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Chobpenthai T, Poosiripinyo T, Warakul C. Reconstruction After En Bloc Resection of a Distal Radius Tumor. An Updated and Concise Review. Orthop Res Rev 2023; 15:151-164. [PMID: 37576613 PMCID: PMC10422987 DOI: 10.2147/orr.s416331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/31/2023] [Indexed: 08/15/2023] Open
Abstract
The distal radius is rarely affected by either primary or metastatic bone cancers. The most frequent tumors of the distal radius are giant cell tumors, which are benign tumors with the propensity to invade. En bloc excision of giant cell tumors of the distal radius achieves a low recurrence rate but compromises the wrist joint, necessitates a significant reconstruction, and has functional consequences. Reconstruction after en bloc resection of a distal radius bone tumor is challenging. Furthermore, orthopedic oncologists disagree on treating such long bone anomalies most effectively. The present article summarizes the various biological and non-biological reconstruction techniques performed after en bloc resection of a distal radius tumor, discusses the advantages and disadvantages of each reconstruction strategy, and summarizes several case studies and case reports.
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Affiliation(s)
- Thanapon Chobpenthai
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Chawin Warakul
- Princess Srisavangavadhana College of Medicine, Chulabhorn Royal Academy, Bangkok, Thailand
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Arauz PG, Chiriboga P, García MG, Kao I, Díaz EA. New technologies applied to canine limb prostheses: A review. Vet World 2021; 14:2793-2802. [PMID: 34903941 PMCID: PMC8654758 DOI: 10.14202/vetworld.2021.2793-2802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
Although only a few studies have investigated about the development of animal prosthesis, currently, there is an increasing interest in canine limb prosthesis design and its clinical application since they offer an alternative to killing the animal in extreme situations where amputating the limb is the only option. Restoring normal function of amputated canine limbs with the use of a prosthesis is challenging. However, recent advances in surgical procedures and prosthesis design technology appear promising in developing devices that closely recreate normal canine limb function. Surgical advances such as evolution of osseointegration (bone-anchored) prostheses present great promise. Likewise, modern computer-aided design and manufacturing technology, as well as novel motion analysis systems are now providing improved prosthesis designs. Advances in patient-customized prostheses have the potential to reduce the risk of implant failure. The objective of this investigation is to present a general review of the existing literature on modern surgical approaches, design and manufacturing methods, as well as biomechanical analyses so that veterinarians can make more and better-informed decisions on the development and selection of proper canine limb prosthesis. Isolated research efforts have made possible an improvement in stability, comfort, and performance of canine limb prosthesis. However, continued multidisciplinary research collaboration and teamwork among veterinarians, engineers, designers, and industry, with supporting scientific evidence, is required to better understand the development of canine limb prosthesis designs that closely replicate the normal limb function.
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Affiliation(s)
- Paul G Arauz
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Patricio Chiriboga
- Department of Mechanical Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - María-Gabriela García
- Department of Industrial Engineering, Universidad San Francisco de Quito, Quito, Ecuador
| | - Imin Kao
- Department of Mechanical Engineering, Stony Brook University, Stony Brook, United States
| | - Eduardo A Díaz
- Department of Veterinary Medicine, Universidad San Francisco de Quito, Quito, Ecuador
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Kalamaras AB, Wavreille V, Jones SC, Litsky AS, Selmic L. Impact of microwave ablation treatment on the biomechanical properties of the distal radius in the dog: A cadaveric study. Vet Surg 2020; 49:1388-1395. [PMID: 32706150 DOI: 10.1111/vsu.13481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine whether microwave ablation (MWA) modifies the biomechanical properties of the normal distal radius in the dog to better estimate the clinical impact of MWA as a tool for the treatment of neoplastic bone lesions. STUDY DESIGN Biomechanical experimental study. SAMPLE POPULATION Sixteen pairs of dog forelimbs from 16 canine cadavers. METHODS From each pair of forelimbs, one radius was randomly assigned to an MWA group, and the other radius was randomly assigned to a control group. Bone tunnels were created in each distal radial epiphysis for a length of 6 cm toward the middiaphysis. In the MWA group, the ablation probe was inserted into the bone tunnel for a series of three ablation treatments. Specimens were then tested in three-point bending to acute failure with the middle point located 3 cm from the distal articular surface (middle of the ablated zone). Load and displacement were continuously recorded to determine maximum displacement and peak load before failure. Data were analyzed with noninferiority tests. RESULTS The mean peak loads for the control group and MWA group were 1641.9 N and 1590.9 N, respectively. Microwave ablation-treated radii were not biomechanically inferior to control radii (P < .0001). CONCLUSION Microwave ablation of normal cadaveric dog distal radii did not affect the maximum displacement and peak load before failure. CLINICAL SIGNIFICANCE Microwave ablation does not affect biomechanical bending properties of the distal radius in the dog. Future studies, both cadaveric and in vivo, are required to evaluate the impact of MWA on neoplastic bone.
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Affiliation(s)
- Alexandra B Kalamaras
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Vincent Wavreille
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Stephen C Jones
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
| | - Alan S Litsky
- Department of Biomedical Engineering, The Ohio State University College of Engineering, Columbus, Ohio
| | - Laura Selmic
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, Ohio
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Salyer SA, Wavreille VA, Fenger JM, Jennings RN, Selmic LE. Evaluation of microwave ablation for local treatment of dogs with distal radial osteosarcoma: A pilot study. Vet Surg 2020; 49:1396-1405. [PMID: 32697356 DOI: 10.1111/vsu.13491] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To evaluate the feasibility and safety of microwave ablation (MWA) as a modality to induce tumor necrosis within distal radial osteosarcoma (OSA). STUDY DESIGN Pilot study. ANIMALS Six client-owned dogs with distal radius OSA confirmed by cytological examination. METHODS Dogs underwent computed tomography for surgical planning before general anesthesia for fluoroscopy-guided ablation. Computed tomography was repeated 48 hours after MWA, before amputation. The ablated tumor was evaluated with histopathology. RESULTS Six dogs underwent MWA of distal radius OSA. A lower power setting (30 W) was selected for the first two dogs to avoid collateral soft tissue damage. The power was increased to 75 W for the last four dogs. The temperature was maintained between 45°C and 55°C (113 °F-131 °F) at the bone/soft tissue interface. Tumor necrosis varied between 30% and 90% (median, 55%) according to histopathology. No intraoperative or periprocedural complications were observed. CONCLUSION Microwave ablation induced variable tumor necrosis and did not induce immediate postablation complications in these six dogs with distal radius OSA. CLINICAL SIGNIFICANCE These results justify further evaluation of MWA as a potential modality to treat primary bone lesions in dogs.
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Affiliation(s)
- Sarah A Salyer
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Vincent A Wavreille
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Joelle M Fenger
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Ryan N Jennings
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - Laura E Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
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Timercan A, Brailovski V, Petit Y, Lussier B, Séguin B. Personalized 3D-printed endoprostheses for limb sparing in dogs: Modeling and in vitro testing. Med Eng Phys 2019; 71:17-29. [PMID: 31327657 DOI: 10.1016/j.medengphy.2019.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 06/21/2019] [Accepted: 07/04/2019] [Indexed: 01/01/2023]
Abstract
Osteosarcoma is the most common type of bone cancer in dogs, treatable by amputation or limb-sparing surgery. For the latter, commercially available plate - endoprosthesis assemblies require contouring, to be adapted to the patient's bone geometry, and lead to sub-optimal results. The use of additively-manufactured personalized endoprostheses and cutting guides for distal radius limb-sparing surgery in dogs presents a promising alternative. Specialized software is used for the bone structure reconstruction from the patient's CT scans and for the design of endoprostheses and cutting guides. The prostheses are manufactured from a titanium alloy using a laser powder bed fusion system, while the cutting guides are manufactured from an ABS plastic using a fused deposition modeling system. A finite element model of an instrumented limb was developed and validated using experimental testing of a cadaveric limb implanted with a personalized endoprosthesis. Personalized endoprostheses and cutting guides can reduce limb sparing surgery time by 25-50% and may reduce the risk of implant failure. The numerical model was validated using the kinematics and force-displacement diagrams of the implant-limb construct. The model indicated that a modulus of elasticity of an implant material ranging from 25 to 50 GPa would improve the stress distribution within the implant. The results of the current study will allow optimization of the design of the personal implants in both veterinary and human patients.
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Affiliation(s)
- Anatolie Timercan
- Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame West, Montreal, Quebec H3C1K3, Canada.
| | - Vladimir Brailovski
- Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame West, Montreal, Quebec H3C1K3, Canada.
| | - Yvan Petit
- Department of Mechanical Engineering, École de technologie supérieure, 1100 Notre-Dame West, Montreal, Quebec H3C1K3, Canada.
| | - Bertrand Lussier
- Faculty of Veterinary Medicine, Université de Montréal, 3200 Sicotte, Saint-Hyacinthe, Quebec J2S2M2, Canada.
| | - Bernard Séguin
- Colorado State University Flint Animal Cancer Center, 300 W Drake, Fort Collins, Colorado 80525, USA.
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Bray JP, Kersley A, Downing W, Crosse KR, Worth AJ, House AK, Yates G, Coomer AR, Brown IWM. Clinical outcomes of patient-specific porous titanium endoprostheses in dogs with tumors of the mandible, radius, or tibia: 12 cases (2013–2016). J Am Vet Med Assoc 2017; 251:566-579. [DOI: 10.2460/javma.251.5.566] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Steffey MA, Garcia TC, Daniel L, Zwingenberger AL, Stover SM. Mechanical properties of canine osteosarcoma-affected antebrachia. Vet Surg 2017; 46:539-548. [PMID: 28152185 DOI: 10.1111/vsu.12628] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 11/08/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To determine the influence of neoplasia on the biomechanical properties of canine antebrachia. STUDY DESIGN Ex vivo biomechanical study. SAMPLE POPULATION Osteosarcoma (OSA)-affected canine antebrachia (n = 12) and unaffected canine antebrachia (n = 9). METHODS Antebrachia were compressed in axial loading until failure. A load-deformation curve was used to acquire the structural mechanical properties of neoplastic and unaffected specimens. Structural properties and properties normalized by body weight (BW) and radius length were compared using analysis of variance (ANOVA). Modes of failure were compared descriptively. RESULTS Neoplastic antebrachia fractured at, or adjacent to, the OSA in the distal radial diaphysis. Unaffected antebrachia failed via mid-diaphyseal radial fractures with a transverse cranial component and an oblique caudal component. Structural mechanical properties were more variable in neoplastic antebrachia than unaffected antebrachia, which was partially attributable to differences in bone geometry related to dog size. When normalized by dog BW and radial length, strength, stiffness, and energy to yield and failure, were lower in neoplastic antebrachia than in unaffected antebrachia. CONCLUSIONS OSA of the distal radial metaphysis in dogs presented for limb amputation markedly compromises the structural integrity of affected antebrachia. However, biomechanical properties of affected bones was sufficient for weight-bearing, as none of the neoplastic antebrachia fractured before amputation. The behavior of tumor invaded bone under cyclic loading warrants further investigations to evaluate the viability of in situ therapies for bone tumors in dogs.
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Affiliation(s)
- Michele A Steffey
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Tanya C Garcia
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Leticia Daniel
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Allison L Zwingenberger
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Susan M Stover
- Department of Anatomy, Physiology and Cell Biology, School of Veterinary Medicine, University of California-Davis, Davis, California
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Mitchell KE, Boston SE, Kung M, Dry S, Straw RC, Ehrhart NP, Ryan SD. Outcomes of Limb-Sparing Surgery Using Two Generations of Metal Endoprosthesis in 45 Dogs With Distal Radial Osteosarcoma. A Veterinary Society of Surgical Oncology Retrospective Study. Vet Surg 2016; 45:36-43. [PMID: 26731595 DOI: 10.1111/vsu.12423] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To report outcomes in dogs with distal radial osteosarcoma (OSA) treated with metal endoprosthesis limb-sparing surgery and compare outcomes between 2 generations of endoprosthesis. STUDY DESIGN Multi-institutional retrospective case series. ANIMALS Forty-five dogs with distal radial OSA treated with endoprosthesis and chemotherapy. METHODS Data of dogs treated with either first-generation endoprosthesis (GEN1) or second-generation endoprosthesis (GEN2) were sourced from medical records and radiographs. Surgical outcomes included postoperative lameness assessment and the presence, severity, and time to onset of complications. Oncologic outcomes included presence of local recurrence or metastasis, time to onset of local recurrence, metastasis-free interval (MFI), and survival time. Results for surgical and oncologic outcomes were compared between GEN1 and GEN2. RESULTS Twenty-eight dogs received GEN1 and 17 dogs received GEN2. There were 39 complications (96%, 14 minor, 29 major) including infection (78%), implant-related complication (36%), and local recurrence (24%). Metastatic frequency was 67% and median MFI was 188 days (95% confidence interval [CI]: 126-250 days). Survival time ranged from 34 days to 6.1 years with a median of 289 days (95% CI: 207-371 days). There was no significant difference in complication severity, frequency, time to complication, MFI, or survival time between dogs receiving GEN1 and GEN2. CONCLUSION There was no significant difference in outcomes between dogs receiving GEN1 and GEN2 for limb-sparing surgery of the radius. Metastatic frequency and survival time for metal endoprosthesis were similar to that of amputation with curative intent chemotherapy.
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Affiliation(s)
- Katherine E Mitchell
- Translational Research and Animal Clinical Trial Study (TRACTS) Group, University of Melbourne Veterinary Teaching Hospital, Werribee, Australia
| | - Sarah E Boston
- College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Marvin Kung
- Australian Animal Cancer Foundation, Brisbane Veterinary Specialist Centre, Albany Creek, Australia
| | - Sarah Dry
- Southpaws Specialty Surgery for Animals, Moorabbin, Australia
| | - Rod C Straw
- Australian Animal Cancer Foundation, Brisbane Veterinary Specialist Centre, Albany Creek, Australia
| | - Nicole P Ehrhart
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Stewart D Ryan
- Translational Research and Animal Clinical Trial Study (TRACTS) Group, University of Melbourne Veterinary Teaching Hospital, Werribee, Australia
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Karnik KS, Samii VF, Weisbrode SE, London CA, Green EM. Accuracy of computed tomography in determining lesion size in canine appendicular osteosarcoma. Vet Radiol Ultrasound 2012; 53:273-9. [PMID: 22413965 DOI: 10.1111/j.1740-8261.2012.01930.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 01/17/2012] [Indexed: 11/29/2022] Open
Abstract
Multidetector contrast enhanced computed tomography with acquisition of 0.625-mm thick transverse images was used to measure the extent of appendicular osteosarcoma in 10 dogs. The measured length of tumor based on CT was compared to the true length of tumor using histopathology. There was a statistically significant association with good correlation between the true length of osteosarcoma compared to the length of intramedullary/endosteal abnormalities on CT with a mean overestimation of 1.8% (SD = 15%). There was not a statistically significant association between the true tumor length and the length of periosteal proliferation on CT with a mean overestimation of 9.7% (SD = 30.3%). There was a statistically significant association, but with poor correlation, between the true tumor length compared to the length of abnormal contrast enhancement with a mean overestimation of 9.6% (SD = 34.8%). The extent of intramedullary/endosteal CT abnormalities assessed from submillimeter transverse images may be of value in assessing patient candidacy and surgical margins for limb-sparing surgery.
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Affiliation(s)
- Ketaki S Karnik
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH 43210, USA.
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Morello E, Martano M, Buracco P. Biology, diagnosis and treatment of canine appendicular osteosarcoma: Similarities and differences with human osteosarcoma. Vet J 2011; 189:268-77. [DOI: 10.1016/j.tvjl.2010.08.014] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 08/12/2010] [Accepted: 08/28/2010] [Indexed: 10/19/2022]
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Hodge SC, Degner D, Walshaw R, Teunissen B. Vascularized Ulnar Bone Grafts for Limb-Sparing Surgery for the Treatment of Distal Radial OsteosarcomaS. J Am Anim Hosp Assoc 2011; 47:98-111. [DOI: 10.5326/jaaha-ms-5504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this retrospective study was to compare vascularized free or roll-in ulnar bone grafts for limb-sparing surgery in dogs with radial osteosarcoma with the cortical allograft, metal endoprosthesis, or distraction osteogenesis techniques. Overall, the ulnar graft techniques used in this study demonstrated excellent healing properties. Complications included recurrence of the tumor in 25% (2/8) of the dogs, metastasis in 50% (4/8) of the dogs, implant loosening in 37.5% (3/8) of the dogs, implant failure in 12.5% (1/8) of the dogs, and infection in 62.5% (5/8) of the dogs. Mean survival time was 29.3 mo (range, 9 to 61 mo). The mean metastasis-free interval was 33.67 mo (range, 8 to 54 mo). Tumors recurred locally in two dogs at 10 mo and 20 mo postoperatively. This study yielded similar long-term complications as other limb-sparing options (such as cortical allografts and metal endoprostheses) and allowed dogs to bear weight on the operated limb with acceptable limb function. More research is needed regarding specific healing times for ulnar vascularized grafts, time until implant removal, and the extent of radial bone that could ultimately be replaced by the ulna.
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Affiliation(s)
- Susan C. Hodge
- Tennessee Avenue Animal Hospital, Cincinnati, OH (S.H.); Michigan Veterinary Specialists, Southfield, MI (D.D.); The Animal Cancer & Imaging Center, Canton, MI (R.W.); and Lakeshore Veterinary Specialists & Emergency Hospital, Port Washington, WI (B.T.)
| | - Daniel Degner
- Tennessee Avenue Animal Hospital, Cincinnati, OH (S.H.); Michigan Veterinary Specialists, Southfield, MI (D.D.); The Animal Cancer & Imaging Center, Canton, MI (R.W.); and Lakeshore Veterinary Specialists & Emergency Hospital, Port Washington, WI (B.T.)
| | - Richard Walshaw
- Tennessee Avenue Animal Hospital, Cincinnati, OH (S.H.); Michigan Veterinary Specialists, Southfield, MI (D.D.); The Animal Cancer & Imaging Center, Canton, MI (R.W.); and Lakeshore Veterinary Specialists & Emergency Hospital, Port Washington, WI (B.T.)
| | - Brian Teunissen
- Tennessee Avenue Animal Hospital, Cincinnati, OH (S.H.); Michigan Veterinary Specialists, Southfield, MI (D.D.); The Animal Cancer & Imaging Center, Canton, MI (R.W.); and Lakeshore Veterinary Specialists & Emergency Hospital, Port Washington, WI (B.T.)
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Abstract
A nine-year-old cat was presented with non-weight-bearing lameness of the right forelimb subsequent to an old fracture of the antebrachium previously treated by external stabilisation. Radiography showed severe atrophic non-union of the distal third of the radius and carpal luxation. Ulnocarpal arthrodesis was performed using a uniplanar external fixator. Follow-up radiography showed that bone fusion was slow but without complication. After 16 weeks, the external fixator was removed, and a Robert-Jones bandage was applied for one month. From postoperative week 2 onwards, the animal progressively made use of the limb in a weight-bearing capacity. At the last examination, one year postoperative, no lameness was observed.
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Affiliation(s)
- B Pucheu
- Saint Maur Veterinary Clinic, 59110 Lille, France
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Jehn CT, Lewis DD, Farese JP, Ferrell EA, Conley WG, Ehrhart N. Transverse ulnar bone transport osteogenesis: a new technique for limb salvage for the treatment of distal radial osteosarcoma in dogs. Vet Surg 2007; 36:324-34. [PMID: 17547595 DOI: 10.1111/j.1532-950x.2007.00273.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To develop instrumentation and a technique for transverse ulnar bone transport osteogenesis in dogs. STUDY DESIGN Cadaveric study and in vivo validation (1 dog). SAMPLE POPULATION Paired cadaveric antebrachii (n=10 dogs) and 1 live dog. METHODS Circular fixator constructs were applied and fitted with reeling or linear motors designed to transport an ulnar segment transversely into a defect created by excising the distal 50% of the ipsilateral radius. A longitudinal osteotomy of the adjacent ulna was created and the segment was transported across the radial defect. Pre- and post-distraction CT scans were used to compare the efficacy of each construct. The procedure was performed unilaterally in a live dog using the reeling motor (RM) construct. RESULTS Both constructs effectively transported the ulnar segment into the defect. Subjectively, the RMs were easier to apply and operate. No significant differences were observed in the objective measures of efficacy between the 2 construct types. The live dog produced viable regenerate bone after transverse ulnar bone transport. CONCLUSIONS Transverse ulnar bone transport should be considered a potential method for limb salvage in dogs with osteosarcoma (OSA) of the distal radius. The RMs were effective and clinically applicable. CLINICAL RELEVANCE Transverse ulnar bone transport osteogenesis affords the benefits of longitudinal radial bone transport osteogenesis, allowing resolution of large longitudinal radial defects in a substantially less time as a result of shortening the transport distance. This would be beneficial when treating conditions such as OSA where minimizing convalescence and maximizing quality of life is a priority.
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Affiliation(s)
- Carl T Jehn
- Department of Small Animal Clinical Sciences and the Center for Veterinary Sports Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32610-0126, USA.
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14
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Liptak JM, Ehrhart N, Santoni BG, Wheeler DL. Cortical Bone Graft and Endoprosthesis in the Distal Radius of Dogs: A Biomechanical Comparison of Two Different Limb-Sparing Techniques. Vet Surg 2006; 35:150-60. [PMID: 16472295 DOI: 10.1111/j.1532-950x.2006.00126.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the biomechanical properties of cortical bone and surgical steel endoprosthesis for limb-sparing surgery of the distal radius in dogs and evaluate the role of the ulna in providing stability to the reconstructed limb. STUDY DESIGN Cadaveric biomechanical study. ANIMALS Twelve pairs of normal canine thoracic limbs. METHODS Paired limbs were divided into 4 groups: endoprosthesis and cortical bone graft, with and without preservation of the ulna. In each limb pair, the distal segment of the radius resected from the limb to be reconstructed with an endoprosthesis was used as the cortical bone graft in the contralateral limb. The ulna was resected en bloc with the radius and at the same level as the radial osteotomy in limbs where the ulna was not preserved. Limbs were tested in axial loading until failure. The load-deformation curve was used to acquire the biomechanical properties of each construct, which were compared using 2-way ANOVA. Failure modes were compared descriptively. RESULTS Limbs reconstructed with the endoprosthesis had significantly greater yield load, energy at yield, and ultimate load compared with limbs reconstructed with a cortical bone graft. There were no significant differences in either energy to failure or stiffness between the 2 constructs. Preservation of the ulna did not significantly improve any of the biomechanical properties tested with either endoprosthesis or cortical bone graft constructs. The modes of failure in all 4 groups were variable and inconsistent. CONCLUSIONS Limbs reconstructed with an endoprosthesis were biomechanically superior to limbs reconstructed with a cortical bone graft in axial loading to failure. Preservation of the ulna is not required to improve the stability in axial compression after limb-sparing surgery of the distal radius. CLINICAL RELEVANCE The endoprosthesis may provide another option for limb-sparing surgery of the distal radius in dogs. It has potential advantages when compared with cortical bone grafts, including better biomechanical performance and resistance to implant failure in axial compression, immediate availability, and no requirement for bone banking facilities. The ulna can be resected en bloc with the radius without having a negative impact on construct stability. En bloc resection of the ulna and radius may decrease the risk of local tumor recurrence after limb-sparing surgery.
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Affiliation(s)
- Julius M Liptak
- Animal Cancer Center and Department of Mechanical and Biomedical Engineering, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA.
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