Veterinary and Comparative Orthopaedics and Traumatology最新文献

To compare immediate, static interfragmentary compression patterns of three tibial plateau leveling osteotomy (TPLO) plate designs.TPLO was performed on 15 synthetic canine tibiae (SYNBONE AG, Switzerland) using 3D-printed guides. Compression was evaluated using pressure-sensitive films (Prescale, Fujifilm, UK). Three 3.5-mm TPLO plates were tested according to the manufacturer guidelines for dynamic compression screws placement: Synthes, Arthrex, and Biocurve. Each plate was tested five times using a new bone model. The interfragmentary surface was divided into quadrants: Q1 (craniomedial), Q2 (craniolateral), Q3 (caudomedial), and Q4 (caudolateral). Compression was classified as low (<0.12 MPa), moderate (0.12-0.25 MPa), or high (>0.25 MPa).Significant differences in overall interfragmentary compression were found among the plates (p < 0.001). The Biocurve plate generated the highest and most uniform compression (Q1: 0.285 ± 0.023 MPa; Q2: 0.304 ± 0.010 MPa; Q3: 0.220 ± 0.014 MPa; Q4: 0.237 ± 0.010 MPa). The Arthrex plate produced high compression in Q2 (0.292 ± 0.012 MPa) and moderate in other quadrants (Q1: 0.177 ± 0.016 MPa; Q3: 0.141 ± 0.011 MPa; Q4: 0.189 ± 0.013 MPa). The Synthes plate showed the lowest compression throughout (Q1: 0.050 ± 0.008 MPa; Q2: 0.075 ± 0.009 MPa; Q3: 0.111 ± 0.008 MPa; Q4: 0.109 ± 0.008 MPa).The Biocurve plate, with two angled dynamic compression screw holes, provided the highest, most uniform compression. Further studies are needed to assess clinical relevance.

The objective of this study was to evaluate the relationship between displaceable meniscal tears of the medial meniscus, such as bucket handle tears and flap tears, and articular cartilage wear of the medial femoral condyle.Articular cartilage was scored at the time of arthroscopy and tibial plateau leveling osteotomy as normal, mild, moderately, or severely damaged based on the modified Outerbridge classification system. Dogs with complete cranial cruciate ligament rupture were included; there were 245 stifles in total and 116 had a concurrent displaceable meniscal tear consisting of 115 bucket handle tears and 1 flap tear. Stifles were classified as either having no/mild or moderate/severe cartilage wear. The frequency of moderate/severe wear was compared between stifles with normal menisci and stifles with displaceable meniscal tears using a Fisher's exact test.Stifles with displaceable meniscal tears had a significantly higher frequency of moderate/severe cartilage wear of the medial femoral condyle in comparison to stifles with normal menisci (p = 0.009).These findings suggest that dogs with cranial cruciate ligament rupture and concurrent bucket handle tears may increase the risk of moderate to severe cartilage injury to the medial femoral condyle.

To develop a patient-specific implant designed for dorsal access instrumentation, which also serves as a guide for screw insertion, for use in dogs with atlantoaxial instability. The implant must demonstrate no failure in finite element analysis.The development of an implant utilizing computational resources based on a computed tomography scan of a patient with atlantoaxial instability. The final implant model was analysed using finite element methods in flexion, extension, lateral flexion, and torsion to evaluate stress distribution and displacement.A patient-specific implant for dorsal instrumentation was developed, featuring six holes for the insertion of 1.7-mm bicortical locking screws, including two transarticular screws and two additional screws per vertebra. The implant demonstrated a maximum stress point of 425 MPa, well below the material yield strength of 880 MPa, with a maximum displacement of only 0.13 mm.The proposed implant shows promise as it can function as a drilling guide, potentially enhancing safety during instrumentation. Using safe corridors may improve the rigidity of the construct. The implant model did not exhibit any failure when subjected to finite element analysis according to the established criteria.

To investigate extravasation of contrast media injected intraarticularly, either immediately following elbow arthroscopy or after arthrocentesis using computed tomographic (CT) imaging at different time points.Cadaveric dog model.A total of 16 elbows of eight canine cadavers (median age 10.2 years, 5.6 to 16.8 years; median weight 35.0 kg, 26.0 to 42.0 kg) were randomly assigned to the arthroscopy group with the contralateral elbow as control. Right after elbow arthroscopy, both elbows were injected with 2.5 mL contrast fluid. Elbow CT scans were obtained at seven time points. To detect a possible loss of contrast medium from the joint, both the total volume and intensity of the contrast fluid were measured intra- and extraarticularly using rendering software. To compare volume and intensity of contrast fluid, a simple linear model and a linear mixed effect model were used.The total volume of contrast-enhanced fluid was increased (avg. difference: 5115 mm³; linear model std. estimate: 1.69, std. error 0.10) and the total intensity decreased (avg. difference: 1330 Hounsfield Units; linear model std. estimate: -1.66, std. error 0.11) in the arthroscopy group compared with the control. Neither total volume nor total intensity of contrast-enhanced fluid changed significantly within 15 minutes.Extravasation of intraarticular injected contrast fluid after elbow arthroscopy without a significant effect of time could be shown. Injection of liquid therapeutics, e.g., orthobiologics, at a later point after arthroscopy should be considered.

Medial and dorsomedial tarsometatarsal subluxation can be surgically managed by screws and orthopaedic wires. The goal of this retrospective study was to provide long-term clinical and radiographic outcome data for this method in dogs.The medical records of dogs diagnosed with medial or dorsomedial luxation to a referral hospital in France from 2012 to 2023 were recorded. Patients treated with prosthetic ligamentoplasty without cartilage debridement or bone grafting were included. Long-term follow-up data were obtained via questionnaire (owners), and clinical and radiographic evaluations were performed by a single surgeon.At the last follow-up, all owners reported that their pets (n = 20) had regained full or acceptable function of the affected limb; 2/15 had grade I lameness. All tarsometatarsal joints were stable. Follow-up radiographs were performed (mean = 4 years) and revealed partial (11/14) to complete (2/14) radiographic bony ankylosis of the tarsometatarsal joint. Complications, mainly consisting of implant migration, were reported in 7/20 of the dogs.Palpable stability and signs of radiographic bony ankylosis can be achieved by prosthetic ligamentoplasty in cases of medial or dorsomedial tarsometatarsal subluxation, leading to full or acceptable function. Tarsometatarsal cartilage debridement and cancellous bone grafting appear non mandatory for achieving joint stability, with lower patient morbidity and surgical time.

To describe cases of septic synovitis and osteomyelitis in foals younger than 6 months presented to a single hospital and their management and to report the value of computed tomography in diagnosis and management of these cases.This is a retrospective descriptive study.Sixty-five foals were included in this study. Forty-six foals (71%) survived to discharge. The presence of osteomyelitis (p = 0.16), umbilical infection (p = 0.41), or infection with Rhodococcus equi (p = 1) did not significantly influence survival. However, risk of nonsurvival was significantly increased if multiple sites were infected (p = 0.007; odds ratio [OR] = 5.80) or when bony lesions were present on admission radiographs (p = 0.03; OR = 3.47). A large proportion of the foals in this study had osteomyelitis (66%; 43/65). Computed tomography use was not significantly associated with survival (p = 0.27) but allowed identification of osteomyelitis lesions in 16 out of 43 cases (37.2%) where radiological findings were unremarkable.This study reports a high frequency of osteomyelitis in foals in multiple different regions of the skeleton, with or without associated synovial sepsis. The prognosis, defined as survival to discharge, for these orthopaedic infections is positive, especially if only one location is affected. Computed tomography scan allows an early diagnosis as well as detection of radiographically silent lesions and is an interesting tool in targeted treatments of these foals. Gram-positive bacterial infections were overrepresented in this study, suggesting some similarities with human paediatric orthopaedic infections.

To establish a highly standardized elbow computed tomography (CT) examination protocol and evaluate inter- and intraobserver reliability of assessment of canine elbow sclerosis in the absence of elbow pathology.Dogs that presented for CT screening for elbow dysplasia prior to breeding were evaluated. Only dogs diagnosed with CT as being free of elbow dysplasia were included. The CT images were randomized and assessed by five blinded observers. Two observers re-reviewed 30 randomly selected studies on a second occasion. A standardized approach to CT image reconstruction to create consistent image planes was used. Sclerosis was subjectively as graded 0 (no sclerosis), 1 (mild sclerosis), and 2 (marked sclerosis). Objective assessment of sclerosis using Hounsfield units (HU) was measured within a standardized region of interest at the medial aspect of the humeral condyle (MAHC) and medial coronoid process (MCP).Complete agreement between observers in ordinal scoring of sclerosis was moderate for each region (MCP traditional 38.8%, MCP modified 28.6%, MAHC 26.5%). Intraobserver reliability of ordinal sclerosis scoring was poor to moderate. The inter- and intraobserver reliability of HU measurements was good to moderate, and good to excellent, respectively. Correlation between sclerosis scores and HU measurements was low to moderate.Subjective and objective assessment of sclerosis of the MCP and MAHC in the absence of elbow pathology is unreliable despite the use of a highly standardized protocol.

The aim of this study was to investigate the short-term outcomes of tibial plateau levelling osteotomy (TPLO) and tibial tuberosity transposition (TTT) for the combined treatment of cranial cruciate ligament rupture and medial patellar luxation (MPL) in small-breed dogs weighing up to 15 kg.Retrospective case series of dogs treated with a single session TPLO-TTT from five referral centres between 2015 and 2023. Intraoperative and postoperative complications were assessed. Osteotomy healing, lameness and presence of patellar luxation or tibial thrust were assessed at a 6- to 12-week follow-up.A total of 37 stifles in 35 dogs. At the time of follow-up, the tibial compression test was negative in all stifles. The MPL grade improved from a median of 3/4 preoperatively to a median of 0/4 (p = 0.0001) postoperatively. Lameness grade improved from a median of 3/5 to 1/5. There were seven minor complications and seven major complications. No catastrophic complications occurred. Osteotomy healing was appropriate in all dogs. Three intraoperative complications related to a TPLO screw near the joint required replacement. Postoperative MPL was noted in three stifle joints (grade 1/4, 3/4 and 4/4). One distal tibial tuberosity fracture and one patella fracture were managed conservatively. Patella ligament desmitis was managed conservatively in five stifles.Combined TPLO-TTT is an effective treatment of cranial cruciate ligament rupture and MPL in small-breed dogs, but surgical accuracy is needed to minimize complications. High-grade patellar luxation may require alternative methods of stabilization.

This study aimed to evaluate percutaneous reduction of feline tibial fractures (gap model) using a three-dimensional-printed external skeletal fixator (jig) and assess the contralateral tibia as a template for virtual planning.Postmortem computed tomography (CT) was performed on 11 skeletally mature feline specimens. A mid-shaft tibial fracture gap model was created, followed by the placement of two lead-marked K-wires per fragment. The DICOMS images of repeated CT scans were imported into the virtual planning software to design a specimen-specific jig using the contralateral side as a template. The jig housed the leads and acted as a connecting bar to facilitate fracture reduction. Post-procedure radiography and CT were performed to evaluate fracture reduction.A total of 22 tibiae of 11 cats were reduced using a jig. There was an average difference of <1 mm in terms of tibial length and <5 degrees in joint angulations and in terms of rotation when comparing the post-procedure tibia with the initial CT/radiograph (p < 0.05). The alignment was considered anatomical in 16 of 21 limbs and acceptable in 5 of 21 limbs. Pin loosening occurred in one case during the jig process.Temporary fracture reduction using the three-dimensional-printed jig was feasible and accurate in 21 of the 22 procedures. When using the contralateral tibia as a template, an asymmetry of up to 6% in terms of joint angulations should be considered.