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1.
Vet Surg ; 49(1): 187-199, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31777975

RESUMO

OBJECTIVE: To determine the ability of tibial plateau leveling osteotomy (TPLO) to address abnormal femorotibial kinematics caused by cranial cruciate ligament (CCL) rupture during walking in dogs. STUDY DESIGN: Prospective, clinical. ANIMALS: Sixteen dogs (20-40 kg) with unilateral complete CCL rupture. METHODS: Lateral view fluoroscopy was performed during treadmill walking preoperatively and 6 months after TPLO. Digital three-dimensional (3D) models of the femora and tibiae were created from computed tomographic (CT) images. Gait cycles were analyzed by using a 3D-to-2D image registration process. Craniocaudal translation, internal/external rotation, and flexion/extension of the femorotibial joint were compared between preoperative and 6-month postoperative time points for the affected stifle and 6-month postoperative unaffected contralateral (control) stifles. RESULTS: In the overall population, CCL rupture resulted in 10 ± 2.2 mm (mean ± SD) cranial tibial translation at midstance phase, which was converted to 2.1 ± 4.3 mm caudal tibial translation after TPLO. However, five of 16 TPLO-treated stifles had 4.1 ± 0.3 mm of cranial tibial subluxation during mid-to-late stance phase, whereas 10 of 16 TPLO-treated stifles had 4.3 ± 0.4 mm of caudal tibial subluxation throughout the gait cycle. Overall, postoperative axial rotational and flexion/extension patterns were not different from control, but stifles with caudal tibial subluxation had more external tibial rotation during mid-to-late stance phase compared with stifles with cranial tibial subluxation. CONCLUSION: TPLO mitigated abnormal femorotibial kinematics but did not restore kinematics to control values in 15 of 16 dogs during walking. CLINICAL SIGNIFICANCE: Tibial plateau leveling osteotomy reduces cranial tibial subluxation during walking, but persistent instability is common.

2.
Vet Surg ; 49(1): 22-32, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31271225

RESUMO

OBJECTIVE: To review fundamental principles of tissue healing and physical rehabilitation as they apply to dogs recovering from cranial cruciate ligament (CCL) surgery. STUDY DESIGN: Invited Review. SAMPLE POPULATION: None. METHODS: A multidisciplinary group of specialists in small animal surgery, rehabilitation/sports medicine, and human physical and occupational therapy reviewed the currently available evidence for rehabilitation post-CCL surgery. Because current evidence is limited, this group proposes guidelines for rehabilitation after CCL surgery based on the fundamental principles of tissue healing and physical therapy. RESULTS: This Review proposes four fundamental principles of small animal physical rehabilitation based on the foundations of tissue healing and patient-centric and goal-oriented therapy. Postoperative rehabilitation programs should be designed such that patient progress is based on individual assessment according to the degree of tissue healing, strength, and achievement of functional goals. Therapists must fully understand phases of tissue healing, reassess the patient frequently, and use clinical reasoning skills to progress treatment appropriately for the individual patient. CONCLUSION: Until more robust evidence is available to guide treatment protocols, fundamental principles of rehabilitation should ideally be adhered to when providing rehabilitation, including after CCL surgery. CLINICAL SIGNIFICANCE: While this Review specifically addresses post-CCL surgery rehabilitation, these fundamental principles should be applied broadly to animals enrolled in rehabilitation programs.

3.
Vet Surg ; 49(1): 80-87, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31390083

RESUMO

OBJECTIVE: To report current recommendations made by veterinarians for rehabilitation after surgical treatment of cranial cruciate ligament (CrCL) disease. STUDY DESIGN: Anonymized electronic survey. SAMPLE POPULATION: Veterinarians performing CrCL stabilization. METHODS: An electronic survey was created to collect information on general attitudes toward postoperative rehabilitation and recommendations regarding therapeutic modalities and bandaging. Quantitative data are reported by descriptive statistical analysis, percentage of responses, or mean (±SD). The recommendations for postoperative bandaging beyond 24 hours and for postoperative rehabilitation after extracapsular stabilization compared with after tibial osteotomy were tested by using Cochran-Mantel-Haenszel tests, with P < .05 considered statistically significant. RESULTS: The data analysis included 376 responses (13% response rate). Most (71%) respondents consistently recommended postoperative rehabilitation. Rehabilitation was more than twofold more likely to be recommended after extracapsular stabilization than after osteotomies (P = .0142). Most respondents did not recommend bandaging beyond 24 hours postoperatively (P = .00012). CONCLUSION: Most respondents recommended either formal or informal postoperative rehabilitation therapy. CLINICAL SIGNIFICANCE: If the survey respondents are representative of veterinarians performing CrCL surgery, the current attitude is supportive of postsurgical rehabilitation. Most respondents would welcome evidence-based guidelines for rehabilitation protocols.

4.
Vet Surg ; 49(1): 207-213, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31373719

RESUMO

OBJECTIVE: To quantitatively evaluate patellofemoral (PF) kinematics during walking in dogs with cranial cruciate ligament (CrCL) deficiency treated by tibial plateau leveling osteotomy (TPLO). STUDY DESIGN: Longitudinal observational study. ANIMALS: Dogs with unilateral CrCL deficiency treated by TPLO (n = 10). METHODS: Horizontal beam fluoroscopic images of the stifles during treadmill walking were acquired 6 months after TPLO. Computed tomography was performed, and digitized bone models of both femurs and patellae were created. These digital models were superimposed over the fluoroscopic images with shape-matching software, and sagittal plane PF kinematics for TPLO-treated and normal contralateral stifles were calculated. Patellofemoral kinematics were described according to phase of gait cycle as well as relative to femorotibial flexion angle. RESULTS: In TPLO-treated stifles, there was an approximately 1-mm increase in cranial displacement of the patella (P < .05) compared with the normal stifle at equivalent femorotibial flexion angles between 120° and 140° and predominately during the stance phase. Proximal-distal translation and patellar flexion angle were mostly unaffected by TPLO when they were assessed according to either equivalent phase of gait cycle or femorotibial flexion angles. CONCLUSION: In vivo PF kinematics in TPLO-treated stifles were subtly different from normal, characterized by slight cranial shifting of the patella relative to the trochlear groove. CLINICAL SIGNIFICANCE: The clinical significance of these results remains unknown. These results may provide further understanding into extensor mechanism abnormalities associated with TPLO.

5.
Vet Surg ; 49(2): 390-400, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31849076

RESUMO

OBJECTIVE: To compare mechanical properties of intact feline medial collateral ligaments and three techniques for treatment of feline medial tarsal instability. STUDY DESIGN: Controlled laboratory study. SAMPLE POPULATION: Forty-eight normal, adult feline tarsi. METHODS: Three repairs were tested: a bone tunnel with polypropylene (PP) suture, a bone tunnel with polyethylene (PE) cord, and a knotless anchor technique with PE cord. A cyclic (6-N preload; 5-N amplitude; 2-Hz frequency) tensile test (600 cycles) was performed on feline tarsi with either the long or the short medial tarsal ligament intact, with each reconstruction technique followed by a single-cycle load-to-failure test (0.5 mm/s) with a failure point at 2 mm of displacement. Total elongation, peak-to-peak elongation, stiffness, and maximum load to failure point were compared with the intact condition. RESULTS: No differences in stiffness, total elongation, or peak-to-peak elongation were found between specimens repaired with the knotless technique and intact controls (P > .04), whereas tarsi repaired with the tunnel technique and PP were weaker (P < .008). Total and conditioning elongation were greater after tunnel reconstruction with PP than after knotless reconstruction (P = .005). Mean load to 2 mm of displacement tended (P = .03) to be higher after knotless than after knotted PP repairs and did not differ (P = .47) between tarsi repaired with the tunnel or anchor repairs with PE. CONCLUSION: The mechanical properties of intact tarsi were superior to those of tarsi repaired with tunnel techniques and PP but were similar to those of tarsi repaired with knotless techniques with PE. CLINICAL SIGNIFICANCE: Feline tarsal stabilization with the knotless technique for tarsal medial collateral ligament insufficiency may reduce the requirement for or duration of postoperative coaptation.

6.
Vet Surg ; 49(2): 281-290, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31876001

RESUMO

OBJECTIVE: To characterize and evaluate risk factors for comorbidities and death of cats with pelvic fractures. STUDY DESIGN: Retrospective case study. ANIMALS: Cats (n = 280). METHODS: Medical records were reviewed for cats in which pelvic fractures had been diagnosed (January 2003 to November 2016). Retrieved data included signalment, mechanism of injury, clinical findings, diagnostic imaging investigations, type and number of concurrent injuries based on anatomical location, type of therapy, and survival. Pelvic fractures were classified according to location and severity. Descriptive statistics were performed, and logistic regression models were constructed to examine associations between risk factors and outcome. RESULTS: Cases consisted of 280 cats with no (9%), unilateral (43%), and bilateral (48%) involvement of the weight-bearing axis. Sacral fractures were found in 12% of cats. Surgical treatment and mortality rates increased progressively with the severity of the pelvic fractures (P < .001). Mean number of concurrent body regions injured was 2.4 ± 1.2 and was associated with mortality (P < .01). Twenty percent of cats did not survive to discharge. Cats with neurologic injuries were more likely not to survive (P = .02). CONCLUSION: Concurrent injuries to at least one body region, especially the abdomen and thorax, were observed in cats sustaining pelvic fractures. Mortality was associated with increased severity of the fractures, neurologic injuries, and increased number of concurrent injuries. CLINICAL SIGNIFICANCE: Concurrent injuries are common in cats with pelvic fractures, and comorbidities may be associated with mortality.

7.
Vet Clin North Am Small Anim Pract ; 50(1): 263-271, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635913

RESUMO

As the saying goes, "cats are not small dogs." Throughout veterinary medicine history, most of the literature focus has been on the canine. Feline patients, however, now constitute a larger proportion of the pet population and are unique in many aspects. They differ anatomically and biomechanically from canines and have specific recovery needs and different pain-related behaviors. It is important that veterinary surgeons understand these differences and improve their knowledge base in the treatment of cats. This article highlights the differences in cats relevant to minimally invasive fracture repair and how they affect a surgeon's approach to fractures in cats.


Assuntos
Placas Ósseas/veterinária , Doenças do Gato/cirurgia , Gatos/lesões , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Especificidade da Espécie
8.
Vet Clin North Am Small Anim Pract ; 50(1): 135-153, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31635915

RESUMO

Minimally invasive plate osteosynthesis (MIPO) is a biologically friendly approach to fracture reduction and stabilization that is applicable to many radius and ulna fractures in small animals. An appropriate knowledge of the anatomy of the antebrachium and careful preoperative planning are essential. This article describes the MIPO technique, which entails stabilization of the fractured radius with a bone plate and screws that are applied without performing an extensive open surgical approach. This technique results in good outcomes, including a rapid time to union and return of function.


Assuntos
Gatos/cirurgia , Cães/cirurgia , Membro Anterior/cirurgia , Fixação Interna de Fraturas/veterinária , Fraturas Ósseas/veterinária , Procedimentos Cirúrgicos Minimamente Invasivos/veterinária , Animais , Gatos/lesões , Cães/lesões , Membro Anterior/lesões , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia
9.
Vet Clin North Am Small Anim Pract ; 50(1): 241-261, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31653536

RESUMO

Arthrodesis is an elective surgical procedure that aims at eliminating pain and dysfunction by promoting deliberate osseous fusion of the involved joint(s). Percutaneous plating can be used to perform carpal and tarsal arthrodeses in dogs and cats. After cartilage debridement is performed, the plate is introduced through separate plate insertion incisions made remote to the arthrodesis site and advanced along an epiperiosteal tunnel, and screws are inserted through the 3 existing skin incisions. The primary advantage of this technique is a decreased risk of soft-tissue complications, including postoperative swelling, ischemia, and wound dehiscence. Preliminary clinical results have been promising.


Assuntos
Artrodese/veterinária , Placas Ósseas/veterinária , Fixação Interna de Fraturas/veterinária , Animais , Artrodese/métodos , Fixação Interna de Fraturas/métodos
10.
Vet Clin North Am Small Anim Pract ; 50(1): 101-121, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31653537

RESUMO

This article describes the technique of percutaneous pinning in dogs and cats. Only acute fractures evaluated within the first 48 hours after trauma are selected for percutaneous pinning. Reduction is performed with careful manipulation of the fracture to minimize the trauma to the growth plate. After ensuring the fracture is reduced anatomically, smooth pins of appropriate size are inserted through stab incisions or through large-gauge needles. Depending on the anatomic location, the pins are cut flush with the bone or bent over. The main advantages of this technique are the minimal surgical trauma and lower perioperative morbidity.


Assuntos
Pinos Ortopédicos/veterinária , Gatos/cirurgia , Cães/cirurgia , Fraturas Ósseas/veterinária , Animais , Gatos/lesões , Cães/lesões , Fraturas Ósseas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos
11.
Vet Surg ; 48(8): 1520-1529, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31441512

RESUMO

OBJECTIVE: To describe the application of a custom acetabular prosthesis (CAP) for total hip replacement (THR) in a dog 20 months after femoral head and neck ostectomy (FHNO). STUDY DESIGN: Case report. ANIMAL: A 10-year-old, male, castrated, Labrador retriever with progressive lameness and pain after FHNO. METHODS: Acetabular bone stock was assessed as insufficient for conventional THR, so a biflanged CAP was designed and three-dimensionally printed in titanium to bridge the bone defect. The CAP had a porous surface for long-term biologic fixation on the backside and was anchored to the ilium and ischium with screws. A polyethylene cup was cemented into the CAP, and a bolted cementless femoral stem was inserted. RESULTS: The loss of the conventional anatomic landmarks complicated intraoperative orientation and led to eccentric reaming and 5-mm malalignment of the CAP. Reduction of the prosthetic joint was difficult because of periarticular fibrosis, loss of functional muscle length, and thickness of the CAP, and intraoperative shortening of the stem neck was required. Postoperative complications included sciatic neurapraxia, which resolved with time and conservative management. Absence of pain and improvement of range of motion were observed at clinical examination 12 months after surgery; however, moderate hind limb lameness persisted due to muscle tension. No evidence of implant loosening was noted on radiographs acquired 24 months after surgery. CONCLUSION: Femoral head and neck ostectomy with poor functional outcome was ameliorated by using a CAP in this dog. CLINICAL SIGNIFICANCE: Use of a CAP can be considered to treat acetabular defects in dogs.

12.
Vet Comp Orthop Traumatol ; 32(5): 351-361, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31279326

RESUMO

OBJECTIVES: The Targon Vet System (TVS) is a 2.5-mm interlocking nail that can be applied minimally invasively. The purpose of this study was to test if the TVS could be safely applied percutaneously to different feline long bones without fluoroscopic guidance. METHODS: A gap fracture was created in 96 feline humeri, femora and tibiae (n = 32/group). Paired bones were randomly assigned to two treatment groups: (1) TVS inserted percutaneously with fluoroscopy and (2) TVS inserted percutaneously without fluoroscopy. Intraoperative evaluation (complications, procedure time, attempts), radiographs (pre-/postoperative alignment, length) and anatomical dissection (neurovascular injury, rotational alignment) were compared between treatment groups. RESULTS: The use of fluoroscopy did not lead to significant differences in any of the outcome measures. Intraoperative complications predominantly occurred in the distal humerus (12/32) and the proximal femur (7/32). In total, 20/96 complications occurred with no complications for the tibia. Neurovascular structures were only damaged at the medial side of the distal humerus (10/32). CLINICAL SIGNIFICANCE: We conclude that the TVS can be safely applied percutaneously to the tibia and with limitations to the femur in normal cadaveric cats without fluoroscopy. Despite the limitations of a cadaveric study, the high number of complications is leading us to consider the humerus not safe for the TVS. A learning curve has to be expected and technical recommendations should be respected to decrease complications.


Assuntos
Pinos Ortopédicos/veterinária , Gatos/cirurgia , Fraturas Ósseas/veterinária , Animais , Cadáver , Fêmur/cirurgia , Fluoroscopia/veterinária , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Úmero/cirurgia , Radiografia/veterinária , Tíbia/cirurgia
13.
Vet Comp Orthop Traumatol ; 32(6): 427-432, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31226723

RESUMO

OBJECTIVE: The aim of this study was to determine the accuracy and repeatability of the shoulder abduction test and to assess the effect of transection of the medial shoulder support structures in canine cadavers. MATERIALS AND METHODS: The shoulder abduction angle was measured by three separate observers, both with the shoulder extended and at a neutral angle. Shoulder abduction was then measured, using craniocaudal fluoroscopic images. Arthroscopy was performed in all shoulder joints, with the medial support structures transected in one shoulder of each dog. The three observers again measured shoulder abduction angles in all dogs. Shoulder abduction was measured again using fluoroscopy. Accuracy and repeatability of the abduction test were assessed using linear mixed models. RESULTS: All three observers had different measured abduction angles when compared with fluoroscopy (p < 0.01); however, the experienced surgeon had an error of only 2.9°. Inter-observer repeatability was poor, with all three observers having different abduction measurements (p < 0.001). Intra-observer repeatability, however, indicated no differences on repeated measurements (p = 0.26). Placing the shoulder at a neutral standing angle, and transection of support structures caused an average increase in abduction by 8.2° (p < 0.001) and 4.4° respectively. CONCLUSION: Significant variation exists between observers performing this test, increased accuracy seen in the more experienced observer. Shoulder flexion angle can significantly affect measured abduction angles.

14.
Vet Surg ; 48(4): 546-555, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30828854

RESUMO

OBJECTIVE: To compare the quality of visualization of canine carpal ligaments by using computed tomography (CT), MRI, CT arthrography (CTA), and magnetic resonance arthrography (MRA). STUDY DESIGN: Prospective descriptive study. STUDY POPULATION: Cadavers from dogs weighing more than 20 kg. METHODS: A 16-slice CT scanner and a 3 Tesla MRI were used for the investigation. A dilute contrast medium was injected into the middle carpal and radiocarpal joints under fluoroscopic control, and CTA and MRA images were acquired. To evaluate the difference between imaging modalities, 3 observers graded carpal ligaments of clinical interest using a scale from 0 to 4 for their quality of visualization. Data were analyzed by using a random-effect ordinal logistic regression with Bonferroni adjustment. The interobserver agreement was calculated by using the weighted Cohen's κ. RESULTS: Normal carpal joints (n = 9) were investigated. Magnetic resonance arthrography improved visualization of the majority of carpal ligaments compared with MRI (P < .05) and offered the best visualization overall. Magnetic resonance imaging and MRA offered better visualization compared with both CT and CTA (P < .05). There was no difference between CT and CTA. Interobserver agreement was discrete (0.2 < κ ≤ 0.4) for all observers. CONCLUSION: Arthrography improved the capabilities of MRI but not of CT for visualization of the canine carpal ligaments. Magnetic resonance arthrography was particularly useful for evaluation of the stabilizers of the antebrachiocarpal joint. CLINICAL SIGNIFICANCE: 3 Tesla MRA and MRI allow excellent visualization of the ligamentous morphology and may be helpful in the diagnostic process of carpal sprains in dogs.


Assuntos
Artrografia/veterinária , Carpo Animal/diagnóstico por imagem , Cães/anatomia & histologia , Ligamentos Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética/veterinária , Tomografia Computadorizada por Raios X/veterinária , Animais , Artrografia/métodos , Cadáver , Articulações do Carpo/anatomia & histologia , Meios de Contraste , Ligamentos Articulares/anatomia & histologia , Estudos Prospectivos
15.
Vet Surg ; 48(3): 437-443, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30820982

RESUMO

OBJECTIVE: To report the successful use of cerclage cables around the periprosthetic region of a femoral fracture after total hip replacement (THR) in a dog with bone stock too limited for other methods of fixation. STUDY DESIGN: Case report. ANIMAL: 6-year-old male neutered, golden retriever. METHODS: Locking plate fixation of a type-B1 diaphyseal periprosthetic femoral fracture (PFF) failed 14 days after cementless THR and 6 days after initial femoral fracture repair. Total hip replacement implants seemed unchanged on radiographs, but lateral retraction of the screw-plate construct from the proximal segment was evident. Bone stock was assessed as insufficient for adequate screw purchase, prompting revision of the fixation with cerclage cable fixation of the proximal segment; the cables were anchored to the original locking plate construct with threaded positioning pins that screwed into the locking holes. RESULTS: Acceptable union was documented on radiographs by 3 months after revision. No lameness and good range of motion of the hip were observed on clinical examination 13 months after surgery. Radiographs at 13 months documented static implant positioning and remodeling at the fracture site. CONCLUSION: Use of a cable-plate construct to stabilize a type-B1 PFF led to successful long-term outcome in this dog. CLINICAL SIGNIFICANCE: Use of a cable-plate construct may be considered to treat type-B1 PFF with limited bone stock.


Assuntos
Artroplastia de Quadril/veterinária , Fios Ortopédicos , Fraturas do Fêmur/veterinária , Fixação Interna de Fraturas/veterinária , Fraturas Periprotéticas/veterinária , Animais , Artroplastia de Quadril/métodos , Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Cães , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/métodos , Masculino , Fraturas Periprotéticas/cirurgia
16.
Am J Vet Res ; 80(3): 235-245, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30801208

RESUMO

OBJECTIVE To provide an objective, quantitative morphometric description of the caudal cervical intervertebral disk (IVD) spaces of dogs. SAMPLE Vertebral specimens consisting of C4 through C7 from 5 medium-sized dogs. PROCEDURES CT images were obtained with the specimens positioned in neutral, flexion, extension, and lateral bending positions. Size and shape of the cranial and caudal end plates, angle between the end plates (IVD wedge angle), and craniocaudal distance (IVD width) between end plates for the 4 loading positions were measured and compared for the 3 segments (C4-5, C5-6, and C6-7). RESULTS End plate size and shape, IVD wedge angle, and IVD width were not significantly different among the 3 segments. Caudal cervical end plates were consistently larger than cranial cervical end plates. The IVD wedge angle ranged from -4.8° to 15.2°. Flexion induced a reduction in IVD width in the ventral portion of the IVD, whereas extension induced a decrease in width in the dorsal portion of the IVD. Central IVD width remained unchanged among the loading positions. CONCLUSIONS AND CLINICAL RELEVANCE Unique morphometric and dynamic characteristics of the caudal cervical IVD space of dogs were detected. These findings may help investigators when designing IVD prostheses for dogs with cervical spondylomyelopathy.


Assuntos
Vértebras Cervicais/anatomia & histologia , Cães/anatomia & histologia , Disco Intervertebral/anatomia & histologia , Tomografia Computadorizada por Raios X/veterinária , Animais , Fenômenos Biomecânicos , Placas Ósseas , Feminino , Masculino , Amplitude de Movimento Articular
17.
Vet Surg ; 48(1): 88-95, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30422336

RESUMO

OBJECTIVE: To determine the biomechanical properties of plating techniques for comminuted feline ilial fractures. STUDY DESIGN: Ex vivo study on 40 paired feline hemipelves. SAMPLE POPULATION: Forty paired fresh-frozen hemipelves that had been collected from 20 cats aged 2-6 years and weighing 4.0-5.5 kg. METHODS: A transverse 3-mm gap was created in each ilium. Hemipelves were fixed with one of the following methods (n = 10 per group): (1) a dorsal plate and nonlocking screws, (2) a lateral plate and nonlocking screws, (3) a lateral plate and locking screws, or (4) a lateral and dorsal locking compression plate using nonlocking screws. Each specimen was subjected to incremental, sinusoidal cyclic loading until failure, defined as 10-mm displacement. The initial stiffness and number of cycles required to reach 1-, 2-, 5-, and 10-mm axial displacement were statistically analyzed. RESULTS: The initial stiffness and number of cycles to failure were higher in specimens fixed with double nonlocking plates than in all other fixations (P < .05) except specimens fixed with lateral locking plate at 10-mm displacement (P = .44). Locking implants withstood more cycles to 5- (P < .05) and 10-mm (P < .05) displacement compared with other single-plate nonlocking groups. Screw loosening occurred only in the 3 nonlocking fixations. CONCLUSION: Double plating improved stiffness and resistance to failure of comminuted feline ilial fracture constructs compared with all other fixations. Single locking plates produced superior constructs compared with single nonlocking constructs. CLINICAL SIGNIFICANCE: Locking implants are recommended to repair comminuted feline ilial fractures for their extended fatigue life and resistance to screw loosening. Orthogonal plating offers a strong nonlocking alternative.


Assuntos
Placas Ósseas/veterinária , Gatos/cirurgia , Fixação Interna de Fraturas/veterinária , Ílio/cirurgia , Animais , Fenômenos Biomecânicos , Parafusos Ósseos/veterinária , Cadáver
18.
Open Vet J ; 9(3): 205-215, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31998613

RESUMO

Background: Medial coronoid process disease is the most common manifestation of canine developmental elbow disease which can progress to a more severe medial compartment disease (MCompD) characterized by full-thickness cartilage loss of the medial coronoid process and the medial humeral condyle. Among others, the "Canine Unicompartmental Elbow" (CUE) has been reported to be an effective treatment strategy for MCompD, with full in 47.6% and acceptable function in 43.7% at 6 months or later of follow-up. Aim: To report on our clinical experiences with the CUE system using the caudo-medial approach in terms of both complications and functional outcome. Methods: Medical records of dogs that underwent CUE procedure using a caudo-medial approach over a 3-year period were retrospectively reviewed. This covered epidemiological data, bi-planar radiographs, subjective gait analysis, owner questionnaire, surgical reports, as well as second-look arthroscopic findings when available. Results: In total, 52 CUE procedures were performed in 44 dogs with a median age of 8.0 years (IQ: 5.0-10.0) and a median bodyweight of 31.9 kg (ranging 20-48 kg) at the surgery. Four cases never return for follow-up, but were included in the analysis to increase the number of cases with pre- and intra-operative data. Mean follow-up time available for the remaining 48 cases was 7.1 (SD: 5.2) months. Radiographic derived implant positioning and alignment proved to be satisfactory in the sagittal plane but parallelism in the frontal plane was only present in three cases. Second-look arthroscopy in five cases with delayed or disappointing functional improvement showed evidence of implant-related contact lesions and progressive erosion of the medial coronoid area in three elbows. Overall, complications occurred in 11 cases (21%), being major in eight (15%) and minor in three (6%). Major complications included refractory pain and lameness 6 to 12 months postoperatively in five cases. At last follow-up, 12 cases (25%) were considered to have full function, 35 cases (73%) acceptable function, and in one case, the function was considered unacceptable. As the only variable related to functional outcome, age had a negative predictive value for full function. Conclusion: The CUE procedure appears to be an effective treatment option for patients with MCompD. Older dogs might be at risk of having an inferior clinical outcome when compared to young patients. The reason for this is unknown and will have to be evaluated in future studies. Compared to a CUE case series of 103 elbows operated through a medial approach, using a caudo-medial approach decreased the incidence of approach-related complication. Nevertheless, the functional outcome in the current case series was less favorable than previously reported. These conflicting findings as well as the occurrence of potentially implant mechanical conflict at the medial joint compartment despite CUE warrants further studies.

19.
Vet Surg ; 47(8): E70-E78, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30267588

RESUMO

OBJECTIVE: To determine current methods of arthroscopic skills training and proficiency assessment, identify skills considered fundamental to arthroscopy, and evaluate desire for a formal training and assessment program. STUDY DESIGN: Anonymized electronic survey. SAMPLE POPULATION: Diplomates and residents of the American College of Veterinary Surgeons (ACVS) and European College of Veterinary Surgeons (ECVS). METHODS: An electronic survey was distributed in commercial software (Qualtrics, Provo, Utah). Questions were divided into 4 categories: (1) demographics, (2) arthroscopy experience, (3) teaching, and (4) proficiency assessment. Descriptive statistical analysis was performed. Comparisons between groups were performed by using χ2 , t tests, and 1-way ANOVA (P ≤ .05). RESULTS: In total, 429 diplomates and 149 residents responded (response rate 28%). Overall, 80% of respondents trained using clinical cases. Barriers to simulator training included cadaver/simulator availability and time. Skills deemed most fundamental included anatomic knowledge, precise portal placement, triangulation, and image orientation. Overall, 90% of respondents supported a formal training program with requirement to demonstrate proficiency; 80% believed this should be part of standard ACVS/ECVS residency training. CONCLUSION: Arthroscopic skills are taught by using clinical cases, with subjective proficiency assessment. Fundamental skills are those that may be taught using simulators. There is enthusiasm for formal arthroscopic skills training and assessment. CLINICAL SIGNIFICANCE: Improved acquisition and assessment of fundamental arthroscopic skills is indicated. A validated methodology for formal training using simulators, minimizing morbidity, and facilitating objective evaluation is warranted. This is the first phase of a project to develop and validate a simulator program.


Assuntos
Artroscopia/veterinária , Competência Clínica , Internato e Residência , Animais , Artroscopia/educação , Educação em Veterinária , Europa (Continente) , Humanos , Avaliação de Programas e Projetos de Saúde , Treinamento por Simulação , Sociedades Veterinárias , Cirurgiões , Inquéritos e Questionários , Estados Unidos
20.
Vet Surg ; 47(6): 817-826, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30091179

RESUMO

OBJECTIVE: To test the feasibility and safety of an arthroscopic imbrication of the medial glenohumeral ligament (MGHL) and the subscapularis tendon with knotless anchors in dogs. STUDY DESIGN: Cadaveric study. SAMPLE POPULATION: Ten limbs. METHODS: Cranial and caudal arms of the MGHL were imbricated with a 2.9- or a 2.4-mm knotless anchor. A horizontal mattress suture secured with a 3.5-mm knotless anchor was used to imbricate the subscapularis tendon. Computed tomography measurements included (1) the bone stock around the anchors, (2) the angle between the anchor and the joint surface (insertion angle), and (3) the angle formed by lines tangent to the cortices of the bones (safety angle). Limbs were dissected to assess the position of anchors. Safety and insertion angles and bone stock were compared among anchors with a Kruskal-Wallis test (P < .05). RESULTS: Surgical repairs were achieved in all limbs, with only 2 of 30 anchors incorrectly placed, both in the glenoid. The safety angle of the humeral anchor (HA; median, 89°) was greater than that of the cranial glenoid anchor (CrGA; P = .0017) and the caudal glenoid anchor (CdGA; P < .001). The insertion angle of the HA (median, 68°) was also greater than that of the other anchors (P < .001 and P = .001). The insertion angle of the CrGA (median, 26°) was greater (P = .0191) than that of the CdGA (median, 7°). All anchors were inserted at the MGHL and subscapularis footprint. CONCLUSION: Arthroscopic imbrication of MGHL and subscapularis tendon was feasible. HA were safer to place than glenoid anchors. CLINICAL SIGNIFICANCE: The results of this feasibility study justify further evaluation of the indications and outcomes of this technique in dogs with shoulder instability.


Assuntos
Artroscopia/veterinária , Instabilidade Articular/veterinária , Ligamentos Articulares/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Técnicas de Sutura/veterinária , Animais , Artroscopia/métodos , Cadáver , Cães , Instabilidade Articular/cirurgia , Escápula/cirurgia , Técnicas de Sutura/instrumentação , Suturas/veterinária , Tomografia Computadorizada por Raios X/veterinária
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