To evaluate owner adherence to recommendations for follow-up examination of dogs and cats following orthopedic procedures and identify factors associated with adherence versus nonadherence.
Medical records of 485 dogs and cats that underwent orthopedic surgery.
Cases were categorized as urgent or elective. Information obtained from the medical records consisted of species, age, body weight, proximity to the hospital, procedure cost, recommendations for coaptation, use of financial aid, and number of owners. Cases were considered adherent to follow-up recommendations if, at the latest visit or communication, no further visits were recommended. Cases were considered nonadherent if owners did not return for recommended follow-up visits.
Overall adherence to follow-up recommendations was 65.8% (319/485). Elective cases were 1.6 times as likely to be adherent to follow-up recommendations as were urgent cases, dog cases were 2.4 times as likely to be adherent as were cat cases, and cases with multiple owners listed were 2.1 times as likely to be adherent as were cases with 1 owner listed. Distance from the hospital had a statistically significant association with adherence, but the effect was not clinically important. Age, weight, coaptation, procedure cost, and use of financial aid were not significantly associated with adherence.
CONCLUSIONS AND CLINICAL RELEVANCE
The percentage of dogs and cats lost to follow-up following orthopedic surgery at an academic veterinary teaching hospital was substantial (166/485 [34.2%]). Efforts to improve follow-up adherence are especially indicated for animals undergoing urgent procedures, animals with single owners, and cats.
Objective—To determine the influence of stifle joint flexion angle, cranial cruciate ligament (CrCL) integrity, tibial plateau leveling osteotomy (TPLO), and cranial tibial subluxation on the distance between the location of the origin and insertion of the CrCL (CrCLd) in dogs.
Samples—4 pairs of pelvic limbs from adult dog cadavers weighing 23 to 34 kg.
Procedures—Mediolateral projection radiographs of each stifle joint were obtained with the joint flexed at 90°, 105°, 120°, 135°, and 150°. Radiopaque markers were then placed at the sites of origin and insertion of the CrCL. Afterward, radiography was repeated in the same manner, before and after CrCL transection, with and without TPLO. Following CrCL transection, radiographs were obtained before and after inducing overt cranial tibial subluxation. Interobserver variation in measuring the CrCLd without fiduciary markers was assessed. The effect of CrCL integrity, cranial tibial subluxation, flexion angle, and TPLO on CrCLd was also determined.
Results—Interobserver agreement was strong, with an intraclass correlation coefficient of 0.859. The CrCLd was significantly shorter (< 1 mm) at 90° of flexion; otherwise, flexion angle had no effect on CrCLd. Cranial tibial subluxation caused a 25% to 40% increase in CrCLd. No effect of TPLO on CrCLd was found, regardless of CrCL integrity, forced stifle joint subluxation, or flexion angle.
Conclusions and Clinical Relevance—Overt cranial tibial subluxation in CrCL-deficient stifle joints can be detected on mediolateral projection radiographs by comparing CrCLd on neutral and stressed joint radiographs at joint angles between 105° and 150°, regardless of whether a TPLO has been performed.
Objective—To validate use of stress MRI for evaluation of stifle joints of dogs with an intact or deficient cranial cruciate ligament (CrCL).
Sample—10 cadaveric stifle joints from 10 dogs.
Procedures—A custom-made limb-holding device and a pulley system linked to a paw plate were used to apply axial compression across the stifle joint and induce cranial tibial translation with the joint in various degrees of flexion. By use of sagittal proton density–weighted MRI, CrCL-intact and deficient stifle joints were evaluated under conditions of loading stress simulating the tibial compression test or the cranial drawer test. Medial and lateral femorotibial subluxation following CrCL transection measured under a simulated tibial compression test and a cranial drawer test were compared.
Results—By use of tibial compression test MRI, the mean ± SD cranial tibial translations in the medial and lateral compartments were 9.6 ± 3.7 mm and 10 ± 4.1 mm, respectively. By use of cranial drawer test MRI, the mean ± SD cranial tibial translations in the medial and lateral compartments were 8.3 ± 3.3 mm and 9.5 ± 3.5 mm, respectively. No significant difference in femorotibial subluxation was found between stress MRI techniques. Femorotibial subluxation elicited by use of the cranial drawer test was greater in the lateral than in the medial compartment.
Conclusions and Clinical Relevance—Both stress techniques induced stifle joint subluxation following CrCL transection that was measurable by use of MRI, suggesting that both methods may be further evaluated for clinical use.
OBJECTIVE To compare stiffness and resistance to cyclic fatigue of two 3.5-mm locking system plate-rod constructs applied to an experimentally created fracture gap in femurs of canine cadavers.
SAMPLE 20 femurs from cadavers of 10 mixed-breed adult dogs.
PROCEDURES 1 femur from each cadaver was stabilized with a conical coupling plating system-rod construct, and the contralateral femur was stabilized with a locking compression plate (LCP)-rod construct. An intramedullary Steinmann pin was inserted in each femur. A 40-mm gap then was created; the gap was centered beneath the central portion of each plate. Cyclic axial loading with increasing loads was performed. Specimens that did not fail during cyclic loading were subjected to an acute load to failure.
RESULTS During cyclic loading, significantly more LCP constructs failed (6/10), compared with the number of conical coupling plating system constructs that failed (1/10). Mode of failure of the constructs included fracture of the medial or caudal aspect of the cortex of the proximal segment with bending of the plate and pin, bending of the plate and pin without fracture, and screw pullout. Mean stiffness, yield load, and load to failure were not significantly different between the 2 methods of stabilization.
CONCLUSIONS AND CLINICAL RELEVANCE Both constructs had similar biomechanical properties, but the conical coupling plating system was less likely to fail than was the LCP system when subjected to cyclic loading. These results should be interpreted with caution because testing was limited to a single loading mode.
To compare initial leak pressure (ILP) between cadaveric canine and synthetic small intestinal segments that did and did not undergo enterotomy.
Eight 8-cm grossly normal jejunal segments from 1 canine cadaver and eight 8-cm synthetic small intestinal segments.
Intestinal segments were randomly assigned to undergo enterotomy (6 cadaveric and 6 synthetic segments) or serve as untreated controls (2 cadaveric and 2 synthetic segments). For segments designated for enterotomy, a 2-cm full-thickness incision was created along the antimesenteric border. The incision was closed in a single layer with 4-0 suture in a simple continuous pattern. Leak testing was performed with intestinal segments occluded at both ends and infused with dilute dye solution (999 mL/h) until the solution was observed leaking from the suture line or serosal tearing occurred. Intraluminal pressure was continuously monitored. The ILP at construct failure was compared between cadaveric and synthetic control segments and between cadaveric and synthetic enterotomy segments.
Mean ± SD ILP did not differ significantly between cadaveric (345.11 ± 2.15 mm Hg) and synthetic (329.04 ± 24.69 mm Hg) control segments but was significantly greater for cadaveric enterotomy segments (60.77 ± 15.81 mm Hg), compared with synthetic enterotomy segments (15.03 ± 6.41 mm Hg).
CONCLUSIONS AND CLINICAL RELEVANCE
Leak testing should not be used to assess the accuracy or security of enterotomy suture lines in synthetic intestinal tissue. Synthetic intestinal tissue is best used for students to gain confidence and proficiency in performing enterotomies before performing the procedure on live animals.
OBJECTIVE To develop a device intended for gradual venous occlusion over 4 to 6 weeks.
SAMPLE Silicone tubing filled with various inorganic salt and polyacrylic acid (PAA) formulations and mounted within a polypropylene or polyether ether ketone (PEEK) outer ring.
PROCEDURES 15 polypropylene prototype rings were initially filled with 1 of 5 formulations and placed in PBSS. In a second test, 10 polypropylene and 7 PEEK prototype rings were filled with 1 formulation and placed in PBSS. In a third test, 2 formulations were loaded into 6 PEEK rings each, placed in physiologic solution, and incubated. In all tests, ring luminal diameter, outer diameter, and luminal area were measured over 6 weeks.
RESULTS In the first test, 2 formulations had the greatest changes in luminal area and diameter, and 1 of those had a greater linear swell rate than the other had. In the second test, 6 of 7 PEEK rings and 6 of 10 polypropylene rings closed to a luminal diamater < 1 mm within 6 weeks. Polypropylene rings had a greater increase in outer diameter than did PEEK rings between 4.5 and 6 weeks. In the third test, 11 of 12 PEEK rings gradually closed to a luminal diameter < 1 mm within 6 weeks.
CONCLUSIONS AND CLINICAL RELEVANCE A PAA and inorganic salt formulation in a prototype silicone and polymer ring resulted in gradual occlusion over 4 to 6 weeks in vitro. Prototype PEEK rings provided more reliable closure than did polypropylene rings.
Objective—To compare accuracy of a noninvasive single-plane fluoroscopic technique with radiostereometric analysis (RSA) for determining 3-D femorotibial poses in a canine cadaver with normal stifle joints.
Sample—Right pelvic limb from a 25-kg adult mixed-breed dog.
Procedures—A CT scan of the limb was obtained before and after metal beads were implanted into the right femur and tibia. Orthogonal fluoroscopic images of the right stifle joint were acquired to simulate a biplanar fluoroscopic acquisition setup. Images were obtained at 5 flexion angles from 110° to 150° to simulate a gait cycle; 5 cycles were completed. Joint poses were calculated from the biplanar images by use of RSA with CT-derived beaded bone models and compared with measurements obtained by use of CT-derived nonbeaded bone models matched to single-plane, lateral-view fluoroscopic images. Single-plane measurements were performed by 2 observers and repeated 3 times by the primary observer.
Results—Mean absolute differences between the single-plane fluoroscopic analysis and RSA measurements were 0.60, 1.28, and 0.64 mm for craniocaudal, proximodistal, and mediolateral translations, respectively, and 0.63°, 1.49°, and 1.58° for flexion-extension, abduction-adduction, and internal-external rotations, respectively. Intra- and interobserver repeatability was strong with maximum mean translational and rotational SDs of 0.52 mm and 1.36°, respectively.
Conclusions and Clinical Relevance—Results suggested that single-plane fluoroscopic analysis performed by use of CT-derived bone models is a valid, noninvasive technique for accurately measuring 3-D femorotibial poses in dogs.
Objective—To compare accuracy of a noninvasive single-plane fluoroscopic analysis technique with radiostereometric analysis (RSA) for determining 3-D femorotibial poses in a canine cadaver stifle joint treated by tibial-plateau-leveling osteotomy (TPLO).
Sample—Left pelvic limb from a 25-kg adult mixed-breed dog.
Procedures—A CT scan of the left pelvic limb was performed. The left cranial cruciate ligament was transected, and a TPLO was performed. Radiopaque beads were implanted into the left femur and tibia, and the CT scan was repeated. Orthogonal fluoroscopic images of the left stifle joint were acquired at 5 stifle joint flexion angles ranging from 110° to 150° to simulate a gait cycle; 5 gait cycles were completed. Joint poses were calculated from the biplanar images by use of a digitally modified RSA and were compared with measurements obtained by use of hybrid implant-bone models matched to lateral-view fluoroscopic images. Single-plane measurements were performed by 2 observers and repeated 3 times by the primary observer.
Results—Mean absolute differences between results of the single-plane fluoroscopic analysis and modified RSA were 0.34, 1.05, and 0.48 mm for craniocaudal, proximodistal, and mediolateral translations, respectively, and 0.56°, 0.85°, and 1.08° for flexion-extension, abduction-adduction, and internal-external rotations, respectively. Intraobserver and interobserver mean SDs did not exceed 0.59 mm for all translations and 0.93° for all rotations.
Conclusions and Clinical Relevance—Results suggested that single-plane fluoroscopic analysis by use of hybrid implant-bone models may be a valid, noninvasive technique for accurately measuring 3-D femorotibial poses in dogs treated with TPLO.
OBJECTIVE To evaluate the closure rate and completeness of closure for a silicone–polyacrylic acid gradual venous occlusion device placed around an intra-abdominal vein to simulate gradual occlusion of an extrahepatic portosystemic shunt.
ANIMALS 3 purpose-bred cats and 2 purpose-bred dogs.
PROCEDURES The device was surgically placed around an external (cats) or internal (dogs) iliac vein. Computed tomographic angiography was performed at the time of surgery and 2, 4, and 6 weeks after surgery. Ultrasonographic examinations of blood flow through the vein within the device were performed at the time of surgery and at weekly intervals thereafter. Dogs were euthanized 6 weeks after surgery, and the external iliac veins were harvested for histologic examination.
RESULTS The prototype gradual venous occlusion device was successfully placed in all animals, and all animals recovered without complications following the placement procedure. The vessel was completely occluded in 2 cats by 6 weeks after surgery, as determined on the basis of results of CT and ultrasonography; there was incomplete occlusion with a luminal diameter of 1.5 mm in the other cat by 6 weeks after surgery. The vessel was completely occluded in both dogs by 6 weeks after surgery. Histologic examination of the external iliac veins obtained from the dogs revealed minimal inflammation of the vessel wall and no thrombus formation.
CONCLUSIONS AND CLINICAL RELEVANCE The prototype device induced gradual attenuation of an intra-abdominal vessel over a 6-week period. This device may provide another option for gradual occlusion of extrahepatic portosystemic shunts.
To assess the feasibility and accuracy of using 2 methods for reduction and alignment of simulated comminuted diaphyseal tibial fractures in conjunction with 3-D–printed patient-specific pin guides.
Paired pelvic limbs from 8 skeletally mature dogs weighing 20 to 35 kg.
CT images of both tibiae were obtained, and 3-D reconstructions of the tibiae were used to create proximal and distal patient-specific pin guides. These guides were printed and used to facilitate fracture reduction and alignment in conjunction with either a 3-D–printed reduction guide or a linear type 1A external fixator. Postreduction CT images were used to assess the accuracy of pin guide placement and the accuracy of fracture reduction and alignment.
The 3-D–printed guides were applied with acceptable ease. Guides for both groups were placed with minor but detectable deviations from the planned location (P = .01), but deviations were not significantly different between groups. Fracture reduction resulted in similar minor but detectable morphological differences from the intact tibiae (P = .01). In both groups, fracture reduction and alignment were within clinically acceptable parameters for fracture stabilization by means of minimally invasive plate osteosynthesis.
Virtual surgical planning and fabrication of patient-specific 3-D–printed pin guides have the potential to facilitate fracture reduction and alignment during use of minimally invasive plate osteosynthesis for fracture stabilization.