Fraturas apendiculares em cães e gatos: métodos de tratamento e desfechos / Appendicular fractures in dogs and cats: treatment methods and outcome

O objetivo deste estudo retrospectivo foi identificar a ocorrência de fraturas apendiculares em cães e gatos, os métodos de tratamento e os resultados obtidos com os mesmos, no Hospital Veterinário (HV) da Universidade Regional do Noroeste do Estado do Rio Grande do Sul (Unijuí), no município de Ijuí - RS, no período de abril de 2013 a abril de 2022. De um total de 370 procedimentos cirúrgicos para tratamento de fraturas do esqueleto apendicular, 117 foram em fêmur (31,6%), 77 em tíbia e fíbula (20,8%), 62 em rádio e ulna (16,8%), 49 em úmero (13,2%), 45 em pelve (12,2%), 7 em metatarso e metacarpo (1,9%), 7 em tarso e carpo (1,9%), 4 em escápula (1,1%) e 2 em falanges (0,5%). O número de procedimentos foi superior ao número de animais, pois alguns apresentavam mais de uma fratura em diferentes ossos. Entre os 329 animais reportados neste estudo, concluiu-se que a principal causa de fraturas em cães e gatos foi atropelamento, sendo os filhotes os mais acometidos e as fraturas femorais as mais frequentes. Os fixadores esqueléticos externos destacaram-se como o método mais utilizado e o desfecho das osteossínteses foi satisfatório, sendo que a maior casuística correspondeu a fraturas cicatrizadas.

This retrospective study aimed to identify the occurrence of appendicular fractures in dogs and cats, treatment methods, and results obtained with them, at the Veterinary Hospital (VH) of the Regional University of the Northwest of the State of Rio Grande do Sul (Unijuí), in the city of Ijuí/RS, from April 2013 to April 2022. A total of 370 surgical procedures for the treatment of fractures of the appendicular skeleton was performed: 117 were in the fêmur (31,6%), 77 in the tíbia and fíbula (20,8%), 62 in the radius and ulna (16,8%), 49 in the humerus (13,2%), 45 in pélvis (12,2%), 7 in metatarsus and metacarpus (1,9%), 7 in tarsus and carpus (1,9%), 4 in the scapula (1,1%), and 2 in phalanges (0,5%). The number of procedures was higher than the number of animals, as some had more than one fracture in different bones. Among the 329 animals reported in this study, it was concluded that the main cause of fractures in dogs and cats was being run over, puppies were the most affected, and femoral fractures were the most frequent. External skeletal fixators stood out as the most used method and the outcome of osteosynthesis was satisfactory, with the largest number of cases corresponding to healed fractures.

Desvio angular tibial varo bilateral em dachshund: relato de caso / Angular deviation pes tibial varus in Dachshund: case report

Varos tibial é um desvio angular decorrente do fechamento precoce parcial da linha fisária de crescimento do osso, levando a um desalinhamento articular com apoio e sobrecarga anormais, causando, secundariamente, osteoartrite, claudicação, luxação de patela, dor e problemas articulares. Neste relato, uma cadela da raça dachshund foi diagnosticada com tal afecção bilateralmente. Foi observado um desvio de ambos os membros posteriores aos 6 meses de idade. A confirmação da deformidade varo foi feita por meio do exame radiográfico e, posteriormente, foi realizada a tomografia e estereolitografia para o planejamento da cirurgia para correção do desvio angular, utilizando a metodologia de correção para desvio angular, denominada de técnica do centro de rotação da angulação (CORA) fechada, removendo uma cunha do osso para a correção da deformidade. A cirurgia foi bem-sucedida, apresentando bons resultados conformacionais, evoluindo sem complicações.(AU)

Tibial pes varus is an angular deviation resulting from the early partial closure of the physeal line of bone growth, leading to joint misalignment with abnormal support and overload, secondarily causing osteoarthritis, claudication, patellar dislocation, pain, among other joint problems. In this report, a female Dachshund canine was diagnosed with this condition bilaterally in the tibias. It was observed a deviation of both hind limbs at 6 months of age. Confirmation of the varus deformity was made through radiographic examination, and later computed tomography and stereolithography were performed to plan the surgery to correct bilateral angular deviation of the tibia, using the angular deviation technique (CORA) closed, removing a wedge from the bone to correct the deviation angular. The surgery was successful, and the angular deviation was correctly corrected, presenting good results to the animal, without complications.(AU)

Osteossíntese em maxila de anta-sul-americana (Tapirus terrestris Linnaeus, 1758) mantida sob cuidados humanos / Jaw osteosynthesis in a captive lowland tapir (Tapirus terrestris Linnaeus, 1758) kept under human care / Osteosintesis en la mandíbula de danta brasileña (Tapirus terrestris Linnaeus, 1758) mantenida bajo cuidado humano

A anta-sul-americana (Tapirus terrestris) é um mamífero de grande porte que habita áreas florestadas com abundância de água. É uma espécie bem representada em zoológicos e centros de triagem e de fácil adaptação ao ambiente artificial. Os problemas veterinários mais comuns em antas são lesões dermatológicas, oculares. em sistema musculoesquelético e, em menor proporção, problemas dentários. Objetivou-se relatar um caso de osteossintese em maxila superior de uma anta do sexo masculino de sete anos de idade, mantida sob cuidados humanos em um zoológico, com fratura da porção rostral maxilar. A metodologia de escolha para o tratamento foi a fixação interdentaria com flo de aço para coaptação dos fragmentos da fratura, seguida de ferulização para estabilização dos focos fraturários. Modificou- se a dieta para não sobrecarregar a força mastigatória durante o processo de cicatrização óssea. Após 120 dias, o animal foi submetido a nova anestesia para avaliação radiográfica e remoção dos implantes da osteossintese, apresentando boa recuperação e sendo incorporado ao grupo.(AU)

The lowland tapir (Tapirus terrestris) is a large mammal that inhabits. forested areas with abundance of water. It is well represented species in zoos and rescue centers and is easily adapted to the artificial environment. The most common veterinary problems in tapirs appear in skin, eye, musculoskeletal system and, to a lesser occurrence, teeth. The objective of this report is to present a case of osteosynthesis in the upper jaw of a seven-year-old male tapir, kept under human care in a zoo, with fracture of the rostral maxillary portion. The methodology of choice for the treatment was interdental fixation with steel wire, for coaptation of the fracture fragments, followed by splinting to stabilize the fracture foci. The diet was modified, to avoid overloading the masticatory force during the bone healing process. After 120 days, the animal underwent a new anesthesia for radiographic evaluation and removal of the osteosynthesis implants, showing good recovery and being incorporated into the group.(AU)

La danta brasilenä (Tapirus terrestris) es un grande mamifero que habita en zonas boscosas con abundancia de agua. Es una especie bien representada en zoológicos y centros de rescates y se adapta fácilmente al ambiente artificial. Los problemas veterinarios más comunes en los tapires son lesiones en piel, ojos y el sistema musculoesquelético y, en menor ocurrencia, los problemas dentales. El objetivo fue reportar un caso de osteosintesis en la mandíbula superior de un tapir macho de siete años, con fractura de la porción maxilar rostral, mantenido bajo cuidado humano en un zoológico. La metodologia de elección para el tratamiento fue el uso de ligadura interdental con alambre de acero para coaptación de los fragmentos de fractura, seguida de ferulización para estabilizar el foco de fractura. Se modificó la dieta para no sobrecargar la fuerza masticatoria durante el proceso de cicatrización osea. Después de 120 dias, el animal fue sometido a una nueva anestesia para evaluación radiográfica y retiro de los implantes de osteosintesis, mostrando buena recuperación e incorporándose al grupo.(AU)

Infecções no sítio cirúrgico em cirurgias ortopédicas de equinos com a utilização de implantes: estudo retrospectivo (2009-2021) / Surgical site infections in equine orthopedic surgeries using implants: retrospective study (2009-2021

A infecção no sítio cirúrgico (ISC) é uma complicação grave que pode acontecer em decorrência das cirurgias ortopédicas que demandam a utilização de implantes nos equinos. Morbidade, tratamentos prolongados e, consequentemente, dispendiosos e até mesmo óbito, são decorrências desta complicação. O presente trabalho analisou de forma retrospectiva os equinos submetidos a osteossíntese ou artrodese, que apresentaram ISC no período pós-cirúrgico atendidos no Hospital Veterinário da FMVZ-USP no período de 2009 a 2021. Sessenta e sete equinos atenderam aos critérios de seleção e, destes, 13 (19,4%) apresentaram ISC no período pós-cirúrgico. Escherichia coli, Streptococcus sp. e Enterobacter cloacae complex foram os agentes mais comumente isolados e a remoção dos implantes foi realizada em 76,9% (10/13) dos pacientes. Aminoglicosídeos associados ou não aos beta-lactâmicos foram as classes de antimicrobianos utilizados na terapia prévia em 84,6% (11/13), houve alteração das drogas utilizadas depois do resultado da cultura e antibiograma em todos os casos, devido à resistência antimicrobiana identificada. A incidência de ISC foi similar ao relatado em outros trabalhos, a retirada dos implantes foi uma estratégia eficiente quando o tratamento clínico não surte melhora. A identificação dos agentes envolvidos e o antibiograma se mostraram decisivos para o manejo dos casos.(AU)

Surgical site infection (SSI) is a serious complication that can occur in orthopedic surgeries that require the use of implants in horses. Morbidity, prolonged and consequently expensive treatments, and even death are consequences of this complication. This paper retrospectively analyzed horses undergoing osteosynthesis or arthrodesis, which presented SSI in the post-surgical period, treated at the Veterinary Teaching Hospital of FMVZ-USP from 2009 to 2021. Sixty-seven horses met the selection criteria and of these, 13 (19.4%) had SSI in the postoperative period. Escherichia coli, Streptococcus sp, and Enterobacter cloacae complex were the most commonly isolated agents and implant removal was performed in 76.9% (10/13) of patients. Aminoglycosides associated or not with beta-lactams were the classes of antimicrobials used in previous therapy in 84.6% (11/13), and in all cases there was a change in the drugs used after the result of the culture and antibiogram, due to antimicrobial resistance identified. The incidence of SSI was similar as reported in other studies, and implant removal was an efficient strategy when clinical treatment fails to improve. The identification of the agents involved and the antibiogram was decisive for cases management.(AU)

Anatomy and surgical approach to the humerus, radius and ulna of common sloth (Bradypus variegatus) / Anatomia e acesso cirúrgico ao úmero, rádio e ulna de preguiça-comum (Bradypus variegatus)

The surgical clinic of wild animals has increased in routine veterinary, where fractures by traumas are of frequent occurrence. This study determined the surgical accesses for osteosynthesis of the diaphyses of the humerus, radius and ulna of common sloth (Bradypus variegatus). Seven cadavers of B. variegatus were used for determination of the muscles of the thoracic limb, as well as the most important vessels and nerves, and better bone area for fixation of internal implants. The structural conformation of the radius and ulna in Bradypus variegatus were like those described in the literature for domestic animals but the humerus presented differences in the distal extremity because it was flattened. The musculature of Bradypus variegatus showed similarities with domestic animals. Due the different conformation of the humerus the surgical access to this bone can be performed by lateral approach, from the incision of M. triceps brachii lateral head, for fixation of the implant on the lateral side of the bone. Surgical access to the radius shaft can be performed by craniolateral approach, by incising the muscular fascia and separation of the cranially M. common digital extensor, and lateral digital extensor caudally. In ulna, a caudal access to the bone can be performed followed by release of the insertion m. flexor carpoulnar for placement of the internal implant on the lateral bone face.

A clínica cirúrgica de animais silvestres tem se intensificado na rotina veterinária, onde fraturas por traumas são frequentes. O objetivo deste estudo foi a determinação de acessos cirúrgicos para osteossíntese das diáfises do úmero, rádio e ulna de preguiça-comum (Bradypus variegatus). Sete cadáveres de B. variegatus foram utilizados para determinação dos músculos do membro torácico, bem como dos vasos e nervos mais importantes, e melhor área óssea para fixação de implantes internos. A conformação estrutural do rádio e da ulna em B. variegatus eram similares às descritas na literatura para animais domésticos, o úmero apresentou diferenças na extremidade distal pois apresentou-se achatado. A musculatura de B. variegatus mostrou semelhanças com os animais domésticos. Devido à diferente conformação do úmero o acesso cirúrgico a este osso pode ser realizado por abordagem lateral, a partir da incisão do M. tríceps braquial cabeça lateral, para fixação do implante na face lateral do osso. O acesso cirúrgico à diáfise do rádio pode ser realizado por abordagem craniolateral, por incisão da fáscia muscular e separação cranialmente do M. extensor digital comum e extensor digital lateral caudalmente. Na ulna, pode-se realizar um acesso caudal ao osso seguido de liberação da inserção do M. flexor carpoulnar para colocação do implante interno na face lateral do osso.

Consolidação de fraturas de tíbia em coelhos / Consolidation of tibia fractures in rabbits

Background: Disorders of the locomotor system are among the main treatments for this species, among the main causes are falls from a cage, arms or stairs and aggression by animals, such as dogs and cats. Biological osteosynthesis promotes early formation of secondary bone callus and allows a less accurate reconstruction of difficult interfragmentary apposition of 100% of the fragments. The objective of this work is to report the method of external immobilization with an aluminum channel aiming at the use of bone biology for the healing of unexposed tibial fractures in 3 rabbits (Oryctolagus cuniculus). Cases: Between 2020 and 2021, 3 cases of rabbits with unexposed tibial fractures were treated at the Veterinary Hospital. The 3 patients were diagnosed through physical examination and radiographic examination. All patients underwent anesthesia, underwent external immobilization with an aluminum channel, received analgesics and anti-inflammatory drugs, and recommended rest and care with the maintenance of external immobilization. Approximately at 30 days of rigid immobilization, all cases were evaluated by means of radiographic examination revealing the formation of bone callus at different post-immobilization times in the case 1 - 30 days, case 2 - 23 days and case 3 - 37 days. Discussion: Some surgical principles in rabbits must be followed, such as preserving vascularity if the open technique is decided, providing adequate diet, controlling edema, promoting analgesia and deciding on closed reduction if the fracture is recent and stable. The external coaptation method is a non-invasive method for the treatment of fractures and is also indicated with a high success rate for fractures of metacarpal, metatarsal and phalange bones in rabbits. The patient's age contributed to the early healing, which corroborates with case 1 (3-month-old), case 2 (6-month-old) and a little later the healing in case 3 (24-month-old), allowing unrestricted use of the member. It is worth reinforcing the point of view which defends that "biological osteosynthesis" promotes a favorable environment, especially in the preservation of the vascular supply of the periosteum when compared to traditional open surgical approaches. In this species, the surgical approach is a challenge due to the fact that the bones break or crack very easily, because the bones have a low density and higher mineral composition. Together, the skeleton represents 7% of the body weight, lower when compared to dogs and cats, which is 12%. In addition to these factors, rabbits are prone to secondary fractures, postoperative infections and rapid development of osteomyelitis, which significantly worsens the prognosis. The aluminum used in the manufacture of the aluminum channel has properties that offer resistance, lightness and radio transparency radiographic examination without removal of the channel, avoiding excessive micro-movement of the focus of the fracture due to lack of stabilization and possible refracture of the tibia. Rigid external immobilization with an aluminum channel was satisfactory in the 3 patients evaluated and preserved bone biology and anatomical axis. The treatment of choice was easy to apply, in addition to enabling better radiographic follow-up, promoting rapid bone healing for patients and early use of limbs without restrictions. However, for the effectiveness of the technique, the collaboration of tutors is essential.

Fraturas apendiculares em cães e gatos: casuística / Appendicular fractures in dogs and cats: casuistry

A ocorrência de fraturas é comum em cães e gatos, principalmente as ocasionadas por atropelamento. Diante disso, um estudo retrospectivo de cães e gatos atendidos entre abril de 2013 e abril de 2020 no Hospital Veterinário da Universidade Regional do Noroeste do Estado do Rio Grande do Sul foi realizado. O estudo teve como objetivo identificar a prevalência das fraturas apendiculares, a etiologia e o tratamento. De um total de 222 animais, 197 (88,7%) eram cães e 25 (11,3%) eram gatos, os quais apresentaram 254 fraturas apendiculares. Quanto às fraturas, os seguintes resultados foram observados: 86 fraturas de fêmur (33,9%), 58 fraturas de tíbia e fíbula (22,8%), 24 fraturas da pelve (9,4%), 39 fraturas do rádio e da ulna (15,4%), 40 fraturas do úmero (15,7%), 3 fraturas de escápula (1,2%), 3 fraturas de metatarso (1,2%) e 1 fratura de metacarpo (0,4%). Os animais mais afetados foram os cães: machos (n=100; 57,8%), com idade de até três anos (n=123; 62,4%), sem raça definida (n=95; 45%), de porte pequeno (n=123; 62,4%). Desta forma, conclui-se que o perfil de animais com fraturas apendiculares da Região Noroeste do Rio Grande do Sul é: cães machos, sem raça definida, jovens, de pequeno porte, sendo que o fêmur foi o osso mais acometido devido a acidentes automobilísticos.

The occurrence of fractures is common in dogs and cats, especially those caused by being run over. Therefore, a retrospective study of dogs and cats attended between April 2013 and April 2020 at the Veterinary Hospital of the Regional University of the Northwest of the State of Rio Grande do Sul was carried out. The study aimed to identify the prevalence of appendicular fractures, the etiology, and the treatment. Among 222 animals, 197 (88.7%) were dogs and 25 (11.3%) were cats, which presented 254 appendicular fractures. Regarding the fractures, the following results were observed: 86 fractures of femur (33.9%), 58 fractures of tibia and fibula (22.8%), 24 fractures of pelvis (9.4%), 39 fractures of radius and ulna (15.4%), 40 fractures of humerus (15.7%), 3 fractures of scapular (1.2%), 3 fractures of metatarsal (1.2%), and 1 fracture of metacarpal (0.4%). The most affected animals were dogs: male (n = 100; 57.8%), aged up to three years (n=123; 62.4%), mixed breed (n=95; 45%), small size (n=123; 62.4%). In conclusion, the animals profile with appendicular fractures of the Northwest Region of Rio Grande do Sul is: male dogs, mixed breed, young, small, and with femur as the most affected bone due to automobile accidents.

Computational development of a precise drilling guide for implant insertion in canine vertebral bodies / [Desenvolvimento computacional de um guia cirúrgico de perfuração precisa para inserção de implantes em corpo vertebral de cães]

O tratamento cirúrgico de estabilização da coluna vertebral de cães usualmente requer osteossíntese com uso de implantes, como pinos e parafusos. No entanto, as técnicas atuais de inserção de implantes no corpo vertebral não são totalmente precisas e várias complicações são atribuídas ao ato, como invasão do canal vertebral, danos vasculares e neurológicos. Para promover segurança na inserção de implantes e reduzir a ocorrência de lesões iatrogênicas, vem crescendo o interesse na produção de guias de perfuração em neurocirurgia veterinária. Com o objetivo de assegurar maior precisão e acurácia durante a perfuração óssea, foi desenvolvido um novo design de guia cirúrgico para inserção de implantes em corpo vertebral específico para a anatomia do paciente. A técnica proposta permite determinar o trajeto e o ângulo de perfuração óssea no corredor de implantação de cada vértebra, pela customização da guia e visa reduzir as taxas de complicações, promover precisão no posicionamento de implantes vertebrais e reduzir o tempo cirúrgico.

Preliminary mechanical evaluation of two novel veterinary angle-stable-threaded interlocking nail systems / Avaliação mecânica preliminar de dois novos sistemas veterinários de haste intramedular bloqueada em ângulo estável roscada

The interlocking nail represents an excellent option as a surgical approach to treat fractures in long bones in veterinary medicine. However, failures were reported mainly due to a slack present in the interface of the rod with the screws. The present study tested and mechanically compare axial compression loads of two novel models of stable angle interlocking nails with threaded holes. Among the two models, one was uniplanar and the other was multiplanar with orthogonally arranged distal holes. Twenty-one specimens made of polylactic acid were used for the implantation of interlocking nail´s rods, divided into three groups: conventional interlocking nail (G1), novel interlocking nail with a stable angle with holes arranged in a single plane (G2), and novel interlocking nail with a stable angle in two planes, with the penultimate hole at 90 degrees from the others (G3). Biomechanical tests were performed using axial, cyclic, and destructive compression load for comparison between them. All the specimens showed plastic deformation in the screws after destructive tests, in both proximal and distal sides, being highly intense in G1. G2 and G3 of the stable angle rods supported higher loads than G1 in all tests performed (P<0.05). The novel stems did not differ statistically from each other (P>0.05). The initial hypothesis that the novel models would provide increased stability was confirmed; however, no differences were demonstrated between them. The screw locking system on the rods allowed high resistance values in the tests performed, proving to be effective and potentially applicable in real clinical situations.

A haste intramedular bloqueada representa excelente opção para abordagem cirúrgica de fraturas em ossos longos na medicina veterinária. Todavia, falhas decorrentes principalmente de "folga" presente na interface da haste com os parafusos foram relatadas. O presente estudo teve como objetivo testar e comparar mecanicamente, por cargas de compressão axial, dois novos modelos de haste intramedular bloqueada de ângulo estável com orifícios roscados, sendo uma delas uniplanar e outra multiplanar com orifícios distais dispostos ortogonalmente. Vinte e um corpos de prova confeccionados em ácido polilático (PLA) foram utilizados para implantação das hastes intramedulares bloqueadas, divididos em três grupos: Haste bloqueada convencional (G1); haste bloqueada nova de ângulo estável com orifícios dispostos em único plano (G2); haste bloqueada nova de ângulo estável em dois planos, com o penúltimo orifício em 90 graus dos demais (G3). Utilizou-se ensaios biomecânicos por carga de compressão axial, cíclicos e destrutivos, para comparação entre eles. Todos mostraram deformação plástica nos parafusos após testes destrutivos, tanto proximais como distais, sendo mais intensa no grupo 1. Os grupos 2 e 3 das hastes de ângulo estável suportaram cargas superiores em relação ao G1 em todos os testes realizados (P<0.05). As hastes novas não diferiram estatisticamente entre si (P>0,05). A hipótese inicial de que os novos modelos proporcionariam maior estabilidade foi confirmada, entretanto não foi demonstrada diferenças entre eles. O sistema de bloqueio roscado dos parafusos nas hastes permitiu valores elevados de resistência nos testes realizados, mostrando-se efetivo e, potencialmente aplicável em situações clínicas reais.

Streptococcus spp. in equines - infection and antimicrobial susceptibility profiles

Background: Empirical antimicrobial prescribing is commonly used in equine veterinary. Therefore, professionals can obtain information about antimicrobial susceptibility profile of the bacterial strains based on veterinary literature. Considering equine infections, Streptococcus spp. are important pathogens that can cause serious damage in horses. Therefore, the aim of this study was to describe the antimicrobial susceptibility testing (AST) and infection profiles of Streptococcus spp. strains isolated from equines with infectious diseases subjected to microbiological analysis. Materials, Methods & Results: Veterinarians sent 13 samples and culture in Blood and MacConkey Agar were performed. After the incubation period, suspected colonies, which showed significative growth, were analyzed by Gram-staining, biochemical tests, and subjected to confirmatory identification in Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry. In vitro AST analysis were performed by disc diffusion method, in accordance with the veterinarians' request. The antimicrobials tested in this study were: ceftiofur, gentamicin, ampicillin, enrofloxacin, amikacin, penicillin, trimethoprim-sulfamethoxazole, ciprofloxacin, doxycycline, vancomycin and metronidazole. The samples included uterine exudate, hock fistula, osteosynthesis exudate, exudate from the guttural pouch, and were originated from animals located in different and distant geographical regions in the cities of Porto Alegre, Pelotas, and Bagé, Rio Grande do Sul, Brazil. Streptococcus dysgalactiae, Streptococcus equi and Streptococcus thoraltensis were the Streptococcus species identified in the samples. S. dysgalactiae was the mainly species found in the uterus samples, while S. thoraltensis, an unusual Streptococcus species, was identified as etiological agent of endometritis in 2 of the analyzed animals. On the other hand, S. equi was found in both the guttural pouch, representing the etiological agent of the strangle case, and in the osteosynthesis exudate, as infectious agent of post-osteosynthesis surgery. The majority of streptococci strains were susceptible to ceftiofur drug. Amikacin and ciprofloxacin, however, were the drugs for which the strains were mainly resistant according to the results. Discussion: The present study provided the AST and infection profile of Streptococcus species related to equine infectious diseases. S. dysgalactiae is considered an unusual bacterium isolated from horses that can be related to endometritis, S. equi is the causative agent of strangles, and S. thoraltensis is unusual in equines. Generally, the observed susceptibility to ceftiofur of the strains analyzed was in agreement with previous results reported in the literature. However, ceftiofur is a third-generation cephalosporin and is considered a critically important antibiotic for human health and its use in veterinary medicine should be cautious. Considering the resistance profile found, Streptococcus spp. can be intrinsically resistant to low drug concentrations of aminoglycosides. Moreover, the emergence and spread of fluoroquinolones resistance may also be due to the acquisition of resistance via horizontal gene transfer. Therefore, the present study described both infection and antimicrobial susceptibility patterns of Streptococcus strains related to equine infectious diseases. Considering the findings, the results found in this study might contribute to the decision-making by veterinarians to further equine treatments.

Pelvic fracture in a cat - precontouring of the plate based on allogenic 3D model and its application

Background: Pelvic fractures are commonly ecountered in cats. The ilium is included in approximately 50% of pelvic fractures in cats. Although conservative management of the pelvic fracture is known to have good prognosis, surgical fixation is recommended for the pelvic fracture with ilial fractures. 3D printing is an accurate digital modeling method by converting two-dimensional (2D) images into 3D model. 3D printing in veterinary medicine has been described in the various orthopedic diseases such angular limb deformities or fractures. The use of 3D model for presurgical planning is helpful to improve the results of complex surgical interventions. The objective of this study is to identify the usefulness of fabricating 3D models based on allogenic 2D data with aid of 3D printer program. Case: A 4-year-old spayed female domestic shorthair cat presented with hindlimb lameness. Radiography revealed left ilial body fracture with multiple fractures including left tuber ischium, pubic symphysis, and bilateral cranial ramuses of pubis. Digital imaging and communication in medicine (DICOM) files of the complete ilium were extracted from a computed tomography (CT) scan of a healthy and castrated male cat of same breed. Volume rendering images were prepared by Slicer program based on DICOM files. After acquired 3D data were converted to STL (Standard Triangulation Language) file for the 3D printing machine, non-fracture involved area was removed except the left ilium using the Meshmixer® software and then data was stored as STL files again. The length of 3D model was adjusted to actual size using 3D printer firmware based on actual size of the ilial length. Subsequently, 3D modelling was performed using 3D printer. The plate was precontoured to conform to the lateral surface of the 3D model. Internal fixation using precontoured plate resulted in accurate bone alignment. The alignment of the ilium remained appropriate throughtout the follow-up period. Complete union was identified 6 months after surgery. Discussion: Although the most common method for the ilial fractures is the application of bone plates to the lateral side of the ilium, bone plate fixation is more challenging in cats owing to the small bone size and small surface area of the fracture sites compared to dogs. Therefore, it is important to make accurate presurgical planning for successful result of a surgery. 3D printing based on actual patient have several limitations including time for complete printing process and additional anesthetic episode to acquire CT images. However, in simple cases, a presurgical CT scan may not be necessary if the plate can be precisely precontured based on the data from the other patient. In this way, the additional financial burden for CT examination also might be reduced. On the other hand, technical difficulty of utilizing hardware and software, and financial availability were another drawback. However, in this current study, most of limitations regarding conventional 3D printing based on actual patient were overcome by the application of the fused deposition modeling (FDM) technology with allogenic data. In the current study, total time for fabrication of 3D model based on FDM technology, was less than 3 h, which are much shorter than the time for conventional 3D printing. The difference of the ilial length between the actual patient and the 3D model was adjusted through the firmware program. Thus, differences of the conformation or size between the 3D model and the ilium of the patient was negligible during the surgery, although 2D images were not acquired from actual patient. Intraoperative contouring of the plate was not required. In conclusion, through presurgical plate contouring by the 3D bone template based on non-patient specific data, successful treatment of the ilial fracture was possible.

Biomechanical comparison of a modified TPLO plate, a locking compression plate, and plate-rod constructs applied medially in a proximal gap model in canine synthetic tibias / [Comparação biomecânica entre placa de TPLO modificada, placa bloqueada e construção placa-pino intramedular aplicadas medialmente em modelo de fratura proximal em tíbias sintéticas caninas]

The aim of this study was to develop a modified tibial plateau leveling osteotomy (TPLO) plate and to compare its biomechanical properties with a locking compression plate (LCP) and plate-rod constructs for the stabilization of experimentally induced gap fractures in canine synthetic tibias. The tibial models were assigned to either repair with a modified TPLO plate (Group 1), locking compression plate construct (Group 2), or plate-rod construct (Group 3). The specimens were loaded to failure in axial compression, three-point mediolateral and craniocaudal bending. There was no statistical difference between the three groups regarding stiffness (N/mm) and deformation (mm) in axial compression. The modified TPLO plate achieved load to failure similar to the plate-rod construct in craniocaudal bending. There was no significant difference between groups on mediolateral bending tests regarding load to failure and deformation. Furthermore, there was no significant difference in stiffness between groups 1 and 2. In conclusion, the modified TPLO plate had similar mechanical properties to LCP and plate-rod construct in the axial compression and bending tests. Nonetheless, clinical studies with a large population of dogs are required to determine the value of this new implant in proximal tibial fracture repair.

Objetivou-se desenvolver uma placa de osteotomia niveladora do platô tibial (TPLO) modificada e compará-la biomecanicamente à placa de compressão bloqueada (LCP) e à construção placa-pino intramedular na estabilização da fratura cominutiva proximal em tíbias sintéticas caninas. Para tal, tíbias caninas sintéticas foram divididas em três grupos, sendo o grupo 1 formado pela placa de TPLO modificada, o grupo 2 por placas LCP e o grupo 3 pela construção placa-pino intramedular. Os espécimes foram submetidos à carga até a falha em compressão axial, flexão mediolateral e craniocaudal em três pontos. Não houve diferença estatística entre os três grupos quanto à rigidez (N/mm) e à deformação (mm) nos testes de compressão axial. A placa de TPLO modificada obteve carga até a falha semelhante à construção placa-pino intramedular em flexão craniocaudal. Não houve diferença significativa entre os grupos nos testes de flexão mediolateral em relação à carga até a falha e a deformação, e a variável rigidez não apresentou diferenças significativas entre os grupos 1 e 2. Em conclusão, a placa de TPLO modificada apresentou similaridade mecânica em comparação com a LCP e a construção placa-pino. No entanto, estudos clínicos são necessários para determinar o valor desse novo implante na fixação de fraturas tibiais proximais.

Fratura de úmero em uma curicaca (Theristicus caudatus) - manejo anestésico e cirúrgico / Humerus fracture in a buff-necked ibis (Theristicus caudatus) - anesthesia and surgical procedures

Background: The medical science of birds, with the exception of aviculture, has a very short history compared to other subdisciplines of veterinary medicine. With this in mind, the current work aims to report the case of a buff-necked ibis with an open fracture of the left humerus, presenting the surgical treatment and anesthetic protocol used, in order to contribute to the avian medical literature. Case: An adult buff-necked ibis (Theristicus caudatus) was referred to the University Veterinary Hospital with an open fracture of the left humeral shaft, 7 days after rescue. During the physical examination, a skin lesion was identified in the fracture area, with signs of low vascularization, devitalization, necrotic tissues, and purulent secretions being noted. On radiographic examination, the fracture was classified as comminuted, with exposure of the left humeral shaft. After evaluating the limb, it was decided to amputate the wing, and 24 h later, the patient was referred to the operating room after fasting for 4 h. As pre-anesthetic medication, ketamine (20 mg/kg) and midazolam (1 mg/kg) were administered, both intramuscularly. Orotracheal intubation was performed, after which the tracheal tube was connected to a Baraka-type gas-free system and the supply of isoflurane was started through a universal vaporizer, diluted in 100% oxygen. For transoperative analgesia, brachial plexus block was performed using 2% lidocaine (2 mg/kg). During the surgical procedure, an incision was made in the skin and subcutaneous tissue in the middle third of the left humerus, and detachment of the greater deltoid muscle was performed with a periosteal elevator, followed by excision of the tensor propatagialis. In the ventrodorsal region, circular ligation of the brachial vein, ulnar vein and artery, and median-ulnar nerve was carried out, and disarticulation of the scapulacoracoid-humeral region. Subsequently, abolition of dead space and a myorrhaphy were performed, followed by demorrhaphy. In the immediate post-operative period, morphine (5 mg/kg), meloxicam (0.1 mg/kg), and enrofloxacin (10 mg/kg) were administered intramuscularly. The patient was discharged from the hospital 6 h after the end of the surgical procedure. Discussion: Interest in the conservation of wild birds is one of the causes of the increased demand for anesthetic and surgical procedures in these species. However, it is a challenge for professionals in the field. The use of analgesics is recommended for reasons of well-being, but also because of the possibility of reducing the concentration of inhalational anesthetics in surgical procedures. Ketamine associated with midazolam promotes sufficient sedation and muscle relaxation in the patient, enabling safe preoperative management, in addition to reducing the amount of inhaled anesthetics used during the transoperative period. Isofluorane promotes safe general anesthesia for birds and has an advantage over injectable drugs, as it provides better dynamic control of anesthetic depth in these species. The brachial plexus block performed is a simple procedure that promotes quality anesthesia and analgesia in the perioperative period. The choice for amputation was due to the absence of musculature for closure, severe skin, muscle, and bone devitalization, and the infectious process in the region, factors that would prevent osteosynthesis. Although amputation through the bone is preferable, the disarticulation technique was used due to the absence of a healthy proximal humeral fragment. The patient's death can be explained by the poor nutritional status the bird was in, as it presented an open fracture with severe contamination, a concomitant injury that occurred during the possible trauma, and the excessive time between the day of the trauma and the day of medical attendance. However, the surgical and anesthetic procedures were adequate and satisfactory for the patient. The importance of identifying and treating diseases secondary to contaminated fractures in these species is emphasized.

Fratura exposta do fêmur em preguiça-real (Choloepus didactylus) - tratamento e reabilitação / Open fracture of the femur in a two-toed sloth (Choloepus didactylus) - treatment and rehabilitation

Background: The Choloepus didactylus is characterized by having 2 fingers on the forelimbs and 3 on the hind limbs, being found more frequently in northern South America, in countries such as Venezuela, Guyana, Ecuador, Peru, and Brazil. In Brazil, deforestation of the Amazon rainforest has threatened the survival of C. didactylus. In addition, these animals can be affected by several diseases, being those of the musculoskeletal system with limited reports. Thus, the present report aimed to describe the treatment and evolution of an open fracture of the femur in a free-living Choloepus didactylus, which after rehabilitation was released back to the wild. Case: A free-living female two-toed sloth (Choloepus didactylus), weighing 7.0 kg, was found in Manaus city and referred to the Wild Animal Treatment Center (CETAS - IBAMA-AM) located in Amazonas, Brazil, after initial treatment and osteosynthesis in a private clinic (CVMinasPet). According to history, the animal had suffered electrocution 30 days ago and, as a result, had an extensive wound that resulted in the exposure of the knee joint, distal fracture of the femur, and areas of necrosis in the right pelvic limb. After cleansing of the area and removal of necrotic tissues, the fracture was stabilized with the cross-pinning technique (2 Steinmann pins). Then, the stifle joint was stabilized with external skeletal fixation (Type 1b, unilateral biplanar). The external fixator and cross-pins were removed 2 months after the surgical procedure, being observed bone healing. Next, the animal underwent physical rehabilitation for 30 days. After the rehabilitation period, a microchip and a radio collar were applied, and the sloth was released back to the wild. Discussion: Electrocution has been one of the causes of wildlife rescue, with consequences varying depending on the degree of the burn. Generally, the burn is most severe at the entry and exit sites. Since suspensory quadrupedal locomotion requires that sloths have specialized hands and feet to connect with the supports, probably the animal of the current report touched the right pelvic limb on a high-tension pole. The cross-pinning technique combined with the external fixator was used because the animal had an exposed Salter-Harris type I fracture with soft tissue loss. The younger the animal presents physeal fractures, the greater is the chance of developing growth abnormalities due to growth plate closure caused by fracture type or immobilization method. Since the sloth was a free-living animal, the age was unknown. However, pelvic limb length discrepancy was not observed after removing the implants. Culture and antimicrobial susceptibility test were not done and may be considered a limitation of this report. However, the application of ceftriaxone was adequate to control the infection, since the animal did not show signs of infection or draining sinus tracts. Ceftriaxone is a third-generation antibiotic that can be used in chronic osteomyelitis. In addition, the animal in the present report showed good adaptation to captive conditions that contributed to the clinical management. The longevity of the sloth in captivity can reach more than 30 years, but the goal is always to return the animal to nature after the treatment. Surgical treatment of the fracture and physical therapy after implant removal allowed this action in the current report, confirmed by monitoring with the radio collar.

Bridge plating for simple tibial fractures treated by minimally invasive plate osteosynthesis / [Estabilização em ponte de fraturas tibiais simples por osteossíntese minimamente invasiva com placa]

This study aimed to evaluate the effectiveness of bridge plating of simple tibial fractures in dogs by minimally invasive plate osteosynthesis (MIPO). Medical and radiographic records of twenty-nine dogs with simple tibial fractures that underwent bridge fixation by MIPO were retrospectively evaluated. The clinical outcome was classified considering the presence of lameness at the end of the treatment. The tibial mechanical joint angles were measured and compared with the values described in the literature. Additionally, fragment apposition and implant disposition were evaluated. Based on the modified Radiographic Union Scale for Tibial fractures, the moment of clinical union was determined. Clinically, at the end of treatment, only one patient presented lameness at a trot. While there was no significant difference between the bone alignment in the frontal plane values and the values described in the literature (P>0.05), the caudal proximal tibial angle was significantly higher (P=0.001). The median fragment apposition was considered acceptable. The average bridge plate ratio, plate working length, and plate screw density were 0.8, 0.57, and 0.48, respectively. The median time to clinical union was 30 days. Bridge plating in simple tibial fractures resulted in fast healing and low complication rates.(AU)

Objetivou-se avaliar a efetividade da estabilização em ponte de fraturas tibiais simples em cães utilizando-se a técnica de osteossíntese minimamente invasiva com placa (MIPO). Registros médicos e radiográficos de 29 cães com fraturas simples de tíbia, fixadas em ponte por meio da MIPO, foram retrospectivamente avaliados. O resultado clínico foi classificado com base na deambulação ao final do tratamento. Os ângulos articulares mecânicos da tíbia foram aferidos e comparados aos valores descritos na literatura. Adicionalmente, foram avaliadas a aposição dos fragmentos e a disposição dos implantes. Por meio da escala modificada de união radiográfica para fraturas de tíbia, determinou-se o momento de união clínica. Clinicamente, ao final do tratamento, apenas um animal apresentou claudicação ao trote. Não houve diferença significativa entre o alinhamento ósseo no plano frontal quando comparado com dados da literatura (P>0,05), enquanto, no plano sagital, o ângulo mecânico caudal proximal da tíbia foi significativamente maior (P=0,001). A mediana para aposição dos fragmentos foi considerada aceitável. As médias para relação placa em ponte, comprimento de trabalho da placa e densidade de parafusos da placa foram, respectivamente, 0,8; 0,57 e 0,48. A mediana para união clínica foi de 30 dias. A estabilização em ponte de fraturas tibiais simples resultou em rápida consolidação óssea, com baixas taxas de complicação.(AU)

Locking compression plate fixation of critical-sized bone defects in sheep. Development of a model for veterinary bone tissue engineering

ABSTRACT Purpose To develop a segmental tibial bone defect model for tissue engineering studies in veterinary orthopedics using single locking compression plate (LCP) fixation and cast immobilization. Methods A 3-cm bone defect was created in the right tibia of 18 adult Suffolk sheep. A 10-hole, 4.5-mm LCP was applied to the dorsomedial aspect of the bone. Four locking screws were inserted into the proximal and three into the distal bone fragment. Operated limbs were immobilized with casts. Animals were submitted to stall rest, but were allowed to bear weight on the operated limb. During the recovery period, animals were checked daily for physiological parameters, behavior and lameness. Follow-up radiographs were taken monthly. Results Surgical procedures and postoperative recovery were uneventful. Animals adapted quickly to casts and were able to bear weight on the operated limb with no signs of discomfort or distress. No clinical or radiographic complications were detected over a 90-day follow-up period. Conclusions Surgical creation of tibial segmental bone defects followed by fixation with single LCP and cast immobilization was deemed a feasible and appropriate model for veterinary orthopedic research in tissue engineering.

A plate-rod construct for repair of a humeral diaphyseal fracture in a black howler monkey infant / Osteossintese de úmero com a utilização de placa e pino intramedular para estabilização de fratura em um filhote de bugio preto

An infant black howler monkey (Alouatta caraya), aged approximately three months, presented with a transverse fracture of the distal third of the right humeral shaft underwent surgical treatment using a plate-rod construct. A 1.00-mm diameter intramedullary pin was used in a retrograde fashion to reduce both the fracture and plate stress. The plate-rod construct was a seven-hole 1.5-mm veterinary cuttable plate, which was installed following the principles of biological osteosynthesis. The animal presented no pain in the postoperative exams and used the limb normally. Bone consolidation was observed for eighth weeks after surgery, showing that the treatment was effective.

Um filhote de bugio preto (Alouatta caraya), com aproximadamente três meses de idade, apresentando uma fratura transversa do terço distal da diáfise umeral, foi submetido a tratamento cirúrgico através da utilização de uma placa de reconstrução com função ponte associada a um pino intramedular. Um pino intramedular de 1,00mm de diâmetro foi utilizado de maneira retrógrada para auxiliar na redução da fratura e para diminuir o estresse sobre a placa. A placa utilizada foi uma de reconstrução de 1,5mm e, para sua colocação, seguiu-se os princípios da osteossíntese biológica. Em todas as avaliações pós-operatórias, o animal não demonstrava dor e utilizava o membro normalmente. Observou-se consolidação óssea na oitava semana após a cirurgia, mostrando que o tratamento utilizado foi eficaz.

A plate-rod construct for repair of a humeral diaphyseal fracture in a black howler monkey infant / Osteossintese de úmero com a utilização de placa e pino intramedular para estabilização de fratura em um filhote de bugio preto

An infant black howler monkey (Alouatta caraya), aged approximately three months, presented with a transverse fracture of the distal third of the right humeral shaft underwent surgical treatment using a plate-rod construct. A 1.00-mm diameter intramedullary pin was used in a retrograde fashion to reduce both the fracture and plate stress. The plate-rod construct was a seven-hole 1.5-mm veterinary cuttable plate, which was installed following the principles of biological osteosynthesis. The animal presented no pain in the postoperative exams and used the limb normally. Bone consolidation was observed for eighth weeks after surgery, showing that the treatment was effective.(AU)

Um filhote de bugio preto (Alouatta caraya), com aproximadamente três meses de idade, apresentando uma fratura transversa do terço distal da diáfise umeral, foi submetido a tratamento cirúrgico através da utilização de uma placa de reconstrução com função ponte associada a um pino intramedular. Um pino intramedular de 1,00mm de diâmetro foi utilizado de maneira retrógrada para auxiliar na redução da fratura e para diminuir o estresse sobre a placa. A placa utilizada foi uma de reconstrução de 1,5mm e, para sua colocação, seguiu-se os princípios da osteossíntese biológica. Em todas as avaliações pós-operatórias, o animal não demonstrava dor e utilizava o membro normalmente. Observou-se consolidação óssea na oitava semana após a cirurgia, mostrando que o tratamento utilizado foi eficaz.(AU)

Humeral fracture repair using a robust fixation in an adult Giant Anteater (Myrmecophaga tridactyla): case report / [Reparo de fratura umeral usando uma fixação robusta em um tamanduá-bandeira adulto (Myrmecophaga tridactyla): relato de caso]

The treatment of fractures from the thoracic limb in giant anteaters is extremely challenging. Unfamiliar and peculiar anatomical characteristics, robust musculature and the imminent need for an early return to limb function highlight such challenges. The objective of this report was to describe the successful use of anatomical osteosynthesis with a robust locking compression plate in a humeral fracture of an adult giant anteater. The patient was rescued on the highway after being run over and presented for treatment at the Veterinary Teaching Hospital. Surgical stabilization was performed using a craniomedial approach to the humerus, using a customized broad 3.5mm locking compression plate. The patient presented early limb support at 24 hours postoperatively. Radiographic monitoring was performed at 30, 60 and 90 days postoperatively, and bone healing was observed without any complications. It is concluded that the treatment of humerus fractures in giant anteaters requires robust fixation. The use of a reinforced locking compression plate system proved to be effective and adequate to the mechanical load that an adult individual of this species needs for early use of the thoracic limb and, at the same time, efficient in controlling interfragmentary movement, which allowed fracture consolidation.(AU)

O tratamento das fraturas do membro torácico dos tamanduás-bandeira (Myrmecophaga tridactyla) é extremamente desafiador. Características anatômicas pouco familiares e peculiares, musculatura muito desenvolvida e necessidade iminente de retorno precoce à função do membro destacam tais desafios. Objetivou-se, neste relato, descrever a utilização com sucesso da osteossíntese anatômica com placa bloqueada robusta em fratura umeral de um tamanduá-bandeira. O paciente foi resgatado em rodovia após atropelamento e atendido no Hospital Veterinário Universitário. Após sedação e avaliação física completa, foi realizado exame radiográfico, o qual revelou fratura completa oblíqua curta em diáfise média de úmero esquerdo. A estabilização cirúrgica foi realizada por abordagem craniomedial ao úmero, utilizando-se placa bloqueada (LCP) do sistema 3,5mm customizada. O paciente apresentou apoio precoce do membro com 24 horas de pós-operatório. Realizou-se acompanhamento radiográfico aos 30, 60 e 90 dias, sendo observada união clínica sem quaisquer complicações. Conclui-se que o tratamento das fraturas do úmero em tamanduás-bandeira exige robustez na fixação. A utilização de sistema reforçado de placa bloqueada mostrou-se efetiva e adequada à carga mecânica de que um indivíduo adulto dessa espécie necessita para uso precoce do membro torácico e, ao mesmo tempo, eficiente no controle da movimentação interfragmentária, o qual permitiu consolidação da fratura.(AU)

Percutaneous application of allogeneic adipose-derived mesenchymal stem cell in dogs submitted to minimally invasive plate osteosynthesis of the tibia

Purpose To evaluate clinical outcome following minimally invasive plate osteosynthesis (MIPO) associated with percutaneous transplantation of allogeneic adipose-derived mesenchymal stem cells (AD-MSC) at the tibial fracture site in dogs. Methods Thirty-six dogs presenting with nonarticular complete tibial fracture were included in this study. All fractures were treated by the same MIPO technique. The animals were divided in group 1 (n = 20) received a percutaneous application of 3 × 106 AD-MSC at the fracture site and group 2 (n = 16) did not receive any adjuvant treatment. Postoperative radiographic examinations were made at 15, 30, 60, 90 and 120 days. Results Fifty-eight percent of the patients were classified as skeletally immature. The median weight of the animals was 18.8 kg. The mean radiographic union time differed statistically between the AD-MSC group (28.5 days) and the control group (70.3 days). Sixty percent of dogs in group 1 and 56.25% of the group 2 were considered immature. Conclusions The use of allogeneic AD-MSC cell therapy and MIPO is a safe, viable and effective technique for promoting bone healing in nonarticular tibial fractures in dogs.(AU)