Isolated Articular Fractures of the Canine Talus: Diagnosis and Signalment in Fourteen Dogs.

OBJECTIVE: The aim of this retrospective multicentre case series was to describe signalment, presenting signs and imaging findings in dogs with isolated articular fractures of the talus. STUDY DESIGN: Medical records (2008-2019) of dogs with isolated articular talar fractures were reviewed. RESULTS: Fourteen dogs met the inclusion criteria; affected breeds were four German Pointer (three shorthair and one wirehaired), three Labrador Retrievers, two Rottweilers, two Springer Spaniels, one cross breed, one Greyhound and one Great Münsterländer. The age range was 1 to 8 years with a median of 4.7 years. Lameness was usually acute in onset and had been present for a range of 4 to 540 days prior to referral.The most common fracture configuration involved the lateral trochlear ridge only (n = 9). Two of the fourteen fractures affected both trochlear ridges. Thirteen dogs were initially assessed radiographically with classic orthogonal views, but a fracture was only visible in five cases. The remainder were confirmed with further radiographic projections (n = 4) or computed tomography (n = 5). In one case, the lameness was located to the tarsus by scintigraphy. CONCLUSION: Isolated articular fracture of the talus is rare and may prove a diagnostic challenge due to the varied presentations and complex anatomy of the bone. Pathology of the talus may be suspected in any case of lameness localized to the tarsus and oblique/skyline radiographic views or advanced imaging should be performed if standard radiographic views are unremarkable.

Investigation of the in vitro antimicrobial activity of triclosan-coated suture material on bacteria commonly isolated from wounds in dogs.

OBJECTIVE: To investigate in vitro effects of triclosan coating of suture materials on the growth of clinically relevant bacteria isolated from wounds in dogs. SAMPLE: 6 types of suture material and 10 isolates each of methicillin-susceptible Staphylococcus pseudintermedius, methicillin-resistant S pseudintermedius, Escherichia coli, and AmpC ß-lactamase and extended-spectrum ß-lactamase-producing E coli from clinical wound infections. PROCEDURES: Isolates were cultured on Mueller-Hinton agar with 3 types of triclosan-coated suture, uncoated counterparts of the same suture types, and positive and negative controls. Zones of inhibition (ZOIs) were measured after overnight incubation. Sustained antimicrobial activity assays were performed with susceptible isolates. The ZOI measurements and durations of sustained antimicrobial activity were compared among suture types and isolates by statistical methods. Suture surface characteristics and bacterial adherence were evaluated qualitatively with scanning electron microscopy. RESULTS: ZOIs were generated only by triclosan-coated materials; triclosan-coated suture had sustained antimicrobial activity (inhibition) for 3 to 29 days against all tested pathogens. The ZOIs around triclosan-coated suture were significantly greater for S pseudintermedius isolates than for E coli isolates. Bacterial adherence to uncoated polyglactin-910 was greatest, followed by triclosan-coated polyglactin-910, and then uncoated monofilament sutures, with least adherence to coated monofilament sutures. CONCLUSIONS AND CLINICAL RELEVANCE: Surface characteristics of suture materials may be as important or more important than triclosan coating for microbial inhibition; however, triclosan coating appeared to affect bacterial adherence for multifilament sutures. Triclosan-coated, particularly monofilament, sutures inhibited pathogens commonly isolated from wounds of dogs, including multidrug-resistant bacteria. Further studies are required to assess clinical efficacy of triclosan-coated suture materials in vivo.

Long-term outcome following management of canine humeral intracondylar fissure using a medial approach and a cannulated drill system.

This study evaluated the feasibility, complications and long-term outcomes of using a cannulated drill system combined with intraoperative imaging to place a transcondylar screw for the management of canine humeral intracondylar fissure. Thirteen dogs were enrolled, with one dog undergoing staged bilateral surgery. No intraoperative complications occurred. Five minor (36%) and three major (21%) postoperative complications occurred, giving an overall complication rate of 57%. None of the screws placed penetrated the articular surface. The mean duration of surgery was 28 min (SD ±3.5) for dogs that developed a major complication versus 46 min (SD ±18.1) for those that did not (p=0.015). The duration of preoperative lameness was significantly shorter for cases which suffered a major complication (2 days; SD ±2.8) than those that did not (34 days; SD ±31.7, p=0.008). None of the variables assessed were significantly associated with minor complications. Median time from surgery to last follow-up was 5.8 years (range 3.5-8.5 years). Median Liverpool Osteoarthritis in Dogs questionnaire score at the final point of follow-up was 16 (range 7-27). A significant number of patients were found to require analgesia at long-term follow-up.

Teaching best practice in hand hygiene: student use and performance with a gamified gesture recognition system.

The use of an automated gesture recognition system to teach the commonly adopted, seven-stage hand hygiene technique to veterinary undergraduate students was evaluated. The system features moderate gamification, intended to motivate the student to use the machine repeatedly. The system records each handwash stage, and those found to be difficult are identified and reported back. The gamification element alone was not sufficient to encourage repeated use of the machine, with only 13.6 per cent of 611 eligible students interacting with the machine on one or more occasion. Overall engagement remained low (mean sessions per user: 3.5, ±0.60 confidence interval), even following recruitment of infection control ambassadors who were given a specific remit to encourage engagement with the system. Compliance monitoring was introduced to explore how students used the system. Hand hygiene performance did not improve with repeated use. There was evidence that the stages-fingers interlaced, rotation of the thumb, rotation of the fingertips and rotation of the wrists-were more challenging for students to master (p=0.0197 to p<0.0001) than the back of the hand and of the fingers. Veterinary schools wishing to use such a system should consider adopting approaches that encourage peer buy-in, and highlight the ability to practise difficult stages of the technique.

Patellar ligament rupture in the cat: repair methods and patient outcomes in seven cases.

The medical records of cats receiving surgical treatment for unilateral patellar ligament rupture between 1999 and 2012 at 12 referral centres in the UK and Ireland were reviewed. Seven cases were identified: six were caused by trauma and one was iatrogenic, occurring as a complication following surgical stabilisation of a tibial fracture. All cases were treated by sutured anastomosis of the ruptured ligament, with six of the repairs protected by a circumpatellar and/or transpatellar loop of suture. The stifle was immobilised by transarticular external skeletal fixation in three cases. No cases required revision surgery. No complications were reported. Final evaluation, performed at a median time of 31 days, determined five patients to have returned to acceptable or good limb function; two cases were lost to follow-up. The data suggest that, in cats, the current surgical techniques extrapolated from their canine counterparts for repair of a completely or partially ruptured patellar ligament are successfully used and result in acceptable limb function.

The effectiveness of 3D animations to enhance understanding of cranial cruciate ligament rupture.

Cranial cruciate ligament (CCL) rupture is one of the most important orthopedic diseases taught to veterinary undergraduates. The complexity of the anatomy of the canine stifle joint combined with the plethora of different surgical interventions available for the treatment of the disease means that undergraduate veterinary students often have a poor understanding of the pathophysiology and treatment of CCL rupture. We designed, developed, and tested a three dimensional (3D) animation to illustrate the pertinent clinical anatomy of the stifle joint, the effects of CCL rupture, and the mechanisms by which different surgical techniques can stabilize the joint with CCL rupture. When compared with a non-animated 3D presentation, students' short-term retention of functional anatomy improved although they could not impart a better explanation of how different surgical techniques worked. More students found the animation useful than those who viewed a comparable non-animated 3D presentation. Multiple peer-review testing is required to maximize the usefulness of 3D animations during development. Free and open access to such tools should improve student learning and client understanding through wide-spread uptake and use.

Aorto-enteric fistula development secondary to mycotic abdominal aortic aneurysm following intravesical bacillus Calmette-Guerin (BCG) treatment for transitional cell carcinoma of the bladder.

INTRODUCTION: Intravesical BCG-instillation for bladder cancer is considered safe but is not without risk. While most side-effects are localised and self-limiting, the development of secondary vascular pathology is a rare but significant complication. PRESENTATION OF CASE: A 77-year-old male presented with a mycotic abdominal aortic aneurysm and associated aorto-enteric fistula 18 months after receiving intravesical BCG-instillations for early stage transitional cell carcinoma. DISCUSSION: Response rates to intravesical BCG for early stage transitional cell carcinoma are high. The procedure produces a localised inflammatory response in the bladder but the exact mechanism of action is unclear. The treatment is generally well tolerated but BCG-sepsis and secondary vascular complications have been documented. Mycotic abdominal aortic aneurysm with associated aorto-enteric fistula secondary to BCG is very rare. Few examples have been documented internationally and the extent of corresponding research and associated management proposals is limited. Surgical options include in situ repair with prosthetic graft, debridement with extra-anatomical bypass and, occasionally, endovascular stent grafting. Recommended medical therapy for systemic BCG infection is Isoniazid, Rifampicin and Ethambutol. CONCLUSION: Current screening methods must be updated with clarification regarding duration of anti-tuberculous therapy and impact of concomitant anti-tuberculous medication on the therapeutic action of intravesical BCG. Long-term outcomes for patients post graft repair for mycotic aneurysm are unknown and more research is required regarding the susceptibility of vascular grafts to mycobacterial infection. Recognition of the risks associated with BCG-instillations, even in immunocompetent subjects, is paramount and must be considered even several months or years after receiving the therapy.

Genetic selection for fast growth generates bone architecture characterised by enhanced periosteal expansion and limited consolidation of the cortices but a diminution in the early responses to mechanical loading.

Bone strength is, in part, dependent on a mechanical input that regulates the (re)modelling of skeletal elements to an appropriate size and architecture to resist fracture during habitual use. The rate of longitudinal bone growth in juveniles can also affect fracture incidence in adulthood, suggesting an influence of growth rate on later bone quality. We have compared the effects of fast and slow growth on bone strength and architecture in the tibiotarsi of embryonic and juvenile birds. The loading-related biochemical responses (intracellular G6PD activity and NO release) to mechanical load were also determined. Further, we have analysed the proliferation and differentiation characteristics of primary tibiotarsal osteoblasts from fast and slow-growing strains. We found that bones from chicks with divergent growth rates display equal resistance to applied loads, but weight-correction revealed that the bones from juvenile fast growth birds are weaker, with reduced stiffness and lower resistance to fracture. Primary osteoblasts from slow-growing juvenile birds proliferated more rapidly and had lower alkaline phosphatase activity. Bones from fast-growing embryonic chicks display rapid radial expansion and incomplete osteonal infilling but, importantly, lack mechanical responsiveness. These findings are further evidence that the ability to respond to mechanical inputs is crucial to adapt skeletal architecture to generate a functionally appropriate bone structure and that fast embryonic and juvenile growth rates may predispose bone to particular architectures with increased fragility in the adult.

The problem surgical colleague.

The surgical profession, more than any other medical specialty, is constantly in the limelight. Frequently, concerns are expressed about our colleagues. The concerns may be personality clashes rather than failure in behaviour or performance. Most concerns can be addressed locally with support from the Royal College Invited Review Mechanism of the National Clinical Assessment Service. Unfortunately, if the concern is sufficiently serious or repetitive it may warrant referral to the General Medical Council (GMC) who alone has the right to withdraw a surgeon's medical registration. The surgeon will then be unable to work in the medical profession in this country. The procedures the the surgeon must undergo if referred to the GMC are stressful and protracted. Even if successful the surgeon will probably be expected to undergo a period of retraining that will prove difficult to arrange. New proposals to modify the GMC procedures will reduce the standard of proof to one of 'balance of probabilities'. The surgical profession should be accountable to its patients and colleagues. Will our Royal College rise to the challenge to establish itself as the bulwark of the surgical profession?

Mechanical loading: biphasic osteocyte survival and targeting of osteoclasts for bone destruction in rat cortical bone.

Bone is removed or replaced in defined locations by targeting osteoclasts and osteoblasts in response to its local history of mechanical loading. There is increasing evidence that osteocytes modulate this targeting by their apoptosis, which is associated with locally increased bone resorption. To investigate the role of osteocytes in the control of loading-related modeling or remodeling, we studied the effects on osteocyte viability of short periods of mechanical loading applied to the ulnae of rats. Loading, which produced peak compressive strains of -0.003 or -0.004, was associated with a 78% reduction in the resorption surface at the midshaft. The same loading regimen resulted in a 40% relative reduction in osteocyte apoptosis at the same site 3 days after loading compared with the contralateral side (P = 0.01). The proportion of osteocytes that were apoptotic was inversely related to the estimated local strain (P < 0.02). In contrast, a single short period of loading resulting in strains of -0.008 engendered both tissue microdamage and subsequent bone remodeling and was associated with an eightfold increase in the proportion of apoptotic osteocytes (P = 0.02) at 7 days. This increase in osteocyte apoptosis was transient and preceded both intracortical remodeling and death of half of the osteocytes (P < 0.01). The data suggest that osteocytes might use their U-shaped survival response to strain as a mechanism to influence bone remodeling. We hypothesize that this relationship reflects a causal mechanism by which osteocyte apoptosis regulates bone's structural architecture.