative Physical Rehabilitation and Tibial Plateau Leveling Osteotomy or Lateral Fabellar Suture Stabilization

Objectives— To compare short‐ and long‐term functional and radiographic outcome of cranial cruciate ligament (CrCL) injury in dogs treated with postoperative physical rehabilitation and either tibial plateau leveling osteotomy (TPLO) or lateral fabellar suture stabilization (LFS). Study Design— Prospective observational clinical study. Animals— Medium to large breed dogs with naturally occurring CrCL injury (n=65). Methods— Dogs with CrCL injury were treated with either TPLO or LFS and with identical physical rehabilitation regimes postoperatively. Limb peak vertical force (PVF) was measured preoperatively and at 3, 5, and 7 weeks, and 6 months and 24 months postoperatively. Stifles were radiographically assessed for osteoarthrosis (OA) preoperatively and 24 months postoperatively. Results— Thirty‐five dogs had LFS and 30 dogs had TPLO. Radiographic OA scores were significantly increased at 24 months compared with preoperative scores in all dogs. Radiographic OA scores preoperatively and at 24 months were not significantly different between treatment groups. PVF was significantly increased from preoperative to 24 months among both treatment groups but not significantly different between treatment groups preoperatively or at 3, 5, 7 weeks, 6, or 24 months. Conclusion— No significant difference in outcome as determined by ground reaction forces or radiographic OA scores were found between dogs with CrCL injury treated with LFS or TPLO. Clinical Relevance— LFS and TPLO remain good options for stabilizing stifles with CrCL injury with all dogs showing significant functional improvement. This study does not support the superiority of either surgical technique.     

Fixation of Cancellous Bone and Physeal Fractures in Dogs and Cats. A Comparison of the Use of Self-reinforced Biodegradable Devices to the Use of Metallic Devices and External Fixations

The use of self-reinforced biodegradable devices made of polyglycolide in the cancellous bone and physeal fractures of dogs and cats was compared to the use of metallic devices and external fixations on similar fractures. The series consisted of 64 dogs and 22 cats divided into 6 comparable groups. The patients in the 2 groups fixed with biodegradable devices started to use their operated limbs earlier than in the other groups. The same 2 groups also healed clinically (showed no lameness) earlier than the other groups. Radiographically there was no statistical difference between the 6 groups.On the basis of this study it may be concluded that the fixation with self-reinforced biodegradable devices is as suitable for the fixation of cancellous bone and physeal fractures of dogs and cats as the fixation with metallic devices or external fixation. This biodegradable technique has additional benefits allowing the patients to feel less pain in their operated limbs and making secondary operations to remove the devices unnecessary.     

Evaluation of Intra‐ and Interobserver Variability and Repeatability of Tibial Plateau Angle Measurements with Digital Radiography Using a Novel Digital Radiographic Program

Objective— To compare the intra‐ and interobserver variability occurring when observers with differing experience levels measure tibial plateau angles (TPAs) with a novel digital radiographic projection program (tibial plateau leveling osteotomy [TPLO] planning program), the Kodak Picture Archiving and Communications System (PACS), and standard sized printed films (SF). Study Design— Cross‐sectional study. Sample Population— Dogs (n=36) with cranial cruciate ligament (CCL) rupture that had a TPLO. Methods— Six observers, divided into 3 equal groups based on experience level, measured TPA on 36 digitally captured radiographic images of tibiae of dogs clinically affected with CCL rupture. Each observer used 3 methods of measuring TPA and repeated the measurements 3 times with each method. The intra‐ and interobserver variability was compared using the coefficient of variation. Results— Averaged over all replications and images, there was no significant difference (P>.05) in the average variability occurring with each method for all but 1 observer. There was no effect of experience level on measurement variability; however, interobserver variability was significantly less with measurements made with the PACS and TPLO planning program compared with measurements made from SF (P<.05). Conclusions— Repeated measurements of TPA made using digital images and computer‐based measurement programs were significantly less variable between observers than those made from images printed on standard radiographic films. Clinical Relevance— Digital radiography and computer‐based measurement programs are effective for determining the TPA, allowing less variability in measurements compared with SF. The ability to manipulate the image may allow better identification of anatomic landmarks.