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
Anderson VSURG 2023
Humeral condylar fractures (HCF) and fissures (HIF) in the French bulldog
MC fracture type?
Repair with highest major comp rate & risk?
TCS migration in which group?
HIF in contralateral limb rate?
Age association with HIF?
Look at CT
Retrospective, 44 elbows
Lateral humeral condylar fx represented 28/44 (64%) of HCF in French bulldogs.
(Bicondylar second most common)
Repair with a transcondylar screw (TCS) and K-wire were 7.62 times more likely to result in a major complication compared to other methods (TCS + epicondylar plate, TCS alone, etc).
All incidences (7/7) of TCS migration were within the TCS + K-wire group.
A HIF was identified in 18/31 (58%) dogs in the contralateral limb.
No age assoc- Older dogs were not significantly less likely to have a HIF than younger animals (HIF was not sig more common in younger)
Davenport VRU 2023
Humeral intracondylar fissures and intracondylar sclerosis are common CT findings in the limb contralateral to a humeral condylar fracture in French bulldogs and spaniel breeds
Over represented breed? Age?
MC fx in each group?
Sclerosis at fx site rate for each breed?
Rate of HIF and sclerosis in contralat elbow for each breed?
Other elbow path?
( French bulldogs (FBD) are reported to be at an increased risk of developing humeral condylar fractures (HCF).
Spaniel breeds have been reported to be at increased risk of HCF due to a high prevalence of humeral intracondylar fissures (HIF).)
FBDs were overrepresented for HCF (most common in skeletally immature) w/ a median age of 4 months.
Lateral condylar fx → most common configuration for both breed groups.
Sclerosis at the fx site was identified in:
62% of Frenchies
95% of Spaniels
HIF & intracondylar sclerosis were commonly observed in the contralateral elbows of FBD (44% and 50%, respectively) and spaniel breeds (58% and 95%, respectively).
Medial coronoid pathology, elbow incongruency, and periarticular osteophytes were not identified in the contralateral elbows of FBD but were identified in 29%, 4%, and 20% of spaniels, respectively.
The high prevalence of HIF in the FBD group may be a predisposing factor for HCF in this breed (in addition to Spaniels).
Simpson JFMS 2022
Defining the safe corridor for transcondylar screw placement in the feline humeral condyle
Entry point positions?
Tolerance angles better drilling from what direction?
Conclusion?
20 elbows from 12 cats
Guidelines for transcondylar screw placement, humeral condylar diameter (HCD)
the medial entry/exit point was cranial and distal to the medial epicondyle,
lateral entry/exit point was cranial and distal to the lateral epicondyle.
Tolerance angles were statistically significantly (P <0.05) larger in both frontal (34.5% larger) and transverse (21.1% larger) planes when drilled from a lateral to medial direction compared with drilling from a medial to lateral direction.
Conclusion: Where possible, drilling from a lateral to medial direction is recommended owing to the higher tolerance angles reducing the likelihood of articular surface damage.
Chan JFMS 2020
Treatment of humeral condylar fractures and humeral intracondylar fissures in cats with patellar fracture and dental anomaly syndrome
Rate of humeral condylar fx in cats with PADS?
Trauma?
8.7% of cats with PADS had humeral condylar fractures
No known trauma
Only two cats were euthanized due to humeral fractures
All cats that had follow-up achieved some degree of recovery of function
Schettler VCOT 2022
A prevalence study of canine humeral condylar fractures (HCF) over a ten-year period at an academic teaching hospital
3 ossification centers of humeral condyle?
Distal physis closes when?
Prevalence of HCF over 10 years?
Highest in what breed?
OR of FBD having HCF?
4 breeds sig. more likely to be affected by HCF? OR?
BG: 3 ossification centers have been noted: capitulum and lateral portion of the condyle (normally fuse by 70 + 14 days), trochlea and medial portion of the condyle (normally fuse by 70 + 14 days), and the medial epicondyle ossification center (fuses by 6-8 months of age); distal humeral physis normally closes by 5-6 months of age
Study: report prevalence of HCF at KSU over 10 years
117 dogs diagnosed with HCF (0.26% prevalence)
French Bulldogs had the highest prevalence of all fracture types with the exception of medial condylar fractures
After adjusting for age and neuter - 6 breeds were highly significantly more likely to be affected by HCF compared to rest of pop (p-value <0.001):
French Bulldogs (49X), Cocker Spaniels 43x), Boston Terriers (23X), Brittany Spaniels (22x), (English Bulldogs).
Conclusions: Frenchies were 49x more likely to be diagnosed with HCF
Guiot Vet Sx 2019
Minimally invasive percutaneous medial plate-rod osteosynthesis for treatment of humeral shaft fractures in dog and cats: surgical technique and prospective evaluation
Rod-to- medullary cavity ratio?
Plate-span ratio?
Major comps?
(11 dogs and 4 cats included
Body weight range 4.5 – 33.6 kg dogs and 2.2 to 3.6 kg in cats
VCP (6/11 dogs and ¾ cats) or LCP was used in plate-rod config (11/11 dogs and 2/4 cats) or alone (2/4 cats))
Rod-to-medullary-cavity ratio was 30%
Plate-span ratio 5.8
No significant differences found in frontal or sagittal plane alignment
Healing time in cases that completed on-time FU (12/15) was 36 days
No major complications seen , 2/12 had mild lameness on first recheck
Gall JFMS 2022
Analysis of feline humeral fracture morphology and a comparison of fracture repair stabilization methods: 101 cases (2009-2020)
MC fx location?
MC cause?
Over represented signalment for the MC cause?
Correlation of BW to healing and fn?
Repairs used for diaphyseal fx?
Fx type associated with more minor comp?
Sig difference in comp rates between repair type?
Sig diff in comp rates bc time to healing or acceptable fn?
- Fx diaphyseal (71%), with only 10% condylar
- MC cause: Road traffic accidents (RTAs)
- Neutered males were over-represented in having a fracture caused by an RTA
- Diaphyseal fractures were significantly more likely to result from an RTA
Body weight had a sig. positive correlation with time to radiographic healing and time to acceptable function
diaphyseal fractures; 16 (28%) were stabilized using a plate–rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only
Open diaphyseal fractures were associated with more minor complications
There was a significant difference between fixation groups in terms of overall complication rate between groups - ESF higher?
There was no significant difference between fixation groups in time to radiographic union (P=0.145) or time to acceptable function
Nickel VRU 2023
Periosteal reaction-like lesions at the cranial aspect of the humeral diaphysis have a high prevalence in older, large breed dogs & may represent entheses of the superficial pectoral muscles
BW and age association?
Breed association?
Proposed pathology?
(Anecdotal observation of lamellar periosteal new bone formation at the cranial aspect of the humeral diaphysis in mediolateral rads of the humerus for large breed dogs w/ no evidence of pain or lameness.
Focal or extended periosteal reaction-like lesions were found on rads in 643 humeri of 387 dogs.
“humeral periosteal reaction-like lesions” (HPRLL) at the cranial aspect of the humerus)
- BW ≥ 30 kg and age ≥ 7 years had a statistically significant, positive effect (P < 0.001) on the presence of HPRLL.
- German Shepherd dogs & Rottweilers were overrepresented in the group w/ HPRLL (P < 0.01).
At the level of the HPRLL, the enthesis of the superficial pectoral mm (M. pectoralis descendens & M. pectoralis transversus) to the Crista tuberculi majoris & Crista humeri were macroscopically & histologically identified.
The authors propose that higher mechanical loads to the enthesis in large breed dogs may lead to physiological, age-related remodeling processes of the muscular attachment. The finding should not be confused w/ a pathological condition.
