Joseph Harari

Complications of external skeletal fixation.

Complications associated with ESF can deleteriously affect soft tissue and bone healing. Adherence to proper surgical techniques and guidelines will minimize development of ESF-related complications. The most common problems associated with ESF are pin tract infections, fixator problems, and soft tissue impalement. These complications can be avoided by using proper pin insertion techniques that reduce skin tension; pin-bone, pin-skin motion; and soft tissue trauma. In addition, proper selection of pins (size, threaded or smooth), fixator configuration, ancillary implants, and a cancellous bone graft further reduce the risk of complications and inadequate healing.

Treatments for feline long bone fractures

Orthopedic injuries in cats occur frequently and are amenable to a variety of surgical and nonsurgical treatment options. Complications and delayed healing have been reported and can be attributed to improper fixation. Clinicians have numerous options ranging from external to internal fixation, casting, cage rest, and limb amputation. The goals of reducing patient morbidity and obtaining a return to normal function warrant the selection of an appropriate treatment based on the nature of the lesion, available expertise, and directives of the client.

Osteochondrosis of the Femur

Osteochondrosis can occur in the stifle joint(s) of young, rapidly growing large breeds of dogs. Although not as common as osteochondrosis of the shoulder, elbow, and hock joints, the osteochondral defect in the femoral condyle(s) and stifle joint fragment can cause a clinically apparent lameness. Radiography is beneficial in identifying the lesion(s), and surgical therapy is useful in restoring limb function.

Caudal Cruciate Ligament Injury

In small animals, CaCL injury occurs infrequently and is associated with isolated ruptures, attachment (bone) avulsions, or combined with multiple ligament injury of the stifle joint. Definitive diagnosis of CaCL usually requires direct examination of the stifle joint because detection of caudal drawer motion is confusing and may be masked by concurrent, possibly more significant lesions. Although the ligament is considered a primary stabilizer of the canine stifle joint, controversy exists regarding the need for surgical repair of CaCL injury. Although reattachment of avulsion injuries seems prudent, results of other stabilizing procedures for midsubstance tears have produced patients with minimal lameness and persistent drawer motion. Based on limited clinical and experimental data, it is conceivable that surgical stabilization of the CaCL-deficient stifle joint may not be necessary in small animals, although more clinical studies would be useful in conclusively delineating the role of this ligament.

Surgical treatments for intervertebral disc disease.

Surgical treatments for intervertebral disc disease are useful for animals with gradually progressive, severely acute, or recurrent lesions. Surgical patients require a diligent neuroradiographic evaluation to confirm location and severity of the discopathy and rule out conditions unrelated to disc disease. Although controversial, some surgeons advocate fenestration for recurrent pain or mild ataxia associated with a noncompressive lesion. Decompressive procedures are recommended for treatment and prognostication of compressive disc-associated myelopathy. Foraminotomy is reserved for patients with lateralizing extrusions confirmed with myelography or newer imaging modalities (CT, MRI). Future treatments for animals may include chemonucleolysis or various discectomy procedures currently performed in humans with symptomatic disc disease.

Clinical Evaluation of the Osteoarthritic Patient

Clinical evaluation of the osteoarthritic patient involves critical evaluation off the animal and associated medical history. The most useful diagnostic aids in veterinary practice include joint palpation, radiography, and arthrocentesis. Accurate patient assessment provides diagnostic and prognostic information as well as serving as a baseline for medical or surgical therapies.