Positron emission tomography assessment of metacarpal/metatarsal condylar fractures post surgical repair: Prospective study in 14 racehorses.

OBJECTIVES: To assess 18F-sodium fluoride (18F-NaF) positron emission tomography (PET) findings associated with metacarpal/metatarsal condylar fractures at the time of fracture repair and through healing. STUDY DESIGN: Prospective descriptive study. ANIMALS: Fourteen Thoroughbred racehorses. METHODS: 18F-NaF PET was performed within 4 days of surgical metacarpal/metatarsal condylar fracture repair, on both the injured and contralateral limb. Follow-up PET scans were offered at 3- and 5-months post fracture repair. Areas of abnormal uptake were assessed using a previously validated grading system. RESULTS: Eight fractures were located in the parasagittal groove (PSG) (six lateral and two medial) and six fractures were located abaxial to the PSG (non-PSG) through the palmar/plantar condyle (all lateral). All horses in the latter group had uptake in the lateral palmar condyle of the contralateral limb suggestive of stress remodeling. Three horses with PSG fractures had uptake in a similar location in the contralateral limb. Horses with lateral condylar fracture only presented minimal or mild uptake in the medial condyle, which is considered atypical in the front limbs for horses in full training. Four horses developed periarticular uptake in the postoperative period suggestive of degenerative joint disease, three of these horses had persistent uptake at the fracture site. These four horses did not return to racing successfully. CONCLUSION: The findings of this study provide evidence of pre-existing lesions and specific uptake patterns in racehorses suffering from metacarpal/metatarsal condylar fractures. CLINICAL SIGNIFICANCE: PET has a possible role in the prevention, diagnosis, and postoperative monitoring of metacarpal/metatarsal condylar fractures in racehorses.

Long-Term Assessment of Bone Regeneration in Nonunion Fractures Treated with Compression-Resistant Matrix and Recombinant Human Bone Morphogenetic Protein-2 in Dogs.

OBJECTIVE: The aim of this study was to assess bone density, bone architecture and clinical function of canine nonunion distal appendicular long bone fractures with a defect treated with fixation, compression-resistant matrix and recombinant human bone morphogenetic protein-2 (rhBMP-2). STUDY DESIGN: Prospective cohort study with dogs at least 1-year post treatment. Computed tomography was performed and quantitative measurements from previous fracture sites were compared with measurements from contralateral limbs. Subjective evaluation included gait assessment and palpation. RESULTS: Six patients met the inclusion criteria. The rhBMP-2 treated bone exhibited higher density at the periphery and lower density in the centre, similar to the contralateral limb. All patients were weight bearing on the treated limb and all fractures were healed. CONCLUSION: The rhBMP-2-treated bone underwent restoration of normal architecture and density. Acceptable limb function was present in all patients. The results of this study can serve as a basis for long-term response in treating nonunion fractures in veterinary patients.

Extended Computed Tomography Scale Images Provide a Detailed Assessment of Metal Screws and Are Superior to Standard Computed Tomography Scale Images and Digital Radiography at Detecting Experimentally Induced Screw Fractures In Vitro.

OBJECTIVES: (1) To compare the ability of standard computed tomography (CT) scale (SCTS) and extended CT scale (ECTS) images, produced using conventional CT technology, to provide detailed assessment of metal screws in vitro. (2) To assess how screw size, type, and orientation relative to the Z-axis of the gantry affect implant assessment. (3) To test the ability of SCTS, ECTS, and radiography to diagnose screw failure when there is negligible screw fragment displacement. STUDY DESIGN: Part 1: 12 screws of different size, type, and composition were scanned in three orientations (parallel or 0°; oblique or 45°; and perpendicular or 90°) relative to the Z-axis of the gantry. SCTS and ECTS reconstructions were made for each screw, in each plane, to assess implant shape, structure, and diameter. Part 2: fatigue-failure was induced in four screws commonly used to stabilize canine humeral intracondylar fissures. Screws were then reassembled achieving grossly perfect apposition and alignment of the fragments. Ability to detect implant failure was tested using SCTS, ECTS, and radiography. RESULTS: ECTS provided better screw assessment compared with SCTS resulting in clear visualization of the structure in 8/12 versus 0/12 screws and shape in 12/12 versus 11/12 screws; however, results were affected by screw size, type, and orientation. ECTS identified all in vitro screw fractures with negligible screw fragment displacement; however, success was affected by screw orientation: 4/4 fractures identified with a 90° angle, 1/4 for 45°, and 0/4 for 0°. SCTS and radiography did not identify any of them. CONCLUSION: The results indicate that ECTS reconstructions are useful for assessment of metal screws and for detection of nondisplaced screw fractures.

Computed tomographic assessment of fracture characteristics and subchondral bone injury in Thoroughbred racehorses with lateral condylar fractures and their relationship to outcome.

OBJECTIVE: To investigate the effects of fracture characteristics and concurrent subchondral bone pathology identified with computed tomography (CT) on the racing performance of Thoroughbred racehorses with fractures of the MC3/MT3 lateral condyle. STUDY DESIGN: Retrospective cohort study. SAMPLE POPULATION: Thoroughbred racehorses (n = 50) with a fracture of the MC3/MT3 lateral condyle, which had preoperative CT and internal fixation performed. METHODS: Medical records were reviewed for age, sex, limb, and surgical treatment. Computed tomography scans were evaluated to determine fracture characteristics including length, whether the fracture was incomplete or complete, and displacement. The presence of subchondral bone injury (SBI), sesamoid bone fracture, articular comminution, and fragmentation in the joint was noted. Racing data was obtained from an online database. Univariable and multivariable analyses determined associations between independent variables and outcomes. RESULTS: Thirty-three (66%) horses raced after surgery. Horses with sesamoid bone fractures (P = .021), MC3/MT3 comminution (P = .016) and intra-articular fragmentation (P = .015) were less likely to race postoperatively. Concurrent SBI did not affect outcome. In the final multivariable model, sex (P = .015) and whether a fracture was incomplete or complete (P = .007) were the most significant predictors of racing postoperatively with females and horses with complete fractures being less likely to race. CONCLUSION: The prognosis for racing after a lateral condylar fracture is favorable but is decreased in horses with complete fractures and certain concurrent joint pathology. CLINICAL SIGNIFICANCE: Horses presenting with lateral condylar fractures commonly have concurrent joint pathology. Computed tomography can aid in preoperative evaluation and prognostication by enabling more complete fracture assessment.

In vitro assessment of the motion of equine proximal sesamoid bones relative to the third metacarpal bone under physiologic midstance loads.

OBJECTIVE: To assess the motion of the proximal sesamoid bones (PSBs) relative to the third metacarpal bone (MC3) of equine forelimbs during physiologic midstance loads. SAMPLE: 8 musculoskeletally normal forelimbs (7 right and 1 left) from 8 adult equine cadavers. PROCEDURES: Each forelimb was harvested at the mid-radius level and mounted in a material testing system so the hoof could be moved in a dorsal direction while the radius and MC3 remained vertical. The PSBs were instrumented with 2 linear variable differential transformers to record movement between the 2 bones. The limb was sequentially loaded at a displacement rate of 5 mm/s from 500 N to each of 4 loads (1.8 [standing], 3.6 [walking], 4.5 [trotting], and 10.5 [galloping] kN), held at the designated load for 30 seconds while lateromedial radiographs were obtained, and then unloaded back to 500 N. The position of the PSBs relative to the transverse ridge of the MC3 condyle and angle of the metacarpophalangeal (fetlock) joint were measured on each radiograph. RESULTS: The distal edge of the PSBs moved distal to the transverse ridge of the MC3 condyle at 10.5 kN (gallop) but not at lower loads. The palmar surfaces of the PSBs rotated away from each other during fetlock joint extension, and the amount of rotation increased with load. CONCLUSIONS AND CLINICAL RELEVANCE: At loads consistent with a high-speed gallop, PSB translations may create an articular incongruity and abnormal bone stress distribution that contribute to focal subchondral bone lesions and PSB fracture in racehorses.

A preclinical large-animal model for the assessment of critical-size load-bearing bone defect reconstruction.

Critical-size bone defects, which require large-volume tissue reconstruction, remain a clinical challenge. Bone engineering has the potential to provide new treatment concepts, yet clinical translation requires anatomically and physiologically relevant preclinical models. The ovine critical-size long-bone defect model has been validated in numerous studies as a preclinical tool for evaluating both conventional and novel bone-engineering concepts. With sufficient training and experience in large-animal studies, it is a technically feasible procedure with a high level of reproducibility when appropriate preoperative and postoperative management protocols are followed. The model can be established by following a procedure that includes the following stages: (i) preoperative planning and preparation, (ii) the surgical approach, (iii) postoperative management, and (iv) postmortem analysis. Using this model, full results for peer-reviewed publication can be attained within 2 years. In this protocol, we comprehensively describe how to establish proficiency using the preclinical model for the evaluation of a range of bone defect reconstruction options.

Biomechanical and Histological Assessment of a Polyethylene Terephthalate Screw Retention Technology in an Ovine Metatarsal Fracture Model.

OBJECTIVE: Screw loosening in fracture fixation poses a clinical risk which may lead to implant failure, particularly in poor bone quality. The objective of this study was to examine the effectiveness of a novel screw retention technology (SRT) for increased screw purchase in a large animal metatarsal fracture model. STUDY DESIGN: This was a biomechanical, radiographic, and histological study utilizing an ovine metatarsal fracture model. Twenty-four sheep metatarsi underwent 3-mm ostectomies and were repaired with a nine-hole plate and 3.5-mm screws placed in oversized 3.5-mm holes to simulate worst case revision surgeries (i.e. no initial screw thread bone contact). Sheep were sacrificed at 3, 6 or 12 weeks (n = 6 each) post-operation. Post-sacrifice, each surgically implanted screw underwent either destructive mechanical testing or histomorphometric analyses. RESULTS: Treated metatarsi showed improved screw retention and normal fracture healing. Significant improvement in breakout strength and pullout strength of screws treated with the SRT were found as a function of healing time. Histologically, bone ingrowth at the screw interface was also shown to significantly increase with healing time. Improvements in fracture healing, indicated by an increase in bone fraction and decrease in void space at the osteotomy, were also observed with healing time. CONCLUSION: The results demonstrate the effectiveness of the SRT as a method for improved screw retention in a rescue-screw type scenario.

Assessment of neovascularization during bone healing using contrast-enhanced ultrasonography in a canine tibial osteotomy model: a preliminary study.

Blood perfusion of skeletal muscle and callus was evaluated using contrast-enhanced ultrasonography (CEUS) in a canine osteotomy model to determine the applicability of CEUS in the assessment of neovascularization during fracture healing and to compare the vascular signals on CEUS between external skeletal fixation and cast-applied dogs. In 6 Beagle dogs, a simple transverse osteotomy was performed at the left tibial shaft and external skeletal fixation (n = 3) or a cast (n = 3) was applied. Radiography, power Doppler ultrasonography (power Doppler), and CEUS were performed until complete union was achieved. On CEUS, vascular changes were quantitatively evaluated by measuring peak intensity (PI) and time to PI in the soft tissue and callus and by counting the vascular signals. Vascular signals from the soft tissue were detected on power Doppler and CEUS on day 2. Significantly more vascular signals were detected by CEUS than by power Doppler. On CEUS, PI in the surrounding soft tissue was markedly increased after the fracture line appeared indistinctively changed on radiography in all dogs. In the cast-applied dogs, vascular signals from the periosteal and endosteal callus were detected on CEUS before mineralized callus was observed on radiography. CEUS was useful in assessing the vascularity of soft tissue and callus, particularly in indirect fracture healing, and provided indications of a normally healing fracture.

Improving intra- and inter-observer repeatability and accuracy of keel bone assessment by training with radiographs.

Assessing keel bone damage reliably and accurately is a requirement for all research on this topic. Most commonly, assessment is done on live birds by palpation and is therefore prone to bias. A 2-day Training School of the COST Action "Identifying causes and solutions of keel bone damage in laying hens" with 16 participants of variable experience was held where palpation of live hens was followed by consulting corresponding radiographic images of keel bones. We hypothesized that the inter-observer and intra-observer repeatabilities as well as the agreement between palpation and assessment from the radiograph (considered as the accuracy) would increase from day 1 to 2. Repeatability estimates were calculated using the R-package rptR and the change in level of accuracy on day 1 and 2 was analyzed with generalized linear models. As predicted, the inter-observer repeatabilities of the assessments of the fractures and deviations were improved by training, but this improvement differed for fractures and deviations between the cranial, middle, and caudal parts of the keel bone. Intra-observer repeatabilities before training also differed between the different parts of the keel bone and were highest for fractures at the caudal part of the keel bone. The training affected the accuracy of palpation to different degrees for the different parts of the keel bone. A training effect was found for the caudal part of the keel bone in regard to fractures and deviations, but for fractures the training effect was missing for the cranial part and for deviations it was missing for the middle part of the keel bone. In conclusion, the training school involving radiographs improved inter-observer repeatabilities in the diagnosis of fractures and deviations of keel bones and thus had the potential to lead to more comparable results among research groups.

Pork quality after electrical or carbon dioxide stunning at slaughter.

A total of 172 pigs were randomly allocated to two stunning treatments: carbon dioxide (CO2) and electrical stunning at a commercial abattoir. The Longissimus lumborum (LL) muscle was used to evaluate the effects of stunning methods on pork quality and financial losses of carcasses and viscera condemnation was also determined following by sanitary inspection. There was no effect due to stunning method on quality parameters (P > .137) of pH 24, drip or thaw loss, lipid oxidation, myofibrillar fragmentation index, shear force or PSE / DFD meat incidence. The LL muscle of the electrically stunned pigs had a higher L * value (P < .05), higher cooking loss (P < .001) and lower pH 45 (P < .05) compared to those stunned with CO2. CO2 stunned pigs had fewer carcasses condemned due to fractures / lesions (P < .05), hepatic and renal congestion (P < .05). CO2 stunning can be beneficial from an economic point of view because it has reduced losses through condemnation at the slaughterhouse.

Assessment of the Efficacy of Platelet-Rich Plasma in the Treatment of Traumatic Canine Fractures.

The role of platelet-rich plasma (PRP) in promoting the healing of bone fractures has not yet been clearly stated. The aim of this prospective clinical study was to evaluate the effectiveness of plasma rich in growth factors (PRGF, a PRP derivate) in the treatment of naturally-occurring bone fractures in dogs. With this objective, sixty-five dogs with radius/ulna or tibia/fibula bone fractures were randomly divided into two groups (PRGF and saline solution (SS) groups) and checked at days 0, 7, 14, 21, 28, 35, 42, 49, 56, 60, 63, 70, 120, and 180. All the fractures were treated with an external skeletal fixation, and pain was controlled with Carprofen. Healing was evaluated by physical examination, limb function, radiography, and by a Likert-type owner satisfaction questionnaire. A faster fracture healing was observed in the PRGF group, with statistically significant differences with respect to the SS group. Swelling at the fracture site was significantly greater at day 14 and 28 in animals injected with PRGF, and more pain on palpation was found in the area at day 28. The injection of PRGF in acute bone fractures accelerates bone healing.

Keel bone damage assessment: consistency in enriched colony laying hens.

Damage to the keel bone is a major issue in the laying hen industry. The goal of this study was to compare palpation results of live laying hens to digital computed tomography (CT) images, to assess changes in palpation reliability as training and familiarity increased, and to examine keel bone morphology over time. The longitudinal study consisted of 2 trials of 3 observation periods using 40 different (n = 120) W-36 hens housed in enriched colony cages. The first trial began when hens were 52 to 58 wk of age repeating the trial when the same birds were 74 to 81 wk of age. At 52 wk of age, each hen's keel bone was palpated by a single individual for keel bone caudal tip fractures (Tip), sagittal deviations (Evenness), and transverse deviations (Straightness). After palpation, each hen was placed in a motion limiting restraint and scanned using CT. The hens spent the next 21 d in their cages and on day 21, the hens were collected, palpated, and CT scanned again. The CT scans were imported into Mimics analysis software, 3D models of each keel bone were constructed and evaluated. Each bone and 3D model was scored (0, 1, 2) on the measurement of transverse deviation based on <0.5 cm, 0.51 to 1.0 cm, and >1.0 cm total deviation, respectively. Analysis of data using Proc Freq and Means in SAS 9.3 revealed minimal to moderate kappa values and moderate agreement percentages between palpators and digital analysis. The computer generated 3D models of individual keel bones were compared to palpation scores for Tip, Evenness, and Straightness at the beginning and end of each trial. The visual observations of the 3D models were qualitative, performed by a single individual. Overall, we found CT scanning to be a useful tool in observing changes to the keel bone, we observed changes in palpation accuracy as training/familiarity increased, and examined changes in keel morphology, specifically in the tip, after 52 wk of age.

Qualitative assessment of bone density at the distal articulating surface of the third metacarpal in Thoroughbred racehorses with and without condylar fracture.

REASONS FOR PERFORMING STUDY: Changes in subchondral bone density, induced by the repetitive cyclical loading of exercise, may potentiate fatigue damage and the risk of fracture. OBJECTIVES: To use computed tomography (CT) to characterise bone density patterns at the articular surface of the third metacarpal bone in racehorses with and without lateral condylar fractures. STUDY DESIGN: Case control METHODS: Computed tomographic images of the distal articulating surface of the third metacarpal bone were obtained from Thoroughbred racehorses subjected to euthanasia in the UK. Third metacarpal bones were divided into 3 groups based on lateral condyle status; fractured (FX, n = 42), nonfractured contralateral condyle (NFX, n = 42) and control condyles from horses subjected to euthanasia for reasons unrelated to the third metacarpal bone (control, n = 94). Colour CT images were generated whereby each colour represented a range of pixel values and thus a relative range of bone density. A density value was calculated qualitatively by estimating the percentage of each colour within a specific region. Subchondral bone density was assessed in 6 regions from dorsal to palmar and 1 mm medial and lateral to the centre of the lateral parasagittal groove in NFX and control condyles and 1 mm medial and lateral to the fracture in FX condyles. RESULTS: Bone density was significantly higher in the FX and NFX condyles compared with control condyles for all 6 regions. A significantly higher bone density was observed in FX condyles relative to NFX condyles in the lateral middle and lateral palmar regions. Fractured condyles had increased heterogeneity in density among the 6 regions of interest compared with control and NFX condyles. CONCLUSIONS: Adjacent to the fracture, a focal increase in bone density and increased heterogeneity of density were characteristic of limbs with lateral condylar fractures compared with control and NFX condyles. These differences may represent pathological changes in bone density that increase the risk for lateral condylar fractures in racehorses.

Methods for assessment of keel bone damage in poultry.

Keel bone damage (KBD) is a critical issue facing the laying hen industry today as a result of the likely pain leading to compromised welfare and the potential for reduced productivity. Recent reports suggest that damage, while highly variable and likely dependent on a host of factors, extends to all systems (including battery cages, furnished cages, and non-cage systems), genetic lines, and management styles. Despite the extent of the problem, the research community remains uncertain as to the causes and influencing factors of KBD. Although progress has been made investigating these factors, the overall effort is hindered by several issues related to the assessment of KBD, including quality and variation in the methods used between research groups. These issues prevent effective comparison of studies, as well as difficulties in identifying the presence of damage leading to poor accuracy and reliability. The current manuscript seeks to resolve these issues by offering precise definitions for types of KBD, reviewing methods for assessment, and providing recommendations that can improve the accuracy and reliability of those assessments.

Decision analysis for fracture management in cattle.

Bovine fractures are common and each bovine patient is unique, presents innumerable challenges, and requires careful judgment. In cattle the fracture repair usually should be of acceptable quality to not cause a decrease in milk or meat production or interfere with natural breeding. The decision to treat a fracture in cattle is made by evaluating the cost and success rates of the treatment, the value of the animal, and the location and type of fracture.

Clinical assessment of a shaft screw for stabilization of the humeral condyle in dogs.

OBJECTIVE: To report the use of a 4.5 mm shaft screw for the management of humeral condylar fractures (HCF) and incomplete ossification of the humeral condyle (IOHC) in dogs, and to assess risk factors for complications. METHODS: Dogs with HCF or IOHC that were managed with a 4.5 mm shaft screw with a minimum follow-up of six months from surgery were included. Data from the case records were used to identify risk factors for complications. Long-term follow-up was provided by an owner questionnaire and veterinary re-examination. RESULTS: Forty-three elbows were treated in 40 dogs (14 IOHC, 29 HCF). Minor complications were seen in four cases (9%) and major complications in 10 cases (23%). There were no statistically significant risk factors for major complication. Infection resulted in shaft screw removal from three IOHC cases. Four of eight IOHC cases that had a lateral approach had a major complication compared with zero out of six dogs that had a medial approach, but this difference was not significant (p = 0.085). Nine of 12 IOHC cases and 20/23 HCF cases had excellent or good limb use at the time of long-term follow-up (median of 106 weeks, range 26-227 weeks). All fractures healed but IOHC fissure healing was inconsistent. Fatigue failure of shaft screws was not seen. CLINICAL SIGNIFICANCE: The use of shaft screws for the management of IOHC and HCF is associated with a relatively low rate of complications (compared to previous reports) and a good long-term outcome.

Keel fracture assessment of laying hens by palpation: inter-observer reliability and accuracy.

The objective of this study was to assess the interobserver reliability (agreement) and accuracy of keel palpation for the purpose of detecting old fractures in an end-of-lay flock of commercial laying hens. The low level of invasiveness and the relative speed at which this evaluation can be carried out lends itself well to use in a welfare audit, but only if the results are reliable and accurate from various assessors. The palpation technique first described by Wilkins and others (2004) was used to manually palpate for keel fractures. The technique was modified in that only keel fractures were considered. Eight assessors with varying laying hen experience palpated 100 live ISA Brown hens that had been in lay for 49 weeks. The hens were then euthanased and examined by dissection to establish whether there had been a keel fracture present (yes/no). The accuracy for individual assessors ranged from 87.1 to 96.8 per cent, with a mean of 91.8 per cent among all eight assessors. The interobserver reliability among all eight assessors was moderate (κ=0.44). Accuracy and κ values were 84.8 per cent and 0.41 for the first 50 hens, and 99.5 per cent and 0.47 for the last 50 hens, respectively, indicating that there was increased accuracy and agreement as the assessors became more experienced at palpation. This level of agreement, and the high level of accuracy, would make this technique an acceptable measure of keel fracture prevalence in a welfare audit.

The effect of keel fractures on egg production, feed and water consumption in individual laying hens.

The impact of keel bone fractures on egg production, egg weight and feed and water consumption in individual laying hens. A total of 165 Lohmann brown laying hens were obtained from a commercial farm that consisted of 105 with keel fractures and 60 without keel fractures. 2. After a 4-d period of acclimatisation, hens were individually housed and provided with ad libitum food and water for a 24-h period. The number of eggs laid, egg weight, feed and water consumption during this period were recorded. Keel bone strength was also assessed. 3. Hens free from keel fractures laid more eggs (91.7% vs. 84.9%) of significantly heavier weight (61.9 g vs. 60.2 g), ate less feed (139 g vs. 151 g) and drank less water (212 ml vs. 237 ml) than hens with fractures. 4. There was a significant positive association between keel fracture severity and water consumption, and a significant negative association between keel fracture severity and egg weight and keel bone strength. 5. This small-scale study on individual birds shows that keel bone fractures may have an impact on the economics of egg production.

Arthroscopic assessment for patellar injuries and novel suture repair of patellar fracture in a cat.

A 4 yr old spayed female domestic shorthair was evaluated for an acute, nonweight-bearing, left hind limb lameness. Following 2 wk of conservative management without clinical improvement, the patient was referred for further examination. The stifle was palpably enlarged with suspected periarticular fibrosis. Radiographs showed a lateral longitudinal patellar fracture as well as a medial patellar luxation. Arthroscopic examination of the stifle and repair of the patellar fracture and luxation were performed with an excellent clinical outcome. Nine weeks postoperatively, the owners reported that the cat was using the leg normally inside, and re-examination revealed no pain or crepitus with manipulation of the limb. To the authors' knowledge, this is the first reported use of arthroscopy as a diagnostic tool and of suture reduction for fracture repair in the management of feline patellar injury.