ABSTRACT
Canine congenital extrahepatic portosystemic shunt (EHPSS) morphologies have not been fully elucidated. The goal of this retrospective, multi-institutional study was to use CT angiography to create an anatomical-based nomenclature system for canine congenital EHPSS. These shunt morphologies were then evaluated to identify any significant association with patient age, sex, breed, weight, or subjective portal perfusion score. Data collected respectively from the SVSTS and VIRIES list-serves included patient DOB, sex, breed, weight, CT date, and reported diagnosis. A single author (C.W.) viewed all CT scans and classified shunts based on the shunt portal vessel(s) of origin, the shunt systemic vessel(s) of insertion, and any substantial portal vessels contributing to the shunt. Additionally, hepatic portal perfusion was subjectively scored between one (poor/none) and five (good/normal) based on the caliber of the intrahepatic portal veins. A total of 1182 CT scans were submitted from 13 different institutions. Due to exclusion criteria, 100 (8.5%) were removed, leaving 1082 CT scans to be included. Forty-five different EHPSS anatomies were identified with five classifications accounting for 85% of all shunts (left gastric-phrenic [27%], left gastric-azygos [19%], left gastric-caval [15%], aberrant left gastric-caval with right gastric vein [12%], and aberrant left gastric-caval with right gastric vein and short gastric vein [11%]). Shunt origin involved the left gastric vein in 95% of the described classifications. Significant differences were identified among the five most common shunt types with respect to age at the time of the CT scan (P < .001), sex (P = .009), breed (P < .001), weight (P < .001), and subjective portal perfusion score (P < .001). An anatomical classification system for canine EHPSS may enable improved understanding, treatment comparisons, and outcome prediction for these patients.
ABSTRACT
OBJECTIVE: To compare the accuracy of reduction and the biomechanical characteristics of canine acetabular osteotomies stabilized with locking versus standard screws in a locking plate. STUDY DESIGN: Ex vivo biomechanical study. SAMPLE POPULATION: Cadaveric canine hemipelves and corresponding femurs (n=10 paired). METHODS: Transverse acetabular osteotomies stabilized with 5-hole 2.4 mm uniLOCK reconstruction plates using either 2.4 mm locking monocortical or standard bicortical screw fixation (Synthes Maxillofacial). Fracture reduction was assessed directly (craniocaudal acetabular width measurements and gross observation) and indirectly (impression casts). All constructs were fatigue-tested, followed by acute destructive testing. All outcome measures (mean+/-SD) were evaluated for significance (P<.05) using paired t-tests. RESULTS: Craniocaudal acetabular diameters before and after fixation were not significantly different (21.9+/-1.2 and 21.5+/-1.2 mm; P=.45). No significant differences were observed in acetabular width differences between pre- and postoperative fixation between groups (locking -0.4+/-0.4 mm; standard -0.4+/-0.3 mm; P=.76). Grossly, there was no significant difference in the repairs and impression casts did not reveal a significant (P=.75) difference in congruency between the groups. No significant differences were found in fracture gap between groups either dorsally (locking 0.38+/-0.23 mm versus standard 0.22+/-0.05 mm; P=.30) or ventrally (locking 0.80+/-0.79 mm versus standard 0.35+/-0.13 mm; P=.23), and maximum change in amplitude dorsally (locking 0.96+/-2.15 mm versus standard 0.92+/-0.89 mm; P=.96) or ventrally (locking 2.02+/-2.93 mm versus standard 0.15+/-0.81 mm; P=.25). There were no significant differences in stiffness (locking 241+/-46 N/mm versus standard 283+/-209 N/mm; P=.64) or load to failure (locking 1077+/-950 N versus standard 811+/-248 N; P=.49). CONCLUSION: No significant differences were found between pelves stabilized with locking monocortical screw fixation or standard bicortical screw fixation with respect to joint congruity, displacement of fracture gap after cyclic loading, construct stiffness, or ultimate load to failure. CLINICAL RELEVANCE: There is no apparent advantage of locking plate fixation over standard plate fixation of 2-piece ex vivo acetabular fractures using the 2.4 mm uniLOCK reconstruction plate.