Bilateral fixation of Y-T humeral condyle fractures via medial and lateral approaches in 29 dogs

OBJECTIVES: To describe bilateral fixation of Y-T fractures of the humeral condyle via combined medial and lateral approaches, and to determine the technique's clinical and radiographic short-term outcomes. METHODS: Details of 30 consecutive fractures in 29 dogs were reviewed. These included signalment, method of fixation, complications, and follow-up limb function and range of elbow joint motion. RESULTS: The age of the dogs ranged from three months to nine years, and bodyweight ranged from 1.9 to 48 kg. The humeral condyle was reattached to the shaft using medial and lateral bone plates in 18 fractures, a medial plate and lateral Kirschner wire(s) in six fractures, and medial and lateral Kirschner wire(s) in six fractures. Major complications were recorded in four fractures and minor complications in two fractures. Limb function at follow-up was graded as excellent in 12, good in 15 and fair in three fractures. The range of elbow flexion was normal in seven, mildly reduced in 18, moderately reduced in four and severely reduced in one fracture. CLINICAL SIGNIFICANCE: In contrast to the caudal approach, combined medial and lateral approaches decrease the extent of periarticular soft tissue dissection, avoid complications associated with olecranon osteotomy and enable exposure of the entire humeral diaphysis for fixation. Bilateral fixation is likely to be better at counteracting bending and torsional forces compared with unilateral fixation.     

Incomplete humeral condylar fractures in the dog

The details of eight dogs (11 elbows) referred to the authors with lameness relating to elbow pain associated with incomplete fracture of the humeral condyle were reviewed. In all cases, a diagnosis was reached by radiographic examination, with the pathognomonic feature being a radiolucent line, in the sagittal plane, through the condyle. Treatment involved placement of a transcondylar bone screw with or without bone tunnels being created parallel to this implant. Six dogs (nine elbows) made a complete recovery without subsequent complications.     

Incomplete Ossification of the Humeral Condyle in Spaniels

An evaluation of 157 dogs with humeral fractures was performed. Cocker spaniels were more likely to have humeral condylar fractures (HCFs) than other breeds ( P < .0001). Male cocker spaniels were at increased risk ( P < .001). Cocker spaniels had more bilateral HCFs than other breeds of dogs ( P < .001). Eighteen dogs (17 purebred spaniels and 1 crossbred spaniel) with HCFs of unknown cause or occurring with normal activity were further studied, using radiography of their humeral condyle bilaterally (n = 18), computed tomography (n = 3), biopsy (n = 2), bone scintigraphy (n = 2), and genetic evaluation (n = 8). Fourteen of these 18 dogs had a nonfractured contralateral condyle. Twelve (86%) of the 14 nonfractured humeral condyles had a radiolucent line within the center of the condyle, 13 (93%) had radiographic signs of degenerative joint disease and an abnormal medial coronoid process, and six (43%) had periosteal proliferation involving the lateral epicondyle. Examination of biopsy samples from the fracture sites of two cocker spaniels showed fibrous tissue present at the fracture surfaces. The results of this study suggest an association between incomplete ossification of the humeral condyle in cocker spaniels and Brittany spaniels and a high prevalence of HCFs. Eight affected cocker spaniels with available pedigree information were found to be genetically related, suggesting that incomplete ossification of the humeral condyle may be a genetic disease with a recessive mode of inheritance.     

Evaluation of surgical repair of humeral condylar fractures using self-compressing orthofix pins in 23 dogs

OBJECTIVE: To report short- and long-term clinical and radiographic outcomes in dogs with humeral condylar fractures repaired using self-compressing Orthofix pins. STUDY DESIGN: Retrospective evaluation with solicited long-term clinical and radiographic evaluations. ANIMALS: Twenty-three dogs with humeral condylar fractures. METHODS: Medical records and radiographs were reviewed. Owners were asked to return dogs for long-term clinical and radiographic evaluation. RESULTS: Dogs were aged 1.5-26 months (mean+/-SD, 5.8+/-5.0 months) with 20 dogs weighing <5 kg (mean, 3.6+/-2.8 kg). Of 21 dogs with immediate post-operative radiographs, 10 had anatomic reduction with the rest having either a step and/or gap at the articular surface. Kirschner wire migration and implant loosening were the most common post-operative complications. All fractures with adequate follow-up radiographic evaluations achieved union. Twelve of 13 dogs returned for long-term evaluation (mean, 19.0+/-18.5 months) were either sound (10 dogs) or had subtle, weight-bearing lameness (2). Fourteen dogs had radiographs >/=75 days after surgery (mean, 18.7+/-18.3 months), 8 dogs (57%) had no radiographic evidence of osteoarthritis (OA; mean OA score, 0.8; median 0), and all dogs had good or excellent limb function. CONCLUSIONS: Self-compressing Orthofix pins are suitable implants for the stabilization of humeral condylar fractures in small breed dogs. Implants were convenient and simple to use and complications were easily resolved. Dogs consistently had good long-term clinical and radiographic outcomes with no or minimal lameness and OA. CLINICAL RELEVANCE: Self-compressing Orthofix pins should be considered for the repair of humeral condylar fractures in small breed dogs.     

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。     

Short-term outcome after total elbow arthroplasty in dogs with severe, naturally occurring osteoarthritis

OBJECTIVE: To evaluate limb function in client-owned dogs before and after total elbow arthroplasty (TEA) for severe, naturally occurring osteoarthritis (OA). STUDY DESIGN: Prospective clinical evaluation comparing limb function before and after surgery. ANIMALS: Twenty adult, large breed dogs with elbow OA. METHODS: Physical, radiographic, and force platform gait examinations were performed on all dogs before surgery. TEA was performed, and examinations were repeated at 3, 6, and 12 months after surgery. Pre- and postoperative findings were compared. RESULTS: TEA led to a satisfactory outcome in 16 dogs. In dogs with a satisfactory outcome, function in the operated limb increased over time, with mean peak vertical force (PVF) and vertical impulse (VI) 1 year after surgery being nearly twice the presurgical value. Serious complications encountered included infection (n = 2), luxation (n = 1), and fracture of the humeral condyle (n = 1). CONCLUSIONS: Although TEA, as presented, has significant limitations, it can be successfully performed in dogs with naturally occurring elbow OA. Improvements in technique and implant design should lead to improved prognosis. CLINICAL RELEVANCE: Based on 1-year data, TEA can be successfully performed in dogs and should be considered as a treatment alternative for adult dogs with lameness from severe OA of the elbow joint.     

Use of a condylar screw plate for repair of a Salter-Harris type-III fracture of the femur in a 2-year-old horse

A 2-year-old sexually intact male Paint horse weighing 427 kg (940 lb) was admitted for examination and treatment of intermittent non-weight-bearing lameness of the right hind limb of 1 week's duration. Radiography revealed a displaced Salter-Harris type-III fracture of the right femoral condyle with the sagittal component of the fracture line located in the intercondylar space and the transverse component exiting on the medial aspect of the femur. The fracture was repaired with a condylar screw plate designed for repair of femoral condylar fractures in humans. The owner reported by telephone 9 months after surgery that the horse was sound. To our knowledge, use of this particular implant system for fixation of a Salter-Harris type-III fracture on the medial side of the femur in a horse has not been described. Results in this horse suggest that this implant can be successfully used for repair of femoral condylar fractures in selected adult horses.     

Kirschner Wire Fixation of Lateral Humeral Condylar Fractures in Small Dogs

Successful treatment of humeral condylar fractures requires accurate reduction and rigid internal fixation. Lag screw fixation is the traditional method of repair for these fractures. An alternative method using Kirschner wire fixation was used to repair humeral condylar fractures in eight small dogs. Long-term follow-up was available for seven dogs: all were reported to have normal limb function.     

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.     

Arthrosis in the elbow joint of young rapidly growing dogs. III. Ununited medical coronoid process of the ulna and osteochondritis dissecans of the humeral condyle. Surgical procedure for correction and postoperative investigation

A surgical procedure for medial arthrotomy in the elbow joint is described. Surgery was performed in an endeavour to remove an ununited coronoid process and/or a loose piece of cartilage from the humeral condyle. A long term follow up investigation of 58 operated and 20 unoperated dogs was undertaken. The prognosis of dogs operated upon because of osteochondritis dissecans of the humeral condyle, was fairly good; 11 of 15 dogs (73.3%) being reported as showing no signs of lameness. When dogs with the both diagnoses were judged together, the percentage of dogs reported not to be lame was 48.3 among operated dogs and 45 among unoperated dogs. However, dogs operated upon, recovered somewhat sooner than unoperated dogs. Of 38 dogs (58 joints) which were clinically and radiographically re-examined by the author, it was found that severe arthrosis (degree 3) developed in about 60% of the joints, no matter whether surgical treatment was carried out or not. However, 19 of these dogs were not lame, or only revealed lameness occasionally.     

Arthrosis with special reference to the elbow joint of young rapidly growing dogs. II. Occurrence, clinical and radiographical findings.

Occurrence, clinical and radiographical findings in ununited medial coronoid process in the ulna and osteochondritis dissecans in the humeral condyle in dogs are presented. One hundred and twelve dogs were examined because of forelimb lameness. Lesions were mostly seen in young dogs of heavy breeds especially the Rottweiler. The ratio male: female was about 2:1. Most of the dogs had bilateral lesions. The lameness varied between grade 1 and 3, judged according to a scale ranging from 1 to 5. The affected limbs were somewhat rotated outwards from the elbow and down. Since the ununited coronoid process is almost impossible to detect on a plain radiograph, it is necessary to look for the presence of secondary developed osteophytes, indicative of an arthrosis. Diagnosis is based upon clinical and radiographical findings, the age and the breed of the dog taken into consideration. Osteochondritis dissecans in the humeral condyle is usually easily seen on the dorsopalmar radiograph.     

Limited open reduction and stabilization of sacroiliac fracture-luxations using fluoroscopically assisted placement of a trans-iliosacral rod in five dogs

Objective— To describe percutaneous fluoroscopically assisted placement of a trans-iliosacral rod to stabilize sacroiliac fracture-luxations after limited open reduction.
Study Design— Retrospective clinical case series.
Animals— Dogs (n=5) with sacroiliac fracture-luxations.
Methods— Medical records and radiographs were reviewed to evaluate implant placement, fracture reduction, pelvic canal diameter ratio, maintenance of reduction, implant stability, assessment of union, and to identify any complications. Owners were contacted to obtain long-term assessment of limb function.
Results— Dogs weighed between 6 and 31 kg. Trans-iliosacral rods were placed correctly traversing the sacral body. Mean (±SD) percent reduction of the sacroiliac joint was 92.9±6.6%. Pelvic canal diameter ratio did not differ significantly between time periods. With the exception of 1 dog, which died in the early postoperative period, all sacroiliac fracture-luxations healed without appreciable complications. Three dogs were sound and 1 dog had a subtle lameness at final physical and radiographic examination (mean±SD: 217±205 days). Owners assessed their dog's limb function (mean±SD: 355±205 days) as good or excellent.
Conclusions— Trans-iliosacral rods can be accurately placed using intraoperative fluoroscopy after limited open reduction of sacroiliac fracture-luxations. Trans-iliosacral rods provided bilateral secure fixation, allowed early weight-bearing and dogs consistently had good long-term clinical results.
Clinical Relevance— Trans-iliosacral rods are suitable implants for the stabilization of sacroiliac fracture-luxations, particularly in dogs with bilateral fracture-luxations and/or concurrent musculoskeletal injuries.     

INCOMPLETE OSSIFICATION OF THE HUMERAL CONDYLE IN VIETNAMESE POT-BELLIED PIGS

The purpose of this study was to evaluate the occurrence of humeral condylar fractures in Vietnamese pot-bellied pigs and to postulate a possible predisposing cause for these fractures. Thirteen Vietnamese pot-bellied pigs (Group A) were evaluated over an eight year period (1990-1998), each with a history of either a unilateral or bilateral forelimb lameness. The cause of lameness was localized to the elbow region. Of the thirteen pigs, twenty-one elbows were evaluated radiographically. Pigs ranged in age from six months to four years old. All pigs over the age of seven months showed radiographic evidence of elbow degenerative joint disease. Fractures involving the medial aspect of the humeral condyle were identified in 8/21 studies (38%). A well-defined linear intracondylar articular lucency was identified in 7/21 studies (33%) on the craniocaudal projection. The site of this lucency corresponded to the location of the articular component of the fractures seen involving the humeral condyle. The elbows of five pot-bellied pigs with no known history of forelimb lameness or trauma (Group B) were evaluated radiographically following euthanasia. All five pigs were of unknown age and gender. An intracondylar vertical linear lucency was identified bilaterally in three pigs (60%). Concurrent degenerative joint disease was present in all instances. The remaining two pigs were radiographically normal. Computed tomography of the elbows was performed in one affected pig from Group B. The radiographic findings in this pig were verified. Histopathology of the right elbow of this affected pig was diagnostic for incomplete endochondral ossification of the humeral condyle. A similar condition involving the humeral condyle has been previously described in Cocker and Brittany Spaniels. These canine breeds also have a high incidence of humeral condylar fractures. It is postulated that Vietnamese pot-bellied pigs are similarly prone to humeral condylar fractures, even in the absence of known trauma, due to incomplete ossification of the humeral condyle.     

Intercondylar humeral fracture in the dog: A review of 20 cases

A review of 20 consecutive cases of intercondylar humeral fracture in dogs referred to Glasgow University Veterinary School (GUVS) was made. The majority of fractures followed apparently minimal trauma to adult animals. All cases were managed by open reduction and internal fixation. Some aspects of the authors preferred surgical technique are discussed. Long term outcome was assessed by owner questionnaire and, or, examination at GUVS. Satisfactory results were seen in 64 per cent of cases with follow up.     

Propagation of a partial incomplete ossification of the humeral condyle in an American cocker spaniel

A hypoattenuating lesion in the left humeral condyle of an American cocker spaniel consistent with partial incomplete ossification of the humeral condyle was observed on computed tomography. Left forelimb lameness developed over the following three weeks at which time repeat computed tomography examination confirmed propagation of the lesion. Lameness resolved following placement of a transcondylar positional screw, suggesting that lameness was secondary to condylar instability. To the authors' knowledge this is the first report of propagation of an intracondylar lesion in a dog.     

Circular external skeletal fixation stabilization of antebrachial and crural fractures in 25 dogs

Fracture stabilization using circular external skeletal fixation was evaluated in 14 dogs with antebrachial fractures and 11 dogs with crural fractures. Most dogs were consistently weight bearing on the stabilized limb by 3 days following surgery. Although all dogs developed minor wire/pin tract inflammation and eight dogs developed major wire/pin tract inflammation, postoperative lameness was not consistently associated with wire/pin tract complications. Fractures in 23 dogs achieved radiographic union (mean +/- standard deviation [SD], 61 +/- 21 days; median, 57 days) without additional surgery; two dogs required restabilization of their fractures with linear fixators. Twenty of the 21 owners that could be contacted felt their dog had no (n=15) or only a mild (n=5) intermittent lameness at the time of final, long-term (mean +/- SD, 37 +/- 17 months; median, 42 months) assessment.     

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.     

Y-T humeral fractures with supracondylar comminution in five cats

Five cats with Y-T fractures of the humeral condyle were reviewed. Breeds presented included domestic shorthair (four cats) and Maine Coon (one cat). Age ranged from two to 16 years. All the cats were neutered males. A road traffic accident was suspected in all cases. Four of the fractures were severely comminuted and one fracture had four fragments. The fractures were repaired via combined medial and lateral approaches. Fixation of the epicondylar ridges was performed using buttress plates in four cases and neutralisation plates in one case. The intracondylar fracture was stabilised using a 2.7 mm lag screw in four cases and a 3.5 mm lag screw in the other. A corticocancellous bone graft was applied in two cases. The intracondylar fracture was accurately reduced in all cases. Complete radiographic healing was documented in two cases 6 and 11 weeks following surgery. Failure of the fixation occurred in the most severely comminuted fracture five days postoperatively. Surgical revision was not performed, and the limb was amputated. Three cats were free of lameness and had resumed outdoor activities at follow-up (five to eight months after surgery). Marked lameness due to loss of elbow movement was observed in the other case.     

A Lateral Approach to the Repair of Propagating Fractures of the Medial Condyle of the Third Metacarpal and Metatarsal Bone in 18 Racehorses

Objectives— To report the technique, observations on fracture configurations and results of treatment by fixation lag screw following the fracture plane determined by an approach to the third metacarpal/metatarsal bone (MC3/MT3) that begins laterally over the metacarpo(metatarso)phalangeal joint and extends dorsally over the diaphysis of the bone.
Study Design— Case series.
Animals— Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3.
Methods— Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection.
Results— Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced.
Conclusions— Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures.
Clinical relevance— Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection.     

Radiographic evaluation of the Zurich cementless total hip acetabular component

OBJECTIVE: To radiographically evaluate the Zurich cementless total hip (ZCTH) cup and correlate lucency with clinical signs of implant instability, time since surgery, and implant generation, using zonal analysis. STUDY DESIGN: Retrospective study. ANIMALS: Client-owned dogs (n = 53). METHODS: Radiographs of dogs that had ZCTH arthroplasty (>1 year) were evaluated using zonal analysis, for lucency surrounding the cup-bone interface (number of zones, length, area). Dogs were examined for clinical signs of implant instability (lameness, hip pain). Lucency was correlated with lameness, time after surgery, and implant generation. RESULTS: Radiographs of 68 implants (18 generation I, 50 generation II) were evaluated. Eight dogs were lame (11.8%). Dogs with lameness were more likely to have lucency in > or =2 zones of analysis (per view), have >2 times the average curvilinear length of lucency, and have >4 times the average area of lucency surrounding the implant compared with non-lame dogs. A weak relationship was observed between time after surgery and implant generation; however, there was no relationship between time after surgery and lucency. CONCLUSIONS: Dogs with lameness after ZCTH arthroplasty were more likely to have lucency at the cup-bone interface. Lucency was better evaluated by radiographic projection than zonal analysis. Temporal progression of lucency was weakly correlated with implant generation. CLINICAL RELEVANCE: Dogs with lucency in > or =2 zones of analysis should be evaluated more frequently for clinical signs of implant loosening. Further investigation of serial radiographs after ZCTH arthroplasty is warranted.