Ultrasonographic Evaluation of the Distal Extremity

Despite the increasing use of magnetic resonance imaging (MRI), ultrasound remains a valuable tool to diagnose injuries that cause distal extremity lameness in the horse. The key to a successful examination is a strong knowledge of anatomy in combination with proper ultrasonographic technique and the patience and dedication to learn these skills. Similar to all imaging modalities, it is equally important to recognize and consider the limitations of ultrasound in this region so that findings can be interpreted appropriately. Ultrasound can be used to diagnose injuries to the deep digital flexor tendon (DDFT), straight distal sesamoidean ligament and branches of the superficial digital flexor tendon using standard pastern ultrasonographic technique. The addition of newer techniques to image the DDFT at the level of P2, the navicular bursa and the collateral sesamoidean ligament can enhance the diagnostic utility of ultrasound in horses with distal extremity lameness. Although visibility is limited, ultrasound can be used to diagnose collateral ligament injuries of the coffin joint in many affected horses. Transcuneal imaging may be useful in some horses to detect abnormalities of the distal sesamoidean impar ligament and navicular bone, but evaluation of the DDFT is limited. Ultrasound should be considered in all horses with distal extremity lameness, regardless of the ability to perform advanced imaging procedures. Information gained is often complementary to other imaging modalities and may provide the basis for recheck examination purposes.     

小型犬尺桡骨,股骨远端骨折的钢板植入及取出手术

本文对小型犬尺桡骨和股骨远端骨折实施了钢板植入和愈合后钢板的取出手术。由于小型犬骨骼细,找不到合适的钢板。我们利用现有的材料根据骨折的具体情况,进行了钢板植入手术的尝试均取得了成功。     

Repair of Fractures of the Distal Aspect of the Radius in Two Horses

Fractures of the distal radius in two horses were repaired by open reduction and interfragmentary compression using screws placed in a lag fashion. One horse had a complete oblique fracture of the medial aspect of the epiphysis of the distal radius and was sound for riding 32 months after surgery. The other horse had an open spiral comminuted fracture with medial displacement of the distal radial fragment. Laminitis developed in the contralateral limb and this horse was euthanatized 5 weeks after surgery. © Copyright 1994 by The American College of Veterinary Surgeons     

The Intraosseous Blood Supply of the Canine Radius: Implications for Healing of Distal Fractures in Small Dogs

The intraosseous vascular anatomy of the radius was studied in 12 pairs of canine cadaver limbs. Six pairs of specimens were obtained from small-breed dogs (less than 6 kg) and six pairs were obtained from large-breed dogs (18 to 30 kg). All specimens were studied after arterial injection with India ink. Samples were fixed, frozen, then sectioned and processed using a modified Spalteholz technique. In all specimens, the intraosseous blood supply arose from the nutrient artery with its associated branches and the metaphyseal arteries. In small-breed dogs, there was decreased vascular density at the distal diaphyseal-metaphyseal junction compared with large-breed dogs. The reduced vascularity corresponded to the region associated with a poor prognosis for fracture healing in small-breed dogs. This regional association suggests that a decreased vascular supply in the distal radius may contribute to a higher frequency of delayed union and nonunion in smaller dogs.     

Ex Vivo Biomechanical Comparison of Pin Fixation Techniques for Canine Distal Femoral Physeal Fractures

Objective— To compare the biomechanical properties of five intramedullary (IM) pin fixation techniques for Salter-Harris type I fractures of the distal femur in dogs.
Study Design— Randomized, one-way factorial design composed of five treatment groups: (1) single IM pin, (2) dynamic IM crossed pins, (3) paired convergent pins, (4) crossed pins, and (5) crossed polyglycolic acid (PGA) rods.
Sample Population— Forty pairs of cadaver canine femurs.
Materials— One femur of each pair was manually fractured and subsequently repaired; the contralateral intact femur served as its control. Each femur was loaded in torsion until failure occurred and load-deformation curves were generated.
Results— The crossed-pin technique sustained the greatest load to failure (116.8%) followed by the paired convergent pins (104.8%), dynamic IM pins (90.6%), single IM pin (72.1%), and crossed PGA rods (71.9%). Statistically significant differences in strength at failure were detected between the crossed-pin and single IM pin and the crossed-pin and crossed PGA rod techniques. All fixation techniques underwent greater deformation (1.5 times as much) and had a lower stiffness (66% to 75%) compared with the intact controls; however, there was no significant difference between techniques. Failure in the paired convergent and crossed-pin techniques occurred by fracture of the bone; failure in the other techniques occurred by distraction at the fracture site.
Conclusion— The rotational stability of any of the fixation techniques appears to be primarily determined by the ability to prevent distraction and maintain interdigitation of the physis.
Clinical Relevance— When choosing a particular fixation technique for repair of a distal femoral physeal fracture, consideration should be given to the technique's relative biomechanical merits.     

Biomechanical Analysis of Stacked Plating Techniques to Stabilize Distal Radial Fractures in Small Dogs

Objective— To evaluate the fatigue life of partially stacked and fully stacked (1.5/2.0 and 2.0/2.7 mm) veterinary cuttable plates (VCP) in a fracture gap model of the distal aspect of the radius. Study Design— In vitro biomechanical study. Methods— Constructs (n=4/group) were assembled for each of 8 groups using 8‐hole plates (1.5/2.0 and 2.0/2.7 mm VCP) in the following configurations: unstacked; 2‐hole stacked centered over the gap (COG); 4‐hole stacked COG; and fully stacked. Plate(s) were secured to 2 separate polyvinylchloride pipe lengths, mounted to a mechanical testing system with a custom jig, and were loaded in axial compression for 10⁶ cycles at 10 Hz or until failure at 6–60 N for the 1.5/2.0 mm VCP and 10–100 N for the 2.0/2.7 mm VCP. Differences in number of cycles, stiffness, and failure mode were recorded. Results— All construct failures occurred through a screw hole adjacent to the gap. Fully stacked and 4‐hole stacked 1.5/2.0 and 2.0/2.7 mm VCP withstood 10⁶ cycles. Fatigue life and stiffness of the 1.5/2.0 or 2.0/2.7 mm unstacked constructs were significantly less than the other constructs. Differences were identified in stiffness among the 1.5/2.0 mm stacked constructs and in fatigue life among the 2.0/2.7 mm VCP stacked constructs. Conclusion— Four‐hole partially stacked VCP (either 1.5/2.0 or 2.0/2.7 mm) have comparable mechanical properties to fully stacked VCP. Clinical Relevance— Partial stacking of 2 holes of VCP on both sides of the fracture gap may provide sufficient strength for healing, but this premise must be tested in vivo.     

Hoof Conformation and Palmar Process Fractures of the Distal Phalanx in Warmblood Foals

This study evaluated onset and incidence of palmar process fractures in foals and investigated corresponding changes in hoof conformation. Radiographs of 17 warmblood foals were taken at 1 week and at 2, 4, 6, 8, and 12 months of age and examined for evidence of palmar process fractures. Hoof parameters were measured from the radiographs, and comparisons were made between fractured and nonfractured feet. All foals suffered at least one fracture during the study period, with an average age of 3.68 ± 0.20 months at fracture occurrence. Hoof conformation and fracture occurrence were not significantly correlated. Foals consistently demonstrated higher lateral heights in the right foot and higher medial heights in the left foot. Hoof angle increased until 3 months of age and then gradually dropped. Hoof-pastern axis exhibited a broken forward conformation, but approached a more correct conformation by 12 months of age. There was a significant reduction in variation of variables for hoof and pastern angle in both feet, and hoof-pastern axis in the right foot. Hoof conformation does not appear to be a causative factor of palmar process fractures. It is possible that these fractures are a normal part of bone remodeling.     

Changes in the Proximal Femur and Coxofemoral Joint Following Intramedullary Pinning of Diaphyseal Fractures in Young Dogs

We report radiographic changes and clinical results seen in the proximal femur and coxofemoral joint of 7 young dogs following intramedullary pinning. Changes seen radiographically included coxa valga, a small malformed femoral head, a short thin femoral neck, and coxofemoral subluxation. Epiphyseal trauma, ischemia, and mechanical impairment of normal femoral neck growth due to presence of the intramedullary pin are discussed as possible etiologic factors.     

Medial Plating for the Repair of Middle and Distal Diaphyseal Fractures of the Humerus in Dogs

Six middle and distal humeral shaft fractures in dogs were repaired by the application of a bone plate along the medial shaft of the humerus. In all animals, clinical and radiographic evidence of normal bone healing was observed. The bone plate and ancillary implants were removed from five dogs by 10 months. In none of the six dogs were any untoward effects of placing the bone plate along the medial shaft of the humerus detected nor were there any difficulties encountered with the medial humeral soft tissues.     

小型犬桡尺骨骨折的PRCL-S5型锁定骨板固定术诊疗

小型犬尤其是玩具型犬的桡尺骨远端骨折的治疗属于临床上的一大难题。治疗过程中需要考虑的问题有很多,如骨折不愈合、延迟愈合、骨髓腔堵塞、应力遮蔽和应力集中等。使用PRCL-S5型锁定骨板对小型犬桡尺骨远端进行内固定治疗,结合适当的术后护理措施,恢复良好。对常用的内固定方案进行了比较分析。     

Use of the Cobra Head Bone Plate for Distal Long Bone Fractures in Large Animals A Report of Four Cases

Four long bone fractures with a short distal fragment were repaired with a cobra head bone plate alone (2 cattle) or in combination with a straight, broad dynamic compression plate (2 horses). Three fractures were of the distal femur (1 horse, 2 cattle) and one was of the distal radius (1 horse). The long-term outcome of the three femoral fractures was soundness in one case and mild lameness in two. Although satisfactory bone healing progressed in the horse with the radial fracture, laminitis in the contralateral forelimb necessitated euthanasia at week 6.