Biomechanical effects of a titanium intervertebral cage as a stand-alone device, and in combination with locking plates in the canine caudal cervical spine.

OBJECTIVE: To evaluate the change in ex vivo biomechanical properties of the canine cervical spine, due to an intervertebral cage, both as a stand-alone device and in combination with plates. STUDY DESIGN: Experimental ex vivo study. ANIMALS: Cervical spinal segments (C5-C7) from eight canine cadavers. METHODS: The range of motion (ROM) and elastic zone stiffness (EZS) of the spines were determined with a four-point bending device in flexion/extension, lateral bending, and axial rotation for four conditions: native, discectomy, cage (at C6-C7), and cage with plates (at C6-C7). The disc height index (DHI) for each condition was determined using radiography. RESULTS: Discectomy resulted in overall increased ROM (p < .01) and EZS (p < .05) and decreased DHI (p < .005) when compared to the native condition. Placement of the cage increased DHI (p < .001) and restored total ROM during flexion/extension, lateral bending and axial rotation, and EZS during flexion/extension to the level of the native spine. Application of the plates further reduced the total ROM during flexion/extension (p < .001) and lateral bending (p < .001), but restored ROM in extension and EZS during lateral bending. No implant failure, subsidence, or significant cage migration occurred during loading. CONCLUSION: An anchorless intervertebral cage used as a stand-alone device was able to restore the disc height and spinal stability to the level of the native cervical spine, whereas the addition of plates further reduced the spinal unit mobility. CLINICAL SIGNIFICANCE: This study implies that the intervertebral cage may be used as a stand-alone device in the spinal unit fixation in the canine cervical spine.

Ex vivo study of minimally invasive procedures for cartilage removal from the metacarpophalangeal or metatarsophalangeal joint and for fetlock tension band application.

OBJECTIVE: To describe reliable minimally invasive procedures for (1) removing cartilage by joint distraction and articular drilling for equine metacarpophalangeal (MCP)/metatarsophalangeal (MTP) arthrodesis; (2) applying a palmar/plantar tension band without MCP/MTP joint luxation. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Cadaveric equine limbs (n = 12). METHODS: All limbs were used to evaluate the drilling technique. First the MCP/MTP joint was distracted with a 5.5-mm cortical screw. Then, through four stab incisions, articular cartilage was removed with a 4.5-mm drill. Six randomly chosen limbs were then tested for minimally invasive tension band application with a specially designed cannula. Accurate positioning of the tension band was assessed radiographically. All MCP/MTP joints were disarticulated, and the areas of removed cartilage were visually assessed and measured by using planimetry. RESULTS: The mean percentage of removed cartilage was 66.8% ± 7.6% for the metacarpus/metatarsus surface, 67.9% ± 8.6% for the proximal phalanx surface, and 59.5% ± 1% for the two sesamoid bones. The tension band could be accurately placed through four stab incisions with the cannula. CONCLUSION: This minimally invasive technique for cartilage removal was efficient and should be favorable for joint fusion in some clinical situations. The minimally invasive tension band application through stab incisions was feasible and repeatable. CLINICAL SIGNIFICANCE: These procedures should allow total minimally invasive MCP/MTP arthrodesis and be used in selected clinical cases.

Kinematic behavior of a novel pedicle screw-rod fixation system for the canine lumbosacral joint.

OBJECTIVE: To determine the biomechanical behavior of a novel distraction-stabilization system, consisting of an intervertebral distraction bolt, polyaxial screws, and connecting rods, in the canine lumbosacral spine. STUDY DESIGN: Biomechanical study. SAMPLE POPULATION: Cadaveric canine lumbosacral spines (L4-Cd3) (N = 8). METHODS: Cadaveric lumbosacral spines were harvested, stripped of musculature, mounted on a 4-point bending jig, and tested in extension, flexion, and lateral bending using nondestructive compressive axial loads (0-150 N). Angular displacement was recorded from reflective optical trackers rigidly secured to L6, L7, and S1. Data for primary and coupled motion were collected from intact spines, after destabilization at L7-S1, and following surgical stabilization with the new implant system. RESULTS: As compared with the intact spine, laminectomy resulted in a modest increase in angular displacement at L6-L7 and a marked increase at L7-S1. Instrumentation significantly reduced motion at the operated level (L7-S1) with a concomitant increase at the adjacent level (L6-L7). CONCLUSION: The combination of a polyaxial pedicle screw-rod system and intervertebral spacer provides a versatile solution of surgical stabilization of the lumbosacral joint following surgical decompression in the canine lumbosacral spine. The increase in motion at L6-L7 may suggest the potential for adjacent level effects and clinical trials should be designed to address this question. CLINICAL RELEVANCE: These results support the feasibility of using this new implant system for the management of degenerative lumbosacral disease in dogs. The increase in motion at L6-L7 may suggest the potential for adjacent level effects and clinical trials should be designed to address this question.

Accuracy and safety of pin placement during lateral versus dorsal stabilization of lumbar spinal fracture-luxation in dogs.

OBJECTIVE: To determine the accuracy and safety of pin placement for lateral vertebral stabilization to the reference dorsal stabilization. STUDY DESIGN: A randomized noninferiority trial. SAMPLE POPULATION: Twenty Greyhound cadaveric lumbar spines (L1-L6). METHODS: One hundred and fifty-nine lumbar vertebral pins placed in 80 vertebrae were assessed; these pins were distributed approximately equally between the dorsal and lateral approaches, and between 2 surgeons. Pin angle accuracy, bone purchase distance, and distances from pin to the spinal canal and the aorta were measured for each pin. RESULTS: The lateral approach was superior for pin angle accuracy and bone purchase. The mean angle of deviation was 15.3° with the dorsal approach and 7.0° with the lateral approach. The mean bone purchase was 16.7 mm with the dorsal approach and 22.2 mm with the lateral approach. Pins were placed at a mean of 2.3 mm from the spinal canal with the dorsal approach and 1.7 mm with the lateral approach. Pins were placed at a mean of 3.8 mm from the aorta with the dorsal approach and 8.0 mm with the lateral approach. The percentage of pins breaching the spinal canal was 14% with the dorsal approach and 19% with the lateral approach. Fourteen percent of pins placed via the dorsal approach breached the aorta, whereas no pins placed via the lateral approach breached the aorta. CONCLUSION: Relative to the dorsal approach, the lateral approach improves angle accuracy, bone purchase, and distance between pins, and the aorta and is noninferior with regards to the distance between pins and the spinal canal.

Bending strength and stiffness of canine cadaver spines after fixation of a lumbar spinal fracture-luxation using a novel unilateral stabilization technique compared to traditional dorsal stabilization.

OBJECTIVE: To 1) assess the bending strength and stiffness of canine cadaver spines after fixation of a lumbar spinal fracture-luxation using a novel unilateral stabilization technique with pins and polymethyl methacrylate (PMMA) and 2) compare the results to a reference standard dorsal pin and PMMA technique. STUDY DESIGN: A randomized non-inferiority trial. SAMPLE POPULATION: Cadaveric lumbar spines (L1-L6) from 20 Greyhounds. METHODS: Specimens were paired to match bodyweight and vertebral size. A standardized fracture/luxation was performed between L3 and L4. One spine within each pair was randomly assigned the unilateral fixation technique and the other received the reference standard dorsal fixation technique. Four-point bending of each specimen in flexion was performed by applying load to pins placed transversely into vertebrae L1, L2, L5, and L6. During testing, angular bending strength and stiffness were measured as a function of flexion angle. Margins for non-inferiority were defined a priori. Strength and stiffness of the specimens for each technique were compared statistically. RESULTS: Lower limits of 95% confidence intervals were above the defined margins for non-inferiority. Thus, based on these margins, for strength and stiffness, unilateral fixation was not inferior to dorsal fixation. CONCLUSIONS: This novel unilateral approach to lumbar spinal fixation yielded comparable strength and stiffness when tested for bending in flexion to that of reference standard dorsal approach. This approach is therefore a suitable alternative to the dorsal approach in appropriate lumbar spinal fracture configurations.

Bone healing by using Ilizarov external fixation combined with flexible intramedullary nailing versus Ilizarov external fixation alone in the repair of tibial shaft fractures: experimental study.

PURPOSE: Our research was aimed at studying the radiographic and histological outcomes of using flexible intramedullary nailing (FIN) combined with Ilizarov external fixation (IEF) versus Ilizarov external fixation alone on a canine model of an open tibial shaft fracture. MATERIALS AND METHODS: Transverse diaphyseal tibial fractures were modelled in twenty dogs. Fractures in the dogs of group 1 (n = 10) were stabilized with the Ilizarov apparatus while it was combined with FIN in group 2 (n = 10). RESULTS: On day 14, a bone tissue envelope started developing round the FIN wires. Histologically, we revealed only endosteal bone union in group 1 while in group 2 the radiographs revealed complete bone union on day 28. At the same time-point, the areas of cancellous and mature lamellar bone tissues were observed in the intermediary area in group 2. The periosteal layers were formed of the trabeculae net of lamellar structure and united the bone fragments. The frame was removed at 30 days after the fracture in group 2 and after 45 days in group 1 according to bone regeneration. CONCLUSION: The combination of the Ilizarov apparatus and FIN accelerates bone repair and augments stabilization of tibial shaft fractures as compared with the use of the Ilizarov fixation alone.

Prospective evaluation of minimally invasive plate osteosynthesis in 36 nonarticular tibial fractures in dogs and cats.

OBJECTIVE: To evaluate the clinical outcome of minimally invasive plate osteosynthesis (MIPO) for nonarticular tibial fractures stabilized using bone plates with or without an intramedullary rod (IMR). STUDY DESIGN: Prospective study. ANIMALS: Dogs (n=28) and 8 cats. METHODS: After closed reduction, fracture fixation was achieved using an epiperiosteal plate inserted percutaneously through epiphyseal small incisions. In some fractures, an IMR was inserted via medial parapatellar arthrotomy. Radiographs were recommended every 3 weeks until clinical union. Postoperative tibial length and alignment were compared with contralateral measurements (P<.05). Time to clinical union and complications were recorded. RESULTS: An IMR was used in 30.5% of the cases. Repaired tibiae were 1% shorter than contralateral tibiae (P<.05). Frontal and sagittal alignment were similar between repaired and contralateral tibiae (P>.05). Six dogs were lost for follow-up; owners indicated normal function. In 30 cases for which bone healing was documented, mean±SD healing time was 45±20.8 days; however, when considering the 23 cases, which completed preestablished scheduled follow-ups, healing time was 36±11.6 days. Minor complications occurred in 4 cases (11%). One major complication (3%) consisting of a plate fracture was successfully revised using MIPO with a larger plate. CONCLUSIONS: Consistent restoration of alignment was accomplished using MIPO techniques. Furthermore, MIPO appeared to yield faster healing times and lower complication rates than those reported with conventional plate osteosynthesis.

Effects of intravenous fentanyl administration on end-tidal sevoflurane concentrations in thoroughbred racehorses undergoing orthopedic surgery.

To evaluate the effects of IV fentanyl administration on the end-tidal sevoflurane concentration (ET(SEVO)) in thoroughbred racehorses, the ET(SEVO) required for internal fixation of longitudinal fractures was compared between horses anesthetized with sevoflurane-fentanyl (Group SF; n=9) and those anesthetized with sevoflurane alone (Group S; n=9). The loading dose of fentanyl (5.0 µg/kg) was administered over 15 min followed by a maintenance dose of fentanyl (0.1 µg/kg/min) throughout the operation in Group SF. The mean ET(SEVO) during the operation in Group SF (2.6 ± 0.2%) was significantly lower than in Group S (3.0 ± 0.3%). The plasma fentanyl concentrations (6.12 ± 0.88 to 7.78 ± 1.12 ng/ml) in 7 out of 9 horses in Group SF were stable and did not change significantly throughout the operation. The mean dobutamine infusion rate required for maintaining a mean arterial blood pressure between 60 and 80 mmHg during the operation in Group SF (0.56 ± 0.30 µg/kg/min) was significantly lower than in Group S (0.90 ± 0.16 µg/kg/min). The qualities of the recoveries were clinically acceptable, and serious complications were not observed in either group. In conclusion, continuous IV fentanyl administration reduced the sevoflurane requirement by 13% in thoroughbred racehorses undergoing orthopedic surgery; however, fentanyl was considered to be less effective in horses compared with other species.

In vitro biomechanical comparison of a modified 5.5 mm locking compression plate fixation with a 5.5 mm locking compression plate fixation of osteotomized equine third metacarpal bones.

OBJECTIVES: To compare number of cycles to failure for palmarodorsal 4-point bending of a modified 5.5 mm broad locking compression plate (M5.5-LCP) fixation with a 5.5 mm broad LCP (5.5-LCP) fixation used to repair osteotomized equine third metacarpal (MC3) bones. STUDY DESIGN: In vitro biomechanical testing. ANIMAL POPULATION: Adult equine cadaveric MC3 bones (n=6 pairs). METHODS: An 8-hole, M5.5-LCP, obtained by having a 1.0 mm thickness removed from the bone contact portion of the 5.5-LCP, was applied to the dorsal surface of 1 randomly selected MC3 from each pair, and an 8-hole, 5.5-LCP was applied dorsally to the contralateral bone from each pair using a combination of cortical and locking screws. Plates and screws were applied using standard ASIF techniques to MC3 bones with a mid-diaphyseal osteotomy. MC3 constructs had palmarodorsal 4-point bending cyclic fatigue testing. Mean cycles to failure for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS: Mean±SD cycles to failure of the M5.5-LCP fixation (188,641±17,971) was significantly greater than that of the 5.5-LCP fixation (166,497±15,539). CONCLUSION: M5.5-LCP fixation was superior to 5.5-LCP fixation of osteotomized equine MC3 bones in resisting cyclic fatigue under palmarodorsal 4-point bending. CLINICAL RELEVANCE: This suggests that biological plate fixation is not the ideal choice for osteotomized equine MC3 bones.

Stabilization of sacroiliac luxation in 40 cats using screws inserted in lag fashion.

OBJECTIVE: To (1) identify prognostic indicators for stability after stabilization of sacroiliac luxation with screws inserted in lag fashion and (2) report dorsoventral dimensions of the sacrum in cats. STUDY DESIGN: Multicenter retrospective study. SAMPLE POPULATION: Cats (n=40) with sacroiliac luxation. METHODS: Case records and radiographs of cats presented at the Queen's Veterinary School Hospital Cambridge and the Royal Veterinary College Hatfield for screw fixation of sacroiliac luxation were reviewed. Dorsoventral dimensions of 15 feline cadaveric sacral bodies were measured to identify the appropriate implant size for use in fixation with screws inserted in lag fashion. RESULTS: Of 40 cats, 13 had left, 14 right, and 13 bilateral sacroiliac luxations. Of 48 screws analyzed, 42 (87.5%) were placed within the sacral body or exited ventrally and 6 (12.5%) were considered malpositioned. Screw purchase within the sacrum was statistically different between unstable and stable repairs (P=.001). Using confidence intervals for screw length within the sacrum and effect on stability, the lowest screw depth that contained 95% of the screws that did not loosen was approximately 60% of the sacral width. Mean dorsoventral sacral dimension at its narrowest point was 5.9+/-1.14 mm. There was no significant difference in the incidence of implant loosening between those luxations that were 100% reduced and those that were <100% reduced (P=.7837). CONCLUSIONS: Screw purchase within the feline sacrum of at least 60% of the sacral width significantly reduces the risk of loosening. CLINICAL RELEVANCE: Screw placement to a depth of 60% of the width of the feline sacrum is recommended.

Use of the Kishigami Atlantoaxial Tension Band in eight toy breed dogs with atlantoaxial subluxation.

OBJECTIVE: To determine the applicability, complications, and long-term functional outcome of the Kishigami Atlantoaxial Tension Band (Kishigami AATB) for management of congenital and traumatic atlantoaxial (AA) instability in toy breed dogs. STUDY DESIGN; Case series. ANIMALS: Toy breed dogs (n=8) with congenital or traumatic AA instability. METHODS: The AA joint of each dog was surgically stabilized through a dorsal approach using the original or a modified version of the Kishigami AATB. Pre- and postoperative neurologic status, radiographs, and complications were reviewed. Follow-up examination was performed at 1 and 12 months. RESULTS: Functional improvement occurred in 5 dogs; 1 dog did not improve or worsen and 2 dogs were euthanatized at owner request. Adequate reduction and stabilization was achieved in 7 dogs based on immediate postoperative radiographs; failure of reduction was evident in 1 dog. No relevant complications occurred. CONCLUSIONS: Kishigami AATB may be acceptable as an alternative method for dorsal stabilization of AA subluxation in toy breed dogs in which use of ventral screws or pins is challenging. Experience with this technique in a larger population is necessary to compare our results to those reported by ventral approach. CLINICAL RELEVANCE; The surgical technique described is effective, safe, and simple in the surgical treatment of AA subluxation in toy breed dogs.

Computed tomography to identify preoperative guidelines for internal fixation of the distal sesamoid bone in horses: an in vitro study.

OBJECTIVE: To assess the reliability of computed tomography (CT) to identify the direction of implant insertion for cortical screws along the longitudinal axis of intact (nonfractured) distal sesamoid bones. STUDY DESIGN: In vitro study. SAMPLE POPULATION: Cadaveric paired equine forelimbs (n=16). METHODS: Insertion of a cortical screw in lag fashion along the longitudinal axis of intact (nonfractured) distal sesamoid bones was evaluated in 2 groups (3.5 and 4.5 mm) of 8 paired limbs. In each group, the direction of the distal sesamoid bone was determined by CT (Equine XTC 3000 pQCT scanner). Screw placement was verified by specimen dissection. Implant direction was considered satisfactory if the entire screw length was within the distal sesamoid bone and not damaging the articular or flexural surfaces. RESULTS: In our sample and according to our criteria, the proportion of satisfactory direction of screws was 0.63 (5/8) for 4.5 mm implants, and 0.87 (7/8) for 3.5 mm implants. CONCLUSIONS: CT is a useful imaging modality to identify anatomic landmarks for insertion of a 3.5 mm cortical screw in the distal sesamoid bone.

Intervertebral biomechanics of locking compression plate monocortical fixation of the canine cervical spine.

OBJECTIVE: To evaluate the use of a locking compression plate (LCP) with monocortical screw purchase for stabilization of the canine cervical spine. STUDY DESIGN: Experimental study. ANIMALS: Cadaveric canine cervical spine specimens (n = 7). METHODS: Flexion and extension bending moments were applied to canine cadaveric specimens (C3-C6) in 4-point bending, before and after creation of a ventral slot at C4-C5, and after fixation with a 5 hole, 3.5 mm LCP with monocortical screw placement. Screw placement and penetration into the vertebral canal were determined by radiography. Range of motion, stiffness, and energy for passive physiologic loads were determined for the C3-C4, C4-C5, and C5-C6 vertebral motion units (VMU). Monotonic failure properties were determined for cervical extension. Effects of treatments on biomechanical variables were assessed using repeated measures analysis of variance and least square means (P ≤ .05). RESULTS: The ventral slot procedure increased range of motion at the treated VMU. Plate fixation decreased range of motion, increased stiffness, and decreased energy at the treated VMU. No changes were observed at adjacent VMUs. None of the screws penetrated the vertebral canal. Mean (± SD) yield bending moment of plate stabilized, slotted spines was 15.6 ± 4.6 N m. CONCLUSION: LCP fixation with monocortical screws stabilized the canine cervical spine.

Biomechanical evaluation of acetabular cup implantation in cementless total hip arthroplasty.

OBJECTIVE: To report biomechanical properties of the Biologic Fixation System (BFX) acetabular cup impacted into a normal canine pelvis and to compare the effect of implant positioned to and beyond the medial acetabular wall. STUDY DESIGN: In vitro cadaveric study. ANIMALS: Hemipelves of mature, large-breed dogs (n=6). METHODS: For each dog, 1 hemipelvis was reamed to the depth of the acetabular wall (group A) and 1 was reamed an additional 6 mm after penetration of the medial cortex of the acetabulum (group B). The hemipelves were implanted with acetabular cups and loaded in compression through a matching femoral prosthetic component until failure. Specimen stiffness, and failure displacement, load, and energy were determined from load and displacement data and results between groups compared with a paired t-test. RESULTS: Mean failure load was greater in group A (3812 ± 391 N) than group B (2924 ± 316 N; P<.014). No other differences (P>.05) were observed between groups. Bone fracture (n=5) and cup displacement (1) occurred in group A whereas in group B there were 3 fractures and 3 cup displacements. CONCLUSIONS: Although medial placement of the BFX cup affected compressive failure loads, failure loads for both groups exceeded normal physiologic loads. CLINICAL RELEVANCE: Medial positioning of the acetabular cup does not appear to compromise acetabular implant-pelvic stability under normal physiologic loads. Because arthroplasty candidates often have abnormal acetabular architecture, mechanical properties of the cup placed in acetabula without a dorsal rim should be investigated.

Ulnar interlocking intramedullary nail stabilization of a proximal radio-ulnar fracture in a dog.

OBJECTIVE: To report use of an ulnar interlocking intramedullary nail for repair of an open highly comminuted fracture of the proximal third of the antebrachium in a dog, caused by gunshot. STUDY DESIGN: Case report. ANIMALS: 1.5-year old, 60 kg, neutered male Mastiff. METHODS: An ulnar interlocking intramedullary nail was used to stabilize an open comminuted proximal antebrachial fracture and a cast applied for 4 weeks. RESULTS: Union by secondary bone healing occurred in 8 weeks. At 16 weeks, there was advanced remodeling of the radial and ulnar bony callus and fracture lines were no longer evident. Limb use was normal with normal pain free range of motion of the right elbow. CONCLUSION: Ulnar interlocking nail is a viable alternative treatment for highly comminuted fracture of the proximal third of the antebrachium in dogs.

An in vitro biomechanical comparison of a locking compression plate fixation and kerf cut cylinder fixation for ventral arthrodesis of the fourth and the fifth equine cervical vertebrae.

OBJECTIVES: To (1) define mechanical properties in flexion, extension, and left lateral bending of cadaveric equine 4th and 5th cervical (C4-C5) articulations, (2) compare biomechanical properties of C4-C5 when stabilized with a kerf cut cylinder (KCC) compared with a ventrally placed 4.5 mm locking compression plate (LCP). STUDY DESIGN: In vitro biomechanical investigation. SAMPLE POPULATION: Cadaveric adult equine cervical vertebral columns (n=54). METHODS: Cervical vertebrae aged by horse dentition and size measured from radiographs were divided into 3 age groups then randomly allocated to 3 groups. The C4-C5 articulation was treated differently in each of the groups: KCC group; KCC-implanted LCP group; 8-hole 4.5 mm LCP implanted and intact group; no implant. Specimens were randomly subdivided into 1 of 3 loading conditions, before testing to failure under 4-point bending. Stiffness, yield bending moment, failure bending moment, and failure mode were recorded. General linear models were performed to analyze associations between biomechanical properties and test variables. RESULTS: All specimens failed at the C4-C5 intervertebral articulation. The cervical vertebrae with the LCP construct had significantly higher stiffness, yield bending moment, and failure bending moment than the KCC-implanted cervical vertebrae. Failure modes differed between groups and varied with loading direction: KCC group, fractures of C5 associated with the KCC were common; LCP group, screw pull out or fractures (of C4 and C5 bodies, during extension and the caudal aspect of C4 during left lateral bending) were common; and intact group, subluxations were most common. CONCLUSIONS: In this model, LCP constructs had superior biomechanical properties compared with KCC constructs. Further research investigating the effect of repetitive loading is indicated.

Surgical stabilization of an occipitoatlantoaxial malformation in an adult dog.

OBJECTIVE: To report surgical planning, technique, and outcome of stabilization surgery in an adult dog with occipitoatlantoaxial malformation (OAAM). STUDY DESIGN: Clinical report. ANIMAL: A 19-month-old, 25.5 kg, male castrated, Shiba Inu. METHODS: Radiographic and magnetic resonance imaging were used to identify and characterize OAAM. Using a ventral approach to the cranial cervical region 2 cortical bone screws were inserted from the axis into the malformed atlas and occiput. RESULTS: Ambulation was conserved postoperatively. Within 4 weeks, neurologic examination was mostly normal except for decreased proprioception in the right pelvic limb. At 9 months, the dog retained an extended neck posture, but had no neurologic abnormalities. CONCLUSION: OAAM should be considered as a differential diagnosis in an adult dog with cervical myelopathy. Surgical fixation with cortical bone screws using a ventral approach can be successful.

Fixin internal fixator: concept and technique.

This report describes the Fixin internal fixator system(a), a fracture fixation device characterised by a locking conical coupling between screw heads and titanium alloy inserts that are screwed into a stainless steel plate construct. The mechanical principles, implants, instruments and surgical technique are discussed.

The stepped hybrid plate for carpal panarthrodesis - Part I: relationship between plate and bone surfaces.

In the 1990s, the AO (Arbeitsgemeinschaft für Osteosynthesefragen) Hand Study Group developed several anatomically bent plates (standard and short) for wrist panarthrodesis in humans. However, only straight plates have been used for carpal panarthrodesis (CP) in animals to date. The primary purpose of this study was to determine if precontoured plates are more anatomical for CP in dogs. Measurement of several of the bones that are implicated in CP, as well as the relationship between their surfaces and the surface of a straight plate, were performed in a radiographic and computed tomographic cadaveric study. Axial and transverse measurements taken at different levels of the metacarpal bones 2, 3 and 4 were also included. The second objective of this study was to develop a more anatomical CP plate according to the results obtained. The measurements and images obtained in this study show that, as in human orthopaedics, bent or stepped plates are more anatomically correct than straight plates for CP in dogs.

The stepped hybrid plate for carpal panarthrodesis - Part II: a multicentre study of 52 arthrodeses.

Fifty-two carpal panarthrodeses (CP) were carried out in 44 dogs (eight bilateral), in a multicentre study using a single (n = 47) or double (n = 5) stepped hybrid CP plate. Of these 44 cases, 39 were between 20-55 kg in bodyweight , 26 were males , and the carpometacarpal was the most common joint involved. Falling and other impact trauma were the most common aetiology. Pain of unknown origin, carpal luxation, chronic accessory carpal bone fracture, distal comminuted intra-articular radial fracture, bone tumour, degenerative joint disease, canine erosive idiopathic polyarthritis, avascular necrosis of the radial carpal bone and fractures of several metacarpal bones were some of the pathologies reported. Fracture of the third metacarpal bone during screw insertion was the only intrasurgical complication. Malpositioning of the plate or screws and over-tightened screws were technical errors observed in seven of the procedures. The radial carpal bone was not fixed with a screw in two cases due to bone deformity. Concurrent plate breakage and bending in the same patient operated on bilaterally was observed during the follow-up period, which represented a major complication rate of 3.8% for all procedures. Minor complications were: low grade infection, lick granuloma, digit hyperextension, screw loosening or failure, incomplete fusion of some joints and a fracture of the third metacarpal bone at the distal screw hole of the plate; which represented a rate of 44.2% on all procedures. Complete carpal healing was observed radiographically in 94.2% of all procedures. Limb function was excellent to good, and all of the owners, except for one, were satisfied with the procedure.