Mary Sarah Bergh

Risk Factors for Tibial Tuberosity Fracture After Tibial Plateau Leveling Osteotomy in Dogs

OBJECTIVE To evaluate factors that predispose to tibial tuberosity (TT) fracture after tibial plateau leveling osteotomy (TPLO) in dogs. STUDY DESIGN Retrospective study. ANIMALS Dogs (n=182) with cranial cruciate ligament (CCL) rupture undergoing 213 TPLO surgeries. METHODS Medical records and radiographs of 2 groups of dogs that had TPLO surgery (2000-2001, 2004-2005) were evaluated to determine the effect of operative technique and surgeon experience on TT fracture. RESULTS TT fracture was diagnosed in 8 dogs (9 TPLO, 4.2% of surgical procedures). Four fractures occurred after unilateral TPLO in 167 dogs (2.4%), 4 fractures occurred after simultaneous bilateral TPLO in 5 dogs (40%), and 1 fracture occurred after staged bilateral TPLO in 36 dogs (2.8%). Simultaneous bilateral TPLO resulted in a 12.4 times higher odds of TT fracture versus unilateral TPLO (P=.046). The mean absolute thickness of the TT after TPLO was less in dogs sustaining TT fractures (7.2 +/- 2.2 mm) than those that did not (10.8 +/- 2.7 mm, P<.0001). The odds of fracture decreased by 37% when the absolute TT width postosteotomy increased by 1 mm (P<.0001). An increase in tibial plateau angle at follow-up versus immediately postoperative was associated with TT fracture (P=.025). Surgeon experience was not associated with TT fracture. CONCLUSION A combination of surgical decision-making and surgical technique play a role in the occurrence of TT fracture after TPLO. Simultaneous bilateral TPLO was associated with a high percentage of TT fracture. CLINICAL RELEVANCE Careful planning of osteotomy positioning is advised while performing TPLO surgery.

A Systematic Review of the Literature Describing the Efficacy of Surgical Treatments for Canine Hip Dysplasia (1948–2012)

Objective To systematically evaluate the literature reporting outcome of surgical treatments for canine hip dysplasia (CHD) and to evaluate whether adequate evidence exists to support a procedure that will allow a consistent return to normal function. Study Design Systematic literature review. Animals Dogs with naturally occurring CHD. Methods An a priori question was defined and a computer-based bibliographic search was performed on PubMed, Medline, CAB Abstracts, and Veterinary Information Network through November 2012. Studies were compared and evaluated with regard to surgical technique, study design, outcome measurements, evidence classification, and evidence quality. Unilateral surgeries with >6 months postoperative follow-up were included. Results Manuscripts (n = 477) were identified and reviewed; 17 met the inclusion criteria. One study provided level I evidence, 2 provided level II evidence, 3 provided level III evidence, and 11 provided level IV evidence relative to the study question. The most common outcome measurements were orthopedic examination (70.6%), owner interview (70.6%), and visual gait observation (64.7%). Three studies used objective kinetic gait assessment. Two studies with level III evidence (total hip replacement) and 1 study with level IV evidence (juvenile pubic symphysiodesis) documented a consistent return to normal function after surgery. Conclusions Despite a large number of publications describing clinical outcome after surgical treatments for CHD, few provided strong evidence to allow an adequate assessment of therapeutic efficacy.OBJECTIVE To systematically evaluate the literature reporting outcome of surgical treatments for canine hip dysplasia (CHD) and to evaluate whether adequate evidence exists to support a procedure that will allow a consistent return to normal function. STUDY DESIGN Systematic literature review. ANIMALS Dogs with naturally occurring CHD. METHODS An a priori question was defined and a computer-based bibliographic search was performed on PubMed, Medline, CAB Abstracts, and Veterinary Information Network through November 2012. Studies were compared and evaluated with regard to surgical technique, study design, outcome measurements, evidence classification, and evidence quality. Unilateral surgeries with >6 months postoperative follow-up were included. RESULTS Manuscripts (n = 477) were identified and reviewed; 17 met the inclusion criteria. One study provided level I evidence, 2 provided level II evidence, 3 provided level III evidence, and 11 provided level IV evidence relative to the study question. The most common outcome measurements were orthopedic examination (70.6%), owner interview (70.6%), and visual gait observation (64.7%). Three studies used objective kinetic gait assessment. Two studies with level III evidence (total hip replacement) and 1 study with level IV evidence (juvenile pubic symphysiodesis) documented a consistent return to normal function after surgery. CONCLUSIONS Despite a large number of publications describing clinical outcome after surgical treatments for CHD, few provided strong evidence to allow an adequate assessment of therapeutic efficacy.

Fractures in regions of adaptive modeling and remodeling of central tarsal bones in racing Greyhounds

OBJECTIVE To evaluate and compare bone modeling and remodeling in fractured and non-fractured central tarsal bones (CTBs) of racing Greyhounds. SAMPLE Paired cadaveric tarsi from 6 euthanized racing Greyhounds with right CTB fractures and 6 racing Greyhounds with other nontarsal injuries. PROCEDURES CTBs were dissected and fractured CTBs were reconstructed. Central tarsal bones were evaluated through standard and nonscreen high-detail radiography, computed tomography, and histologic examination. The bone mineral density (BMD) was calculated adjacent to fracture planes and as a gradient on sagittal computed tomographic images. Sagittal and transverse plane sections of bone were obtained and submitted for subjective histologic assessment. Linear mixed-effects models were used to compare findings. RESULTS Fractured right CTBs had greater BMD in the dorsal and midbody regions of the sagittal plane sections than did nonfractured CTBs. The BMD ratios from bone adjacent to the dorsal slab fracture planes were not different between fractured and nonfractured right CTBs. CONCLUSIONS AND CLINICAL RELEVANCE Findings supported the existence of site-specific bone adaptation in CTBs of Greyhounds, with modeling and remodeling patterns that were unique to fractured right CTBs. The dorsal and midbody regions of fractured bones had greater BMD, and fractures occurred through these zones of increased BMD.

Traumatic craniolateral shoulder luxation and fracture of the lesser tubercle of the humerus in a dog

A five-year old, spayed female, Bearded Collie was presented with a 24-hour history of non-weight-bearing lameness of the right thoracic limb after sustaining vehicular trauma. Radiographs revealed a craniolateral scapulohumeral luxation and a distally and medially displaced fracture of the lesser tubercle of the humerus. Open reduction and internal fixation of the fracture was achieved with lag screw fixation and an anti-rotational Kirschner wire. Surgical repair resulted in compression across the fracture line, anatomic reduction of the articular surface, and a stable scapulohumeral joint following reduction of the humeral head in the glenoid. Six weeks postoperatively, the patient exhibited no evidence of pain or lameness on the right thoracic limb and radiographs revealed complete healing of the fracture and normal articulation of the scapulohumeral joint. This is the first report of a lesser tubercle fracture associated with a craniolateral shoulder luxation. Surgical intervention resulted in the return of full shoulder joint function in this dog.