Ortho HL - Tibia and Tarsus Flashcards
Sadowitz VS 2023 - Effect of screw insertion angle and speed on the incidence of transcortical fracture development in a canine tibial diaphyseal model
What was the main finding of this paper?
Increasing screw insertion angle and insertion speed appear to be predisposing factors for transcortical fracture development
Gutbrod VS 2024 - Ex vivo biomechanical evaluation of 2.4 mm LCP plate rod constructs versus 2.7 mm LCP applied to the feline tibia
What 3 constructs were compared?
Which had the highest torsional stiffness?
Which had the greatest axial stiffness?
Which construct was the strongest/stiffest in 10mm tibia bone gap model?
2.4 LCP w. cortical screws / 1mm IMP
2.4 LCP w. locking screws / 1.6mm IMP
2.7 LCP w. locking screws
No difference in torsional stiffness
2.4 LCP w. locking screws / 1.6mm IMP
2.4 LCP w. locking screws / 1.6mm IMP
Hottmann VCOT 2020 - Biomechanical comparison of two locking plate constructs for the stabilisation of feline tibial fractures
What 2 locking plate constructs were compared?
What was the conclusion?
LCP and Fixin plates
LCP constructs - stiffer, higher yield/failure loads
Miraldo VCOT 2020 - Feline distal tibial physeal fracture repair using a modified cross-pin technique with four pins
Describe the entry point location for the 4 pins
What was the outcome?
See pic
8/9 excellent, 1/9 good (100% good-to-excellent)
Winter JSAP 2022 - Management of proximal metaphyseal curvilinear tibial fractures in 25 skeletally immature dogs (2009 to 2020)
Were these fractures associated with trauma?
How were the majority of these fractures managed?
What % healed?
What was the major and minor complication rates?
All but one were associated with minimal trauma
Internal fixation
100%
8 major complications (32%), 12 minor complications (48%)
Prox tibia valgus and eTPA
Verpaalen VCOT 2021 - Biomechanical Comparison of Three Stabilization Methods for Tibial Tuberosity Fractures in Dogs: A Cadaveric Study
What 3 stabilisation methods were compared?
What was the conclusion?
K wires, pin and TBW, Hybrid ESF fixation
K-wires were less stiff & resistant to load than pin & TBW or ESF fixation.
Arun VCOT 2022 - Factors Contributing to the Need for Non- Elective Explant following Surgical Repair of Tibial Tuberosity Avulsion Fracture
What was the rate of non-elective explant?
What factors increased the risk of explant?
30%
Increased risk for neutered dogs and larger pin size
Verpaalen VCOT 2021 - Use of a hybrid external skeletal fixator construct for managing tibial tuberosity avulsion fractures in three dogs
When were the implants removed?
2 weeks
Complete bridging of physis observed at 12 weeks
Von Pfeil VCOT 2021 - Tibial Apophyseal Percutaneous Pinning in Skeletally Immature Dogs: 25 Cases (2016–2019)
What was the rate of major complications?
What type of pins are not recommended and why?
How should the pins be placed to reduce rate of complications?
What did the authors recommend should be monitored post-op?
0%
Smooth pins resulted in a higher rate of seroma and patellar desmitis (c.f. negative threaded pins). Explantation was necessary in 5/19 smooth pins and 0/6 -ve threaded
Divergent pin placement is recommended
TPA (until skeletal maturity)
Welsh VS 2023 - Biomechanical comparison of one pin versus two pin fixation in a canine tibial tuberosity avulsion fracture model
What was the conclusion?
Vertically angled two pin fixation offers greater strength when compared to single
Banks VCOT 2021 - Establishment of Normal Mechanical Tibial Joint Angles in Dachshunds
What tibial angles are used to establish normal joint angles?
mMPTA
mMDTA
mCdPTA
mCrDTA
Miles VCOT 2020 - Approximations to the tibial distal anatomical axis in the sagittal plane
Which is the most accurate methodology to determine the distal anatomical axis?
DAA was more accurate when based on measurements in the distal 50% of the tibia rather than the distal 67%.
Buj VCOT 2021 - Isolated articular fractures of the canine talus: Diagnosis and signalment in fourteen dogs
What was the most common fracture observed?
What % of fractures were visible on standard radiographic views?
Lateral trochlear ridge
5/13 - 38%
Easter VCOT 2021 - Medial Bone Plating for Management of Type V Central Tarsal Bone Fractures in Six Dogs
How was the plate applied (e.g. bridging/compression etc)?
What % showed evidence of fracture healing on rads at follow up?
Medial plate from neck of talus to 2nd MT bone, bridging central tarsal bone
100%
Von Pfeil VC 2024 - Outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning
What was the median isthmus fill?
What was the median duration of coaptation post-op?
What was the major complication rate?
Median time to bone healing was?
Overall outcome?
96%
14d
0%
6 weeks
All returned to normal gait - 15 excellent and 2 acceptable function @ long term
Petazzoni VCOT 2020 - Radiographic Recognition of Tarsal Malformation in 8- to 9-Week-Old Bernese Mountain Dogs
What % of BMD had abnormal ossification sites?
Where are these ossification sites?
What clinical relevance do these have?
76%
Medial to the tarsus
Should be consistent with tarsal malformation - all clinically normal
Haubler JFMS 2023 - Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 1: study population, injury specification and classification
What is the Meutsege classification of CCT rupture?
What muscles are involved in the achilles tendon in the cat?
What was the most common type of CCT injury observed in this study population?
What type of injury was seen in acute presentation?
What factors were associated with odds of having an atraumatic injury?
Type I is a complete rupture
Type IIa affects the musculo-tendinous junction
Type IIb has an intact paratendon
Type IIc is a Gastroc Tendon avulsion with intact SDFT - hyperflexion of digits
Type III tendinosis and/or peritendinitis
Grastroc, SDFT, CCT (gracillis, biceps femoris, semitendinosus, soleus muscle (only in cats))
Type 2c
Type 1
Increasing age and higher BW
Haubler JFMS 2023 - Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 2: treatment, complications and outcomes
How were the majority treated?
What mode of immobilisation was most frequently used?
What was the rate of short term complications, and what was the most common short term complication?
What was the overall successful long term outcome?
83% surgically
ESF 51% and Calcaneotibial screw 33%
41% short term complications (pin tract infections)
84.9%
Chiu VS 2021 - Ex vivo evaluation of novel core tenorrhaphy patterns in dogs
Which suture patterns were observed to be biomechanically superior?
Exposed double-cross-lock, embedded double-cross-lock and Modified-Tang suture patterns –> superior to 3-loop-pulley for tendon repair without epitendinous sutures.
Beamon VS 2022 - Effect of calcanean bone-tunnel orientation for teno-osseous repair in a canine common calcanean tendon avulsion model
What was the strongest orientation of bone tunnel?
Which bone tunnel orientation required the greatest dissection?
Transverse tunnel failed at higher force than modified bone tunnels. But generally otherwise biomechanically similar.
Vertical tunnels - required more dissection and elevation of the SDFT
Duffy VS 2021 - Biomechanical analysis of accessory tendon graft augmentation for primary gastrocnemius tendon reconstruction in dogs
What is the accessory tendon?
How was the augmentation performed?
What was the biomechanical analysis conclusion?
Accessory tendon = common tendon - biceps femoris, semitend, gracillis
See pic - paired cruciate sutures attaching both tendons together
Accessory tendon graft augmentation increased load to failure and load to gap formation, but did not reduce frequency of gap formation vs locking loop + epitendinous suture alone.
Duffy VS 2020 - Biomechanical evaluation of an autologous flexor digitorum lateralis graft to augment the surgical repair of gastrocnemius tendon laceration in a canine ex vivo model
How was the graft attached to the gastroc?
What was the biomechanical analysis conclusion?
See pic - polypropylene suture in a modified Krackow pattern.
Addition of flexor digitorum lateralis graft increased yield, peak & failure forces and prevented gap formation.
Duffy VS 2020 - Effect of partial vs complete circumferential epitendinous suture placement on the biomechanical properties and gap formation of canine cadaveric tendons
What was biomechanically superior, partial or complete circumferential ES?
Complete circumferential epitendinous suture increased biomechanical strength & reduced gap formation vs partial.
Can be placed as 1 line on each side, or single continuous suture.
Eby VS 2020 - Influence of barbed epitendinous sutures combined with a core locking-loop suture to repair experimental flexor tendon lacerations
What 4 types of sutures were used?
Which was biomechanically the best suture?
Stratafix (bilateral barbs paired), V-loc (unilateral barbs), Quill (bilateral barbs alternating) and smooth suture w. knot
Stratafix performed similarly to smooth knotted suture, and better to Quill and V-loc.
Luescher VS 2020 - Biomechanical comparison of knotted and knotless stabilization techniques of the tarsal medial collateral ligament in cats: A cadaveric study
Where were the anchor points for the knotless stabilisation technique?
What was the strongest technique?
medial cortex of tibia, suture passed through drill hold in medial malleolus and attached to talus and calcaneous
Knotless anchor technique
Holroyd VCOT 2023 - Risk Factors Associated with Plantar Necrosis following Tarsal Arthrodesis in Dogs
Where does the perforating metatarsal artery run?
What % of cases had at least 1 screw that risked damaging artery? What % developed plantar necrosis?
What was the difference in screw position between cases of p.necrosis and not?
What is the advice given by authors when placing screws?
Intermetatarsal channel lies in proximal 25% of MT III in 95% cases.
At least 1 screw risked damaging artery in 92% cases, of which 8% developed plantar necrosis.
No significant difference in screw position between plantar necrosis and not.
Care should be taken when placing screws in the proximal 25% of the
metatarsals, specifically avoiding exiting dorsally between MTII and MTIII and across the distal region of the intermetatarsal channel, where the perforating metatarsal artery passes interosseously, as damage may contribute to the aetiology of plantar necrosis
