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A walk-through the literature on orthopaedic matters

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01 March 2014, at 12:00am

Management of cranial cruciate ligament injuries in small dogs 

Eithne Comerford and others, University of Liverpool 

A number of different surgical techniques have been described over recent years for the treatment of damaged cranial cruciate ligaments in dogs. The authors investigated the favoured strategies among members of the BSAVA and the British Veterinary Orthopaedic Association towards the management of these injuries in small dogs weighing less than 15kg.

Immediate surgical treatment was chosen by just 15.5% of the respondents. For the others, the management strategy would depend on factors such as the severity of lameness, age, bodyweight, degree of instability and the duration of the lameness. Options for the conservative management of cases included non- steroidal anti-inflammatory drugs, short leash walks, weight loss, hydrotherapy, physiotherapy and cage rest.

When surgical management was chosen, 71.4% of respondents would opt to carry out the procedure themselves rather than referring to another practice. Extra-capsular stabilisation would be the first choice strategy for 63.4% of respondents, followed by corrective osteotomies (32.9%) and intra-articular stabilisation (6.8%). 

Veterinary and Comparative Orthopaedics and Traumatology 26 (6): 493-497.

Risk of septic arthritis after intra-articular medication in thoroughbred racehorses 

Cate Steel and others, University of Melbourne

Septic arthritis is a recognised complication of using intra-articular medication for the treatment of joint disease in human and veterinary medicine. The authors investigated the frequency of such problems in thoroughbred racehorses and attempted to identify specific risk factors. From the records of 16,624 treatments in 1,103 horses they found evidence of septic arthritis in 13 cases, or once every 1,279 injections, so though rare these incidents are more common than is reported in human patients. The use of certain corticosteroid products was identified as a risk factor and the frequency of adverse effects varied between different practitioners, possibly in relation to their aseptic techniques. 

Australian Veterinary Journal 91 (7): 268- 273. 

Epidemiological study of carpal joint injuries in cats 

Bedrich Nakladal and others, Free University of Berlin, Germany 

Carpal joint injuries are a comparatively rare finding in cats and are generally attributed to falling from a height, or “high rise syndrome”. The authors examined the case records from 73 cats diagnosed with such injuries over a 12- year period. 

These cases were more likely to present between April and October than at other times of the year and in 72.6% of cases the cat did appear to have fallen from a tall building. Those cats falling from a window on the fourth floor or higher tended to receive injuries to the antebrachiocarpal joint while cats falling a shorter distance were more likely to damage the carpometacarpal joint. 

Veterinary and Comparative Orthopaedics and Traumatology 25 (5): 333-339. 

Autologous platelet therapy for the treatment of osteoarthritis in dogs

Maria Fahie and others, Western University of Health Sciences, Pomona, California

Intra-articular injection of autologous platelet cells has shown promise in the treatment of osteoarthritis in human and canine patients. The benefits appear to be due to the action of growth factors released by the cells. 

The authors investigated the effects of a single intra- articular injection in 20 dogs with naturally occurring OA affecting a single joint. There were no significant changes following a saline injection for dogs in the control group but in the treatment group there was a 55% reduction at week 12 in lameness scores, a 53% decrease in mean pain scores and a 12% improvement in the mean vertical force exerted by the affected limb when walking.

Journal of the American Veterinary Medical Association 243 (9): 1,291-1,297.

Complications of lateral plate fixation in dogs with plantar tarsal ligament disruption 

Darren Barnes and others, Dick White Referrals, Newmarket 

Subluxation of the proximal intertarsal joint occurs commonly in certain dog breeds as a result of a degenerative process affecting the plantar tarsal ligament. The authors analysed the complication rates and outcomes in 61 dogs treated using the lateral plate fixation technique in comparison with those treated with a figure-of-eight tension band wire and either pin or lag screw fixation for arthrodesis of the calcaneoquartal joint. 

Their findings showed that lateral plate procedures were associated with fewer complications than the pin and tension- band wire technique. The numbers of cases requiring further surgery were 

17% and 56% respectively in those groups. Veterinary and Comparative Orthopaedics and Traumatology 26 (6): 445-452.

Bioengineering technique for the treatment of osteochondrosis dissecans in a filly

Nao Tsuzuki and others, Obihiro University, Japan 

Osteochondritis dissecans is a common developmental orthopaedic disease in horses involving focal disturbance of endochondral ossification. The authors describe a bioengineering technique for cartilage repair involving administration of a sponge impregnated with platelet- rich plasma, bone morphogenetic protein-2, mesenchymal stem cells and gelatin beta-tricalcium phosphate. 

This was applied to the medial tibial malleolus in a 13-month-old thoroughbred filly. After 12 weeks there was no radiological evidence of the original defect but the regenerated tissue was fragile fibrocartilage rather than wear-resistant hyaline cartilage. 

Australian Veterinary Journal 91 (10): 411- 415.

CT imaging of bone in Labrador puppies with early stage medial coronoid disease 

Seng Fong Lau and others, Utrecht University, The Netherlands 

Medial coronoid disease is a common developmental condition in young, large- breed dogs for which the aetiopathogenesis remains unclear. The authors used micro-computed tomography to investigate the changes occurring in the early stage of the disease in seven Labrador puppies with uni- or bilateral medial coronoid disease. 

This technique demonstrated that the mean x-ray attenuation of articular cartilage was significantly higher in those puppies with MCD than in healthy controls, indicating reduced glycosaminoglycan content. At this stage, there was no evidence of changes in the subchondral bone micro- architecture due to the presence of this condition in these dogs. 

The Veterinary Journal 198 (1): 116-121.

Outcomes of treatments for different forms of shoulder instability in dogs

Samuel Franklin and others, University of Missouri 

Shoulder instability is a common cause of forelimb lameness in dogs, and the condition can be classified as medial, lateral or multidirectional. The authors describe a multinational, four-centre study to identify the incidence of different forms of the disease and the outcomes of different treatment strategies. 

A retrospective analysis of clinical records over a four-year period showed that medial instability was more common than the lateral or multidirectional forms of the condition. Surgical reconstruction for patients with medial and multidirectional instability appears to produce better results than non-surgical management and the rate of post-surgical complications appears to be low. 

Veterinary Surgery 42 (4): 361-364.

Severity of clinical signs and histopathological changes in intervertebral disc disease 

Diana Henke and others, University of Bern, Switzerland

Spinal surgery in dogs with absent voluntary motor function and nociception following intervertebral disc herniation can have highly variable outcomes. The authors investigated the correlation between clinical signs and histopathological changes in 60 dogs that were euthanased following acute thoracolumbar intervertebral disc disease. 

Clinical neurological grades did correlate significantly with the extent of the white matter damage, yet loss of nociception occurred in six of 31 dogs with relatively mild histological changes. Also, the duration of clinical signs, Schiff-Sherrington posture, loss of reflexes and pain on spinal palpation were not associated with the severity of spinal cord damage.

The Veterinary Journal 198 (1): 70-75.

Arterial thrombosis in a dog with a humeral fracture following a road accident 

Kristina DePaula and others, Tufts University, Massachusetts

A three-year-old female, mixed breed dog was admitted with injuries sustained after being hit by a car, including a pneumothorax, skin wounds and a transverse fracture of the right humerus. Open reduction and internal fixation of the fracture was performed and the patient was weight-bearing at discharge. 

However, eight days later it was readmitted with pain and was non- weight bearing in the affected limb. Ultrasonography revealed a thrombus in the right brachial artery. Following treatment with unfractionated heparin and clopidogrel the clot was eliminated and blood flow to the injured limb restored. 

Journal of the American Veterinary Medical Association 243 (3): 394-398.

Gait analyses in dogs following amputation of a thoracic limb 

Sarah Jarvis and others, Colorado State University

Most dogs appear to adapt well to the removal of a thoracic limb although some patients do have difficulty in returning to anything approaching normal locomotor function. The authors assessed the biomechanical differences between healthy dogs and those with a forelimb amputation using spatial kinematic and kinetic analyses. 

There were significant biomechanical changes after amputation in the vertebral column, carpus, ipsilateral hip and stifle joints. The gait of a thoracic limb amputee appeared to be a mixture of different gait patterns in which the ipsilateral pelvic limb assumed dual thoracic and pelvic limb roles.

American Journal of Veterinary Research 74 (9): 1,155-1,163.

Discospondylitis and epidural empyema due to a Salmonella species infection Ioannis 

Plessas and others, Royal Veterinary College, London

Discospondylitis is an inflammatory condition of the intervertebral disc, the adjacent endplates and vertebral bodies. Staphylococcus pseudintermedius is the most common cause in dogs although a number of other bacterial species have also been isolated. Salmonella infections have been described as a cause of the condition in human patients but there are no previous reports involving these bacteria in dogs. 

The authors describe a case involving a seven-year-old intact male boxer in which the history, clinical signs and magnetic resonance imaging suggested discospondylitis and epidural empyema and Salmonella was identified on blood culture. Following surgery and antimicrobial therapy, the patient made a full recovery.

Canadian Veterinary Journal 54 (6): 595- 598.