Efficacy of virtual surgical planning and a three-dimensional-printed, patient-specific reduction system to facilitate alignment of diaphyseal tibial fractures stabilized by minimally invasive plate osteosynthesis in dogs: A prospective clinical study.

OBJECTIVE: To evaluate the efficacy of a three-dimensional (3D)-printed, patient-specific reduction system for aligning diaphyseal tibial fractures stabilized using minimally invasive plate osteosynthesis (MIPO). STUDY DESIGN: Prospective clinical trial. SAMPLE POPULATION: Fifteen client owned dogs. METHODS: Virtual 3D models of both pelvic limbs were created. Pin guides were designed to conform to the proximal and distal tibia. A reduction bridge was designed to align the pin guides based on the guides' spatial location. Guides were 3D printed, sterilized, and applied, in conjunction with transient application of a circular fixator, to facilitate indirect fracture realignment before plate application. Alignment of the stabilized tibiae was assessed using postoperative computed tomography scans. RESULTS: Mean duration required for virtual planning was 2.5 h and a mean of 50.7 h elapsed between presentation and surgery. Guide placement was accurate with minor median discrepancies in translation and frontal, sagittal, and axial plane positioning of 2.9 mm, 3.6°, 2.7°, and 6.8°, respectively. Application of the reduction system restored mean tibial length and frontal, sagittal, and axial alignment within 1.7 mm, 1.9°, 1.7°, and 4.5°, respectively, of the contralateral tibia. CONCLUSION: Design and fabrication of a 3D-printed, patient-specific fracture reduction system is feasible in a relevant clinical timeline. Intraoperative pin-guide placement was reasonably accurate with minor discrepancies compared to the virtual plan. Custom 3D-printed reduction system application facilitated near-anatomic or acceptable fracture reduction in all dogs. CLINICAL SIGNIFICANCE: Virtual planning and fabrication of a 3D-printing patient-specific fracture reduction system is practical and facilitated acceptable, if not near-anatomic, fracture alignment during MIPO.

Mechanical evaluation of a threaded interference interlocking mechanism for angle-stable intramedullary nailing.

OBJECTIVE: To assess the fatigue and load-to-failure mechanical characteristics of an intramedullary nail with a threaded interference design (TID) in comparison to a commercially available veterinary angle-stable nail with a Morse taper bolt design (I-Loc) of an equivalent size. METHODS: 10 single interlocking screw/bolt constructs of TID and I-Loc implants were assembled using steel pipe segments and placed through 50,000 cycles of simulated, physiologic axial or torsional loading. Entry torque, postfatigue extraction torque, and 10th, 25,000th, and 50,000th cycle torsional toggle were assessed. Each construct was then loaded to failure in the same respective direction as fatigue testing. Four complete constructs of each design were then assessed using a synthetic bone analog with a 50-mm central defect via nondestructive torsional and axial loading followed by axial load to failure. RESULTS: All constructs were angle stable at all time points and withstood fatigue loading. Median insertional torque, extraction torque-to-insertion torque ratio, and torsional yield load were 33%, 33%, and 72.5% lower, respectively, for the TID interlocking screws. No differences in torsional peak load, torsional stiffness, axial yield load, axial stiffness, or axial peak load were identified. No differences in complete construct angle stability, torsional stiffness, axial peak load, axial stiffness, or axial yield load were identified. CLINICAL RELEVANCE: The TID had an inferior torsional yield load when compared to I-Loc implants but generated angle stability and sustained simulated physiologic fatigue loading. The TID may be a suitable mechanism for generating angle stability in interlocking nails.

Three-dimensionally printed osteotomy and reaming guides for correction of a multiplanar femoral deformity stabilized with an interlocking nail in a dog.

OBJECTIVE: To describe the use of virtual surgical planning (VSP) and three-dimensionally (3D) printed surgical guides for corrective osteotomies stabilized with an interlocking nail in a dog with a multiplanar femoral deformity. STUDY DESIGN: Case report. ANIMALS: An 8-year-old male neutered mixed breed dog weighing 44 kg. METHODS: A dog was presented for a right grade 3 lateral patellar luxation secondary to a multiplanar femoral deformity due to a suspected femoral malunion. A computed tomography (CT) scan was obtained to create virtual femoral models. Corrective osteotomies were simulated with VSP. Custom osteotomy guides and reaming guides were designed to facilitate the correction and the placement of an interlocking nail. The preoperative femoral model, virtually aligned femoral model, custom osteotomy guides, and reaming guides were 3D printed, sterilized, and utilized intraoperatively. A CT scan was performed postoperatively to assess femoral length and alignment. RESULTS: Custom osteotomy and reaming guides were used as intended by the VSP. Postoperative femoral length as well as frontal, sagittal, and axial plane alignment were within 0.7 mm, 2.2°, 0.5°, and 1.6°, respectively, of the virtually planned femoral model. Two months postoperatively, the dog was sound on visual gait examination, and the patella tracked in the trochlear groove throughout stifle range of motion and was unable to be manually luxated. Radiographs obtained 2 months postoperatively revealed static femoral alignment and implants. Both osteotomies were discernable with callus bridging. CONCLUSION: Virtual surgical planning and custom osteotomy and reaming guides facilitated complex femoral corrective osteotomies and interlocking nail placement.

Mitigation of gap formation resulting from saw blade in single-cut osteotomy.

Bone loss from the kerf of the sawblade may influence the final outcomes when employing three-dimensional-printed surgical guides. However, no studies have systematically addressed saw blade-induced bone loss. This study aims to quantify bone loss and propose a reduction guide to minimize the fracture gap. The postoperative gap tended to decrease as the amount of gap compensation increased. Osteotomy gaps can be attributed to the thickness of the saw blade, and the proposed methodology addresses this surgical error. Surgeons can proactively plan and design reduction guides with applied compensation using the method described in this study.

Complications and outcomes of total hip arthroplasty in dogs with luxoid hip dysplasia: 18 cases (2010-2022).

OBJECTIVE: To describe the complications and outcomes in dogs with luxoid hip dysplasia (LH) undergoing total hip arthroplasty (THA) and compare complication rates with THA in non-LH dogs. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Client-owned dogs (n = 217) undergoing primary THA (n = 238). METHODS: Medical records (2010-2022) of dogs undergoing THA were reviewed, and LH was defined as complete dorsal displacement of the femoral head from the acetabulum on lateral projection radiographs. Major or catastrophic complications, revisions, and outcomes were recorded for all dogs and they were compared between LH and non-LH groups. RESULTS: Eighteen cases met the subcriterion for the LH group and 220 cases met the subcriterion for inclusion in the non-LH group. There were 14 complications in 13/18 dogs with LH; seven were intraoperative (femoral fissure/fracture) and seven were postoperative (dorsal luxation, n = 5; femoral fracture, n = 1; acetabular cup septic loosening, n = 1). Revisions were performed for all LH dogs that encountered complications; satisfactory outcomes were achieved in 12/13 dogs. Overall, LH dogs had a higher risk of developing complications (p < .001), including intraoperative fracture (p < .001) and postoperative dorsal luxation (p = .019) when compared with non-LH dogs. CONCLUSION: Luxoid hip dysplasia was associated with a higher risk of major complications following THA in dogs, specifically intraoperative fissure/fracture and postoperative dorsal luxation. Despite the increased risk, revisions typically yielded satisfactory outcomes. CLINICAL SIGNIFICANCE: Luxoid hip dysplasia is an important risk factor for the development of major complications in dogs undergoing THA.

Deep learning discrimination of rheumatoid arthritis from osteoarthritis on hand radiography.

PURPOSE: To develop a deep learning model to distinguish rheumatoid arthritis (RA) from osteoarthritis (OA) using hand radiographs and to evaluate the effects of changing pretraining and training parameters on model performance. MATERIALS AND METHODS: A convolutional neural network was retrospectively trained on 9714 hand radiograph exams from 8387 patients obtained from 2017 to 2021 at seven hospitals within an integrated healthcare network. Performance was assessed using an independent test set of 250 exams from 146 patients. Binary discriminatory capacity (no arthritis versus arthritis; RA versus not RA) and three-way classification (no arthritis versus OA versus RA) were evaluated. The effects of additional pretraining using musculoskeletal radiographs, using all views as opposed to only the posteroanterior view, and varying image resolution on model performance were also investigated. Area under the receiver operating characteristic curve (AUC) and Cohen's kappa coefficient were used to evaluate diagnostic performance. RESULTS: For no arthritis versus arthritis, the model achieved an AUC of 0.975 (95% CI: 0.957, 0.989). For RA versus not RA, the model achieved an AUC of 0.955 (95% CI: 0.919, 0.983). For three-way classification, the model achieved a kappa of 0.806 (95% CI: 0.742, 0.866) and accuracy of 87.2% (95% CI: 83.2%, 91.2%) on the test set. Increasing image resolution increased performance up to 1024 × 1024 pixels. Additional pretraining on musculoskeletal radiographs and using all views did not significantly affect performance. CONCLUSION: A deep learning model can be used to distinguish no arthritis, OA, and RA on hand radiographs with high performance.

Biomechanical comparison of canine femurs implanted with either cemented (CFX®) or cementless (with lateral bolt) (BFX®+lb) total hip replacement under 4-point bending or torsional loads.

Objective: Compare biomechanical properties of femurs implanted with either BioMedtrix™ biological fixation with interlocking lateral bolt (BFX®+lb) or cemented (CFX®) stems when subjected to 4-point bending or axial torsional forces. Study Design: Twelve pairs of normal medium to large cadaveric canine femora were implanted with a BFX + lb (n = 12) and a CFX (n = 12) stem-one in the right and one in the left femora of the pair. Pre- and post-operative radiographs were made. Femora were tested to failure in either 4-point bending (n = 6 pairs) or axial torsion (n = 6 pairs), and stiffness, load or torque at failure, linear or angular displacement, and fracture configuration were noted. Results: Implant position was acceptable in all included femora, but CFX stems were placed in less anteversion than BFX + lb stems in the 4-point bending group (median (range) 5.8 (-1.9-16.3) vs. 15.9 (8.4-27.9) anteversion, respectively (p = 0.04)). CFX implanted femora were more stiff than BFX + lb implanted femora in axial torsion (median (range) 2,387 (1,659-3,068) vs. 1,192 (795-2,150) N*mm/o, respectively (p = 0.03)). One of each stem type, from different pairs, did not fail in axial torsion. There was no difference in stiffness or load to failure in 4-point bending, or in fracture configuration for either test, between implant groups. Conclusion: Increased stiffness of CFX implanted femurs under axial torsional forces may not be clinically relevant as both groups withstood expected in vivo forces. Based on this acute post-operative model using isolated forces, BFX + lb stems may be a suitable replacement for CFX stems in femurs with normal morphology (stovepipe and champagne flute morphology were not tested).

Minimally invasive repair of acetabular fractures in dogs: Ex vivo feasibility study and case report.

OBJECTIVE: To describe and evaluate minimally invasive repair of acetabular fractures in dogs using plates contoured to 3D-printed hemipelvic models. STUDY DESIGN: Ex vivo feasibility study and case report. SAMPLE POPULATION: Adult canine cadavers (n = 5); 8 year old male neutered Chihuahua. METHODS: Bone plates were contoured to 3D printed hemipelvic models derived from computed tomographic scans of each dog. In cadavers, acetabular, ischial, and pubic osteotomies were performed. A small craniolateral approach to the ilial body and a caudal approach to the ischium were made and connected through epiperiosteal tunnels. Under fluoroscopic guidance, fractures were reduced, and precontoured bone plates were applied with locking screws. Postoperative computed tomographic images were used to assess fracture gaps, step defects, and pelvic angulation. Cadavers were dissected for subjective assessment of sciatic nerve injury. Radiographic and clinical follow up was acquired for the clinical case. RESULTS: Small fracture gaps (<2 mm) and step defects (<1 mm), low pelvic angulation (<5°), and minimal (none n = 4 and mild n = 1) sciatic nerve injuries were observed in cadaver testing. There was slight (~1 mm) medial displacement of the pubic segment and good functional outcome for the clinical case, with radiographic healing documented at 3 months postoperatively. CONCLUSION: Minimally invasive acetabular fracture repair in dogs with the aid of 3D printing was feasible and accurate. CLINICAL SIGNIFICANCE: Minimally invasive repair techniques assisted by 3D printing may be applicable for acetabular fractures in dogs. The technique should be evaluated further before routine use can be recommended.

Accuracy of needle arthroscopy for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture.

OBJECTIVE: To determine the accuracy of needle arthroscopy (NA) for the diagnosis of medial meniscal tears in dogs with cranial cruciate ligament rupture (CCLR). STUDY DESIGN: Prospective clinical trial. ANIMALS: Twenty-six client-owned dogs. METHODS: Dogs with CCLR and scheduled to undergo tibial plateau leveling osteotomy were recruited for the study. Needle arthroscopy was performed by an experienced surgeon; the same dog subsequently underwent standard arthroscopy (SA) by another experienced surgeon who was blinded to the NA findings. The SA arthroscopy findings were used as the gold standard. Arthroscopy time, visibility of the menisci, ability to probe the menisci, and the presence of meniscal tears were recorded for both arthroscopies. The degree of lameness before and after NA was subjectively quantified. RESULTS: The sensitivity and specificity to diagnose medial meniscal tears with NA was 95% and 100%, respectively. Visibility of the menisci was lower (P < .01), probing of the lateral meniscus was harder (P = .0017), and procedure time was shorter (P = .073) with NA when compared to SA. The lameness scores did not differ before and after NA (P = .25). CONCLUSION: Needle arthroscopy could be performed rapidly with low morbidity, and had high accuracy for detecting medial meniscal tears in dogs with CCLR. CLINICAL SIGNIFICANCE: Needle arthroscopy is a promising minimally invasive technique for diagnosing medial meniscal tears in dogs with CCLR.

Serum acute-phase protein concentrations following uncomplicated total hip arthroplasty in dogs.

OBJECTIVES: To establish preoperative and postoperative serum C reactive protein (CRP) and serum amyloid A (SAA) levels in dogs undergoing uncomplicated total hip arthroplasty (THA). STUDY DESIGN: Prospective clinical trial. ANIMALS: Eighteen client-owned dogs. METHODS: Dogs undergoing THA were recruited. Serum CRP and SAA levels were measured in all dogs the day prior to surgery, and 3 and 6 months following surgery. All dogs received a physical examination and underwent radiography at each visit, and dogs with complications were excluded from the study. For continuous numeric data, histograms were generated and evaluated for normality. A 1-way repeated measures ANOVA was performed to find differences between time points. RESULTS: No complications were encountered in any of the recruited dogs. Median age was 30 months (12-66), and the median bodyweight was 27.3 kg (22.3-40.2). Mean CRP concentrations in the preoperative, 3-month, and 6-month periods were 3.8 mg/L ± 4.4, 0.8 mg/L ± 1.9, and 1.4 mg/L ± 1.4, respectively. The mean SAA concentrations in the preoperative, 3-month, and 6-month periods were 13.9 mg/L ± 8.8, 14.1 mg/L ± 12.6, and 18.4 mg/L ± 15.1, respectively. There were no differences for each parameter between time points. CONCLUSION: C-reactive protein and SAA levels were consistent with levels previously established for noninflammatory and normal conditions in dogs. CLINICAL SIGNIFICANCE: Postoperative CRP and SAA concentrations were low by 3 months following uncomplicated THA.

Minimally invasive plate osteosynthesis of femoral fractures with 3D-printed bone models and custom surgical guides: A cadaveric study in dogs.

OBJECTIVE: Assess the accuracy and efficiency of reduction provided by application of plates precontoured to 3-dimensional (3D)-printed femoral bone models using a custom fracture reduction system (FRS) or intramedullary pin (IMP) to facilitate femoral minimally invasive plate osteosynthesis (MIPO) in dogs. STUDY DESIGN: Experimental cadaveric study. SAMPLE POPULATION: Seven dog cadavers. METHODS: Virtual 3D femoral models were created using computed tomographic images. Simulated, virtual mid-diaphyseal femoral fractures were created and reduced. Reduced femoral models were 3D-printed and a plate was contoured. Custom drill guides for plate screw placement were designed and 3D-printed for the FRS. Mid-diaphyseal simulated comminuted fractures were created in cadavers, and fractures were aligned using FRS or IMP and stabilized with the precontoured plates. Number of fluoroscopic images acquired per procedure and surgical duration were recorded. Computed tomographic scans were repeated to assess femoral length and alignment. RESULTS: Compared to the preoperative virtual plan, median change in femoral length and frontal, sagittal, and axial alignment was less than 3 mm, 2°, 3°, and 3° postoperatively, respectively, in both reduction groups. There was no difference in length or alignment between reduction groups (P > .05). During FRS, fewer fluoroscopic images were taken (P = .001), however, surgical duration was longer than IMP procedures (P = .011). CONCLUSION: Femoral alignment was accurate when using plates precontoured to 3D printed models, regardless of reduction method. CLINICAL SIGNIFICANCE: Accurate plate contouring using anatomically accurate models may improve fracture reduction accuracy during MIPO applications. Custom surgical guides may reduce fluoroscopy use associated with MIPO.

Proximal femoral deformity correction and total hip arthroplasty in a dog using 3D printed custom guides.

OBJECTIVE: To report the successful correction of a proximal femoral deformity (PFD) and total hip arthroplasty (THA) in a dog with the use of three-dimensionally (3D) printed custom surgical guides (CSGs). STUDY DESIGN: Case report. ANIMALS: One-year-old, male neutered, Goldendoodle. METHODS: Uniapical proximal varus and recurvatum femoral deformity (PFD) precluded femoral stem placement for THA, which was indicated for severe hip dysplasia. Using CT-derived bone and implant models, custom ostectomy and reduction guides for deformity correction were designed. A 13-hole 3.5 mm locking compression plate was contoured and applied to 3D printed models of the corrected femur and screw trajectory holes were incorporated into the CSGs. RESULTS: A caudolateral closing wedge ostectomy of the proximal femur was achieved with the aid of the CSGs and precontoured plate to within 2° of varus and 1° of recurvatum of the virtual surgical plan. Placement of a press-fit femoral stem was achieved with 7° of varus and 9° of caudal angulation. The plate was secured using six locking screws, two cortical screws, and two 18-gauge double-loop cerclage wires. No lameness and normal range of motion of the hip were observed on clinical examination 3 months after surgery. Radiographs at 3 and 6 months revealed static implant positioning, and complete bony union at the ostectomy site. CONCLUSION: Virtual surgical planning and CSGs led to successful concurrent THA and femoral deformity correction.

Closed reduction and fluoroscopic-guided percutaneous pinning of femoral capital physeal or neck fractures: Thirteen fractures in 11 dogs.

OBJECTIVES: To report the short-term clinical outcome and complications in dogs that underwent surgical repair of femoral capital physeal or neck fractures via fluoroscopic-guided percutaneous pinning (FGPP). STUDY DESIGN: Retrospective case series. ANIMALS: Client owned dogs (n = 11) with femoral capital physeal or neck fractures (n = 13). METHODS: Records (July 2018-July 2021) of dogs that underwent surgery for femoral capital physeal or neck fracture repair with FGPP from two hospitals were reviewed. Data collected included signalment, age, weight, preoperative lameness severity, fracture factors (etiology, Salter-Harris classification, time from injury to surgery, radiographic displacement), surgical factors (surgery time, number/size of implants, reduction quality) and outcome (follow-up examination findings, radiographic findings, complications). RESULTS: Most fractures (11/13) occurred secondary to trauma. The median time from injury to surgery was 5.5 days. There was mild radiographic displacement preoperatively in 10/13 fractures. Satisfactory fracture healing and limb function was achieved in 10/13 femurs. Complications occurred in 5/11 cases and included intra-articular implants, implant failure/nonunion, implant migration (2), and malunion. Of these five complications, two resolved with implant removal, and a salvage procedure was recommended in the remaining cases. Of the three cases requiring salvage procedures, two originally presented with radiographic evidence of fracture chronicity. CONCLUSIONS: FGPP can be used to successfully treat femoral head and neck fractures with appropriate case selection and precise surgical technique.

Efficacy of two reduction methods in conjunction with 3-D-printed patient-specific pin guides for aligning simulated comminuted tibial fractures in cadaveric dogs.

OBJECTIVE: To assess the feasibility and accuracy of using 2 methods for reduction and alignment of simulated comminuted diaphyseal tibial fractures in conjunction with 3-D-printed patient-specific pin guides. SAMPLE: Paired pelvic limbs from 8 skeletally mature dogs weighing 20 to 35 kg. METHODS: CT images of both tibiae were obtained, and 3-D reconstructions of the tibiae were used to create proximal and distal patient-specific pin guides. These guides were printed and used to facilitate fracture reduction and alignment in conjunction with either a 3-D-printed reduction guide or a linear type 1A external fixator. Postreduction CT images were used to assess the accuracy of pin guide placement and the accuracy of fracture reduction and alignment. RESULTS: The 3-D-printed guides were applied with acceptable ease. Guides for both groups were placed with minor but detectable deviations from the planned location (P = .01), but deviations were not significantly different between groups. Fracture reduction resulted in similar minor but detectable morphological differences from the intact tibiae (P = .01). In both groups, fracture reduction and alignment were within clinically acceptable parameters for fracture stabilization by means of minimally invasive plate osteosynthesis. CLINICAL RELEVANCE: Virtual surgical planning and fabrication of patient-specific 3-D-printed pin guides have the potential to facilitate fracture reduction and alignment during use of minimally invasive plate osteosynthesis for fracture stabilization.

Accuracy of virtual surgical planning and custom three-dimensionally printed osteotomy and reduction guides for acute uni- and biapical correction of antebrachial deformities in dogs.

OBJECTIVE: To report clinical experience using virtual surgical planning (VSP) and surgical application of 3D printed custom surgical guides to facilitate uni- and biapical correction of antebrachial deformities in dogs. ANIMALS: 11 dogs (13 antebrachial deformity corrections). PROCEDURES: Using CT-based bone models, VSP was performed, and surgical guides were designed and 3D printed. The guides were used to execute osteotomies and align bone segments. Postoperative CTs were obtained to compare limb alignment with the VSP. Long-term assessment of lameness and cosmesis were compared with preoperative status. RESULTS: Guides were successfully utilized and postoperative analysis was available for 10 of 13 deformities. Guides were abandoned in 2 deformities due to soft tissue tension. Evaluation of postoperative frontal, sagittal, axial, and translational limb alignment revealed that over 90% of parameters were within the acceptable range of ≤ 5° angulation and rotation or ≤ 5 mm of translation from the VSP. Lameness scores were improved in 7/8 deformities with associated preoperative lameness, and posture was improved in 10/10 deformities in which guides were deployed. Complications included reduced range of carpal motion (n = 2), implant sensitivity (n = 2), fracture (n = 1), and tendon laceration (n = 1). CLINICAL RELEVANCE: VSP and customized surgical guide application facilitated accurate antebrachial limb deformity correction in the majority of deformities in this case series. The use of VSP and 3D printed guides would appear to be a viable and accurate approach for correction of both uni- and biapical antebrachial deformities in dogs.

Evaluation of a crescent saw guide for tibial plateau-leveling osteotomy: An ex vivo study.

OBJECTIVE: To evaluate the effectiveness of a novel crescent-shaped tibial plateau-leveling osteotomy (TPLO) saw guide (crescent guide) to assist with saw control in novice participants. STUDY DESIGN: Ex vivo study. SAMPLE POPULATION: Synthetic bones (n = 54) and medium sized dog pelvic limbs (n = 36). METHODS: The 6 participants (interns and residents) without any prior experience performing a TPLO each performed 9 osteotomies on synthetic tibia models, and 6 osteotomies in cadaveric limbs of medium-sized dogs. Osteotomies made with the crescent guide were compared with those made with a standard jig and a radial saw guide with a jig. Osteotomy angulation, distance of eccentricity (DOE), and medial tibial cortical damage (synthetic bone models only) were measured from calibrated photographs. Participants rated their experiences with each technique. RESULTS: There was no difference in the DOE, coronal or axial osteotomy angulation between the 3 alignment devices for synthetic bone models or cadavers. Average medial cortical damage with the crescent guide (3.8 ± 7.3 mm2 ) was lower than with the radial guide (35.7 ± 27 mm2 ) and standard jig (51.2 ± 63.2 mm2 ) guides (P = <.01). Five of 6 participants preferred the crescent guide over the standard jig and radial guide. CONCLUSION: There was no difference in accuracy of osteotomy positioning but using the crescent guide resulted in lower cortical damage and more favorable participant perceptions. CLINICAL RELEVANCE: The crescent guide may improve control of the radial saw during TPLO in novice surgeons but does not appear to aid accurate osteotomy positioning.

Assessing Impact: Implementing an Opioid Prescription Protocol in Otolaryngology.

OBJECTIVE: A lack of guidance for pain control after otolaryngology surgery can lead to overprescription of opioids. We implemented a postoperative site-specific opioid prescription protocol and analyzed the impact on opioid prescriptions. METHODS: This is a retrospective cohort study. A postoperative opioid prescription protocol was implemented within our otolaryngology department at a tertiary academic medical center on January 1, 2020. Retrospective chart review was completed for all patients undergoing otolaryngology surgery from November 1, 2019, to February 29, 2020 (2 months before and after initiation of intervention; n = 1070). The primary outcome was change in the amount of opioid prescribed for the preintervention and postintervention cohorts. Unplanned contact related to pain and opioid refills were tracked to assess pain control. RESULTS: A total of 940 cases were included; adult and pediatric data were analyzed separately. There were 489 pediatric cases, 250 preintervention and 239 postintervention. There was a significant decrease in the amount of opioid prescribed per pediatric patient in the postintervention cohort (2.7 versus 0.32 morphine milligram equivalents, P = 0.02), and 99% of patients were not prescribed opioids at all. There was no significant change in unplanned contact, and no refills were required. There were 451 adult cases, 200 preintervention and 251 postintervention. There was no statistically significant decrease in the amount of opioid prescribed per adult patient (56.8 versus 51.7 morphine milligram equivalents, P = 0.23). There was no significant increase in unplanned contact or refills. CONCLUSIONS: A postoperative opioid prescribing protocol can reduce the amount of opioid prescribed without increasing unplanned contact or opioid refills.

Use of a bone-to-tendon plate to stabilize a comminuted calcaneus fracture in a dog.

OBJECTIVE: To report the use of an ancillary plate spanning from the calcaneus to the common calcaneal tendon to stabilize a comminuted fracture in a dog. STUDY DESIGN: Case report ANIMALS: Two year old male neutered mix-breed dog. METHODS: The dog presented for a grade IIIa open highly comminuted fracture of the shaft and tuber of the left calcaneus from a suspected gunshot wound. Plantar and lateral locking plates were applied to the calcaneus, with the lateral plate extending proximally and sutured directly to the common calcaneal tendon. Autogenous cancellous and allogenic corticocancellous bone grafts were placed into the fracture site, and a human placental matrix was injected after closure. A lateral tarsal splint was applied for 17 weeks postoperatively. The lateral bone-to-tendon plate was replaced with a smaller lateral plate spanning only the calcaneus 9 weeks after the initial surgery. RESULTS: Radiographic union was documented at 17 weeks. At 25 weeks, both plates were removed due to suspected implant associated infection. At the final follow-up assessment, 36 weeks after initial surgery, the dog had returned to normal function with no observable lameness. CONCLUSION: Incorporation of the common calcaneal tendon as a proximal segment for plate fixation led to successful union of a highly comminuted calcaneal fracture.

Nonadherence to follow-up recommendations is common for dogs and cats undergoing orthopedic surgery.

OBJECTIVE: To evaluate owner adherence to recommendations for follow-up examination of dogs and cats following orthopedic procedures and identify factors associated with adherence versus nonadherence. SAMPLE: Medical records of 485 dogs and cats that underwent orthopedic surgery. PROCEDURES: Cases were categorized as urgent or elective. Information obtained from the medical records consisted of species, age, body weight, proximity to the hospital, procedure cost, recommendations for coaptation, use of financial aid, and number of owners. Cases were considered adherent to follow-up recommendations if, at the latest visit or communication, no further visits were recommended. Cases were considered nonadherent if owners did not return for recommended follow-up visits. RESULTS: Overall adherence to follow-up recommendations was 65.8% (319/485). Elective cases were 1.6 times as likely to be adherent to follow-up recommendations as were urgent cases, dog cases were 2.4 times as likely to be adherent as were cat cases, and cases with multiple owners listed were 2.1 times as likely to be adherent as were cases with 1 owner listed. Distance from the hospital had a statistically significant association with adherence, but the effect was not clinically important. Age, weight, coaptation, procedure cost, and use of financial aid were not significantly associated with adherence. CONCLUSIONS AND CLINICAL RELEVANCE: The percentage of dogs and cats lost to follow-up following orthopedic surgery at an academic veterinary teaching hospital was substantial (166/485 [34.2%]). Efforts to improve follow-up adherence are especially indicated for animals undergoing urgent procedures, animals with single owners, and cats.