International survey of equine orthopaedic specialists reveals diverse treatment strategies for horses with overriding spinous processes.

BACKGROUND: Overriding spinous processes, also known as 'kissing spines', are one of the most common causes of back pain in horses. The aim of this study was to investigate which options for diagnosis and treatment are preferred by equine orthopaedic specialists and assess which techniques are used for local injection. METHODS: An online survey was distributed among members of the European/American College of Veterinary Surgeons, the European/American College of Veterinary Sports Medicine and Rehabilitation, the International Society of Equine Locomotor Pathology and nationally recognised advanced equine orthopaedic practitioners. RESULTS: The survey was completed by 353 respondents. The injection techniques most commonly used involve placing two needles abaxial to the interspinous space (42%) under ultrasonographic guidance (32%) or one needle in the midline (35%) between two spinous processes. The most popular combination for overriding dorsal spinous process therapy was local injection (26.7%) combined with controlled exercise (25.5%). Manual therapy was considered by 42% of European and 25% of American specialists (p = 0.01). Surgical intervention as a first-line treatment was recommended mainly by specialists working in the United States, the UK or Ireland (p = 0.001). Overall, most equine orthopaedic veterinarians (71%; n = 201) preferred conservative management and recommended surgery only for horses that did not respond to conservative therapy. LIMITATIONS: Respondents' personal bias may have skewed the findings. CONCLUSIONS: Despite a growing body of evidence, the therapeutic approach to 'kissing spines' in horses is influenced by professional specialisation and regional preferences. Variations in injection techniques and differing criteria for surgical intervention warrant further investigation.

Initial Psychometric Evaluation of the Portuguese Version of the Canine Orthopedic Index.

OBJECTIVE: The aim of this study was to perform the initial psychometric evaluation of the Portuguese version of the Canine Orthopaedic Index (COI). STUDY DESIGN: In a prospective, randomized study, a group of 50 police working dogs with bilateral hip osteoarthritis was assessed. A copy of the translated Portuguese version of the COI was completed by canine handlers, native Portuguese speakers. This result was compared with that of 50 sound dogs. Construct validity was determined by comparing sound dogs and dogs with osteoarthritis scores with the Mann-Whitney test. Additionally, the Kaiser-Meyer-Olin measure of sampling adequacy, eigenvalue, and scree-plot analysis were performed. Internal consistency was tested with Cronbach's α. RESULTS: A significant difference was observed between osteoarthritis and sound dogs in all dimensions of the COI (p < 0.01 for all), indicating construct validity. Two factors accounted for 87.8% of the total variance. Cronbach's α was 0.98, with a high interitem correlation, accounting for strong internal consistency. CONCLUSION: We presented criterion and construct validity of the Portuguese version of the COI. It is a step in providing clinicians with a validated and accessible tool to evaluate orthopaedic patients. Further studies are required.

Abstract Presentation at Two Veterinary Surgery Conferences and the Impact on Publication Rate.

OBJECTIVES: The aim of this study was to compare the publication rate (PR) and report descriptive findings from abstracts presented at the American College of Veterinary Surgeons (ACVS), the Veterinary Orthopaedic Society (VOS), and those presented at both conferences. STUDY DESIGN: All conference abstracts from 2001 to 2010 ACVS and VOS meetings were reviewed. PR in peer-reviewed journals was evaluated and compared between Group 1 (abstracts presented at ACVS only; n = 1,277), Group 2 (abstracts presented at VOS only; n = 645), and Group 3 (abstracts presented at both conferences; n = 121) abstracts. Abstracts were assigned a level of evidence (LoE) score. RESULTS: Approximately 6% of all abstracts evaluated were presented at two scientific meetings (Group 3). The PR of Group 1 (66%) and Group 3 (62%) abstracts was significantly higher than that of Group 2 (45%). The majority of abstracts were assigned a low LoE (3 or 4). Once presented, most Group 3 abstracts took <12 months to be submitted and <24 months to be published. CONCLUSION: This study found that a limited number of abstracts were presented at both ACVS and VOS, and PR was significantly different between those presented at ACVS only or both ACVS and VOS compared with VOS only. There was no significant difference in PR between Group 1 and Group 3 abstracts. This study has provided the initial comparison between abstracts presented at two veterinary surgical conferences.

Orthopedic Imaging: A Practical Clinical Guide.

Many imaging options are available to the practitioner both in-house and on a referral basis to help make a definitive diagnosis for orthopedic injuries. To guide treatment, a complete understanding of the nature and extent of the injury is ideal. While a thorough orthopedic physical examination is the first step, a complete diagnostic work-up will include at least one and often more than one imaging modality. The goal of this article is to discuss the imaging options for some of the more common orthopedic issues encountered in dogs to help guide the practitioner through the selection of which should be considered to accomplish a diagnosis.

Economic and Clinical Benefits of Orthopedic/Sports Medicine and Rehabilitation.

Orthopedic/Sports Medicine and Rehabilitation can be both a valuable comprehensive patient care service and economic addition to many veterinary practices. As partners within the hospital, the Orthopedic/Sports Medicine and Rehabilitation service not only provides consultations for all patients with the ultimate goal of return to function (regardless of their "job"), the service also contributes to the recovery of patients in hospital, provides critical pain management and mobility assistance for hospitalized and postoperative patients, and champions a wide variety of supportive patient care solutions in many services within a hospital. After patient discharge, the team can then aid in the client and patient recovery at home with key home exercise programs and communications to bolster the patient's home recovery, ongoing rehabilitation, and eventual return to function.

Evidence-Based Complementary and Alternative Canine Orthopedic Medicine.

The use of complementary and alternative veterinary medicine (CAVM) continues to become more widespread, especially for the management of chronic pain conditions such as canine osteoarthritis. Many patients have comorbidities that preclude traditional medical options, have not adequately responded to conventional therapies, or have owners interested in pursuing a complementary approach. Evidence-based CAVM can serve as a safe and effective adjunct to manage chronic pain conditions. There is growing evidence in the veterinary literature for the use of acupuncture and some herbal supplements in the multimodal management of canine osteoarthritis. The majority of evidence supporting chiropractic is limited to equine and human literature.

Assessment of Orthopedic Versus Neurologic Causes of Gait Change in Dogs and Cats.

Diagnosis of forelimb lameness may be challenging, as it not only can be due to multiple common orthopedic diseases but also may occasionally be caused by neurologic disease. A thorough orthopedic and neurologic examination is key to determining which disease category is the likely culprit. Deficits identified on the neurologic examination, such as proprioceptive deficits, changes in reflexes, and presence of spinal hyperesthesia, are key in identifying neurologic causes of forelimb lameness.

Advances in Exotic Animal Osteosynthesis.

Exotic animal orthopedics has not incorporated the most recent progress made in small animal surgery or human medicine. Although minimally invasive osteosynthesis has been incorporated as a routinely used alternative in small animals, its use in exotic animals is still in its infancy. This article compliments the reviews of orthopedics in small mammals, birds, and reptiles in the previous issue. It reviews relevant recent studies performed in laboratory animals about new orthopedic materials and techniques showing potential to become incorporated into the routine orthopedic treatment of exotic animals in the coming years.

Bacterial osteomyelitis in veterinary orthopaedics: Pathophysiology, clinical presentation and advances in treatment across multiple species.

Bacterial osteomyelitis in veterinary patients can be challenging to diagnose and treat, given limited therapeutic options and reported success rates. Osteomyelitis is frequently associated with surgical implant devices, including those required to optimise stability and healing of fractures. However, management of osteomyelitis sometimes necessitates the removal of these surgical implant devices in order to eradicate infection or limit implant-related osteolysis. The goal of this article is to provide a general and species-specific review of bacterial osteomyelitis in a selection of domestic veterinary species, including cats, dogs, horses, cattle and camelids, with a focus on classification, clinical presentation, aetiologic agents, and common therapeutic interventions reported in the literature. New treatment options emerging from research and human medicine will be also discussed, as they also apply to current or future care of veterinary patients with osteomyelitis.

Sensitivity and Specificity of a Weight Distribution Platform for the Detection of Objective Lameness and Orthopaedic Disease.

INTRODUCTION: Weight distribution and off-loading at the stance are commonly used subjective assessments during the orthopaedic examination. The clinical relevance, sensitivity and specificity of limb off-loading have not yet been established. The aim of the study was to assess off-loading on a weight distribution platform (WDP) and determine the sensitivity and specificity at various cut-off points for the detection of objective lameness (OL) and orthopaedic disease (OD). MATERIALS AND METHODS: The total pressure index was used to determine OL on a pressure-sensitive walkway (PSW). Normal weight distribution on both the PSW and WDP was considered 30/30/20/20. A total pressure index standard deviation of 2 was used. The sensitivity and specificity of the WDP for the identification of OL and OD was determined at cut-off points 1 to 6 below normal weight distribution values. RESULTS: All patients in the study (n = 50) had confirmed OD. The PSW identified 36/50 (74%) patients as OL; these were deemed to be OL for sensitivity and specificity analysis of WDP data. At cut-off point 1, the WDP had the highest sensitivity for OD (84%) and OL (97%). At cut-off point 6, the WDP had the highest specificity for OD (98%) and OL (98%). The highest combination of sensitivity and specificity for both OD (1.65) and OL (1.80) was at cut-off point 2. DISCUSSION/CONCLUSION: The WDP provided the highest combined sensitivity and specificity at cut-off point 2 below the normal value for the detection of both OL and OD.

Results of a survey of Veterinary Orthopedic Society members on the preferred method for treating cranial cruciate ligament rupture in dogs weighing more than 15 kilograms (33 pounds).

OBJECTIVE To determine which method (lateral fabellotibial suture [LFS], tibial plateau leveling osteotomy [TPLO], tibial tuberosity advancement [TTA], or tightrope-like braided multifilament suture secured with metallic buttons [TR]) Veterinary Orthopedic Society (VOS) members preferred for treating cranial cruciate ligament rupture (CCLR) in dogs weighing > 15 kg (33 lb), identify factors associated with this preference, and assess concerns related to surgical implant material used. DESIGN Cross-sectional study. SAMPLE 187 VOS members. PROCEDURES All registered VOS members received an online survey from June to July 2016. Responses were compiled and evaluated for associations with method preferences and perceived complications. RESULTS Overall response rate was 38.4% (221/575). Respondents had graduated from veterinary school a mean of 23 years prior to survey completion, and collectively they performed approximately 30,000 CCLR surgeries annually. The most commonly preferred method was TPLO (147 [78.6%]), followed by TTA (26 [13.9%]), the LFS procedure (11 [5.9%]), and the TR procedure (3 [1.6%]). The preference for TPLO was independent of board certification or college of training (American, European, or other College of Veterinary Surgeons). Non-board-certified surgeons, including general practitioners, also favored TPLO. The most common perceptions were that titanium implants (used for TTA) were associated with the lowest incidence of major complications, whereas braided multifilament suture (used for the TR procedure) was associated with the highest incidence of major complications. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that TPLO was preferred for treating CCLR in dogs weighing > 15 kg and that the TR procedure was perceived as having the highest complication rate. With results of this survey in mind, use of the TR procedure should be considered cautiously when treating CCLR.

Contribution of antirotational pins and an intact fibula to the ex vivo compressive strength of four tibial plateau leveling osteotomy constructs.

OBJECTIVE To assess the contribution of antirotational pins (ARPs) and an intact fibula to the compressive strength of 4 tibial plateau leveling osteotomy (TPLO) constructs (bone and implants). SAMPLE 20 hind limbs from 10 canine cadavers. PROCEDURES Each hind limb was assigned to 1 of 4 TPLO constructs (construct in which the ARP was removed, constructs in which 1 or 2 ARPs were left in place, and construct in which the ARP was removed and the fibula was cut). Following TPLO completion, all limbs underwent mechanical testing that included 10,000 cycles of cyclic axial compression followed by testing to failure at a displacement rate of 1 mm/s. Displacement during cyclic testing; load generated at 0.5, 1.0, and 3.0 mm of displacement; ultimate load; and failure type were recorded for each limb. Mean values were compared among the groups. RESULTS None of the specimens failed during cyclic testing. None of the variables assessed during mechanical testing differed significantly among the 4 groups. During testing to failure, the majority (17/20) of specimens failed as the result of a long oblique fracture through the first screw hole in the distal segment. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that the axial compressive strength and stiffness of a TPLO construct were not significantly affected by the addition of 1 or 2 ARPs or the presence of an intact fibula. These findings appear to support removal of ARPs during uncomplicated TPLOs, but further research is warranted to assess the effect of ARP removal on bone healing and complication rates.