TTA-Rapid in the treatment of the canine cruciate deficient stifle: short- and medium-term outcome.

OBJECTIVES: To evaluate complications, short- and medium-term outcomes following treatment of lameness associated with cranial cruciate ligament insufficiency in dogs using the "TTA-Rapid" technique. METHODS: Patient records from two veterinary clinics were retrospectively examined to collect data from cases treated over a period of 21 months. An owner postal questionnaire using a clinical metrology instrument (Liverpool Osteoarthritis in Dogs) evaluated medium-term outcome of at least six months. RESULTS: In total 152 procedures were carried out in 141 dogs by two surgeons. Major complications, requiring further intervention, were identified in 11 (7%). Nine of these involved "late" meniscal injuries and two sustained tibial fractures postoperatively, one requiring internal fixation and the other external coaptation. The 3-month outcome was considered satisfactory in 99% of 135 procedures whilst the medium-term outcome (mean 16 months) was considered satisfactory in 86% of 108 dogs. CLINICAL SIGNIFICANCE: "TTA-Rapid" offers a treatment option for cranial cruciate-deficient stifles with good short- and medium-term outcomes. The complication rate was low in our hands.

A guide to managing anaphylaxis for General Duties Medical Officers.

Anaphylaxis is a severe, life-threatening, generalised hypersensitivity reaction. It affects 1 in 1,333 (~0.08%) of the English population during their lives, with 1% of cases being fatal. Management, underpinned by guidance from the Resuscitation Council (UK), focuses on a thorough clinical assessment and prompt administration of intramuscular adrenaline. Symptoms may recur, so patients must be observed for a period of no less than six hours. In a deployed environment evacuation must be swift and into a safe environment capable of providing critical care support. There are clear occupational implications following a case of anaphylaxis, and a confirmed case may affect service personnel's fitness to deploy. This article will summarise the management of anaphylaxis in Royal Naval personnel.

Operation PATWIN: HMS DARING's experience of providing humanitarian disaster relief following super-Typhoon Haiyan.

Super-Typhoon Haiyan struck the Philippines on 7 November 2013. The initial reports estimated 10 000 fatalities and four million displaced persons. As the United Kingdom's initial response to this disaster, HMS DARING was diverted from her deployment to take part in humanitarian aid, named Operation PATWIN. This article will outline the medical aspects of the relief effort undertaken and aim to identify any lessons that may inform future operations.

Lateral patellar luxation in dogs: a retrospective study of 65 dogs.

OBJECTIVE: To report the signalment and clinical features of dogs with non-traumatic lateral patellar luxation and to report the complications and outcomes following surgery. METHODS: A multicentre retrospective study was performed. Medical records were reviewed and the signalment, clinical features, and treatment of dogs presenting with lateral patellar luxation were recorded. In dogs treated surgically, the outcome and complications were investigated. RESULTS: Sixty-five dogs (95 stifles) were included; 39 were male and median age at presentation was 10 months. Breeds were classified as small (n = 6), medium (n = 23), large (n = 27), and giant (n = 9). Lateral patellar luxation was classified as grade I (n = 14), II (n = 41), III (n = 29), and IV (n = 11). Conformational abnormalities were noted in 34 stifles; genu valgum was the most common (n = 28). Higher-grade luxation was associated with a younger age at presentation (p = 0.032) and genu valgum (p = 0.01). Surgery was performed on 58 stifles, 22 of which sustained one or more complications; 16 complications were managed conservatively, four with implant removal and six with revision surgery. Surgeon-assessed outcome was good or excellent in 47 of the 51 dogs available for review. CONCLUSIONS: Non-traumatic lateral patellar luxation is a disease of predominantly medium and large breed dogs. It has several similar clinical features and can be surgically treated in a similar manner to medial patellar luxation with similar types of complications and outcomes expected.

Effect of surgical technique on radiographic fusion of the anconeus in the treatment of ununited anconeal process.

OBJECTIVES: The aim of this study was to determine if internal fixation of the anconeus combined with a proximal ulnar osteotomy was more likely to result in fusion of the anconeus to the ulna compared with a proximal ulnar osteotomy alone. METHODS: A total of 12 orthopaedic referral clinics reviewed their clinical databases for cases of ununited anconeal process. Demographic and clinical parameters were collected along with radiographic follow-up at a minimum of four weeks. Cases treated with proximal ulnar osteotomy alone were compared with those treated with proximal ulnar osteotomy + internal fixation. Both groups were compared for background and disease variables. We tested for an association between treatment method and whether radiographic anconeal union had occurred. RESULTS: A total of 47 elbows (44 dogs) were identified. Of these, 28 cases (average age 7.6 months) were treated with proximal ulnar osteotomy (of which eight were stabilised with an intramedullary pin) alone. Nineteen cases (average age 7.1 months) were treated with proximal ulnar osteotomy + internal fixation. The two groups were not significantly different in age (P=0.638, Mann-Whitney U test). Fourteen of 28 cases with proximal ulnar osteotomy alone displayed anconeal union at follow-up compared with 16 of 19 cases of proximal ulnar osteotomy + internal fixation, and this difference was statistically significant (P=0.029, Fisher's exact test). CLINICAL SIGNIFICANCE: These data suggest that use of a lag screw to stabilise and compress the ununited anconeal process in addition to proximal ulnar osteotomy produces a better radiographic outcome. It is argued that radiographic union of the anconeus is likely to be associated with better long-term clinical outcome but further studies are required to confirm this.

The prevalence of canine patellar luxation in three centres. Clinical features and radiographic evidence of limb deviation.

The medical records of 155 dogs with patellar luxation (PL) from three different centres were analysed. Each case was classified according to the nature of its luxation and any concurrent orthopaedic conditions plus the age at diagnosis were also noted. Measurements relating to angle of inclination (AOI) of the femoral neck and medio-lateral bowing of the femur and tibia at the stifle were also recorded. The femoral and tibial data were compared to dogs with another orthopaedic condition in a case-control assessment. Labradors were most commonly affected (21%). Most luxations were medial (92%) and 54% of affected dogs were female. The mean AOI of the hip was 148.95 degrees . There was a statistically significant difference between the stifles of dogs with PL compared to a control population. This study concluded that PL in large breeds is increasing. Lateral luxation was uncommon and was not associated exclusively with large breeds. Females were more likely to have PL than males and being female was a risk factor associated with coxa valga. There are significant differences in medio-lateral stifle conformation between dogs with PL and control dogs.

Slipped capital femoral epiphysis in dogs.

In a retrospective review of 43 femoral fractures, three dogs had separation of the femoral capital epiphysis from the metaphysis in the absence of trauma. Two of these dogs also had evidence of pathology in the contralateral femoral neck including, in one dog, displacement of the capital epiphysis in relation to the metaphysis without actual separation. The case histories, radiographic features and histopathological findings of these cases were reviewed and compared with previous cases of slipped capital femoral epiphysis (SCFE) reported in dogs and also with SCFE in children. Pre-slip, acute, chronic and acute-on-chronic slips were Identified. Based on the cases reviewed, the authors advise internal fixation of stable slipped epiphyses in dogs. This may also be appropriate for unstable separations, although resorption of the femoral neck may preclude stable fixation and necessitate femoral head and neck excision.

Incomplete humeral condylar fractures in the dog.

The details of eight dogs (11 elbows) referred to the authors with lameness relating to elbow pain associated with incomplete fracture of the humeral condyle were reviewed. In all cases, a diagnosis was reached by radiographic examination, with the pathognomonic feature being a radiolucent line, in the sagittal plane, through the condyle. Treatment involved placement of a transcondylar bone screw with or without bone tunnels being created parallel to this implant. Six dogs (nine elbows) made a complete recovery without subsequent complications.

Radial carpal bone fractures in 15 dogs.

Between 1977 and 1992, 15 adult dogs were presented to the Universities of Bristol, Glasgow, Liverpool and London with fractures of the radial carpal bone which had occurred without a known episode of violent trauma. Eleven of the dogs were boxers and the other breeds affected were a Pharaoh hound, rottweiler, springer spaniel and a greyhound. The condition was bilateral in three cases. Eleven dogs were treated surgically by cast immobilisation (four cases), fragment removal (one case), lag screw fixation (three cases), pan-carpal arthrodesis (one case) and lag screw reduction followed by pan-carpal arthrodesis (two cases). The remaining four dogs were treated conservatively with rest and tactical use of non-steroidal anti-inflammatory drugs. Follow-up periods ranged from two months to 11 years. Varying degrees of lameness, which tended to be exacerbated by exercise, persisted in all cases. The radial carpal bone appears to have at least three separate centres of ossification which eventually fuse; their planes of fusion correspond approximately to the two main fracture lines. These areas of fusion could be weak points within the radial carpal bone.

Management of cervical spondylopathy-associated intervertebral, disc protrusions using metal washers in 78 dogs.

Intervertebral 7.5 mm (n = 75) and 6.0 mm (n = 22) metal washers were used to distract intervertebral spaces in 78 consecutive cases of canine cervical spondylopathy-associated disc protrusions, where myelography had demonstrated traction-responsive spinal cord compression. Nineteen dogs had compressive lesions at two sites. Fifty lesions were evaluated myelographically on immediate postoperative radiographs; of these, 32 compressions had been eliminated and 18 had been reduced. Euthanasia was performed in nine dogs within six months of surgery and 15 dogs had varying degrees of neck pain during this period. Long-term follow-up information was available on 65 dogs nine to 70 months following surgery (median 32 months). Sixty-three of these dogs improved postoperatively. Neurological function subsequently deteriorated in 17 dogs 10 to 59 months following surgery (median 34 months). Eight of these 17 cases had further myelographic investigations and all had additional disc protrusions with no evidence of cord compression at the previous sites of surgery. The remaining nine cases had a deterioration in hindlimb function but were not investigated further.

Characterization of wear debris associated with aseptic loosening of a canine hip prosthesis.

A 12-month-old Golden Retriever bitch underwent unilateral hip arthroplasty following a diagnosis of coxofemoral osteoarthritis secondary to hip dysplasia. The hip prosthesis underwent aseptic loosening and was removed 6 months after implantation. Synovial biopsies taken at that time revealed scattered foci of granulomatous inflammation associated with intra-cytoplasmic and extracellular particulate material. Electron microscopical analyses demonstrated that this material contained cobalt, chromium, titanium and zirconium, which was probably wear debris from the loosened prosthesis. In human patients with hip arthroplasty, widespread dissemination of wear debris from loosened prostheses occasionally occurs, with an increased prevalence of neoplasia. A similar phenomenon may be predicted to occur with the increasing use of hip arthroplasty in the dog.

Multiple discospondylitis associated with Aspergillus species infection in a dog.

Multiple discospondylitis was diagnosed in a four-year-old, neutered female German shepherd dog which had suffered intermittent pain of the axial skeleton for 10 months, which was followed by the sudden onset of paraplegia associated with the rupture of an affected disc. After surgical and medical management the dog began to improve but then deteriorated as a result of a pathological fracture of the fifth lumbar vertebra. A histological examination revealed fungal hyphae at the sites affected radiographically and they were identified by immunohistochemistry as Aspergillus species. No fungal hyphae were identified in other tissues. This is the first report of canine mycotic discospondylitis in the United Kingdom.

Postoperative analgesic and sedative effects of carprofen and pethidine in dogs.

Forty dogs undergoing a variety of orthopaedic surgical procedures were randomly assigned to one of two analgesic protocols, receiving either pethidine at 2 mg/kg pre-operatively and 3 mg/kg postoperatively, or carprofen, a new non-steroidal anti-inflammatory drug at 4 mg/kg pre-operatively. Analgesia and sedation were assessed after the operations under double blind conditions using a discontinuous scoring system and a visual analogue scale. There was good agreement between the two scoring systems, and a statistical analysis of the visual analogue scores showed that carprofen provided slightly better pain relief than pethidine and produced less sedation. Carprofen provided good analgesia during the 18 hours the dogs were in hospital and no adverse side effects were observed.

A review of the usefulness of myelography in 50 dogs.

Fifty dogs showing clinical signs of spinal disease were investigated by myelography, using iopamidol. In 27 cases the technique was considered worthwhile. Of the 19 dogs not subjected to surgery or euthanasia as a result of the findings, three suffered seizures during recovery from anaesthesia, eight deteriorated in neurological condition and one suffered permanent respiratory arrest as a result of extensive subarachnoid haemorrhage.