Management of proximal metaphyseal curvilinear tibial fractures in 25 skeletally immature dogs (2009 to 2020).

OBJECTIVES: To describe the occurrence, management and outcome of proximal metaphyseal curvilinear tibial fractures in skeletally immature dogs. MATERIALS AND METHODS: A multi-centre retrospective review was conducted, searching for skeletally immature dogs presenting with proximal metaphyseal curvilinear tibial fractures between January 2009 and September 2020. Signalment, fracture description and case management data were retrieved. Outcome was assessed by retrospectively evaluating follow-up radiographs, hospital records and an owner questionnaire. RESULTS: Twenty-five dogs met the inclusion criteria. All but one fracture was a result of minimal trauma. Twenty fractures were managed with internal fixation, two with external fixation and three conservatively. All 25 fractures healed. Eight major complications occurred in seven of 25 (28%) dogs. Twelve minor complications occurred in 10 of 25 (40%) dogs. Owner questionnaire data were available for 12 of 25 dogs; 11 of 12 were reported as having full function and one of 12 as having acceptable function at the time of questioning (median 34.5 months following presentation). At final follow-up, either by clinical examination or owner questionnaire, full function was achieved in 22 of 25 patients and acceptable function in three of 25. CLINICAL SIGNIFICANCE: This study reported a series of proximal metaphyseal tibial fractures in skeletally immature dogs. The most common fixation method was internal fixation, which frequently resulted in full limb function at final follow-up. Owners reported outcome as fully functional in all dogs that underwent surgery at first presentation and had owner follow-up available, though positive outcomes may have been affected by participation bias.

Defining a safe corridor for trans-iliac pin placement in cats.

OBJECTIVE: To identify whether a theoretical predictable safe corridor is available in cats for placement of trans-iliac pins without the use of fluoroscopy. METHODS: Twenty-one cats with straight orthogonal normal pelvic radiographs were included. Two start points were evaluated: a midpoint and a dorsal point. The midpoint was defined as midway between the dorsal lamina of the sacral vertebral canal and the cranial dorsal iliac spine. The dorsal start point was 2 mm ventral to the cranial dorsal iliac spine. The pin was assumed to be driven at 90 degrees to the lateral face of the ilium, and considered surgeon accuracy was ±4 degrees from the perpendicular. The angular range and the distance between the iliac wings from the ventrodorsal radiograph were used to calculate the possible cross-sectional area and pin exit location if driven from one iliac wing to the other. The corridor was then evaluated for repeatability in six randomly selected cats. RESULTS: Vertebral foramina penetration risk was identified in some cats when using a 1.6 and 2 mm-diameter pin using the mid-iliac wing start point. The dorsal start point decreased the available pin placement area but reduced the risk of entering the hazardous zone for all pin sizes up to 2 mm. CONCLUSION AND RELEVANCE: A theoretical defined safe corridor is available for trans-iliac pin placement in cats between 2.0 and 5.5 kg. A 1.2-mm pin is the safest if using the mid-iliac wing start point. A more dorsal start point can accommodate up to a 2.0-mm pin if correctly aligned to the sacrum.

Multi-centre retrospective study of the long-term outcome following suspected traumatic elbow luxation in 32 cats.

OBJECTIVES: To describe reduction techniques and clinical outcome in a series of traumatic elbow luxations in cats. MATERIALS AND METHODS: Retrospective review of unilateral elbow luxations treated at five specialist referral centres. Data included signalment, aetiology, concurrent injuries, luxation direction, time to reduction, primary reduction technique, surgical procedure and complications. Cases were excluded if reduction technique was unknown. Telephone owner questionnaire follow-up was completed using a Feline Musculoskeletal Pain Index. RESULTS: Thirty-two cats were included. Lateral luxations were most common (n = 21). Time (hours) until attempted initial closed reduction was <24 (n = 12), 24-48 (n = 13), >48 (n = 3) or unrecorded (n = 4). Luxation was treated by closed reduction alone (n = 7) or by surgery (n = 25); 14 of 25 cases underwent primary surgical reduction and 11 of 25 were secondary procedures following failure of closed reduction. Transcondylar bone tunnels and circumferential suture (n = 19) was the most commonly used surgical technique. Catastrophic (n = 1), major (n = 11) and minor complications (n = 5) were recorded; reluxation occurred more frequently after closed reduction (n = 8) than after open reduction with fixation (n = 0). Feline Musculoskeletal Pain Index data were available for 12 cats; outcome was good-excellent in all 12, with a median function score of 64.5/68 (range: 55-68) and a median pain score of 0/15 (range: 0-5). Outcome was not associated with reduction technique. CLINICAL SIGNIFICANCE: Elbow reluxation occurred in 61% of cats following primary closed reduction but did not occur in any open reduction cases. Reluxation rate increased with duration from injury. Most cats had good-excellent owner-assessed outcome, regardless of reduction technique.

Relationship between Tibial conformation, cage size and advancement achieved in TTA procedure.

BACKGROUND: Previous studies have suggested that there is a theoretical discrepancy between the cage size and the resultant tibial tuberosity advancement, with the cage size consistently providing less tibial tuberosity advancement than predicted. The purpose of this study was to test and quantify this in clinical cases. The hypothesis was that the advancement of the tibial tuberosity as measured by the widening of the proximal tibia at the tibial tuberosity level after a standard TTA, will be less than the cage sized used, with no particular cage size providing a relative smaller or higher under-advancement, and that the conformation of the proximal tibia will have an influence on the amount of advancement achieved. RESULTS: One hundred sixty-four dogs met the inclusion criteria. The mean percentage under-advancement was 15.5%. All dogs had an advancement less than the stated cage size inserted. An association between the proximal tibial tuberosity angle (increased in cases with low patellar tendon insertion), and percentage under-advancement was found, with an increase of 0.45% under-advancement for every 1 degree increase in angle a (p = 0.003). There was also evidence of a difference between the mean percentage under-advancement in breeds (p = 0.001) with the Labrador having the biggest under-advancement. Cage size (p = 0.83) and preoperative tibial plateau angle (p = 0.27) did not affect under-advancement. CONCLUSIONS: The conformation of the tibial tuberosity and therefore the relative cage positioning have an impact on mean percentage under-advancement of the tibial tuberosity after standard TTA. In all evaluated cases, the advancement of the tibial tuberosity was less than intended by the cage size selected.

Multi-centre retrospective study of long-term outcomes following traumatic elbow luxation in 37 dogs.

OBJECTIVES: Limited guidelines exist regarding the optimal treatment of traumatic canine elbow luxation, and there is a lack of information on long-term functional outcome. Here we report reduction and stabilisation techniques for a series of traumatic elbow luxations and describe clinical outcome plus long-term questionnaire-based follow-up. METHODS: Retrospective review of canine traumatic elbow luxations (2006 to 2013) treated at five referral centres. Data recorded included signalment, luxation aetiology, time to reduction, reduction technique, surgical procedure, post-reduction care and complications. Questionnaire follow-up was attempted for all cases with owners completing the Canine Brief Pain Inventory. RESULTS: Thirty-seven dogs were included. The most frequent cause of luxation was road traffic accident (n=22). Twenty cases were treated surgically. Seven dogs suffered major postoperative complications: reluxation (n=6), infection requiring implant removal (n=1). Four of the six reluxations occurred in dogs that had other orthopaedic injuries. Twenty-two owners completed the Canine Brief Pain Inventory questionnaire: there were 13 excellent, 6 very good, 1 good and 2 fair outcomes. Outcome was not associated with the reduction technique. CLINICAL SIGNIFICANCE: Initial closed reduction, followed by surgical stabilisation if unsuccessful, results in good-to-excellent outcomes in the majority of traumatic canine elbow luxations. Reluxation was the most common major complication and there was a higher incidence of reluxation in patients with multiple orthopaedic injuries.

Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. A retrospective study of sixty dogs and cats.

OBJECTIVES: Casts applied for orthopaedic conditions can result in soft-tissue injuries. The purpose of our study was to describe the nature and prevalence of such complications. METHODS: We performed a retrospective review of medical records of dogs and cats that had a cast placed for an orthopaedic condition between October 2003 and May 2009. The data were analysed and categorised. RESULTS: Of the 60 animals that had a cast placed, 63% developed a soft-tissue injury (60% mild, 20% moderate and 20% severe). Injuries could occur any time during coaptation, and an association with duration of casting and severity (p = 0.42) was not shown. Severe injuries took the longest to resolve (p = 0.003). Sighthounds were significantly more likely to develop a soft-tissue injury (p = 0.04), and cross-breeds were less likely (p = 0.01). All common calcaneal tendon reconstructions suffered soft-tissue injuries, but significance was not shown (p = 0.08). Veterinarians identified the majority of injuries (80%) rather than the owners. The financial cost of treating soft-tissue injuries ranged from four to 121% the cost of the original orthopaedic procedure. CLINICAL SIGNIFICANCE: Soft-tissue injuries secondary to casting occur frequently, and can occur at any time during the casting period. Within our study, sighthounds were more likely to develop soft tissue injuries, and should therefore perhaps be considered as a susceptible group. The only reliable way to identify an injury is to remove the cast and inspect the limb.