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InFocus

Orthopaedics and diagnostic imaging: A look through the latest literature

Our monthly summary of the latest academic publications on this month’s featured topic: orthopaedics and diagnostic imaging

Management of temporomandibular joint fractures in cats and dogs

Boaz Arzi, University of California, Davis

Appropriate management of temporomandibular joint (TMJ) fractures is challenging and has become a controversial area in both the human and veterinary medical fields. Regardless of the preferred management strategy, diagnosis and treatment require precise diagnostic imaging with conventional or cone-beam computed tomography or potentially using magnetic resonance imaging. The author reviews current knowledge from the human and veterinary literature on the surgical and conservative management of these patients. He notes that due to the variability in clinical findings in TMJ fracture cases and the likely differences in the particular circumstances of patient and owner, an individualised treatment plan is recommended. He adds that clinicians must be aware of the range of potential long- and short-term consequences of these lesions, including infection, malocclusion, ankylosis, fibrosis and osteoarthritis.

Journal of the American Veterinary Medical Association, 261, 44-51

A previously unreported form of subchondral bone injury in Thoroughbred racehorses

Virginia Melly and others, University of Pennsylvania, Philadelphia

Subchondral bone injury is a well-recognised cause of poor performance and lameness in racehorses. These lesions usually appear in predictable locations, such as the palmar/plantar metacarpal/tarsal condyles. However, the introduction of computed tomography techniques in equine medicine has helped characterise previously unidentified sites of injury. The authors describe the clinical findings in cases of dorsodistolateral calcaneus injuries. They suggest that subchondral bone injuries in this site may be a primary cause of lameness in racehorses and may contribute to the clinical findings in cases involving injuries to other sites. They further suggest that the incidence of occult subchondral bone injuries in the equine population may be underestimated.

Equine Veterinary Journal, 55, 1029-1037

Feasibility of coxofemoral arthroscopy in cats using a supratrochanteric lateral portal

Courtney Bounds and Caleb Hudson, BluePearl Pet Hospital, Arden Hills, Minnesota

Coxofemoral injury and degenerative joint disease are frequently diagnosed in cats. Surgical treatment of feline hip injuries is usually performed using an open surgical approach. However, arthroscopic surgery can offer several advantages but is rarely considered in cats because of the small size of their joints. The authors investigated whether the arthroscopic techniques used in dogs could be adapted for a smaller patient in an experimental study using feline cadavers. They suggest that coxofemoral arthroscopy is feasible in cats, allowing the visualisation of intra-articular structures without causing significant trauma to adjoining tissues.

Veterinary Surgery, 52, 1202-1208

Lumbosacral endplate contour defect found with other abnormalities in French Bulldogs

Camille Lecourtois and others, Languedocia Veterinary Hospital, Montpellier, France

Vertebral abnormalities, usually involving the thoracic vertebrae, are a common finding in the French Bulldog breed. However, lumbosacral abnormalities have recently been described during computed tomography examinations in this breed. The authors identified cases of French Bulldogs with lumbosacral endplate contour defects – a condition that has previously been described only in large-breed dogs. The condition was present concurrently with various other lumbosacral abnormalities. At this stage, both the aetiology and the long-term clinical consequences of this condition in this particular breed are unclear.

Veterinary Radiology and Ultrasound, 64, 813-822

Comparing three radiographic methods for assessing slipped capital femoral epiphyses

Daniel Butts and others, Stonehouse Veterinary Practice, Gloucester

Slipped capital femoral epiphysis (SCFE) is a rare condition affecting the hindlimbs of cats. Radiological findings include an open proximal femoral physis, osteolysis and sclerosis of the femoral neck. Surgical reduction and stabilisation has been used in these cases, and more recently, treatment involving total hip replacement has been reported. A similar condition is the most frequent hip abnormality in adolescent human patients. The authors applied three radiographic assessment methods used in human patients to investigate feline cases. These were the Klein’s line, a modified Klein’s line and the S-sign. They found that the S-sign in both ventrodorsal extended leg and frog-leg views was successful in detecting SCFE in cats and may allow the earlier diagnosis and treatment of feline patients with only subtle radiographic changes.

Journal of Feline Medicine and Surgery, 25, 1-9

Imaging findings in cases of forelimb extensor tendon rupture in foals

Anna Mokry and others, Ghent University, Belgium

Extensor tendon rupture (ETR) at the dorsal aspect of the carpus has often been described in foals, usually occurring within the first few days of life. The condition may occur on its own or in combination with a flexural limb deformity and has traditionally been regarded as having an unfavourable to hopeless prognosis. The authors describe a retrospective study of the radiological and clinical findings in 29 cases of tendon rupture, including 21 with the accompanying flexural limb deformity, seen at equine hospitals in three countries. Treatment consisted of medical support, immobilisation and box rest. Long-term follow-up was available in two cases with ETR only and seven with the accompanying limb defect. The prognosis in terms of cosmetic appearance and limb function was likely to be poor in those foals with both ETR and a limb deformity.

Equine Veterinary Journal, 55, 777-787

Outcomes in 15 cats with bilateral sacroiliac luxation treated with a toggle suture

Baptiste Froidefond and others, Atlantia Veterinary Hospital, Nantes, France

Sacroiliac luxation/fracture (SILF) is a common finding after blunt trauma such as a road accident or fall. Surgical management of bilateral SILF involves stabilisation with transiliosacral, transilial craniodorsal or bilateral iliosacral implants. The authors describe a novel technique involving the use of a transiliosacral toggle suture repair (miniTightRope – Arthrex GmbH) used in 15 cats with bilateral SILF. Post-operative CT-scan evaluation of the bone tunnels was performed in the first two cases to confirm proper tunnel placement. Anatomical reduction was satisfactory and comparable with previously described techniques. Functional outcomes were good to excellent in the 13 cats that survived to discharge.

Veterinary Surgery, 52, 919-934

Calcinosis circumscripta in a rabbit with recurrent cervical myelopathy

Clotilde Abeloos and others, Anderson Moores Veterinary Specialists, Winchester

A four-year-old neutered male rabbit presented with a three-week history of progressive pelvic limb ataxia. Conscious computed tomography of the head and cervical spine revealed a large, compressive mineralised mass in the region of the atlanto-occipital membrane and minimally compressive soft tissue mineralisation at the C4-5 interarcuate space. The mass was surgically removed, and histopathology revealed localised dystrophic calcification with central deposits of mineral material surrounded by macrophages, multinucleated giant cells and fibrous connective tissue. Following an incomplete recovery, further surgery was carried out two weeks later to remove the C4-5 mass. Four months later, tetraparesis returned, and the rabbit subsequently died. The underlying cause in this case remains unclear.

Journal of Small Animal Practice,64, 490

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