Highly Comminuted, Articular Fractures of the Distal Antebrachium Managed by Pancarpal Arthrodesis in 8 Dogs.

OBJECTIVE: To describe the surgical management by pancarpal arthrodesis for highly comminuted articular fractures of the distal antebrachium in 8 dogs. STUDY DESIGN: Retrospective clinical case series. ANIMALS: Eight dogs. METHODS: Medical records (2001-2014) of dogs with antebrachial fractures were reviewed and dogs with highly comminuted distal antebrachial fractures were identified. The nature of the injury, surgical management by pancarpal arthrodesis, outcome, and complications were recorded. RESULTS: Nine fractures occurred in 8 dogs. Seven dogs were ex-racing greyhounds (8 fractures) and of these, 6/7 dogs had fractures of the right thoracic limb. Compared with the hospital population of dogs with antebrachial fractures, greyhounds were over-represented for the antebrachial injury (odds ratio 117, 95% confidence interval 13-1022). Five dogs sustained injury during exertional exercise or with relatively minor trauma. Submitted bone samples (n = 4) showed no evidence of underlying neoplasia. Mean followup was 15.5 months with 11 complications recorded in 7/8 dogs, including 1 catastrophic, 5 major, and 5 minor complications. Pancarpal arthrodesis allowed a full functional outcome in 3 dogs and an acceptable outcome in 3. CONCLUSION: Comminuted articular fractures of the distal radius and ulna are complex injuries and have a similar presentation to pathologic fractures. Surgical management by pancarpal arthrodesis is associated with a high risk of complication and a guarded prognosis for a full functional outcome.

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.

In vitro performance testing of two arcuate oscillating saw blades designed for use during tibial plateau leveling osteotomy.

OBJECTIVE: To test the cutting performance of 2 commercially available oscillating saws designed for use during tibial plateau leveling osteotomy (TPLO) and to evaluate the influence of saline irrigation on cutting performance. STUDY DESIGN: In vitro experimental study. SAMPLE POPULATION: Composite polyurethane test blocks (n=40); 24 m TPLO saw blades. METHODS: Controlled force cutting tests were performed using custom-made laminated bone substitute blocks to model the canine proximal tibia. Half of the trials were irrigated with 0.9% saline solution. Outcome measures were test block temperature (measured 1.5 m from the cutting zone), cutting rate, and cutting surface wear. Durability was measured by recording change in performance over multiple consecutive trials. RESULTS: The Synthes blade cut the test blocks with ∼64% less heat generation and at a 63% faster cutting rate compared with the Slocum blade. Although wear of the Synthes blade was ∼50% greater after 19 uses, this did not negatively impact cutting performance. Saline irrigation produced no significant effect on peak cutting temperature but significantly reduced cutting rate for both saws. CONCLUSIONS: Our results favor the Synthes blade in terms of cutting performance and the Slocum blade in terms of wear resistance.

Clinical evaluation of pancarpal arthrodesis using a CastLess plate in 11 dogs.

OBJECTIVE: To describe the use of a 3.5/2.7 mm CastLess Plate (CLP) for pancarpal arthrodesis (PCA) in dogs. STUDY DESIGN: Case series. ANIMALS: Dogs with traumatic/degenerative carpal disease (n=11). METHODS: Records (September 2006-July 2007) of dogs that had PCA using a 3.5/2.7 mm CLP were reviewed to determine intra- and postoperative complications and use of external coaptation. Follow-up (> or =12 months) was obtained by telephone interview of owners. RESULTS: Thirteen PCA procedures were performed; 5 intraoperative complications occurred in 4 procedures and included iatrogenic metacarpal fissure fracture (2), inability to remove an alignment pin (1), and poor distal plate position (2). External coaptation was used in 4 dogs: concomitant or iatrogenic injuries (3), bilateral PCA (1), for 3-6 weeks. Clinical evaluation 6-24 weeks postoperatively revealed iatrogenic metacarpal fractures to have healed and that 1 postoperative complication (infection) developed. Telephone follow-up for 10 dogs (mean, 14 months; range, 12-20 months) revealed no further problems. CONCLUSION: PCA using a 3.5/2.7 mm CLP reduces the need for external coaptation and seemingly reduces postoperative morbidity associated with other internal fixation techniques. CLINICAL RELEVANCE: PCA can be performed safely and successfully using a 3.5/2.7 mm CLP, with low postoperative morbidity compared with other PCA techniques. Particular attention should be taken when applying the distal component of the plate.

Ex vivo evaluation of the effect of tibial plateau osteotomy on the proximal tibial soft tissue envelope with and without the use of protective gauze sponges.

OBJECTIVE: To investigate the effect of tibial plateau leveling osteotomy (TPLO) on the proximal tibial soft tissue envelope with and without use of protective gauze sponges, and to determine whether the action of an oscillating saw blade on the gauze sponges would result in retention of particulate cotton debris. STUDY DESIGN: Cadaveric study. ANIMALS: Medium to large breed dog cadavers (n=10; 20 pelvic limbs). METHODS: TPLO was performed using the currently recommended technique involving dissection of the proximal tibial soft tissue envelope and its protection using cotton gauze sponges. In paired limbs, the procedure was repeated but no attempt was made to retract and protect the proximal tibial soft tissue envelope. Damage to the soft tissue envelope and presence of gross particulate cotton debris were investigated by direct observation and photographic analysis. Presence of microscopic cotton debris was investigated using light microscopic analysis of wound lavage fluid. RESULTS: No soft-tissue trauma was found in gauze sponge-protected specimens. When protective gauze sponges were not used, full-thickness (sagittal plane) lacerations to the caudoproximal tibial muscle group occurred in all specimens with a mean craniocaudal width of 9.5 mm (range 2-12 mm). The cranial tibial muscle was traumatized in only 1 specimen without protective gauze sponges. Trauma to the popliteal vessels was not identified in any specimen. No gross cotton debris was identified, but microscopic cotton fibers (diameter, 7-35 microm) were identified in lavage fluid from all gauze sponge-protected specimens. CONCLUSIONS: Use of protective gauze sponges is effective in protecting the proximal tibial soft tissue envelope from an oscillating TPLO saw blade, but results in retention of microscopic cotton particulate debris within the operative site. Significant soft tissue trauma is seen only in the caudoproximal tibial muscle group if protective gauze sponges are not used. CLINICAL RELEVANCE: Retraction and protection of the caudoproximal tibial soft tissue envelope is recommended during TPLO; however, to prevent retention of microscopic particulate cotton debris, alternatives to cotton gauze sponges should be considered as protective devices.

Circumcaval ureter associated with an intrahepatic portosystemic shunt in a dog.

CASE DESCRIPTION: A 4-month-old Bernese Mountain Dog was examined because of shifting hind limb lameness and lethargy of 2 weeks' duration. CLINICAL FINDINGS: The lameness was attributed to hypertrophic osteodystrophy. Portosystemic shunting was suspected on the basis of low serum albumin concentration and high serum bile acids concentration, and an intrahepatic shunt was identified ultrasono-graphically. Celiotomy was performed, and the shunt was partially closed with a cellophane band. During follow-up ultrasonography 7 months later, dilation of the left renal pelvis and proximal portion of the left ureter was identified. During exploratory celiotomy, the left ureter was found to pass dorsal to the caudal vena cava, and circumcaval ureter was diagnosed. TREATMENT AND OUTCOME: The ureter was transected, repositioned ventral to the vena cava, and anastomosed. Follow-up ultrasonographic examinations revealed gradual resolution of the hydronephrosis and hydroureter. CLINICAL RELEVANCE: Findings suggest that circumcaval ureter should be considered in the differential diagnosis for hydronephrosis and hydroureter in dogs. Partial obstruction of the middle segment of the ureter on ultrasonograms or contrast radiographs should increase the index of suspicion for this condition.