Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003-2014)

Reconstruction of Bilateral Chronic Triceps Brachii Tendon Disruption Using a Suture-Mediated Anatomic Footprint Repair in a Dog

A 2-year-old, intact female Pomeranian presented with bilateral forelimb lameness, characterized by the olecranon making contact with the ground. The patient experienced two separate incidents of falling, occurring four and three weeks before admission, respectively. Following each episode, non-weight-bearing lameness was initially observed in the left forelimb, followed by the development of crouch gait. Based on the physical examination, radiographic, and ultrasonographic findings, bilateral triceps brachii tendon disruption was diagnosed. Intraoperatively, excessive granulation tissue at the distal end of the tendon was excised. The footprint region of each triceps brachii tendon was decorticated with a high-speed burr until bleeding was observed. The triceps brachii tendon was reattached to completely cover its footprint on the olecranon using the Krackow suture technique. This method involves anchoring the suture through bone tunnels in the ulna. Trans-articular external skeletal fixation was applied to both forelimbs to immobile and stabilize the elbow joints for nine weeks. Subsequently, the dog gradually increased its walking activities while on a leash over a six-week period. At the three-year follow-up, the patient exhibited improved forelimb function and maintained a normal gait without signs of lameness. Suture-mediated anatomic footprint repair proved useful in this single case and may be an effective surgical alternative for the management of chronic triceps brachii tendon disruption in dogs.

Case report: Nonsimultaneous bilateral triceps tendon rupture and surgical repair in a healthy dog

A 7-year-old female spayed Australian shepherd dog was presented for an acute onset of inability to stand. On physical examination, the dog was unable to support weight on the thoracic limbs. On neurological examination, the thoracic limbs had absent hopping and paw placement and reduced withdrawal reflexes bilaterally. The remainder of the neurological examination was normal. The anatomic lesion localized to the C6-T2 spinal nerve roots, spinal nerves, or the named nerves of the thoracic limb, bilaterally. A lesion affecting the ventral gray column of the C6 through T2 spinal cord segments was considered less likely. In an effort to exclude an orthopedic disorder from consideration, radiographs of the shoulders, elbows, and manus were normal. Magnetic resonance imaging of the cervical and cranial thoracic vertebral column was normal. Analysis of synovial fluid from the carpi, elbows, and shoulders were normal. Ultrasonography of the triceps muscle and tendon of insertion revealed bilateral, acute-subacute tears of the tendon at insertion of the triceps muscles, bilaterally. Magnetic resonance imaging of both elbows revealed complete avulsion of the triceps tendons bilaterally. Surgical repair of both tendons was performed using the Arthrex FiberLoop system combined with autologous conditioned plasma soaked in a collagen sponge. Postoperatively, external coaptation was provided using Spica splints for 6 weeks followed by the use of soft padded orthotic braces for an additional 6 weeks. Concurrently, a front support wheelchair was used for 10 weeks postoperative. By 10 weeks postoperative, the dog was able to ambulate without support. To the authors' knowledge, this is the first report of bilateral triceps tendon avulsion in a dog. Tendon avulsion occurred without a known history of trauma or predisposing metabolic abnormalities. Magnetic resonance imaging provided excellent anatomical detail that aided in surgical repair.

Case Report: Trans-Articular External Skeletal Fixation of the Hip for a Highly Comminuted Juxta-Articular Fracture of the Proximal Femur Caused by Gunshot Injury in a Cat

This report describes a novel surgical technique for trans-articular external skeletal fixation (TA-ESF) of the hip to stabilize a rare, highly comminuted juxta-articular fracture of the proximal femoral segment involving the metaphysis and diaphysis in a cat. A 2-year-old, castrated male, Korean shorthair cat was admitted for a left femoral fracture caused by gunshot injury. Radiographs and computed tomography (CT) scans revealed a highly comminuted proximal femoral diaphyseal fracture that involved the femoral neck and the greater trochanter. The left femoral head was intact on CT. Under fluoroscopic guidance, an intramedullary Steinmann pin was placed to align the femur, and five positive-profile, end-threaded pins were placed in the left hemipelvis and distal femur. A triangulated frame of connecting bars was constructed using Steinmann pins and epoxy resin for TA-ESF. This secured the pins placed in the pelvis and femur as well as the intramedullary pin, providing proximal femoral stabilization by trans-articular fixation of the hip. The cat began placing weight on the left pelvic limb 4 days postoperatively, and progressively obtained near-normal limb function by day 112. The TA-ESF was partially dismantled to a linear tie-in construct on day 64 and was completely removed on day 161. Final radiographs on day 161 revealed lack of bone healing in the proximal segment, especially femoral head and neck, despite functional recovery of the injured leg. At one year postoperatively, the cat had normal limb function without any noticeable complications. On follow-up 29 months after surgery, the owner reported that the cat had normal limb function without any noticeable complications. Despite insufficient bone healing in the cat, TA-ESF of the hip allowed for satisfactory functional recovery of this challenging juxta-articular fracture of the proximal femur, which was not amenable to stabilization with a traditional non-load-sharing fixation system.

Repair of Tendon Disruption Using a Novel Synthetic Fiber Implant in Dogs and Cats: The Surgical Procedure and Three Case Reports

Surgical management of tendon rupture is challenging. One concern is to provide adequate tensile strength to prevent distraction during weight-bearing and gap formation following repair, associated with an increased risk of repair failure. Additional challenges may arise from the nature or the chronicity of the lesion. In the event of avulsion, when the tendon is torn off at the bone insertion, its reinsertion on the bone is generally difficult and may even be impossible in the presence of an avulsion fracture, especially when the bone fragment is too small or fragmented. Repair management is also complicated in chronic cases, as degeneration of the tendon may lead to excessive scar tissue formation, tendon retraction, and muscle atrophy, resulting in a large gap and inadequate tissue for reconstruction. The authors describe the surgical procedure for implanting a novel implant, illustrated by three characteristic clinical cases: (1) an acute Achilles tendon avulsion; (2) a chronic patellar tendon rupture; and (3) a chronic avulsion fracture of the triceps tendon. In these three cases, complete recovery of the function was observed at the last clinical evaluation (6 or 8 months), and no complication was noted. A splinted dressing (6 to 8 weeks) was used successfully in two cases. A resin cast (8 weeks) was preferred in case 1, a very active dog. In conclusion, this novel implant represents a simple procedure for the effective repair of chronic tendon rupture, as well as an effective tendon reinsertion on the bone and adequate support for bone tendon healing in the treatment of tendon avulsion, even in cases of fragmented bone fracture. The thinness of the implant facilitates its insertion into the native tendon, while the bone-screw-implant interface provides immediate and lasting mechanical support. This may facilitate the healing process and potentially shorten the period of immobilization.