Computer assistance was valuable for locating and quantifying this antebrachial deformity and conceptualising the corrective surgery. The results of our study suggest that rapid prototyping can be used to create models and saw guides to simplify one-stage corrective osteotomies and more accurately treat angular limb deformity.
Objective The aim of this study was to report the use of custom saw guides produced using computed tomographic imaging (CT), computer simulation and three-dimensional (3D) printing to aid surgical correction of antebrachial deformities in six dogs. Materials and Methods Antebrachial limb deformities in four small, and two large, breed dogs (seven limbs) were surgically corrected by a radial closing wedge ostectomy and ulnar osteotomy. The location and orientation of the wedge ostectomy were determined using CT data, computer-assisted planning and production of a saw guide in plastic using a 3D printer. At surgery, the guide was clamped to the surface of the radius and used to direct the oscillating saw blade. The resultant ostectomy was closed and stabilized with a bone plate. Results Five limbs healed without complications. One limb was re-operated due to a poorly resolved rotational component of the deformity. One limb required additional stabilisation with external fixation due to screw loosening. The owners of five dogs completed a Canine Orthopedic Index survey at a follow-up period of 37 to 81 months. The median preoperative score was 3.5 and the median postoperative score was 1, representing an overall positive effect of surgery. Radiographically, 5/7 limbs were corrected in the frontal plane (2/7 were under-corrected). Similarly, 5/7 limbs were corrected in the sagittal plane, and 2/7 were over-corrected in the sagittal place. Conclusions Computer-aided design and rapid prototyping technologies can be used to create saw guides to simplify one-stage corrective osteotomies of the antebrachium using internal fixation in dogs. Despite the encouraging results, accurate correction of rotational deformity was problematic and this aspect requires further development.
OBJECTIVE To characterize the processes involved in and outcomes achieved with custom-designed patient-specific implants to provide functional replacement of skeletal structures in dogs with tumors of the mandible, radius, or tibia. DESIGN Prospective case series. ANIMALS 6 dogs with mandibular tumors, 5 with tumors of the distal aspect of the radius, and 1 with a tumor in the distal aspect of the tibia treated from June 2013 to September 2016 at 3 referral centers. PROCEDURES After tumor staging, implants were designed from patients' CT scans by means of various computer-aided design applications and printed by means of selective laser melting in titanium-6 aluminum-4 vanadium alloy. A cutting jig was created in thermoplastic to ensure each osteotomy was performed as planned. Following ostectomy, the implant was secured into the defect with screws of appropriate size and length. RESULTS Initial return to normal clinical function was good to excellent for 11 of the 12 dogs. However, major complications resulted in revision of the implant or amputation of the limb in 5 dogs, and at least 3 of these complications were considered a consequence of faulty implant design or manufacturing. Infection developed in 2 dogs and was successfully treated in 1 dog. The longest-surviving dog maintained good limb function for 2 years. CONCLUSIONS AND CLINICAL RELEVANCE This is the largest reported series of dogs managed with customized 3-D-printed titanium implants. The 3-D printing allowed complex and patient-specific 3-D geometries to be fabricated, enabling function-sparing treatment of bone cancer affecting multiple anatomic sites.
BackgroundCell‐free DNA (cfDNA) comprises short, double‐stranded circulating DNA sequences released from damaged cells. In people, cfDNA concentrations correlate well with disease severity and tissue damage. No reports are available regarding cfDNA kinetics in dogs.Objectives/HypothesisCell‐free DNA will have a short biological half‐life and would be able to stratify mild, moderate, and severe tissue injury. Our study aims were to determine the kinetics and biological half‐life of cfDNA and to contrast them with those of creatine kinase (CK).AnimalsThree groups of 10 dogs undergoing open ovariohysterectomy, surgery for cranial cruciate ligament rupture (CCLR), or hemilaminectomy.MethodsPlasma for cfDNA and CK analysis was collected at admission, at induction of anesthesia, postsurgery (time 0) and at 6, 12, 24, 36, 48, 60, and 72 hours after surgery.ResultsThe biological half‐life of plasma cfDNA and CK were 5.64 hours (95% confidence interval [CI 95], 4.36–7.98 hours) and 28.7 hours (CI95, 25.3–33.3 hours), respectively. In the hemilaminectomy group, cfDNA concentrations differed significantly from admission at 6–12 hours after surgery. Creatine kinase activity differed among the surgical groups and reached a peak 6 hours after surgery. In the ovariohysterectomy and CCLR groups, plasma CK activity 72 hours after surgery did not differ from admission activity of the ovariohysterectomy group. In contrast, in the hemilaminectomy group, plasma CK activity after 72 hours did not return to the ovariohysterectomy group admission activity.Conclusions and Clinical ImportancePlasma CK activity has a longer biological half‐life than previously thought. In contrast to plasma CK activity, cfDNA has a short half‐life and could be a useful marker for peracute severe tissue injury.
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