Correção de luxação valga da articulação rádio-cárpica em um cão através da reconstrução ligamentar com fio sintético: uma alternativa à artrodese / Correction of valgus dislocation of the radio-carpal joint in a dog through ligament reconstruction with synthetic wire: an alternative to arthrodesis

Background: Radio-carpal dislocations are normally related to situations of trauma and may be treated with open or closed reduction, reconstruction of injured structures or arthrodesis. The treatment aims to eliminate pain, abnormal joint movement and restore member functions, avoiding or minimizing the development of arthrosis. Notwithstanding the literature on the treatment options, few of them explain the restorative technical applications and their evolution in a later postoperative period. The aim of the present report is to discuss extra-articular joint reconstruction with nylon wire in a canine patient with radio-carpal joint dislocation and ligament rupture. Case: A 10-year-old mixed-breed bitch, weighing 10 kg, after an 8-meter fall, received care at Animal Care Barueri Clínica Veterinária. The animal presented left thoracic member functional impotence and radio-carpal joint valgus dislocation, pain and joint swelling. The patient was sedated and medium-lateral and dorso-palmar X-rays of the distal area of the thoracic member were performed, showing radio-carpal dislocation and a slight radiotransparent line in caudal cortical of the middle third of the left radium, possibly related to an incomplete fracture due to compaction. At this point, the choice was for a closed reduction performed by means of traction followed by internal rotation of the distal extremity of the member. An immobilization device was placed using a vinyl splint for 4 days, until the date of the surgery. For the surgical procedure, a dorso-medial access was opened in the left radio-carpal joint, restoring the short radium collateral joint with nylon 0 suture, anchored on 3 pathways opened in the bones (2 pathways in the radium and 1 in the carpo-radial bone), forming one knot. The subcutaneous tissue was closed and sutured using absorbable wire of 2-0 polyglycolic acid. The skin was sutured using nonabsorbable wire of 3-0 nylon. The immediate postoperative X-rays showed the pathways created, conservation of the bone structures and restoration of the anatomic axis of the radio-carpal joint. The member was again immobilized for 70 days and, 30 days after removal of the splint, the animal could already bear load over the member, without lameness. At 10 months after the surgery, the patient performed X-rays of the medium-lateral and dorso-palmar projections, showing absence of the signs of arthrosis or any joint impairment. There was also absence of lameness and pain, however with reduction in joint movement amplitude, with total extension but more limited flexion. Discussion: Through comparison with the literature it was possible to find similarities with the joint injury approach reported, mainly regarding the form of the suture and the clinical alterations observed, such as short radium collateral ligament rupture related to joint valgus deviation. The treatment strategy in the case combined temporary closed reduction of the joint, immobilization, later joint access and restoration with synthetic wire and long-term immobilization. The postoperative results obtained showed favorable evolution, without signs of joint degeneration, pain or lameness. Possible unwanted consequences related to arthrodesis make the options for reconstruction techniques seem more interesting; however, further information of their application and the combination of its variations in a more directed fashion are still required. Understanding the types of injuries, together with the development of research that assess their diagnosis and evolution, may help treatments to show even better perspectives.

Descrição anatomo-ultrassonográfica do carpo equino / Anatomic and ultrasonographic description of the equine carpus / Descripción anatómica y ultrasonográfica del carpus equino

O carpo equino é uma região anatômica que apresenta relevância clínica e cirúrgica aos veterinários, sendo o ultrassom uma modalidade de exame complementar útil para auxiliar no diagnóstico de afecções que envolvem as principais estruturas desta articulação. Devido à escassez de trabalhos que ilustrem os aspectos morfológicos da articulação cárpica hígida e também por consequência de sua alta complexidade, foi objetivo deste trabalho apresentar uma minuciosa descrição anátomo-ultrassonográfica comparada do carpo equino. Na primeira etapa deste estudo, foram utilizadas peças anatômicas provenientes de membros torácicos equinos de modo a priorizar estruturas de maior importância clínica dos aspectos dorsal, palmar, lateral e medial da articulação cárpica. Na segunda etapa, por meio do exame por ultrassonografia de dois cavalos, foram geradas imagens longitudinais e transversais das estruturas alvo para o estudo anatômico, as quais foram avaliadas quanto à espessura, ecogenicidade e ecotextura. A partir desses dois estudos, foi realizada a correlação das estruturas macroscópicas das peças com suas respectivas representações ultrassonográficas, levando ao desenvolvimento de imagens didáticas aliadas às descrições das estruturas musculoesqueléticas da articulação cárpica, de modo a auxiliar no estudo desta região.

The equine carpal joint is relevant in clinical and surgical veterinary practices, with the use of ultrasound being very helpful as a complementary exam to diagnose some diseases that involves the principal structures of this articulation. Due to the lack in studies that illustrate the morphological aspect of this region in health horses and for it complexity, it is this study goal to present a meticulous description of the compared ultrasonographic anatomy of the equine carpal joint. For this study, anatomical pieces from equine thoracic limbs were used, being two already dissecated and fixated in formol and four pieces presented in transversal cuts, in order to prioritize the evaluation of the most important structures for clinical practice in the dorsal, medial, lateral and palmar aspects of the equine carpal joint. With the use of ultrasonographic exam in two health horses belonging to the College of Veterinary Medicine and Zootechny, FMVZ/Unesp –Botucatu/SP, longitudinal and transverse images of the respective dissected structures in the anatomical study were generated, wich were evaluated for ecotexture, echogenicity and thickness. From both studies, a correlation was made between the macroscopic structures from the anatomical pieces and the ultrasonographic representations, leading to the development of teaching images and musculoskeletical structures description of the carpal joint, generated in order to help on its study.

El carpo equino es una región anatómica que tiene relevancia clínica y quirúrgica para los veterinarios, siendo el ultrasonido una modalidad útil de examen complementario para ayudar en el diagnóstico de afecciones que involucran las estructuras principales de esta articulación. Debido a la escasez de estudios que ilustran los aspectos morfológicos de la articulación carpiana sana y también como resultado de su alta complejidad, el objetivo de este estudio fue presentar una descripción anatómica y ecográfica detallada del carpo equino. En la primera etapa de este estudio, se utilizaron piezas anatómicas de extremidades torácicas equinas para priorizar estructuras de mayor importancia clínica desde los aspectos dorsal, palmar, lateral y medial de la articulación carpiana. En la segunda etapa, a través del examen de ultrasonido de dos caballos, se generaron imágenes longitudinales y transversales de las estructuras principales para el estudio anatómico, que se evaluaron en cuanto a espesor, ecogenicidad y ecotextura. A partir de estos dos estudios, las estructuras macroscópicas de las piezas se correlacionaron con sus respectivas representaciones ecográficas, lo que condujo al desarrollo de imágenes didácticas combinadas con descripciones de las estructuras musculoesqueléticas de la articulación carpiana, para ayudar en el estudio de esta región.

Descrição anatomo-ultrassonográfica do carpo equino / Anatomic and ultrasonographic description of the equine carpus / Descripción anatómica y ultrasonográfica del carpus equino

O carpo equino é uma região anatômica que apresenta relevância clínica e cirúrgica aos veterinários, sendo o ultrassom uma modalidade de exame complementar útil para auxiliar no diagnóstico de afecções que envolvem as principais estruturas desta articulação. Devido à escassez de trabalhos que ilustrem os aspectos morfológicos da articulação cárpica hígida e também por consequência de sua alta complexidade, foi objetivo deste trabalho apresentar uma minuciosa descrição anátomo-ultrassonográfica comparada do carpo equino. Na primeira etapa deste estudo, foram utilizadas peças anatômicas provenientes de membros torácicos equinos de modo a priorizar estruturas de maior importância clínica dos aspectos dorsal, palmar, lateral e medial da articulação cárpica. Na segunda etapa, por meio do exame por ultrassonografia de dois cavalos, foram geradas imagens longitudinais e transversais das estruturas alvo para o estudo anatômico, as quais foram avaliadas quanto à espessura, ecogenicidade e ecotextura. A partir desses dois estudos, foi realizada a correlação das estruturas macroscópicas das peças com suas respectivas representações ultrassonográficas, levando ao desenvolvimento de imagens didáticas aliadas às descrições das estruturas musculoesqueléticas da articulação cárpica, de modo a auxiliar no estudo desta região.(AU)

The equine carpal joint is relevant in clinical and surgical veterinary practices, with the use of ultrasound being very helpful as a complementary exam to diagnose some diseases that involves the principal structures of this articulation. Due to the lack in studies that illustrate the morphological aspect of this region in health horses and for it complexity, it is this study goal to present a meticulous description of the compared ultrasonographic anatomy of the equine carpal joint. For this study, anatomical pieces from equine thoracic limbs were used, being two already dissecated and fixated in formol and four pieces presented in transversal cuts, in order to prioritize the evaluation of the most important structures for clinical practice in the dorsal, medial, lateral and palmar aspects of the equine carpal joint. With the use of ultrasonographic exam in two health horses belonging to the College of Veterinary Medicine and Zootechny, FMVZ/Unesp –Botucatu/SP, longitudinal and transverse images of the respective dissected structures in the anatomical study were generated, wich were evaluated for ecotexture, echogenicity and thickness. From both studies, a correlation was made between the macroscopic structures from the anatomical pieces and the ultrasonographic representations, leading to the development of teaching images and musculoskeletical structures description of the carpal joint, generated in order to help on its study.(AU)

El carpo equino es una región anatómica que tiene relevancia clínica y quirúrgica para los veterinarios, siendo el ultrasonido una modalidad útil de examen complementario para ayudar en el diagnóstico de afecciones que involucran las estructuras principales de esta articulación. Debido a la escasez de estudios que ilustran los aspectos morfológicos de la articulación carpiana sana y también como resultado de su alta complejidad, el objetivo de este estudio fue presentar una descripción anatómica y ecográfica detallada del carpo equino. En la primera etapa de este estudio, se utilizaron piezas anatómicas de extremidades torácicas equinas para priorizar estructuras de mayor importancia clínica desde los aspectos dorsal, palmar, lateral y medial de la articulación carpiana. En la segunda etapa, a través del examen de ultrasonido de dos caballos, se generaron imágenes longitudinales y transversales de las estructuras principales para el estudio anatómico, que se evaluaron en cuanto a espesor, ecogenicidad y ecotextura. A partir de estos dos estudios, las estructuras macroscópicas de las piezas se correlacionaron con sus respectivas representaciones ecográficas, lo que condujo al desarrollo de imágenes didácticas combinadas con descripciones de las estructuras musculoesqueléticas de la articulación carpiana, para ayudar en el estudio de esta región.(AU)

Deformidade angular adquirida no carpo de muares: diagnóstico, incidência e tratamento

The objective of this study was to diagnose, treat and monitor the occurrence of acquired carpal angular limb deformities (ALD) in a herd of mules. The treatment was determined by the degrees of angulation (DA) measured during the radiological examination. Members with DA 3° were subjected to hoof trimming (TC); DA >3° and 7° were treated with hemicircunfential transection and elevation of the periosteum and hoof trimming (TEP); DA >7° were subjected to the same measures adopted in the group TEP associated with transphyseal staple (GTF). The DA was monitored by radiography obtained 45 days before treatment (T0), at the start of treatment (T1) and 30 (T2) and 60 (T3) after its establishment. The incidence of affected mules was 37.1%, in which the demand for surgical treatment was higher than that reported in horses. The occurrence of DA in this herd was due to the training program established. Between T0 and T1 there was no variation of the DA. In the TEP group, the reduction of DA in T2 was similar to those reported in horses, but the improvement occurred in less time and in mules at the age of 7.9 months. The DA at T3 in the GTF was not satisfactory, probably due to the high average age of this group. It was concluded that the exercises resulted in the incidence of DA in mules. The adopted treatment in the TEP group was able to reduce the DA, despite the age of mules.

O objetivo deste trabalho foi diagnosticar, tratar e monitorar a ocorrência de DA adquirida no carpo de muares. O tratamento instituído nos animais portadores de DA foi determinado pelo desvio angular mensurado em imagens radiológicas. Membros com desvio 3° foram submetidos ao casqueamento (TC); desvios >3° e 7° foram tratados com transecção e elevação de periósteo e casqueamento (TEP); desvio >7° foram submetidos às mesmas medidas adotadas no grupo TEP, associadas ao uso de grampo trans-fisário (GTF). Os desvios foram monitorados através de radiografias obtidas 45 dias antes (T0), no início do tratamento (T1) e com 30 (T2) e 60 (T3) dias após a sua instituição. A incidência de animais acometidos no plantel estudado foi de 37,1%, sendo a demanda por tratamento cirúrgico maior do que a relatada em equinos. O fator determinante para a incidência de DA neste plantel foi o programa de treinamento instituído. Entre T0 e T1, não houve variação da DA. No grupo TEP, a redução a partir de T2 foi semelhante à relatada nos equinos, porém a melhora ocorreu em menos tempo e em muares com idade de 7,9 meses. Não foi obtida redução satisfatória do desvio no grupo GTF, provavelmente, devido à média de idade elevada desse grupo. Conclui-se que os exercícios acarretaram na incidência de DA nos muares. O tratamento instituído no grupo TEP foi capaz de reduzir a DA, apesar da idade dos muares.

Deformidade angular adquirida no carpo de muares: diagnóstico, incidência e tratamento

The objective of this study was to diagnose, treat and monitor the occurrence of acquired carpal angular limb deformities (ALD) in a herd of mules. The treatment was determined by the degrees of angulation (DA) measured during the radiological examination. Members with DA 3° were subjected to hoof trimming (TC); DA >3° and 7° were treated with hemicircunfential transection and elevation of the periosteum and hoof trimming (TEP); DA >7° were subjected to the same measures adopted in the group TEP associated with transphyseal staple (GTF). The DA was monitored by radiography obtained 45 days before treatment (T0), at the start of treatment (T1) and 30 (T2) and 60 (T3) after its establishment. The incidence of affected mules was 37.1%, in which the demand for surgical treatment was higher than that reported in horses. The occurrence of DA in this herd was due to the training program established. Between T0 and T1 there was no variation of the DA. In the TEP group, the reduction of DA in T2 was similar to those reported in horses, but the improvement occurred in less time and in mules at the age of 7.9 months. The DA at T3 in the GTF was not satisfactory, probably due to the high average age of this group. It was concluded that the exercises resulted in the incidence of DA in mules. The adopted treatment in the TEP group was able to reduce the DA, despite the age of mules.

O objetivo deste trabalho foi diagnosticar, tratar e monitorar a ocorrência de DA adquirida no carpo de muares. O tratamento instituído nos animais portadores de DA foi determinado pelo desvio angular mensurado em imagens radiológicas. Membros com desvio 3° foram submetidos ao casqueamento (TC); desvios >3° e 7° foram tratados com transecção e elevação de periósteo e casqueamento (TEP); desvio >7° foram submetidos às mesmas medidas adotadas no grupo TEP, associadas ao uso de grampo trans-fisário (GTF). Os desvios foram monitorados através de radiografias obtidas 45 dias antes (T0), no início do tratamento (T1) e com 30 (T2) e 60 (T3) dias após a sua instituição. A incidência de animais acometidos no plantel estudado foi de 37,1%, sendo a demanda por tratamento cirúrgico maior do que a relatada em equinos. O fator determinante para a incidência de DA neste plantel foi o programa de treinamento instituído. Entre T0 e T1, não houve variação da DA. No grupo TEP, a redução a partir de T2 foi semelhante à relatada nos equinos, porém a melhora ocorreu em menos tempo e em muares com idade de 7,9 meses. Não foi obtida redução satisfatória do desvio no grupo GTF, provavelmente, devido à média de idade elevada desse grupo. Conclui-se que os exercícios acarretaram na incidência de DA nos muares. O tratamento instituído no grupo TEP foi capaz de reduzir a DA, apesar da idade dos muares.

Capillary blood glucose and venous blood glucose measured with portable digital glucometer in diabetic dogs

This study aimed to compare the glycemic values obtained with a glucometer with those determined by a colorimetric enzymatic assay in venous blood as well as to evaluate the possibility of using capillary blood samples of dogs with diabetes mellitus. A group with 30 diabetic dogs was formed and from each dog three blood samples were obtained for glycemic evaluations by different methods and blood collection sites. The mean glycemic values showed no significant difference between the different sites of blood collection and methods (P=0.90). Venous, pinna and carpal pad blood glucose showed excellent correlation with the colorimetric enzymatic assay (r=0.98; r=0.95 and r=0.96 respectively) and the obtained values fit properly the clinically acceptable intervals in the error grid analysis. The present study revealed that carpal pad, venous and pinna glucose measurements are clinically acceptable and this method is feasible for use in hospitalized diabetic dogs. The sample attainment of carpal pad proved to be effective and a viable alternative. Further work is necessary to assess the utility of this technique in a home environment.(AU)

The use of hydroxyapatite for arthrodesis in dogs and cats: a clinical study / Utilização de hidroxiapatita para artrodeses em cães e gatos: ensaio clínico

Twenty-five arthrodeses were performed in four cats and 17 dogs using synthetic hydroxyapatite as fresh autogenous graft cancellous bone substitute. Arthrodesis was performed in the carpal joint in eight cases, in the tarsal joint in 10, in the elbow joint in six, and in the knee joint in one case. The mean radiographic follow-up time was 30 days in one animal, 45 days in another animal and 60 days in the 19 remaining cases. Bone union was observed in 24 arthrodeses. Non-union of one elbow arthrodesis was due to failure of stabilization. Restoration of limb functionality was classified as good to excellent in 22 cases. Hydroxyapatite was able to promote bone growth and is suitable for using in routine surgical procedures for small animals(AU)

Realizaram-se 25 artrodeses em 21 casos, quatro em gatos e 17 em cães, utilizando hidroxiapatita sintética como substituto ao enxerto ósseo autógeno esponjoso fresco, sendo oito na articulação do carpo, 10 na articulação do tarso, seis na do cotovelo e uma na do joelho. As avaliações radiográficas foram realizadas aos 30 dias em um animal, aos 45 dias em outro e aos 60 dias nos 19 casos restantes. Visibilizou-se união óssea em 24 artrodeses e a não-união em um cotovelo foi atribuída a falha na estabilização. O retorno à função do membro foi classificado de bom a excelente em 22 casos. A hidroxiapatita foi capaz de viabilizar o crescimento ósseo e mostrou-se factível para utilização na prática cirúrgica rotineira em pequenos animais(AU)

Estudo da secção do ligamento carpal transverso comparando as técnicas endoscópica e convencional em cadáver humano

PURPOSE: The aim of this study is to evaluate, in human corpses, the section of the transverse carpal ligament by comparing endoscopic (Chow's technique) and conventional (mini-incision) accesses. METHODS: Eighteen fresh not claimed corpses were distributed into 2 groups: group 1 (18 left wrists) and group 2 (18 right wrists). Group 1 was subjected to endoscopic access (Chow's technique) while in Group 2 ligaments were accessed through mini-incisions. RESULTS: Complete section of transverse carpal ligament was attained in 15 cases (83,3 %) in group 1 and 17 cases (94,4 %) in group 2. Operative time in group 1 averaged 27,2 minutes and 29,2 minutes in group 2. Lesion of median nerve occurred in 2 cases (11,1 %) in group 1. Group 2 presented no nerve lesions. CONCLUSION: It is concluded that there is no significant difference when comparing endoscopic and conventional techniques in the section of transverse carpal ligament. The median nerve injury, inspite of its significant (p 0,05) incidence in this study may be related to the researcher's learning curve.

OBJETIVO: Verificar, em cadáver, a secção do ligamento carpal transverso (LCT) comparando as técnicas endoscópica tipo CHOW e convencional tipo mini-incisão. MÉTODOS: Foram utilizados 18 cadáveres, não formolizados, perfazendo um total de 36 punhos, distribuídos em dois grupos. O grupo I compreendeu os 18 punhos esquerdos e utilizou a técnica endoscópica, enquanto o grupo II incluiu os 18 punhos direitos e empregou a técnica convencional. RESULTADOS: A secção completa do LCT ocorreu em 15 casos (83,3 %) no grupo I e em 17 casos (94,4 %) no grupo II. O tempo operatório no grupo I teve uma média de 27,2 minutos, enquanto no grupo II o tempo médio foi de 29,7 minutos. Verificou-se lesão do nervo mediano em dois casos (11,1 %) e somente no grupo I. CONCLUSÃO: Não há diferença significante no que se refere à secção do LCT e ao tempo operatório quando se comparam as técnicas endoscópica tipo Chow e convencional tipo mini-incisão. A incidência de lesão do nervo mediano, porém, é significante (p 0,05) quando se utiliza a técnica endoscópica, o que pode estar relacionado à curva de aprendizagem.

Capillary blood glucose and venous blood glucose measured with portable digital glucometer in diabetic dogs

This study aimed to compare the glycemic values obtained with a glucometer with those determined by a colorimetric enzymatic assay in venous blood as well as to evaluate the possibility of using capillary blood samples of dogs with diabetes mellitus. A group with 30 diabetic dogs was formed and from each dog three blood samples were obtained for glycemic evaluations by different methods and blood collection sites. The mean glycemic values showed no significant difference between the different sites of blood collection and methods (P=0.90). Venous, pinna and carpal pad blood glucose showed excellent correlation with the colorimetric enzymatic assay (r=0.98; r=0.95 and r=0.96 respectively) and the obtained values fit properly the clinically acceptable intervals in the error grid analysis. The present study revealed that carpal pad, venous and pinna glucose measurements are clinically acceptable and this method is feasible for use in hospitalized diabetic dogs. The sample attainment of carpal pad proved to be effective and a viable alternative. Further work is necessary to assess the utility of this technique in a home environment.