Complex angular and torsional deformities (distal femoral malunions)

Michael D. DeTora; Randy J. Boudrieau

doi:10.3415/VCOT-15-08-0145

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 2016; 29(05): 416-425
DOI: 10.3415/VCOT-15-08-0145

Clinical Communication

Schattauer GmbH

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

¹Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA

,

Randy J. Boudrieau

¹Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA

› Author Affiliations

Abstract

Summary

Objective: To describe the surgical technique of complex distal femoral deformity correction with the aid of stereolithography apparatus (SLA) biomodels, stabilized with locking plate fixation.

Methods: Full-size replica epoxy bone bio-models of the affected femurs (4 dogs/5 limbs) were used as templates for surgical planning. A rehearsal procedure was performed on the biomodels aided by a guide wire technique and stabilized with locking plate fixation. Surgery performed in all dogs was guided by the rehearsal procedure. All pre-contoured implants were subsequently used in the definitive surgical procedure with minimal modification.

Results: All dogs had markedly improved, with near normal functional outcomes; all but one had a mild persistent lameness at the final in-hospital follow-up examination (mean: 54.4 weeks; range: 24–113 weeks after surgery). All femurs healed without complications (mean: 34 weeks, median: 12 weeks; range: 8–12 weeks for closing osteotomies, and 26–113 weeks for opening wedge osteotomies). Long-term follow-up examination (mean: 28.6 months; range: 5–42 months) revealed all but one owner to be highly satisfied with the outcome. Complications were observed in two dogs: prolonged tibiotarsal joint decreased flexion that resolved with physical therapy. In one of these dogs, iatrogenic transection of the long digital extensor tendon was repaired, and the other had a peroneal nerve neurapraxia.

Clinical significance: Stereolithography apparatus biomodels and rehearsal surgery simplified the definitive surgical corrections of complex femoral malunions and resulted in good functional outcomes.

Online supplementary material is available for this paper at: http://dx.doi.org/10.3415/VCOT-15-08-0145

Keywords

Angular limb deformity - corrective osteo -tomy - stereolithography - preoperative planning

Full Text

References

References
1 Balfour RJ, Boudrieau RJ, Gores BR. T-plate fixation of distal radial closing wedge osteotomies for treatment of angular limb deformities in 18 dogs. Vet Surg 2000; 29: 207-217.
2 Fox DB, Tomlinson JL, Cook JL. et al. Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs. Vet Surg 2006; 35: 67-77.
3 Dismukes I D, 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.
4 Swiderski J, Palmer R. Long-term outcome of distal femoral osteotomy for treatment of combined distal femoral varus and medial patellar luxation: 12 cases (1999-2004). J Vet Med Assoc Am 2007; 231: 1070-1075.
5 Crosse K, Worth A. Computer-assisted surgical correction of an antebrachial deformity in a dog. Vet Comp Orthop Traumatol 2010; 23: 354-361.
6 Harrysson OLA, Cormier DR, Marcellin-Little DJ. et al. Rapid prototyping for treatment of canine limb deformities. Rapid Prototyping J 2003; 9: 37-42.
7 Tsao J, Chiodo CP, Williamson DS. et al. Computer-assisted quantification of periaxial bone rotation from X-Ray CT. J Comput Assist Tomogr 1998; 22: 615-620.
8 Subburaj K, Ravi B, Argawal M. Computer-aided methods for assessing lower limb deformities in orthopaedic surgery planning. Comput Med Imaging Graph 2010; 34: 277-288.
9 Murase T, Oka K, Moritomo H. et al. Three-dimensional corrective osteotomy of malunited fractures of the upper extremity with use of a computer simulation system. J Bone Joint Surg Am 2008; 90: 2375-2389.
10 Apelt D, Kowaleski M, Dyce J. Comparison of computed tomographic and standard radiographic determination of tibial torsion in the dog. Vet Surg 2005; 34: 457-462.
11 Meola SD, Wheeler JL, Rist CL. Validation of a technique to assess radial torsion in the presence of procurvatum and valgus deformity using computed tomography: A cadaveric study. Vet Surg 2008; 37: 525-529.
12 Boudrieau RJ. Corrective osteotomy - Bringing the plan to the bone (Trigonometry, guide wires, SLA modeling and art). Proceedings of the 2011 ACVS Veterinary Symposium 2011. November 3-5. Chicago, Illinois; USA.:
13 Bindra RR, Cole RJ, Yamaguchi K. et al. Quantification of radial torsion angle with computerized tomography in cadaver specimens. J Bone Joint Surg Am 1997; 79: 833-837.
14 Hespel A-D, Wilhite R, Hudson J. Invited review - Applications for 3D printers in veterinary medicine. Vet Radiol Ultrasound 2014; 55: 347-358.
15 Liska W, Marcellin-little D, Eskelinen E. et al. Custom total knee replacement in a dog with femoral condylar bone loss. Vet Surg 2007; 36: 293-301.
16 D’Urso PS, Barker TM, Earwaker WJ. et al. Stereolithographic biomodelling in cranio-maxillofacial surgery: a prospective trial. J Craniomaxillofac Surg 1999; 27: 30-37.
17 Tomlinson J, Fox D, Cook JL. et al. Measurement of femoral angles in four dog breeds. Vet Surg 2007; 36: 593-598.
18 Dismukes I D, Tomlinson J, Fox DB. et al. Radiographic measurement of the proximal and distal mechanical joint angles in the canine tibia. Vet Surg 2007; 36: 699-704.
19 Weh JL, Kowaleski MP, Boudrieau RJ. Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs. Vet Surg 2011; 40: 670-686.
20 Cook JL, Evans R, Conzemius MG. et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39: 905-908.
21 Hudson JT, Slater MR, Taylor L. et al. Assessing repeatability and validity of a visual analogue scale questionnaire for use in assessing pain and lameness in dogs. Am J Vet Res 2004; 65: 1634-1643.
22 Marcellin-Little DJ, Harrysson OLA, Cansizoglu O. In vitro evaluation of a custom cutting jig and custom plate for canine tibial plateau leveling. Am J Vet Res 2008; 69: 961-966.
23 Fernandez DL. Correction of post-traumatic wrist deformity in adults by osteotomy, bone-grafting, and internal fixation. J Bone Joint Surg Am 1982; 64: 1164-1178.
24 Shea K, Fernandez DL, Jupiter JB. et al. Corrective osteotomy for malunited, volarly displaced fractures of the distal end of the radius. J Bone Joint Surg Am 1997; 79: 1816-1826.
25 Jupiter JB, Ruder RJ. Computer-generated bone models in the planning of osteotomy of multidirectional distal radius malunions. J Hand Surg 1992; 17: 406-415.
26 Addison ES, Emmerson TD, de la Puerta B. et al. Evaluation of osteotomy accuracy and rotational and angular alignment for cranial closing wedge ostectomy performed with and without alignment aids. Vet Surg 2015; 44: 78-84.
27 Millis DL, Ciuperca IA. Evidence for canine rehabilitation and physical therapy. Vet Clin Sm Anim 2015; 45: 1-27.
28 Marcellin-Little DJ, Levine D. Principles and application of range of motion and stretching in companion animals. Vet Clin North Am Small Anim Pract 2015; 45: 57-72.
29 Tepic S, Remiger AR, Morikawa K. et al. Strength recovery in fractured sheep tibia treated with a plate or an internal fixator: An experimental study with a two-year follow-up. J Orthop Trauma 1997; 11: 14-23.
30 Hofer HP, Wildburger R, Szyszkowitz R. Observations concerning different patterns of bone healing using the Point Contact Fixator (PC-Fix) as a new technique for fracture fixation. Injury 2001; 32: S-B15-25.
31 Boudrieau RJ. The advanced locking plate system (ALPS): design rationale, biomechanics and early clinical use. Proceedings of the ACVS Veterinary Symposium 2009. October 8-10. Washington: D.C., USA.;
32 Maretta SM, Schrader SC. Physeal injuries in the dog: a review of 135 cases. J Am Vet Med Assoc 1983; 182: 708-710.
33 McCarthy PE. Bilateral pes valgus deformity in a Shetland Sheepdog. Vet Comp Orthop Tramatol 1998; 11: 197-199.
34 Dismukes D, Fox D, Thomlinson J. et al. Determination of pelvic limb alignment in the large-breed dog: A cadaveric radiographic study in the frontal plane. Vet Surg 2008; 37: 674-682.
35 Off W, Matis U. Excision arthroplasty of the hip joint in dogs and cats. Clinical, radiographic, and gait analysis findings from the Department of Surgery, Veterinary Faculty of the Ludwig-Maximillian’s University of Munich, Germany. Vet Comp Orthop Traumatol 2010; 23: 297-305.
36 Franczuski 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.
37 Blaeser LL, Gallagher JG, Boudrieau RJ. Treatment of biologically inactive nonunions by a limited en-bloc ostectomy and compression plate fixation: A review of 17 cases. Vet Surg 2003; 32: 91-100.
38 Hasler CC, Krieg AH. Current concepts of leg lengthening. J Child Orthop 2012; 6: 89-104.

Supplementary Material

Online Supplementary Material (PDF)