Pierre-Yves Mulon

The Effect of Six Knotting Methods on the Biomechanical Properties of Three Large Diameter Absorbable Suture Materials

OBJECTIVE To evaluate the effect of 6 different knotting methods on the mechanical properties of 3 large absorbable suture materials used in large animal surgery. STUDY DESIGN In vitro mechanical study. Sample Population- Knotted suture loops (n=15 per group). METHODS Suture loops were created between two low-friction pulleys with either 2 polydioxanone, 2 polyglactin 910 or 3 polyglactin 910. Strands were tied using 1 of 6 knotting technique: square knot, surgeon knot, clamped surgeons knot, sliding half-hitch knot (HH), Delimar knot and self-locking knot (SLK). A single cycle to failure test was performed on each suture loop with a distraction rate of 100 mm/min. Failure modes were evaluated and breaking strength, elongation to failure and stiffness were compared. RESULTS All loops except two HH failed at the knot by acute breaking. The double-stranded SLK was both stronger and stiffer than all other knots for each suture material. Clamping the first throw of the surgeon knot decreased load to failure significantly (143.11 +/- 8.64 N) compared with not clamping (159.21 +/- 6.14 N) for polydioxanone. Stiffness and elongation to failure were respectively lower and increased for 2 polydioxanone compared with both polyglactin 910 materials for all knotting techniques. CONCLUSIONS Knotting techniques do influence structural properties of suture loops. The double strand loop conferred stiffer and stronger properties to the SLK CLINICAL RELEVANCE: Clamping the first throw of polydioxanone should be avoided when tying a suture under tension even using large diameter suture materials. Using a SLK might be considered as a useful alternative when excessive tension is present.

Use of a novel intramedullary nail for femoral fracture repair in calves: 25 cases (2008-2009)

OBJECTIVE To describe the use of a novel intramedullary interlocking nail for femoral fracture repair in newborn calves and outcome associated with this treatment modality. DESIGN Retrospective case series. ANIMALS 25 calves. PROCEDURES Medical records from calves referred for femoral fracture repair between November 2008 and June 2009 were included. Signalment, clinical findings, and results of lameness examination and complete radiographic examination were recorded. Details of surgical technique, orthopedic fixation, associated complications, and outcome were also noted. RESULTS 25 Charolais calves were included in the study. All fractures were closed and located in the diaphysis; 18 extended to the distal metaphysis, 1 was located proximally, and 6 were midshaft fractures. Fractures were localized to the left femur in 17 calves and to the right femur in 8 calves. An interlocking nail was used as the sole means of internal fixation in 16 calves and was reinforced in 9 calves. Two calves were euthanatized for reasons related to the surgery, and 4 died of unrelated reasons. Long-term prognosis was considered excellent for 15 calves and fair for 4 calves. Age, body weight, overall musculoskeletal strength at initial evaluation, affected limb, configuration and location of the fracture, need for reinforcement of the repair, and quality of the reduction had no significant association with positive outcome of the surgery. CONCLUSIONS AND CLINICAL RELEVANCE The novel intramedullary interlocking nail used in the present study was associated with a good prognosis for surgical repair of femoral fractures in newborn calves regardless of the location of the fracture.

Degenerative disease of the distal interphalangeal joint and sesamoid bone in calves: 9 cases (1995-2004).

OBJECTIVE To evaluate the clinical signs, diagnosis, treatment, and outcome associated with distal interphalangeal joint (DIJ) degenerative disease in calves. DESIGN Retrospective case series. ANIMALS 9 calves with degenerative disease of the DIJ. PROCEDURES Medical records of calves with lameness for which the cause had been localized to the distal aspect of a limb but without evidence of trauma or sepsis were included. Signalment and results of physical, lameness, radiographic, and postmortem examinations were recorded. Outcomes of medical and surgical treatments were evaluated. RESULTS All 9 calves had forelimb lameness (4 bilaterally). The medial digit was affected in 12 limbs and the lateral digit was affected in 9 limbs. Radiographic examination revealed bridging osteoproliferation along the abaxial and palmar aspects of affected DIJs (18/21), subchondral cyst-like lucencies (19/21), and sclerosis (16/21). The DIJ was resected in 3 calves (7 joints), resulting in resolution of lameness within 3 months. Medical management was attempted in 4 calves (6 joints), and 2 calves (6 joints) did not receive treatment; 5 calves had a normal stance within 5 months. Results of postmortem computed tomographic and histologic examination were in accordance with degenerative joint disease processes. CONCLUSIONS AND CLINICAL RELEVANCE Degenerative disease of the DIJ should be considered in calves with insidious, progressive forelimb lameness. Although the etiology of this process remains undetermined, results of radiographic, computed tomographic, and histologic examinations suggested an underlying developmental anomaly, such as osteochondrosis. Surgical treatment appeared promising on the basis of postoperative resolution of lameness in all surgically treated calves.

Indications and Limitations of Splints and Casts

Long bone fractures are relatively common in cattle, whether they result from a self-inflicted trauma or from external actors (herd mate or farm machinery). Various advanced orthopedic techniques have been described to stabilize and treat fractures in cattle with success. Unfortunately the use of most of those techniques remains unrealistic in a field setting, rendering the realization of splints and casts still accurate for the treatment of long bone fracture in cattle. This article refers to the use of all external coaptation and their specific indications as well as their limitations.

Milk flow obstruction caused by varicose vein of the teat in dairy cattle.

Objective To describe varicose vein as a cause of obstruction of the teat cistern in dairy cattle and to report therapeutic options and outcome. Study Design Retrospective case series. Animals Dairy cows (n = 22). Methods Medical records (1998–2011) of dairy cows admitted for milking difficulties caused by a teat varicose vein were reviewed. Three treatment approaches were used: sclerotherapy, ligation of the vein associated with sclerotherapy, and phlebectomy. Long-term outcome was obtained ≥6 months after treatment and defined as a milking improvement. Descriptive statistics were used to determine the population at risk and a chi square test was used to evaluate the relationship between treatments and outcomes. Results Twenty-four teats (22 cows) had a varicose vein. Forequarters were more frequently affected than rear quarters (P < .01). Three sclerotherapies, 12 ligations associated with sclerotherapy and 6 phlebectomies were performed. Five veins were not treated. Overall prognosis with treatment was good (84%) at ≥ 6 months and was not significantly different between treatment types (P = .38). Recurrence of the obstruction by the varicose vein occurred in 3 of 19 teats. Conclusions and clinical relevance Several surgical options are available for treatment of teat varicose veins. The overall prognosis of return to normal milking is good.OBJECTIVE To describe varicose vein as a cause of obstruction of the teat cistern in dairy cattle and to report therapeutic options and outcome. STUDY DESIGN Retrospective case series. ANIMALS Dairy cows (n = 22). METHODS Medical records (1998-2011) of dairy cows admitted for milking difficulties caused by a teat varicose vein were reviewed. Three treatment approaches were used: sclerotherapy, ligation of the vein associated with sclerotherapy, and phlebectomy. Long-term outcome was obtained ≥ 6 months after treatment and defined as a milking improvement. Descriptive statistics were used to determine the population at risk and a chi square test was used to evaluate the relationship between treatments and outcomes. RESULTS Twenty-four teats (22 cows) had a varicose vein. Forequarters were more frequently affected than rear quarters (P < .01). Three sclerotherapies, 12 ligations associated with sclerotherapy and 6 phlebectomies were performed. Five veins were not treated. Overall prognosis with treatment was good (84%) at ≥ 6 months and was not significantly different between treatment types (P = .38). Recurrence of the obstruction by the varicose vein occurred in 3 of 19 teats. CONCLUSIONS AND CLINICAL RELEVANCE Several surgical options are available for treatment of teat varicose veins. The overall prognosis of return to normal milking is good.

Milk flow obstruction caused by varicose vein of the teat in dairy cattle: Varicose Vein of the Teat in Dairy Cattle

Objective To describe varicose vein as a cause of obstruction of the teat cistern in dairy cattle and to report therapeutic options and outcome. Study Design Retrospective case series. Animals Dairy cows (n = 22). Methods Medical records (1998–2011) of dairy cows admitted for milking difficulties caused by a teat varicose vein were reviewed. Three treatment approaches were used: sclerotherapy, ligation of the vein associated with sclerotherapy, and phlebectomy. Long-term outcome was obtained ≥6 months after treatment and defined as a milking improvement. Descriptive statistics were used to determine the population at risk and a chi square test was used to evaluate the relationship between treatments and outcomes. Results Twenty-four teats (22 cows) had a varicose vein. Forequarters were more frequently affected than rear quarters (P < .01). Three sclerotherapies, 12 ligations associated with sclerotherapy and 6 phlebectomies were performed. Five veins were not treated. Overall prognosis with treatment was good (84%) at ≥ 6 months and was not significantly different between treatment types (P = .38). Recurrence of the obstruction by the varicose vein occurred in 3 of 19 teats. Conclusions and clinical relevance Several surgical options are available for treatment of teat varicose veins. The overall prognosis of return to normal milking is good.OBJECTIVE To describe varicose vein as a cause of obstruction of the teat cistern in dairy cattle and to report therapeutic options and outcome. STUDY DESIGN Retrospective case series. ANIMALS Dairy cows (n = 22). METHODS Medical records (1998-2011) of dairy cows admitted for milking difficulties caused by a teat varicose vein were reviewed. Three treatment approaches were used: sclerotherapy, ligation of the vein associated with sclerotherapy, and phlebectomy. Long-term outcome was obtained ≥ 6 months after treatment and defined as a milking improvement. Descriptive statistics were used to determine the population at risk and a chi square test was used to evaluate the relationship between treatments and outcomes. RESULTS Twenty-four teats (22 cows) had a varicose vein. Forequarters were more frequently affected than rear quarters (P < .01). Three sclerotherapies, 12 ligations associated with sclerotherapy and 6 phlebectomies were performed. Five veins were not treated. Overall prognosis with treatment was good (84%) at ≥ 6 months and was not significantly different between treatment types (P = .38). Recurrence of the obstruction by the varicose vein occurred in 3 of 19 teats. CONCLUSIONS AND CLINICAL RELEVANCE Several surgical options are available for treatment of teat varicose veins. The overall prognosis of return to normal milking is good.