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)

Fixed bilateral endo-exo prostheses in feline femur - case report / Endo-exoprótese bilateral fixa em fêmur de felino - relato de caso

The use of endo-exo prosthesis is an alternative to improve the quality of life of amputees, allowing correct distribution of body weight, reducing skin problems and pain related to the implant, and reducing lameness. The aim of this paper is to report the use of a fixed bilateral endo-exo femur prostheses in a cat with amputation prior to treatment. The endoprostheses were made with titanium and the exoprostheses were made with 3D printing technology. A longitudinal craniolateral surgical approach was used and the skin incision was made over the knee-joint, then fascia lata incision, followed by biceps femoris and vastus lateralis muscles retraction, incision through the joint capsule to expose the tibiofemoral joint, disarticulation, and tibia and fibula removal. Afterwards, a femoral leveling osteotomy and insertion of the implant in the medullary canal were performed, being attached in the cis and trans cortical bone. The patient was evaluated in the immediate post-operative and periodically thereafter, showing satisfactory results, without macroscopic signs of rejection, wound dehiscence or infection, fracture, or injury of limbs, and presented adapted walking. Furthermore, it was observed the return to common behaviors for the species.

O uso de endoexoprótese é uma alternativa para melhoria na qualidade de vida de pacientes amputados, permitindo distribuição correta do peso corporal, redução de problemas de pele e dor ligadas ao implante e redução da claudicação. Este trabalho objetivou relatar a utilização de endoexoprótese bilateral fixa em fêmur em felino com amputação prévia ao atendimento. Foram modeladas endopróteses em titânio e exopróteses projetadas e impressas em 3D. O acesso cirúrgico, em ambos os membros, foi realizado por incisão craniolateral transarticular da pele, incisão da fáscia lata, rebatimento dos músculos bíceps femoral e vasto lateral, incisão da cápsula articular para exposição da articulação femorotibial, desarticulação e remoção cirúrgica da tibia e da fibula. Em seguida, realizou-se osteotomia niveladora femoral e inserção do implante no canal medular, sendo esse fixo nas corticais cis e trans. O paciente foi avaliado no pós-cirúrgico imediato e posteriormente de forma periódica, demonstrando resultados satisfatórios, sem sinais macroscópicos de rejeição, deiscência ou infecção da ferida cirúrgica, fratura ou lesão de membros, e apresentava deambulação adaptada. Além disso, foi observado o retorno de comportamentos comuns da espécie.

Protocolo anestésico em guaxinim submetido à colocefalectomia / Anesthesic protocol in a raccoon submitted to colocephalectomy

Em guaxinins, comumente se observa a presença de osteoartrites acometendo a articulação coxofemoral. Em carnívoros domésticos, o tratamento pode ser conservativo ou cirúrgico e, dentre as técnicas cirúrgicas, cita-se a colocefalectomia. Por ser um procedimento que provoca dor moderada a severa, um protocolo de anestesia balanceada se faz necessário, podendo associar a técnicas de bloqueio locorregional, como a epidural. Protocolos descritos para a espécie são limitados, porém comumente empregados para contenções químicas, avaliações físicas e exames de imagem. Portanto, o objetivo deste trabalho é relatar a o protocolo anestésico realizado em guaxinim (Procyon cancrivorus) submetido à colocefalectomia. Foram utilizados dexmedetomidina (5µg/kg), cetamina (5mg/kg) e diazepam (0,3mg/kg) por via intramuscular como medicação pré-anestésica, indução com propofol e manutenção por anestesia inalatória com isoflurano. Para execução da anestesia epidural, realizou-se uma abordagem na região lombossacral, sendo administrados bupivacaína (1mg/kg) e morfina (0,1mg/kg). Não houve intercorrências e os parâmetros fisiológicos mantiveram-se estáveis. Descartou-se a necessidade de resgate analgésico e a recuperação anestésica foi rápida. Dessa forma, conclui-se que o manejo anestésico proposto promoveu estabilidade hemodinâmica e recuperação satisfatórias para a espécie.

In raccoons, the presence of osteoarthritis affecting the hip joint is commonly observed. In domestic carnivores, the treatment can be conservative or surgical and, among the surgical techniques, colocephalectomy is mentioned. Since it is a procedure that causes moderate to severe pain, a balanced anesthesia protocol is necessary, which can be associated with locoregional block techniques such as the epidural. Protocols described for the species are limited, being commonly used for chemical restraints, physical assessments, and imaging exams. Therefore, this work aims to report the anesthetic protocol performed on a raccoon (Procyon cancrivorus) submitted to colocephalectomy. Dexmedetomidine (5µg/kg), ketamine (5mg/kg), and diazepam (0.3mg/kg) were used intramuscularly as pre-anesthetic medication, in addition to induction with propofol, and the maintenance by inhalational anesthesia with isoflurane. For epidural anesthesia, an approach was performed in the lumbosacral region, with the administration of bupivacaine (1mg/kg) and morphine (0.1mg/kg). There were no complications and the physiological parameters remained stable. The need for analgesic rescue was ruled out and the anesthetic recovery was fast. Thus, it is concluded that the proposed anesthetic management promoted hemodynamic stability and a satisfactory recovery for the species.

Hip dislocation in a calf - treatment with iliofemoral suture

Background: Coxofemoral dislocation is uncommon in large animals, due to anatomical particularities that provide greater stability to this joint. The most common causes of hip dislocation in large animals are related to hypocalcemia, mount trauma, sudden falls on hard surfaces or dystocia. Treatment can be performed by closed reduction, but the reported results are not satisfactory with complications. Several surgical techniques have already been described and successfully used in small animals in the treatment of hip dislocation. The present work aims to describe the technique and the result of the iliofemoral suture in the treatment of hip dislocation in a Girolando heifer. Case: A heifer was attended with a history of difficulty in getting up. According to the owner, the clinical manifestation was sudden, after remaining in a paddock with other animals of different age groups. The calf had reduced skin sensitivity on the croup, and it was impossible to remain in the quadrupedal position, often remaining in sternal recumbency with the left pelvic limb in extension. From the clinical examination, spinal cord injury was suspected and clinical treatment was instituted with dexamethasone, vitamins B1, B12 and dimethylsulfoxide. At the end of the clinical treatment, the animal did not show a favorable evolution, so radiographic examination of the coxofemoral region was performed, revealing dislocation of the left femoral head, indicating surgical correction. Xylazine was administered as pre-anesthetic medication, followed by anesthetic induction with midazolam associated with ketamine, followed by orotracheal intubation. Anesthetic maintenance was instituted with isoflurane and monitoring was performed with a multiparameter monitor. An epidural block was performed with bupivacaine and morphine. A craniolateral approach to the left hip joint was performed. After the dislocation was reduced, sutures were used to better stabilize the joint in question. Following the evolution of the surgical procedure, it was possible to confirm that the femoral head remained in place. After 15 days, the skin stitches were removed and the animal was discharged from the hospital and returned to its original property. The calf was asked to remain in the stall for at least 60 days, gradually releasing it into larger spaces and only after 120 days could it remain in the paddock with other animals. During three months, the tutor was consulted about the evolution of the condition, reporting that the animal was clinically well, being able to get up and walk without difficulty and with a mild degree of lameness, thus suggesting the success of the surgical procedure. Discussion: There are few studies of successful surgical treatments of hip dislocation in large animals, and that number is even smaller when considering cattle alone. It is believed that this is due to difficulties related to the surgical technique and to postoperative handling, given the animal's weight. The iliofemoral suture technique performed on the animal in the present study is commonly employed in small animals, and excellent results have been observed. However, reports on the use of this technique in large animals have not been found. The iliofemoral suture technique has advantages over other reported surgical techniques in cattle. When compared to the femoral head and neck resection, the iliofemoral suture has several advantages, as it allows preservation of the joint and achievement of superior biomechanical results. When compared to the technique of reinforcement of the joint capsule with synthetic material, also reported in cattle, the iliofemoral suture appears to be faster, simpler and more economic, and provides similar stability. We conclude that the iliofemoral suture proved to be a satisfactory alternative for the treatment of hip dislocations in young cattle.

O efeito da ozonioterapia no tratamento de fratura de fêmur em filhote canino: relato de caso / The effect of ozone therapy in the treatment of femur fracture in puppies: case report

Fraturas de fêmur são casos recorrentes na clínica veterinária de pequenos animais, ocorrendo principalmente em filhotes. O seu diagnóstico considera histórico e sinais clínicos apresentados, como sensibilidade dolorosa e apoio do membro em pinça, e é confirmado por exame radiográfico do membro lesionado. Geralmente, esse tipo de fratura tem o tratamento cirúrgico como indicação, entretanto, com o perigo de submeter o animal a riscos tanto anestésicos quanto cirúrgicos. O presente relato de caso descreve o uso da ozonioterapia, uma forma diferente e menos invasiva de se tratar fratura femoral, com um maior potencial de adesão do tutor por ser um tratamento mais acessível e com excelentes resultados.(AU)

Femur fractures are recurrent cases in the small animal veterinary clinic, occurring mainly in puppies. It's diagnosis is based on the history and clinical signs presented, such as painful sensitivity and support of the limb on tweezers, and defined by radiographic examination of the injured limb. Generally, this type of fracture has surgical treatment indication, however, with the danger of subjecting the animal to both anesthetic and surgical risks. The present case report describes the use of ozone therapy, a different and less invasive way of treating a femoral fracture, with a greater potential for adherence by the tutor, as it is a more accessible treatment and with excellent results.(AU)

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.

Osteotomia tripla da pelve por meio de acesso cirúrgico duplo em cães com displasia coxofemoral / Triple pelvic osteotomy through double surgical access in dogs with coxofemoral dysplasia / Triple osteotomía pélvica mediante doble acceso quirúrgico en perros con displasia coxofemoral

A displasia coxofemoral (DCF) é uma alteração ortopédica muito comum nos cães, caracterizada por frouxidão da articulação coxofemoral, com consequente osteoartrose. A osteotomia tripla da pelve (TPO) é um dos procedimentos ortopédicos elegíveis como tratamento da DCF. Por necessitar de três abordagens cirúrgicas, a TPO é considerada uma técnica complexa, não isenta de complicações na abordagem do isquio. Esta pesquisa teve por objetivo relatar e avaliar a realização da TPO através de apenas dois acessos cirúrgicos, possibilitando executar a osteotomia isquiática através do acesso púbico ventral. Foram operados 10 cães com diagnóstico clinico e radiológico de DCF. Para a secção da mesa isquiática utilizou-se um cinzel de rinotomia com a extremidade apoiada na borda isquiática da face caudal do forame obturador. Ante os bons resultados radiológicos e clínicos pós-operatórios, conclui- se que é possivel a realização da osteotomia do isquio na TPO, através do acesso púbico ventral, oferecendo proventos cirúrgicos. (AU)

Hip dysplasia (HD) is an ordinary dog orthopedic disorder concerning osteoarthritis following hip joint laxity. Among eligible procedures to treat this condition, triple pelvic osteotomy (TPO) is a complex technique involving three surgical interventions. This paper reports and evaluates TPO execution using only two surgical accesses to perform a sciatic osteotomy through the pelvic ventral area. Ten suitable for TPO surgery dogs, clinically and radiologically diagnosed were the subject of this study. For the section of the ischial surface, a rhinotome was used with the tip resting on the ischial edge of the caudal surface of the obturator foramen. The experience revealed pelvic ventral area access availability regarding TPO ischial ostectomy with good clinical and radiological outcomes.(AU)

La displasia de cadera (CHD) es un trastorno ortopédico muy común en perros, caracterizado por laxitud de esa articulación con la consiguiente osteoartrosis. La ostectomia pélvica triple (TPO) es uno de los procedimientos ortopédicos elegibles como tratamiento para la CHD. Al requerir tres abordajes quirúrgicos, la TPO se considera una técnica compleja, no exenta de complicaciones en el abordaje del isquion. Esta investigación tuvo como objetivo informar y evaluar la realización de la TPO a través de sólo dos accesos quirúrgicos, posibilitando la realización de la osteotomia isquiática a través del acceso ventral del pubis. Se operaron diez perros con diagnóstico clínico y radiológico de CHD. Para la sección de la mesa isquiática se utilizó un rinotomo con la punta apoyada en el borde isquiático de la superficie caudal del agujero obturador. En vista de los buenos resultados postoperatorios clínicos y radiológicos, se concluye que es posible realizar una osteotomia isquiática en la TPO, a través del acceso ventral púbico, ofreciendo beneficios quirúrgicos.(AU)

Estabilização de ombro em um gato ­ Relato de caso / Shoulder estabilization in a cat ­ Case report

A estabilidade da articulação do ombro é garantida por ligamentos, cápsula articular, tendões e músculos, contudo traumas podem causar falência dos mecanismos estabilizadores, com consequente luxação ou instabilidade articular. Objetivou-se relatar o caso de instabilidade medial e lateral de ombro direito em felino sem raça definida, atendido com queixa de claudicação aguda de membro torácico secundária a trauma por confronto com outro animal. Inicialmente foi realizado tratamento clínico por meio de imobilização articular. Contudo, devido ao insucesso da técnica, procedeu-se para o tratamento cirúrgico de estabilização articular com prótese ligamentar sintética. No pós-operatório imediato, evidenciou-se ausência de crepitações e instabilidade articular. Após oito dias da cirurgia, o paciente apresentou retorno total às funções de apoio do membro e sem sinais de dor ou redução de movimentos. Concluiu-se que, embora de reduzida ocorrência, a instabilidade de origem traumática do ombro configura-se como um diferencial para claudicação aguda de membro torácico e que o tratamento cirúrgico pode ser necessário, mostrando-se eficiente na resolução de tais casos com o acesso e técnica de estabilização propostos.

The stability of the shoulder joint is granted by ligaments, joint capsule, tendons and muscles. However, traumatic injuries can cause failure of the stabilization mechanisms, which leads to articular luxation or instability. The aim of the paper is to report a case of medial and lateral right shoulder joint instability in a mixed-breed cat, presenting acute forelimb lameness after a fight trauma with another cat. Initially, it was recommended a conservative treatment through articular immobilization. However, the technique was unsuccessful, and the surgery treatment was performed, to stabilize the joint with synthetic ligament prosthetic. In the postoperative period, no crepitation or instability were identified. After eight days of surgery, the patient returned totally to the normal function of the forelimb, without movement restriction or pain. It was concluded that, although rare, the traumatic shoulder joint instability is a differential diagnosis for acute forelimb lameness and the surgical treatment can be necessary, showing a good result in the resolution of these injuries with the surgical approach and stabilization method proposed.

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.

Effect of low-level laser therapy on the membrane induced by the Masquelet technique at an orthotopic site in rabbits

ABSTRACT Purpose: To evaluate the low-level laser therapy (LLLT) on the membrane induced by the Masquelet technique in rabbits. Methods: Twelve Norfolk rabbits at approximately 3 months of age were used. A 1-cm segmental defect was induced in both radii, which were filled with polymethylmethacrylate cylinder. LLLT was used postoperatively in the bone defect of one of the forelimbs every 48 hours for 15 days. Six rabbits were euthanatized on third and sixth postoperative weeks. Results: In both forelimbs, radiographs showed new bone growth from radius cut ends on the third postoperative week and more advanced stage on the sixth postoperative week. Ultrasound showed induced membrane one week after the surgery. Histologically, there were no significant differences in the semi-quantitative score of inflammation intensity, total number of blood vessels, bone metaplasia, and collagen. The average thicknesses were 2,050.17 and 1,451.96 μm for control membranes and 2,724.26 and 2,081.03 μm for irradiated membranes, respectively, on third and sixth postoperative weeks. Vascular endothelial growth factor A (VEGF-A) and platelet derived growth factor (PDGF) expression were present in the induced membranes of control and irradiated forelimbs, but there was no significant difference. Conclusions: Based on assessment methods, it was not possible to demonstrate the effect of LLLT on the induced membrane.

Proximal interphalangeal joint arthrodesis in horses: concepts, indications, and techniques / Artrodese interfalangeana proximal em equinos: conceitos, indicações e técnicas

Surgical arthrodesis is effective for treating proximal interphalangeal joint (PIJ) injuries in horses. Despite several techniques described so far, the use of a 3-hole, 4.5mm-locking compression plate, associated with two 5.5-mm transarticular cortex screws, is currently considered the "gold standard." This review describes the anatomy of the pastern, as well as causes, indications, and possibilities for arthrodesis in the equine PIJ. A description of the current surgical technique for joint fixation is also presented.(AU)

A artrodese cirúrgica é efetiva para o tratamento de condições da articulação interfalangeana proximal (AIP) em equinos. Diversas técnicas são descritas, e o uso de uma placa de compressão bloqueada de três orifícios e 4,5 mm associada com dois parafusos corticais transarticulares de 5,5 mm é atualmente o padrão ouro. Esta revisão tem por objetivo descrever a anatomia da região da quartela, bem como as causas, indicações e possibilidades para a artrodese da AIP nos equinos. É apresentada também a descrição da técnica cirúrgica atualmente utilizada para realização da fixação da articulação.(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)

Proximal interphalangeal joint arthrodesis in horses: concepts, indications, and techniques / Artrodese interfalangeana proximal em equinos: conceitos, indicações e técnicas

Surgical arthrodesis is effective for treating proximal interphalangeal joint (PIJ) injuries in horses. Despite several techniques described so far, the use of a 3-hole, 4.5mm-locking compression plate, associated with two 5.5-mm transarticular cortex screws, is currently considered the "gold standard." This review describes the anatomy of the pastern, as well as causes, indications, and possibilities for arthrodesis in the equine PIJ. A description of the current surgical technique for joint fixation is also presented.(AU)

A artrodese cirúrgica é efetiva para o tratamento de condições da articulação interfalangeana proximal (AIP) em equinos. Diversas técnicas são descritas, e o uso de uma placa de compressão bloqueada de três orifícios e 4,5 mm associada com dois parafusos corticais transarticulares de 5,5 mm é atualmente o padrão ouro. Esta revisão tem por objetivo descrever a anatomia da região da quartela, bem como as causas, indicações e possibilidades para a artrodese da AIP nos equinos. É apresentada também a descrição da técnica cirúrgica atualmente utilizada para realização da fixação da articulação.(AU)

Double plating technique for fixing tibial plateau leveling osteotomy and modified cranial closing wedge ostectomy of the tibia in a dog with cranial cruciate ligament disease and excessive plateau angle: case report / [Técnica de placa dupla para fixação concomitante da osteotomia de nivelamento do platô tibial e ostectomia modificada em cunha de fechamento cranial da tíbia em um cão com doença do ligamento cruzado cranial e ângulo de platô tibial excessivo: relato de caso]

Tibial plateau leveling osteotomy (TPLO) associated to cranial wedge closing ostectomy (CCWO) has been one of the best options to manage cranial cruciate ligament (CCL) disease and excessive tibial plateau angle (TPA) in large dogs, however, the complication rate is potentially high. It is believed that a more robust fixation is necessary to stabilize them and decrease the risk of implant failure. A 6-year-old male American Pit Bull, weighing 36kg, with 90-day history of right hind limb lameness, was diagnosed with CCL disease. Due to the excessive tibial plateau angle (42°), TPLO was associated with a modified CCWO using a double plating technique. A final TPA of 12° was accomplished, and a restricted level of exercises and physiotherapy were recommended. The patient was followed monthly until the fifth month postoperatively, when radiographic bone consolidation and no lameness were observed. By the date of this submission, 3 years after the procedure, the owner has reported no complications. The double plating technique for fixing TPLO and modified CCWO proved to be effective for the treatment of CrCL deficiency in a large dog with an excessive TPA.(AU)

A osteotomia de nivelamento do platô tibial (TPLO) associada à ostectomia modificada em cunha de fechamento cranial da tíbia (CCWO) tem sido uma das melhores opções para tratamento de cães grandes com doença do ligamento cruzado cranial (DLCCr) e ângulo excessivo do platô tibial, mas o índice de complicações é alto. Acredita-se haver necessidade de fixação mais robusta para reduzir as chances de falha nos implantes. Um cão macho, seis anos, da raça American Pit Bull, 36kg, com histórico de claudicação em membro pélvico direito há 90 dias, foi diagnosticado com DLCCr. Devido ao ângulo excessivo do platô tibial (42°), a osteotomia de nivelamento do platô tibial foi associada à ostectomia modificada em cunha de fechamento cranial da tíbia (CCWO) por meio da técnica de placa dupla. No pós-operatório imediato, identificou-se TPA de 12°; exercícios controlados e fisioterapia foram recomendados e a evolução do quadro foi analisada mensalmente até o quinto mês pós-cirurgia. Com 150 dias de evolução, não houve alterações de locomoção e havia ocorrido completa consolidação radiográfica das osteotomias. Até o momento da submissão deste artigo, três anos pós-procedimento, o tutor relata ausência de complicações, via contato telefônico. Portanto, a técnica modificada mostrou-se eficaz no tratamento da DLCCr.(AU)

A utilização do laser de baixa intensidade na cicatrização de ferida em cão / The use of low intensity laser in wound healing in dog

Background: Low-intensity laser is effective in cellular metabolism, analgesia, and tissue repair. The bioelectric, bioenergetic, and biochemical effects of laser therapy stimulate local circulation, collagen formation, and epithelization. The objective of this study was to report the use of gallium-aluminum arsenide (GaAlAs) laser (830 nm) in healing two woundscaused by necrosis in a dog. Case: An 8-year-old bitch, a rescued victim of animal abuse, had tibiotarsal dislocation in the left posterior limb. Orthopedic surgery was performed with the placement of an external fixation device with six pins in the distal third of the left posterior limb. A radiographic examination performed 42 days after the surgery revealed the loss of the tibiotarsal ratio, decreased radiopacity of the carpal bones, edema, inflammation, muscle atrophy, and the rotation of the anatomical axis of the metatarsals and phalanges. It was then decided to perform a second orthopedic surgery, in which a bone graft and arthrodesis with an 8-screw titanium plate were performed. Four of the plate screws were placed proximally to the tibia and four distally to the tarsus in addition to a screw and a pin transfixed through the distal metaphyseal region of the tibia and calcaneus. Traction was felt during suturing in the dermis and epidermis of the limb, suggesting the possibility of dehiscence of the stitches. After 3 h of surgery, the limb was cold and edematous. After 5 days, the tissue of the medial region of the tarsus developed necrosis, exposing a wound 6 cm long, 1.5 cm wide, and 2 mm deep (wound 1). Another necrotic lesion was observed in the dorsal region of the tarsos - 6.5 cm long, 2 cm wide, 3 mm deep, and exposing 5 cm of the titanium plate (wound 2). Therapy with GaAlAs laser was then performed over the entire length of the wounds. In each therapeutic session, the laser was first used in punctual mode at 10 J/cm², 830 nm, 20 s at each point of the length of the lesion and then in scan mode at 10 J/cm², 830 nm, 1000 Hz, and 40 s continuously. Laser therapy sessions were conducted at 2-4 day intervals, with a 12-day interval between the eighth and ninth sessions. During the entire treatment, cleansing and debridement of the wounds were performed every 48 h with saline and chlorhexidine digluconate, using a compression bandage, as described earlier. Wound 1 healed completely after two laser therapy sessions. In wound 2, tissue repair stagnated after the ninth and last laser session, leaving 4 cm of the titanium plate still exposed. The limb could not support the body weight of the patient, and radiographic examination revealed that the anatomical axis of the metatarsals and the phalanges was rotated and bone conformation was poor. Given the anatomical conditions associated with the patient's clinical picture, it was decided to amputate the limb between the femur and tibia. Discussion: Therapeutic lasers act on mitochondrial respiration, increasing respiratory metabolism and stimulating DNA synthesis and tissue proliferation. In the present case, there was a decrease in inflammatory cells, edema, and the size of the wounds. The pathological conditions of the affected site, influence of trauma, and degree of tissue damage affected the results of the laser therapy. Despite the size difference between wounds 1 and 2, the exposed titanium plate was a determining factor for the partial healing of wound 2.

Transposição de coxim digital associada à órtese articulada caseira como alternativa à amputação de membro pélvico em cão - relato de caso

Os coxins podem ser definidos como a porção mais resistente da pele de cães e gatos, e possuem as funções de sustentação do peso do animal, e a proteção contra as forças de tração e de atrito. As cirurgias que objetivam a reconstrução dos coxins são alternativas viáveis à amputação do membro em diversas situações clínicas. Dentre as opções cirúrgicas, destaca-se a transposição dos coxins. Entretanto, quando se faz necessária a amputação dos dígitos, o encurtamento do membro pode comprometer a deambulação. Uma alternativa neste sentido é a associação à órteses. O objetivo do presente trabalho foi descrever o caso de um cão da raça pitbull, fêmea, com quatro anos de idade e histórico de gangrena úmida da extremidade do membro pélvico esquerdo, submetida à amputação dos dígitos e transposição dos coxins. Durante o período pós-operatório foi desenvolvida uma órtese articulada caseira a fim de facilitar a sustentação do peso e auxiliar na deambulação do animal. A paciente se adaptou ao dispositivo ortopédico e foi acompanhado até a completa reepitelização do membro residual aos 30 dias de pós-operatório. Desta forma, conclui-se que a transposição dos coxins associada à órtese articulada pode ser uma opção viável à amputação do membro pélvico em cães de grande porte.(AU)

The digital pad can be defined as the most resistant area of the skin of the dogs and cats, which functions includes animal weight support and protection against to tractive and frictional forces. The reconstructive surgeries of the digital pad are viable alternatives to the limb amputation in many clinical situations. Among the surgical options, the transposition of the digital pad is highlighted. However, when amputation of the digits is necessary, shortening of the limb can compromise ambulation. An alternative to this, it is the use of orthoses. The aim of this report was to describe the case of a four-years-old female pit bull with clinical history of wet gangrene of left pelvic limb, submitted to transposition of digital pad, obtained from the contralateral hindlimb. An articulate orthosis was projected at postoperative period in order to facilitate weight support and assist the patient ambulation. The patient has adapted itself to the new orthopedic device, and was constantly monitored until complete reepithelialization of the residual limb at 30 days of postoperative. Thus, it can be concluded that the transposition of digital pad associated to the articulate orthosis can be a viable option to the limb amputation in large breed dogs.(AU)

Transposição de coxim digital associada à órtese articulada caseira como alternativa à amputação de membro pélvico em cão - relato de caso

Os coxins podem ser definidos como a porção mais resistente da pele de cães e gatos, e possuem as funções de sustentação do peso do animal, e a proteção contra as forças de tração e de atrito. As cirurgias que objetivam a reconstrução dos coxins são alternativas viáveis à amputação do membro em diversas situações clínicas. Dentre as opções cirúrgicas, destaca-se a transposição dos coxins. Entretanto, quando se faz necessária a amputação dos dígitos, o encurtamento do membro pode comprometer a deambulação. Uma alternativa neste sentido é a associação à órteses. O objetivo do presente trabalho foi descrever o caso de um cão da raça pitbull, fêmea, com quatro anos de idade e histórico de gangrena úmida da extremidade do membro pélvico esquerdo, submetida à amputação dos dígitos e transposição dos coxins. Durante o período pós-operatório foi desenvolvida uma órtese articulada caseira a fim de facilitar a sustentação do peso e auxiliar na deambulação do animal. A paciente se adaptou ao dispositivo ortopédico e foi acompanhado até a completa reepitelização do membro residual aos 30 dias de pós-operatório. Desta forma, conclui-se que a transposição dos coxins associada à órtese articulada pode ser uma opção viável à amputação do membro pélvico em cães de grande porte.

The digital pad can be defined as the most resistant area of the skin of the dogs and cats, which functions includes animal weight support and protection against to tractive and frictional forces. The reconstructive surgeries of the digital pad are viable alternatives to the limb amputation in many clinical situations. Among the surgical options, the transposition of the digital pad is highlighted. However, when amputation of the digits is necessary, shortening of the limb can compromise ambulation. An alternative to this, it is the use of orthoses. The aim of this report was to describe the case of a four-years-old female pit bull with clinical history of wet gangrene of left pelvic limb, submitted to transposition of digital pad, obtained from the contralateral hindlimb. An articulate orthosis was projected at postoperative period in order to facilitate weight support and assist the patient ambulation. The patient has adapted itself to the new orthopedic device, and was constantly monitored until complete reepithelialization of the residual limb at 30 days of postoperative. Thus, it can be concluded that the transposition of digital pad associated to the articulate orthosis can be a viable option to the limb amputation in large breed dogs.

Cirurgia ortopédica em equinos no brasil: evolução e estudo retrospectivo dos casos de fraturas no serviço de cirurgia de grandes animais da Universidade de São Paulo (1997-2019) / Equine orthopedic surgery in brazil: evolution and retrospective study of cases of the fractures in the service of large animal surgery of the University of São Paulo (1997-2019)

A abordagem de fraturas em equinos é um desafio para os cirurgiões veterinários, devido ao porte e temperamento da espécie, associados aos altos custos envolvidos e prognóstico nem sempre favoráveis. O desenvolvimento de técnicas e materiais tem permitido uma melhor abordagem cirúrgica e refletindo em taxas de sucesso cada vez maior. Neste sentido, este trabalho tem por objetivo discutir alguns fatores que influenciaram a evolução na abordagem do tratamento de fraturas em equinos no Brasil e apresentar estudo retrospectivo de casos de fraturas atendidos no Serviço de Cirurgia de Grandes Animais da FMVZ/USP, entre os anos de 1997 e 2019. Foram analisados os dados de 45 prontuários, mostrando que a abordagem cirúrgica evoluiu com o passar dos anos, com aumento no número de casos e desfechos positivos. Melhoria das técnicas cirúrgicas e dos cuidados pós-operatórios, além da utilização de placas bloqueadas, foram fatores que direcionaram a melhora do prognóstico principalmente com relação à vida do paciente, mas também com relação a função, em casos mais específicos.

Treatment of fractures in horses is a challenge for veterinary surgeons due to the animal size and species temperament, besides high costs and prognosis not always favorable. The development of new techniques and materials has improved the surgical approach and has generated increasing success rates. In this sense, this work aimed to discuss some factors that have been influencing the evolution in equine fracture treatment in Brazil, besides presenting a retrospective study of cases at the Large Animal Surgery Service at FMVZ/USP, between 1997 and 2019. Data from 45 medical records were analyzed, which showed that the surgical approach has evolved over the years, with increases in the number of cases and positive outcomes. The improvement of surgical techniques and postoperative care, as well as use of blocking plates, were factors that led to an enhancement in prognosis, mainly regarding the patient's life but also the function, in more specific cases.

Cirurgia ortopédica em equinos no brasil: evolução e estudo retrospectivo dos casos de fraturas no serviço de cirurgia de grandes animais da Universidade de São Paulo (1997-2019) / Equine orthopedic surgery in brazil: evolution and retrospective study of cases of the fractures in the service of large animal surgery of the University of São Paulo (1997-2019)

A abordagem de fraturas em equinos é um desafio para os cirurgiões veterinários, devido ao porte e temperamento da espécie, associados aos altos custos envolvidos e prognóstico nem sempre favoráveis. O desenvolvimento de técnicas e materiais tem permitido uma melhor abordagem cirúrgica e refletindo em taxas de sucesso cada vez maior. Neste sentido, este trabalho tem por objetivo discutir alguns fatores que influenciaram a evolução na abordagem do tratamento de fraturas em equinos no Brasil e apresentar estudo retrospectivo de casos de fraturas atendidos no Serviço de Cirurgia de Grandes Animais da FMVZ/USP, entre os anos de 1997 e 2019. Foram analisados os dados de 45 prontuários, mostrando que a abordagem cirúrgica evoluiu com o passar dos anos, com aumento no número de casos e desfechos positivos. Melhoria das técnicas cirúrgicas e dos cuidados pós-operatórios, além da utilização de placas bloqueadas, foram fatores que direcionaram a melhora do prognóstico principalmente com relação à vida do paciente, mas também com relação a função, em casos mais específicos.(AU)

Treatment of fractures in horses is a challenge for veterinary surgeons due to the animal size and species temperament, besides high costs and prognosis not always favorable. The development of new techniques and materials has improved the surgical approach and has generated increasing success rates. In this sense, this work aimed to discuss some factors that have been influencing the evolution in equine fracture treatment in Brazil, besides presenting a retrospective study of cases at the Large Animal Surgery Service at FMVZ/USP, between 1997 and 2019. Data from 45 medical records were analyzed, which showed that the surgical approach has evolved over the years, with increases in the number of cases and positive outcomes. The improvement of surgical techniques and postoperative care, as well as use of blocking plates, were factors that led to an enhancement in prognosis, mainly regarding the patient's life but also the function, in more specific cases.(AU)