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Femoral fractures are often considered lethal for adult horses because femur osteosynthesis is still a surgical challenge. For equine femur osteosynthesis, primary stability is essential, but the detailed physiological forces occurring in the hindlimb are largely unknown. The objective of this study was to create a numerical testing environment to evaluate equine femur osteosynthesis based on physiological conditions. The study was designed as a finite element analysis (FEA) of the femur using a musculoskeletal model of the loading situation in stance. Relevant forces were determined in the musculoskeletal model via optimization. The treatment of four different fracture types with an intramedullary nail was investigated in FEA with loading conditions derived from the model. The analyzed diaphyseal fracture types were a transverse (TR) fracture, two oblique fractures in different orientations (OB-ML: medial-lateral and OB-AP: anterior-posterior) and a "gap" fracture (GAP) without contact between the fragments. For the native femur, the most relevant areas of increased stress were located distally to the femoral head and proximally to the caudal side of the condyles. For all fracture types, the highest stresses in the implant material were present in the fracture-adjacent screws. Maximum compressive (-348 MPa) and tensile stress (197 MPa) were found for the GAP fracture, but material strength was not exceeded. The mathematical model was able to predict a load distribution in the femur of the standing horse and was used to assess the performance of internal fixation devices via FEA. The analyzed intramedullary nail and screws showed sufficient stability for all fracture types., (© 2024. The Author(s).)

Background: The bone regeneration potential of erythropoietin (EPO) is not yet fully investigated, but some previous experimental studies demonstrated that its application activated the differentiation of osteoblasts and promoted bone formation., Aim: The aim of the present study was to evaluate the effects of recombinant human erythropoietin (rhEpo) on bone healing in cats with fragmented long bone fractures., Methods: Twelve cats were divided into two groups-control ( n = 6) in which physiological saline was applied at the fracture gap site and EPO ( n = 6) with the application of 1,000 IU rhEpo. The effects of EPO on blood erythrocyte counts, hemoglobin content, and hematocrit were monitored by serial complete blood cell tests, whereas bone formation was evaluated by clinical and radiographic examinations on post-operative weeks 1, 2, 3, 4, 6, and 8., Results: All tested blood parameters were within the reference range. A faster fracture healing and full limb weight-bearing were observed in the EPO group, with statistically significant differences with respect to the control group., Conclusion: The obtained results confirmed that the local application of rhEpo promoted bone healing in cats with fragmented femoral fractures and increased bone callus strength without having significant systemic effects., Competing Interests: The authors declare no conflict of interest.

Objectives: To report the short-term clinical and radiographic outcomes in cats with femoral capital physeal fractures stabilised with transcervical pinning., Materials and Methods: Medical records of cats diagnosed with femoral capital physeal fractures and treated with transcervical pinning were reviewed. The collected data included signalment, weight, time from lameness to surgery, reported trauma, affected side, concomitant orthopaedic injuries, radiographs, osteoarthritis, femoral neck osteolysis, proximal femoral epiphysis to femoral neck ratio, fracture reduction, implants, complications and clinical evaluation results. An owner questionnaire was used for long-term follow-up., Results: Nineteen cats with a total of 21 fractures met the inclusion criteria. Fifteen of the 19 cats showed no signs of lameness at the 1-month follow-up. Major and catastrophic complications occurred in 9.5% and 23.8% of the fractures, respectively. All catastrophic complications occurred in fractures with a high preoperative osteolysis grade (2 or 3)., Clinical Significance: In our study, transcervical pinning was found to be a reliable fixation method for the treatment of femoral capital physeal fractures in cats with minimal preoperative femoral neck osteolysis. High rates of implant failure with loss of fracture reduction were observed in cats with high-grade preoperative osteolysis., (© 2023 British Small Animal Veterinary Association.)

Objective: To describe the success rate and associated complications of external skeletal fixator/intramedullary pin tie-in for calf femoral fracture fixation., Study Design: Clinical retrospective., Animals: Ten calves, less than 30 days old, with diaphyseal/metaphyseal femoral fractures., Methods: Medical records were reviewed from the University of Wisconsin from 2000 to 2020. Fractures were repaired using open reduction and fixation. An intramedullary Steinman pin was placed, exiting near the greater trochanter, and utilized for fracture reduction. Bicortical transfixation pins were placed distal and proximal to the fracture site. Poly(methyl methacrylate) (PMMA)-filled tubing connected the transfixation pins and proximal intramedullary pin, creating a Type 1a external skeletal fixator (ESF) tie-in. Follow up was obtained via medical records and phone interviews., Results: Short-term survival rate was 7/10 (70%). Postanesthetic death occurred once. Postoperative complications occurred in all remaining cases. The most common findings were transfixation pin tract lucency and lameness (6/9 cases), implant dysfunction (5/9 cases), and infection (4/9 cases). Three of five cases with long-term follow up survived; all went on to productive careers., Conclusion: Although patients were prone to postoperative complications, short-term survival was comparable to previous reports., Clinical Significance: The external skeletal fixator/intramedullary (ESF/IM) pin tie-in is less expensive and offers comparable success rates to other methods, providing a lower cost option for calf femoral fracture repair., (© 2023 The American College of Veterinary Surgeons.)

Objective: Assess the accuracy and efficiency of reduction provided by application of plates precontoured to 3-dimensional (3D)-printed femoral bone models using a custom fracture reduction system (FRS) or intramedullary pin (IMP) to facilitate femoral minimally invasive plate osteosynthesis (MIPO) in dogs., Study Design: Experimental cadaveric study., Sample Population: Seven dog cadavers., Methods: Virtual 3D femoral models were created using computed tomographic images. Simulated, virtual mid-diaphyseal femoral fractures were created and reduced. Reduced femoral models were 3D-printed and a plate was contoured. Custom drill guides for plate screw placement were designed and 3D-printed for the FRS. Mid-diaphyseal simulated comminuted fractures were created in cadavers, and fractures were aligned using FRS or IMP and stabilized with the precontoured plates. Number of fluoroscopic images acquired per procedure and surgical duration were recorded. Computed tomographic scans were repeated to assess femoral length and alignment., Results: Compared to the preoperative virtual plan, median change in femoral length and frontal, sagittal, and axial alignment was less than 3 mm, 2°, 3°, and 3° postoperatively, respectively, in both reduction groups. There was no difference in length or alignment between reduction groups (P > .05). During FRS, fewer fluoroscopic images were taken (P = .001), however, surgical duration was longer than IMP procedures (P = .011)., Conclusion: Femoral alignment was accurate when using plates precontoured to 3D printed models, regardless of reduction method., Clinical Significance: Accurate plate contouring using anatomically accurate models may improve fracture reduction accuracy during MIPO applications. Custom surgical guides may reduce fluoroscopy use associated with MIPO., (© 2022 American College of Veterinary Surgeons.)

Objectives: To report the short-term clinical outcome and complications in dogs that underwent surgical repair of femoral capital physeal or neck fractures via fluoroscopic-guided percutaneous pinning (FGPP)., Study Design: Retrospective case series., Animals: Client owned dogs (n = 11) with femoral capital physeal or neck fractures (n = 13)., Methods: Records (July 2018-July 2021) of dogs that underwent surgery for femoral capital physeal or neck fracture repair with FGPP from two hospitals were reviewed. Data collected included signalment, age, weight, preoperative lameness severity, fracture factors (etiology, Salter-Harris classification, time from injury to surgery, radiographic displacement), surgical factors (surgery time, number/size of implants, reduction quality) and outcome (follow-up examination findings, radiographic findings, complications)., Results: Most fractures (11/13) occurred secondary to trauma. The median time from injury to surgery was 5.5 days. There was mild radiographic displacement preoperatively in 10/13 fractures. Satisfactory fracture healing and limb function was achieved in 10/13 femurs. Complications occurred in 5/11 cases and included intra-articular implants, implant failure/nonunion, implant migration (2), and malunion. Of these five complications, two resolved with implant removal, and a salvage procedure was recommended in the remaining cases. Of the three cases requiring salvage procedures, two originally presented with radiographic evidence of fracture chronicity., Conclusions: FGPP can be used to successfully treat femoral head and neck fractures with appropriate case selection and precise surgical technique., (© 2022 American College of Veterinary Surgeons.)

Objective:  Our objectives were to report complications associated with stabilization of long-bone fractures in cats using a 3.5-mm titanium interlocking nail and to examine the influences of signalment, fracture type and fixation evaluations on the occurrence of complications., Study Design:  Retrospective clinical study., Material and Methods:  Medical and radiographic records of cats with long-bone fractures treated with an interlocking nail were reviewed. Data included age, sex, weight, cause of the fracture, fractured bone(s) and fracture type. Complications were classified as minor and major complications. Fisher's exact tests and logistic regression analysis were used to test whether certain variables of signalment and interlocking nail configuration had an effect on the occurrence of complications., Results:  Sixty-seven fractures of 67 cats were examined in this study. Forty-eight femora, sixteen tibiae and three humeri were included. Complications occurred in 11/67 fractures. Major complications occurred in 8/67 fractures and included screw breakage ( n  = 3), nail breakage ( n  = 2), nail bending ( n  = 1), screw loosening ( n  = 1), non-union (n = 1). Statistical analysis showed a significant difference between fracture types and the occurrence of major complications ( p  = 0.02)., Conclusion:  In conclusion, use of this commercially available standard 3.5-mm titanium interlocking nail for stabilization of comminuted and oblique humeral, femoral and tibial fractures in cats is feasible., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: To evaluate the clinical outcomes of total hip replacements (THR) utilizing a BFX lateral bolt stem in dogs with coxofemoral joint disease., Study Design: Retrospective study., Sample Population: A total of 149 dogs representing 195 THR., Methods: Consecutive THRs utilizing a BFX lateral bolt stem were studied. Preoperative, immediate postoperative, 1-, 2-, 3-, 4-, and 12-month postoperative radiographs were performed. All major and minor complications, revisions, outcomes, subsidence, canal flare index (CFI) were recorded., Results: An intraoperative complication rate of 11.8% was observed. The postoperative complication rate was 13.6%, with 9.2% major and 4.4% minor complications. Complications included: postoperative femur fractures (3.6%), coxofemoral luxation (3.6%), stem failure (0.5%), septic loosening (0.5%), aseptic loosening (0.5%), and acetabular fracture (0.5%). Three dogs underwent prophylactic plating after subjective assessment of cortical thickness. Five of 195 (2.6%) cases underwent explant of their prostheses (median = 3 months). Mean stem subsidence at 1 month postoperatively was 1.22 ± 0.16 mm. An increased CFI was associated with postoperative femur fractures (p < .05). A total of 190 of 195 (97.4%) cases returned to normal function in the long-term follow-up period., Conclusion: Use of the BFX lateral bolt stem resulted in minimal postoperative subsidence, a low femoral stem complication rate, and a high rate of achieving normal limb function., Clinical Significance: The BFX lateral bolt stem should be considered in canine THR as the femoral failure rate is low and the long-term success rate is high., (© 2022 American College of Veterinary Surgeons.)

Objective:  The aim of this study was to report the short-term clinical and radiographic outcome for the treatment of femoral capital physeal fractures with cortical positional screws in cats., Study Design:  Medical records and radiographs of cats with femoral capital physeal fractures stabilized with cortical positional screws were retrospectively reviewed. Signalment, bodyweight, femoral head affected, fracture classification, fracture reduction, implants, concurrent orthopaedic injuries, osteoarthritis, femoral neck osteolysis, complications and 6-week follow-up clinical results were recorded. A short- to long-term follow-up was performed by telephone questionnaire with the owners., Results:  Forty-six fractures in 39 cats met the inclusion criteria. In 45/46 fractures, radiographic signs of bone healing were present and 35/39 cats were assessed as walking normally by a veterinarian at 6-week follow-up. There was a significant increase in radiographic signs of osteoarthritis ( p =0.037) and femoral neck osteolysis ( p =0.001) on 6-week follow-up radiographs. Pre- and postoperative osteoarthritis and femoral neck osteolysis were not associated with clinical outcome. The mean follow-up period for the telephone questionnaire was 48 months (range, 5-147 months). Seven out of 25 owners reported a gait abnormality in the short- to long-term., Conclusion:  Femoral capital physeal fractures in cats can be treated successfully with the use of cortical positional screws. This technique may be considered as an alternative to other primary fixation techniques and salvage procedures for the treatment of femoral capital physeal injuries in cats. This technique seemed successful in cats with a low-grade preoperative femoral neck osteolysis., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: Femoral fractures are often catastrophic in large animals. Radiographic diagnosis is limited by patient size and feasibility, especially in ambulatory settings. Ultrasonography is widely available and may provide an alternative to radiography for definitive diagnosis., Animals: 12 large animals (6 horses, 5 cattle, and 1 elephant)., Procedures: Retrospective analysis of large animal patients diagnosed with femoral fracture by use of femoropelvic ultrasonography (2000 to 2019)., Results: 5 of 12 cases were ≤ 1 year of age. The remaining 7 cases were 2 to 33 years of age (median, 13 years). All patients developed severe acute lameness after falling (n = 4), limb entrapment (2), dystocia (1), vehicular collision (1), ipsilateral full limb casting (1), or unknown events (3). All were non-weight-bearing or lame at the walk, including 2 recumbent cattle. Ten cases showed upper limb swelling that was variable in location, and 3 had nonspecific upper limb crepitus. Ultrasonography revealed evidence of diaphyseal (n = 6), greater trochanteric (2), capital physeal (2), and distal femoral (2) fractures. Fracture movement during limb manipulation or weight shifting was sonographically visualized in 5 animals. Radiography confirmed fractures in 3 of 8 animals: 2 bovines with distal femoral fractures detected on standing projections and 1 capital physeal fracture that required ventrodorsal projections under general anesthesia. All animals were euthanized (11) or slaughtered (1 bovine). Postmortem examination confirmed ultrasonographic findings in 10 of 10 necropsied animals., Clinical Relevance: Femoral fractures were not localized nor confirmed in any case prior to ultrasonography. Study findings supported the use of ultrasonography for rapid patient-side diagnosis, prognostication, and decision-making in suspect cases.

Animal posture, limb gait, and body weight-bearing in dogs can be evaluated by limb gait score. In this study, nine adult male dogs of local breed were used to induce a complete transverse femoral mid-shaft fracture fixed internally by intramedullary pining under general anesthesia with the aseptic technique and followed for 60 days postoperative. The data were analyzed, including five degrees that indicate the correlation among animals' posture, limbs, and body weight tolerance per day. The results demonstrated that in grade 5, the animals completely hold the affected limb during standing position 1 st -3 rd day postoperative. From the 4 th -10 th day postoperative, in grade 4, the animals supported the body weight on the affected limb in the standing position and hold it during waking. In grade 3, from 11 th -21 th day postoperative, the operated animals supported body weight on the affected limb in slow waking and hold it in speed waking and running. From the 22 nd -28 th day postoperative, in grade 2, the animals used the limb in speed walking, from the 29 th -35 th day postoperative. In grade1, the animals could use the limb in running from the 36 th -2 nd day postoperative. In grade 0, the animals used the limb normally in walking, running, and jumping until the end of experimental periods (60 th day postoperative). The results indicated that limb gait scores in dogs can be used for the evaluation of the relationships among animals' posture, limb gait, and body-weight bearing per day during bone regeneration processing of femur fracture fixed by intramedullary pining.

Practical Relevance: The femur is the most commonly fractured bone in cats. Femoral fractures usually result from high-velocity trauma such as a road traffic accident or fall from a height and, as such, are associated with a wide variety of concurrent injuries. The initial focus of treatment should always be on assessment and stabilisation of the major body systems. Once any concurrent injuries have been addressed, all femoral fractures need surgical stabilisation, with the notable exception of greenstick fractures in very young cats, which can heal with cage rest alone. A number of different surgical options are available depending on the fracture type, location, equipment, surgeon experience and owner finances., Clinical Challenges: Femoral fractures can vary hugely in complexity and the small size of feline bones can limit the choice of implants. Furthermore, cats can present unique challenges in the postoperative period due to their active nature and the limited means to control their exercise level., Audience: This review is aimed at general and feline-specific practitioners who have some experience of feline orthopaedics, as well as those simply wishing to expand their knowledge., Aims: The aim of this review is to help clinicians assess, plan and manage feline femoral fractures. It provides an overview of diagnostic imaging and a discussion of a range of suitable surgical options, including the principles of different types of fixation. It also highlights cat-specific issues, approaches and implants pertinent to the management of these cases., Evidence Base: A number of original articles and textbook chapters covering many aspects of femoral fractures in cats and dogs have been published. Where possible, this review draws on information from key feline research and, where necessary, extrapolates from relevant canine literature. The authors also offer practical guidance based on their own clinical experience.

Objective: To report outcomes of cementless collared stem total hip replacement (THR) with proximal femoral periprosthetic cerclage application in dogs., Study Design: Retrospective case series., Animals: Client-owned dogs (n = 150) with THR (n = 184)., Methods: Serial postoperative radiographs and medical records of dogs that underwent consecutive index cementless THR, with a single full cerclage wire placed distal to the femoral neck osteotomy line and proximal to the lesser trochanter, were reviewed for intraoperative and postoperative complications., Results: No proximal femoral fractures occurred. No complications associated with the use of the cerclage wire were encountered. A fissure (n = 1) or fractures (n = 2) occurred near the tip of the femoral stem in three cases postoperatively. All three cases required plate and screw fixation. All dogs returned to subjectively normal function at home and all owners were satisfied with the outcome., Conclusion: A single full cerclage wire may minimize the risk of a proximal femur fracture following cementless collared stem total hip replacement in dogs. No complications were encountered with the cerclage wire., Clinical Significance: Application of a cerclage wire is a simple and economically feasible procedure that requires minimal additional instrumentation, takes little time, and may decrease the risk of proximal femur fractures after cementless press-fit THR., (© 2021 American College of Veterinary Surgeons.)

The cross-pin technique for the treatment of distal femoral physis fractures (specifically, Salter-Harris Type I fractures) was investigated using femurs collected from beagle cadavers. The pin was inserted from the medial surface of the femur at an inclination of approximately 30 to 45° relative to the long axis of the femur in the anteroposterior direction; the pin exit was set proximal to the origin of the long digital extensor tendon. Digital and radiographic images of the femur in the anteroposterior and lateral directions were obtained. In both types of images, the insertion angle of the pin relative to the long axis was measured. Results suggest that when inserting a pin proximal to the fracture line, the ideal position can be achieved by inclining the pin approximately 20° cranially relative to the long axis of the lateral direction of the femur, in addition to the previously described criteria., (Copyright and/or publishing rights held by the Canadian Veterinary Medical Association.)