Indications for the removal of implants after fracture healing: A comparison between human and veterinary medicine.

Indications for implant removal after fracture healing are still under debate in both human and veterinary medicine. Although hardware removal is a common procedure, it should not be undertaken lightly. Intra and post-operative complications are common and a thorough evaluation of the risks and benefits should be performed. This review aimed to collect and summarise published data on the indications for implant removal in small animals, compare the collected data with human and equine medicine, and investigate the existence of guidelines for this purpose. There is no international consensual agreement for implant removal after fracture healing, neither in small animals nor in human orthopaedics. Decision-making processes are still controversial in some scenarios, thus clear evidence-based protocols for implant removal are needed.

Microbial Colonization of Explants after Osteosynthesis in Small Animals: Incidence and Influencing Factors.

Despite recent advancements in antibiotics, hygienic measures, and peri-operative systemic antibiotics, post-operative infections in osteosynthesis remain prevalent and continue to be among the most common surgical complications, leading to delayed fracture healing, osteomyelitis, implant loosening, and loss of function. Osteosynthesis implants are routinely utilized in veterinary medicine and the current study investigates the microbial colonization of implants following osteosynthesis in small animals, along with its incidence and influencing factors. The results are analyzed in regard to correlations between infection, patient, disease progression, and radiographic images, as well as other factors that may promote infection. Seventy-one explants from sixty-five patients were examined and evaluated for microbial colonization. Factors like body weight and age, location and type of plate and additional injuries like lung lesions, the surgeon's experience, or the number of people present during the surgical procedure seem to influence the development of an infection. Of the animals, 60% showed osteolytic changes and 73.3% of those with dysfunctional mobility had an implant infection. Microorganisms were detected in almost 50% of the explants, but a clinically relevant infection was only present in five patients (7.3%), suggesting that the presence of microorganisms on an implant does not necessarily lead to treatment complications.

Quantification of skin wound tension using a newly designed wound tensiometer.

OBJECTIVE: To (i) quantitatively measure wound tension in experimental skin wounds using a newly developed wound tensiometer and (ii) establish reference values for primary skin wound closure in medium- and large-breed dogs. STUDY DESIGN: Experimental cadaveric study. ANIMAL POPULATION: Nineteen dogs of medium to large breeds (BW 20 to 40 kg). METHODS: Elliptical skin wounds of different sizes were created on the chest and abdomen. The wounds were gradually enlarged. Experienced surgeons (ECVS diplomates or professors of small animal surgery) and inexperienced surgeons (1st year after graduation) independently assessed wound tension through manual manipulation and determined whether the wound could be closed without tension-relieving measures. In addition, wound tension was objectively quantified using a newly developed wound tensiometer. RESULTS: The upper threshold for wound tension at which direct appositional wound closure was recommended by the experienced surgeons was 5.4 N, and the median minimal tension without recommendations for closure was 6.0 N. The data also demonstrate that wound tension and wound size do not necessarily correlate, and inexperienced surgeons need to develop a feel for wound tension. CONCLUSION: The intraoperative use of the wound tensiometer, in combination with established cut-off values, might facilitate decision-making regarding primary wound closure. CLINICAL RELEVANCE: The findings of this study provide evidence for the applicability of a wound tensiometer in guiding inexperienced surgeons in their choice of the skin wound closure method.

Effect of intraoperative positioning on postoperative neurological status in cats after perineal urethrostomy.

OBJECTIVES: The aim of this study was to evaluate and quantify the changes in neurological status in cats after perineal urethrostomy performed in dorsal and ventral recumbency. METHODS: This was a prospective, randomised study. Twenty male castrated cats with feline lower urinary tract disease presented for perineal urethrostomy were enrolled in this study. Surgery was performed in either dorsal recumbency (group A) or ventral recumbency (group B). Motor response of patellar tendon, gastrocnemius muscle, pelvic limb withdrawal and perineal reflexes, as well as the presence of spinal pain in the lumbosacral region, motor function of the tail and faecal continence, were examined before surgery, and 24 h and 14 days after surgery. RESULTS: The animals had a mean weight of 5.07 ± 1.08 kg, with a mean age of 6.12 ± 1.85 years. Weight and age were not significantly different between groups A and B (both P = 0.897). All tested parameters of the neurological examination performed prior to surgery were considered normal in both groups (P = 1). The comparison between neurological examinations (perineal reflex and spinal pain) before and 24 h after surgery revealed a significantly decreased briskness of the perineal reflex and an increased occurrence of spinal pain 24 h after surgery (P = 0.043 and P = 0.031, respectively). However, the changes of aforementioned parameters were statistically insignificant (P = 0.249 and P = 0.141) between groups A and B. The other parameters (patellar tendon, pelvic limb withdrawal and gastrocnemius muscle reflexes, motor function of the tail and faecal continence) were statistically insignificant (P = 1) before surgery and 24 h after surgery, as well as between groups A and B 24 h after surgery. Results of all tested parameters were statistically insignificant (P = 1) before surgery and 14 days after surgery, as well as between groups A and B 14 days after surgery. CONCLUSIONS AND RELEVANCE: The briskness of the perineal reflex was significantly decreased and the occurrence of spinal pain significantly increased 24 h after surgery. A parallel with a low-grade positioning-dependent nerve injury as described in human medicine may be drawn. However, no positioning method was proven to be superior to the other.

Effect of intraoperative positioning on the diameter of the vertebral canal in cats during perineal urethrostomy (cadaveric study).

Objectives The objective of this study was to quantify the changes in the diameter of the vertebral canal in the lumbosacral and sacrococcygeal column (L6-Co2) in cats in dorsal and ventral recumbency, simulating real body positioning during a perineal urethrostomy. Methods Twenty-one male feline cadavers were enrolled in the study. All feline cadavers were evaluated by CT. Examinations were performed with the cadaver in a neutral position and dorsal and ventral recumbency. Sagittal vertebral canal diameters (VCDs) were obtained by measuring the distance between the ventral and dorsal aspects of the vertebral canal in the middle of the intervertebral space. Results A comparison of the VCDs between L6 and L7, L7 and S1, S3 and Co1 and Co1 and Co2 in neutral position vs dorsal recumbency revealed a reduction of 0.27 mm (14.6%; P <0.001) between S3 and Co1 and 0.26 mm (18.1%; P <0.001) between Co1 and Co2. No differences were seen when comparing L6-L7 and L7-S1. The VCDs were decreased in all segments when comparing neutral with ventral recumbency. This study revealed a reduction of 0.13 mm between L6 and L7 (3.3%; P = 0.003), 0.14 mm between L7 and S1 (4.1%; P = 0.003), 0.61 mm between S3 and Co1 (32.5%; P <0.001) and 0.63 mm between Co1 and Co2 (44.1%; P <0.001). Comparison of the VCD between dorsal and ventral recumbency in L6-L7, L7-S1, S3-Co1 and Co1-Co2 revealed a decrease in the VCDs in ventral recumbency of 0.13 mm (3.3%; P <0.001), 0.12 mm (3.6%; P <0.001), 0.34 mm (21.0%; P <0.001) and 0.37 mm (31.7%; P <0.001), respectively. Conclusions and relevance The results provide evidence that, from an anatomical point of view, perineal urethrostomy performed in dorsal recumbency is superior to ventral recumbency, but further clinical studies to verify these findings are necessary.

[Spontaneous pneumothorax in cats: two case reports and literature review]. / Spontaner Pneumothorax bei der Katze: zwei Fallberichte und Literaturübersicht.

Spontaneous pneumothorax (SP) is a non-traumatic accumulation of air in the pleural cavity. This case report describes a cat with SP as a result of primary pulmonary adenocarcinoma. A second cat was diagnosed with primary pulmonary adenocarcinoma and asthma. A thoracostomy tube was inserted in the first cat while in the second cat a thoracostomy tube was placed and lobectomy of the right cranial and middle lung lobes was performed. Both cats died following treatment. The current literature reviewed here covers the comparative etiologies of SP as well as clinical presentation, diagnostic work-up, therapy and prognosis in cats. A total of 64 cases of cats with secondary spontaneous pneumothorax reported in nine articles are discussed. To our knowledge, there has been no previous description in the literature regarding primary SP in cats. Based on prior case reports, surgery was performed in 16% (10 cats) of SP cases. The current review demonstrates that depending on the underlying lung disease, cats with SP have a careful short-term prognosis because 39 of 64 cats (60%) were discharged.

Radial and ulnar fracture treatment with paraosseous clamp-cerclage stabilisation technique in 17 toy breed dogs.

OBJECTIVE: Description of surgical technique, complications and outcome of radius/ulna fractures in toy and miniature breed dogs treated with the paraosseous clamp-cerclage stabilisation (PCCS) method. STUDY DESIGN: Retrospective study. METHODS: Clinical records of small breed dogs with fractures of the radius and ulna were reviewed between January 2011 and January 2016. Inclusion criteria were bodyweight of ≤3.5 kg, fracture of the radius and ulna of one or two limbs without previous repair attempts, available follow-up information, and the use of PCCS for repair of the fracture as the sole method of fixation. RESULTS: Seventeen fractures in 17 dogs were included in the study. Radiographic union was documented in 13/17 cases. Median time to radiographic union was 13 weeks (range: 5-53 weeks). Major complications occurred in 24 per cent (4/17) due to implant failure, and for revision surgery the PCCS method was chosen in all four cases. Three of four revised fractures healed radiographically. One of the four dogs was lost for radiographic follow-up, but the owner could be contacted for a telephone questionnaire. Eleven of 17 dogs achieved an excellent return to function without any lameness during clinical examination, but 5/17 dogs showed an intermittent mild lameness despite full radiographic union. Routine implant removal was performed in 9/17 dogs. The owners of 15/17 dogs could be contacted for a telephone questionnaire for a long-term follow-up. No further complications were reported. CONCLUSIONS: PCCS is a feasible low-cost internal fixation technique for repairing radial and ulnar fractures in toy breed dogs. Further biomechanical and clinical studies are needed for better evaluation of the PCCS method.

Hypernatremia in a Cat with Toxoplasma-Induced Panencephalitis.

A 12 yr old female neutered Carthusian crossbreed cat was presented due to progressive neurological signs. Clinical signs included dehydration, stupor, and anisocoria. Laboratory examination revealed severe hypernatremia, azotemia, hyperglobulinemia, and an erythrocytosis. Clinical signs and hypernatremia suggested an intracranial process. Imaging studies revealed a loss of structure in the cerebrum, hypothalamus, and pituitary gland. Due to a poor prognosis, the cat was euthanatized. Histopathological examination revealed a subacute granulomatous and necrotizing panencephalitis with Toxoplasma-typical protozoa. The Toxoplasma-induced dysfunction of the hypothalamus and pituitary gland led to diabetes insipidus, which was, in combination with insufficient water intake, the most likely cause for the hypernatremia.

Larynx Trauma and Hyoid Bone Fracture after Bite Injury in Dog: Case Report.

An 8-year-old male Jack Russell crossbreed dog was admitted to our hospital with dyspnea and shock following a dog-bite injury on the ventral neck. Radiographs revealed subcutaneous emphysema and bilateral thyrohyoid bone fractures. Intraoperatively, rupture of both sternohyoid muscles, both hyoepiglotticus muscles, both thyrohyoid muscles, and a partial cranial rupture of the superficial sphincter colli muscle were detected. Part of the epiglottis was detached from the thyroid cartilage. The patient's severed muscles and torn epiglottis were reattached using a simple interrupted suture pattern. Hyoepiglotticus muscles could not be identified. The bilateral thyrohyoid bone fractures were repaired with intraosseous wire suture. A temporary tracheostomy tube and an esophageal feeding tube were placed postoperatively. The dog was discharged after 8 days, re-examined at 2 and 6 months and laryngeal and pharyngeal function were evaluated as normal. To the authors' knowledge, this is the first report of a dog that presented with laryngeal trauma with hyoid bone fracture and acute dyspnea that underwent surgical treatment resulting in an acceptable outcome.

Cartilage thickness of the trochlea of the talus, with emphasis on sites predisposed to osteochondrosis dissecans, in clinically normal juvenile and adult dogs.

OBJECTIVE: To evaluate cartilage thickness of the talus (especially at sites predisposed to osteochondrosis dissecans [OCD]) in growing and adult dogs not affected with OCD. SAMPLE: Tarsocrural joints from cadavers of 34 juvenile (approx 3 months old) and 10 adult dogs. PROCEDURES: Tarsal cartilage thickness was examined via a stereophotography microscopic system. Articular cartilage thickness was determined at 11 locations on longitudinal slices of the trochlear ridges and the sulcus between the ridges and at 2 locations in the cochlea tibiae. Cartilage thickness was measured at the proximal, proximodorsal, dorsal, and distal aspects of the trochlear ridges; proximodorsal, dorsal, and distal aspects of the trochlear sulcus; and craniolateral and caudomedial aspects of the cochlea tibiae. Differences within a joint and between sexes were evaluated. RESULTS: Mean cartilage thickness decreased from proximal to distal in juvenile (lateral trochlear ridge, 1.52 to 0.41 mm; medial trochlear ridge, 1.10 to 0.40 mm) and from proximal to dorsal in adult (lateral trochlear ridge, 0.41 to 0.34 mm; medial trochlear ridge, 0.33 to 0.23 mm) dogs. Cartilage was thickest at the proximal aspect of the lateral trochlear ridge in both groups. Differences in proximodorsal, dorsal, and distal aspects of the ridges were not evident. CONCLUSIONS AND CLINICAL RELEVANCE: Healthy tarsocrural joints did not have thicker cartilage in sites predisposed to development of OCD. Evaluation of affected tarsocrural joints is necessary to exclude influences of cartilage thickness. These data are useful as a reference for distribution of cartilage thickness of the trochlea of the talus in dogs.