Owner-reported outcome measures in veterinary care for companion animal orthopedic patients: An international online survey of veterinarians' expectations and practices.

OBJECTIVE: To report veterinarians' familiarity with and perceptions of owner/observer-reported outcome measures (OROMs) and their applications in routine clinical practice. STUDY DESIGN: Cross-sectional online survey. ANIMALS OR SAMPLE POPULATION: A total of 441 veterinarians with a caseload of companion animal orthopedic patients. METHODS: Respondents answered questions regarding their familiarity with and application of OROMs. Respondents provided opinions on statements related to reasons for using or not using OROMs in routine clinical practice, prerequisites to implement OROMs in routine clinical practice, and whether they would implement OROMs in routine clinical practice if adequate tools/technologies were available. RESULTS: Most (293/441, 66.4%) respondents felt familiarity with at least one OROM. Only 17.5% (77 out of the 440 answering the question about the application of OROMs) applied OROMs in routine clinical practice. The two main reasons for not using OROMs in routine clinical practice were the lack of opportunity/feasibility and the lack sufficient information/knowledge/experiences. User-friendliness, time efficiency, and interpretability were considered the most important prerequisites for implementing OROMs in routine clinical practice. If adequate tools/technologies were available, 266/439 (60.6%) respondents indicated that they would definitely implement OROMs in routine clinical practice. CONCLUSION: Although most respondents were familiar with at least one OROM, fewer than one-fifth applied them in routine clinical practice. Most respondents were willing to implement OROMs in routine clinical practice if adequate tools/technologies were available. CLINICAL SIGNIFICANCE: Our results justify further investigations to improve the application of OROMs in routine clinical practice in veterinary care of companion animal orthopedic patients.

Analysis of feline humeral fracture morphology and a comparison of fracture repair stabilisation methods: 101 cases (2009-2020).

OBJECTIVES: The aims of this study were to describe the type, presentation and prognostic factors of feline humeral fractures over a 10-year period and to compare three stabilisation systems for feline humeral diaphyseal fractures. METHODS: In total, 101 cats with humeral fractures presenting to seven UK referral centres between 2009 and 2020 were reviewed. Data collected included signalment, weight at the time of surgery, fracture aetiology, preoperative presentation, fixation method, surgical details, perioperative management and follow-up examinations. Of these cases, 57 cats with humeral diaphyseal fractures stabilised using three different fixation methods were compared, with outcome parameters including the time to radiographic healing, time to function and complication rate. RESULTS: The majority of the fractures were diaphyseal (71%), with only 10% condylar. Of the known causes of fracture, road traffic accidents (RTAs) were the most common. Neutered males were over-represented in having a fracture caused by an RTA (P = 0.001) and diaphyseal fractures were significantly more likely to result from an RTA (P = 0.01). Body weight had a positive correlation (r = 0.398) with time to radiographic healing and time to acceptable function (r = 0.315), and was significant (P = 0.014 and P = 0.037, respectively). Of the 57 humeral diaphyseal fractures; 16 (28%) were stabilised using a plate-rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only. Open diaphyseal fractures were associated with more minor complications (P = 0.048). There was a significant difference between fixation groups in terms of overall complication rate between groups (P = 0.012). There was no significant difference between fixation groups in time to radiographic union (P = 0.145) or time to acceptable function (P = 0.306). CONCLUSIONS AND RELEVANCE: All three fixation systems were successful in healing a wide variety of humeral diaphyseal fractures. There was a significantly higher overall complication rate with external skeletal fixators compared with bone plating; however, the clinical impact of these is likely low.

Description of neurological mimics presented to the neurology service of a small animal referral hospital.

BACKGROUND: Clinicians observe that cats and dogs referred to neurology services often do not have an underlying neurological disorder. There has been no analysis of the frequency or categorisation of these neurological mimics. METHODS: Retrospective study of 520 cases was carried out. Data on signalment, presenting clinical signs, neurological examination findings and final diagnosis were collected. Final diagnoses were classified as primary neurological, non-neurological in origin but with neurological clinical manifestation, completely non-neurological (neurological mimics) or undiagnosed. Presenting clinical signs and neurological examination results were compared between neurological mimics and primary neurological cases using Chi-square or Fischer exact test. Relative risk (RR) was calculated for significant associations. RESULTS: A total of 74% were primary neurological conditions, 8% neurological mimics, 3% non-neurological with neurological manifestation and 15% undiagnosed. An animal referred for lameness was approximately five times more likely to be diagnosed as a neurological mimic than as a primary neurological disorder (RR = 5.42, p < 0.001). Cases with a normal neurological examination were approximately 15 times more likely to be a neurological mimic (RR = 14.97, p < 0.001). CONCLUSION: Thorough examination with consideration of alternative diagnoses is important when a neurological condition is suspected in an animal that presents with lameness or normal neurological examination.

Evidence-based evaluation of owner-reported outcome measures for canine orthopedic care - a COSMIN evaluation of 6 instruments.

OBJECTIVE: To systematically review the currently available validated owner-reported outcome measures (OROMs) for assessing pain and function in dogs with osteoarthritis and other joint diseases. STUDY DESIGN: Systematic review. METHODS: A systematic literature search of PubMed and Web of Science was performed in December, 2019, using search terms relevant to OROMs for pain and function in dogs with osteoarthritis and other joint diseases. The measurement properties of the resulting outcome instruments and validation studies were evaluated with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN). RESULTS: Seventeen publications describing the validation of 6 OROMs were selected and evaluated with the COSMIN. The Canine Brief Pain Inventory (CBPI), Canine Orthopedic Index (COI), and Liverpool Osteoarthritis in Dogs (LOAD) provided evidence of sufficient content validity. Internal consistency, reliability, construct validity, and responsiveness were the most frequently validated other properties. Both CBPI and COI had sufficient internal consistency; LOAD, being formative in construct, need not be assessed for internal consistency. No instruments provided information on measurement errors. CONCLUSION: The CBPI, COI, and LOAD can be recommended for use in dogs with osteoarthritis. Further evidence is necessary to increase the interpretability of these instruments or expand their application into other canine orthopedic conditions. Further evidence is also needed before the other 3 instruments can be recommended. CLINICAL SIGNIFICANCE: This systematic evaluation of 6 OROMs provides clinicians and researchers with a tool that facilitates and improves evidence-based selection of outcome measures for evaluating canine osteoarthritis and other joint disease treatments.

Reshaping surgical specialist training in small animal surgery during and after the COVID-19 pandemic.

OBJECTIVE: To assess the perceived effects of the COVID-19 pandemic on small animal surgical specialist training, among trainees and supervisors and to propose changes, based upon the results, that could be incorporated into training programs. STUDY DESIGN: Anonymous online questionnaire survey. SAMPLE POPULATION: Eighty-one eligible responses were collected in September 2020, including 52 European College of Veterinary Surgeons (ECVS) residents and 29 ECVS Diplomates acting as supervisors. METHODS: Descriptive statistics were used to analyze the data. Fisher's exact test was used to test for significance. RESULTS: A reduction in surgical case load was reported by 82% (n = 66/81) of respondents, with 82% (n = 54/66) of those believing that COVID-19 had a mild-to-moderate impact on training. Compared to supervisors, residents were less likely to feel that appropriate guidance, a safe working environment, and measures to preserve training had been provided (p < .01). Only 45% (n = 22/49) of residents reported confidence with performing teleconsultations. Ninety percent (n = 73/81) of respondents considered online "case presentations" and "edited surgical video footage" as a positive ancillary tool. CONCLUSION: COVID-19 has resulted in a reduction in case load and training for the majority of residents. A discrepancy between the opinions of residents and supervisors was noted on various aspects of COVID-19 related effects. IMPACT: Open communication, as well as the use of additional training tools through digital platforms may help to preserve safe and effective training during times of decreased clinical activity. While this study has focused on surgical specialist training, the results could be applied to other disciplines.

Lateral Radial Head Subluxation as a Complication Following Proximal Ulnar Osteotomy or Ostectomy in Eight Dogs.

OBJECTIVES: The aim of this study was to report the complication of lateral radial head subluxation following proximal ulnar osteotomy (PUOO) or proximal ulnar ostectomy (PUOE) in eight dogs. MATERIALS AND METHODS: Case records and diagnostic imaging of dogs developing lateral radial head subluxation following PUOO (n = 7) or PUOE (n = 2) were retrospectively reviewed. Information pertaining to clinical history, signalment, presenting condition, lameness grade, diagnostic imaging and initial surgery details, postoperative complications and their management were retrieved. Outcomes were established from subsequent clinical histories or telephone interviews with referring veterinarians. Comparison was made to a single-centre cohort without lateral radial head subluxation following PUOO or PUOE. RESULTS: Eight dogs (median age: 9.5 months [range: 6 months-6 years], median weight 7.7 kg [range: 5-28 kg]) were included. Six dogs had a PUOO performed; five dogs had unilateral surgery and one had bilateral surgery. Two dogs had unilateral PUOE surgery. Median time to diagnosis of lateral radial head subluxation following surgery was 6.5 weeks (range: 2-20 weeks). Five of the eight dogs had surgical revision of lateral radial head subluxation. Resolution of lateral radial head subluxation was achieved in four dogs, with three achieving acceptable to good mobility. One dog had poor postoperative mobility. A fifth dog remained lame after revision surgery failure. Three dogs did not have revision surgery; two underwent limb amputation and one dog remained lame as revision surgery was declined. CLINICAL SIGNIFICANCE: Lateral radial head subluxation is a potentially severe postoperative complication following PUOO or PUOE.

Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003-2014).

This study reports data from a larger number of cases of triceps tendon disruption. Records from 10 veterinary referral hospitals between 2003 and 2014 were searched for canine and feline cases diagnosed with triceps tendon disruption, based on orthopaedic examination confirmed during surgery. Long-term follow-up and owner satisfaction were assessed using a questionnaire. There were 13 cases of triceps tendon disruption diagnosed across seven hospitals (nine dogs, four cats). Trauma, history or presence of a wound, surgery in the region of tendon attachment or corticosteroid treatment preceded triceps tendon disruption. Radiographic signs or histopathology suggestive of a chronic tendinopathy was common. All cases underwent surgical repair involving a tendon suture pattern, 12 of which were secured through bone tunnels. Immobilisation was used in all cases in the form of transarticular external skeletal fixation (TAESF) (8/9 dogs) or spica splint (four cats, two dogs; in one dog a TAESF was applied after complications associated with the spica splint). Complications occurred in 11 cases (17 total complications), frequently associated with the immobilisation method. One case had traumatic tendon rerupture two years following surgery. A wound at presentation was associated with the development of multiple complications. Nine cases had long-term follow-up; five achieved normal function, four achieved acceptable function. Despite the complications, overall return to subjective normal or acceptable function, as assessed by the owners, was achieved in the majority of cases.

Combined physeal fractures of the distal radius and ulna: complications associated with K-wire fixation and long-term prognosis in six cats.

Objectives The objective was to describe the complications and long-term outcome associated with Kirschner (K)-wire fixation of combined distal radial and ulnar physeal fractures in six cats. Methods Medical records (2002-2014) of six referral institutions were searched for cats with combined distal radial and ulnar physeal fractures. Cases with complete clinical files, radiographs and surgical records were retrospectively reviewed. Long-term outcome was assessed via telephone interviews using an owner questionnaire. Results Complete files were available for 6/9 identified cases (cases 1-6). All fractures were classified as Salter-Harris type I or II. Five cases underwent open reduction and internal fixation via cross-pinning of the distal radius and intramedullary pinning of the ulna (cases 1-3); fixation of the distal radial and ulnar physes with one K-wire each (case 4); and K-wire fixation of the radial physis in combination with two transulnoradial K-wires (case 5). One case underwent closed reduction and percutaneous cross-pinning of the distal radius under fluoroscopic guidance (case 6). The complications encountered were: reduced radiocarpal range of motion (ROM) (cases 1, 3, 4, 5); implant loosening/migration (cases 1, 2, 5); and radioulnar synostosis (case 4). None of the cats developed angular limb deformity. Long-term outcome (12 months to 7 years after surgery) was graded as 'excellent' by the owners in all cases. Conclusions and relevance Prognosis is favourable for feline combined distal radial and ulnar physeal fractures following K-wire fixation in cats over 7 months of age. Implant removal after bony union is recommended to minimise reduction in ROM and to prevent implant loosening/migration.

Magnetic resonance imaging features of canine incomplete humeral condyle ossification.

Incomplete ossification of the humeral condyle (IOHC) is characterized by an intracondylar fissure located where the intercondylar physis is present in growing dogs. Its radiologic and computed tomographic features have been described but the magnetic resonance (MR) features have not been characterized. Our purpose was to further describe the range of MRappearances of IOHC, to assess the diagnostic capability of MRrelative to radiology, and to determine whether MRis able to identify the disease before a fissure forms. Thirty-eight elbow MRscans and radiographs, when available, were reviewed and divided into three groups. In Group 1 (affected elbows, n = 22), there was an intracondylar defect on MRwith variable appearance; the defect was not visible radiographically in 32% of the elbows. The main difference between Group 2 (nonaffected elbows, n = 6) and Group 3 (contralaterals to IOHC or to condylar fracture, without fissure, n = 10) was the appearance of the humeral condyle in short tau inversion recovery (STIR) sequences: all elbows in Group 2 had a homogeneous humeral condyle, whereas all but one in Group 3 were heterogeneous. One dog in Group 3 developed a complete condylar fissure 7 months after the first examination, when no evidence of an intracondylar defect had been detected. The MRappearance of IOHC is variable and a heterogeneous humeral condyle in STIR images without a clear defect may warn of the possibility for the subsequent development of a condylar fissure.

Comparison of kinematic variables in defining lameness caused by naturally occurring rupture of the cranial cruciate ligament in dogs.

OBJECTIVE: To (1) discover kinematic variables that differ between dogs with cranial cruciate ligament rupture (CCLR) and control dogs and (2) to identify suitable outcome variables for longitudinal studies on the effects of surgical interventions for CCLR in dogs. STUDY DESIGN: In vivo case-control comparison. ANIMALS: Dogs with unilateral CCLR (n=16), and no other detectable neurologic or orthopedic disease and 10 dogs without CCLR, neurologic, or orthopedic disease. METHODS: Kinematic data was collected from dogs as they walked at constant speed on a treadmill, using an infrared camera system and adhesive reflective markers applied to the pelvic limbs. Data on 5 selected variables was extracted and comparisons made between paired pelvic limbs in both CCLR and control dogs and between control and CCLR dogs. RESULTS: Comparisons in CCLR dogs revealed significant differences between affected and unaffected limbs for many examined variables; the largest differences were in paw velocity and stifle angular velocity. There were highly significant differences between CCLR and control dogs when examining paired limb ratios for 4 of the variables, the largest differences were in stride length and paw velocity. CONCLUSIONS: Kinematic analysis provides straightforward and objective methods for defining the lameness associated with CCLR in dogs. Paw velocity and stride length were most notably reliable and not susceptible to systematic alterations in stifle joint dynamics that might be associated with specific surgical procedures. CLINICAL RELEVANCE: This study identifies several variables that can provide the objective measurements essential to evaluate the efficacy of surgical interventions for CCLR in dogs.

Feline ilial fractures: a prospective study of dorsal plating and comparison with lateral plating.

OBJECTIVE: To (1) report a technique for repair of feline ilial fractures using a dorsally applied bone plate and (2) compare outcome with cats treated by a lateral plate. STUDY DESIGN: Prospective study. ANIMALS: Cats (n=10) with iliac fractures. METHODS: Cats with ilial fractures (January 2005-December 2006) were treated by application of a dorsally applied bone plate. Immediate postoperative radiographs were compared with those taken 4-6 weeks later to assess screw loosening, screw purchase, and pelvic canal narrowing. Owners were contacted for medium-term (>3 month) follow-up. Data were compared with a report of outcome after lateral plating (LP) in 21 cats. RESULTS: Mean (+/- SD) screw purchase (89 +/- 11 mm) was significantly greater (P<.01) with a dorsal plate compared with a lateral plate (33 +/- 8 mm). Significantly more screws (P<.01) were used with a dorsal plate (median, 7) compared with a lateral plate (median, 6). Significantly less postoperative pelvic canal narrowing developed in the dorsal plating group between postoperative and 4-6-week follow-up radiography compared with the LP group (2% versus 15%, P<.01). CONCLUSION: Dorsal plating of feline ilial fractures results in significantly less screw loosening and pelvic canal narrowing at 4-6 weeks after surgery compared with LP. CLINICAL RELEVANCE: Dorsal plating of feline iliac fractures may reduce complications associated with pelvic canal narrowing such as constipation and megacolon.

Biomechanical Analysis of Unilateral External Skeletal Fixators Combined with IM-Pin and Without IM-Pin Using Finite-Element Method.

OBJECTIVES: To determine if a unilateral external skeletal fixator (ESF) with a carbon fiber connecting rod (IMEX SK) without an intramedullary (IM)-pin is mechanically comparable with a unilateral ESF with a stainless-steel connecting rod (IMEX KE) with an IM-pin. STUDY DESIGN: Finite-element method (FEM)-computer simulation. METHODS: FEM models were validated by comparison against data from mechanical testing. Three-dimensional FEM models of a femur with a mid-diaphyseal fracture with a 20 mm gap were developed with 4 unilateral external skeletal fixator devices (6-pin KE, 6-pin KE IM-pin, 6-pin SK, and 6-pin SK IM-pin). A 300 N load was applied to the femur at the proximal end in a direction of theta = 10 degrees distally and phi = 10 degrees laterally cranially. Relative displacements in x-, y- and z-directions at the gap were obtained and the overall stiffness was calculated as 300 N/total displacement. Load transfer at the pin-bone interface (PBI) was assessed by determining the von Mises stress maxima at the PBI-related nodes. RESULTS: The 6-pin SK had superior mechanical performance compared with the 6-pin KE by exhibiting smaller displacements in all directions and higher stiffness. Compared with the 6-pin KE IM-pin, the 6-pin SK (without IM-pin) was superior in craniocaudal and lateromedial displacements, but inferior in axial displacements, overall stiffness and von Mises stress maxima. The 6-pin SK IM-pin was superior to the 6-pin KE IM-pin based on smaller displacements and higher stiffness. CONCLUSIONS: Although the SK device had superior mechanical performance compared with a KE device in a unilateral configuration, the addition of an IM-pin continues to be a powerful method of enhancing mechanical performance of either IMEX SK or IMEX KE unilateral constructs in clinical cases. CLINICAL RELEVANCE: Based on the results of this FEM study we recommend the use of the "tied-in" IM-pin with the ESF clinically when striving for high rigidity. In less challenging situations, a unilateral SK ESF without IM-pin might provide sufficient rigidity for a successful fracture repair.