Successful Nonsurgical Management of a Traumatic Dens Fracture in a Cat with Clinical and Radiographic Resolution

ABSTRACT An adult domestic shorthair presented with obtundation, vestibular ataxia, head tilt, and visible evidence of facial injury following motor vehicle trauma. Plain radiographs and computed tomography imaging revealed a complete minimally displaced transverse fracture of the caudal aspect of the dens of the C2 vertebra and multiple minimally displaced cranial fractures. The dens fracture was managed with 8 wk of strict rest, followed by 4 wk of supervised activity at home. No external immobilization was performed. Neurological examinations at 8 days, 10 wk, and 9 mo following initial presentation were normal. Repeat radiographic and computed tomography examinations at 10 wk and 9 mo following the traumatic event demonstrated progressive and eventual complete osseous union of the fractured dens. To the authors’ knowledge, this is the first report of successful nonsurgical management of a traumatic dens fracture in an adult cat with documented radiographic and clinical resolution. This report suggests that nonsurgical management can be considered in such cats and that complete resolution with osseous union is feasible.

Evaluation of a Diagnostic-Therapeutic Algorithm for Finger Epiphyseal Growth Plate Stress Injuries in Adolescent Climbers

Background: Finger epiphyseal growth plate stress injuries are the most frequent sport-specific injuries in adolescent climbers. Definitive diagnostic and therapeutic guidelines are pending. Purpose: To evaluate a diagnostic-therapeutic algorithm for finger epiphyseal growth plate stress injuries in adolescent climbers. Study Design: Case series; Level of evidence, 4. Methods: On the basis of previous work on diagnostics and treatment of finger epiphyseal growth plate stress injuries (EGPIs) in adolescent climbers, we developed a new algorithm for management of these injuries, which was implemented into our clinical work. During a 4-year period, we performed a prospective multicentered analysis of our patients treated according to the algorithm. Climbing-specific background was evaluated (training years, climbing level, training methods, etc); injuries were analyzed (Salter-Harris classification and UIAA MedCom score [Union Internationale des Associations d’Alpinisme]); and treatments and outcomes were recorded: union, time to return to climbing, VAS (visual analog scale), QuickDASH (shortened version of the Disabilities of the Arm, Shoulder, and Hand), and a climbing-specific outcome score. Results: Within the observation period, 27 patients with 37 independent EGPIs of the fingers were recorded (mean ± SD age, 14.7 ± 1.5 years; 19 male, 8 female; 66.7% competitive athletes). Regarding maturity at time of injury, the mean age at injury did not differ by sex. Average UIAA climbing level was 9.5 ± 0.8, with 6 ± 4.6 years of climbing or bouldering and 14 ± 9.1 hours of weekly climbing-specific training volume. Among the 37 injuries there were 7 epiphyseal strains, 2 Salter-Harris I fractures, and 28 Salter-Harris III fractures (UIAA 1, n = 7; UIAA 2, n = 30). Thirty-six injuries developed through repetitive stress, while 1 had an acute onset. Twenty-eight injuries were treated nonoperatively and 9 surgically. Osseous union was achieved in all cases, and there were no recurrences. The time between the start of treatment and the return to sport was 40.1 ± 65.2 days. The climbing-specific outcome score was excellent in 34 patients and good in 3. VAS decreased from 2.3 ± 0.6 to 0.1 ± 0.4 after treatment and QuickDASH from 48.1 ± 7.9 to 28.5 ± 3.3. Conclusion: The proposed management algorithm led to osseous union in all cases. Effective treatment of EGPIs of the fingers may include nonsurgical or surgical intervention, depending on the time course and severity of the injury. Further awareness of EGPI is important to help prevent these injuries in the future.

Clinical outcomes after mini-hook plate fixation for small avulsion fractures around the interphalangeal or metacarpophalangeal joints of the hand

Background Mini-hook plate has been described for the treatment of various small avulsion fragments in the hand. This retrospective study aimed to evaluate clinical outcomes after mini-hook plate fixation in patients with an avulsion fracture around the interphalangeal or metacarpophalangeal joints of the hand. Methods Nineteen patients with avulsion fractures around the interphalangeal or metacarpophalangeal joints of the hand were included in this study. Seven patients had a mallet fracture, and 12 patients had other phalangeal avulsion fractures including central slip, collateral ligament, volar plate, and flexor avulsion fractures. The osseous union and functional outcomes, including finger joint motion, joint stability, pinching strength, and the disabilities of the arm, shoulder, and hand score, were evaluated. Results The mean duration of follow-up was 33.8 months. All patients in mallet and other phalangeal avulsion fractures achieved osseous union between the avulsion fragment and phalangeal bone, and there was no joint subluxation. There were no significant differences in the disabilities of the arm, shoulder, and hand scores. However, the patients with mallet fracture have lower mean percentage values of the total active range of motion and pinching strength than other phalangeal avulsion fractures. We abandoned this procedure in mallet fractures because the early results after mini-hook plate fixation in mallet fractures appeared unfavorable. Conclusion These results suggest that the mini-hook plate fixation can provide sufficient stability and good clinical outcomes in those with phalangeal avulsion fractures. However, the outcomes for mallet fractures were not as good as those for other phalangeal avulsion fractures.

Patella Fracture Repair Using Multiple Fixation Modalities in a Dog

The 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.

Safe leg surgery: the anatomic principles and techniques

The goals of surgical treatment of leg injury are to achieve soft tissue healing, good osseous union and to restore the length of the limb, correct alignment of both bones with their respective joints and normal range of movements of the entire limb at the earliest. Presently, the surgical treatment has been standardised for the tibia fractures for adults and children. Though the surgical progress made in the implants, instruments and techniques, there are considerable surgical complications happening. This article highlights the need of anatomical expertise and safe operative ability for the surgeon.

Impact of Early Intervertebral Osseous Union After Posterior Lumbar Interbody Fusion on Health-Related Quality of Life

Study Design: Retrospective cohort study. Objectives: Nonunion after posterior lumbar interbody fusion (PLIF) is associated with poor improvements in health-related quality of life (HRQOL). We aimed to investigate the influence of early osseous union after PLIF on HRQOL. Methods: We reviewed 138 patients with 1-level PLIF (mean age 67 years, follow-up period ≥1 year). Postoperative lumbar computed tomography was performed to assess screw loosening and intervertebral union. HRQOL was assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Results: Thirty-nine patients (28%) showed complete union at 6 months postoperatively (early union group). Twenty-eight patients (20%) showed complete union at 6 to 12 months postoperatively (delayed union group), while 71 patients demonstrated noncomplete union. Effective improvement of lumbar spine dysfunction and psychological disorders was achieved in 19 (63.3%) and 17 (50.0%) patients in the early union group, in 9 (42.9%) and 14 (53.8%) patients in the delayed union group, and in 22 (34.9%) and 19 (29.2%) patients in the nonunion group, respectively ( P = .036 and P = .036, respectively). The nonunion group had a significantly higher proportion of cases with screw loosening at 6 and 12 months postoperatively than the complete union group ( P = .033 and P = .022). Conclusions: Lumbar spine dysfunction and psychological disorders improved in cases with early complete union compared to those with nonunion. Screw loosening occurred in cases with nonunion predominantly from 6 months postoperatively. Therefore, the achievement of early complete union might be helpful for better HRQOL and lower incidence of postoperative complications.

Application of Double-Threaded Locking Adaptation Plates used to Repair a Radius and Ulna Fracture in a Domestic Rabbit (Oryctolagus Cuniculus)

Objective This study is a case description of the clinical application of locking plates to repair fractures in the radius and ulna of a 9-month-old, male domestic rabbit. Study Design This study is a case report. Results Double-threaded locking adaptation plates of 1.5 mm were fixated to the radius and ulna of the rabbit using the principles of orthogonal plating. Radiographs of the left radius and ulna were obtained at 8 weeks postoperatively depicting complete osseous union of the fracture and no implant complications were observed. Clinical Significance The authors describe the first clinical report of 1.5 mm locking adaptation plates having been used in repairing radius and ulna fractures in a domestic rabbit.