Use of an interlocking nail-hybrid fixator construct for distal femoral deformity correction in three dogs

Summary

Our purpose was to report the use of an inter-locking nail-hybrid external fixator construct to correct distal femoral deformities in three dogs. Radiographs, computed tomography and a three-dimensional model were used to plan the surgical procedure. A femoral osteotomy or ostectomy was performed at the level of the centre of rotation of angulation in all three dogs. Angular and rotational deformities were corrected acutely. Distraction osteo-genesis was performed to lengthen each femur postoperatively. All three dogs had additional anatomic abnormalities of the affected hindlimb complicating the correction of the distal femoral deformity. While the interlocking nail-hybrid fixator construct allowed for stable distraction of the femur, all three dogs developed complications during the postoperative convalescent period, and each had some degree of residual lameness. Lengthening the femur following acute deformity correction is problematic and additional experimental and clinical studies are warranted to decrease postoperative morbidity and improve functional results.

Keywords

Hybrid external fixator - distraction osteogenesis - interlocking nail - femur - dog

• References

• 1 Stallings JT, Lewis DD, Welch RD. et al. An introduction to distraction osteogenesis and the principles of the Ilizarov method. Vet Comp Orthop Traumatol 1998; 11: 59-67.
• 2 Welch RD, Lewis DD. Distraction osteogenesis. Vet Clin North Am Small Anim Pract 1999; 29: 1187-1205.
• 3 Ilizarov GA. The tension stress effect on the genesis and growth of tissues. In: Transosseous Osteosyn-thesis: Theoretical and Clinical Aspects of the Regeneration and Growth of Tissue. New York: Springer-Verlag; 1992: pg. 137-197.
• 4 Ilizarov GA. Clinical application of the tension-stress effect for limb lengthening. Clin Orthop 1990; 250: 8-26.
• 5 Jerram RM, Walker AM, Sutherland-Smith J. et al. Treating pedal shortening in a dog by metatarsal distraction osteogenesis. J Small Anim Pract 2005; 46: 191-195.
• 6 Ehrhart N. Longitudinal bone transport for treatment of primary bone tumors in dogs: a classification of the technique and summary of nine cases. Vet Surg 2005; 34: 24-34.
• 7 Hancock RB, Cook JL, Tomlinson JL. Distraction osteogenesis for treatment of premature physeal closure and shortening of the third and fourth metatarsals of a dog. J Am Anim Hosp Assoc 2003; 39: 97-103.
• 8 Marcellin-Little DJ. Treating bone deformities with circular external skeletal fixation. Compend Contin Educ Pract Vet (Small Anim) 1999; 21: 481-491.
• 9 McCartney WT. Limb lengthening in three dogs using distraction rates without a latency period. Vet Comp Orthop Traumatol 2008; 21: 385-480.
• 10 Lewis DD, Radasch RM, Beale BS. et al. Initial clinical experience with the IMEX circular external skeletal fixation system. Part II: Use in bone lengthening and correction of angular and rotational deformities. Vet Comp Orthop Traumatol 1999; 12: 118-127.
• 11 Farese JP, Lewis DD, Cross AR. et al. Use of IMEX SK-circular external fixator hybrid constructs for fracture stabilization in dogs and cats. J Am Anim Hosp Assoc 2002; 38: 279-289.
• 12 Kirkby KA, Lewis DD, Lafuente MP. et al. Management of humeral and femoral fractures in dogs and cats with linear-circular hybrid external skeletal fixators. J Am Anim Hosp Assoc 2008; 44: 180-197.
• 13 Anderson GM, Lewis DD, Radasch RM. et al. Circular external skeletal fixation stabilization of ante-brachial and crural fractures in 25 dogs. J Am Anim Hosp Assoc 2002; 39: 479-498.
• 14 Owen MA. Use of the Ilizarov method to manage a septic tibial fracture nonunion with a large cortical defect. J Small Anim Pract 2000; 41: 124-127.
• 15 Rovesti GL, Bascucci M, Schmidt K. et al. Limb sparing using a double bone-transport technique for treatment of a distal tibial osteosarcoma in a dog. Vet Surg 2002; 31: 70-77.
• 16 Tommasini MD, Betts CW. Use of the “Ilizarov” external fixator in a dog. Vet Comp Orthop Traumatol 1991; 4: 70-76.
• 17 Radasch RM, Lewis DD, McDonald DE. et al. Pes varus corrction in Dachshunds using a hybrid external fixator. Vet Surg 2008; 37: 71-81.
• 18 Sereda CW, Lewis DD, Radasch RM. et al. Descriptive report of antebrachial growth deformity correction in 17 dogs from 1999 to 2007, using hybrid linear-circular external fixator constructs. Can Vet J 2009; 50: 723-732.
• 19 Clark SP, Carmichael S. Treatment of distal diaphy-seal fractures using hybrid external skeletal fixation in three dogs. J Small Anim Pract 2006; 47: 98-103.
• 20 Griffin H. Linear distractor/compression assembly available for mini SK and small SK fixators. IMEX Update: A Resource for Veterinary Surgeons. IMEX Vet, Inc., June 2006
• 21 Paley D. Osteotomy concepts and frontal plane realignment. In: Principles of Deformity Correction. New York, NY: Springer-Verlag; 2003: pg. 99-110.
• 22 Gordon JE, Goldfarb CA, Lhmann SJ. et al. Femoral lengthening over a humeral intramedullary nail in preadolescent children. J Bone Joint Surg 2002; 84 A 930-937
• 23 Zhihong L, Xiangsheng Z, Liqun D. et al. Distraction osteogenesis technique using an intramedullary nail and a monolateral external fixator in the reconstruction of massive postosteomyelitis skeletal defects of the femur. Can J Surg 2009; 52: 103-111.
• 24 Hay CS, Johnson KA. Interlocking nail fixation of an opening wedge corrective osteotomy for femoral malunion in a dog. Vet Comp Orthop Traumatol 1995; 8: 218-221.
• 25 Dudley RM, Kowaleski MP, Drost WT. et al. Radiographic and computed tomographic determination of femoral varus and torsion in the dog. Vet Radiol Ultrasound. 2006; 47: 546-551.
• 26 Matsubara H, Tsuchiya H, Sakurakichi K. et al. Deformity correction and lengthening of lower legs with an external fixator. Int Orthop 2006; 30: 550-554.
• 27 Piermattei DL, Johnson KA. An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat. 4th ed. Philadelphia, PA: WB Saunders; 2004: pg. 336-341.
• 28 Paley D, Herzenberg JE, Paremain G. et al. Femoral lengthening over an intramedullary nail. A matched –case comparison with Ilizarov femoral lengthening. J Bone Joint Surg 1997; 79 A 1464-1480.
• 29 Theyse LFH, Voorhout G, Hazenwinkel HAW. Prognostic factors in treating antebrachial growth deformities with a lengthening procedure using a circular fixation system in dogs. Vet Surg 2005; 34: 424-435.
• 30 Dismukes DI, Fox DB, Tomlinson JL. et al. Use of radiographic measures and three-dimensional computed tomographic imaging in surgical correction of an antebrachial deformity in a dog. J Am Vet Med Assoc 2008; 232: 68-73.
• 31 Harrysson OLA, Cormier DR, Marcellin-Little DJ. et al. Rapid prototyping for treatment of canine limb deformities. Rapid Prototyping J 2003; 9: 37-42.
• 32 Wheeler JL, Lewis DD, Cross AR. et al. Intramedullary interlocking nail fixation in dogs and cats: clinical applications. Compend Contin Educ Pract Vet (Small Anim) 2004; 26: 531-544.
• 33 Kocaoglu M, Eralp L, Kilicoglu O. et al. Complications encountered during lengthening over an intramedullary nail. J Bone Joint Surg 2004; 86 A 2406-2411.
• 34 Sangkaew C. Distraction osteogenesis of the femur using conventional monolateral external fixator. Arch Orthop Traum Surg 2008; 128: 889-899.
• 35 Kojimoto H, Yasuni N, Goto T. et al. Bone lengthening in rabbits by callus distraction. J Bone Joint Surg 1988; 70 B 543-549.
• 36 Delloye C, Delefortrie G, Coutelier L. et al. Bone regenerate formation in cortical bone during distraction lengthening. Clin Orthop 1990; 250: 34-42.
• 37 Hermanson JW, Evans HE. The muscular system. Evans HE. In Miller’s Anatomy of the Dog. 3rd ed. Philadelphia, PA: WB Saunders; 1993: pg. 364-365.
• 38 Donnan LT, Saleh MS, Rigby AS. Acute correction of lower limb deformity and simultaneous lengthening with a monolateral fixator. J Bone Joint Surg 2003; 85 B 254-260.
• 39 Berg RJ, Egger EL, Konde LJ. et al. Evaluation of prognostic factors for growth following distal fe-moral physeal injuries in 17 dogs. Vet Surg 1984; 13: 172-180.
• 40 Piermattei DL, Flo GL, DeCamp CE. Brinker, Piermattei and Flo’s Handbook of Small Animal Orthopedics and Fracture Repair. 4th ed. St. Louis, MO; WB Saunders: 2006: pg. 748.
• 41 Franczuszki D, Chalman JA, Butler HC. et al. Postoperative effects of experimental femoral shortening in the mature dog. J Am Anim Hosp Assoc 1987; 23: 429-437.
• 42 Jazrawi LM, Majeska RJ, Klein ML. et al. Bone and cartilage formation in an experimental model of distraction osteogenesis. J Orthop Trauma 1998; 12: 111-116.
• 43 Lin CC, Huang SC, Liu TK. et al. Limb lengthening over an intramedullary nail. An animal study and clinical report. Clin Orthop 1996; 330: 208-216.
• 44 Yasui N, Sato M, Ochi T. et al. Three modes of ossification during distraction osteogeneisis in the rat. J Bone Joint Surg 1997; 79 B 824-830.
• 45 Paley D. Problems, obstacles and complications of limb lengthening. In Bianchi Maiocchi A, Aronson J. editors Operative principles of Ilizarov. Medi Surgical Video; Milan, Italy: 1991: 352-365.
• 46 Black AP, Withrow SJ. Changes in the proximal femur and coxofemoral joint following intramedullary pinning of diaphyseal fractures in young dogs. Vet Surg 1979; 8: 19-24.