Surgical repair of Salter-Harris type II fracture of the distal humerus: short and long-term outcomes in a case series of three dogs and one cat.

CASE HISTORIES: Three dogs and one cat sustained forelimb trauma and were presented to a university veterinary clinic (Liège, Belgium) and a private veterinary hospital (Beacouzé, France). All four animals were referred for surgery. CLINICAL FINDINGS: Two dogs and the cat were ambulatory on admission but unable to bear weight on the affected limb. One dog was non-ambulatory and lacked voluntary movement and sensation in one forelimb. Salter-Harris type II fractures of the distal humerus were diagnosed by radiography in all cases; avulsion of the brachial plexus and pelvic fractures were also present in the non-ambulatory dog. TREATMENT AND OUTCOME: All Salter-Harris type II fractures were stabilised by open reduction and internal fixation with cross pins. One minor complication (seroma) and three major complications (implant migration) developed after surgery. The pins were completely removed in one case and partially removed in two cases to resolve these complications. At the final follow-up examination (12-31 months after surgery), owners reported no lameness in three of the four cases and grade 2/5 left forelimb lameness in one case. CLINICAL RELEVANCE: This type of fracture is rarely described in the literature; however, it should be included in the differential diagnoses of traumatic humeral fractures in growing dogs and cats. In this case series, we achieved fair-to-excellent short-term and long-term outcomes after osteosynthesis of Salter-Harris type II fractures by cross pinning.

Review of dietary supplements for the management of osteoarthritis in dogs in studies from 2004 to 2014.

Osteoarthritis (OA) is a chronic, painful, degenerative and inflammatory disease that affects the synovial joints and leads finally to the loss of mobility. It is highly prevalent in dogs. Nowadays, no cure exists, and the pharmacological treatment is limited to clinical signs alleviation. Some positive beneficial effects have been highlighted with dietary supplements in the course of dog OA. The goals of this narrative review are to summarize the scientific data available in the literature on dietary supplements assessed in dog OA and to discuss some trails about how to improve several aspects of research and issues with dietary supplements, such as bioavailability and dosage regimen. Chondroitin sulphate, glucosamine, undenaturated type II collagen, avocado-soya bean unsaponifiables, curcumin and polyunsaturated fatty acids were studied in dog OA and therefore discussed in the present review. Most of them showed anticatabolic and anti-inflammatory effects. Unfortunately, few data exist concerning their pharmacokinetics. Their bioavailability is low, but new formulations are developed to enhance their gastrointestinal absorption. The clinical relevance of these new formulations compared to native forms should be demonstrated in good clinical trials. Even if further investigations are needed, dietary supplements should be considered in OA management.

Relationship between arthroscopic joint evaluation and the levels of Coll2-1, Coll2-1NO(2), and myeloperoxidase in the blood and synovial fluid of horses affected with osteochondrosis of the tarsocrural joint.

OBJECTIVE: To evaluate the levels of plasmatic and synovial Coll2-1, Coll2-1NO(2) and myeloperoxidase (MPO) in horses with osteochondral lesions of the tarsocrural joint and to investigate how these levels relate to arthroscopic findings of inflammation and degeneration. MATERIALS AND METHODS: Venous blood and synovial fluid samples were collected from 63 horses presented for arthroscopic removal of osteochondral fragments in the tarsocrural joint. Prior to removal of the osteochondral fragment, an exploration of the joint was performed and an inflammatory and degenerative score was determined. The blood and synovial levels of Coll2-1, Coll2-1NO(2) and MPO were also measured. The effects of the arthroscopic evaluation (inflammatory and degenerative classes) on the blood and synovial markers were evaluated using a linear model (GLM procedure), and correlations between biochemical markers in the blood and synovial fluid and the arthroscopic evaluation (inflammatory and degenerative classes) were established (Pearson's correlations). RESULTS: Significantly higher levels of Coll2-1 were detected in synovial fluid of higher degenerative classes. There was a significant correlation between the degenerative score and the synovial levels of Coll2-1 (r=0.27). According to the logistic regression model, there was a significant effect of the degenerative class on synovial levels of Coll2-1. CONCLUSIONS: Coll2-1 correlates well with the degenerative state of tarsocrural joints as evaluated by arthroscopy. This marker can therefore be classified as a burden-of-disease marker in the assessment of joint disease in horses.

Preliminary experience of a modified Maquet technique for repair of cranial cruciate ligament rupture in dogs.

The modified Maquet technique (MMT) uses the same principle as the tibial tuberosity advancement (TTA) for stabilization of the cranial cruciate ligament-deficient stifle in the dog. In the MMT, the tibial tuberosity is advanced in a similar manner to that used in the TTA, however the means by which the tibial crest is stabilized differs. The plate and fork originally described by Montavon et al. are not used (7). The MMT was first described by Maquet for use on humans; it leaves intact a distal bony attachment to the tibial shaft, and the tuberosity is either reinforced or not by a figure-of-eight wire. In this paper, we describe the MMT, and we report the results of our first 20 canine patients with cranial cruciate ligament rupture that were treated by the MMT. Mean clinical bone healing time was 6.8 weeks (range 4 to 12 weeks). The evidence provided by this clinical communication suggests that it is technically possible to achieve an advancement of the tibial tuberosity without the need for a plate. The MMT deserves consideration as a primary treatment option for cranial cruciate ligament rupture in dogs, and further evaluation in large clinical studies. Long-term follow-up and force plate analysis would be necessary to compare the MMT to both the TTA and the tibial plateau levelling osteotomy.

Theoretical discrepancy between cage size and efficient tibial tuberosity advancement in dogs treated for cranial cruciate ligament rupture.

OBJECTIVES: To calculate the difference between the desired tibial tuberosity advancement (TTA) along the tibial plateau axis and the advancement truly achieved in that direction when cage size has been determined using the method of Montavon and colleagues. To measure the effect of this difference on the final patellar tendon-tibial plateau angle (PTA) in relation to the ideal 90°. METHODS: Trigonometry was used to calculate the theoretical actual advancement of the tibial tuberosity in a direction parallel to the tibial plateau that would be achieved by the placement of a cage at the level of the tibial tuberosity in the osteotomy plane of the tibial crest. The same principle was used to calculate the size of the cage that would have been required to achieve the desired advancement. The effect of the difference between the desired advancement and the actual advancement achieved on the final PTA was calculated. RESULTS: For a given desired advancement, the greater the tibial plateau angle (TPA), the greater the difference between the desired advancement and the actual advancement achieved. The maximum discrepancy calculated was 5.8 mm for a 12 mm advancement in a case of extreme TPA (59°). When the TPA was less than 31°, the PTA was in the range of 90° to 95°. CLINICAL SIGNIFICANCE: A discrepancy does exist between the desired tibial tuberosity advancement and the actual advancement in a direction parallel to the TPA, when the tibial tuberosity is not translated proximally. Although this has an influence on the final PTA, further studies are warranted to evaluate whether this is clinically significant.

Mechanical testing of a modified stabilisation method for tibial tuberosity advancement.

OBJECTIVES: This in vitro study evaluated three modified techniques of tibial tuberosity advancement (TTA). Loads to failure were calculated for each technique. METHODS: A 9 mm TTA procedure was performed in the tibiae of dogs weighing between 32 and 38 kg. In group 1 (n = 12), the distal part of the tibial crest was left attached to the tibia by the cranial cortex, and a figure-of-eight wire was added for stabilisation. In group 2 (n = 12), the tibial crest was left attached but no additional device was used for stabilisation. In group 3 (n = 12), the tibial crest was completely separated from the tibia and fixed by a figure-of-eight wire so that, in this group, only the wire opposed avulsion of the tibial crest. Unidirectional axial force was applied via the patella to determine the maximal load to failure of the model. RESULTS: There was no significant difference between group 1 and group 2. These two groups both had a significantly stronger construct than that of group 3. CLINICAL SIGNIFICANCE: We described modifications to the TTA procedure without plate fixation that warrant clinical investigation. When the crest is broken during its advancement, the tension sustained by the repair is significantly weaker from a biomechanical point of view and the use of such a repair clinically is not recommended by the authors.

Traumatic partial elbow luxation in a dog.

Traumatic partial elbow luxation (unilateral medial humeroulnar) was diagnosed in a 2.5-year-old crossbreed dog. Previous reports of traumatic elbow luxation in the dog described lateral and less frequently medial humeroradioulnar luxations. The treatment consisted of closed reduction of the affected joint under general anaesthesia. The functional outcome was excellent.

Organic and mechanical properties of Cervidae antlers: a review.

There is a resurgence of interest in the study of deer antlers. Recent research advocates their potential for use in bone xenografts. Using this working hypothesis, we can formulate many questions: do antlers really present unique or interesting mechanical properties, and if so, which factors affect these properties? Many other issues, including tissue compatibility, could be discussed; however, this article will focus on the biomechanical features of antlers. This paper reviews some answers found within current published material, and could help determine the optimal selection of some antlers for further experimental studies and clinical trials. Some general elements like anatomy and histology of deer antlers are briefly summarised. This paper will attempt to define the fundamental differences between skeletal bone and antler bone in terms of their organic and mechanical properties. We will then compare the previously published data, which details the mechanical properties of antlers from different species of Cervidae, by reviewing several aspects such as: sex; geographical situation; morphology; hydration state; and mineral composition. Some findings emerge: mechanical properties do not vary with gender or latitude, and the most important determining factor appears to be the species, alongside morphology and use of antlers. The state of hydration and mineral composition also has an influence on the mechanical properties of Cervidae antlers.

Complications and outcome of a new modified Maquet technique for treatment of cranial cruciate ligament rupture in 82 dogs.

OBJECTIVES: To describe the complications, short and long-term outcome and owner satisfaction of dogs with cranial cruciate ligament rupture treated with a recently described new osteotomy for the modified Maquet technique (N-MMT). MATERIALS AND METHODS: Medical records and radiographs of 82 dogs (84 stifles) were reviewed. Details regarding short-term outcome and complications were recorded from the medical records. Long-term follow-up information was obtained by telephone interview. Historical data and complications were statistically analysed. RESULTS: Major complications occurred in 34/84 stifles. Intra-operative complications occurred in 26/84 stifles, all of which were fissures or fractures of the cortical hinge. Twenty-one of these fractures or fissures were repaired with a figure-of-eight wire. The second most common major complication was late meniscal tears in 3/84 stifles. One dog sustained a complete tibial fracture. Non-displaced fracture of the cortical hinge was the most common postoperative minor complication, which occurred in 5/84 stifles. The median preoperative lameness score was 3 out of 6. Final in-hospital re-evaluation of limb function was available in 58 dogs. The median lameness score at that time was 0 out of 6. Development of osteotomy related complications was not associated with a significant change in the postoperative lameness score. CLINICAL SIGNIFICANCE: Subjectively assessed clinical outcome with the N-MMT was good to excellent in this cohort of dogs. However, a high rate of intra- and postoperative complications of the N-MMT procedure was also present in these dogs.

Effect of EHDP on fracture healing in dogs.

Ethane-1-hydroxy-1,1-diphosphonate (EHDP) was administered subcutaneously to mature beagle dogs at dose levels of 0.1, 0.5, and 5.0 mg/kg/day for a 20 week period to determine the drug's effects on fracture healing. Uniform, transverse fractures of the midshaft radius were created in one limb and treated by external splintage. Drug-induced effects on fracture healing were monitored radiographically, histologically, and histomorphometrically; mechanical properties of the healing bones were determined in 4-point bending tests. At a dose of 0.1 mg/kg/day, ultimate load at failure and flexural rigidity of the fractured limbs equaled or exceeded that of saline control animals, and radiographic healing was normal. At a dose of 0.5 mg/kg/day ultimate load at failure and flexural rigidity of the fractured limbs proved inferior to saline control values, and radiographic healing appeared delayed. At a dosage of 5.0 mg/kg/day, there was obvious radiographic nonunion, and the callus of fractured radii had little inherent flexural rigidity or strength. Histomorphometrically, no differences were noted between control animals and the 0.1 or 0.5 mg/kg/day groups; however, mineralization activity appeared totally disrupted at the higher dosage level (5.0 mg/kg/day). In the 5.0 mg/kg/day group, EHDP-induced effects proved reversible with mineralization evident as early as 3 weeks following drug withdrawal. In mature beagle dogs EHDP proved to have dose-dependent and reversible inhibitory effects on secondary fracture healing.

Nature of the late potentials and F-ratio values in dogs.

There is controversy about the nature of the late potentials (F-waves and H-reflexes) in dogs. This work has attempted to clarify the problem by comparing late potentials in eight intact and four chronically deafferented dogs. Pure H-reflexes were recorded inconsistently from intact preparations at voltages below the threshold for the M-wave. At stimulation voltages giving maximum direct responses, there was no statistically significant difference between the amplitude and latency of the late potentials of the two groups. However, there was a tendency for the late potentials to be of larger amplitude and longer duration in intact preparations. Late potentials in intact preparations had a composite waveform consisting of both F-waves and H-reflex components. F-waves only were present in deafferented limbs, and their amplitude was proportional to the intensity of the stimulus. F-ratios could be calculated by using the latencies of the late potentials, because the F-wave did not have a longer latency than the H-reflex. The following reference values for the F-ratio are proposed: 1.954 +/- 0.086 when stimulating at the hock and 0.883 +/- 0.052 when stimulating at the popliteal fossa.

Cardiac performance in conscious healthy dogs during dobutamine infusion.

The aim of this study was to determine the cardiac performance of conscious healthy dogs during stimulation with dobutamine. Eight healthy unsedated beagle dogs were used. Cardiac output was measured by the thermodilution technique and blood pressures by extravascular pressure transducers. Dobutamine challenge at a dosage ranging from 27.5 to 50 micrograms kg-1 min-1 induced a significant rise in cardiac power index (CPI), cardiac index (CI), stroke index (SI) and heart rate (HR) and a significant decrease in pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR). The highest CPI was 2.05 times greater than its basal resting value. The CI was primarily responsible for this increase in CPI. The SI and HR contributed approximately 55 per cent and 45 per cent respectively of the maximal increase in CI.

Effects of dobutamine on isovolumic and ejection phase indices of cardiac contractility in conscious healthy dogs.

The aim of this study was to determine cardiac contractility using indices derived from cardiac catheterisation in conscious healthy dogs during dobutamine infusion. Eight dogs were studied. An ECG was recorded together with left ventricular pressure and volume which were measured using a conductance catheter with an integrated microtip pressure sensor. Eight indices of left ventricular systolic performance were derived from these records. Measurements were realised under basal conditions and during an incremental dobutamine challenge. The maximal rate of rise in ventricular pressure (max dP/dt), max dP/dt divided by the developed pressure and the mean systolic ejection rate were the most sensitive indices to detect dobutamine induced changes in contractility with maximal percentage changes of 122+/-11 per cent, 130+/-7 per cent and 102+/-24 per cent respectively. Ejection fraction increased significantly during dobutamine infusion (maximal percentage change of 43+/-9 per cent) whereas the pre-ejection period (PEP) and the left ventricular ejection time (LVET) decreased significantly (maximal percentage change of -41+/-2 per cent and -28+/-3 per cent respectively). All these six indices were significantly correlated with each other. Conversely, the ratio PEP/LVET and the LVET corrected for heart rate dependency showed a maximal percentage change of only -10+/-1 per cent and -16+/-7 per cent, respectively, during the dobutamine infusion and were not significantly correlated with the other contractility indices. This study demonstrated the feasibility of the conductance method to determine cardiac contractility in conscious healthy dogs submitted to a pharmacological stress testing and provides control values for eight indices of left ventricular contractility during dobutamine infusion at increasing dosages.

Hemiurothorax following diaphragmatic hernia and kidney prolapse in a cat.

A 3-year-old cat was presented with increasing dyspnoea over the past four days. Unilateral pleural effusion was diagnosed and a modified transudate was drained several times. Surgical exploration revealed intra-thoracic prolapse of the left kidney and partial herniation of the spleen through a dorsal, circumferential diaphragmatic tear. Biochemical analysis of the pleural fluid confirmed urothorax. Due to excessive fibrin deposit on the well-vascularised kidney it was impossible to re-establish left urinary pathways. Left-sided nephrectomy and diaphragmatic herniorrhaphy were performed. Postoperative recovery was uneventful and complete. This is the first report of an urothorax in veterinary medical literature.

Influence of body size on tibial nerve somatosensory evoked potentials in dogs.

Somatosensory evoked potentials in response to tibial nerve stimulation were recorded from the scalp of 31 clinically normal mixed-breed dogs. The latency and amplitude of a main positive potential (P18), recorded with a frontal electrode referenced to the nose, were measured in subjects with body length ranging from 316 to 962 mm. A linear relation to body size explained the variations in latency among dogs (r2 = 0.81); the amplitude variations were explained in part by body size (r2 = 0.44). Bilateral tibial nerve stimulation significantly (P < 0.05) increased the amplitude of P18, but its latency was unaffected, compared with unilateral stimulation. Results of unilateral right and left tibial nerve stimulation were compared and were not different. Replacing acepromazine with xylazine as premedication before thiopental anesthesia did not influence the recordings.

Somatosensory potentials in dogs with naturally acquired thoracolumbar spinal cord disease.

Somatosensory evoked potentials (SEP) were recorded at the scalp and at various levels along the lumbar and caudal thoracic parts of the spine in response to tibial nerve stimulations. The SEP were observed in 24 diseased dogs, 2 with a vertebral fracture, 1 with a spinal cord tumor, 1 with a vertebral tumor, and 20 with disk herniation. Cord compression location was confirmed by myelography, laminectomy, or both. The clinical state had significant (P < 0.0001) influence on SEP characteristics. The scalp-recorded SEP latency changed only in association with the most severe lesions; spine-recorded SEP conduction velocity was lower in association with mild lesions; scalp-recorded SEP amplitude changed with lesions of intermediary severity. Because these 3 electrophysiologic variables were influenced differently by cord damage, it was possible to discriminate the various clinical grades by use of these techniques. However, dogs with signs of pain only could not be differentiated from clinically normal dogs. The evoked injury potential was observed in all but 4 diseased dogs, and its maximal amplitude corresponded, in all cases, with cord damage location. Increased duration (P < 0.05) of the spine-recorded SEP was associated with long-standing problems, but not necessarily with clinically detectable malfunction. Use of SEP and evoked injury potential for identifying lateralized cord damage may be of value.

Study of spinal cord evoked injury potential by use of computer modeling and in dogs with naturally acquired thoracolumbar spinal cord compression.

OBJECTIVE: To add objective measurements of the characteristics of evoked injury potentials (EIP) and their relations to clinical severity in dogs with thoracolumbar spinal cord damage. ANIMALS: 25 dogs with naturally acquired spinal cord compression attributable to disk extrusion or vertebral fracture at the level of the thoracolumbar junction and with various degrees of paresis/paralysis. PROCEDURE: Spinal cord potentials evoked by tibial nerve stimulation were recorded every 5 to 10 mm at the lamina level in the vicinity of the cord compression. This allowed an EIP to be recorded even in the least handicapped dogs. A computer model yielded information about the waveform changes of the EIP in the vicinity of conduction blocks. RESULTS: The EIP waveform changed from biphasic to monophasic a short distance caudad to the location of spinal cord compression. Location of a maximal conduction block was measured in relation to position of the electrodes recording this waveform change. The distance between the assumed conduction block and the actual spinal cord compression was larger in the most affected dogs. The amplitude of the EIP was not related to severity of the clinical picture; however, the proximity of the recording electrode to the spine influenced the amplitude and the waveform of the EIP. CONCLUSION AND CLINICAL RELEVANCE: Change in the EIP waveform from biphasic to monophasic makes it possible to estimate the conduction block location along the spinal cord. A large distance between the assumed conduction block and site of actual cord compression could be an objective argument to confirm severity of a lesion.

Effect of bilateral stimulation on spinal evoked potentials in dogs.

We compared the effects of bilateral vs unilateral tibial nerve stimulation of percutaneously recorded spinal evoked potentials (SEP) in the lumbar and caudal thoracic area in dogs. The overall amplitude of the SEP is increased by this means. Use of this method could improve legibility of the recordings. Amplitudes of root and interneuronal components of the SEP are doubled as are cranially transmitted depolarizations. However, the amplitude of the SEP component arising from the primary afferents' depolarization was less than doubled. Latencies of the components were unaffected by bilateral stimulation. Careful observation of the latencies disclosed a 0.9-ms delay in transmission of the fastest component in the midlumbar area. This delay was consistent with results of previous cordotomy experiments, and could influence precision of conduction velocity measurement.

Effect of stimulus intensity on spine recorded somatosensory evoked potential in dogs.

OBJECTIVE: To investigate the effect of stimulus intensity on the characteristics of the spine recorded somatosensory evoked potentials (SEP) in dogs. ANIMALS: 11 healthy Beagles, 1 to 2 years old. DESIGN AND PROCEDURE: In 10 dogs, square-wave stimuli (0.1-ms duration, 4 Hz) were delivered through needle electrodes inserted close to the right tibial nerve at the tibiotarsal joint. A standard stimulus strength (reference effective stimulus [RS]) was established for each dog by determining the stimulus necessary to induce a maximal M wave (muscle evoked potential) in the plantar interosseus muscles. The polarity of the stimulating electrodes was then reversed, and an SEP was recorded at the level of the T13-L1 interarcuate ligament. Subsequently, stimuli at fractions (1/4x, 1/2x) and multiples (2x, 4x) of RS were delivered. Recordings, using 10x RS stimuli, also were obtained in 2 dogs; in 1 of them, the recordings were obtained before and after curarization. In each instance, the latencies and the amplitudes of the first 3 reproducible deflections were measured and evaluated. RESULTS: The SEP waveform recorded at the T13-L1 level using RS was similar in all dogs; at least 3 deflections were recognized. Altering stimulus intensity did not significantly change latency of the first 3 peaks; conversely, amplitudes of the first 3 peaks increased (P < 0.01) when the stimulus intensity was increased from 1/4x RS to 1x RS. Stimulation at 10x RS induced the recording of a large potential, which was suppressed by the curarization. CONCLUSION: Only slight variations affect latency data through a wide range of stimulus intensities; latency measurement can be considered a robust tool in the vicinity of RS. Slight variations in the electrode position during an SEP session should not invalidate the results. Differences in the definition of the stimulus intensity among laboratories should not preclude the comparison of the results.

Comparison of radiography, magnetic resonance imaging, and surgical findings in dogs with elbow dysplasia.

OBJECTIVE: To describe the magnetic resonance imaging (MRI) appearance of medial coronoid process and humeral condyle lesions in dysplastic cubital joints and to compare survey radiography and MRI for evaluation of fragmented medial coronoid process (FMCP) and lesions of the medial aspect of the humeral condyle (MAHC). ANIMALS: 18 dogs with elbow dysplasia. PROCEDURE: Radiography of 22 cubital joints was performed. The 22 joints then underwent MRI. The scans were evaluated with regard to the shape and signal of the coronoid process; articular cartilage change, subchondral bone disruption of the MAHC. Surgical findings were used as the standard to calculate accuracy, sensitivity, specificity, and positive- and negative-predictive values for specific diagnosis of FMCP (free fragment) and lesions of the MAHC. RESULTS: At surgery, 31.8% of the joints had FMCP (free), 36.4% had nondisplaced unmineralized coronoid process, and 27.2% had nondisplaced mineralized coronoid process. Eleven joints had lesions of the MAHC, and wear lesions were observed in 41% of the joints. On radiography, FMCP (free) was visualized in 9% of the joints and lesions of the MAHC were observed in 23%. MRI had the highest accuracy (95.5%), sensitivity (100%), and negative-predictive value (100%) for detection of FMCP (free), and had accuracy (91%), sensitivity (87.5%), specificity (92.5%), and positive (87.5%)- and negative (92.5%)-predictive values for detection of nondisplaced unmineralized coronoid process. CONCLUSIONS AND CLINICAL RELEVANCE: Compared with radiography, MRI was useful for detection of nondisplaced unmineralized coronoid process; images consistently correlated with surgical findings. The technique is accurate and especially useful when radiographic findings are inconclusive.