Surgical management of radial head luxation in a dog using an external skeletal traction device.

A five-month-old Airedale Terrier was presented with a history of right thoracic limb lameness. Clinical and radiographic examinations revealed caudolateral luxation of the right radial head. Surgical intervention involved an oblique proximal radial osteotomy and gradual craniomedial traction of the radial head using an external skeletal fixator (ESF) incorporating a traction device. The radial head was gradually reduced over 16 days. After radiographic confirmation of appropriate radial head reduction, a consolidation phase followed, with removal of the traction ESF after 24 days. Follow-up radiographs documented remodelling of the radial head. Clinical follow-up three years postoperatively revealed nearly normal ground reaction forces. Activity was unrestricted and there was no requirement for analgesic medications.

Ventral stabilization and facetectomy in a Great Dane with wobbler syndrome due to cervical spinal canal stenosis.

This report describes the management of clinically significant, single level cervical spinal canal stenosis associated with articular facet hypertrophy in a three-year-old Great Dane dog, by combined surgical decompression and spinal stabilization. Spinal column stabilization was achieved by ventral application of two String of Pearls locking plates and subsequent decompression was accomplished by unilateral facetectomy. The six-month postoperative reassessment examination confirmed satisfactory clinical outcome with a complete return to normal activity, resolution of neurological deficits and maintenance of implant positioning.

Osteochondral autograft transfer for the treatment of osteochondritis dissecans of the medial femoral condyle in dogs.

OBJECTIVE: To describe the clinical application of osteochondral autograft transfer procedure for the treatment of osteochondritis dissecans (OCD) of the canine medial femoral condyle and to report clinical and force plate outcomes. METHODS: Osteochondral autograft transfer (OATS™ Arthrex, Naples FL, USA) instrumentation was employed in six stifle joints of five dogs. Clinical examination was performed preoperatively and at two to three weeks, six to eight weeks, 12-18 weeks and at >22 months postoperatively. Radiography and arthroscopy were performed preoperatively and 12-18 weeks postoperatively. The follow-up examinations performed at 22 to 56 months included radiography, questionnaire completion with the owner, and force plate gait evaluation. RESULTS: Articular surface reconstruction was radiographically (for 6 stifle joints) and arthroscopically (for 5 stifle joints) maintained at 12-18 weeks. Subjectively-assessed lameness resolved in five out of six stifles by the 12 to 18 week reassessment. Morbidity included lateral patellar luxation at seven weeks and cranial cruciate ligament rupture at 11 months postoperatively. At the >22 month re-evaluation examination, subjectively-assessed lameness and signs of discomfort were minimal. Owner perceptions of outcome were positive; force plate assessment of gait indicated that weight bearing on three out of six OAT implanted limbs was less than the contralateral limb, but these comparisons were not evaluated statistically. A progression in the development of osteophytes was radiographically evident. CLINICAL SIGNIFICANCE: The OAT procedure can reconstruct medial femoral condyle OCD defects in dogs. Long-term lameness and progressive osteophytosis may occur but can be associated with other pathology such as cruciate ligament insufficiency.

Linear-circular external skeletal fixation of intra-condylar humeral fractures with supracondylar comminution in four cats.

OBJECTIVES: Intra-condylar humeral fracture with supracondylar comminution in cats is rare, and the stabilisation for such fractures is challenging. The purpose of our study was to describe the use of a hybrid external skeletal fixator, and to report the complications and outcomes of this surgical technique. METHODS: A retrospective review was performed of clinical, radiographic and surgical records of all cats with intra-condylar humeral fractures and non-reconstructable supracondylar comminution stabilized by linear- circular external skeletal fixator in two institutions between January 2005 and March 2010. RESULTS: Four cats met the inclusion criteria of the study. All cases achieved fracture union and clinical outcome was considered excellent at the time of the final assessment (11 - 24 weeks). CLINICAL SIGNIFICANCE: This study demonstrates that a linear-circular fixator system can be used successfully in the management of intra-con dylar humeral fractures with non-reconstructable supracondylar comminution in cats.

The double-arch modified type-1b external skeletal fixator. Technique description and functional outcome for surgical management of canine antebrachial limb deformities.

OBJECTIVES: To describe acute correction of antebrachial angular and rotational limb deformities (ARLD) using a new external skeletal fixator (ESF). METHODS: Dogs that were presented with lameness caused by ARLD were treated by radial and ulnar osteotomies and acute realignment. A modified type-1b ESF incorporating double arches (DA-ESF) and a novel connecting configuration facilitated alignment with six degrees of freedom. Bilateral deformities were corrected surgically in the same session. Aseptic preparation of both antebrachii allowed comparison of limb alignment. Radiographic evaluation was performed using centre of rotation of angulation (CORA) methodology. RESULTS: Thirty-five antebrachii (22 dogs) underwent surgery. Postoperative limb function was graded as good (n = 31), fair (n = 2), or poor (n = 2). Persistent medial carpal instability was associated with a suboptimal outcome. Postoperative radiographic images of the frontal and sagittal plane joint angles and elbow-to-carpus translation were compared with values that were reported in previous studies, and were within published reference ranges in most cases. Complications included delayed radial osteotomy union (n = 5), delayed ulnar osteotomy union (n = 2) and implant-associated morbidity (n = 3). CLINICAL RELEVANCE: A practical technique for acute correction of complex antebrachial ARLD is suggested, incorporating a new configuration of ESF. Putative limitations of radiographic planning using CORA may be compensated by careful attention to intra-operative visual and palpatory assessment.

Tibial tuberosity transposition-advancement for treatment of medial patellar luxation and concomitant cranial cruciate ligament disease in the dog. Surgical technique, radiographic and clinical outcomes.

OBJECTIVE: To report surgical technique, morphometric effects and clinical outcomes for tibial tuberosity transposition-advancement (TTTA), sulcoplasty and para-patellar fascial imbrication for management of concomitant medial patellar luxation (MPL) and cranial cruciate ligament (CCL) disease in 32 dogs. STUDY DESIGN: Case series. METHODS: A previous technique for tibial tuberosity advancement was modified to incorporate lateral and distal tibial tuberosity transposition. Preoperative, immediate, and six to eight week postoperative radiographs were reviewed with morphometry of a range of tibial and stifle anatomic parameters. Findings of sequential clinical examinations to six to 20 months postoperatively were recorded. RESULTS: Thirty-nine stifles were treated by surgery. Medial patellar luxation grade ranged from II to IV/IV. The CCL rupture was complete in 17/39 stifles, and incomplete in 22/39. Complications occurred in 11/39 stifles including MPL recurrence (n=4). Resolution of subjectively-assessed lameness occurred in 29/39 stifles at the six to eight week assessment. Resolution of lameness was eventually documented in 35/39 stifles (4/39 lost to follow-up), and was maintained at the six to 20 month reassessment where available. The TTTA induced relative patella baja in 31/39 stifles. Magnitude of actual tibial tuberosity advancement was lower than that predicted by cage size. CLINICAL SIGNIFICANCE: Tibial tuberosity transposition-advancement is a potential treatment modality for concomitant CCL disease and MPL in the dog, but refinement of planning is required, while biomechanical and kinematic effects remain unknown.

Headless self-compressing cannulated screw fixation for treatment of radial carpal bone fracture or fissure in dogs.

OBJECTIVES: To report the application and clinical outcome of the treatment of radial carpal bone fracture in five dogs using a variably-pitched, headless cannulated compression screw (Acutrak). METHODS: Arthroscopy was performed prior to surgical repair in three cases. In two cases, a fissure within the radial carpal bone was more clearly apparent when oblique indirect illumination was employed at arthrotomy. Following Acutrak screw placement via arthrotomy, external coaptation was applied in all cases for a period of two weeks. RESULTS: Five dogs were treated, of which four were Boxers, and one was a Labrador Retriever crossbreed. All dogs were lame prior to treatment. There was no history of trauma, and all dogs had soft tissue swelling on the dorsal aspect of the radiocarpal joint. In all cases the fissure or fracture line was oblique in orientation, extending disto-medially from the midpoint of the radiocarpal joint proximally to the level of the second carpal bone distally. All fractures treated demonstrated progressive radiographic healing, and all dogs were free of lameness at six weeks post- operatively, but two of the five fractures failed to reach complete radiographic union. All dogs remained lameness-free with mean follow-up of 12.5 months. DISCUSSION: Acutrak screws are headless devices which achieve compression, even in small bone fragments. Threads engage both the near and far fracture segments, leading to increased screw-bone contact which maximizes pull-out strength and may increase the fatigue strength of the screw. CLINICAL SIGNIFICANCE: Fixation of two-piece canine radial carpal-bone fractures with the Acutrak screw proved a reliable alternative to conventional compression screw fixation, and may have benefits over alternatives attributable to screw design and application technique.