Transarticular External Skeletal Fixation Research Articles

Short-term outcome after treatment of talocrural instability in cats using modified type II transarticular external skeletal fixation

Transarticular external skeletal fixation (TESF) is repeatedly used for temporary stabilisation of tarsal joint in cats. Hence, this study aimed to evaluate the use of temporary modified type II TESF for management of talocrural instability (TCI) in cats without joint arthrodesis and to rate short-term outcomes and complications. Medical records of all cats treated for TCI between January 2012 and December 2021 were reviewed. Information was collected including signalment, degree of lameness, type of TCI, accompanying soft tissue and bone injuries, and post-operative follow-up assessment including time of frame removal, complications, degree of lameness, range of joint motion and ankylosis. Surgical management didn’t involve debridement of the articular cartilage. Eighty-five percent of cats had satisfactory joint stability at the time of frame removal. Eighteen cats exhibited minor complications, six cats had major complications, and 8 cats showed persistent lameness. All cats showed reduction of joint motion range by 20°–30° directly after frame removal while returned to normal in 79% of cats 4 weeks later. Variable degrees of joint ankylosis were reported. In conclusion, this study supports the use of temporary modified type II TESF for management of TCI in cats without joint involvement as an excellent alternative to tarsal arthrodesis.

Achilles Tendon Rupture Treated with Flexor Digitorum Lateralis Tendon Transposition and Transarticular External Skeletal Fixator in Ouessant Sheep

Abstract Objective To describe the appositional augmentation of a complete Achilles tendon rupture in Ouessant sheep, using the intact flexor digitorum lateralis tendon, and immobilization with a type II transarticular external skeletal fixator. Clinical Report A 1-year-old neutered male Ouessant sheep was presented for Achilles tendon rupture and multiple bite wounds, secondary to a dog attack. The Achilles tendon was torn entirely, and a significant 3-cm gaping defect was present. The remnants of the Achilles tendon were debrided and attached using locking-loop and epitendinous sutures. The intact flexor digitorum lateralis tendon was then transposed and secured over the tendinous repair to increase the tendon strength. The bite wounds were closed with a primary repair. Finally, a type II transarticular external skeletal fixator was used to immobilize the tarsocrural joint for 6 weeks. Results A mild lameness, associated with a decreased range of motion of the tarsocrural joint, was present at the time of external skeletal fixator removal. Four months postoperatively, the lameness had completely resolved. A slight decrease in the range of motion of the tarsocrural joint was conserved. Clinical Significance In a small ruminant, transposition of the flexor digitorum lateralis was successful for the repair of an Achilles tendon rupture with a large musculotendinous gap and infected open wounds. To the authors' knowledge, this is the first such case described in sheep.

The Efficacy of Modified Transarticular External Skeletal Fixation Type II Technique for Management of Talocrural Instability in Dogs: Outcomes and Complications

The Efficacy of Modified Transarticular External Skeletal Fixation Type II Technique for Management of Talocrural Instability in Dogs: Outcomes and Complications

Modified Wendelburg caudomedial approach for treatment of a distomedial humeral condylar fracture in a cat

AbstractA 6‐year‐old outdoor cat presenting with a progressive 5‐month duration right thoracic limb lameness was diagnosed with an articular fracture of the distal caudomedial part of the right humeral condyle. Surgical repair was performed via the modified Wendelburg caudomedial approach to the elbow using a positional screw to reduce the fragment and applying a temporary transarticular external skeletal fixator. Three weeks after surgery, the transarticular external fixator was removed and 6 weeks after surgery, a CT scan was performed revealing satisfactory bone healing. Eight months after the surgery, the cat had no lameness and a normal level of exercise.

Patellar Tendon Repair Using a Patellar Tendon Allograft and External Fixator in Three Dogs

Abstract Objective The aim of this study was to report on complications and outcomes with repair of ruptured canine patellar tendons using primary tenorrhaphy coupled with patellar tendon allograft transplantation and use of a transarticular external skeletal fixator. Materials and Methods This report includes three dogs with acutely ruptured patellar tendons, all of whom had surgical repair using a patellar tendon allograft. Dogs were assessed postoperatively by physical examination, owner input, and/or video review. Functional outcomes were classified as full, acceptable, or unacceptable based on previously established criteria. Results Follow-up time was between 24 and 46 weeks. Two dogs obtained full function and one dog reached acceptable function. The acrylic connecting bars of the external fixator fractured and needed to be replaced in one dog. There were no other problems or complications. There was no evidence of rejection of any allograft. Clinical Significance Primary tenorrhaphy supported by patellar tendon allograft transplantation and transarticular skeletal fixation appears to be a viable option without evidence of patellar tendon allograft rejection and acceptable or full recovery in the three dogs of this report.

Novel Achilles tendon repair technique utilizing an allograft and hybrid external fixator in dogs.

Background:Achilles mechanism rupture is a surgical condition involving primary tenorrhaphy with various described means of surgical augmentation and bolstering.Aim:To report complications and outcomes with a novel Achilles repair technique in dogs using a superficial digital flexor tendon (SDFT) or deep digital flexor tendon (DDFT) allograft.Methods:Medical records were reviewed for dogs with chronic rupture or deterioration of the Achilles mechanism. Fibrous tissue was excised and either primary tenorrhaphy or reattachment of the tendon(s) to the calcaneus was performed. The surgical repair was supplemented by an SDFT or DDFT allograft, and postoperative immobilization was provided using a transarticular hybrid external skeletal fixator. Complications were classified as minor, major, or catastrophic, and function was classified as full, acceptable, or unacceptable, based on established guidelines.Results:Complications occurred with 6 out of 12 repairs, including 1 minor, 6 major, and 2 catastrophic complications. The two catastrophic complications were the recurrence of tarsal hyperflexion and lameness at 20 weeks and 18 months following surgery. Of the 12 surgeries performed, 2 resulted in full function, 8 with acceptable function, and 2 with unacceptable function at last follow-up 17–98 weeks postsurgery (mean = 45 weeks) for a success rate of 10/12 cases.Conclusion:The use of SDFT or DDFT allografts, coupled with an external fixator, can provide a moderate rate of full or acceptable functional outcomes and appears a viable treatment. However, complications were frequent and without a comparison group no conclusions can be drawn about the inferiority or superiority of this technique to other techniques for Achilles mechanism repair in dogs.

Combined internal fixation and transarticular external skeletal fixation to treat traumatic patellar fractures in five dogs

Case history : Medical records were reviewed of dogs (n=5) presented to a single referral hospital in the United Kingdom between 2015 and 2017 with a traumatic patellar fracture treated with transarticular external skeletal fixation (TA-ESF) to augment internal fixation. Clinical findings and treatment : Two dogs had polar patellar fractures, two had comminuted fractures and one dog had a transverse fracture. The median age at the time of the surgery was 21 (min 8, max 132) months and the median body weight was 19.0 (min 8.3, max 28.6) kg. In all cases, TA-ESF (Type IA lateral triangulated or modified Type II) was used in combination with internal fixation with pins and/or orthopaedic wire, supported by nylon leader line (patella-to-tibia mattress suture) and/or absorbable suture in a locking loop and/or circum-patellar pattern. All cases had short-term (6-12 weeks) postoperative radiographic follow-up, which showed evidence of fracture healing in 2/5 cases. All TA-ESF were removed 6 or 7 weeks postoperatively and four dogs had minor complications related to TA-ESF. More than 2 years postoperatively, the owners of all dogs were contacted and questioned regarding the mobility of their pet using the Liverpool Osteoarthritis in Dogs questionnaire. Four of the five cases were re-examined to evaluate their long-term outcomes. Based on the results of goniometric measurement of stifle range of motion, subjective gait assessment and objective gait analysis with a pressure sensitive walkway, all dogs showed a satisfactory outcome at the final follow-up. Clinical relevance : A combination of internal fixation and TA-ESF for stabilisation of traumatic patellar fractures is a valid treatment option. Further investigations with larger case numbers are necessary to evaluate success and complication rates.

Patella Fracture Repair Using Multiple Fixation Modalities in a Dog

AbstractThe aim of this study was to describe the clinical use of a titanium locking plate and screws as an adjunct for the surgical treatment of an open, transverse, mid-body patellar fracture. A 2-year-old crossbreed dog was diagnosed with an open, transverse, mid-body patellar fracture. Initial fracture reduction and compression were achieved with two parallel Kirschner wires and a figure of eight tension band wire. This was followed by a titanium locking plate and screws placed on the cranial aspect of the patella. A transarticular circular external skeletal fixator was used as an additional augmentation for 5 weeks. Wire failure was noted in the transarticular circular external skeletal fixator at 10 days postoperation, necessitating wire replacement. Complete return to previous activity level and progressive radiographic osseous union were observed 8 weeks after surgery. Breakage of the Kirschner wires at the proximal pole of the patella was noted 3 years after surgery and explantation of all implants was performed. Recheck evaluation at 8 months after explantation confirmed full return to athletic function. This case report described the clinical use of a locking plate and screws as an adjunct for transverse patellar fracture repair and its long-term functional outcome.

Tarsocrural Instability in Cats: Combined Internal Repair and Transarticular External Skeletal Fixation

Abstract Objective The aim of this study was to report outcomes after combined internal repair and transarticular external skeletal fixation (TESF) for the treatment of tarsocrural joint instabilities (TCI) in cats. Materials and Methods Open reduction of the tarsal joint was performed followed by combined (1) internal repair (tibial/ fibular malleolar osteosynthesis or primary ligament suture and/or prosthetic ligament repair) and (2) temporary TESF. Stability of the tarsus was determined at short-term follow-up (4–8 weeks postoperatively). Short-term complications were evaluated and midterm outcome assessed by an owner telephone questionnaire. Results Fourteen cats were included of which nine had open TCI. Median time for frame removal was 47 days. Eleven patients had satisfactory stability of the tarsus at short-term follow-up. Catastrophic complications occurred in three cats consisting of extensive skin necrosis of the paw with subsequent hindlimb amputation in two and multiple digit amputations in one cat. Major complications occurred in one cat with persistent TCI requiring pantarsal arthrodesis. Nine cat owners indicated a ‘full or acceptable’ outcome at midterm (median, 1.5 years). Conclusion Close monitoring in the postoperative period until TESF removal is important for early identification of complications. Despite good joint stability at short-term, persistent or recurrent lameness at midterm can occur.

Treatment of Common Calcaneal Tendon Rupture Using a Central Gastrocnemius Turnover Aponeurotic Flap Technique in a Dog

AbstractA 9-year-old, intact male, German wirehaired pointer was referred for suspected Achilles tendon rupture 3 weeks after an injury. A three-loop pulley suture pattern combined with a locking loop suture reduced the gap between the tendon ends to 7 mm and a central gastrocnemius turnover aponeurotic flap was used to cover the remaining gap. A type II free-form methyl methacrylate transarticular external skeletal fixator was used to keep the tarsocrural joint in extension until 45 days postoperatively. Short- and long-term clinical and ultrasonographic evaluations showed gradual improvement in weight-bearing and progressive tendon healing. At 6 months after surgery, the dog had normal limb function and had returned to the previous activity level. To the authors' knowledge, this tendon repair technique has been described in humans and in one cat but has not yet been reported in dogs.

Management of Complete Talocrural Luxations by Selective Talocrural Arthrodesis using Hybrid Transarticular External Skeletal Fixation in Dogs.

This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Retrospective study. Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003–2014)

This study reports data from a larger number of cases of triceps tendon disruption. Records from 10 veterinary referral hospitals between 2003 and 2014 were searched for canine and feline...

Fratura cominutiva e articular distal de úmero tratada com fixador esquelético externo transarticular em três gatos

Background: Humeral fractures account for 13% of all fractures in cats and commonly affect the middle diaphysis and supracondylar region with comminution. They are usually the result of high energy traumas such as falls, car accidents and firearm injuries. There are few treatment options for these types of fractures and since they are joint injuries, early surgical repair is mandatory to achieve perfect anatomical reduction, to maintain joint congruence and to allow early weight bearing. Our purpose is to report four subacute and chronic fractures of the distal diaphysis associated with comminuted supra and intercondylar fractures, stabilized with transarticular external skeletal fixator in three domestic felines.Cases: (1)- A 3-year-old male docile Siamese cat with 3.7 kg of body weight was presented for consultation with a 14-day history of high rise syndrome after falling from a 12-meter high. It presented distal comminuted humeral fracture that involved the inter and supracondylar regions. It also had right carpal-ulnar subluxation and comminuted right olecranon fracture involving the articular surface in the left thoracic limb. Fracture and joint stabilization was achieved by use of a transarticular hybrid external skeletal fixator on the right front limb. Fracture healing was observed at 150 days postoperatively. (2)- A 10-year-old female aggressive mixed breed cat with 4.1 kg of body weight was presented for consultation with a 16-day history of high rise syndrome after falling from a 9-meter high. The cat had a comminuted right humeral articular fracture with supra and intercondylar involvement and scapular fracture on the contralateral limb. The humerus fracture was treated with a transarticular linear external skeletal fixator and fracture healing was obtained at 240 postoperative days. (3)- A 1-year-old female unsociable mixed breed cat with 4.5 kg of body weight was presented for consultation with a 15-day history of humeral fractures after falling from a 12-meter high building. The cat had comminuted bilateral humeral articular fracture with supra and intercondylar involvement. Fracture stabilization was achieved by use of a transarticular hybrid external skeletal fixator on both limbs. Fracture healing was achieved after 60 days on the right front limb, and after 120 days on the left front limb.Discussion: Patients with distal humeral diaphyseal fractures should be assessed for peripheral nerve injury. None of the reported cases had neurological damage despite having suffered high energy trauma. Surgical approach to humeral distal fractures may be craniolateral, medial or caudal or even combined. In chronic fractures like those in our study, (fractures with more than 14 days of evolution), perfect anatomic reduction wasn’t considered due to presence of fibrous tissue that would require excessive manipulation, leading to injuries to soft tissues and blood supply, what would increase the risk of infection and bone sequestrum. The gold standard for the treatment of articular fractures is rigid internal fixation by means of compressive screws and compressive plates, and they require open reduction. Whenever anatomical reduction can not be performed, due to either the fracture’s evolution period or by the diminished bone length, closed reduction is indicated and stabilization with transarticular fixators is an alternative. Hybrid constructs are well tolerated by patients since they are lighter than circular apparatus and more versatile than linear fixators. In our study, transarticular fixators were used based on the location of the fractures and fracture period. Despite the ankyloses of the humeral-radio-ulnar joint, all patients adapted to the fixator devices very well and presented satisfactory ambulation weight bearing on the first postoperative day already. A disadvantage of the skeletal fixators is the postoperative care, which includes daily dressings, e-collaring, resting and co-operation on behalf of the owner. Two animals presented aggressive/unsocial behavior and still the prolonged postoperative management and adaptation to the fixator were successful. The results suggest that comminuted humeral distal articular fractures can be treated by the use of transarticular external skeletal fixators in cats.

Tratamiento quirúrgico de hiperextensión tarsal bilateral congénita en 2 gatos

Two kittens were admitted with bilateral congenital tarsal abnormalities.We decided they should both undergo surgicaltreatment at an early age. Surgical treatment consisted in transarticularExternal Skeletal Fixation (ESF) for a period of 3 to 4weeks. Shortly after ESF removal both patients re-gained tarsalmobility, remaining stable with adequate functionality. One patienthad two coexisting developmental orthopedic pathologies

Management of traumatic tarsal luxations with transarticular external fixation in cats.

To report our experience with the use of contoured mini circular transarticular external skeletal fixators for the management of traumatic tarsal luxations in 15 cats. Fifteen cats with traumatic tarsal joint luxation treated by using mini circular transarticular external fixators with available clinical records and complete clinical and radiographic follow-up of at least 30 weeks duration were included in the study. Data collected were the signalment, history, type of injury, concomitant injury, frame configuration, stabilization technique, duration of the surgery, time to first use of the operated limb, fixator removal time, complications, final outcome and follow-up. The surgical procedure chosen was based on the type of luxation; partial tarsal arthrodesis was performed in 10 cases, tarso-crural stabilization in four cases, and pantarsal arthrodesis in three cases. Five cats started to use the operated limb immediately after recovering from anaesthesia. In the other 10 cats, time to first use ranged from one to four days (mean 2 days). In one case, early pin loosening due to half pin fixation bolt failure was observed as a postoperative complication. Fixator removal time ranged from 24 to 60 days (mean 45 days). Functional outcome was excellent in 15 cats and good in two. This is a preliminary report about the treatment of tarsal luxations with a mini circular transarticular external fixation system in which early postoperative and long-term results seem to be favourable.

Patellar ligament rupture in the cat: repair methods and patient outcomes in seven cases.

The medical records of cats receiving surgical treatment for unilateral patellar ligament rupture between 1999 and 2012 at 12 referral centres in the UK and Ireland were reviewed. Seven cases were identified: six were caused by trauma and one was iatrogenic, occurring as a complication following surgical stabilisation of a tibial fracture. All cases were treated by sutured anastomosis of the ruptured ligament, with six of the repairs protected by a circumpatellar and/or transpatellar loop of suture. The stifle was immobilised by transarticular external skeletal fixation in three cases. No cases required revision surgery. No complications were reported. Final evaluation, performed at a median time of 31 days, determined five patients to have returned to acceptable or good limb function; two cases were lost to follow-up. The data suggest that, in cats, the current surgical techniques extrapolated from their canine counterparts for repair of a completely or partially ruptured patellar ligament are successfully used and result in acceptable limb function.

Patellar ligament rupture in the dog: repair methods and patient outcomes in 43 cases

The medical records of dogs receiving surgery for unilateral patellar ligament rupture between 1999 and 2012 at 12 multidisciplinary referral centres were reviewed. Forty-three cases were identified; 26 were traumatic...

Management of carpal hyperextension injury in a cat using combined temporary transarticular internal and external skeletal fixation

This report describes the successful management of a carpal hyperextension injury in a cat using combined temporary transarticular internal and external skeletal fixation, without performing an arthrodesis. To our knowledge, there have been no previous reports of management of feline carpal hyperextension injuries in this fashion.

Evaluation of short-term outcomes of experimental stifle luxation in feral pigeons (Columba livia domestica) treated with a hinged transarticular external skeletal fixator and physical therapy

To evaluate the use of the FESSA hinged linear transarticular external fixator (HLTEF) and the effect of early physical therapy after experimental stifle luxation in pigeons, eight feral pigeons (Columba livia domestica) underwent surgery and afterwards one group started physical therapy on day 1 post surgery, while the other after HLTEF removal on day 21. Healing was evaluated with clinical, radiographic, patho

Caudal Elbow Luxation in a Dog Managed by Temporary Transarticular External Skeletal Fixation

This case report details a caudal unilateral traumatic elbow luxation in a 4-year-old male neutered Labrador following a road traffic trauma. This is a highly unusual injury in the dog. The pathogenesis and successful treatment by closed reduction followed by stabilisation with a temporary transarticular external skeletal fixator are discussed. The dog was assessed at 4 weeks and 6 months after surgery. Findings at 6 months after treatment demonstrated a normal gait with no pain or crepitation. A mild amount of soft tissue thickening around the elbow was noted. The range of motion of the elbow was limited to 45 degrees of flexion and 150 degrees of extension. This is the first case of a traumatic caudal luxation of the elbow in a dog described in the English veterinary literature and the first report of successful management of an elbow luxation in a dog by closed reduction and temporary transarticular fixation.