Effects of Three Intramedullary Pinning Techniques on Proximal Pin Location and Articular Damage in the Canine Tibia

The effects of three different techniques of intramedullary (IM) pin placement on pin location and incidence of stifle joint injury were evaluated using 70 cadaver canine tibiae after middisphyseal osteotomy. In 50 tibiae, pins were placed retrograde in either a nondirected (group A) or a craniomedially directed fashion (group B) with 25 tibiae in each group. Pins were driven normograde (group N) in 20 tibiae. All the stifles were dissected to qualitatively evaluate pin interference with different joint structures. End-on radiographs of the tibial plateaus were used to quantitatively evaluate pin location. Interference with the caudal cruciate ligament, medial meniscus, lateral meniscus, or meniscal ligaments was not observed in any group. There was a significant association between pinning technique and incidence of involvement of the cranial cruciate ligament ( P < .005), patella ( P < .001), patellar ligament ( P < .005), and femoral condyle ( P < .01). Pin location for group A was significantly different from either other group in a cranial-caudal direction ( P = .003), and was significantly different from group N in a medial-lateral direction ( P = .005). No significant difference was observed between pin location for groups B and N in either plane. It was concluded that although nondirected retrograde pinning cannot be recommended, retrograde pins directed craniomedially may be an acceptable technique for the repair of proximal to mid-diaphyseal tibial fractures if care is taken to properly seat the pins.     

Relationship of Femoral Intramedullary Pins to the Sciatic Nerve and Gluteal Muscles after Retrograde and Normograde Insertion

An anatomic analysis of retrograde and normograde intramedullary (IM) pinning of proximal, midshaft, and distal femoral fractures was performed in 28 canine cadavers. For all fracture locations, normograde pins were significantly more cranial in the middle gluteal muscle than retrograde pins (p less than 0.01). There was no significant difference between pinning techniques in craniocaudal position of the IM pin in the superficial gluteal muscle. In distal fractures, normograde pins were placed significantly more lateral than retrograde pins in the superficial gluteal muscle (p less than 0.01). One of 15 normograde pins and 9 of 13 retrograde pins were located in the medial half of the trochanteric fossa. Normograde pins were significantly more lateral in the trochanteric fossa than were retrograde pins in midshaft fractures (p less than 0.01). Normograde pins were significantly (p less than 0.01) farther from the sciatic nerve than retrograde pins when the hip was positioned at coxofemoral flexion angles of 85 degrees in midshaft and 110 degrees in distal fractures. Seven of 13 retrograde pins, but none of 15 normograde pins, contacted the sciatic nerve. Normograde pinning of the femur may be less likely to induce sciatic nerve injury, particularly in midshaft and distal fractures.     

Supracondylar femoral fractures in 159 dogs and cats treated using a normograde intramedullary pinning technique

Three separate studies that collectively represent 107 dogs and 52 cats with supracondylar femoral fractures are presented. The animals were treated using a normograde intramedullary pinning technique at the Norwegian School of Veterinary Science during the period 1964 to 1993. The surgical technique involves insertion of one or two intramedullary pins normograde from the stifle joint without passing their proximal end proximal to the level of the femoral neck. The results of treatment were obtained for 73 dogs and 39 cats. Of these cases, 58 dogs (79.5 per cent) and 32 cats (82.1 per cent) were found to be free of lameness after the completion of treatment. Differences in the results of treatment, based on species or size, were not found. Of all cases in which the results of treatment were known (n = 112), complications were recorded in nine animals (8.0 per cent). Infection and instability were the most common complications, affecting four and three cases, respectively.     

Closed Reduction of a Tibial Nonunion by Transfixation Pinning

Closed reduction and fixation by transfixation pinning is a successful operation for nonunion of the tibia following failure of intramedullary pin fixation. This technique has several advantages. It allows compression at the site of nonunion. It can be performed in a short time and causes minimal tissue trauma. The joints are not restricted and the patient has unrestricted ambulation.     

Stifle joint luxation in the dog and cat: the use of temporary intraoperative transarticular pinning to facilitate joint reconstruction.

Multiple ligament injuries of the canine and feline stifle joint which result in luxation are uncommon. Two cats and one dog, that had sustained such a joint injury were surgically treated. A rupture of the cranial and caudal cruciate ligaments, and at least one collateral ligament was observed in all of the three animals. Prosthetic reconstruction was used, as previously described, in combination with a novel technique of intraoperative placement of a temporary trans-articular pin (TTP) to maintain intra-operative anatomical reduction. TTP placement facilitated maintenance of joint alignment during surgical reconstruction and aided appropriate tensioning of the prosthetic sutures, preventing collapse of femorotibial joint compartments. The TTP was removed prior to closure of the joint allowing immediate post-operative joint mobilisation. Based on assessment by their owners, all the animals made a complete recovery. TTP was considered a relatively simple and effective adjunctive aid for surgical treatment of traumatic luxation of the stifle joint.     

Rotational strength of double-pinning techniques in repair of transverse fractures in femurs of dogs

Transverse midshaft fractures of femurs from freshly euthanatized dogs were stabilized by means of 6 methods: (1) 3.5-mm bone plate and screws, (2) single intramedullary pin, (3) double intramedullary pins retrograded proximally and driven distally to the level of the femoral trochlea, (4) double intramedullary pins retrograded distally and driven proximally into the trochanteric region, (5) double intramedullary pinning in Rush pin fashion, and (6) multiple intramedullary pinning that filled the medullary cavity at the fracture site. All bones were subjected to torsional stress. The measured strain was converted to forces of torque and correlated with bone diameter to normalize the data. The forces of torque from each fixation technique were compared with each other and with the mean torque force necessary to fracture intact femurs. Torsional shear applied to plated femurs resulted in failure at a mean level of 33.8% of the calculated theoretic moment. Torsional forces were concentrated at one end of the plate and catastrophically failed at that point, whereas the fracture site remained rigidly fixed. There was no significant difference in the initial moment of torsional failure between the single intramedullary pin technique (0.05 Nm) and the double-pinning techniques (0.03 to 0.04 Nm). The multiple-pinning technique was 1.8 to 3 times as effective in resisting rotational forces, compared with the other pinning techniques, but not significantly so.     

Use of a Rush pin to repair fractures of the distal femur in cats

Nine fractures of the distal femur in eight cats were repaired by using a 2.4 mm Rush pin as an intramedullary nail, placed between the condyles via a lateral or medial parapatellar approach to the stifle joint. In all cases the fractures were reduced and stabilised accurately with good postoperative results.     

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.     

Stifle joint luxation in the cat: treatment using transarticular external skeletal fixation

Extra-articular suturing techniques and transarticular external skeletal fixators were used to repair traumatic luxation of the stifle joint in four cats. Rupture of the cranial cruciate, caudal cruciate and medial collateral ligaments, together with injury to one or both menisci, were the most common injuries observed. The method of stifle repair was successful in all cases, but serious complications occurred when cats with transarticular external fixators were not kept confined indoors. Complications consisted of pin loosening and disruption of the fixator, or fractures through proximal or distal pins. Transarticular external skeletal fixation was considered to be a simple and effective method of maintaining short-term joint stability to allow healing of injured soft tissue structures. The apparatus facilitated early weightbearing and, on removal, allowed for the return of near-normal stifle function. Careful pin insertion and owner compliance in enforcing confinement are essential in minimising complications associated with immobilising the stifle joint using transarticular external skeletal fixation.     

A Novel Pin Distraction Device for Arthroscopic Assessment of the Medial Meniscus in Dogs

Objective— To describe an extra-articular joint distractor for meniscal examination and treatment during canine stifle arthroscopy.
Study Design— Case series.
Animals— Dogs ≥20 kg with suspected cranial cruciate ligament (CrCL) deficiency.
Methods— A custom designed linear side bar was constructed to allow invasive pin distraction of the stifle joint. Its design efficacy for distraction of the medial joint compartment, observation and probing of the medial meniscus, and value during meniscal surgery was evaluated by clinical use.
Results— Application of the stifle distractor medial to the stifle joint using 2 negative threaded pins was easily performed percutaneously without the need of power equipment; however, unintended intra-articular placement of 1 threaded pin occurred in 2 stifles, without appreciable consequence to joint function. Observation as well as thorough probing of the caudal horn of the medial meniscus, even in the presence of a prominent remnant of the CrCL or severe periarticular fibrosis, was possible. Partial meniscectomy was effectively performed as needed without apparent damage to the associated articular surfaces.
Conclusions— Distraction and translation of the medial compartment of the stifle joint using invasive pin distraction allowed observation and palpation of the caudal horn of the medial meniscus so that assessment and treatment were readily accomplished without apparent morbidity.
Clinical Relevance— With careful attention to accurate pin placement, invasive pin distraction of the medial compartment of the canine stifle joint may improve arthroscopic evaluation and treatment of meniscal pathology.     

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.     

Experimental use of polyamide bands in combination with intramedullary pinning for repair of oblique femoral fractures in rabbits

OBJECTIVE: To evaluate the use of polyamide bands, manufactured for securing electrical cables, for repair of oblique femoral fractures in rabbits. STUDY DESIGN: Experimental study. ANIMALS: Twelve nulliparous, 21-25-week-old, California female rabbits. METHODS: Rabbits were divided into 3 groups (n=4) and studied for 14, 28, or 56 days. A Z-shaped mid-diaphyseal femoral osteotomy was repaired with a 2.5 mm intramedullary pin and a polyamide 6.6 cerclage band. Healing was evaluated at intervals by physical examination, limb use, femoral radiographs, and callus histology. RESULTS: Rabbits had early limb use with good wound healing. From the 1st day, movement of the hip and stifle joints was satisfactory. Radiographically, fractures were healed at 28 days. Histologically, there was no foreign body reaction and bone healing was normal. CONCLUSION: Nylon cerclage band application was accomplished easily, maintained reduction, and resulted in good healing and limb use. CLINICAL RELEVANCE: Sterilized nylon bands, manufactured for electrical use, can be used for cerclage in rabbits.     

Folding of the Caudal Horn of the Medial Meniscus Secondary to Severence of the Cranial Cruciate Ligament

Folding of the caudal horn of the medial meniscus after surgical severence of the cranial cruciate ligament was investigated. When the stifle was flexed and the tibia was placed in a cranial position, the caudal horn of the medial meniscus could move forward without damaging the meniscus or the caudal joint capsule. Forward movement of the tibia with the stifle extended could damage the meniscus and/or the joint capsule. Abnormal position of the meniscus did not necessarily indicate meniscal damage.     

Mini review of canine stifle joint anatomy

The stifle is a complex, condylar, synovial joint that allows motion in three planes. The complexity of the normal motion is directly related to the structure and functions of the anatomical components that form the joint. Alteration in any one of these components often leads to dysfunction as well as an increased risk of damage to other structures in the joint. Thus understanding of the normal anatomy and function of each stifle joint component is essential for proper diagnosis and treatment of any stifle joint injury. This review highlights the basic anatomy and function of the stifle joint components.     

Management of quadriceps contracture in a dog using a static flexion apparatus and physiotherapy

A four-month-old golden retriever developed quadriceps contracture following management of a comminuted femoral fracture with an intramedullary pin and cerclage wire. Management involved surgical release of the quadriceps, rigid stabilisation of the fracture, use of a static stifle flexion apparatus and postoperative physiotherapy. The dog returned to full activity with normal stifle function.     

Comparison of endotracheal intubation techniques in llamas

This study evaluated a retrograde orotracheal intubation technique and compared it to the traditional normograde intubation technique used in llamas. Oral anatomical features, which can impair visualization of the epiglottis and laryngeal structures, and the production of excessive salivary secretions make it difficult to establish an airway under emergency conditions. Normograde intubation involves placing a stylet through the mouth into the trachea and advancing the endotracheal tube over the stylet into the trachea. For retrograde intubation, a nested trochar with cannula is placed into the cervical trachea and a stylet is advanced through the cannula and out the mouth. The endotracheal tube is advanced over the stylet back into the trachea. Our evaluation of both techniques found no statistical difference in time to place the stylet or endotracheal tube; however, fewer attempts were needed to place the tube using the retrograde technique. We found the retrograde technique to be a viable option for intubating llamas.     

Stifle joint osteoarthritis at the time of diagnosis of cranial cruciate ligament injury is higher in Boxers and in dogs weighing more than 35 kilograms

Osteoarthritis is a ubiquitous disease in dogs. The purpose of this retrospective study was to characterize the severity and distribution of osteoarthritis (OA) within the joint and to identify differences among dog breeds in the severity of OA in the cranial cruciate ligament (CCL)‐deficient stifle joint. Radiographs of 240 stifles from 51 Boxers, 66 German Shepherds, 100 Labrador Retrievers, and 23 Siberian Huskies with confirmed CCL rupture were included. Radiographs of the stifle joint were evaluated and OA severity was graded at 33 sites within and around the joint, and patella alta was graded as present or absent for a potential total stifle OA score of 100. Osteophyte size was correlated to OA severity score. Total OA scores were calculated and compared within and between breeds globally as well as at each joint site. Dogs weighing >35 kg had a higher total OA score than those weighing <35 kg. Osteoarthritis scores were highest at the apical patella, proximolateral tibia, and sesamoid bones, corresponding to the proximal, lateral, and caudal aspects of the joint, respectively. No statistically significant differences were found among the mean OA scores of various stifle joint regions. Boxer dogs had a higher total OA score than other breeds. We concluded that dogs have a consistent distribution pattern of OA within the stifle joint after CCL injury. Radiographic OA is more severe in the proximal, lateral, and caudal aspects of the joint. Boxers had more severe OA than the other breeds evaluated in the study.     

Fracture healing after stabilization with intramedullary xenograft cortical bone pins: a study in pigeons

OBJECTIVE: To investigate the effectiveness of intramedullary xenograft cortical bone pins compared with stainless steel Kirschner wire for the repair of a standardized avian humeral fracture. STUDY DESIGN: Prospective randomized study. SAMPLE POPULATION: Thirty mature pigeons (Columba livia). METHODS: Birds were randomly assigned to 3 groups. Transverse mid-diaphyseal humeral fractures were created in 1 humerus in each bird. Fractures were stabilized with intramedullary ostrich or canine xenograft cortical bone pins or Kirschner wire. Radiographic, histological, and biomechanical assessments were used to compare fracture healing 6 weeks after fracture stabilization. The contralateral humerus of each bird was used as a control. RESULTS: All fractures healed regardless of intramedullary pin type. There were no statistically significant biomechanical differences among groups or within groups. Xenograft cortical bone pins induced a mononuclear inflammatory reaction that did not impair bone healing. Bones stabilized with intramedullary cortical bone pins had more periosteal callus and inflammation at the fracture site than bones stabilized with stainless steel Kirschner wires. CONCLUSIONS: Intramedullary xenograft cortical bone pins, derived from mammalian or avian sources, appear to represent an alternative for the repair of avian humeral fractures. CLINICAL RELEVANCE: Intramedullary xenograft cortical bone pins are biodegradable and may reduce the need for additional surgery to remove implants after fracture healing.