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1.
The objective of this retrospective study was to identify risk factors for screw migration after triple pelvic osteotomy (TPO) in clinical patients. The medical records, radiographs made immediately after surgery, and follow-up radiographs documenting a healed osteotomy were reviewed for 52 dogs treated with unilateral TPO and 38 dogs treated with bilateral TPO. Signalment, surgeon expertise, length of surgery, sequence of surgery in dogs treated bilaterally, use of ischial or ilial wires or both, screw depth in the sacrum, and screw migration were documented for each of the 128 pelvic osteotomies. Screws placed in the first and second plate hole, securing the cranial portion of the plate, loosened most frequently. Factors associated with decreased screw migration included use of an ischial hemicerclage wire and increased depth of sacral purchase with the first and second cranial screws.  相似文献   

2.
OBJECTIVE: To detect early screw loosening in triple pelvic osteotomy (TPO) and to evaluate the efficacy of retightening using fluoroscopic guidance and minimally invasive surgery to maintain acetabular alignment and achieve bone healing. STUDY DESIGN: Prospective clinical study. SAMPLE POPULATION: Sixteen dogs that had TPO. METHODS: Dogs (16) had TPO (21) by using pre-angled plates secured with 3.5 and 4.0 mm screws, with ischiatic or iliac cerclage, for osteosynthesis. In all but 1 TPO at least 1 screw was inserted into the sacral body (43 screws). The mean radiographic screw length inserted in the sacrum was 10.2 mm, and the mean percent sacral engagement was 22%. Dogs were examined clinically and radiographically immediately postoperatively, and at 10, 30, 60, and 90 days to evaluate screw position. Loose screws were retightened through stab incisions using fluoroscopy to locate the screw. RESULTS: TPO was performed without operative complications. At 10 days, 12 TPOs (57%; 11 dogs) had loose screws primarily located in the cranial aspect of the plate. This represented 20% (25) of the inserted screws. In 5 dogs, screw loosening resulted in medial rotation of the acetabular segment. All loose screws were retightened; 3 screws loosened again in 2 dogs and were detected at 60 days. However, the osteotomies healed with the planned acetabular rotation without further intervention. Screw tightening corrected the acetabular segment displacement. Screws correctly seated at 10 days did not subsequently loosen. Clinical and radiographic outcome was judged excellent in all dogs. CONCLUSION: Loose screws in TPO plates can be identified by 10 days postoperatively and retightened using fluoroscopic guidance to achieve acetabular realignment and healing without need for further surgery. CLINICAL RELEVANCE: Postoperative radiographic evaluation of screw position at 10 days after TPO is recommended to detect loose screws. Retightening loose screws should be considered as an alternative to TPO revision or confinement, especially in immature dogs.  相似文献   

3.
OBJECTIVE: To investigate factors influencing screw loosening after triple pelvic osteotomy (TPO) and ischial wire stabilization of the acetabular segment. DESIGN: Retrospective case series. Animals-227 dogs with congenital hip dysplasia or subluxated hip joints. PROCEDURES: Medical records and radiographs of 227 dogs that underwent 332 TPO procedures were evaluated, and data pertaining to screw type, plate position, sacral screw engagement, use of ischial interfragmentary wires, and pelvic alignment were assessed for associations with screw loosening. RESULTS: Complications developed in 96 of the 332 (29%) procedures. Cancellous screws without sacral engagement were associated with the lowest frequency (6%) of loosening, compared with cancellous and cortical screws engaging the sacrum and cortical screws that did not engage the sacrum. Frequency of screw loosening increased when cortical or cancellous screws engaged the sacrum and when cortical screws were used. In dogs that had surgery bilaterally, the first limb on which TPO was performed had a higher frequency of screw loosening than the second limb. Pelvic alignment loss was greatest (5.4 degrees ) when the 3 most cranial screws were loosened. Loss of pelvic alignment was significantly different between dogs that underwent surgery and had complications and those that underwent surgery and did not have complications in association with loosening of 1, 2, and 3 screws. CONCLUSIONS AND CLINICAL RELEVANCE: TPO screw loosening was multifactorial and related to stability of the affected ilium, screw type, and screw position. Placing cancellous screws that do not engage the sacrum in pelvic osteotomy plate positions 1 through 3 may decrease the number of screws that loosen.  相似文献   

4.
Thirty-six dogs undergoing 49 pelvic osteotomies (POs) stabilised either by manually twisted dynamic compression plates (DCPS; n= 29) or canine pelvic osteotomy plates (CPOPS; n = 20) were retrospectively reviewed. Postoperative radiographs were available for all POs and 36 had additional radiographic follow-up. Pelvic osteotomies with CPOPs were more likely to have three screws placed in the sacrum while DCPs were associated with none, one or two screws in the sacrum. There was no difference in the postoperative sagittal alignment of the acetabular segments for POs with DCPs or CPOPs. Screw loosening was the most common complication (n = 13/36, 36 per cent), usually involving screws in the ilial segment. On follow-up radiographs, medial displacement of the acetabular segment was most frequently associated with screw loosening and plate bending. Medial displacement of the acetabular segment caused apparent pelvic narrowing on radiographs, more pronounced in dogs with bilateral POs, but clinical problems were not reported.  相似文献   

5.
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6.
Objective— To (1) report a technique for repair of feline ilial fractures using a dorsally applied bone plate and (2) compare outcome with cats treated by a lateral plate.
Study Design— Prospective study.
Animals— Cats (n=10) with iliac fractures.
Methods— Cats with ilial fractures (January 2005–December 2006) were treated by application of a dorsally applied bone plate. Immediate postoperative radiographs were compared with those taken 4–6 weeks later to assess screw loosening, screw purchase, and pelvic canal narrowing. Owners were contacted for medium-term (>3 month) follow-up. Data were compared with a report of outcome after lateral plating (LP) in 21 cats.
Results— Mean (± SD) screw purchase (89 ± 11 mm) was significantly greater ( P <.01) with a dorsal plate compared with a lateral plate (33 ± 8 mm). Significantly more screws ( P <.01) were used with a dorsal plate (median, 7) compared with a lateral plate (median, 6). Significantly less postoperative pelvic canal narrowing developed in the dorsal plating group between postoperative and 4–6-week follow-up radiography compared with the LP group (2% versus 15%, P <.01).
Conclusion— Dorsal plating of feline ilial fractures results in significantly less screw loosening and pelvic canal narrowing at 4–6 weeks after surgery compared with LP.
Clinical Relevance— Dorsal plating of feline iliac fractures may reduce complications associated with pelvic canal narrowing such as constipation and megacolon.  相似文献   

7.
OBJECTIVE: To describe a technique for closed reduction and percutaneous insertion of a lag screw for fixation of sacroiliac fracture-luxations, and to report the success of this technique in stabilizing sacroiliac fracture-luxations. STUDY DESIGN: A retrospective clinical study. STUDY POPULATION: 13 consecutive client-owned dogs with sacroiliac fracture-luxations. METHODS: Sacroiliac fracture-luxations were stabilized by using a closed reduction and percutaneous lag screw fixation technique. Preoperative, postoperative, and last re-examination radiographs were used to assess the location and number of pelvic injuries, other orthopedic injuries, percent reduction of the sacroiliac joint, percent sacral width screw depth, position of the screw, pelvic canal diameter ratio, hemipelvic canal width ratio, and complications. Information on signalment, weight, weight-bearing status, neurologic status, and complications was obtained from the medical record. RESULTS: Mean percent reduction of the sacroiliac joint was 92.33%. All screws were placed within the sacral body with a mean screw depth/sacral width of 79.03%. No screw loosening occurred. Mean pelvic canal diameter ratios were 0.99, 1.20, and 1.14 preoperatively, immediately postoperatively, and at the last re-examination, respectively. Nine of 13 dogs were willing to walk on the ipsilateral rear leg the day after surgery. CONCLUSIONS: Closed reduction and percutaneous insertion of a lag screw for stabilization of fracture-luxation of the sacroiliac joint is an acceptable method of repair. CLINICAL RELEVANCE: Sacroiliac fracture-luxations can be successfully reduced and stabilized using a minimally invasive technique.  相似文献   

8.
Objective: To (1) identify prognostic indicators for stability after stabilization of sacroiliac luxation with screws inserted in lag fashion and (2) report dorsoventral dimensions of the sacrum in cats. Study Design: Multicenter retrospective study. Sample Population: Cats (n=40) with sacroiliac luxation. Methods: Case records and radiographs of cats presented at the Queen's Veterinary School Hospital Cambridge and the Royal Veterinary College Hatfield for screw fixation of sacroiliac luxation were reviewed. Dorsoventral dimensions of 15 feline cadaveric sacral bodies were measured to identify the appropriate implant size for use in fixation with screws inserted in lag fashion. Results: Of 40 cats, 13 had left, 14 right, and 13 bilateral sacroiliac luxations. Of 48 screws analyzed, 42 (87.5%) were placed within the sacral body or exited ventrally and 6 (12.5%) were considered malpositioned. Screw purchase within the sacrum was statistically different between unstable and stable repairs (P=.001). Using confidence intervals for screw length within the sacrum and effect on stability, the lowest screw depth that contained 95% of the screws that did not loosen was ∼60% of the sacral width. Mean dorsoventral sacral dimension at its narrowest point was 5.9±1.14 mm. There was no significant difference in the incidence of implant loosening between those luxations that were 100% reduced and those that were <100% reduced (P=.7837). Conclusions: Screw purchase within the feline sacrum of at least 60% of the sacral width significantly reduces the risk of loosening. Clinical Relevance: Screw placement to a depth of 60% of the width of the feline sacrum is recommended.  相似文献   

9.
Objective— To evaluate outcome by radiographic assessment after closed reduction and percutaneous screw fixation in lag fashion of sacroiliac fracture‐luxations in dogs. Study Design— Retrospective study. Animals— Dogs (n=24) with sacroiliac fracture‐luxations. Methods— Medical records (1999–2006) and radiographs of 24 dogs (29 fracture‐luxations) that had stabilization of sacroiliac fracture‐luxation by fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion were reviewed. Signalment, body weight, number, and location of all concurrent injuries and implants used for repair were recorded. Radiographs were used to evaluate the accuracy of screw placement in the sacral body, screw depth/sacral width ratio, reduction of the sacroiliac joint, pelvic canal diameter, and hemipelvic canal width. Radiographic re‐examination (range, 4 to >8 weeks postoperatively) was available for evaluation. Results— Mean screw depth/sacral width ratio on immediate postoperative and re‐examination radiographs was 64% and 61%, respectively. Mean percentage reduction of the sacroiliac joint on immediate postoperative and re‐examination radiographs were 91% and 87%, respectively. Pelvic canal diameter ratio demonstrated successful restoration of the pelvic canal. Hemipelvic canal width ratio documented successful closed reduction repair independent of concurrent pelvic injuries. Conclusion— Successful repair of sacroiliac fracture‐luxations, determined by radiographic assessment, can be achieved by fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion. Clinical Relevance— Fluoroscopic‐guided closed reduction and percutaneous screw fixation in lag fashion of sacroiliac fracture‐luxations is a minimally invasive technique that restores and maintains pelvic canal dimensions and should be considered as an alternative to open reduction or nonsurgical management of sacroiliac fracture‐luxations.  相似文献   

10.
OBJECTIVE: To define a safe corridor in the dorsoventral plane to facilitate placement of screws inserted in lag fashion within the sacral body for fixation of sacroiliac fracture-luxation injuries in dogs. STUDY DESIGN: Anatomic study. SAMPLE POPULATION: Cadaveric canine sacra. METHODS: Canine sacra (n=45) were used for a radiographic study to define a safe corridor in the dorsoventral plane for placement of screws inserted in lag fashion for fixation of sacroiliac luxation in the dog. The defined safe corridor allowed drilling to a depth of 65% of the sacral width to ensure screw purchase of > or =60%. Effects of positioning and measurement techniques were evaluated. RESULTS: Eighty-seven safe corridors were measured. The mean articular surface was 100+/-4.52 degrees from horizontal. Mean maximum, optimum, and minimum safe corridor drill angles were 111+/- 4.57 degrees, 100+/-4.70 degrees, and 89+/-5.17 degrees, respectively, from the articular surface. Predicted surgeon error of +/-4 degrees was used to define the safe corridor for use clinically. CONCLUSIONS: In 91% of sacra, a drill angle of 100+/-4 degrees would remain ventral to the vertebral canal. Twelve sacra (14%) were at risk of penetration of the pelvic canal. A drill angle of 97+/-4 degrees avoids penetration of the vertebral canal in all sacra measured but risks ventral exit from the body in 30% of sacra studied. CLINICAL RELEVANCE: A drill angle of 97 degrees from the articular surface is recommended for insertion of screws for lag fixation of canine sacroiliac luxation.  相似文献   

11.
CLINICAL SUMMARY: The surgical repair of comminuted ilial wing fractures (comprising a long oblique fracture with ventral multiple fragmentation) in three cats using composite internal fixation is reported. The technique comprised the use of pins, screws, wire and polymethylmethacrylate. All cases had an excellent outcome with uneventful bone healing. One case had a very mild reduction in pelvic canal diameter postoperatively. There was no evidence of implant loosening or migration in any cat on follow-up radiographs. PRACTICAL RELEVANCE: This technique provided a quick and highly adaptable means of stabilising this fracture configuration, as well as restoring pelvic symmetry, when limited buttressing support and bone stock were available cranial and ventral to the acetabulum. This method of fixation may have biomechanical advantages over lateral or dorsal plating techniques for this particular type of fracture configuration.  相似文献   

12.
OBJECTIVE: To describe and evaluate facet stabilization as an aid for open reduction and fixation of sacral fractures. STUDY DESIGN: A clinical case series. STUDY POPULATION: Eight consecutive client-owned dogs with sacral fractures. METHODS: A combination of a standard lateral approach to the ilium and a dorsal approach to the articular facets of L7-S1 was performed. The articular facets were reduced and stabilized with a Kirschner wire or a combination of a Kirschner wire and a cortical screw. Primary stabilization of the sacrum was then accomplished using a cortical screw inserted from the lateral aspect of the ilium, through the sacral fracture into the body of the sacrum. Accuracy of reduction, position of the implants, percent screw depth/sacral width, pelvic canal diameter ratio, and complications were assessed using radiographs and physical examination. RESULTS: Mean sacral fracture reduction was 91% immediately after surgery, and was 87% when measured at follow-up examinations. Mean screw depth/sacral width was 66%. Mean pelvic canal diameter ratio was 1.12 postoperatively and 1.03 at the 4- to 6-week reevaluation. Six of the 8 dogs were using the leg well 10 to 12 days after surgery; none had clinically detectable neurologic deficits. The long-term (mean, 2.7 years) outcome for these dogs was good (normal to grade I lameness). CONCLUSION: Fixation of the L7-S1 facet joints facilitates repair of sacral fractures.  相似文献   

13.
Bilateral, midshaft metacarpal osteotomies were performed in 11 sheep and bilateral, midshaft radial osteotomies were performed in 7 sheep. The lesions were repaired with bone plates. One of each pair of plates was luted with polymethylmethacrylate and all screws were tightened uniformly with a torque screwdriver. Sheep were allowed unrestricted exercise after surgery. At 8 weeks, 10 of 11 sheep with metacarpal osteotomies were sound and both osteotomies were healing. Seven were lame on the limb with the unluted plate during the first 3 weeks; 4 were never lame on either limb. The screws of the unluted plates were significantly (P less than 0.01) looser at 8 weeks than those in the luted plates. All of the sheep with radial osteotomies were lame in the limb with the unluted plate. Four of 7 sheep had overt loosening of the unluted plates. One sheep only had mild screw loosening with continued alignment of the osteotomy. Two of 7 sheep fractured the radius with the luted plate; these 2 sheep were lame in the limb with the unluted plate and were using the limb with the luted plate vigorously. Excluding the 2 sheep with fractures, all had substantially more screw loosening in the unluted plate. Histologically, there were no discernible differences in the vascularity or porosity of the bone under the luted vs the unluted plates. The only adverse consequence of the luting technique was introduction of a small amount of polymethylmethacrylate into the osteotomy gap in 5 bones.  相似文献   

14.
Ventral Approach to the Pelvic Canal in the Female Dog   总被引：1，自引：1，他引：0  
A ventral approach to the pelvic canal by bilateral pubic and ischial osteotomy was performed in five female dogs. The entire urogenital tract could be exposed and easily manipulated through this approach. All animals were ambulatory within 24 hours. Clinical union had formed in three of the four osteotomies by the time of euthanasia (months 2-4) in all animals. Incomplete union in some osteotomies indicated that exercise should be restricted for at least 4 months after the procedure. The procedure was determined to be clinically useful when wide exposure of the entire female urogenital tract is desired.  相似文献   

15.
Fracture-luxations of the seventh lumbar vertebrae in two large dogs were stabilised with bone screws and methylmethacrylate. Screws inserted bilaterally into the bodies of the lumbar vertebrae and ilial wings were left protruding by about 2 cm, and embedded in methylmethacrylate bone cement. Implant failure occurred in one dog six days after surgery, necessitating a revision of the fixation. Fracture healing and return of normal ambulation ocurred in both dogs. Implants were removed in one dog because of screw loosening and discomfort.  相似文献   

16.
A combined tension band and lag screw technique for fixation of olecranon osteotomies was used in six canine clinical patients weighing 4.5 to 19 kg. After the proximal part of the ulnar shaft was exposed, a screw hole was drilled and tapped just cranial to the caudal cortex of the olecranon. An osteotomy was performed and the hole in the olecranon fragment was overdrilled to form a gliding hole. For reconstruction, the olecranon was reduced anatomically and compressed with a screw placed in lag fashion. With the trochlear notch exposed, a Kirschner wire was inserted cranial to the screw, using care not to enter the elbow joint. A double-twist figure-eight tension band wire was placed around the Kirschner wire in five dogs and around the screw in one dog. In this dog, a spiked washer was used with the screw because a small olecranon fragment had been produced by incorrect osteotomy position. A painful soft tissue swelling over the prominent washer, which resolved after implant removal, was the only complication attributed to the technique. The combined tension band wire and lag screw technique was a rapid and reliable method for fixation of olecranon osteotomies.  相似文献   

17.
classification scheme for sacral fractures was based on a review of sacral fractures in 34 dogs and 17 cats. They were classified into five categories based on their radiographic appearance on standard lateral and ventrodorsal radiographs of the pelvis. Concomitant pelvic injuries were commonly observed: 32 per cent of dogs had a fracture of an ilium and 65 per cent of cats had unior bilateral sacroiliac subluxation. Neurological deficits were common where the fractures traversed the spinal canal or sacral foraminae. Comparison is made between sacral fractures in dogs and cats, and humans.  相似文献   

18.
One hundred canine sacral bone specimens were examined to identify surgical landmarks that may improve screw placement in sacroiliac repair. A lateral view of the sacral wing was studied, as this structure is most easily identified in the dorsal approach used for sacroiliac repair. The height and length of each sacral wing were measured. Four other features of the canine sacrum were identified and measured in comparison with the sacral wing height and length. The cranial overlap of the sacral wing over the intervertebral space of L7-S1 was found to have a mean of 14% of the length of the sacral wing. The ventral overlap of the sacral wing over the pelvic canal was found to be 21% of the height of the sacral wing. The ventral limit of the spinal canal (dorsal limit of the sacral body) was 45% of the sacral wing height. The first pelvic foramen was located at a mean distance of 64% of the sacral wing length and 20% of the sacral wing height. Using these four features, a composite view of the sacral wing is described to illustrate the area of the sacral body where screw placement is optimal.  相似文献   

19.
Objective— To compare locking screws with conventional screws inserted in the tibial plateau fragment for reduction and stability of the construct after tibial plateau leveling osteotomy (TPLO), using a locking TPLO plate.
Study Design— Experimental biomechanical study.
Animals— Cadaveric canine pelvic limbs (n=8 pairs).
Methods— TPLO was stabilized with either conventional cortical screws or locking screws in a compressed osteotomy model. Titanium pins inserted into the tibial plateau and proximal metaphysis were used to track bone fragment location by computed tomography (CT) imaging. CT imaging was performed after osteotomy reduction, after plate stabilization, and after 30,000 cycles of axial compression testing. After 30,000 cycles, cyclic loading was continued with monotonically increasing peak-load until failure.
Results— The magnitude of rotation about the sawing axis was significantly greater for the conventional screw group because of plate application ( P =.009). Translational movement of the tibial plateau fragment toward the plate was significantly greater for the conventional screw group ( P =.006). There were no significant differences between groups in stiffness or number of cycles to failure.
Conclusion— Maintenance of tibial plateau position was significantly superior for the locking screw group during plate application; however, screw type had no effect on fixation stability under cyclic loading.
Clinical Relevance— These results suggest that conventional screws and careful contouring of the TPLO plate can provide comparable mechanical stability to fixation with locking screws in the tibial plateau under load-sharing conditions, but potentially at the expense of osteotomy reduction.  相似文献   

20.
BackgroundMinimally invasive surgery (MIS) technique of sacroiliac luxation in toy breed dogs using cannulated screws has not been described.ObjectivesThe purpose of this study was to evaluate the effectiveness of pelvic canal recovery, the reproducibility of successful surgery outcomes, and the acceptable difficulty of the procedure in MIS of sacroiliac luxation in toy breed dogs.MethodsMIS using 2.3-mm cannulated screws was demonstrated in 12 toy breed dog cadavers with sacroiliac luxation artificially induced. Pre and postoperative radiographs were used to evaluate the pelvic canal diameter ratio (PCDR), hemipelvic canal width ratio (HCWR), and reduction rate. Dorsoventral angle (DVA) and craniocaudal angle (CCA) of the inserted screw were obtained postoperative computed tomographic scan.ResultsThe statistically significant difference between the mean pre and postoperative PCDR was found (1.10 ± 0.12 and 1.26 ± 0.11, respectively; p = 0.002), and the mean HCWR close to 1.0 meaning symmetric pelvis also was obtained (0.97 ± 0.07). The mean DVA and CCA were 2.26° ± 1.33° and 2.60° ± 1.86°, respectively.ConclusionsMIS of sacroiliac luxation using 2.3-mm cannulated screws is applicable to toy breed dogs with acceptable difficulty.  相似文献   

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