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Lahiani J, Freire M, Montasell X, Juette T, Gagnon D. Effects of Transfixation Pin Positioning on the Biomechanical Properties of Acrylic External Skeletal Fixators in a Fracture Gap Model. Vet Comp Orthop Traumatol 2023; 36:273-278. [PMID: 37336472 DOI: 10.1055/s-0043-1768990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the biomechanical effects of transfixation pin positioning in acrylic columns of external skeletal fixators (ESF). STUDY DESIGN Twenty-four type I acrylic ESF were built simulating a fracture gap-model. Transfixation pins were placed centric (n = 12) or eccentric at ¼ of the column diameter (n = 12) in the acrylic columns. Six constructs from each group were subjected to axial compression and four-point bending tests. Stiffness, yield load and mode of failure were recorded. RESULTS Stiffness was not influenced by centring (p = 0.373), but it was higher in four-point bending than in axial compression (p < 0.001). Pin positioning had no influence on the yield (p = 0.535) and failure loads (p = 0.715) in axial compression, nor on the yield load in bending (p = 0.135). Eccentric pin positioning decreased failure loads by 28% in bending (p < 0.001). CONCLUSION Eccentric position of transfixation pins within the acrylic columns alters the biomechanical properties of type I ESF constructs. While acrylic offers several advantages, when forming the columns, frame strength will be optimized if pins are centrally located.
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Affiliation(s)
- Joachim Lahiani
- Faculty of Veterinary Medicine, University of Montreal, Saint Hyacinthe, Québec, Canada
| | - Mila Freire
- Faculty of Veterinary Medicine, University of Montreal, Saint Hyacinthe, Québec, Canada
| | | | - Tristan Juette
- Faculty of Veterinary Medicine, University of Montreal, Saint Hyacinthe, Québec, Canada
| | - Dominique Gagnon
- Faculty of Veterinary Medicine, University of Montreal, Saint Hyacinthe, Québec, Canada
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Freeman A, Southerden P. Mandibular fracture repair techniques in cats: a dentist's perspective. J Feline Med Surg 2023; 25:1098612X231152521. [PMID: 36744847 PMCID: PMC10812066 DOI: 10.1177/1098612x231152521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PRACTICAL RELEVANCE Feline head trauma injuries are common in general practice, often resulting in mandibular fracture. An understanding of the recent advances in the field of mandibular fracture repair will facilitate evidence-based decision-making in clinical practice. CLINICAL CHALLENGES Feline maxillofacial and oral anatomy brings unique challenges in comparison with dogs. It has been commonplace to adapt techniques and equipment that are better suited to other body regions or are species-inappropriate for use in feline maxillofacial surgery, and this has traditionally resulted in high morbidity. AIMS This review presents an overview of the diagnosis of, and decison-making for, maxillofacial trauma in cats, specifically with reference to the feline mandible. The challenges associated with the management of these injuries are presented. Techniques for repair that can be employed in general practice, as well as more advanced surgical options, are discussed, as well as the indications for invasive vs non-invasive management. Underutilised methods involving composite dental materials and their versatility for the repair of mandibular fractures in cats, and miniplates for caudal mandibular fractures in cats, are specifically covered, as well as other recent advances in the field, including three-dimensional printing and custom-printed implants. EVIDENCE BASE Management of feline facial fractures is an often neglected topic, with very few published studies choosing to focus on head trauma outcomes in cats. Where available, however, this review draws on the published literature, as well as the authors' own clinical experience.
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Affiliation(s)
- Alix Freeman
- Department of Dentistry, Oral and Maxillofacial Surgery, Eastcott Referrals, Swindon, UK
| | - Peter Southerden
- Department of Dentistry, Oral and Maxillofacial Surgery, Eastcott Referrals, Swindon, UK
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Snyder CJ, Lothamer C. Patient Triage, First Aid Care, and Management of Oral and Maxillofacial Trauma. Vet Clin North Am Small Anim Pract 2021; 52:271-288. [PMID: 34838254 DOI: 10.1016/j.cvsm.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Maxillofacial trauma is a common presentation in veterinary medical practice. Accurate assessment, diagnostics, pain management, and finally repair are tenants to treatment. In addition to typical tenants for fracture repair, the restoration of occlusion and return to function (eating, drinking, grooming) are unique to trauma management in these patients. Options for repair include conservative management (tape muzzles), noninvasive repair techniques (interdental wiring and composite splinting), and invasive repair techniques (interfragmentary wiring and plate and screw fixation).
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Affiliation(s)
- Christopher J Snyder
- University of Wisconsin-Madison, School of Veterinary Medicine, 2015 Linden Drive, Madison, WI 53706, USA.
| | - Charles Lothamer
- University of Tennesee, College of Veterinary Medicine, 2407 River Drive, Knoxville, TN 37996, USA
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Abstract
PRACTICAL RELEVANCE Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice. CLINICAL APPROACH Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient's ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries. TREATMENT GOALS AND TECHNIQUES A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal's oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain. AIM This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.
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Affiliation(s)
- Cristina Rizkallal
- Department of Animal Medicine and Surgery, Universidad CEU Cardenal Herrera, C/Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
| | - Pilar Lafuente
- Department of Animal Medicine and Surgery, Universidad CEU Cardenal Herrera, C/Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain
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Virgilio F, Bourbos A, Cinti F, Pisani G. Right mandibular angle and left comminuted mandibular body fractures stabilised with a combination of an acetabular plate and secured pin intermandibular ventral epoxy resin (SPIVER) frame in a four‐month‐old puppy. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - Alexandros Bourbos
- SurgeryClinica Veterinaria Pisani Carli ChiodoLuni MareOrtonovoItaly
- SurgeryClinica Veterinaria VezzoniCremonaCremonaItaly
| | - Filippo Cinti
- SurgeryClinica Veterinaria Pisani Carli ChiodoLuni MareOrtonovoItaly
- SurgeryEastcott referralsSwindonUnited Kingdom
| | - Guido Pisani
- SurgeryClinica Veterinaria Pisani Carli ChiodoLuni MareOrtonovoItaly
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Arzi B, Fiani N, Peralta S, Verstraete FJM. Feline skull injuries: treatment goals and recommended approaches. J Feline Med Surg 2020; 22:453-455. [DOI: 10.1177/1098612x20917603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Leitch BJ, Worth AJ. Mechanical testing of a steel-reinforced epoxy resin bar and clamp for external skeletal fixation of long-bone fractures in cats. N Z Vet J 2018; 66:144-153. [PMID: 29466683 DOI: 10.1080/00480169.2018.1443406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIMS To provide veterinarians with confidence when using a commercially available epoxy resin in external skeletal fixators (ESF), testing was conducted to determine exothermia during curing of the epoxy resin compared to polymethylmethacrylate (PMMA), the hardness of the epoxy resin as a bar over 16 weeks, and the strength of the epoxy resin bar compared with metal clamps in similarly constructed Type 1a ESF constructs simulating the repair of feline long bone fractures. METHODS Exothermia of the epoxy resin during curing was tested against PMMA with surface temperatures recorded over the first 15 minutes of curing, using four samples of each product. The hardness of 90 identical epoxy resin bars was tested by subjecting them to cyclic loads (1,000 cycles of 20.5 N, every 7 days) over a 16-week period and impact testing 10 bars every 2 weeks. Ten bars that were not subjected to cyclic loads were impact tested at 0 weeks and another 10 at 16 weeks. Strength of the epoxy resin product, as a bar and clamp composite, was tested against metal SK and Kirschner-Ehmer (KE) clamps and bars in Type 1a, tied-in intramedullary pin, ESF constructs with either 90° or 75° pin placement, subjected to compressive and bending loads to 75 N. RESULTS The maximum temperature during curing of the epoxy resin (min 39.8, max 43.0)°C was less than the PMMA (min 85.2, max 98.5)°C (p<0.001). There was no change in hardness of the epoxy resin bars over the 16 weeks of cyclic loading (p=0.58). There were no differences between the median strength of the epoxy resin, SK or KE ESF constructs in compression or bending when tested to 75 N (p>0.05). Stiffness of constructs with 75° pin placement was greater for SK than epoxy resin constructs in compression (p=0.046), and was greater for KE than epoxy resin constructs in bending (p=0.033). CONCLUSIONS The epoxy resin tested was found to be less exothermic than PMMA; bars made from the epoxy resin showed durability over an expected fracture healing timeframe and had mechanical strength characteristics comparable to metal bar and clamp ESF constructs. CLINICAL RELEVANCE The epoxy resin ESF construct tested in this study can be considered a suitable replacement for SK or KE ESF constructs in the treatment of feline long-bone fractures, in terms of mechanical strength.
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Affiliation(s)
- B J Leitch
- a Massey University Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University , Private Bag 11 222, Palmerston North 4442, New Zealand.,b Current address: Veterinary Surgical Referrals Ltd , 49b Coopers Road, Gate Pa, Tauranga 3112, New Zealand
| | - A J Worth
- a Massey University Veterinary Teaching Hospital, Institute of Veterinary, Animal and Biomedical Sciences, Massey University , Private Bag 11 222, Palmerston North 4442, New Zealand
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Beever L, Giles K, Meeson R. Postoperative complications associated with external skeletal fixators in cats. J Feline Med Surg 2017; 19:727-736. [PMID: 28592224 DOI: 10.1177/1098612x17699466] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective of this study was to quantify complications associated with external skeletal fixators (ESFs) in cats and to identify potential risk factors. METHODS A retrospective review of medical records and radiographs following ESF placement was performed. RESULTS Case records of 140 cats were reviewed; fixator-associated complications (FACs) occurred in 19% of cats. The region of ESF placement was significantly associated with complication development. Complications developed most frequently in the femur (50%), tarsus (35%) and radius/ulna (33%). Superficial pin tract infection (SPTI) and implant failure accounted for 45% and 41% of all FACs, respectively. SPTI occurred more frequently in the femur, humerus and tibia, with implant failure more frequent in the tarsus. No association between breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, degree of fracture load sharing, and the incidence or type of FAC was identified. No association between region of placement, breed, age, sex, weight, fracture type (open vs closed), ESF classification, number of pins per bone segment, fracture load sharing and the time to complication development was identified. CONCLUSIONS AND RELEVANCE Complication development is not uncommon in cats following ESF placement. The higher complication rate in the femur, tarsus and radius/ulna should be considered when reviewing options for fracture management. However, cats appear to have a lower rate of pin tract infections than dogs.
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Affiliation(s)
- Lee Beever
- Queen Mother Hospital for Animals, Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK
| | - Kirsty Giles
- Queen Mother Hospital for Animals, Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK
| | - Richard Meeson
- Queen Mother Hospital for Animals, Department of Clinical Sciences and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, Hertfordshire, UK
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Moores A. Author's reply. J Small Anim Pract 2011. [DOI: 10.1111/j.1748-5827.2011.01112.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Çetinkaya MA, Yardimci C, Kaya U. Lingual Arch Bar Application for Treatment of Rostral Mandibular Body Fractures in Cats. Vet Surg 2011; 40:457-63. [DOI: 10.1111/j.1532-950x.2011.00809.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Moores AP. Maxillomandibular external skeletal fixation in five cats with caudal jaw trauma. J Small Anim Pract 2010; 52:38-41. [DOI: 10.1111/j.1748-5827.2010.01011.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Marshall WG, Farrell M, Chase D, Carmichael S. Maxillomandibular Circular External Skeletal Fixation for Repair of Bilateral Fractures of the Caudal Aspect of the Mandible in a Dog. Vet Surg 2010; 39:765-70. [DOI: 10.1111/j.1532-950x.2010.00714.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tuxbury KA, Clayton LA, Snakard EP, Fishman EK. Multiple Skull Fractures in a Captive Fly River Turtle (Carretochelys insculpta): Diagnosis, Surgical Repair, and Medical Management. ACTA ACUST UNITED AC 2010. [DOI: 10.5818/1529-9651-20.1.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Eileen P. Snakard
- Dog and Cat Veterinary Referral, 6700 Laurel-Bowie Road, Bowie, MD 20715, USA
| | - Elliot K. Fishman
- Johns Hopkins Hospital, 601 North Caroline Street, Baltimore, MD 21287, USA
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