Ch. 51: Humerus Flashcards
Chase Vet Sx 2019 PQ
Short and long-term outcome after transcondylar screw placement to treat humeral intracondylar fissure in dogs
Post-op complication #s? What was most common?
RF identified?
What was most sig association with unsatisfactory long term outcome?
18/26 sx managed elbows were diagnosed with post-operative complication – 11 / 18 major complications
11 consisted of SSI
No risk factors for short-term complications or long-term outcome ID
Dogs with SSI 28 x more likely to have unsatisfactory long-term outcome than dogs without SSI
Symmetry indices between TL and PL did not return to published normal values
Outcomes satisfactory in 12/19 dogs and unsatisfactory in 7/19 dogs
No difference in SI of dogs with HIF and sx repaired contralateral humeral condylar fracture
No association between variables and postop complications
Castaldo VCOT 2021 PQ
Biomechanical Comparison of External Fixation and Double Plating for Stabilization of a Canine Cadaveric Supracondylar Humeral Fracture Gap Model
Which was stronger?
Which one may be ideal for patients with complicated healing/poor healing/poor patient compliance? PQ
double-plate (DB-PLATE) and linear external fixator with an intramedullary pin tie-in (ESF-IMP) fixation techniques
Both DB-PLATE and ESF-IMP survived cyclic testing with no change in dynamic stiffness.
* DB-PLATE was stronger than ESF-IMP in load-to-failure testing, which may make this construct preferable when prolonged healing or poor patient compliance is anticipated. *
Results suggest that either method may be appropriate for fixation of comminuted supracondylar humeral fractures.
Guiot Vet Sx 2019
Minimally invasive percutaneous medial plate rod osteosynthesis for treatment of bicondylar humeral fractures in dogs: Surgical technique and case report
General repair technique?
Main fx pathology?
Conclusion?
Condylar component reduced using percutaneous forceps + K wire
Transcondylar screw applied, epicondylar pins preplaced medially and laterally
Metaphyseal part reduced and stabilized with the pins, then bone plate applied medial surface
Incomplete ossification ID as primary pathology in 2 / 3
Good outcomes without complication in 3/3 cases
Conc: MIPO represents an alternative to ORIF in the treatment of comminuted humeral T-Y fractures.
Mofatt VCOT 2019
Repair of Y-T humeral condyle fractures with locking compression plate fixation
Accurate repair based on what? # cases considerate accurate repair?
Short term outcome? Overall outcome?
Which 2 complications?
Conclusion?
12/18 dogs had simple fractures, and 6 had comminuted fractures
Postop radiographs revealed accurate intracondylar reconstruction (articular step defect < 1 mm) in 17/18 patients
Short-term outcome fully functional in 9/13 and acceptable in 3/13 patients; 8/9 clients said tx resulted in excellent overall outcome
Complications diagnosed in 2/13; infection in 1 with resolution after antibiotic treatment, and one case of implant failure
Conc: Repair of Y-T humeral fractures with LCP allowed for hybrid fixation and monocortical screw placement in distal fracture fragments. There was no significant ASD at the intracondylar fracture line in most cases
Villamil Vet Sx 2020
Impact of breed on canine humeral condylar fracture configuration, surgical management, and outcome
Predisposed breeds?
Risk ratio of #1 breed?
Which fixation method associated with lower comp?
Overall complication rate? Vast majority major or minor?
Most common comps (2)?
Associations with comps?
Take away?
Look at rads
French bulldogs and spaniel breeds predisposed
Frenchies 6.58 x more likely than other breeds to have medial HCF
Epicondylar plate fixation associated with reduced complications compared with lag screws and K wires
Outcome considered excellent in 26 / 31 dogs with long-term FU (median 36 mo)
Overall complication rate 30% - 33/35 major, 1 / 35 minor
16% complications implant related, 11% infection related
NO association between fracture type and complication type
Take away: French bulldogs are predisposed to HCF, including medial HCF. Epicondylar plate fixation is recommended over other epicondylar fixation methods to reduce complications.
Franklin VRU 2023
Prevalence of incidental humeral intracondylar fissures in brachycephalic breed dogs in CT studies
Overall prevalence of HIF in French bulldogs? Pugs?
“At the dog level,” Prevalence of HIF in at least one elbow of a Frenchie?
Presence of HIF in at least one elbow of Pug?
Sig diff bw breeds?
Inter reviewer reliability of CT scoring for HIF?
Look at CT images
Retrospective, observational, prevalence study using CT of Frenchies & other brachycephalic dogs presenting for an unrelated condition.
Score 1 = normal
Score 2 = centralized sclerosis
Score 3 = partial fissure
Score 4 = complete fissure
228 total elbows from 122 dogs
145 elbows from French Bulldogs, 54 Pugs + others
The prevalence of HIF (score 3 or 4) in elbows of the:
- French bulldog = 6.9% … prevalence in at least 1 elbow = 11.8%
- Pug = 5.6% … prevalence in at least 1 elbow = 11.1%
There was no significant difference btwn the breed groups.
The inter-reviewer reliability for CT scoring of HIF based on Cohen’s weighted kappa was low at 0.19.
Garcia Vet Sx 2020
Bilateral locking compression plate and transcondylar screw fixation for stabilization of canine bicondylar humeral fractures
MC breed?
% skeletally immature?
% resolution of lameness 6 weeks post-op?
Major complications? RF?
Conc?
French bulldog MC represented breed
7 (25%) dogs were considered skeletally immature.
27 (96%) dogs were considered to have had resolution of lameness at 6 weeks.
Major complications in 2 (7%) dogs; 1 dog required surgical revision, and 1 dog had catastrophic complications leading to amputation of the limb
Risk factors for major complications were not identified in our sample population.
Management of Y-T humeral fractures stabilized with bilateral LCP and transcondylar screws led to a low complication rate with a good to excellent long-term outcome according to O responses.
Pardo Vet Sx 2021
Accuracy of medial-to-lateral transcondylar screw placement using an aiming device & preoperative computer tomography planning for the treatment of humeral intercondylar fissure
Did device help place screws within condyle?
Distance in mm deviation from planned entry / exit?
Degree of deviation?
33/34 screws were completely within the humeral condyle.
13/34 screws were placed less than 2 mm from planned entry and exit points in both the transverse and the frontal plane.
The axis of the screw deviated by a mean of 3.2° (transverse plane) and 3.5° (frontal plane) from the planned axis.
Raleigh Vet Sx 2021
Influence of interlocking thread screws to repair simulated adult canine humeral condylar fractures
Conclusion?
- simulated fractures of the lateral aspect of the humeral condyle were stabilized by a 3.5 mm interlocking thread screw (ITS) or 3.5 mm buttress thread screw placed in lag (BTS-L) or positional fashion (BTS-P)
- axially loaded at a walk, trot, 2-mm displacement, and failure cycles.
- Compact flute drill bits (CFBs) were used for ITS constructs and standard flute drill bits (SFB) for BTS constructs
Conclusion: Biomechanical performance of constructs was improved with ITS rather than BTS fixation.
Serrano Crehuet Vet Sx 2021
Biomechanical comparison of humeral condyles with experimental intracondylar fissures immobilzed with a transcondylar positional or a lag screw: an ex-vivo study in dogs
Stiffness and load better with which?
21 humeri were included in each of the lag and positional screw fixation groups
Stiffness, yield load, maximum load were significantly greater for the positional screw group compared with the lag screw group
= mechanical properties were improved when the transcondylar osteotomy was stabilized with a 4.5 mm positional screw rather than a lag screw.
FYI - Failure patterns obtained in this study differed substantially from the ones most commonly reported clinically
Clinically: lateral humeral condylar fracture (65.2%), bicondylar humeral condylar fracture (26.1%) and, medial humeral condylar fracture (8.7%)
Study: transverse fracture of the medial part of the condyle (23.8%), comminution at the level of the distal metaphysis (19.0%) and, comminution of the medial aspect of the condyle/oblique fracture of the metaphysis (14.3%)
Smith JSAP 2020
Effect of breed as a risk factor for humeral condylar fracture in skeletally immature dogs
Two over represented breeds & % of pop?
Median age at fx?
MC fx configurations?
MC fx etiologies?
Odds of FBD compared to others? ESS?
UK - 41% French bulldogs, 15% English springer spaniels over represented
Median age at time of fx was 4 months
(84% occurred between 3 and 6 months of age)
Fracture configuration: Lateral 70%
Y/T 21%
Fracture etiology: Jumping or falling in 50%
French bulldogs had 5.86 times the odds of developing fractures compared to mixed-breed
English springer spaniels 5.66 times
Carwardine JSAP 2021
Outcomes, complications and risk factors following fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure
Post-op comp rate %?
% requiring revision?
Comp more likely with what?
2 factors protective against comp?
Conclusion?
62 dogs (82 elbows) were reviewed
post-op complication rate was 45%; a total of 15% of cases required revision surgery.
Complications were more likely in cases operated on earlier in the case series and with increasing dog bodyweight.
Both increasing surgical time and being a neutered female were protective against postoperative complications.
Conc: Fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure is associated with a high postoperative complication rate (45%) with 15% of cases requiring revision surgery.
Kvale JSAP 2022
Epicondylar plate fixation of humeral condylar fractures in immature French bulldogs: 45 cases (2014-2020)
Repair done?
Comp rate?
Short term OC excellent %? Good %?
Long term OC?
Closure of physis & effect?
Contralateral HIF rate?
Repair: transcondylar screw and epicondylar locking (LCP)
or hybrid locking plates crossing the distal humeral physis in skeletally immature Frenchies
6 cases had complications (13%): two (4%) minor and four (9%) major.
Short-term clinical outcome was excellent in 35 (78%), good in nine (20%) and poor in one (2%) case.
Long term outcome excellent
41/45 fractures had reached radiographic union of both the humeral condyle and supracondylar crest at the short-term radiographic follow-up
Closure of distal humeral physis was confirmed in all cases & no evidence of condylar deformity was noted
found radiographic evidence of a contralateral HIF at the time of fracture in 6/41 (15%) of our dogs and two of these dogs subsequently developed contralateral condylar fractures within 7 days of the original surgery
Eayrs VCOT 2021
Repair of fractures of the lateral aspect of the humeral condyle in skeletally mature dogs with locking and non-locking plates
Major breed?
HIF presence?
Repairs done?
Comp rate? Major rate?
Peri op outcome of full function?
Incomplete or non-union in #?
Long term (O perceived) outcome?
Vast majority Spaniels (23/29)
30/31 had HIF
lateral aspect of the humeral condyle with a transcondylar screw and epicondylar plate (SOP, LCP, LC-DCP)
Comp: 6/31 = 16%. 3 major (10%)
Peri op outcome = full function for 24 fractures (77%) and acceptable in 6, 1 unacceptable (implant failure)
Post op rads showed visible intracondylar fracture line in 20/26
= incomplete or non-union of the intracondylar fracture in 20/26 elbows
Long term outcome = O perceived excellent in 26/27
Walton JSAP 2020
A humeral intracondylar repair system for the management of humeral intracondylar fissure and humeral condylar fracture
Conclusion?
Comp rates -
- minor for fissures vs fx?
- total major (medical or surgical) for fissures? fx?
- total post op for fissure? fx?
Look at screw pic
conclusion: this repair system is associated w/ low complication rates and favorable healing rates, particularly for intracondylar fissure
10% minor complication rate for fissures, 7% for fx cases
total major complication rate (medical comp /sx comp) 6% for fissures, 2% for fx
total postop complications: 15% fissure, 30% fx
