RESUMO
OBJECTIVE: To compare the efficacy and clinical outcomes of computed tomography (CT)-based virtual surgical planning (VSP) and a three-dimensional (3D)-printed, patient-specific reduction system to conventional indirect reduction techniques for diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO) in dogs. STUDY DESIGN: A prospective clinical study with a historic control cohort. SAMPLE POPULATION: Dogs undergoing MIPO stabilization of diaphyseal tibial fractures using a custom 3D-printed reduction system (3D-MIPO; n = 15) or conventional indirect reduction techniques (c-MIPO; n = 14). METHODS: Dogs were prospectively enrolled to the 3D-MIPO group and CT scans were used to design and fabricate a custom 3D-printed reduction system to facilitate MIPO. Medical records were searched to identify dogs for the c-MIPO group. Pre-, intra- and postoperative parameters were compared between groups. RESULTS: The duration from presentation until surgery was 23 h longer in the 3D-MIPO group (p = .002). Fewer intraoperative fluoroscopic images were acquired (p < .001) and mean surgical duration was 34 min shorter in the 3D-MIPO group (p = .014). Median postoperative tibial length, frontal alignment, and sagittal alignment were within 4 mm, 3° and 3°, respectively, of the contralateral tibia in both groups and did not differ between reduction groups (p > .1). Postoperative complications occurred in 27% and 14% of fractures in the 3D-MIPO and c-MIPO groups, respectively. CONCLUSION: Both reduction methods yielded comparable results. Although the preoperative planning and guide preparation was time consuming, surgery times were shorter and fluoroscopy use was less in the 3D-MIPO group. CLINICAL SIGNIFICANCE: VSP and the custom 3D-printed reduction system facilitated efficient MIPO.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Impressão Tridimensional , Fraturas da Tíbia , Animais , Cães/cirurgia , Cães/lesões , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/veterinária , Fraturas da Tíbia/diagnóstico por imagem , Placas Ósseas/veterinária , Masculino , Feminino , Estudos de Casos e Controles , Estudos Prospectivos , Tomografia Computadorizada por Raios X/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Doenças do Cão/cirurgia , Cirurgia Assistida por Computador/veterinária , Cirurgia Assistida por Computador/métodosRESUMO
Monteggia fractures (MFs) are proximal ulnar fractures with concurrent dislocation of the radial head. This retrospective study aims to report the clinical findings and discuss the treatments and outcomes in MFs cases of 9 cases. Previous medical records of the animals were reviewed for history, clinical features, radiographic findings and choice of treatment. Treatment follow-up was evaluated over the telephone by discussion with the owners. Six animals included in the study were presented 2 days after the initial trauma. Five dogs were presented after common road traffic accidents and two after unknown traumas. All dogs had type I MFs, while the cat had a type III MF. Radiographical findings showed that six animals had extra-articular ulnar fractures, while three animals had intra-articular ulnar fractures. All animals were treated with open reduction of the ulna and internal fixation surgical methods. Six ulnar fractures were stabilized with intramedullary pin(s) with cerclage wire. The clinical outcome was assessed by the owners as full function in 3 dogs, acceptable function in 2 dogs and unacceptable function in 2 dogs with intraarticular ulnar fractures. The cat case was rated as full function. One dog died from a pulmonary fat embolism. The findings presented here provide some support that cerclage wire placement could be a satisfactory method for annular ligament reconstruction as a simple and economical treatment option. Also, to the authors' knowledge, this is the third report of MFs with intraarticular ulnar fractures. In this series, comminuted, intraarticular fractures were related to major postoperative complications.
Assuntos
Fratura de Monteggia , Animais , Cães/lesões , Estudos Retrospectivos , Gatos/lesões , Masculino , Feminino , Fratura de Monteggia/veterinária , Fratura de Monteggia/cirurgia , Doenças do Cão/cirurgia , Resultado do Tratamento , Doenças do Gato/cirurgia , Fixação Interna de Fraturas/veterinária , Radiografia/veterinária , Fraturas da Ulna/veterinária , Fraturas da Ulna/cirurgiaRESUMO
OBJECTIVE: To evaluate the efficacy of a three-dimensional (3D)-printed, patient-specific reduction system for aligning diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO). STUDY DESIGN: Prospective clinical trial. SAMPLE POPULATION: Fifteen client owned dogs. METHODS: Virtual 3D models of both pelvic limbs were created. Pin guides were designed to conform to the proximal and distal tibia. A reduction bridge was designed to align the pin guides based on the guides' spatial location. Guides were 3D printed, sterilized, and applied, in conjunction with transient application of a circular fixator, to facilitate indirect fracture realignment before plate application. Alignment of the stabilized tibiae was assessed using postoperative computed tomography scans. RESULTS: Mean duration required for virtual planning was 2.5 h and a mean of 50.7 h elapsed between presentation and surgery. Guide placement was accurate with minor median discrepancies in translation and frontal, sagittal, and axial plane positioning of 2.9 mm, 3.6°, 2.7°, and 6.8°, respectively. Application of the reduction system restored mean tibial length and frontal, sagittal, and axial alignment within 1.7 mm, 1.9°, 1.7°, and 4.5°, respectively, of the contralateral tibia. CONCLUSION: Design and fabrication of a 3D-printed, patient-specific fracture reduction system is feasible in a relevant clinical timeline. Intraoperative pin-guide placement was reasonably accurate with minor discrepancies compared to the virtual plan. Custom 3D-printed reduction system application facilitated near-anatomic or acceptable fracture reduction in all dogs. CLINICAL SIGNIFICANCE: Virtual planning and fabrication of a 3D-printing patient-specific fracture reduction system is practical and facilitated acceptable, if not near-anatomic, fracture alignment during MIPO.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Impressão Tridimensional , Fraturas da Tíbia , Animais , Cães/lesões , Cães/cirurgia , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/veterinária , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Placas Ósseas/veterinária , Estudos Prospectivos , Masculino , Feminino , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentaçãoRESUMO
OBJECTIVE: To describe the successful surgical management of a previously unreported Salter-Harris type I fracture of the accessory carpal bone in a dog. ANIMAL: An 11-week-old intact female Golden Retriever-Poodle cross presented with a history of a marked left forelimb lameness following a suspected fall from a height. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES: On physical examination, the patient demonstrated a severe left forelimb lameness and pain on palpation and range of motion of the left carpus. Orthogonal radiographs of the distal left forelimb demonstrated a type I Salter-Harris fracture of the accessory carpal bone with proximal displacement of the palmar fragment. TREATMENT AND OUTCOME: The patient underwent open reduction and internal fixation wherein the fracture was reduced and stabilized with two 1.1-mm Kirschner wires. Postoperatively, the patient was initially managed with a carpal flexion bandage for 2 weeks and then a soft padded bandage was maintained until 4 weeks postoperatively. The patient recovered well and was walking and weight-bearing comfortably following removal of the carpal flexion bandage. Repeat radiographs performed 4 and 8 weeks postoperatively demonstrated adequate fracture healing but showed mild proximocaudal implant displacement. Implant removal was not performed, as the patient was doing well at home and the implant migration appeared static and was not causing clinical morbidity. CLINICAL RELEVANCE: To the authors' knowledge, this was the only reported case of a Salter-Harris fracture of the accessory carpal bone in a dog and the only described case of successful surgical stabilization.
Assuntos
Ossos do Carpo , Fraturas Ósseas , Animais , Cães/lesões , Feminino , Ossos do Carpo/cirurgia , Ossos do Carpo/lesões , Fraturas Ósseas/veterinária , Fraturas Ósseas/cirurgia , Coxeadura Animal/cirurgia , Coxeadura Animal/etiologia , Fixação Interna de Fraturas/veterinária , Doenças do Cão/cirurgia , Fios Ortopédicos/veterinária , Carpo Animal/cirurgia , Carpo Animal/lesõesRESUMO
Femoral fractures are often considered lethal for adult horses because femur osteosynthesis is still a surgical challenge. For equine femur osteosynthesis, primary stability is essential, but the detailed physiological forces occurring in the hindlimb are largely unknown. The objective of this study was to create a numerical testing environment to evaluate equine femur osteosynthesis based on physiological conditions. The study was designed as a finite element analysis (FEA) of the femur using a musculoskeletal model of the loading situation in stance. Relevant forces were determined in the musculoskeletal model via optimization. The treatment of four different fracture types with an intramedullary nail was investigated in FEA with loading conditions derived from the model. The analyzed diaphyseal fracture types were a transverse (TR) fracture, two oblique fractures in different orientations (OB-ML: medial-lateral and OB-AP: anterior-posterior) and a "gap" fracture (GAP) without contact between the fragments. For the native femur, the most relevant areas of increased stress were located distally to the femoral head and proximally to the caudal side of the condyles. For all fracture types, the highest stresses in the implant material were present in the fracture-adjacent screws. Maximum compressive (-348 MPa) and tensile stress (197 MPa) were found for the GAP fracture, but material strength was not exceeded. The mathematical model was able to predict a load distribution in the femur of the standing horse and was used to assess the performance of internal fixation devices via FEA. The analyzed intramedullary nail and screws showed sufficient stability for all fracture types.
Assuntos
Fraturas do Fêmur , Fixação Interna de Fraturas , Membro Posterior , Animais , Cavalos/fisiologia , Fenômenos Biomecânicos , Fraturas do Fêmur/veterinária , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Membro Posterior/cirurgia , Análise de Elementos Finitos , Fêmur/cirurgia , Modelos Biológicos , Suporte de Carga , Fixação Intramedular de Fraturas/veterinária , Fixação Intramedular de Fraturas/instrumentaçãoRESUMO
CASE SERIES SUMMARY: A total of 13 cases of cats with a caudal mandibular fracture treated with a novel surgical technique using the Ramus Anatomical Plate system were reviewed. Preoperative, immediate postoperative and a minimum of 8 weeks postoperative CT images were required as inclusion criteria. The outcome and complications were determined from clinical data and radiographic follow-up examinations. All cases achieved adequate anatomical reduction, resulting in a functional and atraumatic occlusion postoperatively. No intraoperative complications were reported. Time to voluntary food intake was in the range of 1-25 days. No evidence of disruptions to the implants or screw loosening was observed in the 8-week postoperative CT imaging, with radiographic evidence of complete osseous union in all fractures. The most common postoperative complication was swelling at the surgical site. Two cats had postoperative exophthalmos due to retrobulbar haemorrhage, and one cat exhibited partial wound dehiscence 5 days postoperatively, which resolved with medical management. Longer-term complications included intraoral plate exposure in one cat, which required plate removal 10 months postoperatively. RELEVANCE AND NOVEL INFORMATION: In this case series, rigid internal fixation of caudal mandibular fractures using the Ramus Anatomical Plate osteosynthesis system was associated with a minimal complication rate, and satisfactory radiographic and clinical outcomes. The reported outcomes of this novel technique are favourable when compared with previous techniques described for the management of these fracture types.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas Mandibulares , Gatos/lesões , Animais , Placas Ósseas/veterinária , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Fraturas Mandibulares/veterinária , Fraturas Mandibulares/cirurgia , Masculino , Feminino , Resultado do Tratamento , Complicações Pós-Operatórias/veterinária , Tomografia Computadorizada por Raios X/veterinária , Doenças do Gato/cirurgiaRESUMO
This report describes a centralisation procedure for the treatment of a radial non-union, characterised by extensive bone loss and an intact ulna, in an 18-month-old toy poodle. A lateral approach to the radius/ulna shafts was realised and, after debridement of the non-union site, an ulnar osteotomy was performed proximal to the styloid process of the ulna. Transposition of the distal fragment of the radius to the distal end of the osteotomised proximal segment of the ulna was performed and the stabilisation was obtained using a locking plate with proximal screws in the ulnar shaft and distal screws in the radius epiphysis. The patient achieved bone union in 10 weeks and the last evaluation, performed 112 weeks postoperatively, showed a full return to pre-injury function. Based on the results of this report, the centralisation was effective in the treatment of post-traumatic absence of the radial shaft in a dog.
Assuntos
Osteotomia , Rádio (Anatomia) , Cães/lesões , Animais , Rádio (Anatomia)/cirurgia , Rádio (Anatomia)/lesões , Osteotomia/veterinária , Osteotomia/métodos , Ulna/cirurgia , Placas Ósseas/veterinária , Masculino , Parafusos Ósseos/veterinária , Resultado do Tratamento , Doenças do Cão/cirurgia , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/veterinária , Fraturas do Rádio/cirurgiaRESUMO
OBJECTIVE: To report the surgical approaches and stabilization of lateral and medial tibial plateau fractures (TPF), as well as the long-term outcome following repair. STUDY DESIGN: Prospective series of three client-owned dogs. ANIMALS: Three dogs. METHODS: For the two lateral TPF cases (Unger type 41-B1), the surgical approach included separation of the lateral collateral ligament and long digital extensor tendon. The lateral meniscus was elevated to allow visualization of the tibial surface and assess fracture reduction. The first case was repaired using two 2.0 mm lag screws (with washers). The second case sustained a lateral TPF, fibular fracture and concurrent tubercle of Gerdy fracture. Both tibial fractures were stabilized using two 2.0 mm lag screws with washers and two 0.9 mm Kirschner wires (K-wires). A third case, diagnosed with an Unger type 41-B2 medial TPF, was treated using 0.9 mm K-wires and 22-gauge tension band. RESULTS: There were no major complications noted. One minor complication occurred (screw yield two weeks postoperatively). By 8 weeks, all patients reached clinical union with good limb function. Owners were contacted 9-36 months postoperatively. LOAD scores and examinations were performed for two of three patients; the third patient was not contactable after relocating out of state. Both cases with completed questionnaires had a LOAD score of 5/52. CONCLUSION: Tibial plateau fractures are rare in canine patients. While challenging, they can be successfully managed using a combination of lag screws, K-wires, and tension band. CLINICAL SIGNIFICANCE: Surgical stabilization of TPF is feasible and may reduce the risk of meniscal injury.
Assuntos
Fixação Interna de Fraturas , Fraturas da Tíbia , Cães/lesões , Animais , Fraturas da Tíbia/veterinária , Fraturas da Tíbia/cirurgia , Masculino , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Feminino , Estudos Prospectivos , Resultado do Tratamento , Parafusos Ósseos/veterinária , Fios Ortopédicos/veterinária , Doenças do Cão/cirurgia , Fraturas do Planalto TibialRESUMO
OBJECTIVES: To describe the clinical presentations, outcomes and complications associated with the use of dorsal transiliac locking plates to stabilise sacral fractures in dogs and cats. MATERIALS AND METHODS: A single-centre retrospective analysis of all patients that presented with sacral fractures between February 2017 and February 2023 that were managed surgically using paired dorsal transiliac locking plates. Twelve animals met the criteria for inclusion in a retrospective clinical case series. An owner questionnaire was employed to assess long-term outcomes. RESULTS: Eleven dogs and one cat with a mean age of 3.1 years (range 0.6 to 8.8) were included. Eleven patients presented following a motor vehicle accident and most were either non-ambulatory (n=8) or displayed severe unilateral hindlimb lameness (n=4). Nine sacral fractures were considered Anderson type II and three Anderson type V. The plate fixation was augmented with additional surgical stabilisation in 11 cases. Eleven patients were ambulatory at discharge and all cases healed uneventfully without major surgical or postoperative complications. Long-term follow-up (>60 days) was available in 10 animals at a mean of 694 days (range 65 to 1805) and owner-assessed outcomes via questionnaire were reported as good to excellent in all cases. CLINICAL SIGNIFICANCE: The application of transiliac locking plates provided sufficient stability to facilitate sacral fracture healing with minimal clinical complications. This method represents a robust and safe option to stabilise sacral fractures in dogs and cats, offering an alternative to iliosacral lag screw fixation.
Assuntos
Doenças do Gato , Doenças do Cão , Fraturas Ósseas , Gatos/cirurgia , Cães , Animais , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Estudos Retrospectivos , Resultado do Tratamento , Doenças do Cão/cirurgia , Placas Ósseas/veterinária , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterináriaRESUMO
OBJECTIVE: To determine the influence of screw configuration on the reduction and stabilization of simulated complete lateral condylar fracture. STUDY DESIGN: Randomized experimental crossover study. METHODS: A lateral condylar fracture was simulated in 18 cadaver limbs from nine horses. Each limb underwent repair with 4.5 mm diameter cortex screws, tightened to 4 Nm, in a linear and triangular configuration. Computed tomography (CT) of each repair was performed with the limbs in unloaded and loaded conditions. Fracture gaps were measured at the dorsal, palmar, and middle locations of the third metacarpal condyle. Fracture gap measurements were graded 0-4, based on voxels. Following descriptive analysis, a Bayesian network (BN) model was fitted to the data. RESULTS: The median fracture grade was 0 (range: 0-4) for unloaded linear repairs and 2 (0-4) for loaded linear repairs. The median fracture grade was 0 (0-3) for unloaded triangular repairs and 1 (0-3) for loaded triangular repairs. Bayesian network sensitivity analysis showed that the construct configuration reduced the uncertainty in the measured fracture outcome by 0.8%. CONCLUSION: Triangular screw configuration resulted in better fracture reduction and stability in comparison with linear screw configuration. However, the BN sensitivity analysis results showed that the effect of construct configuration on fracture outcome was weak. CLINICAL SIGNIFICANCE: These findings indicate a low probability that triangular repair of lateral condylar fracture will result in improved outcomes, when compared with linear repair.
Assuntos
Fraturas Ósseas , Doenças dos Cavalos , Ossos do Metatarso , Cavalos , Animais , Teorema de Bayes , Estudos Cross-Over , Fraturas Ósseas/veterinária , Parafusos Ósseos/veterinária , Extremidade Superior , Fenômenos Biomecânicos , Ossos do Metatarso/cirurgia , Fixação Interna de Fraturas/veterináriaRESUMO
OBJECTIVES: The objectives of this study were to report the complications in radial and ulnar diaphyseal fractures in cats and to compare the differences in outcome between single and dual bone internal fixation. METHODS: Medical records between 2004 and 2022 were searched retrospectively for cats with antebrachial diaphyseal fractures treated with internal bone-plate fixation. In total, 49 cases were included from six referral hospitals, including one teaching hospital. Patient information was collated, including fracture configuration, location, repair method and clinical outcome as assessed by veterinary physical examination, radiography and owner questionnaire. RESULTS: A total of 47 cats (mean age 4.2 years) were included. Fractures were located distally (24/49, 49%), proximally (13/49, 26.5%) and mid-diaphyseally (12/49, 24.5%). Dual bone fixation was used in 13/49 (26.5%) cases, with only 1/13 (7.7%) having major complications. By comparison, 4/36 (11.1%) of single plated fractures had major complications. Single bone fixation was 14.25 times more likely (95% confidence interval [CI] 2.07-97.99) to have a successful outcome (veterinarian-assigned score of 0) compared with dual bone fixation (P = 0.007). When evaluating owner-assessed outcomes, single bone fixation was 9.4 times more likely (95% CI 1.4-61.96) to have a successful outcome (owner score of 0) compared with dual bone fixation (P = 0.019). CONCLUSIONS AND RELEVANCE: Fractures that were repaired with single bone fixation had a greater chance of a better outcome. Although the difference was not significant, there was a higher major complication rate and a lower minor complication rate for cases treated with single bone fixation compared with dual bone fixation. The majority of fractures were located in the distal diaphysis. Comminution of the fracture and concurrent orthopaedic issues did not significantly affect the outcome. Further prospective studies with standardised follow-up, radiographic assessment, surgeon and implants are required to truly assess the difference between dual and single bone fixation.
Assuntos
Doenças do Gato , Fraturas Ósseas , Gatos , Animais , Estudos Retrospectivos , Diáfises/cirurgia , Estudos Prospectivos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterinária , Fixação Interna de Fraturas/veterináriaRESUMO
OBJECTIVE: To report the inciting cause and configuration of humeral condylar fractures in French Bulldogs, and to identify risk factors for complications associated with their surgical stabilization, as well as their occurrence. STUDY DESIGN: Retrospective multicenter clinical cohort study. ANIMALS: French bulldogs (n = 136) with humeral condylar fracture. METHODS: Records from eight United Kingdom referral centers were reviewed for French bulldogs that underwent surgery for humeral condylar fracture between January 2017 and January 2021. RESULTS: Lateral fractures of the humeral condyle represented two-thirds of condylar fractures in this study (95 elbows; 69.8%); medial fractures of the humeral condyle and intracondylar Y or T fractures affected 22 (16.2%) and 19 (14%), respectively. A fall was the inciting cause for 60 elbows (45.6%), with stairs implicated in 27 (20.45%) elbows. Skeletal immaturity was significantly correlated with fracture. Complications affected 30 out of 132 dogs (136 elbows) (22%), of which 10 (33%) were major, and 20 (66%) were minor. Fixation method did not significantly impact complication rate for medial or lateral fractures of the humeral condyle (p = 0.87). Comminution increased the risk of complication for all humeral condylar fracture types (p = 0.02). CLINICAL RELEVANCE: Fixation method was not found to significantly impact the complication rate of surgically managed fractures of the humeral condyle in French bulldogs. Stair use, falling from low heights, and skeletal immaturity were common inciting reasons for humeral condylar fractures.
Assuntos
Doenças do Cão , Fixação Interna de Fraturas , Fraturas do Úmero , Animais , Cães/lesões , Estudos Retrospectivos , Masculino , Feminino , Fraturas do Úmero/veterinária , Fraturas do Úmero/cirurgia , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/efeitos adversos , Doenças do Cão/cirurgia , Doenças do Cão/etiologia , Complicações Pós-Operatórias/veterinária , Complicações Pós-Operatórias/etiologia , Estudos de Coortes , Fatores de Risco , Acidentes por QuedasRESUMO
OBJECTIVE: The aim of this study was to compare stiffness and strain of an in vitro fracture-gap model secured with a primary 3.5-mm locking compression plate (LCP) at three primary plate working lengths without and with an orthogonal 2.7-mm LCP. STUDY DESIGN: Primary plate screw configurations modeled short working length (SWL), medium working length (MWL), and long working length (LWL) constructs. Construct stiffness with and without an orthogonal plate during nondestructive four-point bending and torsion, and plate surface strain measured during bending, was analyzed. RESULTS: Single plate construct stiffness was significantly, incrementally, lower in four-point bending and torsion as working length was extended. Addition of an orthogonal plate resulted in significantly higher bending stiffness for SWL, MWL, and LWL (p < 0.05) and torsional stiffness for MWL and LWL (p < 0.05). Single plate construct strain was significantly, incrementally, higher as working length was extended. Addition of an orthogonal plate significantly lowered strain for SWL, MWL, and LWL constructs (p < 0.01). CONCLUSION: Orthogonal plate application resulted in higher bending and torsional construct stiffness and lower strain over the primary plate in bending in this in vitro model. Working length had an inverse relationship with construct stiffness in bending and torsion and a direct relationship with strain. The inverse effect of working length on construct stiffness was completely mitigated by the application of an orthogonal plate in bending and modified in torsion.
Assuntos
Placas Ósseas , Placas Ósseas/veterinária , Animais , Fenômenos Biomecânicos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterinária , Teste de Materiais , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/instrumentação , Estresse Mecânico , Parafusos Ósseos/veterináriaRESUMO
OBJECTIVE: To describe fluoroscopically-assisted closed reduction and percutaneous fixation of sacroiliac-luxation (SIL) in cats and report radiographic results and long-term functional outcomes. STUDY DESIGN: Retrospective clinical study. ANIMALS: Eleven cats. METHODS: Percutaneous fixation of 17 SILs in 11 cats was performed with 2.4 mm headless cannulated compression screws under fluoroscopic guidance. Luxation-reduction, screw placement and purchase within the sacral body, pelvic canal diameter ratio (PCDR) and hemipelvic canal width ratio (HCWR) were assessed on pre- and postoperative radiographs. Radiographic follow-up was performed to assess the same parameters when available. Long-term clinical outcome was evaluated with an owner questionnaire. Wilcoxon paired-test was performed for comparison. RESULTS: Mean age and bodyweight of the cats were 3.3 ± 2.6 years and 4.0 ± 0.82 kg, respectively. Nine cats presented with concurrent pelvic injuries. Median luxation-reduction was 94.1% (IQR = 13.9) and median screw-purchase within the sacral body was 73.3% (IQR = 17.0) immediately postoperatively. One screw exited the sacral body caudally. Upon 7-week radiographic follow-up, luxation-reduction (88.3%, IQR = 20.1) and screw-purchase (70.7%, IQR = 12.8) had decreased compared to immediately postoperatively (p = .008 and p = .013 respectively). Screw migration was not observed. PCDR and HCWR measured on postoperative radiographs indicated successful restoration of the pelvic canal width. Owners reported an excellent long-term functional outcome (mean postoperative time: 19 ± 5 months). CONCLUSION: Fluoroscopically-assisted closed reduction and fixation of feline SIL using 2.4 mm headless cannulated compression screws allowed good reduction and optimal screw purchase within the sacral body. An excellent functional outcome was reported. CLINICAL SIGNIFICANCE: Minimally invasive reduction and fixation with headless compression screws should be considered in cats with SIL.
Assuntos
Parafusos Ósseos , Luxações Articulares , Articulação Sacroilíaca , Animais , Gatos , Parafusos Ósseos/veterinária , Estudos Retrospectivos , Masculino , Feminino , Fluoroscopia/veterinária , Articulação Sacroilíaca/cirurgia , Articulação Sacroilíaca/lesões , Luxações Articulares/veterinária , Luxações Articulares/cirurgia , Resultado do Tratamento , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentaçãoRESUMO
OBJECTIVE: The aim of this study was to report postoperative complications and long-term outcomes following transcondylar screw placement for humeral intracondylar fissure (HIF). STUDY DESIGN: It was a retrospective single-centre case series. Medical records (2018-2022) were reviewed for dogs with HIF treated with transcondylar screw placement. Data collected included signalment, concurrent orthopaedic disease, partial or complete HIF, surgeon, surgical approach, surgical technique and implant type, transcondylar screw angulation, postoperative complications and outcomes. Long-term outcome was assessed with owner questionnaire, orthopaedic examination and follow-up radiography. Statistical analysis was performed to identify risk factors predisposing to a complication or a poor outcome. RESULTS: Forty-seven dogs (57 elbows) met the inclusion criteria; long-term follow-up was available in 41 dogs (50 elbows). Minor and major medical complications were noted in seven and three elbows respectively. The total complication rate was 17.5%. Increasing age was significantly associated with a reduced risk of postoperative complications (p = 0.0051). No other risk factors were identified. A postoperative complication was not associated with a less than full outcome (p = 0.5698). CONCLUSION: Transcondylar screw placement for HIF is associated with a low complication rate and good outcome.
Assuntos
Parafusos Ósseos , Complicações Pós-Operatórias , Animais , Cães/cirurgia , Estudos Retrospectivos , Masculino , Parafusos Ósseos/veterinária , Feminino , Complicações Pós-Operatórias/veterinária , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Doenças do Cão/cirurgia , Úmero/cirurgia , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/efeitos adversos , Fraturas do Úmero/cirurgia , Fraturas do Úmero/veterináriaRESUMO
OBJECTIVE: The aim of this study was to determine the effect of plate-bone distance (PBD) and working length on 2.0-mm locking compression plate (LCP) stiffness and strain in four-point bending and torsion in a diaphyseal fracture gap model. STUDY DESIGN: A total of 54 LCP with three screws per fragment were assigned to one of nine combinations of working length (WL; short, medium, and long), and PBD (1, 1.5, and 3 mm) for a sample size of six per construct configuration. Stiffness was measured under quasistatic, nondestructive four-point compression bending and torsion. Plate surface strain was recorded using three-dimensional (3D) digital image correlation during four-point compression bending. RESULTS: WL had a significant effect on overall construct stiffness in both compression bending and in torsion, with shorter WL constructs having higher stiffness (p < 0.0001). PBD had no effect on construct stiffness in compression bending; however, a significant reduction in stiffness was noted in torsion (p = 0.047) as PBD incrementally increased. WL had a significant effect on plate strain in compression bending, with shorter WL constructs having lower plate strain (p < 0.0001). PBD had no effect on plate strain in compression bending except for lower plate strain recorded in long WL constructs with 1-mm PBD, compared with 1.5- and 3-mm PBD constructs (p < 0.0001). CONCLUSION: Longer WL constructs, regardless of PBD, had lower stiffness in compression bending, while in torsion, some modulation of this effect was noted with incremental decreases in PBD. Longer WL resulted in high plate strain, regardless of PBD.
Assuntos
Fixação Interna de Fraturas , Fraturas Ósseas , Animais , Fixação Interna de Fraturas/veterinária , Fixação Interna de Fraturas/métodos , Fenômenos Biomecânicos , Fraturas Ósseas/veterinária , Placas Ósseas/veterinária , Osso e OssosRESUMO
OBJECTIVES: To determine the influence of a stainless-steel cable (SSC) tension band fixation as an adjunct to a locking compression plate (LCP) for arthrodesis of the equine metacarpophalangeal (MCP) joint. STUDY DESIGN: Experimental. An ex vivo biomechanical paired equine cadaver limb study. SAMPLE POPULATION: Five MCP joint pairs were collected from adult Thoroughbred horses, euthanized for reasons unrelated to orthopedic disease. METHODS: Each pair of MCP joints were randomly implanted with either a dorsally placed 5.5 mm LCP and a palmarly placed 2.0 mm SSC or a dorsally placed 5.5 mm LCP alone. Each construct was tested in cyclic loading followed by single cycle to failure in axial compression. Displacement at a target load of 1 kN over 3600 cycles at 1 Hz was recorded prior to single cycle to failure testing. RESULTS: In cyclic testing, displacement was not significantly different between the first and last 5% of testing cycles regardless of construct. Maximum displacement of each construct during cyclic testing was <1.1 mm. In single cycle testing, the observed yield point did not reveal any difference between LCP and LCP-SSC (p = .440). The maximum load at failure was significantly higher in LCP-SSC compared to constructs with the LCP alone (p = .046). CONCLUSION: The addition of the SSC to the LCP did not statistically affect construct displacement during cyclic loading or construct yield load during subsequent single cycle to failure. CLINICAL SIGNIFICANCE: This study provided much needed information regarding the necessity of a tension band SSC application in the arthrodesis of the MCP/MTP joint in horses.
Assuntos
Artrodese , Doenças dos Cavalos , Cavalos/cirurgia , Animais , Fenômenos Biomecânicos , Artrodese/veterinária , Placas Ósseas/veterinária , Articulação Metacarpofalângica/cirurgia , Cadáver , Fixação Interna de Fraturas/veterinária , Doenças dos Cavalos/cirurgiaRESUMO
OBJECTIVE: The aim of this study is to describe the use of String of Pearls (SOP) plates for the surgical management of feline pelvic fractures, including surgical technique, proposed indications, complications, and outcomes in a cohort of cats. STUDY DESIGN: This study is a single-center retrospective clinical case series. METHODS: Medical records (2015-2019) of cats presenting for pelvic fractures (n = 33) were reviewed. Type of fracture, preoperative and postoperative imaging, and complications were retrospectively retrieved. Owners were contacted via questionnaire for medium- and long-term follow-up. RESULTS: A total of 20 cats met the inclusion criteria. Minor intraoperative complications were encountered in three patients. One patient suffered a major intraoperative complication. Five major complications were encountered postoperatively. These included two greater trochanter osteotomy fixation implant removal and three SOP plate removal. Full function was recovered in all patients according to the owners' assessment. CLINICAL SIGNIFICANCE: The use of SOP plates in feline pelvic fractures appears to yield a consistently good outcome with a very low incidence of canal narrowing and screw loosening. SOP plates are easy to contour and to apply along the entire pelvic length.
Assuntos
Doenças do Gato , Fraturas Ósseas , Ossos Pélvicos , Gatos , Animais , Estudos Retrospectivos , Fraturas Ósseas/cirurgia , Fraturas Ósseas/veterinária , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Fixação Interna de Fraturas/veterinária , Pelve , Placas Ósseas/veterinária , Doenças do Gato/diagnóstico por imagem , Doenças do Gato/cirurgiaRESUMO
OBJECTIVE: The aim of this study was to assess screw placement in simulated dorsomedial-plantarolateral central tarsal bone (CTB) fractures using two imaging guidance techniques - computed tomography (CT) with fluoroscopy compared to digital radiography alone (DR). STUDY DESIGN: Experimental study. SAMPLE POPULATION: Equine cadaver hindlimbs (n = 10 pairs). METHODS: One tarsus per pair was randomly assigned to have a 4.5 mm cortical screw placed across the CTB using CT and fluoroscopy (CT/F group) or digital radiography alone (DR group). Postoperative CT was performed on all limbs. Variables related to marker placement, procedure time, and screw positioning were recorded and compared using a paired t-test for dependent means (p < .05). RESULTS: Time for marker placement was longer for the CT/F group (p = .001), with no difference in total procedure time (p = .12). CT/F was not superior to radiography alone (p > .05) for parameters related to screw positioning. Based on the 95% CI, there was greater range in relative screw length using radiography (76.5%-91.2%) versus CT/F (78.4%-84.0%). CONCLUSION: Internal fixation of CTB fractures can be successfully performed using either technique for imaging guidance. CT and fluoroscopy did not result in faster or more accurate screw placement compared to radiographs alone, except in determining screw length. CLINICAL SIGNIFICANCE: Mild adjustments in fluoroscopic or radiographic angle appeared to be a point of variability in the perception of screw placement. While CT is recommended for improved understanding of fracture configuration and surgical planning, radiographic guidance may be a suitable alternative for internal fixation of dorsomedial-plantarolateral fractures.