Short‐ and long‐term outcome after transcondylar screw placement to treat humeral intracondylar fissure in dogs

Abstract

Objective: To describe the postoperative complications and long-term functional outcome after surgical management of humeral intracondylar fissure (HIF) by transcondylar screw (TCS) placement. Study design: Retrospective study. Sample population: Nineteen dogs (26 elbows) Methods: Medical records (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009) were reviewed for dogs with a diagnosis of HIF according to results of computed tomography and treated by TCS placement at a single referral institution. Collected data included signalment, surgical technique, surgical duration, surgeon experience, use of antibiotics, and the presence and nature of any complications. Owner questionnaire, orthopedic examination, and pressure platform analysis were used to assess long-term outcome. The relationship between these variables was statistically analyzed. Results: In total, 18 of 26 surgically managed elbows were diagnosed with a postoperative complication; 11 of these consisted of a surgical site infection (SSI). No risk factors for short-term complications or long-term outcome were identified. Dogs with an SSI (n = 11) were 28 times more likely to have an unsatisfactory long-term outcome than dogs without an SSI (n = 8). Symmetry indices (SI) between thoracic and pelvic limbs did not return to published normal values. There was no difference in the SI of dogs with HIF and a surgically repaired contralateral humeral condylar fracture. Conclusion: Placement of a TCS was commonly associated with short-term complications, affecting long-term outcome. Clinical significance: The high complication rate after placement of lateromedial TCS provides evidence to justify the development of alternative strategies to manage HIF.

Long‐term outcome following management of canine humeral intracondylar fissure using a medial approach and a cannulated drill system

“…A recent study looking at the long-term outcome following placement of a transcondylar lag screw via a lateral approach reported that dogs which sufered SSI had a higher likelihood of an unsatisfactory outcome as assessed by owner questionnaire. 19 This diference in outcome may be related to the higher number of dogs with SSI (11/26) compared with our report (2/14), to the difering surgical techniques, or to both factors.…”

“…Force plate data have recently been reported for dogs with HIF treated with a transcondylar lag screw placed via a lateral approach, and this report found reduced peak vertical force in treated limbs, with similarly reduced values in the limbs treated for humeral condylar fracture. 19 We found no relationship between outcome and screw angulation or eccentricity. Our range of screw angulation was similar to previous reports on lateral humeral condylar fractures and HIF.…”

“…Similarly, a previous study found progression of radiographic osteoarthritis in 5/9 elbows with HIF at long-term follow-up. 19 The development of osteoarthritis may be inluenced by concurrent joint disease, most commonly MCPD. It has previously been reported that patients with concurrent MCPD showed a deterioration in limb use over time following transcondylar screw placement.…”

Impact of breed on canine humeral condylar fracture configuration, surgical management, and outcome

“…Sixty‐nine percent of dogs had reduced elbow ROM at the first follow‐up, which decreased to 33% at last radiographic follow‐up; reduced ROM is not unexpected after humeral articular fracture repair 33 . Despite reduced joint mobility, only minimally detectable lameness was present at first and last follow‐ups, and the outcome was excellent in 87% of dogs according to the long‐term CBPI and questionnaire results.…”

Comparing the accuracy of freehand, fluoroscopically guided and aiming device-assisted drilling in veterinary orthopaedic surgery

“…Reported mean surgical duration for luoroscopic transcondylar screw placement is 35 minutes (range 20-70), 19 while the reported mean duration for conventional transcondylar screw placement is 47 minutes (range 20-185). 20 This, when considered in combination with our collected times, highlights that the additional time required to perform luoroscopy may be compensated for by greater certainty or conidence in where the drill should be placed in the clinical setting, as there is a consequence to inaccurate drilling, which is not observed in the model setting. Limitations in this study included the number of participants and sample sizes, which were restricted because of the ethical considerations of using ionising radiation in an experimental study.…”