Ortho HL - Tibia and Tarsus

Question 1

Sadowitz VS 2023 - Effect of screw insertion angle and speed on the incidence of transcortical fracture development in a canine tibial diaphyseal model

What was the main finding of this paper?

Answer 1

Increasing screw insertion angle and insertion speed appear to be predisposing factors for transcortical fracture development

Question 2

Gutbrod VS 2024 - Ex vivo biomechanical evaluation of 2.4 mm LCP plate rod constructs versus 2.7 mm LCP applied to the feline tibia

What 3 constructs were compared?

Which had the highest torsional stiffness?

Which had the greatest axial stiffness?

Which construct was the strongest/stiffest in 10mm tibia bone gap model?

Answer 2

2.4 LCP w. cortical screws / 1mm IMP
2.4 LCP w. locking screws / 1.6mm IMP
2.7 LCP w. locking screws

No difference in torsional stiffness

2.4 LCP w. locking screws / 1.6mm IMP

2.4 LCP w. locking screws / 1.6mm IMP

Question 3

Hottmann VCOT 2020 - Biomechanical comparison of two locking plate constructs for the stabilisation of feline tibial fractures

What 2 locking plate constructs were compared?

What was the conclusion?

Answer 3

LCP and Fixin plates

LCP constructs - stiffer, higher yield/failure loads

Question 4

Miraldo VCOT 2020 - Feline distal tibial physeal fracture repair using a modified cross-pin technique with four pins

Describe the entry point location for the 4 pins

What was the outcome?

Answer 4

See pic

8/9 excellent, 1/9 good (100% good-to-excellent)

Question 5

Winter JSAP 2022 - Management of proximal metaphyseal curvilinear tibial fractures in 25 skeletally immature dogs (2009 to 2020)

Were these fractures associated with trauma?

How were the majority of these fractures managed?

What % healed?

What was the major and minor complication rates?

Answer 5

All but one were associated with minimal trauma

Internal fixation

100%

8 major complications (32%), 12 minor complications (48%)
Prox tibia valgus and eTPA

Question 6

Verpaalen VCOT 2021 - Biomechanical Comparison of Three Stabilization Methods for Tibial Tuberosity Fractures in Dogs: A Cadaveric Study

What 3 stabilisation methods were compared?

What was the conclusion?

Answer 6

K wires, pin and TBW, Hybrid ESF fixation

K-wires were less stiff & resistant to load than pin & TBW or ESF fixation.

Question 7

Arun VCOT 2022 - Factors Contributing to the Need for Non- Elective Explant following Surgical Repair of Tibial Tuberosity Avulsion Fracture

What was the rate of non-elective explant?

What factors increased the risk of explant?

Answer 7

30%

Increased risk for neutered dogs and larger pin size

Question 8

Verpaalen VCOT 2021 - Use of a hybrid external skeletal fixator construct for managing tibial tuberosity avulsion fractures in three dogs

When were the implants removed?

Answer 8

2 weeks

Complete bridging of physis observed at 12 weeks

Question 9

Von Pfeil VCOT 2021 - Tibial Apophyseal Percutaneous Pinning in Skeletally Immature Dogs: 25 Cases (2016–2019)

What was the rate of major complications?

What type of pins are not recommended and why?

How should the pins be placed to reduce rate of complications?

What did the authors recommend should be monitored post-op?

Answer 9

0%

Smooth pins resulted in a higher rate of seroma and patellar desmitis (c.f. negative threaded pins). Explantation was necessary in 5/19 smooth pins and 0/6 -ve threaded

Divergent pin placement is recommended

TPA (until skeletal maturity)

Question 10

Welsh VS 2023 - Biomechanical comparison of one pin versus two pin fixation in a canine tibial tuberosity avulsion fracture model

What was the conclusion?

Answer 10

Vertically angled two pin fixation offers greater strength when compared to single

Question 11

Banks VCOT 2021 - Establishment of Normal Mechanical Tibial Joint Angles in Dachshunds

What tibial angles are used to establish normal joint angles?

Answer 11

mMPTA
mMDTA
mCdPTA
mCrDTA
Saggital plane diff to other breeds

Question 12

Miles VCOT 2020 - Approximations to the tibial distal anatomical axis in the sagittal plane

Which is the most accurate methodology to determine the distal anatomical axis?

Answer 12

DAA was more accurate when based on measurements in the distal 50% of the tibia rather than the distal 67%.

Question 13

Buj VCOT 2021 - Isolated articular fractures of the canine talus: Diagnosis and signalment in fourteen dogs

What was the most common fracture observed?

What % of fractures were visible on standard radiographic views?

Answer 13

Lateral trochlear ridge

5/13 - 38%

Question 14

Easter VCOT 2021 - Medial Bone Plating for Management of Type V Central Tarsal Bone Fractures in Six Dogs

How was the plate applied (e.g. bridging/compression etc)?

What % showed evidence of fracture healing on rads at follow up?

Answer 14

Medial plate from neck of talus to 2nd MT bone, bridging central tarsal bone

100%

Question 15

Von Pfeil VC 2024 - Outcomes of 15 dogs and two cats with metabone fractures treated with fluoroscopically guided normograde metabone pinning

What was the median isthmus fill?

What was the median duration of coaptation post-op?

What was the major complication rate?

Median time to bone healing was?

Overall outcome?

Answer 15

96%

14d

0%

6 weeks

All returned to normal gait - 15 excellent and 2 acceptable function @ long term

Question 16

Petazzoni VCOT 2020 - Radiographic Recognition of Tarsal Malformation in 8- to 9-Week-Old Bernese Mountain Dogs

What % of BMD had abnormal ossification sites?

Where are these ossification sites?

What clinical relevance do these have?

Answer 16

76%

Medial to the tarsus

Should be consistent with tarsal malformation - all clinically normal

Question 17

Haubler JFMS 2023 - Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 1: study population, injury specification and classification

What is the Meutsege classification of CCT rupture?

What muscles are involved in the achilles tendon in the cat?

What was the most common type of CCT injury observed in this study population?

What type of injury was seen in acute presentation?

What factors were associated with odds of having an atraumatic injury?

Answer 17

Type I is a complete rupture
Type IIa affects the musculo-tendinous junction
Type IIb has an intact paratendon
Type IIc is a Gastroc Tendon avulsion with intact SDFT - hyperflexion of digits
Type III tendinosis and/or peritendinitis

Grastroc, SDFT, CCT (gracillis, biceps femoris, semitendinosus, soleus muscle (only in cats))

Type 2c

Type 1

Increasing age and higher BW

Question 18

Haubler JFMS 2023 - Retrospective multicentre evaluation of common calcaneal tendon injuries in 66 cats. Part 2: treatment, complications and outcomes

How were the majority treated?

What mode of immobilisation was most frequently used?

What was the rate of short term complications, and what was the most common short term complication?

What was the overall successful long term outcome?

Answer 18

83% surgically

ESF 51% and Calcaneotibial screw 33%

41% short term complications (pin tract infections)

84.9%

Question 19

Baroncelli VCOT 2021 - Use of a transarticular calcaeno-tibial locking plate for temporary immobilisation of the tarsocrural joint following surgical repair of common calcaneal tendon rupture in eight dogs

What locking plate was used and how was it applied?

What angle was the tarsus fixed to?

When was it explanted?

What was the complication rate?

Answer 19

Fixin Locking L/T plate, medially applied with 2 locking screws in calcaneus and 2 in distal tibia

Fixed at 150 degrees

6 weeks

No complication observed, all dogs returned to full function and tendons healed

Question 20

Goffart VS 2021 - Biomechanical comparison of screw and suture fixation for temporary transarticular tarsocrural immobilization in canine cadavers

What implants were compared?

Which technique had higher failure loads?

Answer 20

1mm diameter UHMW polyethylene suture (Isolock) vs 4.5mm screw.

Both techniques intact with loading up to 180N, but failure loads were higher for the screw vs suture.

Question 21

Del Signore VS 2021 - Sonoelastography of normal canine common calcaneal tendon: Preliminary results

What was the stiffest part of the CCT tendon?

Answer 21

Enthesis - decreasing towards the musculotendinous junction

Question 22

Chiu VS 2021 - Ex vivo evaluation of novel core tenorrhaphy patterns in dogs

Which suture patterns were observed to be biomechanically superior?

Answer 22

Exposed double-cross-lock, embedded double-cross-lock and Modified-Tang suture patterns –> superior to 3-loop-pulley for tendon repair without epitendinous sutures.

Question 23

Beamon VS 2022 - Effect of calcanean bone-tunnel orientation for teno-osseous repair in a canine common calcanean tendon avulsion model

What was the strongest orientation of bone tunnel?

Which bone tunnel orientation required the greatest dissection?

Answer 23

Transverse tunnel failed at higher force than modified bone tunnels. But generally otherwise biomechanically similar.

Vertical tunnels - required more dissection and elevation of the SDFT

Question 24

Cocca VCOT 2020 - Biomechanical comparison of three epitendinous suture patterns as adjuncts to a core locking loop suture for repair of canine flexor tendon injuries

Name the 3 patterns tested.

What was the difference in strength between the suture patterns?

What was the difference in gap formation between the suture patterns?

Answer 24

Simple continuous, Silfverskiold cross stitch, interlocking horizontal mattress

No difference between epitendinous suture patterns BUT all sig. stronger with less gap formation than locking loop ALONE

Question 25

Cocca VCOT 2020 - Influence of interlocking horizontal mattress epitendinous suture placement on tendinous biomechanical properties in a canine common calcaneal laceration model What was the biomechanical difference between the LLoop alone and with the addition of the epitendinous sutures?

Answer 25

Addition of an epitendinous suture pattern significantly reduced gap formation between tendon ends and significantly increased loads at yield (1.8x), peak (2.0x) and failure (2.0x) force of repairs.

Question 26

Curcillo VCOT 2021 - Ex Vivo Biomechanical Assessment of a Novel Multi-Strand Repair of Canine Tendon Lacerations How did the addition of sutures (1 vs 3 locking loop sutures) affect the biomechanics of the fixation?

Answer 26

Increasing the number of sutures (1-3 locking-loop sutures) in tendon repair increased yield, peak & failure force as well as reducing gap formation.

Question 27

Duffy VS 2021 - Biomechanical evaluation of a novel barbed suture pattern with epitendinous suture augmentation in a canine flexor tendon model What was the main conclusion of this paper?

Answer 27

Novel barbed suture pattern with epitendinous sutures biomechanically similar to 3-loop pulley suture with ES

Question 28

Duffy VS 2021 - Biomechanical analysis of accessory tendon graft augmentation for primary gastrocnemius tendon reconstruction in dogs What is the accessory tendon? How was the augmentation performed? What was the biomechanical analysis conclusion?

Answer 28

Accessory tendon = combined tendon - biceps femoris, semitend, gracillis See pic - paired cruciate sutures attaching both tendons together Accessory tendon graft augmentation increased load to failure and load to gap formation, but did not reduce frequency of gap formation vs locking loop + epitendinous suture alone.

Question 29

Duffy VS 2020 - Biomechanical evaluation of an autologous flexor digitorum lateralis graft to augment the surgical repair of gastrocnemius tendon laceration in a canine ex vivo model How was the graft attached to the gastroc? What was the biomechanical analysis conclusion?

Answer 29

See pic - polypropylene suture in a modified Krackow pattern. Addition of flexor digitorum lateralis graft increased yield, peak & failure forces and prevented gap formation.

Question 30

Duffy VS 2020 - Effect of partial vs complete circumferential epitendinous suture placement on the biomechanical properties and gap formation of canine cadaveric tendons What was biomechanically superior, partial or complete circumferential ES?

Answer 30

Complete circumferential epitendinous suture increased biomechanical strength & reduced gap formation vs partial. Can be placed as 1 line on each side, or single continuous suture.

Question 31

Eby VS 2020 - Influence of barbed epitendinous sutures combined with a core locking-loop suture to repair experimental flexor tendon lacerations What 4 types of sutures were used? Which was biomechanically the best suture?

Answer 31

Stratafix (bilateral barbs paired), V-loc (unilateral barbs), Quill (bilateral barbs alternating) and smooth suture w. knot Stratafix performed similarly to smooth knotted suture, and better to Quill and V-loc.

Question 32

Putterman VS 2019 - Effect of a continuous epitendinous suture as adjunct to three-loop pulley and locking-loop patterns for flexor tendon repair in a canine model Which was observed to be stronger: 3-loop pulley and locking loop? What did the addition of epitendinous sutures do?

Answer 32

Gap formation was best prevented with 3 loop pulley rather than locking loop when used alone. Addition of epitendinous suture increased load to failure & reduced gap formation.

Question 33

Schulz VS 2019 - Clinical outcomes after common calcanean tendon rupture repair in dogs with a loop-suture tenorrhaphy technique and autogenous leukoreduced platelet-rich plasma What was the major complication rate? What was the outcome?

Answer 33

2/12 - 17.5% No difference in anatomic measurements between treated & contralateral limbs at 12 months --> indicates good healing

Question 34

Gunstra JAVMA 2019 - Description and outcome of prosthetic ligament placement for stabilisation of medial or dorsomedial tarsometatarsal joint luxation in dogs and cats: 16 cases (2004-2017) Where were the screws placed? What was the minor complication rate? What was the overall long term outcome?

Answer 34

Screw in central tarsal bone and based on 2nd metatarsal bone 6/16 - 38% - bandage related Satisfactory long-term function in all cases

Question 35

Luescher VS 2020 - Biomechanical comparison of knotted and knotless stabilization techniques of the tarsal medial collateral ligament in cats: A cadaveric study Where were the anchor points for the knotless stabilisation technique? What was the strongest technique?

Answer 35

medial cortex of tibia, suture passed through drill hold in medial malleolus and attached to talus and calcaneous Knotless anchor technique

Question 36

Schmierer VS 2023 - Patient specific, synthetic, partial unipolar resurfacing of a large talar osteochondritis dissecans lesion in a dog Which part of the tarsus is most prone to OCD? What is the composition of the resurfacing implant? How did they access the affected area?

Answer 36

Medial talar ridge Titanium socket and polycarbonate urethrane bearing surface Medial malleolar osteotomy

Question 37

Holroyd VCOT 2023 - Risk Factors Associated with Plantar Necrosis following Tarsal Arthrodesis in Dogs Where does the perforating metatarsal artery run? What % of cases had at least 1 screw that risked damaging artery? What % developed plantar necrosis? What was the difference in screw position between cases of p.necrosis and not? What is the advice given by authors when placing screws?

Answer 37

Intermetatarsal channel lies in proximal 25% of MT III in 95% cases. At least 1 screw risked damaging artery in 92% cases, of which 8% developed plantar necrosis. No significant difference in screw position between plantar necrosis and not. Care should be taken when placing screws in the proximal 25% of the metatarsals, specifically avoiding exiting dorsally between MTII and MTIII and across the distal region of the intermetatarsal channel, where the perforating metatarsal artery passes interosseously, as damage may contribute to the aetiology of plantar necrosis

Question 38

Goh JSAP 2022 - Surgical management of superficial digital flexor tendon luxation in dogs: 48 cases (2005-2020) What was the method of surgical management? What was the rate of reluxation? What increased the risk of surgical failure? How much did it increase the risk by?

Answer 38

Redundant retinacular tissue was either imbricated or excised. The SDFT was reduced and stabilised using interrupted suture patterns 15% Absorbable suture used and non-rigid post-op immobilisation 60% higher w. absorbable suture

Question 39

Jury JSAP 2021 - Surgical repair for luxation of the superficial digital flexor tendon using a temporary restraining pin What breed appeared to be predisposed? What direction would the SDFT luxate? What was the rate of reluxation? What was the major and minor complication rate? What was the most common minor complication?

Answer 39

Shetland sheepdogs Laterally in all but one 9% 3/23 major (13%), minor 8/23 (35% Pin irritation