Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008-2016).

OBJECTIVE: To determine the prevalence of surgical site infection (SSI) after internal fixation and to identify risk factors for SSI and nonsurvival. STUDY DESIGN: Retrospective study. ANIMALS: One hundred fifty-five horses with long bone fractures or arthrodesis treated by internal fixation at 1 hospital between 2008-2016. METHODS: Signalment, diagnosis, surgical repair, surgeon, surgical time, antimicrobial use, SSI onset, bacterial identification, and adjunct treatments were recorded. Perioperative variables were analyzed to identify risk factors associated with outcomes. RESULTS: Surgical-site infection was reported in 22 of 155 (14.2%) horses, which is lower than what has been previously reported (P = .003). Horses with fetlock arthrodesis or ulnar fracture were more likely to develop SSI. Local prophylactic antimicrobial therapy was associated with an increased risk of SSI. Horses with SSI were 12 times (P < .0001) less likely to survive to discharge than horses without SSI. Horses with a fetlock or carpal arthrodesis or those with radial/humeral/femoral fractures were less likely to survive. No association was identified between open fractures, open reduction and internal fixation, or surgical times and SSI. CONCLUSION: The prevalence of SSI in this population was lower than what has been previously reported. Horses with fetlock or carpal arthrodesis or radial/humeral/femoral fractures were at increased risk for SSI and/or nonsurvival to discharge. A protective role of local antimicrobial therapy for SSI could not be established. CLINICAL RELEVANCE: The impact of SSI on outcomes of cases of equine internal fixation remains substantial. Identification of cases at higher risk of SSI should influence surgical technique, postoperative management, and early intervention when SSI is suspected. Additional investigation is warranted regarding local antimicrobial therapy.

Retrospective evaluation of the efficacy of minimally invasive, fluoroscopic-assisted reduction and stabilisation of unicondylar humeral fractures.

OBJECTIVE: This study evaluated the proficiency in executing closed, fluoroscopic-assisted reduction of unicondylar humeral fractures. The following were hypothesised: experienced surgeons would be highly successful in performing closed reduction; body weight, time to surgery and surgeon experience would influence the reduction method; and the reduction method would not affect technical aspects of the repair. METHODS: All unicondylar humeral fractures stabilised between January 2007 and January 2017 were reviewed. Signalment and time to surgery, experience of the attending surgeon, and the initial and definitive reduction methods were recorded. Initial and subsequent postoperative radiographs were used to assess fracture reduction, implant placement and complications. Univariate polychotomous logistic regressions, Fisher's exact test, Kruskal-Wallis rank sums non-parametric test or equivalence tests were used to compare parameters evaluated based on the approach employed (P < 0.05 significant). RESULTS: A total of 36 dogs with 37 fractures were identified (median weight: 5.4 kg; median time to surgery: 3 days). Of these, 11 of 15 attempted closed reductions were successful. Successful closed reductions had shorter times to surgery than limited open or open reductions (P = 0.009). Age, weight and surgeon experience did not influence the definitive reduction method. Technical aspects of reduction and stabilisation were similar among the reduction methods. Surgery times were shorter for closed reductions (P = 0.034). Of the fractures, 75% healed without complications and 85% had excellent long-term function. CONCLUSION: The results suggested that closed, fluoroscopic-assisted reduction is a proficient (73% successful) and efficient (shorter surgery times with comparable technical results compared with other limited open and open reduction) means of stabilising acute unicondylar humeral fractures.

A simple technique to repair a hand fracture in a captive Siamang.

A 5-year-old female Siamang (Hylobates syndactilus) in captivity sustained a displaced closed fracture of the proximal phalanx of the middle digit, resulting in finger deformity and hand functional disability. Anatomical reduction and stabilization of the fracture were obtained surgically using two multifilament wire sutures. The primate had a successful functional recovery.

Comparison of open reduction versus minimally invasive surgical approaches on screw position in canine sacroiliac lag-screw fixation.

OBJECTIVE: To compare accuracy and consistency of sacral screw placement in canine pelves treated for sacroiliac luxation with open reduction and internal fixation (ORIF) or minimally invasive osteosynthesis (MIO) techniques. METHODS: Unilateral sacroiliac luxations created experimentally in canine cadavers were stabilized with an iliosacral lag screw applied via ORIF or MIO techniques (n = 10/group). Dorsoventral and craniocaudal screw angles were measured using computed tomography multiplanar reconstructions in transverse and dorsal planes, respectively. Ratios between pilot hole length and sacral width (PL/SW-R) were obtained. Data between groups were compared statistically (p <0.05). RESULTS: Mean screw angles (±SD) were greater in ORIF specimens in both transverse (p <0.001) and dorsal planes (p <0.004). Mean PL/SW-R was smaller (p <0.001) in the ORIF group, yet was greater than 60%. While pilot holes exited the first sacral end-plate in three of 10 ORIF specimens, the spinal canal was not violated in either group. CONCLUSIONS: This study demonstrates that MIO fixation of canine sacroiliac luxations provides more accurate and consistent sacral screw placement than ORIF. With proper techniques, iatrogenic neurological damage can be avoided with both techniques. The PL /SW-R, which relates to safe screw fixation, also demonstrates that screw penetration of at least 60% of the sacral width is achievable regardless of surgical approach. These findings, along with the limited dissection needed for accurate sacral screw placement, suggest that MIO of sacroiliac luxations is a valid alternative to ORIF.