Idiopathic arteriopathy-induced focal osteonecrosis of the femoral head in a young dog.

CASE DESCRIPTION: A 15-month-old 6.5-kg (14.3-lb) castrated male mixed-breed dog was evaluated because of a 4-month history of progressive intermittent non-weight-bearing lameness of the left pelvic limb. CLINICAL FINDINGS: Orthogonal radiography of the hip joints revealed a 4-mm atypical radiolucent lesion on the distal caudomedial aspect of the left femoral head and a disproportionately large-diameter femoral medullary canal with a low canal flare index. Prolonged unresponsiveness to medical management and progressive enlargement of the lesion prompted the recommendation for total hip replacement (THR). TREATMENT AND OUTCOME: THR was performed to restore pain-free function of the left pelvic limb and normal activity. A circular osteochondral flap was grossly evident on the femoral head. Histopathologic findings for this portion of the bone indicated an arteriopathy-induced focal subchondral osteonecrosis that had resulted in articular surface collapse. The noted idiopathic arteriopathy had disrupted the normal blood supply to the affected area. On reexamination and radiographic evaluation 13 months after THR, the dog appeared to have pain-free function of the affected limb and had returned to normal activity with no reported complications or problems. CLINICAL RELEVANCE: To the authors' knowledge, this report represented the first description of arteriopathy-induced focal osteonecrosis of the caudomedial aspect of the femoral head and its successful treatment in a young dog. This type of lesion may more commonly be the cause of hip joint osteoarthritis in young dogs than previously recognized because establishing a definitive diagnosis requires early recognition and histologic evaluation before advanced degenerative changes develop that obscure the underlying etiology.

Cryptococcal Maxillary Osteomyelitis and Osteonecrosis in a 18-Month-Old Dog.

An 18-month-old neutered male labradoodle was treated with surgical debridement for maxillary osteomyelitis and sequestrum formation. Histopathologic findings of the necrotic bone were consistent with Cryptococcus subspecies, confirmed with latex agglutination serum titer testing. The patient responded to a combination of fluconazole and surgical debridement and was titer negative after 8 months of medical therapy. The patient never exhibited signs of systemic illness which is commonly reported with cryptococcosis. Cryptococcus subspecies infection in dogs in the Pacific Northwest is part of an ongoing outbreak in the region, first reported in 2001, and is associated with specific risk factors. This is the first published case of oral cryptococcosis from primary inoculation.

Non-invasive magnetic resonance imaging diagnosis of presumed intermedioradial carpal bone avascular necrosis in the dog.

A 5-year-old, spayed female Weimaraner dog was evaluated for progressive left forelimb lameness localized to the carpus. Magnetic resonance imaging (MRI) was used to arrive at a presumptive diagnosis of intermedioradial carpal (IRC) bone fracture with avascular necrosis (AVN). To the authors' knowledge, this is the first report of naturally occurring AVN of the canine IRC diagnosed using MRI.

Diagnostic non invasif, à l'aide d'imagerie par résonnance magnétique, d'une nécrose avasculaire présumée de l'os intermédioradial du carpe chez le chien. Une chienne Weimaraner stérilisée âgée de 5 ans a été évaluée pour une boiterie progressive de la patte avant gauche située au carpe. L'imagerie par résonance magnétique (IRM) a été utilisée pour parvenir à un diagnostic présomptif d'une fracture de l'os intermédioradial du carpe (IRC) avec nécrose avasculaire. À la connaissance des auteurs, il s'agit du premier rapport d'une nécrose avasculaire naturelle l'IRC canin diagnostiquée à l'aide de l'IRM.(Traduit par Isabelle Vallières).

The role of osteonecrosis in canine coronoid dysplasia: arthroscopic and histopathological findings.

Coronoid dysplasia (CD) or medial coronoid disease is part of canine elbow dysplasia and eventually results in osteoarthrosis. Although CD was originally attributed to disturbed endochondral ossification, more recent data point to the subchondral bone. The objective of this study was to assess dysplastic bone and cartilage of dogs that underwent unilateral or bilateral arthroscopic subtotal coronoidectomy for the treatment of CD. Arthroscopic findings and histopathology of bone and cartilage removed from elbow joints with CD were compared. The most common arthroscopic finding was fragmentation with softening of the subchondral bone of the central part of the medial coronoid process. In dogs without obvious fragmentation, CD was characterised by bone softening and chondromalacia. During arthroscopic intervention dysplastic bone and cartilage were collected for histopathological assessment. Forty-five slices of formalin-fixed, paraffin-embedded bone and cartilage samples were stained using haematoxylin and eosin and evaluated. Histopathological findings primarily consisted of osteonecrosis of subchondral bone with necrosis within the marrow spaces. Histopathological changes in the articular cartilage were characterised by fibrillation, chondrocyte clone formation, and focal cartilage necrosis. The pathology was found primarily in the subchondral bone and not in the articular cartilage. Vascular compromise may play a role in the pathogenesis of osteonecrosis in CD.

Idiopathic ischemic necrosis of an accessory carpal bone in a dog.

CASE DESCRIPTION: A 6-year-old neutered female mixed-breed dog was evaluated because of a 6-week history of left forelimb lameness that varied in severity. CLINICAL FINDINGS: Radiography revealed expansile and lytic changes of the left accessory carpal bone (ACB). Results of histologic evaluation of ACB core biopsy specimens indicated areas of bone necrosis. The entire left ACB was excised and submitted for histologic evaluation; results confirmed a diagnosis of idiopathic ischemic necrosis. TREATMENT AND OUTCOME: Left pancarpal arthrodesis was performed to treat carpal hyperextension and persistent lameness. The dog had an excellent functional outcome with no other problems related to the carpus until its death 4 years later, further decreasing suspicion that the problem was attributable to an undetected neoplasm or bacterial or fungal osteomyelitis. CLINICAL RELEVANCE: The radiographic and histologic findings for the dog of this report were similar to previously reported findings for dogs with ischemic femoral head necrosis and humans with ischemic carpal (pisiform or lunate bone) necrosis. The etiology of the ischemic ACB necrosis in this dog was not determined. To the authors' knowledge, this is the first report of a dog with idiopathic ischemic ACB necrosis. Idiopathic ischemic necrosis should be included as a differential diagnosis for dogs with lameness and destructive and expansile ACB radiographic lesions. An excellent functional outcome may be attained by means of ACB excision and pancarpal arthrodesis.

Oral and maxillofacial surgery in dogs and cats.

Advancements in diagnostic and treatment modalities for oral and maxillofacial surgery have allowed veterinarians to offer clients a range of alternatives for their pets. Categories of oral and maxillofacial surgery reviewed in this article include jaw fracture management, management of palatal/oronasal defects, recognition and treatment of oral masses, and management of several miscellaneous pathologic conditions. Miscellaneous oral lesions discussed in this article include odontogenic cysts, osteonecrosis and osteomyelitis, and lesions of the tongue and lips.

Avascular necrosis of the canine radial carpal bone: a condition analogous to Preiser's disease?

An eight-year-old male neutered Staffordshire bull terrier was presented for investigation of right forelimb lameness of 14 months' duration. Radiography showed mottled osteolysis of the right radial carpal bone. Histopathology of the bone demonstrated replacement of healthy bone with granulation tissue suggestive of ischaemic necrosis. Lameness resolved following pancarpal arthrodesis. In humans, Preiser's disease is a condition in which idiopathic ischaemic necrosis of the scaphoid bone, the equivalent of the canine radial carpal bone, occurs. This disease may be analogous to the presentation seen in this case. To the authors' knowledge, this is the first report of such a condition in a dog.

Dexamethasone triggers lameness associated with necrosis of the proximal tibial head and proximal femoral head in broilers.

Bacterial chondronecrosis with osteomyelitis (BCO) and turkey osteomyelitis complex (TOC) are characterized by bacterial infection and necrotic degeneration within the tibiae and femora. Stress and immunosuppression have been implicated in the pathogenesis of BCO and TOC. Immunosuppressive doses of dexamethasone (DEX) trigger high incidences of TOC in turkey poults. The present study was conducted to determine if DEX injections or heat stress can trigger BCO and lameness in broilers. In 3 independent experiments, broilers were weighed and either remained uninjected or received repeated injections of 0.9% saline or DEX dissolved in saline (0.45 to 1.5 mg of DEX/kg of BW). Across all 3 experiments, the incidences of lameness were 0% for uninjected controls, 0 to 8% in saline-injected groups, and 24 to 68% in groups injected with 0.9 to 1.5 mg of DEX/kg of BW. Growth was inhibited by DEX injections regardless of whether the birds became lame or survived. When compared with saline-injected groups, DEX injections consistently increased the incidence of severe proximal tibial head necrosis in lame birds as well as in survivors. The DEX injections also triggered a subset of lesions that are not considered pathognomonic for BCO (for example, avascular femoral head necrosis and fatty necrosis of the tibiae). In a fourth experiment, repeated episodes of heat stress did not trigger lameness, although the subclinical incidence of tibial head necrosis was substantially higher at 28 and 35 d of age in heat-stressed broilers when compared with broilers reared under thermoneutral conditions. Accordingly, stress and immunosuppression must be considered contributing factors in the pathogenesis of tibial and femoral lesions associated with lameness in broilers. A subset of the lesions triggered by repeated DEX injections did not precisely mimic the pathogenesis of BCO in broilers, and DEX consistently inhibited growth whereas BCO is associated with rapid growth. These caveats must be acknowledged when DEX is used to trigger lameness in broilers.

Bisphosphonate related osteonecrosis of the jaws: a review.

Bisphosphonate use has increased in veterinary medicine over the last decade. During this time, bisphosphonate related osteonecrosis of the jaws (BRONJ) in human patients has been identified. Only recently was a dog model for BRONJ developed for human oral surgery and medicine. Veterinary patients treated with bisphosphonates may be at an increased risk for BRONJ There has been little, to no, investigation of potential long term side-effects of bisphosphonate use in veterinary patients; potential sequelae are unknown. The history of bisphosphonates, their use, and BRONJ in veterinary patients are discussed.

Osteomyelitis and osteonecrosis after intraosseous perfusion with gentamicin.

OBJECTIVE: To describe and discuss previously unreported complications associated with intraosseous perfusion with gentamicin in horses. STUDY DESIGN: Case report. ANIMALS: Ten-year-old Warmblood gelding. METHODS: Intraosseous perfusion with gentamicin into the proximal phalanx (P1) was used as part of the treatment regimen for distal interphalangeal joint and navicular bursa synovial sepsis. Although the sepsis responded favorably complications developed at the perfusion site, including persistent osteomyelitis, progressive osteonecrosis, and ultimately pathologic fracture of P1. RESULTS: The progression of the clinical signs and findings at necropsy are suggestive of a toxic osteonecrosis secondary to intraosseous perfusion. CONCLUSIONS: Further work is needed to investigate the effects of high dose gentamicin on equine mesenchymal cells that may be achieved during intraosseous perfusion. CLINICAL RELEVANCE: Lower doses of perfusate within the medullary canal of P1 or alternative perfusion sites should be considered.

Use of autologous bone marrow mononuclear cells and cultured bone marrow stromal cells in dogs with orthopaedic lesions.

The aim of the study is to evaluate the clinical application in veterinary orthopedics of bone marrow mononuclear cells (BMMNCs) and cultured bone marrow stromal cells (cBMSCs) for the treatment of some orthopaedic lesions in the dog. The authors carried out a clinical study on 14 dogs of different breed, age and size with the following lesions: 1 bone cyst of the glenoid rime; 2 nonunion of the tibia; 3 nonunion of the femur; 2 lengthening of the radius; 1 large bone defect of the distal radius;1 nonunion with carpus valgus; 4 Legg-Calvé-Perthés disease. In 9 cases the BMMCNs were used in combination with a three dimensional resorbable osteogenic scaffold the chemical composition and size of which facilitates the ingrowth of bone. In these cases the BMMNCs were suspended in an adequate amount of fibrin glue and then distribuited uniformly on a Tricalcium-Phosphate (TCP) scaffold onto which were also added some drops of thrombin. In 1 case of nonunion of the tibia and in 3 cases of Legg-Calvè-Perthés (LCP) disease the cultured BMSCs were used instead because of the small size of the dogs and of the little amount of aspirated bone marrow. X-ray examinations were performed immediately after the surgery. Clinical, ultrasounds and X-ray examinations were performed after 20 days and then every month. Until now the treated dogs have shown very good clinical and X-ray results. One of the objectives of the study was to use the BMMNCs in clinical application in orthopaedic lesions in the dog. The advantages of using the cells immediately after the bone marrow is collected, are that the surgery can be performed the same day, the cells do not need to be expanded in vitro, they preserve their osteogenic potential to form bone and promote the proper integration of the implant with the bone and lastly, the technique is easier and the costs are lower.

Pathological fractures secondary to metaphyseal osteopathy in a dog.

A four-month-old German Shepherd Dog (GSD) was admitted with bilateral non-weight bearing hindlimb lameness and pyrexia. A diagnosis of bilateral distal femoral fractures secondary to metaphyseal osteopathy was made on the basis of clinical signs, radiography and biopsy. The dog returned to normal function following conservative management. As far as the authors are aware there are no previous reports of pathological fractures secondary to this condition.

Decompression syndrome and the evolution of deep diving physiology in the Cetacea.

Whales repetitively dive deep to feed and should be susceptible to decompression syndrome, though they are not known to suffer the associated pathologies. Avascular osteonecrosis has been recognized as an indicator of diving habits of extinct marine amniotes. Vertebrae of 331 individual modern and 996 fossil whales were subjected to macroscopic and radiographic examination. Avascular osteonecrosis was found in the Oligocene basal odontocetes (Xenorophoidea) and in geologically younger mysticetes, such as Aglaocetus [a sister taxon to Balaenopteridae + (Balaenidae + Eschrichtiidae) clade]. These are considered as early "experiments" in repetitive deep diving, indicating that they independently converged on their similar specialized diving physiologies.

Cumulative sperm whale bone damage and the bends.

Diving mosasaurs, plesiosaurs, and humans develop dysbaric osteonecrosis from end-artery nitrogen embolism ("the bends") in certain bones. Sixteen sperm whales from calves to large adults showed a size-related development of osteonecrosis in chevron and rib bone articulations, deltoid crests, and nasal bones. Occurrence in animals from the Pacific and Atlantic oceans over 111 years made a pathophysiological diagnosis of dysbarism most likely. Decompression avoidance therefore may constrain diving behavior. This suggests why some deep-diving mammals show periodic shallow-depth activity and why gas emboli are found in animals driven to surface precipitously by acoustic stressors such as mid-frequency sonar systems.