Search Results (14)

Articular fractures require precise anatomical reduction and rigid fixation to heal appropriately. In veterinary cases that involve fracturing of the lateral humeral condyle, cortical bone screws inserted in lag fashion with Kirschner wire are the preferred method for surgical fixation. However, relatively high complication rates associated with cortical lag screws (CLSs) highlights the need to investigate alternate screw designs. Variable-pitch headless compression screws (VPHCSs) are unique as they advance beneath the cortical surface. Although the use of VPHCSs are widely utilised in human orthopaedics, the current use in veterinary orthopaedics is limited. This study aimed to evaluate the peak interfragmentary force (PIF) and area of compression (AOC) generated by a 3.5 mm self-tapping cortical screw placed in lag fashion and a 3.5 mm VPHCS inserted to four depths. PIF and AOC were measured using a pressure-sensitive film placed between two blocks of polyurethane foam (0.24 g/cm³), simulating a transverse fracture. CLSs were inserted by hand into predrilled 2.5 mm pilot holes. PIF and AOC were measured at full insertion. VPHCSs were placed into predrilled 2.5 mm pilot holes, followed by a 3.5 mm tapered countersink. The screw was inserted until the head was level with the surface. PIF and AOC were measured between the two blocks. The screw was continued until the head was at a depth of 2, 5, and 9 mm below the surface, and the PIF and AOC were measured again at each stage. There was no detectable difference in PIF and AOC between CLSs and VPHCSs countersunk to −2 mm (PIF–CLS: Mean = 12.886, SD = 2.370; 2 mm: Mean = 17.301, SD = 8.858, p = 0.319; AOC–CLS: Mean = 0.936, SD = 0.291; 2 mm: Mean = 0.925, SD = 0.447, p = 0.872). VPHCSs countersunk to −5 mm and −9 mm produced significantly greater PIF compared to CLSs (5 mm: Mean = 16.086, SD = 6.799, p = 0.002; 9 mm: Mean = 34.987, SD = 4.015, p < 0.001). VPHCSs countersunk to −5 and −9 mm produced significantly greater PIF and AOC compared to CLSs in this model. Further investigation is required to produce recommendations for clinical use. Full article

Background/Objectives: Transphyseal fracture of the distal humerus (TFDH) is a rare but clinically important pediatric elbow injury that predominantly affects children under 3 years of age. Due to the radiolucent nature of the cartilaginous distal humeral epiphysis in this age group, TFDH is often misdiagnosed as elbow dislocation, supracondylar fracture, or lateral/medial condyle fracture. Time pressures, limited pediatric musculoskeletal expertise, and incomplete clinical histories in emergency settings further compound this diagnostic challenge. Despite the importance of early and accurate diagnosis to prevent complications such as cubitus varus, systematic studies on diagnostic pitfalls and strategies for improving recognition remain scarce. We therefore aim to characterize misclassification patterns, standardize radiographic cues, and evaluate management outcomes. Methods: We conducted a single-center retrospective review of 25 pediatric patients with TFDH who were misdiagnosed at initial presentation between 2012 and 2022. Clinical records, radiographic features, treatment modalities, and complications were analyzed over a minimum follow-up period of 24 months. Results: All 25 cases were initially misdiagnosed. The most common misdiagnoses were supracondylar and lateral condyle fractures (each 6/25, 24%), followed by elbow dislocation (4/25, 16%). Misclassification was primarily attributed to failure to assess global forearm–humerus alignment and misinterpretation of the radiocapitellar line. All patients underwent emergency management, with 18/25 (72%) receiving closed reduction and percutaneous K-wire fixation, and 7/25 (28%) undergoing closed reduction and cast immobilization. Cubitus varus developed in 5/25 (20%) overall and was more frequent after closed reduction with cast immobilization (3/7, 43%) than after K-wire fixation (2/18, 11%). Overall, 92% achieved excellent functional outcomes according to the Mayo Elbow Performance Index (MEPI). The implementation of a targeted curriculum improved diagnostic accuracy among trainees from 70% to 100%. Conclusions: TFDH poses substantial cognitive and radiographic diagnostic challenges. A structured radiographic assessment, early senior review, and targeted education may improve recognition and outcomes. These findings offer actionable insights to enhance diagnostic accuracy and optimize care for this vulnerable patient population. Full article

Due to the complex anatomical structure of the distal humerus, elbow joint, and the soft tissue mantle (the triceps brachii muscle, large nerves, and vessels), fractures of the distal humerus and humeral condyle are difficult to treat. In most cases, strong instrumentation is needed to stabilize the fractures. To improve exposure of the distal humerus and humeral condyle, we proposed a caudolateral approach that involves elevating the anconeus muscle and splitting the triceps brachii. This study presents the results of using this approach in 16 canine cadavers. After exposing the distal humerus and maximally flexing the elbow joint, photographs were taken of the condyle from the same distance before and after olecranon osteotomy. The visible surface area of the articular cartilage was then calculated in square pixels after calibrating the photographs. It was possible to reach the distal and middle humerus in all cases. The only vital structure that could be easily identified and protected in all cadavers was the radial nerve. The visible area of the articular surface of the humeral condyle increased after olecranon osteotomy. The A₀ (visible area before osteotomy) was significantly smaller than the A₁ (visible area after osteotomy) in all dogs (p < 0.001). The ratio of A₀ to A₁ ranged from 57% to 67% in 15 dogs (median: 64%, interquartile range (IQR): 61–66%), with a very high value of 85% observed in one dog. This experiment used cadavers with intact elbows. This could limit the study’s findings because the effectiveness of the proposed access in reducing T-Y fractures was not assessed. The caudolateral approach is a valuable alternative to other methods for treating T-Y humeral fractures in dogs. Olecranon osteotomy widens access to the condyle. Further studies are needed to evaluate the necessity of olecranon osteotomy in clinical cases. Full article

Background and Clinical Significance: Non-prosthetic peri-implant fractures (NPPIFs) are rare injuries occurring around internal fixation devices, and are distinct from periprosthetic fractures. While most studies focus on the femur, humeral NPPIFs remain poorly documented. This case illustrates a complex humeral NPPIF and highlights key surgical considerations. Case Presentation: A 62-year-old woman presented with a spiral humeral shaft fracture (AO 12B2) after a fall. Following closed reduction and antegrade intramedullary nailing, an intraoperative peri-implant fracture occurred at the distal interlocking screw. CT imaging revealed a complex fracture extending from the lateral condyle to the proximal humerus. Treatment included implant removal and open reduction with dual plate fixation—lateral distal and helically contoured proximal plates—plus cerclage bands and antibiotic-loaded beads. Recovery was uneventful, with a full range of motion achieved at six months. At one year, the DASH score and MEPS were 86 and 75, respectively. Conclusions: Humeral NPPIFs are challenging and require individualized, biomechanically sound strategies. This case reinforces the importance of intraoperative assessment and careful implant selection in humeral fracture management. Full article

This study compares the compression force of cortical screws used in lag fashion with partially threaded cannulated screws and fully threaded headless cannulated screws as fixation methods for humeral condylar fractures in dogs. Cadavers of eleven dogs weighing an average of 10.99 ± 2.51 kg (6.1–14.4 kg) were used. The humeri were subjected to simulated fracture by performing an osteotomy at the trochlea of humerus and classified into three groups: Group 1 applied a 3.0 mm cortical screw applied in a lag fashion, Group 2 applied a 3.0 mm partially threaded cannulated screw, and Group 3 applied a 3.5 mm fully threaded headless cannulated screw. The samples were then placed in a material testing machine, and a compression force was applied vertically to the lateral condyle until failure. There were statistically significant differences in failure load between the groups (p = 0.009). The maximum failure load in Group 3 was significantly higher than in Group 2 (p = 0.014), while there were no statistically significant differences between Group 1 and Group 2) or between Group 1 and Group 3. Partially threaded cannulated screws and fully threaded headless cannulated screws can be alternatives to traditional stabilization methods, offering simpler procedures and additional advantages. Full article

Pediatric elbow fractures are quite common, accounting for up to 34% of bone fractures in children. Among these, acute lateral humeral condyle (LHC) fractures represent up to 22%. The accurate diagnosis and early treatment of LHC fractures are crucial due to the potential for abnormal growth and significant long-term impacts on joint motion. With the aim of enhancing the understanding of pediatric LHC fracture management among pediatric healthcare practitioners, we present a literature review combined with our technical recommendations based on our experience. Imaging through AP, lateral, and internal oblique X-rays remains the gold standard for diagnosis, although there is increasing focus on non-irradiating techniques, considering the skeletally immature nature of the patients. Several classification systems aid in fracture assessment, each varying in their simplicity, reproducibility, and inter- and intra-observer correlations. The treatment approaches for LHC fractures include conservative management with immobilization for minimally displaced fractures and surgical intervention for displaced fractures. The surgical options encompass closed and open reductions, using Kirschner wires or cannulated screws for fixation. While both methods show favorable outcomes, recent years have seen a growing interest in expanding the traditional indications for closed approaches. After a period of post-surgical immobilization of the limb, rehabilitation care is recommended to assist in the recovery of the range of motion. During the postoperative period, the most frequent complications are bony overgrowth, malunion, and infection, although with highly variable rates, which typically do not result in functional impairment if managed properly. Regular follow-up and monitoring are essential for optimal recovery and minimizing long-term complications. Full article

Pediatric elbow fractures and dislocations have always been a challenge from a diagnostic and therapeutic point of view, primarily due to the complex nature of the pediatric elbow, especially its developmental anatomy. They must be diagnosed and treated on time to prevent numerous complications with long-term consequences. With the development of radiology and pediatric surgery and orthopedics, as well as the development of modern osteosynthesis materials, concerning current scientific and professional knowledge, the outcomes are getting better, with fewer acute and chronic complications. This comprehensive review aims to provide clinicians current knowledge about pediatric elbow fractures and dislocations so that in daily practice they have as few doubts as possible with the best possible treatment outcomes. Full article

Fractures of the lateral condyle of the humerus are one of the most common fractures in children, accounting for between 10% and 20% of fractures involving the elbow, with a peak incidence at 6 years of age. Treatment is often surgical for displaced fractures > 2 mm, according to Milch and Jakob classification. There is no consensus in the literature about the appropriate surgical management of these fractures. Objectives: The aim of this study is to describe, propose, and evaluate outcomes and complications of the surgical technique of reduction and osteosynthesis using trans-bone suture with resorbable threads. Methods: Patients with lateral condyle fractures treated with this surgical technique from 2015 to 2019 were included in this retrospective study, with a minimum follow-up of 24 months. For clinical and functional assessment of the elbow, Mayo Elbow Scores were recorded; we assessed the time of fracture healing, carrying angles, and Baumann angle of the affected limb compared to the healthy contralateral elbow for radiographic data. Complications have also been described. Results: We achieved satisfactory results; 36 patients with lateral condyle fractures were included in this study. Radiological healing was achieved in all cases. There was only one complication. No cases required additional surgical procedures. Almost all patients achieved a complete flexion of 110 degrees or more and complete extension. Conclusions: This surgical technique has good functional outcomes and fracture healing, a lower incidence of complications when compared to other surgical techniques, and no mechanical failure with good clinical and radiological results. Full article

(1) Background: Anatomically pre-contoured plates usually require only minimal or even no intraoperative contouring. For complex cases, such plates also assist the surgeon as an anatomical template during fracture reduction. In this study, we present our experience of using a 3D printing technology for the treatment of bicondylar humeral fractures in feline cadavers. (2) Methods: Surgeries were performed on 15 pairs of front limbs amputated at the scapula. The limbs were obtained from 15 adult cats without obvious pathology of the skeleton. After flexion of the elbow and subperiosteal elevation of the anconeus muscle, the humeral Y-T fractures were created using a bone chisel and mallet. A custom-made anatomically pre-contoured interlocking plate was used to reduce and stabilise the medial aspect of the humeral condyle to the humeral diaphysis. After reduction of the humeral condyle, a positional locking screw was then inserted from the medial to the lateral side and a straight 2.4/2.7 interlocking bone plate was used to stabilise the lateral part of the condyle to the humeral diaphysis. (3) Results: The length of the humerus ranged from 98.2 to 107.0 mm and did not differ significantly between the left and right bone. The diameter of the isthmus of the humeral condyle ranged from 5.2 to 5.5 mm and did not differ significantly between the left and right bone. In all 30 limbs, bicondylar fracture was accompanied by epicondylar comminution. In 7/30 limbs (4 left, 3 right) the fracture of the humeral shaft was also present. In the left limbs, the postoperative articular surface defect of the humeral condyle was small (<1 mm) in 11/15 cases, moderate (1–2 mm) in 2/15 cases and large (>2 mm) in 2/15 cases in which the condylar screw was incorrectly inserted. In the right limbs, the postoperative articular surface defect of the humeral condyle was small (<1 mm) in 14/15 cases and moderate (1–2 mm) in 1 case. (4) Conclusions: 3D printing and the technology of metal powder sintering offers a wide range of possibilities for the development of new surgical implants. The anatomically pre-contoured bone plate appears to be a valuable tool in the reduction and stabilisation of Y-T humeral fractures in adult domestic cats weighing 3.0 to 4.5 kg. Full article

Background and Objectives: The goal of this study was to evaluate the functional outcomes of patient treatment using an allograft after chronic locked posterior shoulder dislocation associated with a bony defect of the upper edge of the humerus that involves 25–50% of the articular surfaces. Materials and Methods: A total of 20 patients were included in this study. Electrocution was the cause of injury in eight patients; in ten patients, the cause was direct trauma; and in two patients, the cause of injury was a fall due to hypoglycemic coma. A standard deltoid pectoral approach was used and a fresh-frozen osteochondral allograft of the femoral condyle was applied. In evaluating the results, Constant’s scoring scale was used. Results: The average value of Constant’s point scale for the operated shoulder is 84.14 points. This result is good according to the average value of Constant’s point scale. Conclusions: Patients with locked chronic posterior dislocation in combination with a bony defect of the humeral head that covers 25–50% of the articular surface, in our opinion, should be treated using bone allografts rather than non-anatomical reconstruction methods. Full article

Lateral humeral condyle fractures are frequently seen in pediatric patients and have a high risk of unfavorable outcomes. A fall on the outstretched arm with supination of the forearm is the most common trauma mechanism. A physical examination combined with additional imaging will confirm the diagnosis. Several classifications have been described to categorize these fractures based on location and comminution. Treatment options depend on the severity of the fracture and consist of immobilization in a cast, closed reduction with percutaneous fixation, and open reduction with fixation. These fractures can lead to notable complications such as lateral condyle overgrowth, surgical site infection, pin tract infections, stiffness resulting in decreased range of motion, cubitus valgus deformities, ‘fishtail’ deformities, malunion, non-union, avascular necrosis, and premature epiphyseal fusion. Adequate follow-up is therefore warranted. Full article

A seven-month-old male Shetland Sheepdog was presented for assessment of thoracic limb lameness of 3 weeks duration. Orthopaedic examination revealed severe discomfort in elbow extension, bilaterally. CT-scan confirmed presence of a complete humeral intracondylar fissure (HIF), bilaterally, and arthroscopic examination of both elbows confirmed the presence of the cartilaginous lesion previously reported in dogs suffering from HIF. A staged oblique proximal ulnar osteotomy was performed to address the humero-anconeal incongruency believed to be the cause of HIF formation. Orthopaedic examination performed 5 weeks after each surgical procedure confirmed that pain previously present on elbow manipulation had subsided. Follow-up examination performed 8 months after the second surgery revealed the dog to be sound at walking on the thoracic limbs with no discomfort present on elbow manipulation. Repeated CT scan confirmed complete healing of both HIFs. This is the first report documenting the presence of HIF in a Shetland sheepdog and complete healing of both HIFs following a proximal ulnar osteotomy. Full article

Background: Neglected fractures of the lateral humeral condyle (LHC) are misdiagnosed or insufficiently treated fractures, presenting later than 3 weeks after injury. The management of neglected LHC fractures in children remains controversial. Methods: Twenty-seven children were included in this retrospective study. Charts and medical records were investigated for demographics, time interval between injury and treatment, and type of treatment. Baseline radiographs were assessed for fracture grading and displacement. Final radiographs were investigated for bone healing, avascular necrosis, elbow deformities and growth disturbances. Complications were classified by the Clavien–Dindo–Sink (CDS) system. Outcomes were assessed according to the Dhillon Score (DhiS) and Mayo Elbow Performance Score (MEPS). Results: The mean time from injury to presentation was 27 months. Treatments included nonoperative management (6 patients), “in-situ” fixation (7 patients), open reduction and internal fixation (11 patients) and corrective osteotomy (3 patients). The mean follow-up was 7 years (range: 2–16). Overall, we observed complications in 16 patients (59%); six complications were considered major (22%) and occurred in Weiss Grade 3 fractures, with lateral displacement ≥5 mm. At the latest follow-up, pain and functional scores improved in 23 of 27 patients (85%). Mean MEPS increased from an average of 62 points preoperatively to 98 points postoperatively, while mean DhiS improved on average from 5 to 8 points. CDS score and time interval between injury and treatment were independent predictors of MEPS and DhiS. Conclusion: Our study describes outcomes from a cohort of children undergoing different treatments for neglected LHC fractures. Prolonged time interval between injury and treatment and perioperative major complications negatively impacted the treatment outcomes. Our findings strengthen the requirement for widely agreed guidelines of surgical management in neglected LHC fractures. Full article

Lameness is a major cause of poor longevity and poor welfare in replacement gilts. The problem is exacerbated by inappropriate housing and diet during the rearing period. Replacement gilts are often reared with male finisher pigs destined for slaughter. If they are not castrated, they perform high levels of potentially injurious sexual and aggressive behaviour. Furthermore, finisher pig diets are not designed to meet the needs of developing gilts and may not supply the necessary minerals to support good limb health. The objective of this study was to evaluate the effect of supplementing the diet of replacement gilts with copper, zinc and manganese and separating them from males during the rearing period on locomotory ability, bone mineral density and cartilage lesion scores. A 2 × 2 factorial design experiment investigated the effect of female-only or mixed-sex rearing, with or without supplementary minerals (Copper, Zinc and Manganese). In total, 384 maternal line gilts were assigned to 32 pens of 12 and were locomotion scored during the rearing period. A sub-sample (n = 102) of gilts were culled at breeding age and the front right limb was removed at slaughter. Areal bone mineral density (aBMD) was measured using dual energy X-ray absorptiometry, after which the limb was dissected to score the condition of the cartilage. The addition of trace minerals to the diet resulted in increased aBMD in the humerus (P < 0.05) compared to the control diet. Rearing gilts in female-only groups reduced the number of cartilage lesions overall (P < 0.05), and on the humeral condyle (P < 0.05). Rearing replacement gilts in female-only groups and with mineral supplementation had benefits for limb health. Full article