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Low D, Hutchings V, Rutherford S. Long-Term Outcome and Complications after Transcondylar Screw Placement for Canine Humeral Intracondylar Fissure. Vet Comp Orthop Traumatol 2024; 37:206-212. [PMID: 38190989 DOI: 10.1055/s-0043-1777808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
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.
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Affiliation(s)
- Daniel Low
- frank. Pet Surgeons., Leeds, United Kingdom
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2
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Payne DJL, Sparks TH, Smith MAJ, Macdonald NJ. Computed Tomography Topographical Analysis of Incomplete Humeral Intracondylar Fissures in English Springer Spaniel Dogs. Vet Comp Orthop Traumatol 2024; 37:64-73. [PMID: 37967844 DOI: 10.1055/s-0043-1776708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
OBJECTIVE The aim of this study was to use computed tomography (CT) images obtained from English springer spaniels (ESS) with different sizes of humeral intracondylar fissure (HIF) to describe the typical shape, origin and a possible propagation pattern of HIF in this breed. STUDY DESIGN It is a retrospective analysis of 32 elbow CT from 27 ESS with incomplete HIF. Measurements included HIF articular surface length, centre of HIF at articular surface relative to the caudal edge of the supratrochlear foramen (CHIF), HIF depth and sagittal area of fissure. Measurement of isthmus area and diameter was obtained for each elbow. Humeral intracondylar fissure measurements were analysed as proportions of the isthmus. For parts of analysis, elbows were grouped by HIF area as a percentage of isthmus area (%HIF) into less than 20% (n = 10), 20 to less than 40% (n = 8), 40 to less than 60% (n = 9) and 60 to less than 90% (n = 5). RESULTS The mean isthmus diameter was 12.31 mm (range: 10.96-13.69 mm). Mean CHIF for %HIF groups less than 20%, 20 to less than 40%, 40 to less than 60% and 60 to less than 90% were 57, 74, 86 and 96 degrees, respectively. The less than 20% group was significantly lower than 20 to less than 40% group (p = 0.035) and 40 to less than 60% and 60 to less than 90% groups (p < 0.001); the 20 to less than 40% group was significantly lower than the 60 to less than 90% group (p = 0.015). Humeral intracondylar fissure articular surface length increased in a sigmoidal fashion relative to %HIF, corresponding to segmental enlargement of the fissure as %HIF increases. CONCLUSION In ESS, HIF typically originates approximately 57 degrees caudal to the supratrochlear foramen in the sagittal plane and may propagate in a segmental fashion with lesser propagation through the proximal intracondylar region.
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Affiliation(s)
- Dylan J L Payne
- Northwest Veterinary Specialists, Delamere House, Ashville Point, Sutton Weaver, United Kingdom
| | - Tim H Sparks
- Waltham Petcare Science Institute, Freeby Lane, Waltham on the Wolds, Melton Mowbray, Leicestershire, United Kingdom
| | - Matthew A J Smith
- Northwest Veterinary Specialists, Delamere House, Ashville Point, Sutton Weaver, United Kingdom
| | - Nicholas J Macdonald
- Northwest Veterinary Specialists, Delamere House, Ashville Point, Sutton Weaver, United Kingdom
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Carwardine D, Mather A, Schofield I, Langley-Hobbs S, Carbonell-Buj E, Belch A, Barthelemy N, Parsons K. Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures: A randomized clinical trial. Vet Surg 2024; 53:264-276. [PMID: 37435744 DOI: 10.1111/vsu.13993] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/24/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
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.
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Affiliation(s)
| | | | | | - Sorrel Langley-Hobbs
- Faculty of Health Sciences, Bristol Veterinary School, University of Bristol, Bristol, UK
| | | | - Alex Belch
- Langford Veterinary Services, Bristol, UK
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Potamopoulou M, Brown G, Whitelock R. Correlation between the Insertion Side of a Transcondylar Screw for the Surgical Management of Humeral Intracondylar Fissures in Dogs and the Incidence of Postoperative Surgical Site Infection. Vet Comp Orthop Traumatol 2023; 36:311-316. [PMID: 37160257 DOI: 10.1055/s-0043-57223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE An increased rate of surgical site infection (SSI) following treatment of canine humeral intracondylar fissure (HIF) with a lateromedially (LM) placed transcondylar screw (TCS) compared with a mediolateral (ML) TCS has been previously postulated. We hypothesized that the direction of insertion of the TCS would not affect the incidence of postoperative SSI. STUDY DESIGN It was single-centre retrospective study. Dogs with HIF confirmed by computerized tomography, treated by TCS placement (between 2008 and 2019) and with a minimum follow-up of 12 weeks, were included. The following data were recorded: signalment, presenting clinical signs, direction of placement and size of the utilized TCS, surgical and anaesthetic times, concurrent surgical procedures, presence of concomitant elbow pathology, perioperative and postoperative antibiotic usage and postoperative complications. Recorded data were analysed with a multinomial logistic regression model with a p-value less than or equal to 0.05. RESULTS Thirty-five dogs (46 elbows) met the inclusion criteria. Median clinical follow-up interval was 52 weeks. Seven of thirty-one elbows with a ML TCS, and 4/15 elbows with a LM TCS developed SSI. Four of nine dogs that underwent bilateral single-surgery TCS placement developed SSI unilaterally. CONCLUSION No significant difference was shown in short-term SSI occurrence between the ML and the LM direction of placement of the TCS.
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Affiliation(s)
| | - Gordon Brown
- Grove Orthopaedic Referrals, Fakenham, United Kingdom
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5
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Neal KM, Gallaher HM, Thompson A, Kerby MD. The effect of an aiming device on the accuracy of humeral transcondylar screw placement. Vet Surg 2023; 52:538-544. [PMID: 36929604 DOI: 10.1111/vsu.13952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/18/2023]
Abstract
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.
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Affiliation(s)
- Katherine M Neal
- Department of Clinical Sciences in Veterinary Medicine, Mississippi State University, Starkvilln, Mississippi, USA
| | | | - Alexis Thompson
- Department of Comparative Biomedical Sciences, Mississippi State University, Starkvilln, Mississippi, USA
| | - Mary D Kerby
- Department of Clinical Sciences in Veterinary Medicine, Mississippi State University, Starkvilln, Mississippi, USA
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Simpson M, Meeson R. Defining the safe corridor for transcondylar screw placement in the feline humeral condyle. J Feline Med Surg 2022; 24:e453-e458. [PMID: 36219455 PMCID: PMC10812328 DOI: 10.1177/1098612x221121899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aim of this study was to develop guidelines for the optimal location of drill entry and exit points for insertion of a transcondylar screw across the feline humeral condyle. METHODS Multiplanar reconstruction of feline elbow CT scans performed between 2016 and 2021 at one referral institution were reviewed. The optimum medial and lateral epicondylar entry and exit points for transcondylar screw placement were determined. These values were normalised to the humeral condylar diameter (HCD) for each elbow to determine the transcondylar screw placement guidelines. These guidelines were applied to each elbow and tolerance angles were determined in the transverse and frontal plane CT images to determine the safe corridor for screw placement. RESULTS Twenty elbows from 12 cats were evaluated in this study. The guidelines for transcondylar screw placement were as follows: the medial entry/exit point was 0.38 × HCD cranial and 0.16 × HCD distal to the medial epicondyle, and the lateral entry/exit point was 0.3 × HCD cranial and 0.16 × HCD distal to the lateral epicondyle. Tolerance angles were statistically significantly (P <0.05) larger in both frontal (34.5% larger) and transverse (21.1% larger) planes when drilled from a lateral to medial direction compared with drilling from a medial to lateral direction. CONCLUSIONS AND RELEVANCE The guidelines determined from this study may aid clinicians in the placement of humeral transcondylar screws in cats. Where possible, drilling from a lateral to medial direction is recommended owing to the higher tolerance angles reducing the likelihood of articular surface damage. Further studies are warranted to determine whether these guidelines are clinically useful and result in the safe insertion of a transcondylar screw in the clinical setting.
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Jenkins G, Moores AP. Medial epicondylar fissure fracture as a complication of transcondylar screw placement for the treatment of humeral intracondylar fissure. Vet Surg 2022; 51:600-610. [PMID: 35383973 DOI: 10.1111/vsu.13800] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/06/2020] [Accepted: 10/18/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the incidence of medial epicondylar fissure fracture (MEFF) after medial-to-lateral transcondylar screw placement in dogs with humeral intracondylar fissure (HIF) and to identify risk factors for MEFF. STUDY DESIGN Retrospective study. SAMPLE POPULATION Seventy-four client-owned dogs (88 elbows). METHODS Medical records of dogs surgically treated for HIF, and postoperative imaging studies were reviewed for demographics, fracture characteristics, and repair techniques. The width of the transcondylar screw was expressed relative to the height of the condyle. Screw angle and degree of countersinking were recorded. Information from case records and follow-up radiographs were used to identify complications. RESULTS Medial epicondylar fissure fracture was identified in 10 elbows (11.4%) following medial-to-lateral transcondylar screw placement: 4 cases were detected intraoperatively, 2 on immediate postoperative radiographs, 1 during routine radiographic follow up, and 3 when radiographs were reviewed for this study. A larger relative screw size was found to increase the risk of MEFF (P = .004, OR = 1.5). Fifteen additional complications were identified in 13/80 elbows at a median of 6 weeks postoperatively (range 1-56 weeks). Screw loosening was the most frequent complication (n = 9) and was the only complication in dogs with MEFF (n = 3); MEFF tended to increase the risk of perioperative screw loosening (P = .06). CONCLUSION Medial epicondylar fissure fracture occurred in 10/88 elbows treated for HIF and was more common in elbows treated with a larger screw size relative to the height of the condyle. CLINICAL SIGNIFICANCE Placing transcondylar screws with a diameter inferior to 41% of the height of the condyle is recommended to avoid MEFF. Medial epicondylar fissure fracture appears to have a low clinical significance in the perioperative period, although its effect on long-term outcome remains unknown.
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Affiliation(s)
| | - Andy P Moores
- Anderson Moores Veterinary Specialists, Winchester, UK
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8
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Condon A, Keeley B, Beaumont GL. Ulnar neuropathy: A postoperative complication following placement of a humeral transcondylar screw in a dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anna Condon
- Small Animal Surgery Manchester Veterinary Specialists Manchester UK
| | - Ben Keeley
- Small Animal Surgery Manchester Veterinary Specialists Manchester UK
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9
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Almeida M, Yeadon R. Humeral intracondylar fissure in a boxer breed dog. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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10
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Serrano Crehuet T, de Linares Tuduri P, Biskup J. Biomechanical comparison of humeral condyles with experimental intracondylar fissures immobilized with a transcondylar positional or a lag screw: An ex-vivo study in dogs. Vet Surg 2021; 50:1443-1448. [PMID: 34382699 DOI: 10.1111/vsu.13714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the axial biomechanical properties of intracondylar humeral osteotomies fixed with 4.5 mm transcondylar positional or cortical lag screws. STUDY DESIGN Ex vivo study. SAMPLE POPULATION Paired humeri from 21 canine cadavers. MATERIALS AND METHODS An intracondylar osteotomy was created on each humerus to mimic an intracondylar fissure. Paired humeri were randomly assigned to fixation with a positional or a lag screw. All specimens were radiographed postinstrumentation to document proper screw placement. Axial load was applied to the distal articular surface of the trochlea at a rate of 1 mm/s until a 40% decrease in load was measured. Specimens were assessed for mode of failure with visual inspection and radiographs. RESULTS Stiffness (1236.7 ± 181 N/mm vs. 1050.8 ± 265 N/mm), yield load (3284.3 ± 1703 N vs. 2071.1 ± 740 N), and maximum load (7378.0 ± 1288 vs. 5793.7 ± 2373 N) were greater in constructs fixed with a positional rather than a lag screw (p = .0008, .044, and .040, respectively). CONCLUSION In our model, mechanical properties were improved when the transcondylar osteotomy was stabilized with a 4.5 mm positional screw rather than a lag screw. CLINICAL SIGNIFICANCE This ex vivo study suggests that a transcondylar lag screw and positional screw are not biomechanically equal. Additional in vivo studies are need to help with clinical decision making when prophylactically treating HIF.
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Affiliation(s)
- Tomas Serrano Crehuet
- Surgery Department of Small Animal Teaching Hospital, Oregon State University, Corvallis, Oregon, USA
| | - Pablo de Linares Tuduri
- Surgery Department of Small Animal Teaching Hospital, Oregon State University, Corvallis, Oregon, USA
| | - Jeffery Biskup
- Surgery Department of Small Animal Teaching Hospital, Oregon State University, Corvallis, Oregon, USA
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Pardo M, Morris AP, Frazzica F, Barnes DM. Accuracy of medial-to-lateral transcondylar screw placement using an aiming device and preoperative computer tomography planning for the treatment of humeral intracondylar fissure. Vet Surg 2021; 50:1218-1226. [PMID: 34076290 DOI: 10.1111/vsu.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/15/2021] [Accepted: 04/17/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the accuracy of transcondylar screws placed from medial-to-lateral using preoperative planning on computed tomography (CT) and an aiming device in elbows with humeral intracondylar fissures (HIFs). STUDY DESIGN Retrospective case series. ANIMALS Twenty-five client-owned dogs with HIF. METHODS A 4.5-mm transcondylar screw was placed in 34 elbows with HIF. humeral condylar diameter (HCD) was measured at the humeral condylar isthmus on CT. Entry and exit points were planned at 0.3 × HCD cranial and 0.2 × HCD distal to the medial epicondyle and 0.3 × HCD cranial and 0.3 × HCD distal to the lateral epicondyle. An aiming device was used to guide drilling from the medial entry point to the lateral exit point. The difference between planned and actual screw entry and exit points, and the angular deviation of the actual screw axis from the planned screw axis, was assessed on the postoperative CT scans. RESULTS Thirty-three out of 34 screws were completely within the humeral condyle. Thirteen out of 34 screws were placed less than 2 mm from planned entry and exit points in both the transverse and the frontal plane. The axis of the screw deviated by a mean of 3.2° (transverse plane) and 3.5° (frontal plane) from the planned axis. CONCLUSION Humeral transcondylar screws placed with the technique tested here were entirely within the humeral condyle in 33 out of 34 elbows. CLINICAL SIGNIFICANCE Use of CT planning and an aiming device allows accurate placement of transcondylar screws from medial-to-lateral in dogs with HIF.
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Affiliation(s)
- Maite Pardo
- Eastcott Referrals, Eastcott Veterinary Clinic and Hospital, Swindon, UK
| | - Andy P Morris
- Eastcott Referrals, Eastcott Veterinary Clinic and Hospital, Swindon, UK
| | - Fabio Frazzica
- Eastcott Referrals, Eastcott Veterinary Clinic and Hospital, Swindon, UK
| | - Duncan M Barnes
- Eastcott Referrals, Eastcott Veterinary Clinic and Hospital, Swindon, UK
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Strohmeier UW, Harris KP. Humeral intracondylar fissures in French bulldogs. Vet Rec 2021; 189:e504. [PMID: 34021603 DOI: 10.1002/vetr.504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 02/17/2021] [Accepted: 05/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND French bulldogs have previously been reported to be at an increased risk of developing humeral condylar fractures (HCF). Humeral intracondylar fissures (HIF) are thought to be a predisposing factor for HCF occurrence in skeletally mature dogs particularly when the fracture occurs during normal activity. We hypothesised that HIF may be a predisposing factor for HCF in French bulldogs. METHODS A retrospective case series of nine French bulldogs that had sustained HCF and where CT was performed prior to surgery. RESULTS Five of the fractured humeri had sclerosis adjacent to the fracture site. Six of the contralateral intact humeri were diagnosed with HIF on the basis of a partial (2/6) or complete (4/6) hypoattenuating area extending between the distal articular surface and the supratrochlear foramen in the sagittal plane, with adjacent sclerosis (6/6). CONCLUSIONS Recognition of sclerosis at the intracondylar fracture surface on CT can prompt suspicion that HIF preceded HCF. A predisposing HIF has potentially great clinical significance for this breed if we draw parallels with breeds such as the springer spaniel for whom HIF and HIF-associated condylar fracture is well documented.
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Affiliation(s)
- Ulrike W Strohmeier
- Department of small animal surgery, ophthalmology, dentistry and physiotherapy, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Karen P Harris
- Southern Counties Veterinary Specialists, Ringwood, Hampshire, UK
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Raleigh JS, Filliquist B, Kapatkin AS, Chou PY, Marcellin-Little DJ, Garcia TC, Jacques KL, Stover SM. Influence of interlocking thread screws to repair simulated adult canine humeral condylar fractures. Vet Surg 2021; 50:1237-1249. [PMID: 33959975 DOI: 10.1111/vsu.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 04/14/2021] [Accepted: 04/26/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the influence of interlocking screw threads on the biomechanical properties of repaired canine humeral condylar fractures. STUDY DESIGN Ex vivo biomechanical study. SAMPLE POPULATION Thirty-six humeral condyles. METHODS Simulated fractures of the lateral aspect of the humeral condyle were stabilized by a 3.5 mm interlocking thread screw (ITS) or 3.5 mm buttress thread screw placed in lag (BTS-L) or positional fashion (BTS-P) and axially loaded at a walk, trot, 2-mm displacement, and failure cycles. Compact flute drill bits (CFBs) were used for ITS constructs and standard flute drill bits (SFB) for BTS constructs. The effects of bit type on drilling parameters and screw type on screw insertion properties and fragment stability were assessed. RESULTS CFB produced a 6°C greater temperature increase (p = .042) and required 20 N higher torque (p = .003) than SFB. Insertional torque was greater for ITS than BTS-P (p = .001) and BTS-L (p = .001). Condylar fragment rotation at failure was lower in ITS (lsmean ± SE, 8.3° ± 1.9°) than BTS-L constructs (14.5° ± 2.3°, p = .011). ITS resisted greater loads (1503 ± 105 N) than BTS-P (1189 ± 99 N, p = .038) but not BTS-L (1249 ± 123 N, p = .121) constructs. CONCLUSION Biomechanical performance of constructs was improved with ITS rather than BTS fixation. CLINICAL SIGNIFICANCE ITS can be considered for stabilization of humeral condylar fractures in adult dogs.
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Affiliation(s)
- Joseph S Raleigh
- William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Barbro Filliquist
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Amy S Kapatkin
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Po Yen Chou
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Denis J Marcellin-Little
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Tanya C Garcia
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Kevin L Jacques
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
| | - Susan M Stover
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California, USA
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Abstract
Humeral intracondylar fissure (HIF) was first described as incomplete ossification of the humeral condyle. It is now known that the fissure is a stress fracture in some dogs. The descriptive term HIF is therefore preferred. In young dogs an incomplete ossification cause may still be valid. Symptomatic HIF is treated surgically with a transcondylar implant. The aim is to alleviate lameness and avoid condylar fracture. Choosing an appropriate surgical approach and implant can reduce complications. HIF is not always symptomatic and, in these cases, surgical management is more controversial, because a minority of such cases become lame or fracture.
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Affiliation(s)
- Andy P Moores
- Anderson Moores Veterinary Specialists, Bunstead Barns, Poles lane, Hursley, Winchester, SO21 2LL, United Kingdom.
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Faux I, Hall JL, Schwarz T, Clements DN, Ryan J. Comparing the accuracy of freehand, fluoroscopically guided and aiming device-assisted drilling in veterinary orthopaedic surgery. Vet Rec 2020; 187:e126. [PMID: 33033104 DOI: 10.1136/vr.105834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 07/15/2020] [Accepted: 08/06/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Drilling accuracy is essential in the correct positioning of implants and avoidance of iatrogenic damage to surrounding tissues. The use of augmented drilling methods has been documented as an approach to improving the accuracy of drilling. The aim of this study was to compare the accuracy of two augmented drilling methods (fluoroscopically guided and aiming device) to freehand (FH) drilling. METHODS Three experienced specialist surgeons and three veterinary surgeons without primary orthopaedic experience drilled into synthetic bone towards a target using the three different methods at three different angles (0°, 10° and 20°). The duration of drilling was recorded, and the accuracy of drilling was measured using photographs before and after drilling. RESULTS The two augmented methods were more accurate than FH drilling in synthetic bone, with the aiming device producing the greatest accuracy. Increased angulation of drilling decreased the drilling accuracy. Surgeon experience did not impact on drilling accuracy. Surgeon inexperience and augmented drilling methods both increased the time taken to drill. CONCLUSION The use of augmented drilling methods improved the accuracy of drilling, and surgeons should consider their use when drilling in anatomical regions where the margin of error is small.
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Affiliation(s)
- Ian Faux
- R(D)SVS, The University of Edinburgh, Edinburgh, UK
| | - Jon L Hall
- VetEd Specialists, VetEd Specialists Ltd, Quothquan, South Lanarkshire, UK
| | - Tobias Schwarz
- Clinical Veterinary Studies, The University of Edinburgh, Roslin, UK
| | | | - John Ryan
- R(D)SVS, The University of Edinburgh, Edinburgh, UK
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Affiliation(s)
- Kinley Smith
- Willows Referral and Veterinary Centre, Highlands Road, Solihull, B90 4NH, UK
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Easter TG, Bilmont A, Pink J, Oxley B. Accuracy of three-dimensional printed patient-specific drill guides for treatment of canine humeral intracondylar fissure. Vet Surg 2019; 49:363-372. [PMID: 31713891 DOI: 10.1111/vsu.13346] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 09/01/2019] [Accepted: 09/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the accuracy of three-dimensional printed patient-specific drill guides (3D-PDG) as treatment of humeral intracondylar fissures (HIF) in dogs. STUDY DESIGN Retrospective consecutive case series. ANIMALS Client-owned dogs with HIF treated with a 5-mm transcondylar screw (TCS) placed from medial to lateral with a 3D-PDG. METHODS The proposed TCS entry point and trajectory were planned using computed tomography (CT) data and computer-aided design software (CAD), and a 3D-PDG was produced. During surgery the 3D-PDG was used to drill the pilot hole from medial to lateral; the guide was then removed, the pilot hole was overdrilled, and a 5-mm TCS was placed. Postoperative CT data were imported into CAD software, and the entry points, exit points, and trajectories were compared between the planned and actual screw locations. RESULTS Sixteen elbows from 11 dogs were included. Mean (SD) entry point translation was 1.3 mm (0.64), with all screws entering cranial to the proposed location. Mean maximum screw angulation was 5.2° (2.10°), with most screws directed caudodistal to the desired trajectory. Mean (SD) exit point translation was 1.8 mm (0.89) from the planned location. There was no intra-articular screw placement. CONCLUSION Use of a 3D-PDG permitted accurate placement of a mediolateral 5-mm locking TCS within the humeral condyle. CLINICAL SIGNIFICANCE Three-dimensional printed patient-specific drill guides should be considered as accurate and consistent for placing TCS for treatment of HIF in dogs.
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Affiliation(s)
- Tim G Easter
- Willows Referral Service, Solihull, United Kingdom
| | | | | | - Bill Oxley
- Willows Referral Service, Solihull, United Kingdom
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McCarthy J, Woods S, Mosley JR. Long-term outcome following management of canine humeral intracondylar fissure using a medial approach and a cannulated drill system. Vet Rec 2019; 186:490. [PMID: 31413118 DOI: 10.1136/vr.105403] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/17/2019] [Accepted: 07/09/2019] [Indexed: 11/04/2022]
Abstract
This study evaluated the feasibility, complications and long-term outcomes of using a cannulated drill system combined with intraoperative imaging to place a transcondylar screw for the management of canine humeral intracondylar fissure. Thirteen dogs were enrolled, with one dog undergoing staged bilateral surgery. No intraoperative complications occurred. Five minor (36%) and three major (21%) postoperative complications occurred, giving an overall complication rate of 57%. None of the screws placed penetrated the articular surface. The mean duration of surgery was 28 min (SD ±3.5) for dogs that developed a major complication versus 46 min (SD ±18.1) for those that did not (p=0.015). The duration of preoperative lameness was significantly shorter for cases which suffered a major complication (2 days; SD ±2.8) than those that did not (34 days; SD ±31.7, p=0.008). None of the variables assessed were significantly associated with minor complications. Median time from surgery to last follow-up was 5.8 years (range 3.5-8.5 years). Median Liverpool Osteoarthritis in Dogs questionnaire score at the final point of follow-up was 16 (range 7-27). A significant number of patients were found to require analgesia at long-term follow-up.
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Affiliation(s)
- Jessica McCarthy
- Royal (Dick) School of Veterinary Sciences, University of Edinburgh, Roslin, UK
| | - Samantha Woods
- Royal (Dick) School of Veterinary Sciences, University of Edinburgh, Roslin, UK
| | - John R Mosley
- Royal (Dick) School of Veterinary Sciences, University of Edinburgh, Roslin, UK
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Bishop ES, Hall JL, Handel I, Clements DN, Ryan J. Sequential drilling and drill angulation reduce the accuracy of drill hole start location in a synthetic bone model. Vet Rec 2019; 184:383. [DOI: 10.1136/vr.104897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/13/2018] [Accepted: 12/28/2018] [Indexed: 11/03/2022]
Affiliation(s)
| | - Jon L Hall
- Hospital for Small Animals, University of Edinburgh; Edinburgh UK
| | - Ian Handel
- Royal Dick School of Veterinary Studies, University of Edinburgh; Edinburgh UK
| | | | - John Ryan
- Hospital for Small Animals, University of Edinburgh; Edinburgh UK
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Chase D, Sul R, Solano M, Calvo I, Joslyn S, Farrell M. Short‐ and long‐term outcome after transcondylar screw placement to treat humeral intracondylar fissure in dogs. Vet Surg 2019; 48:299-308. [DOI: 10.1111/vsu.13155] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 03/14/2018] [Accepted: 04/03/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Damian Chase
- Veterinary Specialists Group Auckland New Zealand
| | - Rui Sul
- North Downs Specialist Referrals Surrey United Kingdom
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Brioschi V, Cook J, Arthurs GI. Can a surgeon drill accurately at a specified angle? Vet Rec Open 2016; 3:e000172. [PMID: 27547423 PMCID: PMC4964160 DOI: 10.1136/vetreco-2016-000172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/26/2016] [Accepted: 05/04/2016] [Indexed: 11/25/2022] Open
Abstract
Objectives To investigate whether a surgeon can drill accurately a specified angle and whether surgeon experience, task repetition, drill bit size and perceived difficulty influence drilling angle accuracy. Methods The sample population consisted of final-year students (n=25), non-specialist veterinarians (n=22) and board-certified orthopaedic surgeons (n=8). Each participant drilled a hole twice in a horizontal oak plank at 30°, 45°, 60°, 80°, 85° and 90° angles with either a 2.5 or a 3.5 mm drill bit. Participants then rated the perceived difficulty to drill each angle. The true angle of each hole was measured using a digital goniometer. Results Greater drilling accuracy was achieved at angles closer to 90°. An error of ≤±4° was achieved by 84.5 per cent of participants drilling a 90° angle compared with approximately 20 per cent of participants drilling a 30–45° angle. There was no effect of surgeon experience, task repetition or drill bit size on the mean error for intended versus achieved angle. Increased perception of difficulty was associated with the more acute angles and decreased accuracy, but not experience level. Clinical significance This study shows that surgeon ability to drill accurately (within ±4° error) is limited, particularly at angles ≤60°. In situations where drill angle is critical, use of computer-assisted navigation or custom-made drill guides may be preferable.
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Affiliation(s)
- Valentina Brioschi
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
| | | | - Gareth I Arthurs
- Department of Veterinary Medicine, University of Cambridge, Cambridge, UK
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