Isolated Articular Fractures of the Canine Talus: Diagnosis and Signalment in Fourteen Dogs

Objective The aim of this retrospective multicentre case series was to describe signalment, presenting signs and imaging findings in dogs with isolated articular fractures of the talus. Study Design Medical records (2008–2019) of dogs with isolated articular talar fractures were reviewed. Results Fourteen dogs met the inclusion criteria; affected breeds were four German Pointer (three shorthair and one wirehaired), three Labrador Retrievers, two Rottweilers, two Springer Spaniels, one cross breed, one Greyhound and one Great Münsterländer. The age range was 1 to 8 years with a median of 4.7 years. Lameness was usually acute in onset and had been present for a range of 4 to 540 days prior to referral.The most common fracture configuration involved the lateral trochlear ridge only (n = 9). Two of the fourteen fractures affected both trochlear ridges. Thirteen dogs were initially assessed radiographically with classic orthogonal views, but a fracture was only visible in five cases. The remainder were confirmed with further radiographic projections (n = 4) or computed tomography (n = 5). In one case, the lameness was located to the tarsus by scintigraphy. Conclusion Isolated articular fracture of the talus is rare and may prove a diagnostic challenge due to the varied presentations and complex anatomy of the bone. Pathology of the talus may be suspected in any case of lameness localized to the tarsus and oblique/skyline radiographic views or advanced imaging should be performed if standard radiographic views are unremarkable.

Right mandibular angle and left comminuted mandibular body fractures stabilised with a combination of an acetabular plate and secured pin intermandibular ventral epoxy resin (SPIVER) frame in a four-month-old puppy

This case report aimed to describe a surgical technique combining a secured pin intermandibular ventral epoxy resin (SPIVER) frame and an acetabular plate to manage a complex mandibular fracture configuration in a puppy. A four-month-old, entire male, German wirehaired pointer was referred for assessment of a combination of recent (three days before hospitalisation) and older traumatic (45 days before hospitalisation) facial injuries inflicted by the dam. CT revealed multiple mandibular and maxillary fractures with complex acute mandibular fractures requiring surgical stabilisation. wo techniques were combined on stabilisation of the mandible: a single acetabular plate 2.7 to repair the mandibular angle fracture and a SPIVER frame to repair the comminuted mandibular fracture. Both fractures healed uneventfully, and the dog had normal jaw function one year postoperatively. Occlusion was not modified compared with the preoperative condition, considering that the patient already had a malocclusion defect due to old lesions. The combination of two different osteosynthesis techniques had satisfactory short-term and long-term outcomes in this puppy.

Proximal humeral fracture morphology in patients with advanced osteoarthritis: An observational study in a surgically treated cohort

Background: Several factors affect proximal humeral fracture (PHF) morphology. In the presence of glenohumeral osteoarthritis (GOA), the joint kinematics is alternated which might influence fracture configuration. The purpose of this study was to identify fracture patterns in patients with advanced osteoarthritis to facilitate recognition and treatment. Methods: In this retrospective analysis, and computed tomography (CT) scans of all patients undergoing surgical treatment for a PHF during a 5-year period were analyzed. Fracture pattern according to the AO Foundation/Orthopaedic Trauma Association (AO-OTA) classification and the presence of GOA were evaluated. In addition, critical shoulder angle (CSA), glenoid configuration, and glenoid inclination (GI) were measured. Results: Of the 713 patients, 574 met the inclusion criteria. A total of 166 patients showed radiological signs of GOA (28.9%). Advanced GOA (stage 2 or 3) was identified in 23 patients (4.0%). In this group, the mean age was 77 ± 10 years, mean CSA was 28.8 ± 4.2°, and the mean GI was 19.0 ± 7.8°. All fractures were extra-articular metaphyseal fractures (5 A2, 11 A3, 7 B1.1). Patients with advanced GOA had more than threefold risk (risk ratio 3.2; confidence interval 95% 2.80–3.74; p < 0.0001) for sustaining a metaphyseal fracture. In patients with GOA grade 1 compared to patients with no radiographic signs of GOA, this could not be observed. Conclusion: Patients experiencing PHF with radiological signs of advanced GOA have a higher risk of sustaining a metaphyseal fracture compared to individuals with the absence of or mild GOA. To date, no classification system for PHFs takes preexisting osteoarthritis into account, although it might indicate a different treatment and therefore the recognition is crucial.

Is serial radiological evaluation of one-part proximal humeral fractures necessary?

Aims In order to determine whether and for whom serial radiological evaluation is necessary in one-part proximal humerus fractures, we set out to describe the clinical history and predictors of secondary displacement in patients sustaining these injuries. Patients and Methods Between January 2014 and April 2016, all patients with an isolated, nonoperatively treated one-part proximal humerus fracture were prospectively followed up. Clinical and radiological evaluation took place at less than two, six, 12, and 52 weeks. Fracture configuration, bone quality, and comminution were determined on the initial radiographs. Fracture healing, secondary displacement, and treatment changes were recorded during follow-up. Results In 100 patients (59 female, 41 male; mean age 57 years), 91 of the fractures (91%) remained stable. In five of nine patients (55%) with secondary displacement, surgery was recommended. Comminution, present in 23 patients (23%), was identified as a predictor of secondary displacement (p < 0.001). Patients’ age, sex, fracture configuration, and bone quality were not associated with secondary displacement (p ≥ 0.438). Nonoperative treatment resulted in a mean absolute Constant score (CS) of 80 (49 to 98), relative CS of 101% (63% to 138%), median subjective shoulder value of 95% (interquartile range (IQR) 90% to 100%), and median EuroQol five-dimensional questionnaire score of 0.89 (IQR 0.80 to 1.00) with bone union in all cases at one-year follow-up. Conclusion Radiological re-evaluation was only necessary in patients presenting with comminution and may be redundant for 77% of patients with one-part proximal humerus fractures. Nonoperative treatment of one-part proximal humerus fractures remains the mainstay of treatment with a low rate of secondary surgery, a high union rate, and good clinical results. Cite this article: Bone Joint J 2019;101-B:1307–1312

Conservative management of sacroiliac luxation fracture in cats: medium- to long-term functional outcome

Objectives The aim of this study was to determine the functional medium- to long-term outcome for cats with a conservatively managed sacroiliac luxation fracture (SILF). Methods Inclusion criteria were conservative management of SILF in cats with no other concurrent fractures of the pelvic weightbearing axis and availability of radiographs for review. Radiographic measurements of percentage displacement of the sacroiliac joint and the sacral index were obtained and fracture configuration was assessed. A specific owner questionnaire was completed a minimum of 6 months after the injury. The questionnaire assessed the ability of the cat to perform normal activities, the time to recovery, any behavioural changes and any requirement for long-term analgesia. Results Seventeen cats met the inclusion criteria, and 13 owners completed the questionnaire. Twelve cats had an excellent outcome, with no difficulty performing normal activities. One cat had a good outcome, with slight or occasional difficulty performing normal activities. Conclusions and relevance Our study provides evidence to support the current guidelines of conservative management of SILF. The inherent bias of case selection in our population implies that this treatment cannot be recommended for all cases of SILF.

Surgical Treatment Strategy for Distal Humerus Intra-articular Fractures

Treating distal humerus fractures, especially those involving intra-articular lesions, is complex and often technically demanding. Although there still exist many controversial issues, the goal of treatment is to establish anatomical stable fixation by restoring the two columns and the articular surface. Universally, a posterior midline incision is applied, and the approach varies according to the further management of the triceps or olecranon. Evidence supports dual plate fixation as the optimal fixation method, and debates regarding appropriate plating configuration are still ongoing. As multiple clinical studies comparing results of parallel and perpendicular plate fixation have shown no actual difference, it is important to place the plates according to the fracture configuration.

Medial malleolar fractures

The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well-reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants. Cite this article: Bone Joint J 2019;101-B:512–521.