Nina R. Kieves

High energy focused shock wave therapy accelerates bone healing. A blinded, prospective, randomized canine clinical trial.

OBJECTIVES To evaluate the influence of shock wave therapy (SWT) on radiographic evidence of bone healing after tibial plateau leveling osteotomy (TPLO). METHODS Healthy dogs between two to nine years of age that underwent TPLO were randomly assigned to receive either electro-hydraulic SWT (1,000 shocks) or sham treatment (SHAM). Treatment or SHAM was administered to the osteotomy site immediately postoperatively and two weeks postoperatively. Three blinded radiologists evaluated orthogonal radiographs performed eight weeks postoperatively with both a 5-point and a 10-point bone healing scale. Linear regression analysis was used to compare median healing scores between groups. RESULTS Forty-two dogs (50 stifles) were included in the statistical analysis. No major complications were observed and all osteotomies healed uneventfully. The median healing scores were significantly higher at eight weeks postoperatively for the SWT group compared to the SHAM group for the 10-point (p <0.0002) and 5-point scoring systems (p <0.0001). CLINICAL SIGNIFICANCE Shock wave therapy applied immediately and two weeks postoperatively led to more advanced bone healing at the eight week time point in this study population. The results of this study support the use of electro-hydraulic SWT as a means of accelerating acute bone healing of canine osteotomies. Additional studies are needed to evaluate its use for acceleration of bone healing following fracture, or with delayed union.

Hip toggle stabilization using the TightRope® system in 17 dogs: technique and long-term outcome.

OBJECTIVE To describe the technique for, and long-term clinical outcome of, a modified hip toggle stabilization using the TightRope® system for coxofemoral luxation repair. STUDY DESIGN Retrospective case series. METHODS Medical records (July 2008-July 2010) including radiographs (17 limbs) of dogs that had coxofemoral luxation repaired with the TightRope system were reviewed. Follow-up (≥12 months) was obtained by telephone interview of owners. Six dogs were available for re-evaluation, radiographs, and objective gait analysis. RESULTS Follow-up (mean, 24 months; range, 12-43 months) by telephone interview was available for 17 dogs. Of these, 6 dogs were re-evaluated (mean, 7.5 months; median 12.5 months: range, 4-24 months) and had gait analysis. Mean duration of luxation before surgical intervention was 7.5 days (median, 7 days; range, 2-44 days). There was a single case of relaxation 27 months postoperatively. One dog died from non-surgical related circumstances. Objective gait analysis showed equal pelvic limb use in all 6 dogs available for re-evaluation. All owners of living dogs reported limb function as being good to excellent, and perceived that their dogs were pain free. Radiographs (mean, 7.5 months; median, 12.5 months; range, 4-24 months post surgery) of 6 dogs showed no progression of osteoarthritis in comparison to immediate postoperative radiographs. CONCLUSIONS Hip toggle with the TightRope system as a prosthetic ligament of the head of the femur produces a favorable clinical outcome with high owner acceptance.Objective To describe the technique for, and long-term clinical outcome of, a modified hip toggle stabilization using the TightRope® system for coxofemoral luxation repair. Study Design Retrospective case series. Methods Medical records (July 2008–July 2010) including radiographs (17 limbs) of dogs that had coxofemoral luxation repaired with the TightRope system were reviewed. Follow-up (≥12 months) was obtained by telephone interview of owners. Six dogs were available for re-evaluation, radiographs, and objective gait analysis. Results Follow-up (mean, 24 months; range, 12–43 months) by telephone interview was available for 17 dogs. Of these, 6 dogs were re-evaluated (mean, 7.5 months; median 12.5 months: range, 4–24 months) and had gait analysis. Mean duration of luxation before surgical intervention was 7.5 days (median, 7 days; range, 2–44 days). There was a single case of relaxation 27 months postoperatively. One dog died from non-surgical related circumstances. Objective gait analysis showed equal pelvic limb use in all 6 dogs available for re-evaluation. All owners of living dogs reported limb function as being good to excellent, and perceived that their dogs were pain free. Radiographs (mean, 7.5 months; median, 12.5 months; range, 4–24 months post surgery) of 6 dogs showed no progression of osteoarthritis in comparison to immediate postoperative radiographs. Conclusions Hip toggle with the TightRope system as a prosthetic ligament of the head of the femur produces a favorable clinical outcome with high owner acceptance.

Business Education in Veterinary Schools: The Potential Role of the Veterinary Business Management Association

Studies have indicated the importance of business education in improving the income level attained by veterinarians and the quality of service they provide. The Veterinary Business Management Association (VBMA), a national organization of veterinary students, has the potential to augment veterinary curricula by providing additional education to help ensure professional success. Local chapters at 27 of the 28 veterinary colleges in the United States (as of 2007) supplement the curriculum by focusing on business topics. A national governing board oversees the chapters, helping to ensure that high-quality educational programs are conducted and providing a conduit for communication.

Vaginal resection and anastomosis for treatment of vestibulovaginal stenosis in 4 dogs with recurrent urinary tract infections

CASE DESCRIPTION-4 dogs were evaluated because of recurrent urinary tract infections. CLINICAL FINDINGS-All dogs had recurrent urinary tract infections and similar clinical signs; 3 dogs had urinary incontinence. Digital vaginal examination revealed vestibulovaginal stenosis in all dogs, which was confirmed by results of contrast vaginourethrography. From image measurements, the vestibulovaginal ratio (ratio of the height of the vestibulovaginal junction to the maximum height of the vagina on a lateral vaginourethrogram) was calculated for each dog. Three dogs had severe stenosis (vestibulovaginal ratio, < 0.20; severe stenosis is defined as a vestibulovaginal ratio < 0.20), whereas the fourth dog had moderate stenosis (vestibulovaginal ratio, 0.24; ratio range for moderate stenosis is 0.20 to 0.25). TREATMENT AND OUTCOME-All dogs were anesthetized for surgical correction of the vestibulovaginal stenosis. Vaginal resection and anastomosis of the stenosis was performed in all 4 dogs, with 1 dog also undergoing episioplasty. Complete resolution of clinical signs was apparent in 3 dogs; 1 dog had postoperative complications including pollakiuria and stranguria, which resulted in rectal and vaginal prolapse. This dog underwent ovariohysterectomy, after which clinical signs resolved. All dogs had resolution of urinary tract infections at the time of follow-up (6 to 8 months after surgery). CLINICAL RELEVANCE-Resection and anastomosis may resolve recurrent urinary tract infections in dogs with severe or moderate vestibulovaginal stenosis. Episiotomy was not necessary for success of surgical treatment, and overall, that procedure increased morbidity, the severity of intraoperative hemorrhage, and duration of surgery.

Comparison of tensile strength among simple interrupted, cruciate, intradermal, and subdermal suture patterns for incision closure in ex vivo canine skin specimens

OBJECTIVE To compare suture placement time, tension at skin separation and suture line failure, and mode of failure among 4 suture patterns. DESIGN Randomized trial. SAMPLE 60 skin specimens from the pelvic limbs of 30 purpose-bred Beagles. PROCEDURES Skin specimens were harvested within 2 hours after euthanasia and tested within 6 hours after harvest. An 8-cm incision was made in each specimen and sutured with 1 of 4 randomly assigned suture patterns (simple interrupted, cruciate, intradermal, or subdermal). Suture placement time and percentage of skin apposition were evaluated. Specimens were mounted in a calibrated material testing machine and distracted until suture line failure. Tensile strength at skin-edge separation and suture-line failure and mode of failure were compared among the 4 patterns. RESULTS Mean suture placement time for the cruciate pattern was significantly less than that for other patterns. Percentage of skin apposition did not differ among the 4 patterns. Mean tensile strength at skin-edge separation and suture-line failure for the simple interrupted and cruciate patterns were significantly higher than those for the intradermal and subdermal patterns. Mean tensile strength at skin-edge separation and suture-line failure did not differ significantly between the intradermal and subdermal patterns or the simple interrupted and cruciate patterns. The primary mode of failure for the simple interrupted pattern was suture breakage, whereas that for the cruciate, intradermal, and subdermal patterns was tissue failure. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested external skin sutures may be preferred for closure of incisions under tension to reduce risk of dehiscence.

Comparison of leak pressures for single‐layer simple continuous suture pattern for cystotomy closure using barbed and monofilament suture material in an ex vivo canine model*

Objective: To compare leak pressures following simple continuous closure of cystotomy with barbed suture to an analogous monofilament suture, in an ex vivo canine model. Study design: Ex vivo, simple randomized study. Animals or sample population: Urinary bladders harvested from canine cadavers (n = 21). Methods: Urinary bladders were harvested from cadavers immediately following euthanasia. A 3‐cm cystotomy was made on ventral midline of the urinary bladder. Urinary bladders were randomly assigned a suture for closure. A digital pressure transducer was inserted through 1 ureter, and the other ligated, while colored isotonic saline was infused into the urinary bladder via a Foley catheter inserted in the urethra. The initial leak pressure was defined as the pressure at which the colored saline solution first leaked from the cystotomy, and the maximum leak pressure was recorded when the pressure reached a plateau or catastrophic failure occurred. A Welchs 2‐sample t test was used to compare leak pressure between the barbed and non‐barbed closures, with significance set at P < .05. Results: There was no significant difference in the initial or maximum leak pressure between the barbed and non‐barbed closures. Conclusions: This study showed no difference in initial or maximum leak pressure between cystotomy closures with barbed or non‐barbed suture under ex vivo conditions. This indicates barbed suture may be appropriate for cystotomy closure but in vivo studies are needed to support this finding.

Pilot study measuring the effects of bandaging and cold compression therapy following tibial plateau levelling osteotomy.

OBJECTIVES To compare cold compression therapy, modified Robert-Jones bandage or the combination of cold compression therapy plus modified Robert-Jones bandage on operated limbs following tibial plateau levelling osteotomy in dogs. METHODS Twenty-one client-owned dogs with cranial cruciate ligament disease were prospectively enrolled. Dogs were randomly assigned to one of three postoperative treatment groups: cold compression therapy, modified Robert-Jones bandage or a combination of both. Patients were evaluated preoperatively and at 12, 24 and 36 hours following tibial plateau levelling osteotomy. Measurements included weight-bearing on the operated limb, stifle flexion and extension angles and circumference of the operated limb at four levels. RESULTS There was no significant difference in weight-bearing, range of motion or limb swelling between groups. There was a trend for dogs in the cold compression therapy and cold compression therapy with a bandage groups to have a greater increase in weight-bearing after surgery compared with the bandage-only group. CLINICAL RELEVANCE Cold compression therapy is a safe modality following tibial plateau levelling osteotomy surgery. The trend towards improved use of the operated limb in the groups receiving cold compression therapy compared with those treated with only a bandage may be an indication that these patients are more comfortable in the postoperative period. The small sample size limits interpretation of the data but this pilot study provides data to guide future investigation.

Comparison of owner satisfaction between stifle joint orthoses and tibial plateau leveling osteotomy for the management of cranial cruciate ligament disease in dogs

OBJECTIVE To compare owner satisfaction between custom-made stifle joint orthoses and tibial plateau leveling osteotomy (TPLO) for the management of medium- and large-breed dogs with cranial cruciate ligament disease (CCLD). DESIGN Owner survey. SAMPLE 819 and 203 owners of dogs with CCLD that were managed with a custom-made stifle joint orthosis or TPLO, respectively. PROCEDURES Client databases of an orthosis provider and veterinary teaching hospital were reviewed to identify potential survey respondents. An online survey was developed to evaluate owner-reported outcomes, complications, and satisfaction associated with the nonsurgical (orthosis group) and surgical (TPLO group) interventions. Survey responses were compared between groups. RESULTS The response rate was 25% (203/819) and 37% (76/203) for the orthosis and TPLO groups, respectively. The proportion of owners who reported that their dogs had mild or no lameness and rated the intervention as excellent, very good, or good was significantly greater for the TPLO group than for the orthosis group. However, ≥ 85% of respondents in both groups reported that they would choose the selected treatment again. Of 151 respondents from the orthosis group, 70 (46%) reported skin lesions associated with the device, 16 (11%) reported that the dog subsequently underwent surgery, and 10 (7%) reported that the dog never tolerated the device. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated high owner satisfaction rates for both interventions. Owners considering nonsurgical management with an orthosis should be advised about potential complications such as persistent lameness, skin lesions, patient intolerance of the device, and the need for subsequent surgery.

Assessment of novel digital and smartphone goniometers for measurement of canine stifle joint angles

OBJECTIVE To evaluate accuracy and reliability of 3 novel goniometers for measurement of canine stifle joint angles and compare the results with those obtained with a universal goniometer (UG). SAMPLE 8 pelvic limbs from 4 canine cadavers. PROCEDURES Each limb was secured to a wooden platform at 3 arbitrarily selected fixed stifle joint angles. Goniometry was performed with 2 smartphone-based applications (novel goniometers A and B), a digital goniometer (novel goniometer C), and a UG; 3 evaluators performed measurements in triplicate for each angle with each device. Results were compared with stifle joint angle measurements on radiographs (used as a gold standard). Accuracy was determined by calculation of bias and total error, coefficients of variation were calculated to estimate reliability, and strength of linear association between radiographic and goniometer measurements was assessed by calculation of correlation coefficients. RESULTS Mean coefficient of variation was lowest for the UG (4.88%), followed by novel goniometers B (7.37%), A (7.57%), and C (12.71%). Correlation with radiographic measurements was highest for the UG (r = 0.97), followed by novel goniometers B (0.93), A (0.90), and C (0.78). Constant bias was present for all devices except novel goniometer B. The UG and novel goniometer A had positive constant bias; novel goniometer C had negative constant bias. Total error at 50° and 100° angles was > 5% for all devices. CONCLUSIONS AND CLINICAL RELEVANCE None of the devices accurately represented radiographically measured stifle joint angles. Additional veterinary studies are indicated prior to the use of novel goniometers in dogs.

Effects of low-intensity pulsed ultrasound on radiographic healing of tibial plateau leveling osteotomies in dogs: a prospective, randomized, double-blinded study

OBJECTIVE To determine the influence of low-intensity pulsed ultrasound (LIPUS) on radiographic healing and limb function after uncomplicated, stable osteotomies in dogs. STUDY DESIGN In vivo, prospective, randomized, double-blinded, placebo-control study. SAMPLE POPULATION Fifty client-owned dogs. METHODS Fifty client-owned dogs with naturally occurring unilateral cranial cruciate ligament rupture were enrolled prior to tibial plateau leveling osteotomy. Dogs were assigned to an active (LIPUS) treatment group or a placebo control (SHAM) treatment group via block randomization on the basis of age, weight, and affected limb. Dogs in the LIPUS treatment group underwent LIPUS treatments for 20 minutes daily: 1.5-MHZ ultrasound wave pulsed at 1 kHZ with a 20% duty cycle at an intensity of 30 mW/cm2 for the duration of the study (12 weeks). Radiographic evaluation was performed at 4, 8, 10, and 12 weeks postoperatively to evaluate bone healing. Limb function was assessed with temporal-spatial gait analysis preoperatively and at 4, 8, and 12 weeks postoperatively by using a pressure-sensitive walkway system. RESULTS Both groups had significant improvement in radiographic score and limb use over time. However, there was no significant difference in radiographic bone healing, or limb use as measured by objective gait analysis detected between the LIPUS treatment group and SHAM treatment group at any point in the study. CONCLUSION LIPUS treatment did not improve healing in this stable osteotomy model. CLINICAL SIGNIFICANCE This study does not provide evidence to support the clinical application of LIPUS to stimulate the healing of stable, uncomplicated osteotomies to accelerate bone healing.