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.

The effect of grip location on Kirschner wire bend characteristics: An in vitro study

OBJECTIVE

To determine the effect of Kirschner wire (K-wire) grip location on bend angle, bend radius, and torque when performing a Z-bend technique.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

Ten samples at each of five grip locations for each of three K-wire diameters.

METHODS

K-wires of three diameters (0.9, 1.1, 1.6 mm) were drilled into PVC pipe, and a Jacob's chuck was used to bend the wires at five periodic grip locations (distance from the bone model). Torque, bend angle, and bend radius were determined for each sample. Outcome variables were statistically analyzed by grip location to determine significant relationships.

RESULTS

A grip location of 2.0 cm in the 0.9 mm K-wire group minimized bend angle (mean ± SD: 75.92° ± 0.81) and bend radius (2.89 mm ± 0.08). A grip location of 3.0 cm in the 1.1 mm K-wire group minimized bend angle (72.88° ± 0.98) and bend radius (2.47 mm ± 0.20). A grip location of 3.0 cm minimized bend angle (74.38° ± 1.93) and bend radius (2.71 mm ± 0.27) in the 1.6 mm K-wire group. Torque at these grip locations for the 0.9, 1.1, and 1.6 mm K-wires was 6.50 N-m ± 0.0, 11.00 N-m ± 0.0, and 19.05 N-m ± 0.16, respectively.

CONCLUSION

Bend angle and bend radius can be minimized by bending K-wires at specific grip locations, though torque is not minimized at these locations. Clinical significance These findings provide an evidence-based recommendation of where surgeons should grip K-wires when bending them.

Retrospective evaluation of surgical technique, complications and long-term outcome of lateral and medial humeral condylar fractures in 80 dogs

CASE HISTORY

Medical records of a single veterinary teaching hospital in Giessen, Germany were retrospectively reviewed for dogs presented for medial or lateral humeral condylar fractures (HCF) between 2007 and 2019. Data regarding surgical technique and complications were collected from the medical records. The latter was supplemented through information obtained from telephone interviews with referral veterinarians and from an owner questionnaire completed ≥12 months after surgical repair, which also provided data regarding outcome.

CLINICAL FINDINGS

Eighty dogs with 85 HCF were identified: 13 (15.3%) HCF were medial (bilateral in two dogs) and 72 (84.7%) were lateral (bilateral in three dogs). French Bulldogs (n = 19/80; 23.8%) were most commonly affected. Patients were predominantly skeletally immature and light-weight, with a median age at the time of presentation of 3 (min 2, max 118) months and with a median body weight of 6.4 (min 1, max 46) kg. There were 38 female (47.5%) and 42 male (52.5%) dogs. Fractures developed most frequently secondary to minor trauma (67/77; 87.0%). Dogs were presented in 35/84 (41.7%) cases more than 24 hours after fracture occurrence.

TREATMENT AND OUTCOME

Surgical treatment was performed in 80/85 (94.1%) HCF. An open reduction and internal fixation approach was chosen in all cases. A transcondylar screw (TS) combined with a supracondylar (SC) K-wire (67/80; 83.8%) was the most frequently used fixation technique. Considering all fracture fixation methods, complications (26/80; 32.5%) were classed as minor in 10 (12.5%), major in 14 (17.5%) and catastrophic in two (2.5%) of the 80 surgically treated HCF. Long-term outcome was excellent in 68.6% (24/35 HCF) and very good in 22.9% (8/35 HCF) of the cases for which follow-up information was obtained. Additionally, owner information revealed that 85.7% of dogs (30/35 HCF) were free of lameness in the long-term.

CLINICAL RELEVANCE

This case series demonstrates that surgical repair of lateral and medial HCF with a TS and SC K-wire is a viable option to consider in skeletally immature and light-weight patients. Complications occur frequently after surgical fixation of HCF, but owners can expect a very good to excellent long-term outcome in the majority of cases.

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

OBJECTIVES

The objective of this study was to report outcome and postoperative complications following stabilisation of humeral condylar fractures in skeletally immature French bulldogs with a transcondylar screw combined with locking or hybrid locking plates.

MATERIALS AND METHODS

Medical records from one referral hospital were reviewed to identify skeletally immature French bulldogs with humeral condylar fractures treated with a transcondylar screw and epicondylar locking or hybrid locking plates crossing the distal humeral physis.

RESULTS

Forty-five fractures in 41 different dogs with a mean age of 4 months (range 3.5 to 5) were identified. Six cases had complications: two (4.4%) minor and four (8.9%) major. Short-term clinical outcome was excellent in 35 (77.8%), good in nine (20%) and poor in one (2.2%) case. Forty-one of 45 fractures reached radiographic union without further surgical intervention; the remaining four cases reached union following revision surgery. Long-term owner assessed outcome by telephone interview was graded as excellent in all available cases (26 of 41 dogs).

CLINICAL SIGNIFICANCE

This study suggests that the stabilisation of humeral condylar fractures in skeletally immature French bulldogs with combinations of a transcondylar screw and epicondylar locking or hybrid locking plates crossing the distal humeral physis was safe and led comparable outcomes and complication rates to previous reports.

A review of minimally invasive fracture stabilization in dogs and cats

OBJECTIVE

To summarize and discuss peer-reviewed studies on minimally invasive osteosynthesis (MIO) of long bone, physeal, and articular fractures in dogs and cats.

STUDY DESIGN

Invited review.

METHODS

A critique of literature was performed to assess MIO feasibility, outcomes, and complications through PubMed, Scopus, and CAB abstracts research databases (2000-2020).

RESULTS

More than 40 MIO articles have been published in the last 15 years, but most studies had small numbers, lacked control groups, and used limited outcome measures. Studies generally showed that MIO was feasible in dogs and cats with low complication rates. The current evidence does not demonstrate superior bone healing or functional outcomes with MIO when compared to standard methods. Although treatment principles, case selection, and techniques varied depending on the anatomical location, there were no salient differences in complication rates among long bones, physeal, and articular fractures treated by MIO.

CONCLUSION

The current available evidence and the personal experience of the authors support MIO as a promising fracture management modality. MIO can yield excellent outcomes when applied in carefully selected cases, performed by surgeons experienced in the technique. We cannot, however, conclude that MIO is superior to open fracture stabilization based on the available evidence in veterinary literature. Randomized controlled studies are warranted to prospectively compare MIO with other osteosynthesis techniques and thereby validate its role in fracture management for dogs and cats.

Influence of interlocking thread screws to repair simulated adult canine humeral condylar fractures

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.

Computed tomographic findings in three Pinschers affected by incomplete ossification of the humeral condyle

Incomplete ossification of the humeral condyle is a cause of forelimb lameness in dogs. Affected dogs are predisposed to humeral condylar fractures. Incomplete ossification of the humeral condyle has been reported in breeds such as Spaniel, Rottweiler, Labrador and Pug. Diagnosis is made by a radiographic or computed tomographic study of the elbow, while treatment includes the placement of a bone screw across the humeral condyle. This paper discusses the computed tomography findings of incomplete ossification of the humeral condyle in three Pinschers.

Impact of breed on canine humeral condylar fracture configuration, surgical management, and outcome

OBJECTIVE

To report the prevalence, configuration, risk factors, fixation methods and outcomes after repair of humeral condylar fractures (HCF) in dogs.

STUDY DESIGN

Retrospective nested cohort study.

SAMPLE POPULATION

One hundred twelve dogs.

METHODS

Medical records of dogs referred between January 2010 and August 2018 were searched for HCF. Demographics, fracture configuration, repair, and complications were obtained from medical records. Radiographs were assessed for fracture reduction, implant positioning, and bone healing. Short-term radiographic and clinical outcomes, and long-term owner-assessed outcome was determined. Associations between these variables were statistically analyzed.

RESULTS

Dogs with HCF represented 112 of 43 325 (0.26%, 95% CI 0.22-0.31) referrals. French bulldogs and spaniel breeds were predisposed to HCF (P < .02). French bulldogs were 6.58 times (95% CI 1.62-26.7) more likely than other breeds to have a medial HCF (P = .008). Epicondylar plate fixation was associated with reduced complications compared with lag screws and Kirschner wires (P = .009). Lameness was scored as 1 of 5 (median) in the 85 dogs with initial follow-up (median 6 weeks) after HCF repair. Outcome was considered excellent in 26 of 31 dogs with long-term follow-up (median 36 months).

CONCLUSION

French bulldogs and spaniels were predisposed to HCF, and medial HCF were more common in French bulldogs. Epicondylar plate fixation was associated with reduced complications.

CLINICAL SIGNIFICANCE

French bulldogs are predisposed to HCF, including medial HCF. Epicondylar plate fixation is recommended over other epicondylar fixation methods to reduce complications.

Minimally Invasive Osteosynthesis Techniques for Articular Fractures

Articular fractures are common injuries in veterinary medicine. The principles of articular fracture repair are anatomic reduction and rigid fixation in order to optimize joint function. Fluoroscopy and arthroscopy are tools commonly used to allow for anatomic reduction with a minimally invasive approach. Minimally invasive techniques can decrease morbidity and promote an early return to function. Different types of articular fractures and options for minimally invasive repair are reviewed in this article.

Percutaneous tibial physeal fracture repair in small animals: technique and 17 cases

OBJECTIVES

To retrospectively describe cases treated via percutaneous tibial physeal fracture repair (PTPFR), using intra-operative fluoroscopy (IFL) or digital radiography (DR). To describe a technique ("spiking"), used to treat tibial tuberosity avulsion fractures.

METHODS

Clinical data of 14 dogs and three cats were included. The "spiking" technique was described.

RESULTS

Intra-operative fluoroscopy (n = 11) and DR (n = 6) were successfully used in 11 tibial tuberosity avulsion fractures, one combined proximal physeal and tibial tuberosity avulsion fracture, and five distal tibial/fibular physeal fractures. Surgery times ranged from eight to 54 minutes. The "spiking" technique was successfully applied in six tibial tuberosity avulsion fracture cases. Return to function was at a mean (± standard deviation) of 1.9 (± 1.6) weeks. Long-term (>12 months; n = 17) follow-up was available at a mean of 40.6 (± 13.4) months. Major complications consisted of skin irritation from a pin (distal tibia / fibula physeal fracture case; 8 weeks post-PTPFR), and a bilateral grade II medial patella luxation (tibial tuberosity avulsion fracture case; 1.5 years post-PTPFR). One case developed a mild tibial tuberosity avulsion fracture re-avulsion. All conditions in these three cases were not of clinical concern at follow-up and final outcome was graded as good in these and excellent in the other 14 cases.

CLINICAL SIGNIFICANCE

Percutaneous tibial physeal fracture repair can be considered as a technique to treat tibial physeal fractures. The "spiking" technique was successfully applied in six dogs. A larger, prospective case series is indicated to provide additional clinical information.