Humeral intracondylar fissures in French bulldogs

Diagnostic accuracy of radiographs for the diagnosis of humeral intracondylar fissure in dogs

OBJECTIVES

To assess the diagnostic accuracy of radiographs in identifying humeral intracondylar fissures in dogs.

MATERIALS AND METHODS

Clinical data from dogs undergoing CT and radiographic elbow investigations at a single institution were reviewed. Based on CT diagnosis, radiographs were classified as having fissures and not having fissures. The radiographic images were evaluated by three blinded observers for the presence/absence of a fissure, type (partial or complete), and for secondary signs that could suggest the presence of a fissure in case this was not visible.

RESULTS

A total of 81 radiographs (76 elbows) were reviewed. Based on CT findings, 37 elbows had fissures and 44 did not. Radiographic interpretation demonstrated a sensitivity of 47.7% (confidence interval 95%: 0.40 to 0.59) and specificity of 85.6% (confidence interval 95%: 0.72 to 0.93) in correctly identifying humeral intracondylar fissures. The positive predictive value was 75.5% (confidence interval 95%: 0.64 to 0.84) and the negative predictive value was 66.1% (confidence interval 95%: 0.63 to 0.68). Agreement with CT images was <0.4, and interobserver and intraobserver agreements were <0.8. The radiographic orientation and type of fissure did not significantly affect interpretation outcomes.

CLINICAL SIGNIFICANCE

Radiographic imaging alone is insufficient for reliably diagnosing humeral intracondylar fissures in dogs.

Humeral Condylar Fractures in French Bulldogs: Prevalence of Contralateral Intracondylar Fissure, Treatment, and Outcome

OBJECTIVE

 The aim of this study was to report (1) the prevalence of contralateral humeral intracondylar GAP/HIF (HIF) in French Bulldogs with humeral condylar fractures (HCF) and (2) treatment and short- and long-term outcome in French Bulldogs with HCF.

MATERIALS AND METHODS

 Medical records of French Bulldogs treated surgically for HCF between January 2011 and November 2022 were reviewed. Perioperative imaging, surgical technique, complications, and long-term outcome were assessed.

RESULTS

 Eighty-nine dogs with HCF were included and 36/89 were diagnosed with HIF. Surgical repair was performed in all HCF and a prophylactic transcondylar screw was placed in 20/36 HIF. For prophylactic transcondylar screw placement, two dogs required immediate revision surgery. Complications occurred in 12/89 HCF, and there were major complications in 6/89 HCF. Long-term outcome evaluated by owner questionnaire (n = 27) was rated as being excellent in 18/27 dogs, good in 8/27 dogs, and fair in 1/27 dogs.

CLINICAL SIGNIFICANCE

 Forty percent of French Bulldogs with HCF had a contralateral HIF. HIF as a cause of HCF should be considered in the French Bulldog, and a computed tomography (CT) scan of both elbows may be advisable prior to HCF repair. The complication rate of HCF surgery in the French Bulldog is significant.

Computed tomographic re-evaluation of skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissure: 12 cases (2018-2022)

OBJECTIVES

The objective of this study was to present the follow-up findings obtained through computed tomography in skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissures.

MATERIALS AND METHODS

Medical records from a surgical referral centre between January 2018 and September 2022 were evaluated for all dogs with a humeral condylar fracture where preoperative CT of both humeri was performed. French bulldogs between the age of 12 weeks and 12 months were identified and evaluated for the presence of contralateral humeral intracondylar fissure. The dogs with follow-up CT were evaluated for humeral intracondylar fissure resolution.

RESULTS

A total of 137 humeral condylar fractures were operated on within the study period, 58 of which were in French bulldogs. Twenty-seven French bulldogs had a contralateral humeral intracondylar fissure with 12 dogs matching the inclusion criteria. Follow-up CT demonstrated resolution of the humeral intracondylar fissure in 11 (91.7%) of 12 cases.

CLINICAL SIGNIFICANCE

Contralateral humeral intracondylar fissures are common in skeletally immature French bulldogs sustaining humeral condylar fractures and the majority of these fissures tend to fuse within the follow-up period. Due to the potential for breed variation in ossification of the humeral condyle, follow-up CT may be warranted in skeletally immature French bulldogs before considering prophylactic transcondylar screw placement.

Long-Term Outcome and Complications after Transcondylar Screw Placement for Canine Humeral Intracondylar Fissure

OBJECTIVE

 The aim of this study was to report postoperative complications and long-term outcomes following transcondylar screw placement for humeral intracondylar fissure (HIF).

STUDY DESIGN

 It was a retrospective single-centre case series. Medical records (2018-2022) were reviewed for dogs with HIF treated with transcondylar screw placement. Data collected included signalment, concurrent orthopaedic disease, partial or complete HIF, surgeon, surgical approach, surgical technique and implant type, transcondylar screw angulation, postoperative complications and outcomes. Long-term outcome was assessed with owner questionnaire, orthopaedic examination and follow-up radiography. Statistical analysis was performed to identify risk factors predisposing to a complication or a poor outcome.

RESULTS

 Forty-seven dogs (57 elbows) met the inclusion criteria; long-term follow-up was available in 41 dogs (50 elbows). Minor and major medical complications were noted in seven and three elbows respectively. The total complication rate was 17.5%. Increasing age was significantly associated with a reduced risk of postoperative complications (p = 0.0051). No other risk factors were identified. A postoperative complication was not associated with a less than full outcome (p = 0.5698).

CONCLUSION

 Transcondylar screw placement for HIF is associated with a low complication rate and good outcome.

Humeral Condylar Fractures in French Bulldogs-Inciting Cause and Factors Influencing Complications of Internal Fixation in 136 Dogs

OBJECTIVE

 To report the inciting cause and configuration of humeral condylar fractures in French Bulldogs, and to identify risk factors for complications associated with their surgical stabilization, as well as their occurrence.

STUDY DESIGN

 Retrospective multicenter clinical cohort study.

ANIMALS

 French bulldogs (n = 136) with humeral condylar fracture.

METHODS

 Records from eight United Kingdom referral centers were reviewed for French bulldogs that underwent surgery for humeral condylar fracture between January 2017 and January 2021.

RESULTS

 Lateral fractures of the humeral condyle represented two-thirds of condylar fractures in this study (95 elbows; 69.8%); medial fractures of the humeral condyle and intracondylar Y or T fractures affected 22 (16.2%) and 19 (14%), respectively. A fall was the inciting cause for 60 elbows (45.6%), with stairs implicated in 27 (20.45%) elbows. Skeletal immaturity was significantly correlated with fracture. Complications affected 30 out of 132 dogs (136 elbows) (22%), of which 10 (33%) were major, and 20 (66%) were minor. Fixation method did not significantly impact complication rate for medial or lateral fractures of the humeral condyle (p = 0.87). Comminution increased the risk of complication for all humeral condylar fracture types (p = 0.02).

CLINICAL RELEVANCE

 Fixation method was not found to significantly impact the complication rate of surgically managed fractures of the humeral condyle in French bulldogs. Stair use, falling from low heights, and skeletal immaturity were common inciting reasons for humeral condylar fractures.

Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures: A randomized clinical trial

OBJECTIVE

To determine the influence of screw direction on complications following transcondylar screw placement for the treatment of canine humeral intracondylar fissures (HIFs).

STUDY DESIGN

Equivalence, parallel group, randomized clinical trial.

SAMPLE POPULATION

Fifty-two client owned dogs (73 elbows).

METHODS

Transcondylar screw placement was randomized to either a medial or lateral approach. The primary outcome was the incidence of postoperative complications.

RESULTS

There were 37 cases in the lateral approach group and 36 cases in the medial approach group. There was a significantly greater proportion of postoperative complications following placement of transcondylar screws from a lateral to medial direction (p = .001). There were seven cases with complications (19%) in the medial approach group versus 23 cases with complications (62%) in the lateral approach group. The majority of complications were seromas (n = 13) and surgical site infections (n = 16) with 4 complications requiring further surgery. Implant area moment of inertia (AMI), normalized to bodyweight, was lower in dogs with a major complication (p = .037).

CONCLUSION

Transcondylar screws placed from lateral to medial for canine HIFs had a greater proportion of postoperative complications in this randomized clinical trial design. Implants with a lower AMI, relative to bodyweight, were more likely to lead to major complications.

CLINICAL SIGNIFICANCE

We recommend placing transcondylar screws from medial to lateral for canine HIFs to reduce the risk of postoperative complications. Relatively small diameter implants had an increased risk of major complications.

The effect of an aiming device on the accuracy of humeral transcondylar screw placement

OBJECTIVES

(1) To evaluate the accuracy of an aiming device on placement of humeral transcondylar screws compared to fluoroscopic methods. (2) To compare experience level on outcome.

STUDY DESIGN

Randomized, match pair, prospective ex-vivo study.

SAMPLE POPULATION

A total of 68 dogs.

METHODS

Canine cadaveric forelimbs were randomly assigned to either aiming device or fluoroscopic-guided groups, and to diplomate or resident. Digital radiography was used to evaluate screw trajectory deviation and eccentricity on the humeral condyle. Procedure time, outcome based on experience, and complications were recorded.

RESULTS

The aiming device screw trajectory angle was decreased in the right limb (1.9 ± 1.1°) compared with the left (3.6 ± 1.1°, p = .0178), and compared to fluoroscopy (3.4 ± 1.1° p = .0128). There was no difference between leg laterality with fluoroscopy (p = .9979). Trajectory angle was increased with resident versus diplomate (3.4 ± 1.1° and 2.5 ± 1.1° respectively, p = .0366). Eccentricity deviation was decreased using fluoroscopy versus aiming device (3.1 ± 0.36 mm, 4.2 ± 0.36 mm, respectively, p = .0017). The risk of joint involvement was 8 times greater in aiming device groups, though not significant (p = .0575). Significant complications included increased drill attempts in fluoroscopic groups (p = .0237).

CONCLUSION

The aiming device provided accurate placement of transcondylar screws, in terms of both position on the condyle and trajectory angle. Results were similar to fluoroscopic-guided method.

CLINICAL SIGNIFICANCE

An aiming device is an acceptable means of placing humeral transcondylar screws. The use of the aiming device had an eight times increased risk of joint involvement compared to fluoroscopy.

Proximal Ulnar Osteotomy as a Treatment for Humeral Intracondylar Fissure in a Shetland Sheepdog

A seven-month-old male Shetland Sheepdog was presented for assessment of thoracic limb lameness of 3 weeks duration. Orthopaedic examination revealed severe discomfort in elbow extension, bilaterally. CT-scan confirmed presence of a complete humeral intracondylar fissure (HIF), bilaterally, and arthroscopic examination of both elbows confirmed the presence of the cartilaginous lesion previously reported in dogs suffering from HIF. A staged oblique proximal ulnar osteotomy was performed to address the humero-anconeal incongruency believed to be the cause of HIF formation. Orthopaedic examination performed 5 weeks after each surgical procedure confirmed that pain previously present on elbow manipulation had subsided. Follow-up examination performed 8 months after the second surgery revealed the dog to be sound at walking on the thoracic limbs with no discomfort present on elbow manipulation. Repeated CT scan confirmed complete healing of both HIFs. This is the first report documenting the presence of HIF in a Shetland sheepdog and complete healing of both HIFs following a proximal ulnar osteotomy.

Humeral condylar fractures and fissures in the French bulldog

OBJECTIVE

To report the configuration, risk factors, fixation methods and complication rates after repair of humeral condylar fractures (HCF) in French bulldogs, and report the presence of humeral intracondylar fissures (HIF) in this population as a possible predisposing factor.

STUDY DESIGN

Retrospective clinical cohort study.

SAMPLE POPULATION

Forty-four elbows.

METHODS

The medical records of dogs referred between January 2012 and December 2021 were searched for French bulldogs presenting with HCF. Signalment, fracture configuration, stabilization method and complication occurrence were obtained. Postoperative radiographs were assessed for implant positioning, and computed tomography (CT) scans were assessed for the presence and size of HIF in the contralateral elbow.

RESULTS

Lateral humeral condylar fractures represented 28/44 (63.6%) of HCF in French bulldogs. Repair with a transcondylar screw (TCS) and Kirschner-wire(s) (K-wire) were 7.62 times more likely to result in a major complication (95% CI: 1.43, 21.89; p = .01) compared to other methods. All incidences (7/7) of TCS migration were within the TCS + K-wire group. A HIF was identified in 18/31 (58.1%) dogs. Older animals were not significantly less likely to have a HIF than younger animals (p = .129).

CONCLUSIONS

Fracture stabilization with a TCS and K-wire(s) was associated with an increased risk of major complications and migration of the TCS. A HIF was present in the contralateral elbow of over half of the French bulldogs where CT was available.

CLINICAL SIGNIFICANCE

A HIF may be a predisposing factor of HCF in French bulldogs. Alternative methods of stabilization to a TCS and K-wire(s) should be used to reduce complication risk.

Demography, management and outcomes of canine physeal fractures (103 cases)

BACKGROUND

This study is a retrospective review of the demography, management, complications and outcomes of canine physeal fractures.

METHODS

Clinical records were reviewed for dogs with appendicular physeal fractures, and descriptive statistical analysis was applied to the data set.

RESULTS

One hundred and three fractures were included, of which 68 had follow-up. Fractures of the distal humerus were the most common (n = 57), followed by proximal tibial fractures (n = 16). Outcome was fair for most fractures at all locations, aside from the distal humerus, where most outcomes were good. At radiographic follow-up, most physes were closed at all locations aside from the distal tibia. Implant removal to allow ongoing physeal growth was performed in only 3/18 (17%) fractures, in 15/18 (83%) implant removal related to complications.

LIMITATIONS

Only short-term follow-up data were present, and hence it is not possible to give a longer term indication of return to function.

CONCLUSIONS

The management and demography of canine physeal fractures have evolved considerably from previous publications. Routine implant removal to allow ongoing growth was not regularly performed at all locations in this cohort.

A Prevalence Study of Canine Humeral Condylar Fractures Over a Ten-Year Period at an Academic Teaching Hospital

Objective The aim of this study was to investigate the prevalence, breed predisposition and fracture conformation of humeral condylar fractures (HCF) over a 10-year period. Results were compared with published studies emanating from the United Kingdom exploring effect of breed on HCF.

Methods Data for all canine admissions to the Veterinary Teaching Hospital at Kansas State University were extracted for the period January 2010 to October 2020. Humeral fractures were recorded and further subclassified as medial, lateral and ‘T’/‘Y’ condylar fractures. The associations between HCF and subtypes with breed were assessed using univariate logistic regression with a comparison group. Multivariable logistic regression was used to evaluate the effect of breed while accounting for dog age, sex and neuter status.

Results Of the 44,952 canine patients seen during the study period, period prevalence (95% confidence interval [CI] for HCF was 0.26% [0.22, 0.31]). After adjustment for age and neuter status, French Bulldogs were 49 times more likely to be diagnosed with a HCF compared with the comparison breed group (odds ratio [OR], 49.0; 95% CI, 26.9–89.3). After adjustment for age and neuter status, Cocker Spaniels (OR, 42.8; 95% CI, 16.8–108.6), Boston Terriers (OR, 22.9; 95% CI, 11.0–47.9) and Brittany Spaniels (OR, 21.5; 95% CI, 7.3–63.1) had the next highest increase in HCF compared with the comparison group.

Conclusion Based on a study population from the United States, French Bulldogs were 49 times more likely to be diagnosed with a HCF compared with the comparison breed group.