Epicondylar plate fixation of humeral condylar fractures in immature French bulldogs: 45 cases (2014-2020)

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.

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.

Use of cannulated screws in the treatment of unicondylar humeral condylar fractures in dogs

OBJECTIVE

To describe unicondylar humeral fracture (UHF) repair using cannulated transcondylar screws, report postoperative fracture reduction, healing, and complication rates.

STUDY DESIGN

Retrospective.

ANIMALS

A total of 49 client owned dogs with UHF.

METHODS

Surgical technique and approach (i.e., open, limited open, or minimally invasive) were recorded. Articular step defect (ASD) and gap (Gap) at the humeral condylar articular surface were measured on pre- and postoperative images and reported as percentages. Fracture healing was graded on follow-up radiographs. Functional outcome was based on client questionnaire over the phone. General linear models were used to assess the impact of surgical approach on %ASD, %Gap, whereas Cox regression was used to assess prognostic factors of full fracture healing.

RESULTS

A total of 49 fractures repaired with a transcondylar screw with or without an antirotational pin(s) were included. Surgical approach did not have an impact on postoperative %ASD, %Gap or development of complications. The overall complication rate was 26% (11/42), with no revision surgery necessary. Of the dogs that encountered complications, 50% required pin and/or screw removal after fracture healing. For 29 dogs with a minimum of four-month owner telephone questionnaire follow-up, 90% reported no lameness and only three reported intermittent lameness. Achieving complete fracture healing was affected by increased postoperative %ASD (p = .033).

CONCLUSION

The UHFs repaired by transcondylar cannulated screws had acceptable outcomes and fracture reduction with complication rates being similar regardless of the surgical approach.

CLINICAL SIGNIFICANCE

Cannulated screws can be implanted with varying surgical approaches to successfully repair UHFs with comparable clinical outcome to previous reports.

Thermographic analysis of perforations in polyurethane blocks performed with experimental conical drill bit in comparison to conventional orthopedic drill bit: a preliminary study

OBJECTIVE

Conical orthopedic drill bits may have the potential to improve the stabilization of orthopedic screws. During perforations, heat energy is released, and elevated temperatures could be related to thermal osteonecrosis. This study was designed to evaluate the thermal behavior of an experimental conical drill bit, when compared to the conventional cylindrical drill, using polyurethane blocks perforations.

RESULTS

The sample was divided into two groups, according to the method of drilling, including 25 polyurethane blocks in each: In Group 1, perforations were performed with a conventional orthopedic cylindrical drill; while in Group 2, an experimental conical drill was used. No statistically significant difference was observed in relation to the maximum temperature (MT) during the entire drilling in the groups, however the perforation time (PT) was slightly longer in Group 2. Each drill bit perforated five times and number of perforations was not correlated with a temperature increase, when evaluated universally or isolated by groups. The PT had no correlation with an increase in temperature when evaluating the perforations universally (n = 50) and in Group 1 alone; however, Group 2 showed an inversely proportional correlation for these variables, indicating that, for the conical drill bit, drillings with longer PT had lower MT.

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.

Adjunctive fixation of the humeral epicondyle in a lateral condylar fracture model: Ex vivo comparison of pins and plates with a novel composite (AdhFix)

OBJECTIVE

To compare the biomechanical properties of using a novel composite construct (AdhFix) to an interfragmentary Kirschner wire or a reconstruction plate as adjunctive epicondylar stabilization in simulated lateral unicondylar humeral fractures.

STUDY DESIGN

Cadaveric biomechanical assessment.

SAMPLE POPULATION

Paired humeri harvested from skeletally mature dogs (14-41 kg), nine cadavers per group.

METHODS

Simulated lateral unicondylar humeral fractures were stabilized with a transcondylar 4.5 mm cortical screw placed in lag fashion. Adjunct fixations consisting of a novel composite incorporating 2.7 mm cortical screws on one side, and either a 2.7 mm reconstruction plate or a 1.6 mm Kirschner wire on the contralateral side, were tested within paired humeri. Repaired humeri were axially loaded to failure and construct stiffness, yield load, and ultimate load were obtained from the load-deformation curves.

RESULTS

In pairwise comparison, yield load was significantly higher for AdhFix group compared to the pin group, p = .016. No statistical significance was seen in the comparison between AdhFix group and the plate group, p = .25.

CONCLUSION

Adhfix was mechanically superior to K-wires, and comparable to plate fixation, for adjunctive fixation in a lateral humeral condylar model. Our results support further investigation of the novel composite for adjunct fracture fixation in lateral humeral condylar fractures.

CLINICAL SIGNIFICANCE

The novel composite tested may be a viable alternative for adjunct fixation of humeral condylar fractures, a technique that circumvents plate contouring.

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.