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Csiszer AB, Daly CM, Dyce J, Litsky AS, Olmstead ML. Comparison of the effects of two screw insertion patterns on bone fragment translocation in a 3.5 mm dynamic compression plate and a 3.5 mm limited-contact dynamic compression plate. Vet Surg 2011; 41:300-6. [PMID: 22092067 DOI: 10.1111/j.1532-950x.2011.00882.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the effects of screw insertion pattern, plate type, application of bone reduction forceps, and additional load screw insertion in an 8-hole 3.5 mm dynamic compression plate (DCP) and limited-contact dynamic compression plate (LC-DCP) on bone fragment translocation (BFT) in a fracture gap model. STUDY DESIGN In vitro mechanical study. METHODS Two screw insertion patterns were tested in the DCP and newly redesigned LC-DCP using gap model synthetic bone constructs. In Pattern 1, screws were first inserted into the holes at each end of the plate, then screws were inserted into the holes adjacent to the fracture gap. In Pattern 2, screws were only inserted into the holes adjacent to the fracture gap. The effects of tight or loose bone forceps securing the plate, loosening a neutral screw in Pattern 1, and inserting up to 4 additional load screws with each pattern were tested. Changes in the fracture gap were measured after insertion of all neutral screws and after each load screw. RESULTS Pattern 2 BFT was significantly greater than Pattern 1 BFT when bone forceps were loose with both plates (P < .001). In the DCP, the BFT was significantly increased by loosening the bone forceps with Pattern 2 (P < .001) and by loosening 1 neutral screw in Pattern 1 (P < .001). The BFT for each additional load screw inserted was significantly less than 1.0 mm. CONCLUSIONS A tight neutral screw in the same bone fragment as the load screw or bone clamps that tightly secure the plate to the bone can limit BFT.
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Affiliation(s)
- Amie B Csiszer
- Oregon Veterinary Referral Associates, Springfield, OR 97477, USA.
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Abstract
OBJECTIVE To report the clinical, radiographic, and pathologic features of extraosseous cement granuloma (ECG), a low occurrence, long-term complication of total hip replacement (THR). STUDY DESIGN Retrospective clinical study. Sample Population-Six client-owned dogs. METHODS Medical records for 6 dogs that had a cemented modular THR and developed ECG were reviewed for the clinical, radiologic, and histopathologic findings of ECG. Morphologic and elemental analyses of retrieved particles were conducted in 2 dogs using scanning electron microscopy (SEM) and energy-dispersive x-ray spectroscopy (EDS). RESULTS Three golden retrievers and 3 Labrador retrievers had progressive lameness in the operated limb 4 to 7 years after THR and developed ECG. Other clinical features included an acute deterioration to non-weight bearing associated with pathologic fracture of the proximal femur in 2 dogs, and obstipation in 1 dog. In 5 dogs, there was a large caseous mass surrounding the proximal femur. Obstipation in 1 dog was caused by a similar mass adjacent to bone cement used for fixation of the acetabular cup. Radiographic changes included a multilobular soft tissue mass, containing irregular mineral densities, in the gluteal mass surrounding the proximal femur, THR interface deterioration, osteolysis, new bone formation, and implant subsidence were consistent with chronic aseptic loosening. The histopathologic diagnosis was sterile granuloma associated with a massive heterogeneous particulate burden, which was assumed to have resulted from severe wear of all prosthesis components. CONCLUSIONS ECG is a manifestation of severe aseptic loosening of cemented total hip replacement, with the generation of wear debris probably responsible for granuloma formation. CLINICAL RELEVANCE Because revision can offer a good prognosis in early aseptic femoral loosening, yearly radiographic monitoring of the recipients is recommended.
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Affiliation(s)
- Matthew P Palmisano
- Ohio State University College of Veterinary Medicine, Veterinary Teaching Hospital, Columbus, OH, USA
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Abstract
OBJECTIVE To evaluate a femoral window technique for retrieval of cemented total hip prostheses. STUDY DESIGN Retrospective clinical study. ANIMALS Twelve dogs with infection of a cemented modular total hip prosthesis. METHODS Implant removal was performed by an extended craniolateral approach to the hip and proximal femur without trochanteric osteotomy. The femoral cement mantle was fragmented and removed with simple orthopedic instrumentation by a lateral femoral window that was repaired using cerclage wires. Surgical technique, intraoperative and postoperative complications, bacterial culture results, histopathologic findings, and completeness of cement removal were recorded. Follow-up radiographs were taken 5 to 9 weeks postoperatively. Long-term follow-up information was obtained by client questionnaire. Functional outcome was assessed by scoring ability to stand, sit, walk, run, play, climb stairs, and get into a car. RESULTS Prosthesis retrieval was performed 2 to 41 months after implantation (median, 14 months). Complete removal of femoral cement was achieved in 10 dogs. A nondisplaced femoral fissure, extending proximally from the window, was an intraoperative complication in 2 dogs. Staphylococcus spp was most commonly isolated (6 dogs) from interfacial membrane samples. Systemic antibiotic therapy, dependent on susceptibility testing, was administered for 3 to 10 weeks postoperatively. There was radiographic evidence of osteotomy healing at 5- to 9-week reassessment. Recurrence of osteomyelitis was not observed. Long-term functional outcome was considered mildly abnormal. CONCLUSIONS The lateral window was an effective technique for retrieval of retained femoral cement. CLINICAL RELEVANCE Removal of an infected prosthesis using this technique generally resulted in a clinical outcome comparable to that with ab initio femoral head and neck excision.
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Affiliation(s)
- Jonathan Dyce
- Ohio State University College of Veterinary Medicine, Veterinary Teaching Hospital, Columbus, USA
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Abstract
OBJECTIVE To assess the usefulness of standard radiographic projections for determining acetabular cup position and to compare 2 radiographic methods for calculation of the angle of lateral opening of the acetabular cup. STUDY DESIGN In vitro radiographic study. METHODS Acetabular components were mounted on a custom-built inclinometer. The effect of varying the angles of lateral opening, inclination, version, and centering of the x-ray beam on the radiographic appearance of the cup was investigated. The angle of lateral opening was calculated trigonometrically after direct measurement and by means of computer-aided image analysis. RESULTS Using a ventrodorsal radiograph, the computer-aided measurement of angle of lateral opening was accurate to within 5 degrees when the true angle of lateral opening was > or = 40 degrees. In the case of direct measurement, the calculated angle was accurate to within 5 degrees only when the true angle was > or = 60 degrees. An increasing angle of inclination was associated with reduced accuracy of calculation of the angles of lateral opening and version. Standard radiographic assessment of acetabular version and inclination was not found to be clinically useful. The displacement of the x-ray beam, which would cause significant error in the determination of lateral opening, is unlikely to be exceeded in practice. Cup size had no significant effect on the accuracy of the results. CONCLUSIONS Computer-aided image analysis can be used to calculate angles of lateral opening to within 10 degrees throughout the range of acetabular positions seen in practice and is appropriate for postoperative documentation of cup position. The angles of inclination and version should be interpreted with caution.
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Affiliation(s)
- J Dyce
- College of Veterinary Medicine and University Medical Center, The Ohio State University, Columbus 43210-1089, USA
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Abstract
OBJECTIVE To identify risk factors for luxation after canine total hip replacement (THR). STUDY DESIGN Retrospective study. SAMPLE POPULATION 256 client-owned dogs that underwent THR. METHODS Patient data surveyed included signalment, body weight, diagnosis, prior hip surgery, implant size, intraoperative complications, and angle of lateral opening of the acetabular component. RESULTS Postoperative complications were recorded in 20 cases (7.8%). The most common complication was dorsal luxation which occurred in 12 dogs (4.7%). The interval between joint replacement and luxation ranged from 1 to 116 days (mean, 44 days). In 1 case, luxation was attributable to failure of the repair of an intraoperative fracture of the greater trochanter. Excluding this case, the mean angle of lateral opening in those dogs that sustained luxation was 62 degrees (range, 46 degrees - 75 degrees). The mean angle of lateral opening overall was 48 degrees (range, 18 degrees - 76 degrees). The angle of lateral opening was the only factor that had a statistically significant effect on whether luxation occurred (P = .035). Acetabular revision, performed primarily to reduce the angle of lateral opening, was performed in 8 dogs and successfully prevented subsequent luxation. CONCLUSION Luxation of the prosthesis is substantially under the control of the surgeon. It is recommended that the acetabular cup be inserted at an angle of lateral opening of 35 degrees to 45 degrees. In those cases of THR luxation in which an inappropriate angle of lateral opening is identified, acetabular revision arthroplasty generally results in a good clinical outcome.
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Affiliation(s)
- J Dyce
- College of Veterinary Medicine, and Biostatistics Program, University Medical Center, The Ohio State University, Columbus, USA
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Weisman DL, Olmstead ML, Kowalski JJ. In vitro evaluation of antibiotic elution from polymethylmethacrylate (PMMA) and mechanical assessment of antibiotic-PMMA composites. Vet Surg 2000; 29:245-51. [PMID: 10871226 DOI: 10.1053/jvet.2000.4389] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine whether different methods of sterilization of antibiotic vials or the heat of polymerization altered the antimicrobial activity or mechanical properties of antibiotic/polymethylmethacrylate (PMMA) composites when compared to antibiotic-free PMMA. STUDY DESIGN In vitro study. METHODS Steam-sterilized, gas-sterilized, and non-sterilized 1 gram vials of cefazolin and injectable gentamicin sulfate (high and low doses) were mixed with PMMA to prepare composites for antibiotic elution evaluation, compression, and elongation testing. Blocks of PMMA that contained antibiotic were assayed for antibacterial activity using an agar gel diffusion method or were placed in phosphate buffered saline (PBS) to assess elution of antibiotic. Phosphate buffered saline samples from steam-sterilized cefazolin and high-dose gentamicin groups were assayed on days 1, 2, 5, and 9 for cefazolin or gentamicin concentration by high-pressure liquid chromatography or fluorescent polarization immunoassay, respectively. RESULTS PMMA blocks containing antibiotic inhibited bacterial growth of Staphylococcus aureus 25923 for an average of 9 days. Cefazolin and gentamicin concentration in PBS decreased dramatically after the first 24 hours, but remained above minimum inhibitory concentration (MIC) throughout the experiment for all groups except low-dose gentamicin. Compressive strength of plugs made from plain cement and plugs made from PMMA mixed with untreated and steam-sterilized cefazolin was similar, but was significantly different from the other groups. There appeared to be an inverse relationship between compressive strength and elongation. CONCLUSION PMMA/antibiotic composites inhibited bacterial growth for 7 to 10 days. Compressive strength was affected by different additions of antibiotic. CLINICAL RELEVANCE Bacteria introduced during a surgical procedure may be inhibited by elution of antibiotic from PMMA at the time of contamination.
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Affiliation(s)
- D L Weisman
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus 43210, USA
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Abstract
Total hip replacements in the dog have become well established over the past 20 years as an effective method for treating disabling hip conditions. A fixed head prosthesis has been the mainstay during most of this period. Return to normal function with this prosthesis has been reported at 95 per cent. Although patient selection, pre- and post surgical care, the surgical technique and the treatment or prevention of complications has been continually improved, it was not until recently that the prosthesis and its instrumentation were improved. Now a modular prosthesis with improved instrumentation gives the veterinary surgeon state of the art' implants and instruments. The prosthesis is easier to implant, the surgeon has greater flexibility in surgery and improved results are expected. Total hip replacement continues to be an effective way to give dogs a pain-free, mechanically sound hip joint.
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Affiliation(s)
- M L Olmstead
- Ohio State University, College of Veterinary Medicine, Columbus 43210, USA
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Abstract
Total hip replacement (THR) is well established as a treatment modality for dogs with noninfectious, nonneoplastic, disabling conditions of the coxofemoral joint. Since the mid 1970s, a fixed-head prosthesis has been used in this procedure. A modular prosthesis, which is based on many of the technical advances found in human prostheses, now is available for use in veterinary medicine. The prosthesis, surgical instrumentation, surgical technique, and clinical results have been evaluated in a prospective study conducted at The Ohio State University's College of Veterinary Medicine. The modular prosthesis provides results equal to or better than the fixed-head prosthesis.
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Affiliation(s)
- M L Olmstead
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus 43210, USA
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Abstract
Extracapsular suture stabilization is a long-accepted technique for stabilization of cranial cruciate deficient stifles in small-breed dogs. Use of stainless steel wire as the suture material in the extracapsular technique extends the procedure to use in many large breed dogs and is currently the author's surgery of choice. The surgical technique and illustrative cases are described.
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Affiliation(s)
- M L Olmstead
- Department of Veterinary Clinical Sciences, Ohio State University College of Veterinary Medicine, Columbus
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Abstract
The complications associated with bone plates and screws often are related to undersized or oversized implant selection, improper number of implants, inadequate or improper screw fixation, malpositioned plates or screws, poor plate contouring, and failure to use cancellous bone grafts when a gap is present at the fracture site. A thorough understanding of the principles of plate and screw application helps to avoid most problems. The surgeon must use an implant that will stabilize the fracture adequately during the healing process. The patient's activity levels must not exceed the mechanical limits of the implant. Methods to promote bone healing, such as using cancellous bone grafts when a deficit is present, help to protect the implant from fatiguing before the fracture is healed. Proper positioning and contouring of the implants are important to the successful application of plates and screws. It must be realized that even if all of these things are done, some complications still will occur. When that happens, the complication should be dealt within a manner that will allow the objectives of fracture treatment (a healed bone and normal limb function) to be achieved.
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Affiliation(s)
- M L Olmstead
- Department of Veterinary Clinical Sciences, Ohio State University College of Veterinary Medicine, Columbus
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Olmstead ML. Preface. Vet Clin North Am Small Anim Pract 1991. [DOI: 10.1016/s0195-5616(91)50093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
No surgical procedure is free of complications. Determining the reason that a complication of a fracture repair occurred and developing a treatment plan are important if the objectives of fracture treatment are to be met. It is also necessary to deal with owners, and, sometimes, other veterinarians in meeting these objectives.
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Affiliation(s)
- M L Olmstead
- Department of Veterinary Clinical Sciences, Ohio State University College of Veterinary Medicine, Columbus
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Butler DL, Grood ES, Noyes FR, Olmstead ML, Hohn RB, Arnoczky SP, Siegel MG. Mechanical properties of primate vascularized vs. nonvascularized patellar tendon grafts; changes over time. J Orthop Res 1989; 7:68-79. [PMID: 2908914 DOI: 10.1002/jor.1100070110] [Citation(s) in RCA: 183] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Mechanical properties of patellar tendon autografts used to replace the anterior cruciate ligament (ACL) in the cynomolgus monkey were measured at four time periods up to 1 year. The ACL was replaced in each knee with the medial half of the patellar tendon: as a vascularized graft (VG) on one side and as a nonvascularized or free graft (FG) on the other. Postoperative care consisted of 4 weeks of cast immobilization at 30 degrees flexion followed by unrestricted activity in a large cage. Both grafts showed low stiffness and maximum force at 7 weeks (24% and 16% of ACL control values, respectively), increasing to 57% of control ACL stiffness and 39% of control maximum force by 1 year. Corresponding material properties, modulus and maximum stress, also increased over time, but at 1 year were only 34% and 26% of ACL values, respectively. The results indicate that retaining vascularity does not prevent significant reduction in graft properties that occur postoperatively, nor does it accelerate the return in strength and stiffness. Tissue stiffness, which returns earlier than maximum force and joint anteroposterior (AP) force displacement data, should be routinely reported in any healing study. Finally, in studies of this kind, the large variation in the results makes sampling only one or two animals from each time period unreliable.
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Affiliation(s)
- D L Butler
- Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, OH 45221-0048
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Smeak DD, Olmstead ML, Hohn RB. Brucella canis osteomyelitis in two dogs with total hip replacements. J Am Vet Med Assoc 1987; 191:986-90. [PMID: 3679997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Brucella canis was isolated from the cement or bone surrounding a hip prosthesis after total hip replacement was performed for treatment of hip dysplasia in 2 dogs. Lameness or signs of infection were not evident for 9 and 16 months after surgery. Osteomyelitis surrounding the prostheses was detected radiographically only after the lameness developed. The origin of the B canis infection in the 2 dogs was believed to be hematogenous because of the biologic behavior of this organism and because of the duration of excellent limb function after hip replacement. A slide agglutination test for B canis should be performed as a screening test on any canine total hip candidate when the anamnesis and physical examination indicate that the dog may have been exposed to or infected with B canis.
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Affiliation(s)
- D D Smeak
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Ohio State University, Columbus 43210
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Abstract
Total hip replacement in the dog has proved to be a highly successful method of restoring normal, pain-free motion to the coxofemoral joint. In a prospective study done at The Ohio State University College of Veterinary Medicine and the Berwyn Veterinary Associates Hospital, the indications and contraindications, the most effective surgical technique, the complication rate, and the long-term functional evaluation have been established for canine total hip replacements. This study has established that a 95 per cent success rate for function of the hip joint can be achieved if the established guidelines are followed.
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Abstract
Fourteen dogs were presented with caudal cruciate ligament (CaCL) rupture without concurrent cranial cruciate ligament (CrCL) rupture. The history usually included moderate to severe trauma. Presenting signs included lameness, positive drawer sign, and additional orthopedic injuries. A final diagnosis of CaCL rupture was made during surgical exploration of the joint in 12 of the dogs. In nine of the dogs, this diagnosis was not included in the preoperative differential diagnoses, and seven of the dogs were misdiagnosed as sustaining CrCL rupture. Methods of treatment included intracapsular and extracapsular stabilization. Follow-up time ranged from 3 weeks to 7 years. Function of the limbs was good regardless of surgical procedure chosen and did not appear to depend upon stifle stability.
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Affiliation(s)
- A L Johnson
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana
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Olmstead ML, Hohn RB, Turner TM. A five-year study of 221 total hip replacements in the dog. J Am Vet Med Assoc 1983; 183:191-4. [PMID: 6885591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Stevenson S, Hohn RB, Pohler OE, Fetter AW, Olmstead ML, Wind AP. Fracture-associated sarcoma in the dog. J Am Vet Med Assoc 1982; 180:1189-96. [PMID: 6953062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Seven fracture-associated sarcomas developed in large-breed dogs after stabilization of comminuted long bone fractures with stainless steel plates and screws. In most cases, the healing pattern of the fractures was disturbed. The mean interval between fracture occurrence and tumor diagnosis was 5.5 years. Radiographically, the sarcomas were typified by smooth-bordered subperiosteal proliferation and soft tissue mineralization. Cortical destruction was variable. Several histologic subtypes of osteosarcoma were seen. Four sarcomas had a marked inflammatory cell component and 5 of the dogs had clinical evidence of chronic infection. These findings were similar to those in 35 previously reported fracture-associated sarcomas, even though many types of fixation devices in addition to plates, as well as no fixation at all, were represented in these cases. Fracture-associated sarcomas most frequently were found to be diaphyseal, and the femur accounted for almost half of the sarcomas reported.
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Olmstead ML, Stoloff DR, O'Keefe CM. Correction of traumatic avulsion of the upper lip in two dogs. Vet Med Small Anim Clin 1976; 71:1228-9. [PMID: 1049170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Olmstead ML, Butler HC. Surgical correction of avulsion of the origin of the long distal extensor muscle in the dog. (a case report). Vet Med Small Anim Clin 1976; 71:608-10. [PMID: 1046327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Dorn AS, Olmstead ML. Herniation of the urinary bladder through the public symphysis in a dog. J Am Vet Med Assoc 1976; 168:688-9. [PMID: 1262246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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