Ortho HL - Pelvis, hip and femur Flashcards
Hanlon VS 2022 - Mechanical evaluation of canine sacroiliac joint stabilization using two short screws
How did the 2 short screw stabilisation compare to the single long lag screw?
Were positional or lag short screws mechanically superior?
Peak load, yield load, and stiffness were more than 2 times greater in both the SLS and SPS groups when compared with the LLS group.
No mechanical difference was identified between the short-screw groups
McCarthy VS 2022 - Accuracy of drilling with a custom 3D printed guide or free-hand technique in canine experimental sacroiliac luxations
How did the use of a custom 3D printed guide (c.f. free-hand technique) affect the accuracy of drilling?
Improved accuracy of drilling
Naiman VS 2021 - Radiation exposure associated with percutaneous fluoroscopically guided lag screw fixation for sacroiliac luxation in dogs
What technique did Naiman use and what was the radiation exposure for the surgical team?
14G needles & K-wires used to orient cannulated drill bits for placements of 3.5mm screws.
Low levels of radiation exposure measured.
Rollins VCOT 2019 - Evaluation of fluoroscopic-guided closed reduction versus open reduction of sacroiliac fracture-luxations stabilized with a lag screw
What was the main finding?
What % of fluoro cases required conversion?
Optimal screw depth to sacral body width ratio (>60%) was achieved in a significantly higher proportion of FGCR cases than openly reduced fracture-luxations.
A significantly lower rate of lag screw loosening was found for FGCR cases.
24% (4/17 cases)
Han JFMS 2022 - Evaluation of a screw insertion landmark for a minimally invasive repair technique in induced bilateral sacroiliac luxation in feline cadavers
Describe the location of the landmark
What % of cases had a screw placed outside the normal range?
Line between caudal iliac crest & cranial acetabular rim, 2nd line perpendicular from caudal iliac crest - screw inserted halfway across ilial body along 2nd line.
1/7 (14%)
Bird JFMS 2020 - Conservative management of sacroiliac luxation fracture in cats: medium- to long-term functional outcome
What SI lux cases were chosen to manage conservatively (displacement/pelvic narrowing)?
What was the outcome?
<50% SI displacement, <45% pelvic narrowing
12/13 cats (92%) had excellent outcome
Jourdain VS 2024 - Fluoroscopically-assisted closed reduction and percutaneous fixation of sacroiliac luxations in cats using 2.4 mm headless cannulated compression screws: Description, evaluation and clinical outcome
What was the conclusion of this study?
What was observed at the follow up and long term?
Screws allowed good reduction and optimal screw purchase within the sacral body. An excellent functional outcome was reported.
Reduction (88%) and screw purchase (70%) significantly reduced. Screw migration not observed.
Successful restoration of pelvic canal width with long-term excellent outcome.
Froidefonde VS 2023 - Outcomes for 15 cats with bilateral sacroiliac luxation treated with transiliosacral toggle suture repair
What implant was used? What is the suture material?
What was the outcome?
No.2 fibrewire mini-TightRope Arthrex. (UHMWPE braided).
Excellent outcome in 100% that survived to discharge
Vardanega JSAP 2024 - Sacral fracture stabilisation using dorsal transiliac locking plates: 12 cases (2017-2023)
What % of cases had additional surgical stabilisation?
What % of outcomes were reported good or excellent?
92% (11/12) - often a transiliac bolt
100%
Petrovsky VS 2021 - Short-term outcomes of 59 dogs treated for ilial body fractures with locking or non-locking plates
What % of non-locking constructs have implant failure (c.f. with locking plates)?
What is the conclusion of this paper?
Non-locking 17/38 dogs (45%), locking 1/25 dogs (4%)
Surgeons should consider repairing ilial body fractures in dogs with LPS to reduce the risk of short-term implant failure.
Murugarren VCOT 2023 - Locking Compression Plate Fixation of Feline Acetabular Fractures: Application, Complications and Perioperative Outcome
What % of fractures required ancillary implants?
What % of cases had good and excellent outcome?
What was the major complication rate?
What was the overall conclusion of the study?
4/15 (27%)
47% 7/15, 53% 8/15
0%
LCP considered suitable for acetabular fracture repair in cats
Haine JFMS 2019 - Outcome of surgical stabilisation of acetabular fractures in 16 cats
How were the acetabular fractures surgical stabilised?
What was the major complication rate? What were the major complications?
What % recovered full function and acceptable function?
5 fractures were stabilised using screws, wire, pins and polymethylmethacrylate, 9 straight dynamic compression plate and 3 locking plate.
Major complications included implant failure (two fractures), one requiring the cat to have a unilateral excision arthroplasty, and loosening of the trochanteric osteotomy pin, requiring pin removal.
Acceptable13/16 (81%), Full 3/16 (19%)
Roberts VCOT 2021 - Management and Long-Term Outcome of Acetabular Fractures in Dogs: A Retrospective Study of 49 Dogs
How did the location of the fractures affect the treatment approach?
Which dogs had worse CBPI scores?
Cranial fractures more likely to have salvage surgery, mid-third direct surgical repair & caudal conservative management
Conservatively managed dogs had worse CBPI scores than surgical cases.
Piana VCOT 2022 - Locking Plate Fixation for Canine Acetabular Fractures
What % of dogs required adjunctive fixation?
What % of dogs returned to function?
8/18 - 44%
16/17 - 94%
Dalton VS 2023 - Minimally invasive repair of acetabular fractures in dogs: Ex vivo feasibility study and case report
Describe the technique utilised
What was the outcome of the clinical case?
Plates contoured to 3d scans. Small approach to ilium and ischium connected epiperiosteal tunnels. Reduced under fluoroscopic guidance (difficult) and arthrotomy and plates locked.
1mm medial displacement, and good functional outcome, healing documented at 3 months.
Wiersema VCOT 2021 - Comparison of Single versus Double Lateral Plating in Treatment of Feline Ilial Fractures Using Veterinary Cuttable Plates
What was the main finding of this paper?
What was observed on radiographs at the follow up?
Implant failure more frequent in single VCP group vs double VCP.
Pelvic canal width maintained in double VCP group, but reduced over time in single VCP group (small amount).
Hammer VS 2021 - Predictors of comorbidities and mortality in cats with pelvic fractures
What were negative factors for survival?
Severity of pelvic fractures, number of concurrent body regions affected and neurological issues
Bourbos VCOT 2021 - The use of intraoperative skeletal traction for the repair of pelvic fractures: An experimental cadaveric study
How was traction applied to the pelvis?
In what % of fractures was it possible to attain 2cm distraction?
3mm Steinmann pin placed 2cm from caudal edge of ischial tuberosity.
100% - Distraction of >2cm obtained for all fractures.
Rodriguez JFMS 2021 - Treatment of pelvic fractures in cats with patellar fracture and dental anomaly syndrome
What % of cats with PADS had pelvic fractures?
What morphology and location of fractures were most common?
27%
All simple complete transverse/oblique
Majority were acetabular
Adrian VCOT 2024 - Use of Locking Plates Fixed with Cortical Screws for Pelvic Fracture Repair in 20 Cats
What locking system was utilised?
What % had a trochanteric osteotomy?
What % had major complications and what were they?
What was the long term outcome?
String of Pearls
11/20 - 55%
5/20 (25%) - sciatic impingement, screw loosening, infection, 2xgreter trochanteric osteotomy fixation implant removal
Full function in 100%
Cooper JFMS 2020 - Evaluation of prognostic factors for return of urinary and defecatory function in cats with sacrocaudal luxation
What % of cats regained urinary function?
What factors are associated with a decreased likelihood of return of urinary function?
What factors are associated with a longer time to return of urinary function?
What factors are associated with return to defecatory function?
90% (0-52d) - 87% within 30d
Higher neuro grade
Higher neuro grade
NONE
Cooper JFMS 2020 - Evaluation of prognostic factors for return of urinary and defecatory function in cats with sacrocaudal luxation
How were cats graded?
Kang - Biomechanical Comparison of Double 2.3-mm Headless Cannulated Self-Compression Screws and Single 3.5-mm Cortical Screw in Lag Fashion in a Canine Sacroiliac Luxation Model: A Small Dog Cadaveric Study
What were the biomechanical findings?
Two 2.3mm screws better resist rotation than one 3.5mm cortical lag with significantly higher maximum failure load
Cinti VCOT 2020 - Triple Pelvic Osteotomy Fixed with Lag Screw for the Treatment of Pelvic Canal Stenosis in Five Cats
Describe the procedure performed
What was the mean pelvic canal enlargement achieved?
What was the outcome?
Pelvic canal widened by moving caudal part of ilium to lateral aspect of cranial fragment, fixed with lag screw
20% canal enlargement
Minor complications in 1 case - no recurrence in obstipation in any cases
Bounds VS 2023 - Feasibility of feline coxofemoral arthroscopy using a supratrochanteric lateral portal: A cadaveric study
Describe port positioning
Label the numbered structures in the picture
1 - femoral head
2. acetabulum
3 - round ligament
4 - joint capsule
5 - transverse acetabular ligament
6. dorsal acetabular rim
Bounds VS 2023 - Feasibility of feline coxofemoral arthroscopy using a supratrochanteric lateral portal: A cadaveric study
What size scope was used?
What % of hips had iatrogenic cartilage injury?
1.9mm
100%
Klever VCOT 2024 - Influence of Femoral Position and Pelvic Projection on Norberg Angle Measurements
What was the conclusion of this paper?
Tilted images that are subjectively perceived evaluable have only little
effect on the Norberg angle and are therefore probably acceptable
Ulfelder VS 2019 - Correlation of distraction index with arthroscopic findings in juvenile dogs with hip dysplasia
What was the correlation between DI and arthroscopic findings?
What region of the hip was most likely to be arthroscopically abnormal?
Low positive correlation between synovitis and distraction index
Region at insertion of ligament of head of femur
Klever VCOT 2019 - Comparison of reliability of Norberg Angle and Distraction Index as measurements for hip laxity in dogs
What angle is deemed ‘normal’ for the Norberg angle?
> 105 degrees
Martins VCOT 2019 - Effect of the dog positioning on x-ray table on hip dysplasia parameter evaluation
How did pelvic tilting affect hip dysplasia parameters?
How did femoral tilting affect hip dysplasia parameters?
Pelvic tilting to L/R results in changes in Norberg angle, subluxation index & category (worse on lower hip & better on higher hip).
Internal/external femoral rotation did not affect variables.
Meomartino JSAP 2021 - Joint laxity in canine hip dysplasia assessed using the hip flexed not distracted ventrodorsal view
How did the hip flexed view affect the Norberg angle and laxity index values (c.f. extended VD view)?
This view had lower Norberg angle and higher laxity index values than standard VD extended.
Ruperez VS 2023 - Arthroscopic-assisted hip toggle stabilization (AAHTS) in cats: An ex vivo feasibility study
Describe the procedure briefly
What was reported to be the most challenging aspect of the procedure?
Intraoperative complication rate was…
Minor articular cartilage damage was observed in what %?
Pre-op arthroscopy, drill arthroscopic guide (Bio-Compression Screw C-RingGuide), k wire advanced through femur/acetabulum, 2.7mm cannulated drill, 2.0mm toggle 150lb fibrewire
Toggle passage through femoral tunnel
36% (5/14)
71% (10/14)
Letesson JFMS 2022 - Validation of a biomechanical testing protocol of craniodorsal hip luxation in feline cadavers and comparison of two ultra-high molecular weight polyethylene materials used for extra-articular hip stabilisation
What was the main finding of this study?
Extra-articular UHMWPE secured with interference screw was more effective than iliofemoral suture.
Sapora VS 2021 - Ventral femoral head and neck ostectomy: Standard versus novel K-wire guided technique using a premeasured ostectomy angle in canine cadavers
Describe this technique
What was the conclusion of this study?
Placement of a 1.6 mm K wire just cranial to and at the proximal aspect of the lesser trochanter approximately perpendicular to the anatomic axis of the femur. This K-wire was then bent down the long axis of the femur using a K-wire bender to the premeasured iFHOA +10 degrees
Subjectively use of K-wire guide improved soft tissue retraction, neck visualisation and confidence in cut angulation.
Objectively - No difference in residual femoral neck between groups.
Mitchell VS 2020 - Comparison of femoral stem subsidence between three types of press-fit cementless total hip replacement in dogs.
Which 3 implants were compared?
What was the difference in subsidence between the 3 press-fit implants?
BFX collarless, collared and lateral bolt
Subsidence LOWER w. lateral bolt. No difference between collared and collarless
THERE WAS NO DIFFERENCE IN COMPLICATION RATES OR CFI BETWEEN GROUPS
Worden VCOT 2022 - Effect of Stem Positioning on Biomechanical Performance of a Novel Cementless Short-Stem Canine Total Hip Implant
What system was assessed?
What was the main conclusion?
Biomedtrix short-stem implant (Centerline).
Biomechanical performance was improved by preserving more femoral neck, having higher CFI & using smaller implant size relative to femoral neck isthmus.
Bondonny VCOT 2024 - Use of a Modified Intramedullary Pinning Technique for Distal Femoral Physeal Salter–Harris Type I and II Fracture Management: A Retrospective Study of 31 cats
What was the surgical technique?
What % had bone healing @ 8 weeks?
What % had full function at mid term follow up?
What was the short and mid-term complication rate?
Sx tech: Steinmann pin was inserted normograde into the medullary cavity via the intercondylar fossa. An antirotational K wire was placed laterally.
100%
97% (30/31)
5/31 (16%) short term
1/31 (3%) mid-term complication
Butts JFMS 2023 - Comparison of three radiographic assessment methods for detecting slipped capital femoral epiphyses in cats: Klein’s line, modified Klein’s line and the S-sign
Describe the appearance of the Klein’s line, m.Klein’s line and S sign
Which of these had the greatest sens/spec?
See image
S line (greater sens on VD extended, greater spec on VD frog-leg)
Mund VCOT 2023 - Management of Feline Femoral, Tibial and Humeral Fractures Using a 3.5 mm Titanium Interlocking Nail
What system was used? And what type of ILN is it?
What was the complication rate?
What was the major complication rate and what were they?
What was associated with major complications?
Marmed (non-angle stable ILN)
16%
12%, screw breakage, nail breakage, nail bending, screw loosening and non-union
Fracture morphology - transverse fractures more prone to major complications
Peterson VS 2020 - Radiographic determination of normal canine femoral alignment in the sagittal plane: A cadaveric pilot study
Describe the method for evaluating the femur in the sagittal plane?
Proximal JOL = midpoint of femoral head & neck connected.
Distal JOL = best-fit line over physeal scar.
DAA = perpendicular to midpoint of distal JOL.
PAA = Line between midpoint of femur at 1/3 & 2/3 diaphyseal length.
Intermediate axis = Best-fit line along cranial cortex of distal 1/3 segment, positioned at diaphyseal midpoint at this level.
Vezzoni VCOT 2022 - Hemiepiphysiodesis for the Correction of Distal Femoral Valgus in Growing Dogs
What age was this usually performed in?
What surgical fixation was utilised?
What the mean change in aLDFA observed?
Why do the authors recommend removal of the surgical implants once correction is achieved?
5.3 months was median
2.4mm 5 hole VCP (with 1x monocortical prox and distal) or titanium staple - both applied medially)
82 to 93 degrees (+11)
Rebound growth is rare in dogs (occurred in 25% of cases, 12/17 cases had explant)
