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.     

Coxofemoral luxation in pet rabbits: nine cases

Of the pet rabbits presented at one private practice between August 2011 and August 2016 (n=1369), 5·6% presented with a traumatic orthopaedic injury. Of these, 7·8% (n=6) presented with traumatic coxofemoral luxation, the most frequently observed type of luxation. Three cases of non‐traumatic coxofemoral luxation in pet rabbits are also discussed. Eight rabbits presented with craniodorsal luxation and one with caudoventral luxation. Five rabbits were initially treated using closed reduction and an Ehmer sling under sedation. Two rabbits responded satisfactorily to closed reduction; their bandages remained in place for 10 and 14 days, and movement was cage‐limited for 1 month after bandage placement. The bandage did not prevent re‐luxation in three cases. Therefore, two rabbits received iliofemoral nylon sutures, and three rabbits received a femoral neck and head ostectomy. One rabbit was treated directly using open reduction and an iliofemoral nylon suture due to fractures in the same limb. One rabbit was presented in shock, coxofemoral luxation was noticed as an incidental finding and euthanasia was elected by the owner. In conclusion, of the three rabbits treated via femoral neck and head ostectomy one rabbit had an unsatisfactory outcome and two rabbits have non‐assessable outcomes. The three rabbits treated with iliofemoral sutures showed satisfactory long‐term outcomes and the two rabbits treated with closed reduction and an Ehmer sling showed satisfactory medium and long‐term outcomes.     

Stabilization of a proximal femoral physeal fracture in a filly by use of cancellous bone screws.

A Salter-Harris type-II fracture of the proximal portion of the right femur in a 2-month-old filly was reduced and stabilized with three 6.5-mm-diameter, 100-mm-long cancellous bone screws through a dorsal approach to the right coxofemoral joint. The screws were removed after 11 months because the filly became lame in the affected limb. The surgical wounds dehisced despite preventive measures, most likely because of tightness of skin in the coxal region. Seven years after the original injury, the horse could perform vigorous paddock exercise without any disability. Early internal fixation of proximal femoral physeal fractures in foals can provide a good long-term prognosis.     

Traumatic craniolateral shoulder luxation and fracture of the lesser tubercle of the humerus in a dog

A five-year old, spayed female, Bearded Collie was presented with a 24-hour history of non-weight-bearing lameness of the right thoracic limb after sustaining vehicular trauma. Radiographs revealed a craniolateral scapulohumeral luxation and a distally and medially displaced fracture of the lesser tubercle of the humerus. Open reduction and internal fixation of the fracture was achieved with lag screw fixation and an anti-rotational Kirschner wire. Surgical repair resulted in compression across the fracture line, anatomic reduction of the articular surface, and a stable scapulohumeral joint following reduction of the humeral head in the glenoid. Six weeks postoperatively, the patient exhibited no evidence of pain or lameness on the right thoracic limb and radiographs revealed complete healing of the fracture and normal articulation of the scapulohumeral joint. This is the first report of a lesser tubercle fracture associated with a craniolateral shoulder luxation. Surgical intervention resulted in the return of full shoulder joint function in this dog.     

Treatment of methicillin-resistant Staphylococcus epidermidis infection following repair of an ulnar fracture and humeroradial joint luxation in a horse

A 27-month-old Rocky Mountain Horse was examined because of a fracture of the proximal portion of the ulna and luxation of the humeroradial joint (Monteggia fracture). Open reduction was performed, using a mechanical distractor, and the ulnar fracture was stabilized by application of a bone plate and screws. After surgery, the horse developed an infection of the surgical site, and bacterial culture of fluid from the surgical site yielded a pure growth of methicillin-resistant Staphylococcus epidermidis susceptible to oxytetracycline, erythromycin, rifampin, and vancomycin. Treatment with oxytetracycline did not result in a favorable clinical response. Therefore, the horse was treated systemically with vancomycin and rifampin, and vancomycin-impregnated polymethyl methacrylate beads were implanted at the surgical site. Six months after surgery, the horse was sound at a walk or trot, and bony union was evident on radiographs of the elbow joint.     

A technique for internal fixation of scapulohumeral luxation using scapulohumeral tension sutures in three alpacas and one miniature steer

Objective— To report a technique for open reduction and internal fixation of scapulohumeral joint luxation in large animals, and outcome.
Study Design— Clinical case reports.
Animals— Mature alpacas (n=3) and immature miniature steer (1).
Methods— Shoulder joint luxation was diagnosed by physical examination and confirmed by radiography. Open reduction was performed with internal fixation using lateral tension band sutures.
Results— Animals maintained shoulder joint reduction and were sound with radiographically normal shoulder joints (n=2) and normal range of motion without appreciable gait abnormalities (4) at follow-up 8–36 months later.
Conclusions— In contrast to previous reports of open reduction with internal fixation of shoulder joint luxation in large animals, open reduction and use of lateral scapulohumeral tension sutures resulted in functionally normal shoulder joints.
Clinical Relevance— Stabilization of the shoulder joint with lateral scapulohumeral tension sutures after open reduction is effective, technically simple, and should be considered in large animal species weighing <100 kg.     

Elbow joint luxation in a 1-month-old foal

This paper reports on luxation of the elbow joint without concomitant fracture in a 1-month-old foal. Conservative treatment, with closed reduction and full-limb bandaging, including caudal and lateral splints, seemed successful initially, however, failed to provide enough stability and luxation recurred, and open reduction and surgical placement of prosthetic collateral ligaments was required. Luxation of the elbow joint should be considered when acute non-weight bearing forelimb lameness occurs associated with pain and swelling in the area of the elbow in young foals. Closed reduction failed to provide sufficient joint stability.     

Dicondylar humeral fracture stabilisation in a dog using a transilial rod and external fixation

Repair of a Salter-Harris type IV dicondylar humeral fracture was performed on a 15-week-old pitbull terrier. Interfragmentary compression of the intracondylar component of the fracture was achieved with a transilial rod and locking nuts (Trans-ilial Rod; IMEX Veterinary, Inc.). The transilial rod was articulated with a modified type I external fixator which functioned as adjunctive stabilisation for the supracondylar component of the fracture. Fracture healing was confirmed radiographically five weeks following surgery. The dog had no appreciable lameness when examined 12 months after fracture repair.     

Use of a dynamic compression plate and a cable cerclage system for repair of a fracture of the radius in a horse

A pregnant 9-year-old Peruvian Paso mare was evaluated because of a fracture involving the left radius. On examination, grade IV/V lameness of the left forelimb was observed; radiography of the limb revealed a longitudinal oblique displaced fracture that extended from the caudal cortex of the radial mid-diaphysis into the humeroradial joint. To minimize the development of degenerative joint disease in the humeroradial joint, repair with internal fixation was recommended. A dynamic compression plate was applied to the cranial aspect of the radius; three 2-mm stainless steel cable cerclages were positioned around the mid- and proximal diaphysis. The horse was maintained in a sling for 8 to 12 hours daily for 3 weeks after surgery. Five months after surgery, the mare had foaled without complications, and grade I/V lameness during trotting only was observed. The combination of 1 dynamic compression plate and cable cerclage may provide satisfactory stabilization of this type of fracture in small to medium-sized horses.     

Surgical repair of a cervical fracture/dislocation in a mature horse

The treatment of a cervical fracture/dislocation in an 11-year-old Anglo-Arab gelding is described. Six months after surgical repair of a luxation of the second left true intervertebral joint the animal appeared clinically normal.     

Tarsocrural joint luxation in a horse.

A 14-year-old Quarter Horse x Thoroughbred gelding was admitted to the teaching hospital because of inability to bear weight on its right hind limb, associated with a severe deviation of the tarsus. The provisional diagnosis was tarsal joint luxation or fracture. Radiography revealed complete luxation of the tarsocrural joint. The luxation was reduced, using minimal force. The horse was confined to a box stall and was maintained in a full-length hind-limb cast for 33 days. Box stall confinement was continued for 3 months after removal of the cast. On reexamination 18 months after the injury, the horse had only mild lameness (grade 1 of 5), but had marked reduction in the range of motion of the tarsus. Radiography revealed extensive changes indicative of severe degenerative joint disease. The horse was still used occasionally as a light pleasure riding horse and maintained itself on pasture well.     

SURGICAL MANAGEMENT OF A TRAUMATIC ELBOW LUXATION WITH CIRCUMFERENTIAL SUTURE PROSTHESES IN A RABBIT (ORYCTOLAGUS CUNICULUS)

A 2-year-old dwarf rabbit was referred for right forelimb lameness of 1-week duration. Physical examination and radiographic findings were consistent with an elbow luxation. Manual reduction under anesthesia was unsuccessful in correcting the luxated joint. A surgical approach was recommended to repair the rabbit elbow luxation. Transcondylar, transradial, and transulnar tunnels were drilled from lateral to medial with 2 suture prostheses being placed, 1 from the radius to the humerus and 1 from the humerus to the ulna. Analgesia was provided and the patient was reevaluated on days 2, 7, and 14 after the procedure. The luxation was reduced and no recurrence was noted a year following the surgical procedure. Circumferential suture prostheses, recently described with no reported postoperative complications in cats, can be used successfully in rabbits as evidenced in this case report.     

Surgical treatment of tarsometatarsal joint luxation in a miniature horse foal

A 2-week-old Miniature Horse foal was referred for evaluation and treatment of a luxated right tarsometatarsal joint. Treatment consisted of closed reduction and internal fixation using two partially threaded Steinmann pins placed in normograde fashion through the tuber calcis into the proximal third metatarsus. Traumatic luxation has been reported to occur in the tarsocrural, proximal intertarsal and tarsometatarsal joints within the equine tarsus. Treatment for luxation of the distal intertarsal joint has not been documented. The treatment method most commonly suggested for tarsal luxation is closed reduction and cast immobilisation. Internal fixation using lag screws and plating has also been described. A combination of internal fixation and external coaptation is thought to achieve maximal stability and allow faster convalescence in cases of tarsal luxation. This case report describes for the first time a technique using two Steinmann pins to achieve successful internal fixation of a traumatic tarsometatarsal joint luxation in a 2-week-old Miniature Horse foal.     

Tibial tuberosity avulsion fracture in dogs: a review of 59 dogs

OBJECTIVES: To evaluate the high incidence of tibial tuberosity avulsion fracture diagnosed in skeletally immature Staffordshire bull terriers presenting to a UK animal welfare charity hospital. METHODS: A retrospective review of tibial tuberosity avulsion fractures treated by the hospital between 2002 and 2007. RESULTS: Sixty-five tibial tuberosity avulsion fractures were recorded in 59 dogs. Fifty-one tibial tuberosity avulsion fracture-affected dogs (86 per cent) were Staffordshire bull terriers. Dogs sustaining tibial tuberosity avulsion fractures had median and mean ages of five and 4.9 months, respectively (range three to 10 months). Where recorded, injury was associated with a short fall or jump (typically 3 to 4 feet) in 29 of 50 dogs. Three fracture patterns were recorded: 37 stifles sustained isolated tibial tuberosity avulsion fracture; 15 stifles sustained tibial tuberosity avulsion fracture accompanied by separation of the proximal tibial epiphysis; in 13 stifles epiphyseal separation extended to produce Salter-Harris type II fracture of the caudal tibial metaphysis. On analysis of the hospital database, tibial tuberosity avulsion fracture was a reason for presentation in 51 (3.3 per cent) of 1536 Staffordshire bull terriers, but only five (0.18 per cent) of 2815 other breed dogs, registered under the age of 12 months during the study period (P<0.001). CLINICAL SIGNIFICANCE: Staffordshire bull terriers commonly present with tibial tuberosity avulsion fracture, with or without concurrent separation of the proximal tibial epiphysis, to this urban charity hospital.     

Bilateral hypoplasia of the minor tubercle of the humerus with medial luxation of the biceps tendon in two Quarter Horses

Two Quarter Horses were examined at the Washington State University Veterinary Teaching Hospital with forelimb lameness. Case 1 was a 4‐year‐old female with a 4 month history of intermittent forelimb lameness that had partially responded to oral anti‐inflammatories. The horse was in full training and actively competing in cutting. Case 2 was a one‐year‐old filly bred for cutting that presented with a right forelimb lameness of 3 weeks’ duration, which was not responsive to oral anti‐inflammatories. The horse was not in training. On lameness examination, Case 1 was grade 1/5 (American Association of Equine Practitioners scale) lame in the left forelimb in a straight line on a hard surface, extension and flexion of the shoulder was resented and exacerbated the lameness. Case 2 was grade 3/5 lame in the right forelimb in a straight line on a hard surface, flexion and extension of the shoulder was resented and exacerbated the lameness. Both horses had a characteristic dished appearance to the dorsal aspect of the shoulder, with prominence of the proximal aspect of the humerus. Ultrasound and proximodistal oblique (skyline) radiographic views of the scapulohumeral joints demonstrated bilateral hypoplasia of the minor tubercle of the humerus with bilateral medial luxation of the proximal biceps tendon in both cases. To the authors' knowledge this is the first report of 2 cases of bilaterally affected horses, as well as the first report of the condition in the Quarter Horse breed.     

Subluxation/luxation of the second carpal bone in two racing greyhounds and a Staffordshire bull terrier

Subluxation of the second carpal bone (C2) in two racing greyhounds, and luxation associated with other carpal injuries in a Staffordshire bull terrier, were diagnosed as causes of thoracic limb lameness. The clinical signs of subluxation were subtle, with local soft tissue swelling and a pain reaction on digital pressure over the dorsal aspect of C2. In contrast, the dog with a complete luxation was very lame, having marked soft tissue swelling with carpal hyperextension and valgus. Diagnosis was made by radiography. Subluxation of C2 was seen as a small, dorsally displaced opacity between the proximal and distal rows of carpal bones on the mediolateral view and, on the oblique view taken in only one case, as a marked dorsal displacement of one-third of the proximal joint surface of C2. In the case of luxation, C2 appeared on the mediolateral view lying dorsal to the radial carpal bone. There was also fracture of C4. Both greyhounds were treated by internal fixation and returned to racing. The Staffordshire bull terrier was treated by pancarpal arthrodesis with a successful outcome.     

Scapulohumeral arthrodesis in miniature horses

OBJECTIVES: To describe surgical arthrodesis of the scapulohumeral joint and to evaluate its efficacy in reducing morbidity associated with severe shoulder dysfunction in miniature horses. STUDY DESIGN: Retrospective study. ANIMALS: Four miniature horses. METHODS: Medical records and radiographs were reviewed for history, physical examination findings, lameness evaluation, radiographic evaluation, surgical techniques, postoperative complications, and outcome. A 10- or 11-hole, 4.5-mm narrow dynamic compression plate and 4.5-mm cortical screws were applied to the cranial surface of the scapula and cranial surface of the humerus after osteotomy of the intermediate tubercle. In most horses, 1 or 2 screws were inserted in lag fashion across the joint, through holes in the plate. RESULTS: Scapulohumeral osteoarthritis was diagnosed radiographically in 4 horses, and 3 horses had concurrent shoulder luxation or subluxation. All horses had grade 3 or 4 lameness before surgery, and most improved by 1 to 2 grades after surgery. Despite complications of implant failure (2 horses), infection (2 horses), scapular fracture (1 horse), and atrophy of the shoulder muscles (1 horse), functional arthrodesis reduced morbidity in all horses. CONCLUSIONS: Scapulohumeral arthrodesis facilitates early return to weight bearing in miniature horses with severe scapulohumeral joint osteoarthrosis. Despite functional gait abnormality, the horses ambulated quite well after surgery. CLINICAL RELEVANCE: Scapulohumeral arthrodesis should be considered for debilitating conditions of the shoulder joint in miniature horses, especially when the intended outcome is breeding or pasture soundness.     

Minimally‐invasive plate osteosynthesis of a Salter‐Harris type 2 fracture of the proximal phalanx in a filly

A 7‐month‐old Warmblood filly was referred to the equine hospital because of a Salter‐Harris type 2 fracture of the proximal physis of the right hind P1. On admission, the filly had acute grade 3/5 lameness at the walk and diffuse swelling in the area of the right hind proximal phalanx. Radiographs were taken to assess the fracture and plan treatment. Surgical treatment using two 4.5 mm narrow locking compression plates (PIP‐LCPs) resulted in fracture stabilisation and rapid healing. This case report suggests that internal fixation using PIP‐LCPs is useful for the treatment of Salter‐Harris type 2 fractures of the proximal physis of P1 in large foals.     

Traumatic elbow luxation repair in a common squirrel monkey (Saimiri Sciureus) and a bonnet macaque (Macaca radiata).

Traumatic elbow luxation was diagnosed in a common squirrel monkey (Saimiri sciureus) and a bonnet macaque (Macaca radiata). In the common squirrel monkey, the luxation was complicated by an ulnar fracture and would not stay reduced when attempts at closed reduction were made. The luxation was surgically reduced and a transarticular type I external skeletal fixator was placed. In the bonnet macaque, closed reduction was performed and the elbow was stabilized using a cast. Both monkeys regained good function of the injured elbows.