Management of bilateral patellar luxation in an alpaca.

OBJECTIVE: To report surgical management bilateral lateral patellar luxation in a mature alpaca using a combination of trochlear wedge recession (TWR), tibial tuberosity transposition (TTT), and joint capsule imbrication. STUDY DESIGN: Clinical case report. ANIMALS: 9-year-old castrated male Alpaca. METHODS: Bilateral, grade III/IV, lateral patellar luxation was identified by palpation, lameness examination and confirmed with radiography and ultrasonography. Surgical procedures were staged, with the left stifle treated first. Bilateral TWR, TTT, and joint capsule imbrication were performed. Outcome was assessed by radiography and follow up lameness examinations. RESULTS: An immediate improvement in weight bearing occurred after surgery of the left hind limb. Five months after initial surgery, right hind limb patella luxation was corrected. After surgery on the 2nd limb, the alpaca had progressive improvement in weight bearing during hospitalization. At 12 months, there were no signs of lameness and the alpaca had resumed normal activities. CONCLUSIONS: For bilateral lateral patellar luxation, a combination of TWR, TTT, and joint capsule imbrication resulted in excellent long-term outcome.

Long-bone fractures in llamas and alpacas: 28 cases (1998-2008).

Treatment and outcome of camelids with long-bone fractures are described. Medical records (1998-2008) of camelids (n = 28) with long-bone fractures were reviewed for signalment, time to presentation, fracture type, method of repair, duration of hospitalization, and post-operative complications. Follow-up information was obtained via telephone interviews with owners. Mean age and weight at presentation were 3.4 years and 56.3 kg, respectively. Twenty-six fractures were treated with internal fixation (n = 11), external fixation (n = 10), combination of internal and external fixation (n = 3), amputation (n = 1), and external fixation followed by amputation (n = 1). Long-term follow-up information was obtained for 19 of the 26 animals. The post-operative complication rate was 23% and owner satisfaction was high. Animals with open fractures were more likely to experience complications. Internal fixation was associated with superior alignment and outcome. Internal fixation techniques should be recommended for camelids.

Trochlear block recession in an alpaca with traumatic lateral patellar luxation.

OBJECTIVE: To report surgical treatment of traumatic lateral patellar luxation using trochlear block recession in an alpaca. STUDY DESIGN: Clinical case report. ANIMALS: Five-year-old female alpaca. METHODS: Grade IV/IV lateral, left patella luxation and mild femoropatellar joint effusion was identified by palpation and visual assessment, and confirmed by ultrasonography and radiographs. Trochlear block recession combined with lateral retinacular release and medial imbrication to restore patella function. RESULTS: Progressive improvement in weight bearing occurred during hospitalization (6 days) and at 3.5 weeks, no lameness was observed; radiographically, the patella was in normal anatomic alignment. At 15 months, there were no signs of lameness with unrestricted exercise and the alpaca had given birth to another cria. CONCLUSIONS: In this alpaca with traumatic origin of the lateral patellar luxation and normal femoro-tibial alignment, a combination of retinacular imbrication, contralateral release, and trochlear block recession were successful for long-term treatment of lateral patellar luxation. CLINICAL RELEVANCE: Although trochlear block recession is most commonly performed in small animals, this technique may be useful in treatment of traumatic patellar luxations in camelids.

Total hip replacement in an alpaca using a cementless implant.

OBJECTIVE: To report use of a cementless total hip prosthesis in an alpaca. STUDY DESIGN: Case report. ANIMALS: Alpaca (n=1) with chronic craniodorsal coxofemoral luxation. METHODS: A 2.5-year-old Suri alpaca, 3 months pregnant, was admitted for evaluation of acute onset severe left hind limb lameness (grade 4/5) of 6 weeks duration. After diagnosis of craniodorsal luxation of the left femoral head, total hip replacement (THR) using a cementless implant was performed because of the poor prognosis for reduction of a chronic luxation. RESULTS: A press-fit prosthesis was used and the alpaca delivered a live cria 8 months later. Persistent mild mechanical lameness remained after surgery, with moderate reduction in mobility of the coxofemoral joint. The prosthesis was stable and correctly positioned at 7 weeks and at 9 months. There was mild exostosis surrounding the proximal aspect of the femur at 9 months, and Steinmann pins used to repair the trochanteric osteotomy were removed because of migration. At 1 year, the alpaca has a slight gait abnormality, remains with the herd on pasture and has been re-bred. CONCLUSION: Chronic coxofemoral luxation in an alpaca can be managed by THR. CLINICAL RELEVANCE: THR is a viable treatment option in alpacas with severe coxofemoral disease.

Complications after orthopedic surgery in alpacas and llamas: 24 cases (2000-2006).

OBJECTIVE: To report complications associated with orthopedic surgery in alpacas and llamas. STUDY DESIGN: Retrospective study. ANIMALS: Alpacas (n=18) and llamas (n=6) that orthopedic surgery using internal or external fixation. METHODS: Medical records (January 2000-December 2006) and radiographs were reviewed and owners contacted for follow-up information for alpacas and llamas that had orthopedic surgery involving internal or external fixation. Fourteen camelids had internal fixation, 7 had external fixation, and 3 had a combination of internal and external fixation. RESULTS: Twenty-two animals (92%) were discharged after surgery (mean hospitalization, 15 days). Of 20 animals with >or=1 year follow-up information, 18 were alive (82%). Postoperative complications related to fracture healing, infection, soft tissue structures, or joints occurred in 21 camelids (87%). Thirteen animals returned to their intended use, 4 animals returned to breeding but not their intended use, 4 were euthanatized, and 3 were only able to be used as pets. CONCLUSIONS: Fixation type (internal, external) did not have any significant effect on complications involving fracture healing, infection, soft tissue structures, or chronic lameness. Camelids with open fractures were more likely to have complications associated with fracture healing, repair, and infection than closed fractures. CLINICAL RELEVANCE: Complications after orthopedic surgery in alpacas and llamas are more common than previously reported and may result in chronic lameness or prevent return to their intended use.

Use of a circular external skeletal fixator for stabilization of a comminuted diaphyseal metatarsal fracture in an alpaca.

CASE DESCRIPTION: A 3-year-old male alpaca was evaluated because of non-weight-bearing lameness (grade 5/5) in the left hind limb. CLINICAL FINDINGS: Clinical and radiographic examination revealed a closed, comminuted, nonarticular, displaced diaphyseal fracture of the left third and fourth metatarsal bones. TREATMENT AND OUTCOME: Initial attempts at treatment via reduction of the fracture under traction and subsequent application of a cast were unsuccessful, and more stable fracture fixation was pursued. The alpaca underwent closed reduction of the fracture, which was stabilized by the application of a 3-ring circular external skeletal fixator (CESF). Improved weight bearing on the affected limb was evident soon after surgery and gradually increased; full weight bearing was evident by the seventh day after discharge from the hospital (day 20 after application of the CESF). Lameness was hardly noticeable during walking at that time. After 3 months, complete fracture healing was evident and the CESF was removed; mild outward rotation of the distal fragment and metatarsophalangeal joint was present. A Robert Jones bandage was applied to the limb, and the alpaca was kept in a stall for another 4 weeks. Eleven months after CESF application, the owners and referring veterinarian reported that the alpaca was healthy, not lame, and serving as a stallion without apparent impediment. CLINICAL RELEVANCE: Although mostly restricted to small animals, application of a CESF can be a viable alternative for management of long bone fractures in South American camelids.

Surgical repair of femoral fractures in New World camelids: five cases (1996-2003).

Five New World camelids were admitted to the Western College of Veterinary Medicine between 1996 and 2003 for evaluation of femoral fractures. There were three alpacas and two llamas. Four of the animals were female and three were less than 3 months of age. Fracture configurations consisted of distal physeal fractures (three), a comminuted diaphyseal/metaphyseal fracture, and a transverse diaphyseal fracture. Fractures were diagnosed with a combination of physical examination and radiographs in all cases. All five fractures were repaired with internal fixation and three animals were discharged from the hospital with fractures that healed. One cria underwent successful internal fixation but died from pulmonary oedema during recovery from anaesthesia. Postoperative complications were rare and limited to inadequate fracture stability in one alpaca and prolonged recovery to weight bearing in another. One llama with a comminuted metaphyseal fracture, repaired with a 4.5 mm dynamic compression plate, subsequently had catastrophic failure of the bone 17 days after surgery. Overall the clients were pleased with the outcome of discharged animals. Although femoral fractures are considered rare, they pose a unique opportunity for the large animal veterinarian to successfully achieve fracture union with the aid of internal fixation.

Humerus fractures in llamas and alpacas: seven cases (1998-2004).

OBJECTIVE: To describe treatment and outcome of humerus fractures in llamas and alpacas. STUDY DESIGN: Retrospective study. ANIMALS: Llamas (n=4) and alpacas (3) with humerus fracture. METHODS: Medical records (January 1, 1998-August 1, 2004) were reviewed for small camelids with a humeral fracture. Retrieved data were signalment, history, physical examination and radiographic findings, surgical and medical treatment, and outcome. RESULTS: Humeral fracture occurred in 7 of 38 (18%) camelids admitted with fractures. Affected animals were aged from 1 month to 3 years old. Fracture configuration included long-oblique (n=4), short-oblique (2), and Salter-Harris Type II fracture of the proximal physis (1). One adult llama was managed by stall confinement and surgical repair was attempted in the other camelids: fixation by screws inserted in lag fashion (n=3), intramedullary pinning and fixation by screws inserted in lag fashion (1), rush pinning (1), and bone plating (1). A Velpeau sling was used for additional support in 3 animals. All fractures healed but temporary radial nerve paresis occurred in 3 animals. Limb shortening and permanent lameness occurred in the llama managed conservatively. CONCLUSIONS: Humerus fractures in small camelids are amenable to surgical repair which may offer better long-term outcome than medical treatment alone. CLINICAL RELEVANCE: Surgical treatment of humerus fractures should have a good prognosis in llamas and alpacas. In select cases, minimally invasive techniques, such as rush pinning or fixation by screws inserted in lag fashion are sufficient for fracture healing.

Treatment of long bone fractures in South American camelids: 5 cases.

An adult llama and four alpacas were referred with long bone fractures. The llama presented with a closed, comminuted fracture of the right metatarsal bones. Two of the alpacas presented with comminuted fractures of the proximal radius. One fracture was closed and one was open. One alpaca had a closed, comminuted fracture of the distal radius, and the final alpaca had a closed, oblique fracture of the metatarsus. A diagnosis was made in each animal on the basis of clinical examination and radiographs. All fractures were managed by open reduction and internal fixation using selective placement of lag screws and dynamic compression plates. Four animals made uneventful recoveries and no long-term complications were encountered. One alpaca was re-admitted for plate failure and non-union of the fracture 5 weeks after surgery. The plate and screws were removed and a transfixation cast was applied. The fracture healed, however the alpaca showed signs of radial nerve paralysis after the cast was removed. With confinement in a small yard, full function gradually returned to the leg over the ensuing 4 months. Using techniques recommended in other species, South American camelids are suitable candidates for long bone fracture repair using open reduction and internal fixation.

Tibial plateau leveling osteotomy in a llama with a ruptured cranial cruciate ligament.

A 3-year-old 155-kg (342-lb) castrated male llama was examined because of left hind limb lameness of acute onset. A diagnosis of cranial cruciate ligament and medial collateral ligament rupture was made, and tibial plateau leveling osteotomy was recommended. The tibial plateau leveling osteotomy procedure was performed as described for dogs, except that 2 orthopedic plates were used to stabilize the osteotomy because of the size of the llama. The medial collateral ligament was sutured and reinforced with 2 strands of size-2 polypropylene placed in a figure-8 fashion between cancellous bone screws in the femur and tibia. Four days after surgery, failure of the medial collateral ligament repair was evident. Approximately 3.5 years after surgery, the llama was reexamined. The owners reported that the llama had full use of its left hind limb, and only mild lameness (grade 1 of 5) was evident. Results suggest that tibial plateau leveling osteotomy may be applicable in camelids with rupture of the cranial cruciate ligament. However, additional study is needed before tibial plateau leveling osteotomy can be routinely recommended. In particular, additional information is needed on the tibial plateau slope in healthy camelids, the role of the fibula in tibial plateau leveling osteotomy procedures, and the prevalence of cranial cruciate ligament rupture in camelids.

[Open diagonal fracture of metatarsus III/IV and internal fixation in an alpaca]. / Offene Schrägfraktur von Metatarsus III/IV und interne Fixation bei einem Alpaka.

This report describes the case of a 15-month-old alpaca stallion with an open fracture of metatarsus (MT) III/IV that occurred during transportation. Despite of a guarded prognosis, the animal was operated on request of the owner. The surgical intervention consisted of meticulous lavage and curettage of the wound and affected bone, precise fracture reduction, internal fixation with a 12-hole broad 3.5 mm DCP and implantation of a gentamicin impregnated collagen sponge. Primary wound healing was evident and the implant was removed at 3 months after the initial intervention. At 14 months after surgery, the stallion did not show any signs of lameness and was used for service.

Type 1B external fixation of a metacarpal fracture in an alpaca.

External skeletal fixation can be used in small ruminants as a successful, economic, alternative to internal fixation. In this case report, a type 1B frame was used on an alpaca to salvage a comminuted metacarpal fracture after failed internal fixation. Positioning the frame on the caudal aspect of the limb allowed full carpal flexion for kneeling and hence normal use of the limb throughout the recovery period. Complete healing occurred without further complications.

Treatment of temporary upward fixation of the patella in an alpaca by abrasion trochleoplasty and imbrication of the medial retinacular fascia.

A two-year-old female alpaca suddenly became lame on its right hindlimb. Eight days later clinical and radiographic examinations showed that the patella had become temporarily fixed within the supratrochlear notch of the femur. Under general anaesthesia an abrasion trochleoplasty followed by fascial imbrication was carried out. After two weeks in supporting slings, the animal put full weight on the leg, and six months after the surgery it showed no signs of lameness or recurrence of the upward fixation.

Long-bone fractures in llamas: six cases (1993-1998).

OBJECTIVE: To determine clinical and radiographic findings, treatment, and outcome for llamas with long-bone fractures. DESIGN: Retrospective study. ANIMALS: 6 llamas. PROCEDURE: Medical records of llamas admitted between 1993 and 1998 because of long-bone fractures were reviewed. Data collected included age, sex, type of fracture, method of fracture repair, and postoperative complications. The Fisher exact test was used to compare age and sex of the llamas with long-bone fractures with those of the hospital population of llamas. All owners were contacted by telephone to determine perceived postoperative problems and whether the llamas were able to perform as expected. RESULTS: Mean age was 160.8 days (range, 23 to 365 days). There was 1 male and 5 females. Fractures were more likely to occur in young llamas (< or = 1 year old) than in adults. Five of the fractures were attributed to traumatic episodes. Long bones affected included the tibia (n = 2), radius (2), femur (1), and humerus (1). Internal fixation with lag screws, plating, or both was performed on fractures of all llamas except 1; that llama was treated by use of confinement to a stall. None of the llamas had intraoperative complications, but postoperative complications were reported in 2 llamas. All fractures healed eventually, and clients were pleased with outcomes. CONCLUSIONS AND CLINICAL RELEVANCE: Long-bone fractures in llamas are uncommon. Several types of long bone fractures can be successfully repaired by use of internal fixation, resulting in few complications and minimal convalescent time.

Repair of cranial cruciate ligament rupture in an alpaca.

A mature male alpaca with acute lameness of the left handlimb was diagnosed as having a rupture of the cranial cruciate ligament. Repair was achieved using a combination of surgical techniques. A patellar ligament autograft was passed under the cranial meniscal ligament, through the joint and over the femoral condyle, and anchored using a screw and washer. Two nylon sutures were passed through a hole made in the tibial crest, and secured under the screw. The alpaca was confined in a stall for 3 months. Exercise was then increased progressively for 3 months. One year after surgery the alpaca is sound and has resumed breeding activity.

Conservative management of a ruptured gastrocnemius muscle in a male llama.

Rupture of the gastrocnemius muscle was diagnosed in an obese llama using physical examination and ultrasound imaging. Conservative therapy consisting of the use of a cast to immobilize the affected limb permitted the muscle to heal. Only mild, residual gait abnormalities were observed on follow-up examination.

Surgical repair of patellar luxation in llamas: 7 cases (1980-1996).

OBJECTIVE: To evaluate anatomy of the stifle in llamas and determine outcome of llamas that underwent surgery for repair of patellar luxation. DESIGN: Anatomic and retrospective study. ANIMALS: 6 llamas with unilateral patellar luxation and 1 llama with bilateral luxations. PROCEDURE: 6 stifles from llama cadavers were dissected to determine anatomy. Medical records were reviewed to identify history, procedure, outcome, and complications of llamas that underwent surgery. RESULTS: 6 llamas had lateral patellar luxation (including the llama with bilateral luxations), and 1 had medial patellar luxation. Six llamas had a history of trauma before onset of clinical signs. Two llamas underwent tibial tuberosity transposition, but luxation recurred in both and 1 had problems with breakage of implants. The other 5 llamas underwent imbrication and release procedures; however, luxation recurred in 4 of the 5. Surgery was repeated in 2 llamas, with successful outcomes. CLINICAL IMPLICATIONS: Results suggest that imbrication and release procedures may be useful for correction of patellar luxation in llamas without other bony abnormalities. However, long (20 cm) imbrication and release incisions are needed for a successful outcome. Use of a sling after surgery, to allow a gradual return to weight bearing and exercise, may also be important.

Neurologic diseases of llamas.

Supportive care, including physical therapy, is the key to successful treatment of neurologic disorders in llamas. Be sure to eliminate the possibility of myopathies, especially heat stress, metabolic, skeletal, neuromuscular, or other disorders. Prevention of secondary pressure sores can be challenging. Keep the patient comfortable and well fed. A happy patient is more likely to recover!