Don A. Hulse

Arthroscopic documentation of elbow cartilage pathology in dogs with clinical lameness without changes on standard radiographic projections.

OBJECTIVE To document cartilage damage associated with elbow lameness in dogs without radiographic signs. STUDY DESIGN Case series. ANIMALS Dogs (n=16). METHODS Medical records (November 2004-January 2006) of dogs with undiagnosed forelimb lameness localized to the elbow but without radiographic signs that had lesions identified by either computed tomography (CT) or nuclear scintigraphy and confirmed by arthroscopy were included. Signalment, duration of clinical signs before admission, surgical diagnosis, and treatment were recorded. RESULTS Sixteen dogs (10 left, 6 right elbows) were identified. Median age was 30.1 months and median duration of clinical signs before admission was 15.6 months. CT or scintigraphy were strongly suggestive of elbow pathology before confirmation by arthroscopy. Medial coronoid pathology was identified in every abnormal elbow and osteochondrosis dissecans in 2 elbows. CONCLUSIONS Elbow pathology not associated with radiographic changes can be identified by CT and scintigraphy. Coronoid pathology is the most likely diagnosis. CLINICAL RELEVANCE Absence of radiographic signs in elbows with clinical signs of lameness should be evaluated with advanced imaging techniques (CT, scintigraphy) and arthroscopy to identify the cause of lameness.

Second Look Arthroscopic Findings after Tibial Plateau Leveling Osteotomy

Objective: To describe the long-term (range, 2–69 months) arthroscopic appearance of intraarticular structures of the stifle after tibial plateau leveling osteotomy (TPLO). Study Design: Case series. Animals: Dogs (n=63) that had repeat arthroscopic examination of the stifle after TPLO for treatment of a cranial cruciate ligament (CCL) deficient stifle. Methods: Medical records (2002–2008) of dogs that had repeat arthroscopic examination to evaluate intraarticular structures after previous TPLO for treatment of CCL injury. Regions of interest were the CCL, caudal cruciate ligament, articular cartilage, and menisci. Signalment, weight, and time to 2nd look arthroscopy were recorded. Radiographs were reviewed to measure pre- and postoperative tibial plateau angle, and craniocaudal limb alignment. Results: There were 17 partial CCL tears with early fiber tearing and 46 stifles with a complete CCL tear or incompetent partial CCL tear. Stifles with an early partial tear had normal to near normal appearance of intraarticular structures. Most dogs with a complete or incompetent partial CCL tear had axial or abaxial grades 3 or 4 articular cartilage abrasion of the medial or lateral femoral condyle. Conclusion: Intraarticular structures appeared normal or near normal in dogs with early fiber tearing (caudolateral or craniomedial fibers). Most dogs that had a partial tear with an incompetent remaining CCL or a completely ruptured CCL had grades 3 or 4 articular cartilage abrasion. Clinical Relevance: Early diagnosis of a CCL injury and treatment by TPLO may be protective against further CCL disruption lending stability to the joint and decreasing the incidence of meniscal injury and articular cartilage damage.OBJECTIVE To describe the long-term (range, 2-69 months) arthroscopic appearance of intraarticular structures of the stifle after tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Case series. ANIMALS Dogs (n=63) that had repeat arthroscopic examination of the stifle after TPLO for treatment of a cranial cruciate ligament (CCL) deficient stifle. METHODS Medical records (2002-2008) of dogs that had repeat arthroscopic examination to evaluate intraarticular structures after previous TPLO for treatment of CCL injury. Regions of interest were the CCL, caudal cruciate ligament, articular cartilage, and menisci. Signalment, weight, and time to 2nd look arthroscopy were recorded. Radiographs were reviewed to measure pre- and postoperative tibial plateau angle, and craniocaudal limb alignment. RESULTS There were 17 partial CCL tears with early fiber tearing and 46 stifles with a complete CCL tear or incompetent partial CCL tear. Stifles with an early partial tear had normal to near normal appearance of intraarticular structures. Most dogs with a complete or incompetent partial CCL tear had axial or abaxial grades 3 or 4 articular cartilage abrasion of the medial or lateral femoral condyle. CONCLUSION Intraarticular structures appeared normal or near normal in dogs with early fiber tearing (caudolateral or craniomedial fibers). Most dogs that had a partial tear with an incompetent remaining CCL or a completely ruptured CCL had grades 3 or 4 articular cartilage abrasion. CLINICAL RELEVANCE Early diagnosis of a CCL injury and treatment by TPLO may be protective against further CCL disruption lending stability to the joint and decreasing the incidence of meniscal injury and articular cartilage damage.

Minimally invasive application of a radial plate following placement of an ulnar rod in treating antebrachial fractures. Technique and case series.

OBJECTIVE To describe a surgical technique for placement of a minimally invasive radial plate following application of an ulnar rod (MIPR) for treatment of antebrachial fractures. METHODS Medical records (November 2005-June 2009) were searched to identify dogs with diaphyseal radius and ulna fractures stabilised by MIPR. Data retrieved included signalment, weight, limb affected, cause of injury, open versus closed fracture, number of fragments, implant size, number of screws used and cortices engaged, number of open screw holes, operative time, rod removal, complications and time to radiographic healing. To be included, dogs had to have evidence of radiographic healing during follow-up. RESULTS Eight dogs with diaphyseal radius and ulna fractures treated with MIPR were included in the case series. All fractures were due to trauma and two fractures were open (grade 1). Rod loosening and osteomyelitis of the ulna occurred in one case which subsequently resolved with rod removal. Healing occurred in all cases with no implant failures. Median time to radiographic union was 10.5 weeks (mean ± SD = 17 ± 15 weeks; range 4-52 weeks). CLINICAL RELEVANCE Use of MIPR constructs on diaphyseal fractures of the radius and ulna is an effective technique for managing these fractures using principles of biological osteosynthesis. An intramedullary rod in the ulna assists with fracture reduction and stabilisation and rod removal is recommended once fracture healing has occurred.

Treatment Methods for Pain in the Osteoarthritic Patient

Osteoarthritis is one of the most common clinical problems for which pet owners seek veterinary consultation. Proper management of osteoarthritis is rewarding to the patient, client, and veterinarian alike. The foundation for treatment of osteoarthritis is weight control, exercise moderation, and administration of anti-inflammatory agents. This section of the text addresses clinically important mechanisms of osteoarthritis and the use of anti-inflammatory agents targeted to reduce pain and inflammation associated with the disease.

Thoracic Limb Alignment in Healthy Labrador Retrievers: Evaluation of Standing Versus Recumbent Frontal Plane Radiography

OBJECTIVE To report thoracic limb alignment values in healthy dogs; to determine if limb alignment values are significantly different when obtained from standing versus recumbent radiographic projections. STUDY DESIGN Prospective cross-sectional study. ANIMALS Labrador Retrievers (n = 45) >15 months of age. METHODS Standing and recumbent radiographs were obtained and limb montages were randomized before analysis by a single investigator blinded to dog, limb, and limb position. Twelve limb alignment values were determined using the CORA methodology. Measurements were performed in triplicate and intra-observer variability was evaluated by intra-class correlation coefficient (ICC). Limb alignment values were reported as mean ± SD and 95% confidence intervals. Linear mixed models were used to determine if significant associations existed between limb alignment values and limb, limb position, gender, age, weight, and body condition score. RESULTS There were significant differences in standing and recumbent limb alignment values for all values except elbow mechanical axis deviation (eMAD). Limb, gender, age, body weight, and body condition score had no effect. ICC values ranged from 0.522 to 0.758, indicating moderate to substantial agreement for repeated measurements by a single investigator. CONCLUSIONS Limb alignment values are significantly different when determined from standing versus recumbent radiographs in healthy Labrador Retrievers.

Stabilization of the CORA based leveling osteotomy for treatment of cranial cruciate ligament injury using a bone plate augmented with a headless compression screw.

OBJECTIVE To report the effectiveness of a bone plate/headless compression screw (HCS) construct in preventing tibial plateau angle (TPA) shift postoperatively and to describe radiographic healing of the osteotomy. STUDY DESIGN Case series. ANIMALS Dogs (n = 31). METHODS Records of dogs diagnosed with cranial cruciate ligament (CCL) injury treated with the center of rotation of angulation (CORA) based leveling osteotomy (CBLO) stabilized with a bone plate augmented with a HCS were reviewed. Breed, age, weight, and gender were recorded. Radiographs were reviewed for determination of preoperative tibial plateau angle (PreTPA), postoperative TPA (PostTPA), patellar tendon angle (PTA) postoperatively, and TPA at final evaluation (FinalTPA). Difference between PostTPA and FinalTPA was used to define any TPA shift. Radiographic healing at final evaluation was graded based on a 5-point scale. RESULTS Mean time to final recheck was 88 days (range 49-237 days) with mean ± SD PreTPA = 28.6 ± 4.8°; PostTPA = 9.2 ± 2.2°; FinalTPA = 9.7 ± 2.6°; and TPA Shift = 0.52 ± 1.61°. There was no significant difference between PostTPA and FinalTPA (P = .084, power > 0.80). Mean postoperative PTA was 89.9 ± 1.7°. There were 2 implant related complications; 1 HCS migration and 1 HCS failure. CONCLUSION Stabilization of the CBLO using a bone plate augmented with a HCS was effective in maintaining PostTPA and achieving satisfactory radiographic healing.

Elbow denervation in dogs: Development of an in vivo surgical procedure and pilot testing

The objective of this study was to develop a surgical technique for sensory denervation of the canine elbow joint and to assess the effects of denervation on limb function in normal dogs. Twenty cadavers (40 elbows) were used to characterize innervation and design the surgical protocol which was tested in 13 cadavers (26 normal elbows). The effect of denervation on limb function was assessed in vivo in four dogs with the elbow randomly selected for the procedure. Primary outcome measures were static bodyweight distribution and distal limb mechanical sensory thresholds; secondary outcome measures were subjectively scored lameness, neurological function and pain on manipulation. Histology was performed on all resected tissues to determine whether nerves had been resected. Denervation was achieved by separate medial and lateral surgical approaches. In testing the developed surgical protocol, 111/130 resected samples contained nerve tissue in the healthy cadaveric elbows and 18/20 in the in vivo study. Limb function and sensation were not altered by elbow joint denervation. The protocol developed for denervation of the canine elbow appears feasible and does not result in any sensory or motor deficits of the forelimb.

Owner Evaluation of a CORA‐Based Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Injury in Dogs

OBJECTIVE To evaluate a center of rotation of angulation (CORA)-based leveling osteotomy for cranial cruciate ligament injury in dogs. STUDY DESIGN Retrospective case series. ANIMALS Dogs (n=70). METHODS Medical records (March 2011 to March 2012) of dogs diagnosed with a cranial cruciate ligament (CCL) injury treated with a CORA-based leveling osteotomy and stabilized using a bone plate and headless compression screw were reviewed. Radiographs were reviewed for tibial plateau angle and radiographic healing at final evaluation graded on a 5-point scale. Follow-up for a minimum of 6 months postoperatively was conducted by owner completion of a questionnaire regarding their dogs function after surgery. Based on owner responses, clinical outcomes were established. RESULTS CORA-based leveling osteotomy was used for 70 stifles with CCL injury. The mean time to final radiographic recheck was 107 days (range, 32-424 days). Radiographic healing scores were 42 dogs (69%) with grade 4, 17 dogs (28%) with grade 3, and 2 dogs (3%) with grade 2. The mean time to follow-up was 11.9 months (range 6-18 months). Fifty-four of the 70 (77%) dogs had full function, 13 (19%) had acceptable function, and 3 (4%) had unacceptable function. Complications occurred in 11 stifles (16%), including 3 incisional, 6 late-onset meniscal tears, and 2 implant related. CONCLUSION The described method of a CORA-based leveling osteotomy can be successfully performed for treatment of CCL injury in dogs. At the time of mid-term and long-term owner follow-up, most dogs in this case series had returned to full function.

Outcome Following Surgical Correction of Grade 4 Medial Patellar Luxation in Dogs: 47 Stifles (2001-2012).

Grade 4/4 medial patellar luxation (MPL) is a complex disease of the canine stifle that often requires surgical realignment of the patella to resolve clinical lameness. Outcome following surgery remains poorly described. Medical records were retrospectively reviewed for surgical correction of grade 4 MPL. Signalment and exam findings, surgical procedures performed, complications, and clinical outcome were reported. Data was statistically analyzed for association with major complication occurrence and unacceptable function following surgery. Forty-seven stifles from 41 dogs were included. The surgical procedures most frequently utilized for patellar realignment were the combination of femoral trochleoplasty, tibial tuberosity transposition, and joint capsule modification. Median in-hospital veterinary examination was performed at 69 days (range 30-179 days) following surgery. Full function was reported for 42.6% of cases (n=20). Acceptable function was reported for 40.4% of cases (n=19). Unacceptable function was reported for 17% of cases (n=8). The overall complication rate was 25.5% (n=12), with revision surgery for major complications required in 12.8% of cases (n=6). Corrective osteotomies were associated with major complications (P < 0.001). In general, pelvic limb function improves following surgical correction of grade 4 MPL; however, a return to full function should be considered guarded.

MIPO Techniques for the Humerus in Small Animals

Knowledge of regional and topographic anatomy is paramount for success when using minimally invasive plate osteosynthesis (MIPO) for fracture management. Preoperative planning is essential for an optimal outcome and reducing stress among the surgical team; factors to consider include biologic assessment, mechanical assessment, clinical assessment, portal placement, and implant selection. MIPO is a useful technique for the direct or indirect reduction of humeral diaphyseal fractures. Implants should span the length of the bone for ease of implant application and to optimize the mechanical advantage of the implant. After surgery, incision care and controlled activity are 2 primary considerations.