DOCSLIB.ORG

Complex Angular and Torsional Deformities (Distal Femoral Malunions)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Complex Angular and Torsional Deformities (Distal Femoral Malunions) 416 Clinical Communication Complex angular and torsional deformities (distal femoral malunions) Preoperative planning using stereolithography and surgical correction with locking plate fixation in four dogs Michael D. DeTora; Randy J. Boudrieau Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA Keywords but one had a mild persistent lameness at Introduction Angular limb deformity, corrective osteo - the final in-hospital follow-up examination tomy, stereolithography, preoperative plan- (mean: 54.4 weeks; range: 24–113 weeks A number of methods have been utilized ning after surgery). All femurs healed without in the dog for both pre-surgical planning complications (mean: 34 weeks, median: 12 and surgical correction of angular limb Summary weeks; range: 8–12 weeks for closing osteot- deformities (1–5). Some angular limb de- Objective: To describe the surgical tech- omies, and 26–113 weeks for opening formities are typically challenging to as- nique of complex distal femoral deformity wedge osteotomies). Long-term follow-up sess radiographically due to multi-planar correction with the aid of stereolithography examination (mean: 28.6 months; range: torsional and angular deformities, making apparatus (SLA) biomodels, stabilized with 5–42 months) revealed all but one owner to accurate measurements difficult to obtain locking plate fixation. be highly satisfied with the outcome. Compli- (3, 5, 6). In addition, the femur is particu- Methods: Full-size replica epoxy bone bio- cations were observed in two dogs: prolong- larly difficult to assess as the frontal and models of the affected femurs (4 dogs/ ed tibiotarsal joint decreased flexion that re- sagittal plane orientation can easily be 5 limbs) were used as templates for surgical solved with physical therapy. In one of these masked by the inability to easily locate the planning. A rehearsal procedure was per- dogs, iatrogenic transection of the long digi- hip joint orientation in the presence of formed on the biomodels aided by a guide tal extensor tendon was repaired, and the torsion or multiplanar deformities. As wire technique and stabilized with locking other had a peroneal nerve neurapraxia. such, this combination of factors can rea- plate fixation. Surgery performed in all dogs Clinical significance: Stereolithography ap- sonably define such deformities as com- was guided by the rehearsal procedure. All paratus biomodels and rehearsal surgery plex, although we realize this is a subjec- pre-contoured implants were subsequently simplified the definitive surgical corrections tive definition. Software manipulation of used in the definitive surgical procedure with of complex femoral malunions and resulted computed tomography (CT) data has Downloaded by: Ondokuz Mayis University. Copyrighted material. minimal modification. in good functional outcomes. been described in humans, and also has Results: All dogs had markedly improved, been used to allow more accurate assess- with near normal functional outcomes; all ment in the dog (5, 7-11). However, even with these data and techniques, the surgi- cal planning of such deformities remains Correspondence to: Vet Comp Orthop Traumatol 2016; 29: 416–425 difficult to accurately assess (5, 6). More- Randy J. Boudrieau, DVM, Diplomate ACVS & ECVS http://dx.doi.org/10.3415/VCOT-15-08-0145 over, translating this information from the Cummings School of Veterinary Medicine at Tufts Received: August 26, 2015 radiographs and the CT to the patient at University Accepted: June 21, 2016 Department of Clinical Sciences Epub ahead of print: July 21, 2016 the time of the surgical procedure can be 200 Westboro Road difficult in both dogs and humans (5, 9, N. Grafton, MA 01536 Online supplementary material is available for this 12, 13). United States paper at: http://dx.doi.org/10.3415/VCOT-15-08-0145 Various methods of three-dimen- E-mail: [email protected] sional (3D) printing have been utilized to reproduce anatomical structures for medical use in both human and veterin- ary medicine (14). Stereolithography is a rapid prototyping technology that allows the creation of solid, 3D objects obtained Vet Comp Orthop Traumatol 5/2016 © Schattauer 2016 M. D. DeTora, R. J. Boudrieau: Complex deformity correction aided by 3D biomodels 417 Figure 1 A) Ventrodorsal pelvis radiograph preoperatively in a nine- that shows the right femoral angular and torsional femoral deformity: month-old castrated male mixed breed dog (limb 5) with a biapical deformity proximal procurvatum with distal recurvatum and valgus malalignment; also of the femur; note the malposition of the hip joint. B, C) Craniocaudal and notice the proximal femoral torsion (position of femoral head, neck and lateral three-dimensional reconstruction from computed tomography data greater trochanter); D, E) compare with the opposite normal femur. from CT data with computer aided de- Materials and methods Criteria for case selection sign (CAD) software, and as such the ability to create accurate full-size ana- The study was conducted in a manner con- Medical records of four client owned dogs tomical models of the bone. The use of sistent with the US National Institutes of (5 limbs) with severe distal femoral mal- stereolithography has been reported in Health “Guide for the Care and Use of Lab- union and treated at the Cummings School veterinary medicine to assist correction oratory Animals” and the Animal Welfare of Veterinary Medicine at Tufts University of antebrachial deformities, pelvic limb Acts (US PL 89–544; 91–579; 94–279). using SLA planning and titanium locking deformity, and total knee arthroplasty (3, 5, 6, 15). Accurate pre-planning with 3D biomodels in humans has been reported to translate into a more definite surgical process with increased knowledge of the intricacies of the procedure, improved Downloaded by: Ondokuz Mayis University. Copyrighted material. surgeon confidence, increased surgical efficiency, and reduced anaesthesia time (16). The purpose of this study was to de- scribe the surgical techniques in complex distal femoral deformity corrections with the aid of stereolithography apparatus (SLA) biomodels, and stabilized with multiple titanium locking plate fixation in four dogs (5 limbs). Our aims were to evaluate the use of SLA biomodels to facili- tate the pre- and intra-operative surgical Figure 2 Skyline view (limb 5) three-dimensional (3D) reconstruction from computed tomography (CT) data that demonstrates the inability to assess the femoral torsion of the right femur (A and B), as plan, and as a result, obtain appropriate the anteversion of the femoral head and neck, and position of the femoral condyles cannot be viewed realignment of the affected limb and an simultaneously (upper views are radiographic opacity images, while the lower views are bone opacity improved functional outcome without images so as to more easily interpret the bone conformation); C) compare with opposite normal femur. major complications. A further aim was to Preoperative CT data and further software image manipulation cannot identify the specific areas of evaluate healing after multiple titanium deformity, much less quantify them with any degree of accuracy, as these remain two-dimensional locking plate fixation. images of a 3D structure. © Schattauer 2016 Vet Comp Orthop Traumatol 5/2016 418 M. D. DeTora, R. J. Boudrieau: Complex deformity correction aided by 3D biomodels the opposite normal limb in order to match the mirrored orientation; in the one case with bilateral deformities, a comparison was made to anatomical specimens from a dog of similar size. Guide wires were used to assist in determining the proper spatial orientation and also the corrections to be made (▶ Appendix I: available online at www.vcot-online.com). Corrective osteo- tomy with plate fixation was performed as a rehearsal procedure (▶ Figure 4). The pre-contoured plates were removed and sterilized in preparation for the definitive surgical procedure. Definitive surgical technique Dogs were positioned in dorsal recumben- cy with the affected limb aseptically pre- pared to the dorsal midline. Perioperative cefazolin sodium (22 mg/kg) was adminis- tered intravenously every two hours throughout the duration of the procedure. A standard lateral approach to the femur Figure 3 Stereolithographic epoxy biomodels Figure 4 Stereolithographic epoxy biomodels of was performed combined with a lateral of the right and left (normal) femurs (limb 5). the right and left (normal) femurs after rehearsal parapatellar arthrotomy (and extended surgery on the right femur (limb 5). The torsional craniomedially and distally to approach the deformity has been corrected with a transverse medial aspect of the tibia if necessary). A plates (January 2007 - June 2012) were re- osteo tomy at (a) and spanned with a 5-hole ALPS tibial tuberosity osteotomy was performed viewed. Signalment, orthopaedic examin- (advanced locking plate system) 10 cranially; the dis- using a sagittal saw, and the tuberosity re- ation, assessment of pelvic limb use as a re- tal valgus and recurvatum have been corrected with flected both proximally and medially in a second biplanar cuneiform (medial and caudal) sult of the obvious angular or torsional de- closing wedge osteotomy at (b). Both osteotomies order to gain full bilateral exposure to the formity observed (varus/valgus, pro-/re- were spanned laterally with a 10-hole ALPS 10 (a stifle joint and femoral condyles. curvatum, femoral torsion), patellar stabil-
Load more

Recommended publications
  • Angular Limb Deformities in Foals: Treatment and Prognosis*
    Article #4 CE Angular Limb Deformities in Foals: Treatment and Prognosis* Nicolai Jansson, DVM, PhD, DECVS Skara Equine Hospital Skara, Sweden Norm G. Ducharme, DVM, MSc, DACVS Cornell University ABSTRACT: This article presents an overview of the clinical management of foals with angular limb deformities. Both conservative and surgical treatment options exist; the choice of which to use should be based on the type, severity, and location of the deformity as well as the age of the foal. Conservative measures include controlled exercise, rigid external limb support, and corrective hoof trimming. Surgical treatment modalities comprise tech- niques for manipulating physeal growth and, after physeal closure, various corrective osteotomy or ostectomy methods. The prognosis is generally good if treatment is initi- ated well in advance of physeal closure. ngular limb deformities and their treat- Conservative Treatment ment in foals and young horses constitute In most foals born with mild to moderate a significant part of the orthopedic prob- angular deformities, spontaneous resolution A 2 lems that veterinarians must manage. This article occurs within the first 2 to 4 weeks of life. In discusses the clinical management and prognosis newborn foals, periarticular laxity is the most of these postural deformities. likely cause, and these foals require no special treatment other than a short period of con- TREATMENT trolled exercise. In our opinion, mildly and The absence of controlled studies has moderately affected foals should not be confined impaired the accumulation of scientific data to a stall because exercise is important for nor- guiding the management of angular limb defor- mal muscular development and resolution of the mities in foals (Table 1).
    [Show full text]
  • Conformational Limb Abnormalities and Corrective Farriery for Foals
    Conformational Limb Abnormalities and Corrective Farriery for Foals For the past couple of years the general public has questioned the horse industry, and one of the questions is “Are we breeding horses more prone to breakdown with injuries”? It seems that we hear more often now that there are more leg and foot problems than ever before. Is it that we are more aware of conformational deficits and limb deviations, or are there some underlying factors that make our horses prone to injury? To improve, or even just maintain the breed, racing should prove soundness as well as speed and stamina. 1 The male side is usually removed from the bloodline if unable to produce good results at the racetrack. However, the female may have such poor conformation that she never even gets into training, but yet she enters the broodmare band. The generational effect of this must surely lead to an increase in the number of conformational deficits in our foals and yearlings.1 Something that we hear quite often is “Whoever saw the perfect horse”? and “There are plenty of horses with poor conformation that win races”. That doesn’t mean we should not continue to attempt to produce horses with good conformation. There is an acceptable range of deviation from the ideal, and therefore these deformities have to be accepted if it does not jeopardize the overall athletic soundness of the horse. Although mild conformational deficits may not significantly impact soundness, more significant limb deformities cause abnormal limb loading, lameness, gait abnormalities, and interference issues. 2 Developmental deformities of the limb include angular, flexural, and rotational limb deformities.
    [Show full text]
  • Veterinary Orthopedic Society 43Rd Annual Conference Abstracts
    A16 2016 VOS Abstracts Veterinary Orthopedic Society purpose of this study was to compare DI measurements with hip arthroscopy findings in dogs undergoing DPO. rd 43 Annual Conference Abstracts Materials and Methods: Medical records, arthroscopic images, and radio- graphs from 14 patients (26 hips) undergoing unilateral or bilateral DPO were reviewed. DI was measured using distraction view radiographs. Arthro- February 27 – March 5, 2016 scopic images were analyzed and findings graded using the Modified Outer- Big Sky, Montana, USA bridge Scale. ANOVA was used to compare DI between grade groups. Results: The highest grades of cartilage wear were noted cranially on the fe- moral head, mid-acetabulum, and caudally on the DAR. No significant dif- Part II ferences in DI were identified between groups of cartilage wear grade on the femoral head, acetabulum, or DAR, nor were any significant differences in DI 2016 VOS Abstracts VOS 2016 PODIUM ABSTRACTS (continued) identified between grade groups for the round ligament, labrum, or degree of synovitis. Discussion/Conclusion: This study found no significant differences in DI 52 COMPARISON OF ULTRASOUND AND MRI TO with different grades of cartilage, DAR, round ligament, or labral wear, or de- ARTHROSCOPY FOR ASSESSMENT OF MEDIAL MENISCAL gree of synovitis. No trend was noted for DI to increase as wear grade in- PATHOLOGY IN DOGS WITH CRANIAL CRUCIATE LIGAMENT creased in any region of the joints evaluated. Arthroscopic evaluation should DISEASE be considered prior to DPO as part of appropriate candidate selection. Acknowledgement: There was no proprietary interest or funding provided Samuel Patrick Franklin1; James L. Cook2; Cristi R.
    [Show full text]
  • University of Washington Department of Orthopaedics and Sports Medicine
    Discoveries 2012 University of Washington Department of Orthopaedics and Sports Medicine UNIVERSITY OF WASHINGTON Department of Orthopaedics and Sports Medicine 2012 Research Report Department of Orthopaedics and Sports Medicine University of Washington Seattle, WA 98195 Editor-in-ChiEf: Jens R. Chapman, M.D. Managing Editor: Fred Westerberg Front Cover Illustration: Pottery by Jack Routt, Photographer: Conrad Lilleness. The cover features a ceramic basin by Jack Routt. In Latin, the word for basin is sometimes translated as pelvis. Pelvic surgery is one of the orthopaedic specialities of Jack’s father, Milton L. Routt, Jr., M.D., Professor. Jack Routt (above) is a junior at King’s High School in Seattle, WA who enjoys creating ceramic art. Contents 1 Foreword 4 In Memoriam: Paul J. Benca, M.D. July 24, 1958 - June 27, 2011 6 David R. Eyre, Ph.D.: Steindler Award 7 Peter Simonian, M.D., 2012 Grateful Alumnus 8 Robert M. Berry, M.D., 2012 Distinguished Alumnus 9 New Faculty 10 Department of Orthopaedics and Sports Medicine Faculty 14 Visiting Lecturers 16 A Very Successful Year in Orthopaedics Salvage of Failed Custom Total Ankle 20 Michael E. Brage, M.D. Replacement: A Case Report Temporary External Fixation in Calcaneal 22 John Munz, M.D., Patricia A. Kramer, Ph.D., Fractures and Stephen K. Benirschke, M.D. Enhancing Pedicle Screw Fixation in the 23 Harsha Malempati, M.D., Bopha Chrea B.S., Lumbar Spine Utilizing Allograft Bone Plug Jeffrey Campbell M.S., Sonja Khan B.S., Interference Fixation: A Biomechanical Study Randal P. Ching, Ph.D., and Michael J. Lee, M.D.
    [Show full text]
  • ANGULAR LIMB DEFORMITIES of FOALS in These Congenital Or Acquired Skeletal Defects, the Distal Portion of a Limb Deviates Laterally Or Medially Early in Neonatal Life
    tions. The various types of tenosynovitis include idiopathic, acute, chronic, and septic 1 (infectious). Idiopathic synovitis refers to synovial distention of tendon sheaths in young f animals, in which the cause .is uncertain. Acute and chronic tenosynovitis are due to trauma Septic tenosynovitis may be associated with penetrating wounds, local exten- sion of infection, or a hematogenous infection. Clinical Findings and Diagnosis: There are varying degrees of synovial distention of the tendon sheath and lameness, depending on the severity. Horses are markedly lame in septic tenosynovitis. Chronic tenosynovitis is common in horses in the tarsal sheath of the hock (thoroughpin) and in the digital sheath (tendinous windpuffs). These two entities must be differentiated from bog spavin and synovial effusion of the fetlock. aeatment: In idiopathic cases, no treatment is initially recommended. Acute cases with clinical signs may be treated symptomatically with cold packs, nonsteroidal anti-in- flammatory drugs, and rest. Application of counterirritants and bandaging has been used in more chronic cases. Radiation therapy is helpful. Septic tenosynovitis requires systemic antibiotics and drainage. If adhesions develop between the tendon sheath and the tendon, persistent effusion and lameness is the rule. Congenital and inherited anomalies can result in the birth of diseased or deformed neonates. Congenital disorders can be due to viral infections of the fetus or to ingestion 1 of toxic plants by the dam at certain stages of gestation. The musculoskeletal system can also be affected by certain congenital neurologic disorders. See also WNGEHITAL MY- OPATHIES, p 867. ANGULAR LIMB DEFORMITIES OF FOALS In these congenital or acquired skeletal defects, the distal portion of a limb deviates laterally or medially early in neonatal life.
    [Show full text]
  • Proceedings 10.Pdf
    FRONTISPIECE. Steve Nesbitt was awarded the 4th L. H. WALKINSHAW CRANE CONSERVATION AwARD on 10 February 2006 in Zacatecas City, Zacatecas, Mexico. Steve’s work with Florida sandhill cranes began over 3 decades ago. He first published a paper on cranes in 1974, and since has authored or co-authored >65 publications on cranes. Steve, a founding member of the North American Crane Working Group, is the world’s authority on Florida sandhill cranes. Steve has been active in the conservation of other races of sandhill cranes, including the eastern greater sandhill crane and the Cuban sandhill crane. Over 27 years Steve banded 1,093 individual sandhill cranes. Steve was the driving force in Florida for the re-establishment of non-migratory whooping cranes. In addition, Steve has published 40 other papers on species such as red- cockaded woodpeckers and wood storks. His life’s work (much of which can only be described as of pioneering quality) focused on conservation of species threatened with extinction. Though employed for 34 years by the Florida Fish and Wildlife Conservation Commission (previously the Florida Game and Fresh Water Fish Commission), Steve’s conservation efforts go beyond Florida’s boundaries. Steve, through the donation/translocation from the State of Florida, has been instrumental in the recovery of the brown pelican and bald eagle. (Photo by Scott Hereford.) Front Cover: At first light in the Sierra Madre, sandhill cranes fly over pasture lands toward feeding grounds near Laguna de Babicora in the Chihuahuan Desert of northern Mexico. Image Copyright Michael Forsberg / www.michaelforsberg.com. Back Cover: Scenes from the Tenth Workshop in Zacatecas by Marty Folk.
    [Show full text]
  • Assessment of Canine Elbow Joint for Osteoarthritis and Treatment with Synovetin OA®
    Assessment of Canine Elbow joint for osteoarthritis and treatment with Synovetin OA® Steven M. Fox, MS, DVM, MBA, PhD PAIN Pain is the clinical sign most frequently associated with osteoarthritis (OA).1 The clinical manifestation of this pain is lameness. When an animal presents with clinical lameness, a determination must be made whether the animal is unable to use the limb or is unwilling to use the limb. Inability to use the limb may be attributable to musculoskeletal changes, such as joint contracture or muscle atrophy. These anomalies are best addressed with physical rehabilitation. On the other hand, unwillingness to use a limb is most often attributable to pain. Herein, lameness is an avoidance behavior. Ironically, articular cartilage is frequently the focus of studies regarding OA. However, clinical treatment of the OA patient is most often focused on the alleviation of pain. Appreciating that articular cartilage is aneural, the focus of OA pain management resides in the periarticular structures. No pain is elicited by stimulation of cartilage, and stimulation of normal synovial tissue rarely evokes pain.2 OA pain is the result of a complex interplay between structural change, biochemical alterations, peripheral and central pain-processing mechanisms, and individual cognitive processing of nociception. The source of pain in the joint ‘organ’ is multifocal: direct stimulation of the joint capsule and bone receptors by cytokines/ligands of inflammatory and degradative processes, physical stimulation of the joint capsule from distension (effusion) and stretch (laxity, subluxation, abnormal articulation), physical stimulation of subchondral bone from abnormal loading, and (likely) physical stimulation of muscle, tendon, and ligaments.
    [Show full text]
  • Three-Dimensional Computer-Assisted Corrective Osteotomy with a Patient-Specific Surgical Guide for an Antebrachial Limb Deformity in Twodogs
    Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2019 Three-dimensional computer-assisted corrective osteotomy with a patient-specific surgical guide for an antebrachial limb deformity in twodogs Longo, Francesco ; Penelas, Alexandra ; Gutbrod, Andreas ; Pozzi, Antonio Abstract: We describe patient-specific surgical guide prototyping and surgical treatment of acomplex antebrachial deformity in two skeletally mature dogs presenting with chronic lameness. Computer-assisted surgery was elected to increase accuracy in the correction of the complexity deformity. Radiographs and CT scans revealed a biplane deformity with valgus, procurvatum and external torsion of the right radius in both cases. The pre-surgical planning started from the quantification of the angular deformity, computer simulated correction to end up with a rehearsal surgery on 3D printed bone models. During the surgery, the custom-made osteotomy guides closely fitted the bone, allowing for a precise corrective osteotomy, that was stabilized with two locking plates. Postoperative x-rays showed successful correction of the deformity. At the follow up recheck examinations at 8 and 12 weeks postoperatively the dogs had improved lameness, weight-bearing and progression of bone healing were observed in both dogs. Patient- specific surgical guides allowed for a satisfactory correction of the antebrachial deformity. Additional benefits of using customized surgical devices include standardization and reduced surgical time. DOI: https://doi.org/10.17236/sat00216 Other titles: Dreidimensionale computerunterstützte Korrekturosteotomie mit einer patientenspezifischen chirurgischen Schablone bei zwei Hunden mit antebrachiellen Deformitäten Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-171890 Journal Article Accepted Version Originally published at: Longo, Francesco; Penelas, Alexandra; Gutbrod, Andreas; Pozzi, Antonio (2019).
    [Show full text]
  • Flexural Limb Deformities in Thoroughbred Foals in New Zealand
    Copyright is owned by the Author of the thesis. Permission is given for a copy to be downloaded by an individual for the purpose of research and private study only. The thesis may not be reproduced elsewhere without the permission of the Author. FLEXURAL LIMB DEFORMITIES IN THOROUGHBRED FOALS IN NEW ZEALAND A thesis presented in partial fulfilment of the requirements for the degree Master of AgriScience (Equine) at Massey University, Manawatu, New Zealand. AMANDA KYLIE SHOTTON 2014 (Submitted 17 April, 2014) Abstract The aims of this thesis were to describe the descriptive epidemiology of congenital flexural limb deformities (FLD) in foals on commercial Thoroughbred stud farms, and to describe the management and treatment of these foals. Data were collected on five commercial Thoroughbred stud farms in the Auckland and Waikato regions. Data were collected primarily by stud farm personnel, and assisted by study personnel when on farm. Data were collected on a selective population of 203 foals during the 2013/2014 season. Pre-selection by stud farm personnel towards foals with FLD prevented the calculation of prevalence and resulted in 67% (135/203) of the foals with records having one or more FLD recorded. Laxity was observed to affect 87/135 foals, contracture of at least one joint region 57/135 foals and 6/135 foals were back at the knee; nine foals suffered from multiple forms of deformity. The median score for laxity was 2 (IQR 2-3) on a four point scale. The median score for contracture affecting hoof-ground contact was 2 (IQR 2-3) on a three point scale, while the median score for contracture affecting the fetlock and carpal regions was 2 (IQR 2-2).
    [Show full text]
  • Farriery for the Foal: a Review Part 2: Therapeutic Farriery S
    EQUINE VETERINARY EDUCATION 1 Equine vet. Educ. (2019) () - doi: 10.1111/eve.13073 Review Article Farriery for the foal: A review part 2: Therapeutic farriery S. E. O’Grady* Virginia Therapeutic Farriery, Keswick, Virginia, USA *Corresponding author email: [email protected] Keywords: horse; foals; therapeutic farriery; hoof trimming; tendon laxity; flexural deformity; angular limb deformity Summary metacarpophalangeal and distal interphalangeal joints) and The extensive nature of this topic warrants this review paper to are characterised by abnormal flexion of a given joint or all be divided into two parts: ‘Basic trimming in foals’ and involved joints and the inability to extend the joint. Proposed ‘Therapeutic farriery in foals’. Management of the feet and limbs aetiologies of congenital flexural deformities include mal- during this juvenile period will often dictate the success of the positioning of the fetus in utero, nutritional mismanagement foal as a sales yearling or mature sound athlete. Overall hoof of the mare during gestation, teratogens in various forages care in the foal is often a joint venture between the veterinarian ingested by the mare and maternal exposure to influenza and the farrier. The orthopaedic disorders discussed in this virus; it is also possible that the deformities could be genetic paper that require input from the two professions are flexural in origin (Hunt 2012; Caldwell 2014, 2017). Treatment of foals limb deformities (FLD) and angular limb deformities (ALD). The with a congenital flexural deformity varies with the severity concept of protecting the foot from the deleterious effects of and location of the deformity. It is not uncommon to see a mal-loading created by many FLDs and ALDs is just as important foal born with a flexural deformity (generally bilateral) that as using the symptomatology as an instrument to correct the involves a combination of joints in the forelimb such that the deformity.
    [Show full text]
  • Correction of Biapical Tibial Deformity by True Spherical Osteotomy, Modified Circular External Skeletal Fixation and Distractio
    Published online: 2019-06-14 THIEME Case Report e73 Correction of Biapical Tibial Deformity by True Spherical Osteotomy, Modified Circular External Skeletal Fixation and Distraction Osteogenesis Darby Walmsley1 Noel Fitzpatrick1 Cameron Black1 1 Department of Orthopaedics and Neurology, Fitzpatrick Referrals, Address for correspondence Darby Walmsley, BVSc MRCVS, Godalming, Surrey, United Kingdom Department of Orthopaedics and Neurology, Fitzpatrick Referrals, Halfway Lane, Godalming, Surrey, GU7 2QQ, United Kingdom VCOT Open 2019;2:e73–e80. (e-mail: [email protected]). Abstract Objectives Theaimof thisstudywastodescribeacaseofbiapicaltibialdeformityasa result of premature distal physeal closure corrected by true spherical osteotomy, circular external skeletal fixation and distraction osteogenesis. Methods A 6-month-old male Labrador Retriever was presented for the evaluation and treatment of angular limb deformity of the left pelvic limb, with radiography and computed tomography revealing a multiplanar, biapical, compensatory tibial growth deformity, with marked distal tibial recurvatum and varus. A true spherical osteotomy was performed at the distal tibial centre of rotation of angulation (CORA), allowing for correction of the deformity in three planes, with a transverse osteotomy performed at the most proximal CORA. A circular external skeletal fixator was applied and distraction osteogenesis performed at the transverse osteotomy. Latency, distraction osteogen- Keywords esis, and consolidation were performed over a 113-day period. ► angular limb Results At frame removal, tibial length discrepancy improved from 16.8% to 0.6% and deformity frontal plane varus angulation improvement from 20° to 5°, when compared with the ► true spherical contralateral limb. Long-term evaluation revealed a satisfactory clinical and cosmetic osteotomy outcome, judged by the clinician and owners, with force plate analysed symmetry ► distraction index of the pelvic limb within reported normal limits.
    [Show full text]
  • Developmental Orthopaedic Disease in Horses
    Developmental Orthopaedic Disease in Horses Janine Aldred BVSc Department of Animal Science University of Sydney NSW 2006 February 1998-12-09 RIRDC Publication No. 97/79 RIRDC Project No US-45A 1 © 1998 Rural Industries Research and Development Corporation. All rights reserved. ISBN 0 642 ISSN 1440-6845 The views expressed and the conclusions reached in this publication are those of the author and not necessarily those of persons consulted. RIRDC shall not be responsible in any way whatsoever to any person who relies in whole or in part on the contents of this report. This publication is copyright. However, RIRDC encourages wide dissemination of its research, providing the Corporation is clearly acknowledged. For any other enquiries concerning reproduction, contact the Publications Manager on phone 02 6272 3186. Researcher Contact Details Janine Aldred Department of Animal Science University of Sydney Sydney NSW 2006 Phone: 02 9351 2709 Email: [email protected] RIRDC Contact Details Rural Industries Research and Development Corporation Level 1, AMA House 42 Macquarie Street BARTON ACT 2600 PO Box 4776 KINGSTON ACT 2604 Phone: 02 6272 4539 Fax: 02 6272 5877 Email: [email protected] Website: http://www.rirdc.gov.au Published in February 1998 Printed by Better Printing, Quenabeyan 2 3 1. What is Developmental Orthopaedic Disease? ____________________________5 1.1 Introduction______________________________________________________6 1.2 Developmental Orthopaedic Disease in Australia _______________________7 1.3 Developmental
    [Show full text]