Clinical outcomes of double pelvic osteotomies in eight dogs with hip dysplasia aged 10-28 months.

OBJECTIVE: To report the short-term outcome of double pelvic osteotomy (DPO) in dogs with canine hip dysplasia ≥10 months of age. STUDY DESIGN: Case series. ANIMALS OR SAMPLE POPULATION: Eleven hips in eight dogs aged between 10 to 28 months. METHODS: Dogs clinically affected by hip dysplasia with a hip reduction angle <40°, subluxation angle <25°, dorsal acetabular rim angle between 7.5-25°, and minimal osteoarthritic changes were considered as candidates for DPO. The clinical outcome was subjectively assessed using a lameness score and pain scale upon hip extension. Norberg angle, percentage of the area of the femoral head coverage, percentage of linear femoral head coverage, pelvic width dimensions were measured on pre and postoperative radiographs. RESULTS: At the 8-week follow-up examination, all the dogs had no lameness with no pain upon hip extension. Median Norberg angle increased by 21.8% (p < .01), median percentage of the area of the femoral head coverage increased by 66.7% (p < .01) and percentage of linear femoral head coverage increased by 162.5% (p < .01) 1 year after DPO. No changes to pelvic canal width after DPO were detected. CONCLUSION: Double pelvic osteotomy improved joint congruity and clinical signs in dogs affected by hip dysplasia without osteoarthritis that were ≥10 months of age. CLINICAL SIGNIFICANCE (OR IMPACT): Double pelvic osteotomy may be a treatment option for dogs with hip dysplasia ≥10 months of age. A large study assessing long-term outcomes is indicated.

Outcome of rest with or without bandaging for treatment of carpal flexural contracture deformities in puppies: 47 puppies and 75 joints (2000-2018).

OBJECTIVE: To review outcome of dogs with carpal flexural contracture deformities treated with rest alone or with rest and bandaging. ANIMALS: 47 dogs (75 joints). PROCEDURES: Medical records of dogs with unilateral or bilateral carpal flexural contracture deformities were reviewed, and dogs were grouped according to deformity severity grade (graded on a scale from 1 to 3) at the time of diagnosis. Two treatment groups were compared: rest only and rest with a modified Robert-Jones bandage. All dogs were reevaluated weekly until recovery (ie, resolution of the deformity and lameness). RESULTS: All dogs responded to conservative management, with all dogs regaining full extension of the antebrachiocarpal joint and ambulating normally at the time of the final visit. Mean ± SD time from initial diagnosis to recovery (ie, resolution of the deformity and lameness) was 2.9 ± 2.2 weeks (median, 2 weeks; range, 1 to 9 weeks). For dogs with grade 1 or 2 severity, mean time to recovery did not differ significantly between treatment groups. For dogs with grade 3 severity, however, mean time to recovery was significantly shorter for dogs treated with rest and bandaging than for dogs treated with rest alone. CLINICAL RELEVANCE: Results suggested that conservative management (rest alone or rest and bandaging) was a successful treatment option for puppies with carpal flexural contracture deformity and that bandaging resulted in a shorter time to recovery for dogs that were severely affected.

Radiographic Recognition of Tarsal Malformation in 8- to 9-Week-Old Bernese Mountain Dogs.

INTRODUCTION: Tarsal malformation is a skeletal malformation of unknown aetiology associated with a variety of morphologic changes to the tarsal and metatarsal bones of the dog. OBJECTIVE: The aim of this study was to determine if early diagnosis and prevalence of tarsal malformation could be obtained at approximately 8 to 9 weeks of age in multiple litters of Bernese Mountain dogs. METHODS: A prospective study of 51 Bernese Mountain dog puppies were evaluated from 12 litters in northern Italy. Dorsoplantar radiographic views of the tarsus were obtained at 60 ± 5 days of age. Tarsal malformation was defined as an abnormal extension of the central tarsal bone on its medial side, or the presence of ectopic bone located medially to the central tarsal bone, talus and second metatarsal bones (proximomedial, distomedial and metatarsal ossification sites respectively). RESULTS: All puppies were found to be clinically normal. Thirty-nine of the 51 puppies showed ossification sites medial to the tarsus as defined. A metatarsal ossification was present in all dogs with either a proximo- or distomedial ossification site. No central tarsal bone extensions were observed. The remainder of the tarsometatarsal joints were normal. CLINICAL SIGNIFICANCE: Tarsal malformation can be identified in the 8- to 9-week-old Bernese Mountain dog. The clinical significance of tarsal malformation remains to be determined, either as an incidental finding or a precursor to the development of other clinically relevant and related issues in the tarsus.

Good Inter- and Intra-Observer Reliability for Assessment of Radiographic Femoral and Tibial Frontal and Sagittal Planes Joints Angles in Normal Cats.

OBJECTIVE: The aim of this study was to evaluate the inter- and intra-observer reliability of plain digital radiographs for assessing normal feline femoral and tibial joint reference angles in the sagittal and frontal planes. STUDY DESIGN: This was a cadaveric radiographic anatomical study. that involved 20 short-haired domestic adult cats. MATERIALS AND METHODS: Sagittal and frontal plane tibial and femoral joint angles of 40 limbs were measured twice by three observers with different levels of experience. Inter- and intraobserver reliability was determined by the intra-class correlation coefficient (ICC). An ICC > 0.75 was considered high correlation, 0.74 > ICC > 0.60 good correlation, 0.59 > ICC > 0.4 fair correlation and an ICC < 0.40 poor correlation. RESULTS: Mean ± standard deviation angles were anatomic lateral proximal femoral angle (aLPFA) 110.6 ± 3.6; anatomic lateral distal femoral angle (aLDFA) 91.9 ± 2.1; mechanical lateral proximal femoral angle; mLPFA (mLPFA) 107.3 ± 3.6; mechanical lateral distal femoral angle (mLDFA) 95.5 ± 1.7; femoral neck anteversion (FNA) 121.9 ± 4.1; anatomical caudal proximal femoral angle (aCPFA) 156.1 ± 3.9; anatomical caudal distal femoral angle (aCDFA) 101.4 ± 1.4; mechanical medial proximal tibial angle (mMPTA) 93.5 ± 1.2; mechanical medial distal tibial angle (mMDTA) 100.5 ± 2.3; mechanical cranial proximal tibial angle (mCrPTA) 113.1 ± 3.2; tibial plateau angle (TPA) 23.1 ± 3.2; mechanical cranial proximal tibial angle (mCrDTA) 86.7 ± 3.1.The intra-observer ICC indicated high correlation for 70% or more of the measurements. The inter-observer agreement among observers was high. These results show that the radiographic method for measuring femoral and tibial joint angles was good or high, except for FNA and mCrDTA. CONCLUSIONS: This study provides some radiographic anatomical and mechanical joint angles of the femurs and tibias of normal domestic short-haired cats. We found good reliability for both intra- and interobserver measurements.

Computed tomographic localization of the deepest portion of the femoral trochlear groove in healthy dogs.

OBJECTIVE: To validate a computed tomographic (CT) method to measure the femoral trochlear groove depth (FTGD). STUDY DESIGN: Cadaveric study. SAMPLE POPULATION: Fifteen dogs, 26 femoral trochleae. METHODS: Five points were identified from proximal to distal (proximal point [PP], P25, P50, P75, and distal point [DP]) along the trochlea via three-dimensional volume-rendering function on the sagittal plane and measured on multiplanar reconstruction images. Each rater repeated measurements in duplicate, unaware of the identity of the joint. The FTGD was quantitated on the anatomical specimens and statistically compared with CT measurements. Intrarater and interrater agreements were analyzed by using intraclass coefficients. Accuracy was evaluated by using either adjusted R2 coefficients (R2 > 80% was considered acceptable) or Student's t test. The ratio of the patellar and the trochlear width and the ratio of the patellar craniocaudal thickness inside the trochlear groove were calculated at three different patellar locations. RESULTS: Good to excellent intrarater and interrater agreements were observed in four of five trochlear points (P25, P50, P75, and DP), and accuracy was acceptable for these points (R2 > 80%). Computed tomographic measurements differed from the mean anatomical measurements at three of five points (PP, P50, and P75; P < .01), overestimating the FTGD by an overall mean of 0.18 mm (range, 0.02-0.3). P25 and P50 were the deepest points measured. CONCLUSION: Computed tomography allowed precise measurements of trochlear groove depth except for the most proximal point. The deepest trochlear points were P25 and P50. P25 was the most precise and accurate point measured, while PP was the least consistent. CLINICAL SIGNIFICANCE: The deepest portion of the trochlea groove may be located between P25 and P50. Evaluation of this CT method in dogs with patellar luxation is recommended.

Simultaneous fluoroscopic-guided tibial plateau leveling and fracture reduction for the concurrent treatment of chronic cranial cruciate ligament tear and comminuted diaphyseal fracture of the tibia and fibula in a dog.

CASE DESCRIPTION A 12-year-old obese spayed female American Staffordshire Terrier was admitted for evaluation of acute non-weight-bearing lameness of the right pelvic limb attributed to motor vehicle-related trauma that occurred 2 hours previously. The owners reported a chronic, progressive weight-bearing lameness of the right pelvic limb secondary to a complete cranial cruciate ligament (CrCL) rupture that was diagnosed 6 months previously. They had declined surgery for CrCL repair because of the advanced age of the dog. CLINICAL FINDINGS Physical examination revealed a 2-cm skin wound on the craniomedial aspect of the midtibial region. The dog had non-weight-bearing lameness of the right pelvic limb with associated muscle atrophy and signs of pain on palpation of the right tibia. Radiography was performed, and tibial and fibular fractures were diagnosed. The fractures were classified as second-degree open, severely comminuted, complex nonreconstructible diaphyseal fractures. TREATMENT AND OUTCOME The tibial fracture and CrCL rupture were treated by closed reduction and simultaneous tibial plateau leveling by indirect fluoroscopic-guided alignment, plus stabilization with a monoplanar external fixator. The 2 main tibial fragments were manipulated via the frame clamps to restore limb length and alignment and tibial plateau slope. Both the tibial and fibular fractures healed within 16 weeks after surgery. At the 2-month recheck examination after implant removal, the dog was walking normally. CLINICAL RELEVANCE Simultaneous treatment of tibial fracture and CrCL rupture with unilateral external fixation was successful in this dog and may be helpful in similar cases.

Computed Tomographic Trochlear Depth Measurement in Normal Dogs.

OBJECTIVES: The main purpose of this study was to describe the relationship between patellar maximal craniocaudal thickness and femoral trochlear groove depth in normal dogs and to valuate the intra-observer or inter-observer variability of maximal trochlear depth and maximal patellar craniocaudal thickness using computed tomography. METHODS: Trochlear groove depth and patellar maximal craniocaudal thickness of 40 limbs (20 dogs) were measured by three independent veterinarians using three-dimensional multiplanar reconstruction computed tomography images. The patellar maximal craniocaudal thickness/trochlear depth ratio was determined. RESULTS: The mean ratio of these stifles was 0.46 (range 0.24-0.70), meaning that the mean maximal depth of the trochlea was 46% of the mean maximal-patellar thickness. CLINICAL SIGNIFICANCE: A wide range of maximal-patellar-craniocaudal-thickness/maximal trochlear-depth ratio was found suggesting that breed studies should be performed to determine a breed-specific patellar-thickness/trochlear-depth ratio. To make decisions on when and where to perform a sulcoplasty during patellar luxation surgery, patella/trochlea thickness relationship should be measured for each breed with patellar tracking from stifle hyperflexion to stifle hyperextension.

Comparison of Rotation Force to Maintain Acetabular Ventroversion after Double Pelvic Osteotomy and 2.5 Pelvic Osteotomy in a Canine Cadaveric Model.

OBJECTIVE: The aim of this article was to compare the force required to maintain the acetabular ventroversion after double pelvic osteotomy (DPO) and modified triple pelvic osteotomy (2.5PO). METHODS: Unilateral DPO (group A) and unilateral modified DPO (group B = 2.5PO) were performed on cadaveric canine pelves (n = 10/group). The twisting moment required to maintain fragment position for DPO and 2.5DPO was compared. RESULTS: Mean twisting moment for the DPO group [5.92 N/m ± 2.59 (range, 2.61-12.17 N/m)] and the 2.5PO group [2.11 N/m ± 0.93 (range, 0.63 -3.85 N/m)] was significantly different (p < 0.01). CONCLUSION: Dorsal cortex osteotomy of the ischium decreases the acetabular segment rotation force. Decreased force may facilitate acetabular rotation during DPO procedure.

Prevalence, treatment and outcome of patellar luxation in dogs in Italy. A retrospective multicentric study (2009-2014).

OBJECTIVE: To determine the prevalence of patellar luxation in dogs in Italy and its relation to signalment, the frequency and the type of postoperative complications and the outcome of treatment, and to compare the findings with those of other studies. MATERIALS AND METHODS: The medical records from four referral clinics were searched for dogs with orthopaedic disorders referred from 2009 to 2014. From these data, the records of dogs with patellar luxation were identified, and the signalment, age and body weight, grade, side and direction of patellar luxation, treatment, postoperative complications, and outcome were retrieved. Univariate and multivariate statistical analyses were used to evaluate the data. RESULTS: Of 8,694 canine orthopaedic cases, fractures not included, patellar luxation was diagnosed in 559 dogs (801 stifles). Mixed breed dogs were most commonly affected (18%), 85% of the luxations were medial, and 52% of the dogs were female. Of the 559 dogs examined, 400 (574 stifles) met the inclusion criteria for treatment evaluation. Minor complications occurred in five percent of the dogs, and major complications in 16%, including recurrence of patellar luxation in seven percent of the dogs. The outcome was good in 88% of stifles, fair in two percent, and poor in 10%. CLINICAL SIGNIFICANCE: Although patellar luxation was more common in small breed dogs, it also was diagnosed in a significant number of large breed dogs, which included medial patellar luxation in 73% and lateral patellar luxation in 27% of stifles. Body weight and grade of luxation were the only variables statistically correlated with surgical complications.

Contralateral bone widening and transfer for limb sparing in a cat.

OBJECTIVE: To report on a novel surgical procedure to treat a long segmental tibial defect in a five-year-old 5 kg spayed female Main Coon cat using transverse distraction osteogenesis in the contralateral tibia to create a free autograft. METHODS: A long free bone segment was created from the cranial half of the normal tibia. A circular external fixator was constructed to give the segment 7 mm of cranial distraction. After 42 days the widened section of tibial bone was removed and transferred to the defect in the contralateral tibia. Locking plates were used to stabilize the graft and to protect the donor tibial sites. RESULTS: By 27 months, both tibias were healed, all implants had been removed, function was excellent, and the overall limb length was 90% of the normal side. CLINICAL RELEVANCE: Compared with longitudinal distraction osteogenesis in long bone defects, transverse distraction of a normal bone requires a significantly shorter distraction distance to produce a similar amount of bone. Thus, distraction time is reduced, with less likelihood of significant soft tissue damage. New bone may be more reliably regenerated in a normal limb due to better tissue health, and native bone may be more readily incorporated than allografts in compromised sites. Disadvantages include the increased morbidity, as well as the risk and expense associated with involvement of a normal limb.

Femoral angular correction and lengthening in a large-breed puppy using a dynamic unilateral external fixator.

OBJECTIVE: To report treatment of a large-breed puppy with combined distal femoral valgus and length deficit caused by partial distal physeal closure. STUDY DESIGN: Clinical report. ANIMALS: Bernese Mountain Dog (4.5-month-old male). METHODS: The puppy was admitted for evaluation of a progressive severe left pelvic limb lameness (grade 3/4) of 6-week duration. Distal femoral valgus and severe length deficit deformity were treated by acute angular correction using a closing wedge ostectomy and progressive rapid-rate callus distraction using a dynamic, telescoping unilateral External Skeletal Fixator (ESF) designed for people. After acute angular correction and a 3-day latency period, a mean linear distraction rate of 3 mm/day was maintained for 3 weeks. The dynamic ESF (dESF) was removed at 4 weeks, after a 1-week consolidation phase. RESULTS: The dESF was stable and functional during distraction and bone healing. Distal femoral valgus conformation improved 50° (from 41° to 91°) and femoral length increased 42 mm at dESF removal (from 158 mm to 200 mm; 27%). After cessation of bone growth, no valgus and minimal (6%) length deficit were detected. At 4, 5, 6, 12, and 24 months after surgery, the dog was walking, trotting, and galloping normally. CONCLUSION: Acute angular correction and progressive rapid-rate callus distraction using a unilateral dESF allowed satisfactory treatment of combined distal femoral valgus and length deficit in a large-breed puppy.

Correction of rotational deformity of the pes with external skeletal fixation in four dogs.

OBJECTIVE: To report unilateral correction and initial stabilization with external skeletal fixation (ESF) of metatarsal rotation in 4 immature Bernese Mountain Dogs. STUDY DESIGN: Case series. ANIMALS: Bernese Mountain Dogs (n=4). METHODS: The limb deformity, including degree and origin of the deformity at the level of the proximal intertarsal joint and involvement of the central tarsal bone, was characterized by clinical and radiographic assessment. Unilateral surgical correction of the most severely affected limb was performed by disrupting the ligaments and debriding the articular cartilage of the proximal intertarsal joint to allow for derotation of the deformity and arthrodesis of the proximal intertarsal joint stabilized with either circular or linear ESF. RESULTS: Initial metatarsal rotation of the corrected limbs ranged from 60 degrees to 80 degrees of external rotation (mean, 72.5 degrees). Three limb corrections were stabilized with circular ESF and 1 with a biplanar linear ESF. Implants were removed at the time of radiographic bony union (range, 7-10 weeks; mean, 8.6 weeks). Residual deformity was minimal, ranging from 6 degrees to 15 degrees (mean, 11 degrees). Two minor complications (loosening of 1 pin, serous drainage from 1 pin) resolved with treatment. CONCLUSION: Correction of rotational deformity of the pes with intertarsal arthrodesis yielded an excellent clinical outcome, with only a mild residual deformity. CLINICAL RELEVANCE: Rotational metatarsal deformities can have a significant impact on gait, ambulation, and appearance. Correction of these deformities and stabilization with ESF and intratarsal arthrodesis can yield an excellent functional outcome, with improved gait and ambulation.