Human placenta-derived matrix with cancellous autograft and demineralized bone matrix for large segmental long-bone defects in two dogs with septic nonunion.

OBJECTIVE: To report the successful treatment of septic nonunion in two dogs with large segmental defects secondary to long-bone fractures by using a novel human placenta-derived matrix (hPM) as adjunct to fixation. ANIMALS: One 3-kg 9-year-old neutered male Yorkshire terrier with a distal antebrachial fracture and one 6-kg 4-year-old spayed female miniature pinscher with a distal humeral fracture. STUDY DESIGN: Short case series. METHODS: Both dogs presented for septic nonunion after internal fixation of Gustilo type II open diaphyseal fractures from dog bite injuries. During revision, debridement of nonviable bone resulted in segmental defects of 32% and 20% of the bone length for the antebrachial and humeral fractures, respectively. The antebrachial fracture was stabilized with a circular external fixator, and the humeral fracture was stabilized with biaxial bone plating. The fracture sites were not collapsed, and full length was maintained with the fixation. Autogenous cancellous bone graft and canine demineralized bone allograft were packed into the defects, and hPM was injected into the graft sites after closure. RESULTS: Radiographic union was documented at 8 weeks and 6 weeks for the antebrachial and humeral fractures, respectively. Both dogs became fully weight bearing on the affected limbs and returned to full activity. CONCLUSION: Augmenting fixation with grafts and hPM led to a relatively rapid union in both dogs reported here.

Corrective osteotomy and partial tarsal arthrodesis in two greyhounds with calcaneal malunion.

OBJECTIVE: To describe the clinical presentation and outcome of two greyhounds with calcaneal malunions that were treated with corrective osteotomy and partial tarsal arthrodesis. STUDY DESIGN: Short case series. ANIMALS: Two adult racing greyhounds. METHODS: Varus and recurvatum deformity of the calcaneus was ascribed to malunion of prior calcaneal fracture with concomitant central bone fracture that had been sustained during racing in both dogs. Both dogs exhibited severe, weight-bearing lameness and had radiographic evidence of moderate to severe osteoarthritis of the proximal intertarsal joint. A closing wedge corrective osteotomy and partial tarsal arthrodesis were performed with a 2.7-mm locking compression plate and cancellous autograft. RESULTS: Calcaneal morphology and alignment of the common calcaneal tendon seemed restored postoperatively. The implant was removed in one dog, while the other dog experienced no postoperative complications. Lameness improved in both dogs, although residual intermittent lameness after heavy exercise was reported by owners of both dogs 1 year after surgery. Overall, owner satisfaction and outcome were considered good-to-excellent in both dogs. CONCLUSION: Corrective osteotomy and partial tarsal arthrodesis for treatment of malunited calcaneal fractures may be considered in dogs with clinical signs related to calcaneal malunion.

Use of three-dimensionally printed ß-tricalcium phosphate synthetic bone graft combined with recombinant human bone morphogenic protein-2 to treat a severe radial atrophic nonunion in a Yorkshire terrier.

OBJECTIVE: To describe a novel surgical approach to treat a critical-sized bone defect due to severe, radial atrophic nonunion in a miniature dog. STUDY DESIGN: Case report ANIMAL: A 1-year-old Yorkshire terrier with a critical-sized left radial defect after failed internal fixation of a transverse radial fracture. METHODS: Computed tomographic (CT) images of the radius were imported for three-dimensional (3D) printing of a custom-designed synthetic 3D-printed ß-tricalcium phosphate (ß-TCP) scaffold. The radius was exposed, and the ß-TCP scaffold was press-fitted in the bone gap underneath the plate. Recombinant human bone morphogenic protein-2 (RhBMP-2) collagen sponges were squeezed to soak the scaffold with growth factor and then placed on both sides of the synthetic graft. Two additional cortical screws were also placed prior to routine closure of the surgical site. RESULTS: Radiographic examination was consistent with complete healing of the radius defect 4 months after surgery. The bone plate was removed 10 months after surgery. According to CT examination 18 months after surgery, there was no evidence of the synthetic graft; instead, complete corticalization of the affected area was noted. Complete functional recovery was observed until the last clinical follow-up 36 months postoperatively. CONCLUSION: Screw fixation and use of a 3D-printed ceramic scaffold augmented with rhBMP-2 resulted in excellent bone regeneration of the nonunion and full recovery of a miniature breed dog. CLINICAL SIGNIFICANCE: The therapeutic approach used in this dog could be considered as an option for treatment of large-bone defects in veterinary orthopedics, especially for defects affecting the distal radius of miniature dogs.

Triple Pelvic Osteotomy Fixed with Lag Screw for the Treatment of Pelvic Canal Stenosis in Five Cats.

OBJECTIVE: The aim of this study was to describe the technique and the clinical outcome of cats with obstipation as a result of pelvic canal narrowing, treated using an alternative triple pelvic osteotomy technique. METHODS: Five cats with obstipation as a result of pelvic canal narrowing due to pelvic fracture malunion or secondary hyperparathyroidism were treated by triple pelvic osteotomy. After performing the iliac osteotomy and medial partial cortical debridement (4/5 cases), the pelvic canal was widened by moving the caudal fragment of the ilium to the lateral aspect of the cranial fragment. The iliac fragments were fixed by a 2.7-mm lag screw (5/5 cases) and an additional 2 Kirschner wires 0.8 mm (1/5 cases). RESULTS: The radiographic examination immediately postoperatively and 8 weeks postoperatively showed a mean pelvic canal enlargement of 20% (range 7-38%). Minor complication occurred in one case; this resolved 15 days postoperatively without any treatment. Complications and recurrence of obstipation did not occur during the final follow-up, ranging between 5 months and 1 year in any of these cases. CLINICAL SIGNIFICANCE: The use of lag screw fixed triple pelvic osteotomy resulted in widening of the pelvic canal and led to a satisfactory outcome with no major complications. This technique is fast, requires no expensive implants and it is relatively straightforward. Further cases are required to determine the success and complication risk of the procedure.

Wing Abnormality in a Wild-Hatched Whooping Crane (Grus americana) Chick from the Nonmigratory Population in Louisiana, USA.

We describe a wing abnormality in a wild-hatched Whooping Crane (Grus americana) chick from the reintroduced Louisiana, US nonmigratory population. Despite its seemingly compromised flight ability, the chick fledged, reached independence, and lived until 13 mo of age. Necropsy revealed an axial malunion near the left carpus likely resulting from trauma.

Effect of intrafragmentary bupivacaine (haematoma block) on analgesic requirements in dogs undergoing fracture repair.

OBJECTIVE: To test the efficacy of intraoperative intrafragmentary administration of bupivacaine (haematoma block) in controlling postoperative pain in dogs undergoing osteosynthesis of long-bone isolated diaphyseal fractures. STUDY DESIGN: Randomized, 'blinded', placebo-controlled, prospective study. ANIMALS: A total of 23 client-owned dogs with isolated long-bone fractures. METHODS: Dogs were allocated randomly to two groups: bupivacaine group (B) or placebo group (P). Group B dogs (n = 11) were administered an intraoperative intrafragmentary injection of 0.5% bupivacaine (1.1 mg kg-1) just before fracture fixation, whereas group P dogs (n = 12) were administered normal saline. Postoperative pain evaluations using the University of Melbourne Pain Scale (UMPS) and algometer were performed upon arrival to the recovery room and 1, 2, 4, 6, 8, 20 and 32 hours later. Algometer measurements were performed on: the incision site, a healthy region near the fracture line and the contralateral healthy limb. When the pain score exceeded 14 points in the UMPS, rescue analgesia was administered. The time-standardised area under the curve (AUCst) was used to compare UMPS scores and mechanical pain thresholds between the two groups. RESULTS: None of the group B dogs required rescue analgesia, whereas eight of the 12 group P dogs did (p = 0.001). The pain threshold AUCst at the incision line was higher in group B [16.3 (2.9-41.6) N] than in group P [5.6 (2.5-17.4) N] (p = 0.029). The mean UMPS score AUCst was lower in group B (3.7 ± 1.8) than in group P (9.4 ± 4.6) (p = 0.016). In a small number of animals of both groups that were evaluated radiologically, adequate bone healing was noted. CONCLUSIONS AND CLINICAL RELEVANCE: An intraoperative bupivacaine haematoma block is a simple, quick and effective method that can be used to aid in postoperative pain control in dogs submitted to long-bone osteosynthesis.

Internal hemipelvectomy for treatment of obstipation secondary to pelvic malunion in 3 cats.

Pelvic fractures are a common injury in cats, and both surgical and conservative management approaches have been described. One of the major complications of pelvic fractures managed conservatively is narrowing of the pelvic canal. Severe pelvic canal narrowing can result in constipation and subsequent megacolon. The purpose of this case series is to describe the long-term outcome for 3 cats with obstipation treated with internal hemipelvectomy because of megacolon secondary to pelvic canal narrowing after conservative management. All cats had a good functional outcome of the affected limb. Two cats required ongoing medical management for recurrent constipation. Overall, internal hemipelvectomy offers good long-term limb function; however, its success in relieving clinical signs of constipation requires additional research.

Hémipelvectomie interne pour le traitement de la constipation opiniâtre secondaire à un cal vicieux pelvien chez 3 chats. Les fractures pelviennes sont une blessure commune chez les chats et les approches chirurgicales et prudentes ont toutes deux été décrites. L'une des complications majeures des fractures pelviennes gérées de manière prudente consiste à raccourcir le canal pelvien. Un rétrécissement sévère du canal pelvien peut se traduire par la constipation et un mégacôlon subséquent. Le but de cette série de cas consiste à décrire le résultat à long terme pour 3 chats souffrant de constipation opiniâtre traitée par une hémipelvectomie interne en raison d'un mégacôlon secondaire au rétrécissement du canal pelvien après une gestion prudente. Tous les chats ont obtenu de bons résultats fonctionnels du membre affecté. Deux chats ont nécessité une gestion médicale permanente pour une constipation opiniâtre. En général, l'hémipelvectomie interne offre une bonne fonction du membre, mais son succès dans le soulagement des signes cliniques de la constipation exige de la recherche additionnelle.(Traduit par Isabelle Vallières).

Distraction Osteogenesis Correction of Mandibular Ramis Fracture Malunion in a Juvenile Mute Swan ( Cygnus olor ).

A juvenile mute swan (Cygnus olor) was presented with right lateral deviation of the mandible. Radiographs demonstrated a healed fracture of the right mandibular ramis, which had compromised osteogenesis. A corrective osteotomy was performed and an osteogenic distractor was inserted over the lateral aspect of the right mandible. Dental acrylic implants were fixed to the rhinotheca to correct rotational alignment. A pharyngostomy tube was placed to facilitate administration of nutrition and medication. Postoperative images confirmed correct alignment of the mandible in relation to the maxilla. Implants were removed and postoperative complications were not reported. This is the first report of an osteogenic distractor used to correct mandibular deviation in an avian species. Distraction osteogenesis should be considered as a valid surgical option in juvenile or adult avian patients with pathologic bone shortening.

Corrective osteotomy for procurvatum deformity caused by distal femoral physeal fracture malunion stabilised with String-of-Pearls locking plates: results in two dogs and a review of the literature.

BACKGROUND: This report describes the treatment of severe procurvatum because of distal femoral physeal fracture malunion in two skeletally immature dogs. CASE REPORTS: Both dogs presented with severe right hindlimb lameness and markedly reduced stifle extension at less than 5 months of age. Severe distal femoral procurvatum and mild-to-moderate femoral shortening secondary to distal femoral physeal fracture malunion were evident on radiographs. The sagittal plane deformities were addressed with a caudal opening-wedge osteotomy in one dog and cranial closing wedge ostectomy in the other dog. String-of-Pearls locking plates were used to stabilise the osteotomies. Functional stifle extension range of motion and femoral length were improved post surgery in both dogs. Explantation of the plates was required in both dogs because of local soft tissue irritation. Both dogs had excellent outcomes based on subjective and objective measures (pressure sensitive walkway, force platform analysis) when assessed at skeletal maturity. CONCLUSIONS: Corrective osteotomy stabilised with String-of-Pearls locking plates is a viable treatment option for improving limb function in dogs with severe procurvatum deformities caused by distal femoral physeal fracture malunion.

Correction of the antebrachial deformity using circular external skeletal fixator in 7 dogs.

This study was carried out on 7 dogs with antebrachial deformity caused by malunion on radius-ulna fracture, treated with the Ilizarov method. The 1st, 3rd and 5th case were progressive correction group, in which the fixation consisted of a two-ring frame hinged with a ring in 100 mm diameter. The 2nd, 4th, 6th and 7th case were acute correction group, applied on a plain three-ring, non-hinged apparatus with the ring diameter of 80 mm. In the progressive correction group, the hinged fixator was placed in such a position that two rings would be localized on the proximal fragment and third on the distal fragment, whilst the site of osteotomy would be between the 2nd and 3rd rings after a bone segment removed. In the acute correction group, two rings were located on the proximal fragment with the third on the distal fragment, and the osteotomy was in the same position. The cases started using their extremities in postoperative days 1-8 (mean 2.5 days), and the initial weight bearing was observed on the postoperative days 18-28 (mean 18.5 days). The radiographic examinations revealed that antebrachial deformity and shortness of the extremity was corrected, and the consolidation was completed in postoperative days 35-50 (mean 40.7 days). In conclusion, using the Ilizarov apparatus for the acute correction of antebrachial deformities can provide faster, better and more practical treatment than more progressive correction with the hinged-apparatus. Provided that enough attention is paid during this acute treatment, flexion contracture can be avoided.

Use of T-plates for the stabilisation of supra-cotyloid ilial fractures in 18 cats and five dogs.

The use of the AO (Arbeitgemeinschaft für Osteosynthesenfragen) veterinary T-plates (1.5/2 mm and 2.7/3.5 mm) for stabilisation of supracotyloid ilial fractures in 18 cats and five dogs was evaluated in a retrospective study. The distal fragment from the coxofemoral joint ranged from 0.5 cm to 1 cm with a mean distance of 0.85 cm. Twenty out of 23 (87%) ilial fractures healed in original alignment. Three out of 23 (13%) animals had two loosened screws of the distal fragment with fracture malunion and minor medial displacement of the acetabular fragment. Screw or plate breakage was not observed and the implants were not removed. The clinical result was 'excellent' for 18 animals (78%), 'good' for four animals (17%), and 'poor' for one animal (5%). The use of T-plates permits good correction of supracotyloîd fractures with minimal approach and minimizes post-operative complications.

Two surgical approaches to fracture malunion repair.

Two birds were presented with malunion fractures. The first was a young toco toucan (Ramphastos toco) with malunion of the tarsometatarsus that was treated by an opening-wedge corrective osteotomy and an acrylic-pin external skeletal fixator (type II) to stabilize the osteotomy. The second bird was an adult southern caracara (Caracara plancus) with radial and ulnar malunion that was treated by closing-wedge osteotomies. Stabilization of the osteotomy sites was accomplished through a bone plate fixed cranially on the ulna with 6 cortical screws and an interfragmentary single wire in radius. In both cases, the malunion was corrected, but the manus of the southern caracara was amputated because of carpal joint luxation that induced malposition of the feathers.

Symphyseal distraction-osteotomy using a novel spacer of spirally fashioned orthopaedic wire for the management of obstipation.

Three domestic shorthair cats, one male and two females, 17.6+/-6.5 months old and 3.5+/-0.4 kg body weight, were admitted with a 6.6+/-1.1 (range 6-8) month history of recurrent bouts of obstipation. Defecatory difficulties had started within a month of conservatively managed pelvic fractures. Clinical and radiographic examination revealed severe colonic distension with faeces and a narrow pelvic canal caused by malunion of the pelvic fractures. A pelvic symphyseal distraction-osteotomy (SDO) technique was performed, using a novel metal spacer of spirally fashioned orthopaedic wire. Pelvic canal enlargement allowed the insertion of an index finger into the rectum. Following this, no further episodes of obstipation occurred during a follow-up period of 1-3 years. The SDO technique may be successful for the treatment of obstipation secondary to post-traumatic pelvic canal stenosis in the cat, if the colon motility is not already permanently affected.

Common complications of fracture repair.

Complications are a reality of fracture repair. Many can be avoided or minimized by being aware of their pathophysiology and predisposing factors. Others are unavoidable but their resolution may be aided by early diagnosis and appropriate treatment. Major complications of fracture repair include osteomyelitis, delayed union, nonunion, malunion, premature physeal closure, and fracture associated sarcoma. Consideration of these complications should factor into presurgical patient evaluation as well as postoperative management. This discussion focuses on how to avoid, recognize, and treat these complications.

Use of an external ring fixator for correction of an acquired angular limb deformity in a donkey.

Numerous techniques for surgical correction of angular limb deformities in horses involving an osteotomy of the affected bone and stabilization with an internal fixation device have been described. However, because the osteotomy typically has to be performed at the level of the physis, leaving little bone between the physis and the nearest joint, stabilizing the osteotomy by use of internal fixation devices may be difficult. In horses with severe chronic angular limb deformities, the amount of soft-tissue contracture may make it impossible to correct the deformity during a single procedure without causing stretch injuries to the adjacent tendons and neurovascular structures. Adjustable external ring fixators incorporating hinged rods on 1 side of the limb and an angular motor assembly on the other may be useful for treatment of severe chronic angular limb deformities in younger equids, because they allow for gradual correction of the deformity.

Calving chain fractures. Radiographic assessment of healing.

Calving chain fractures are highly characteristic injuries that when treated by casting, exhibit a predictable healing pattern. By knowing how such fractures appear radiographically at 1, 2, and 3 months following injury, it is much easier to decide when the fracture has become strong enough to bear weight, thus avoiding recasting the leg. This article describes the appearance of calving chain fractures as they heal over time, and how they appear when they do not.

Symphyseal distraction-osteotomy using an ulnar autograft for the treatment of pelvic canal stenosis in three cats.

Three adult cats with obstipation due to stenosis of the pelvic canal were treated by symphyseal distraction-osteotomy using an ulnar autograft. The duration of clinical signs before the surgery in the three cats was one, three and 19 months; the first two cats had no recurrence of signs after surgery, and the third had less severe and less frequent bouts of constipation.