Richard Meeson

Soft-tissue injuries associated with cast application for distal limb orthopaedic conditions. A retrospective study of sixty dogs and cats.

OBJECTIVES Casts applied for orthopaedic conditions can result in soft-tissue injuries. The purpose of our study was to describe the nature and prevalence of such complications. METHODS We performed a retrospective review of medical records of dogs and cats that had a cast placed for an orthopaedic condition between October 2003 and May 2009. The data were analysed and categorised. RESULTS Of the 60 animals that had a cast placed, 63% developed a soft-tissue injury (60% mild, 20% moderate and 20% severe). Injuries could occur any time during coaptation, and an association with duration of casting and severity (p = 0.42) was not shown. Severe injuries took the longest to resolve (p = 0.003). Sighthounds were significantly more likely to develop a soft-tissue injury (p = 0.04), and cross-breeds were less likely (p = 0.01). All common calcaneal tendon reconstructions suffered soft-tissue injuries, but significance was not shown (p = 0.08). Veterinarians identified the majority of injuries (80%) rather than the owners. The financial cost of treating soft-tissue injuries ranged from four to 121% the cost of the original orthopaedic procedure. CLINICAL SIGNIFICANCE Soft-tissue injuries secondary to casting occur frequently, and can occur at any time during the casting period. Within our study, sighthounds were more likely to develop soft tissue injuries, and should therefore perhaps be considered as a susceptible group. The only reliable way to identify an injury is to remove the cast and inspect the limb.

Management of Pelvic Trauma Neurological Damage, Urinary Tract Disruption and Pelvic Fractures

Practical relevance Cats commonly present with pelvic trauma following road traffic accidents (RTAs). A logical step-wise approach to diagnostics and subsequent management can significantly improve the prognosis in the majority of cases. This article provides a practical guide to assist decision-making and optimise management of these cats. Clinical challenges Affected cats may have sustained trauma to several body systems and, hence, their management can be complex, requiring good clinical, diagnostic and surgical skills (often both soft tissue and orthopaedic!). Patient group Any cat allowed access to the outdoors is potentially at risk of being involved in an RTA and sustaining pelvic trauma. Young male cats are most commonly affected. Evidence base Many original articles and textbook chapters have been published on aspects of pelvic trauma. However, to the authors’ knowledge, this is the first comprehensive overview of the assessment and management of the feline pelvic trauma case. The review begins by discussing initial triage and neurological examination, and then focuses, in turn, on assessment and management of the ‘tail pull’ injury, the diagnosis and management of urinary tract rupture, and the approach to managing specific pelvic fractures.

Feline ilial fractures: a prospective study of dorsal plating and comparison with lateral plating.

OBJECTIVE To (1) report a technique for repair of feline ilial fractures using a dorsally applied bone plate and (2) compare outcome with cats treated by a lateral plate. STUDY DESIGN Prospective study. ANIMALS Cats (n=10) with iliac fractures. METHODS Cats with ilial fractures (January 2005-December 2006) were treated by application of a dorsally applied bone plate. Immediate postoperative radiographs were compared with those taken 4-6 weeks later to assess screw loosening, screw purchase, and pelvic canal narrowing. Owners were contacted for medium-term (>3 month) follow-up. Data were compared with a report of outcome after lateral plating (LP) in 21 cats. RESULTS Mean (+/- SD) screw purchase (89 +/- 11 mm) was significantly greater (P<.01) with a dorsal plate compared with a lateral plate (33 +/- 8 mm). Significantly more screws (P<.01) were used with a dorsal plate (median, 7) compared with a lateral plate (median, 6). Significantly less postoperative pelvic canal narrowing developed in the dorsal plating group between postoperative and 4-6-week follow-up radiography compared with the LP group (2% versus 15%, P<.01). CONCLUSION Dorsal plating of feline ilial fractures results in significantly less screw loosening and pelvic canal narrowing at 4-6 weeks after surgery compared with LP. CLINICAL RELEVANCE Dorsal plating of feline iliac fractures may reduce complications associated with pelvic canal narrowing such as constipation and megacolon.

Epidemiology of Cranial Cruciate Ligament Disease Diagnosis in Dogs Attending Primary‐Care Veterinary Practices in England

OBJECTIVE To estimate the prevalence and risk factors for a diagnosis of cranial cruciate ligament (CCL) disease in dogs and to describe the management of such cases attending primary-care veterinary practices. STUDY DESIGN Historical cohort with a nested case-control study. SAMPLE POPULATION Nine hundred and fifty-three dogs diagnosed with CCL disease from 171,522 dogs attending 97 primary-care practices in England. METHODS Medical records of dogs attending practices participating in the VetCompass project that met selection criteria were assessed. Univariate and multivariate logistic regression methods were used to evaluate association of possible risk factors with diagnosis of CCL disease. RESULTS The prevalence of CCL disease diagnosis was estimated at 0.56% (95% confidence interval 0.52-0.59). Compared with crossbred dogs, Rottweilers, West Highland White Terriers, Golden Retrievers, Yorkshire Terriers, and Staffordshire Bull Terriers showed increased odds of CCL disease diagnosis while Cocker Spaniels showed reduced odds. Increasing bodyweight within breeds was associated with increased odds of diagnosis. Dogs aged over 3 years had increased odds of diagnosis compared with dogs aged less than 3 years. Neutered females had 2.1 times the odds of diagnosis compared with entire females. Insured dogs had 4 times the odds of diagnosis compared with uninsured dogs. Two-thirds of cases were managed surgically, with insured and heavier dogs more frequently undergoing surgery. Overall, 21% of cases were referred, with referral more frequent in heavier and insured dogs. Referred dogs more frequently had surgery and an osteotomy procedure. CONCLUSION Breed predispositions and demographic factors associated with diagnosis and case management of CCL disease in dogs identified in this study can be used to help direct future research and management strategies.

Short and long-term outcome following surgical stabilization of tarsocrural instability in dogs

OBJECTIVES To evaluate the outcome and complications following surgical stabilization of canine tarsocrural luxations. METHODS Medical records of dogs which were surgically treated for tarsocrural joint instability between February 2007 and June 2014 were reviewed. Surgical technique, complications and long-term outcome (via questionnaire and Canine Brief Pain Inventory) were assessed. RESULTS Twenty-four dogs (26 joints) were included. All injuries were traumatic. All joints had associated fractures; malleolar in 21/26 limbs (13/26 medial). Eight joints had internal fracture fixation and transarticular external skeletal fixator, six had external fixator alone, four had prosthetic ligaments with external fixator, and four had prosthetic ligaments with external coaptation. Two joints had pantarsal arthrodesis and two primary ligament repair. Complications occurred in 24/26 limbs giving 45 distinct complications; 16 were minor, 29 major, and 31 complications were external fixator associated. Prosthetic ligaments were significantly associated with major complications (p = 0.017); five out of eight required subsequent removal between 105-1006 days. Cost was significantly associated with major complications (p = 0.017) and soft tissue wounds (p = 0.03). Long-term lameness was seen in nine of 14 dogs. There was no association between pain severity (p = 0.3) and pain interference scores (p = 0.198) when comparing stabilization methods. CLINICAL SIGNIFICANCE Complications are common; however many are external fixator related. Prosthetic ligaments are significantly associated with major complications. Regardless of technique, a degree of ongoing lameness is likely.

Clinical Comparison of the Hybrid Dynamic Compression Plate and the Castless Plate for Pancarpal Arthrodesis in 219 Dogs

OBJECTIVE To describe and compare a large population of dogs that had pancarpal arthrodesis (PCA) using either a hybrid dynamic compression plate (HDCP) or a CastLess Plate (CLP). STUDY DESIGN Multicenter, retrospective, cohort study. ANIMALS Dogs (n = 240; 261 PCA). METHODS Medical records (2000-2012) from 12 UK orthopedic centers were reviewed for dogs that had PCA to document signalment, diagnosis, arthrodesis method, and complication rates. Follow-up data were used to compare outcome (lameness evaluation and radiographic healing) after use of HDCP and CLP plates. RESULTS PCA was performed with HDCP in 125 cases, CLP in 105, and by other techniques in 31. Carpal hyperextension injury was the most common diagnosis in HDCP and CLP groups. Surgical site infection (18.3%) was the most common postoperative complication. There was no difference in intra- (11% HDCP, 21% CLP) or postoperative (34% HDCP, 41% CLP) complication rates. Use of external coaptation did not affect postoperative complication rates or outcome. External coaptation related complications occurred in 32% HDCP and 18% CLP (P = .02). At median follow-up, most dogs were classified as having no or mild lameness (73% HDCP, 83% CLP) and there was radiographic healing in 40% HDCP and 46% CLP (P = .8) cases. CONCLUSIONS CLP and HDCP may both be used successfully to achieve pancarpal arthrodesis. Adjunctive external coaptation does not appear to have a measurable clinical benefit but is associated with morbidity.

A biomechanical evaluation of a Hybrid Dynamic Compression Plate and a CastLess Arthrodesis Plate for pancarpal arthrodesis in dogs.

OBJECTIVE To determine mechanical differences between two plates with different requirements for supplementary casting after pancarpal arthrodesis (PCA): the Veterinary Instrumentation Hybrid Dynamic Compression Plate (HDCP), and the OrthoMed CastLess Arthrodesis Plate (CLP). STUDY DESIGN In vitro mechanical analysis. SAMPLE POPULATION HDCP(n = 10), CLP(10). METHODS Single-cycle load to failure using a materials-testing machine and cyclic loading between 38 and 380 N ± 5% to simulate estimated in vivo loads until failure or 10(6) cycles. RESULTS Single-cycle to failure: bending stiffness was significantly higher for the HDCP(2269 ± 175 N/mm) than CLP(1754 ± 88 N/mm; P < .001). Bending structural stiffness was higher for the HDCP(3.8 ± 0.3 Nm(2) ) versus CLP(2.9 ± 0.2 Nm(2) ; P= .0022). A difference between the 2 plates for bending strength was not demonstrated; HDCP= 13.9 ± 1.4 Nm, CLP13.2 ± 0.5 Nm (P= .24). Cyclic Loading: no failures occurred with either plate type when plates were cycled to 10(6) cycles. CONCLUSION There is no mechanical advantage in bending resistance afforded by the CLPover the HDCP. Fatigue failure of either plate during the convalescent period of an estimated 150,000-250,000 cycles is unlikely. Based on the bending performance, there is no evidence to support the use of the CLPover the HDCPfor castless PCA.

Prevalence, duration and risk factors for appendicular osteoarthritis in a UK dog population under primary veterinary care.

Osteoarthritis is the most common joint disease diagnosed in veterinary medicine and poses considerable challenges to canine welfare. This study aimed to investigate prevalence, duration and risk factors of appendicular osteoarthritis in dogs under primary veterinary care in the UK. The VetCompassTM programme collects clinical data on dogs attending UK primary-care veterinary practices. The study included all VetCompassTM dogs under veterinary care during 2013. Candidate osteoarthritis cases were identified using multiple search strategies. A random subset was manually evaluated against a case definition. Of 455,557 study dogs, 16,437 candidate osteoarthritis cases were identified; 6104 (37%) were manually checked and 4196 (69% of sample) were confirmed as cases. Additional data on demography, clinical signs, duration and management were extracted for confirmed cases. Estimated annual period prevalence (accounting for subsampling) of appendicular osteoarthritis was 2.5% (CI95: 2.4–2.5%) equating to around 200,000 UK affected dogs annually. Risk factors associated with osteoarthritis diagnosis included breed (e.g. Labrador, Golden Retriever), being insured, being neutered, of higher bodyweight and being older than eight years. Duration calculation trials suggest osteoarthritis affects 11.4% of affected individuals’ lifespan, providing further evidence for substantial impact of osteoarthritis on canine welfare at the individual and population level.

Management and long-term outcome of pelvic fractures: a retrospective study of 43 cats

Objectives The aim of the study was to evaluate the management and long-term outcome of cats with pelvic fractures. Methods Cats with pelvic fractures had their records and radiographs reviewed. Radiographs were reviewed for fracture configuration, implants and pelvic canal narrowing. Owners were contacted for long-term follow-up. Results Forty-three cats met the criteria (mean follow-up 24 months [range 6–45 months]). The majority (93%) had more than one orthopaedic pelvic injury, with sacroiliac fracture luxations seen most commonly; 23% had presurgical neurological deficits. Most cats (74%) were managed surgically; 60% of sacroiliac fracture luxations, 82% of ilial fractures and 50% of acetabular fractures received surgery. The complication rate was 22%, most commonly sciatic neurapraxia (13%). Seventy-nine percent of all neurological deficits resolved and the remainder improved. Mean pelvic canal narrowing after trauma was −15% in surgical and −16% in conservatively managed cats. Canal width was improved postoperatively (–8%) but mildly narrowed further by follow-up (–12%); however, these changes were not significant. Nineteen percent of cats had constipation postsurgery; none developed megacolon. There was no clear correlation between the degree of narrowing of the pelvic canal up to −50%, or whether conservative treatment was opted for, and the development of constipation. Long-term mobility was not impaired in 86% of cats, and 84% did not have any lameness detectable. Conclusions and relevance The majority of cats were managed surgically, with a 22% complication rate; the most common being transient sciatic neurapraxia. Long-term outcome was generally excellent and most had a full recovery. Constipation/obstipation was very uncommon and no clear relationship with pelvic canal narrowing could be found when considering narrowing of up to −50% in both surgical and conservative groups. As no cats in this cohort had narrowing greater than −50%, the current recommendation of surgery to improve the canal width if narrowing is greater than −45% to −50% should remain.

Angiostrongylus vasorum Causing Severe Granulomatous Hepatitis with Concurrent Multiple Acquired PSS

A 14 mo old female Jack Russell terrier presented with a 12 hr history of vomiting and inappetence. She was subsequently diagnosed with multiple acquired portosystemic shunts during an exploratory celiotomy. Gross and histopathological hepatic abnormalities were consistent with chronic disease, including features suggestive of portal hypertension that was potentially caused by migrating and resident Angiostrongylus vasorum larvae. Fecal analysis and polymerase chain reaction of hepatic tissue confirmed the presence of Angiostrongylus vasorum . The dog recovered clinically following empirical treatment and supportive care. A lack of parasite burden was confirmed 9 wk postdiagnosis; however, serum biochemical analysis at that time was suggestive of ongoing hepatic dysfunction.