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Miller ZA, Cabrera SY, Mason D, Kass PH. Good clinical outcomes achieved in young dogs with tibial tuberosity avulsion fracture repairs when implants were left in situ past skeletal maturity. J Am Vet Med Assoc 2022; 260:1941-1946. [PMID: 36170215 DOI: 10.2460/javma.22.07.0336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate outcomes of tibial tuberosity avulsion fractures (TTAF) in dogs with implants left in situ past skeletal maturity and to compare clinical outcomes with published outcomes in dogs whose implants were removed 4 to 6 weeks postoperatively. ANIMALS 47 client-owned dogs. PROCEDURES In this retrospective study, 47 dogs had surgery to correct a TTAF before 10 months of age and had the implants left in situ past skeletal maturity. Of these, 42 were followed for a median of 36 months postoperatively. Short- and long-term complications were recorded and compared with historically published data in which the implants were removed within 6 weeks of surgery. RESULTS 14% (6/42) of our population experienced minor long-term complications (stiffness and lameness), 6% (3/47) experienced major short-term complications (repair failure), and 14% (6/24) experienced major long-term complications (implant removal). There was no difference in long-term outcomes when compared with results of historical reports in which implants were removed 4 to 6 weeks postoperatively. Client satisfaction was high, with 93% (38/41) grading outcomes as excellent and 95% (39/41) stating they would have surgery performed again in retrospect. CLINICAL RELEVANCE Immature dogs with surgically repaired TTAFs have favorable long-term outcomes when the implants were left in situ past skeletal maturity. Dogs with TTAF repairs may not need implant removal unless it becomes clinically necessary. Avoiding a second procedure will decrease patient morbidity, recovery time, and cost.
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Affiliation(s)
- Zachary A Miller
- 1Department of Surgery, Las Vegas Veterinary Specialty Center, Las Vegas, NV.,2Department of Surgery, Metropolitan Animal Hospital, Copley, OH
| | - Sady Y Cabrera
- 3Department of Surgery, Metropolitan Animal Specialty Hospital, Los Angeles, CA
| | - David Mason
- 1Department of Surgery, Las Vegas Veterinary Specialty Center, Las Vegas, NV
| | - Philip H Kass
- 4Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA
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Arun A, Park SJ, Pavia PR, Kalafut SR, Hofmeister E. Factors Contributing to the Need for Non-Elective Explant following Surgical Repair of Tibial Tuberosity Avulsion Fracture. Vet Comp Orthop Traumatol 2022; 35:184-190. [PMID: 35679872 DOI: 10.1055/s-0042-1743562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate factors contributing to the need for non-elective explant following surgical repair of tibial tuberosity avulsion fractures. STUDY DESIGN Retrospective multicentre case-control study. Over a 5-year period, dogs (n = 63) that underwent surgical repair of tibial tuberosity avulsion fractures (n = 64) were considered. Dogs that underwent a non-elective explant were compared with those that did not. Continuous variables were compared with the Mann-Whitney U test. Categorical variables were compared with the Fisher's exact test. Variables which were significant on univariate analysis were entered into a multiple logistic regression model. Significance was set at p < 0.05. RESULTS Non-elective explant was performed in 20/64 fractures and elective explant was performed in 2/64 fractures. Neutered dogs were found to be 19 times (95% confidence interval: 2.1-172) more likely to require explant compared with intact dogs (p = 0.009). Every 0.25 mm increase in average pin size was found to make it 2.5 times (95% confidence interval: 1.3-4.9) more likely to require explant (p = 0.006). CONCLUSION The findings suggest that use of the smallest appropriate pin should be considered for standard surgical repair of tibial tuberosity avulsion fractures to minimize the risk of requiring non-elective explant.
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Affiliation(s)
- Aparna Arun
- BluePearl Veterinary Partners LLC, Surgery Service, New York, New York, United Sates
| | - Stephanie J Park
- BluePearl Veterinary Partners LLC, Surgery Service, New York, New York, United Sates
| | - Philippa R Pavia
- BluePearl Veterinary Partners LLC, Surgery Service, New York, New York, United Sates
| | - Sarah R Kalafut
- BluePearl Veterinary Partners LLC, Surgery Service, New York, New York, United Sates
| | - Erik Hofmeister
- Auburn University, Veterinary Anaesthesia and Analgesia, Auburn, Alabama, United Sates
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Verpaalen VD, Lewis DD. Use of a hybrid external skeletal fixator construct for managing tibial tuberosity avulsion fractures in three dogs. J Am Vet Med Assoc 2021; 258:1098-1108. [PMID: 33944593 DOI: 10.2460/javma.258.10.1098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION 3 juvenile (4 to 5 months of age) medium- to large-breed or crossbred dogs were evaluated for sudden unilateral non-weight-bearing lameness in a pelvic limb after a fall during strenuous activity. CLINICAL FINDINGS All dogs had non-weight-bearing lameness (n = 2) or bore minimal weight (1) on the affected pelvic limb, had soft tissue swelling over the cranial aspect of the stifle joint in the affected limb, seemed to resist manipulation of the affected joint, and had tibial tuberosity avulsion fracture confirmed with radiography. TREATMENT AND OUTCOME Each dog underwent surgical fracture reduction and stabilization with a hybrid circular-linear external skeletal fixator construct with interfragmentary Kirschner wires used to stabilize the avulsed tibial tuberosity. Successful fracture reduction and stabilization were achieved, and only minor postoperative complications occurred. Construct removal 2 weeks postoperatively resulted in no displacement of the tibial tuberosity in 2 dogs and only minor proximal displacement in the remaining dog, allowed for continued unencumbered growth through the apophysis and proximal tibial epiphysis in all dogs, and did not result in tibial conformational anomalies. Clinical outcome was considered excellent in 2 dogs with complete resolution of lameness and good in 1 dog with subsequent occasional mild lameness. CLINICAL RELEVANCE Our findings suggested that the described hybrid external skeletal fixator construct could be used as a minimally invasive strategy to successfully manage tibial tuberosity avulsion fractures in dogs and may be advantageous in very young medium- to large-breed dogs in which premature closure of the tibial tuberosity apophysis could result in distal translocation of the tibial tuberosity and deformity of the tibial plateau.
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Verpaalen VD, Lewis DD, Billings GA. Biomechanical Comparison of Three Stabilization Methods for Tibial Tuberosity Fractures in Dogs: A Cadaveric Study. Vet Comp Orthop Traumatol 2021; 34:279-286. [PMID: 33979879 DOI: 10.1055/s-0041-1726082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim of this study was to compare the biomechanical properties of a hybrid external skeletal fixator (HESF) construct to the placement of paired interfragmentary Kirschner wires alone, and pin and tension band wire (PTBW) fixation for the stabilization of simulated tibial tuberosity fractures in dogs. STUDY DESIGN Tibias were harvested from 12 skeletally mature dog cadavers weighing 20 to 30 kg. An osteotomy was made through the base of the tibial tuberosity, which was subsequently repaired with either paired Kirschner wires, PTBW fixation or a HESF. A tensile load was applied to the tibial tuberosity until failure occurred. Mode of failure was described and biomechanical parameters obtained were compared between fixation groups. RESULTS The PTBW fixation and HESF construct afforded greater stiffness and load at 3 mm of axial displacement compared with fixation with Kirschner wires alone. There was no significant difference in stiffness and load at 3 mm displacement between PTBW and HESF fixation. Failure occurred by bending and pullout of the Kirschner wires for all fixation groups, preceded by untwisting of the knot in PTBW specimens. CONCLUSION The HESF may provide a favourable alternative to PTBW fixation for tibial tuberosity avulsion fracture stabilization in dogs with substantial remaining growth potential.
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Affiliation(s)
- Valentine D Verpaalen
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States
| | - Daniel D Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States
| | - Gary A Billings
- Georgia Department of Agriculture, Animal Industry Division, Atlanta, Georgia, United States
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von Pfeil DJF, Megliolia S, Malek S, Rochat M, Glassman M. Tibial Apophyseal Percutaneous Pinning in Skeletally Immature Dogs: 25 Cases (2016-2019). Vet Comp Orthop Traumatol 2020; 34:144-152. [PMID: 33212512 DOI: 10.1055/s-0040-1719091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to report the clinical experience with fluoroscopically guided tibial apophyseal percutaneous pinning (TAPP) for tibial tuberosity avulsion fractures (TTAF). STUDY DESIGN This is a retrospective case series. MATERIALS AND METHODS Medical records of skeletally immature dogs (n = 25) were reviewed. The association of pin design [smooth (SP); negatively threaded (NTP)], pin insertion angles, TTAF-type, age and breed with various outcome variables was statistically evaluated. Long-term follow-up was assessed via direct examination, radiographs, questionnaires and videos. RESULTS Mean age, weight and surgery times were 6.2 months, 9.6 kg and 21 minutes respectively. No major complications occurred among the 19 SP and 6 NTP; no pin broke. Seromas and patellar desmitis rates were higher with SP (11/19; 16/19) versus NTP (0/6; 2/6) (p = 0.02; 0.03). The median horizontal pin cross angles for cases without and with desmitis were 40 and 26 degrees respectively (p = 0.047). Explantation was needed in 5/19 SP and 0/6 NTP cases. The mean tibial plateau angle (TPA) changed significantly between initial (25.6 degrees) and follow-up (18.8 degrees) radiographs (p = 0.0002). Long-term outcome, obtained at a mean of 19.9 months, was excellent in all cases. CONCLUSION Tibial apophyseal percutaneous pinning can be considered to treat TTAF. Divergent pin placement and using NTP might reduce complications. Tibial plateau angle should be monitored until skeletal maturity has been reached. Long-term outcome post TAPP can be expected to be excellent.
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Affiliation(s)
| | - Sara Megliolia
- Friendship Surgical Specialists of the Friendship Hospital for Animals, Washington DC, United States
| | - Sarah Malek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States
| | - Mark Rochat
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, United States
| | - Mathieu Glassman
- Friendship Surgical Specialists of the Friendship Hospital for Animals, Washington DC, United States
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Minimally displaced tibial tuberosity avulsion fracture in nine skeletally immature large breed dogs. Vet Comp Orthop Traumatol 2017; 25:524-31. [DOI: 10.3415/vcot-11-12-0170] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 06/27/2012] [Indexed: 11/17/2022]
Abstract
SummaryObjective: The objective of this study was to describe the clinical and radiographic features, as well as the treatment and outcome of minimally displaced tibial-tuberosity-avulsion-fractures (MDTTAF).Materials and methods: Signalment, history, diagnostics, therapy, and outcome were recorded. Follow-up was documented as re-examination, radiographic assessment or telephone conversation.Results: Nine large breed dogs that were presented with lameness originating from the proximal tibia were included. All showed signs of pain when pressure was applied to the tibial tuberosity. There was no stifle instability or intra-articular disease. The main feature on mediolateral radiographs was a widened tibial-tuberosity-physis with reactive new bone and loss of edge definition of the epiphyseal and metaphyseal margins. Non-surgical treatment was chosen in eight dogs, and surgery in one dog. Radiographic follow-up showed progressive closure of the tibial-tuberosity-physis and healing. Clinical signs resolved at a median of 28 days (range: 14–120).Discussion: Minimally displaced tibial-tuberosity-avulsion-fractures should be a differential diagnosis in skeletally immature large breed dogs older than nine months of age with signs of subtle pelvic-limb lameness, and signs of proximal tibial pain, but no evidence of stifle joint disease. Thorough clinical examination and critical review of bilateral radiographs are important to diagnose MDTTAF. The outcome in these cases suggests that the prognosis for MDTTAF is excellent. Age and size of the affected dogs in this study differ from an earlier publication that illustrated more severely displaced tibial tuberosity avulsion fractures, occurring mainly in terriers around five months of age.
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Abstract
Osteochondrosis is a common and clinically important joint disorder that occurs in human beings and in multiple animal species, most commonly pigs, horses, and dogs. This disorder is defined as a focal disturbance of enchondral ossification and is regarded as having a multifactorial etiology, with no single factor accounting for all aspects of the disease. The most commonly cited etiologic factors are heredity, rapid growth, anatomic conformation, trauma, and dietary imbalances; however, only heredity and anatomic conformation are well supported by the scientific literature. The way in which the disease is initiated has been debated. Although formation of a fragile cartilage, failure of chondrocyte differentiation, subchondral bone necrosis, and failure of blood supply to the growth cartilage all have been proposed as the initial step in the pathogenesis, the recent literature strongly supports failure of blood supply to growth cartilage as being the most likely. The term osteochondrosis has been used to describe a wide range of different lesions among different species. We suggest a refinement of this terminology to include the modifiers latens (lesion confined to epiphyseal cartilage), manifesta (lesion accompanied by delay in endochondral ossification), and dissecans (cleft formation through articular cartilage). The purpose of this review is to provide an overview of the disease, focusing on the most commonly cited theories, recent research findings, and our own views regarding the etiology and pathogenesis of osteochondrosis, in order to provide a better understanding of this apparently complex disease.
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Affiliation(s)
- B Ytrehus
- Section for Wildlife Diseases, National Veterinary Institute, N-0033 Oslo, Norway.
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Nehrbass D, Arens D, Zeiter S. Spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit - a counterpart to Osgood-Schlatter disease in humans? ACTA ACUST UNITED AC 2014; 67:223-7. [PMID: 25435475 DOI: 10.1016/j.etp.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
The first reported case describing a spontaneous bilateral avulsion fracture of the tuberositas tibiae in a New Zealand White rabbit is presented. So far in animals, this condition has been only described in dogs and horses. In humans, this condition is also called Osgood-Schlatter disease (OSD) or syndrome, traction apophysitis of the tibial tubercle (ATT) or patellar tendon enthesopathy of the tibial tuberosity respectively. It is mainly seen in young adolescents coinciding with periods of growth spurts. In humans, its pathogenesis is believed to be caused by repetitive tendon/muscle strain at the insertion of the patellar tendon to the immature tibial tuberosity, which has its own secondary ossification center. Morphologically this case is characterized by bilateral chronic avulsion with incomplete separation of the tuberositas tibae, and proximal dislocation of the patella (patella alta). Despite these marked pathological changes, the animal was clinically without findings. Nevertheless, this case emphasizes the need for thorough clinical and radiological examination of rabbits intended for preclinical research studies prior to study begin, especially in orthopedic research.
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Affiliation(s)
- D Nehrbass
- AO Research Institute Davos, Switzerland.
| | - D Arens
- AO Research Institute Davos, Switzerland
| | - S Zeiter
- AO Research Institute Davos, Switzerland
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Avulsion fragmentation of the tibial tuberosity apophysis and associated patellar tendon enthesopathy in a skeletally immature dog. Vet Comp Orthop Traumatol 2013; 26:242-7. [PMID: 23677126 DOI: 10.3415/vcot-12-07-0088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 01/04/2013] [Indexed: 11/17/2022]
Abstract
A 9.5-month-old, female entire, 31.3 kg crossbred dog was presented with a 12 week history of moderate weight-bearing right pelvic limb lameness. Radiographic, computed tomographic, and ultrasonographic imaging revealed progressive avulsion fragmentation of the right tibial tuberosity apophysis and a patellar tendon insertional enthesopathy without physeal involvement. Conservative management was successful in achieving a good clinical outcome. A progressive avulsion of the contralateral proximal tibial physes that occurred concurrently resulted in development of an excessive tibial plateau slope angle. The additional development of a moderate left distal femoral varus deformity was surgically corrected. This is the first report of a progressive, traction injury to the tibial tuberosity apophysis in a dog that appears clinically and radiographically very similar to Osgood-Schlatter disease in humans.
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De Simone A, Gernone F, Ricciardi M. Imaging diagnosis-bilateral abnormal ossification of the supraglenoid tubercle and cranial glenoid cavity in an English Setter. Vet Radiol Ultrasound 2012; 54:159-63. [PMID: 23094792 DOI: 10.1111/j.1740-8261.2012.01993.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 09/12/2012] [Indexed: 11/29/2022] Open
Abstract
An 8-month-old intact male English Setter was presented with bilateral shoulder lameness. Radiographic and CT examinations demonstrated bilateral irregular margination and separation of the supraglenoid tubercle from the scapula, with involvement of the cranial articular surface of the glenoid cavity. After 30 days of cage rest, complete fusion of proximal portions of both supraglenoid tubercles and persistent un-united cranial portions of both glenoid cavities were evident. Histopathologic findings from biopsies of glenoid cavity defects were consistent with osteochondrosis or focal chondrodysplasia.
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Gower JA, Bound NJ, Moores AP. Tibial tuberosity avulsion fracture in dogs: a review of 59 dogs. J Small Anim Pract 2008; 49:340-3. [DOI: 10.1111/j.1748-5827.2008.00566.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Tibial fractures are common in small animal practice. As with other appendicular fractures, the patient's age, fracture location, and fracture type must be considered thoroughly. While methods for tibial fracture repair are similar to those used for appendicular fractures elsewhere, there are some unique considerations, both anatomically and functionally, that must be contemplated before repair. The following article will review the incidence of tibial fractures, tibial fracture types, and options for tibial fracture management and treatment. The use of external fixators, orthopedic bone plates, open reduction with internal fixation (ORIF), and external coaptation will be discussed. An emphasis will be placed on the most common types of tibial fractures, as well as those best suited for repair by general practitioners of veterinary medicine. Three case based examples will follow the overview.
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Pratt JN. Avulsion of the tibial tuberosity with separation of the proximal tibial physis in seven dogs. Vet Rec 2001; 149:352-6. [PMID: 11594381 DOI: 10.1136/vr.149.12.352] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Seven dogs developed avulsions of the tibial tuberosity apophysis in combination with a fracture of the proximal tibial physis. Six of them were small terrier breeds, treated by internal fixation using two Kirschner wires and a tension band in five cases, and crossed Kirschner wires alone in the other. The seventh case was managed conservatively. The tension band repair was simple, provided adeqate fixation and avoided the placement of implants across the proximal tibial physis.
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Affiliation(s)
- J N Pratt
- Hospital for Small Animals, Royal Dick School of Veterinary Studies, University of Edinburgh, Easter Bush Veterinary Centre, Roslin, Midlothian
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