Medial patellar luxation is defined as medial displacement of the patella from the trochlear groove. In dogs, medial luxations account for 75% of all patellar luxation cases, and are frequently associated with patella alta. Common surgical treatments for medial luxation are trochleoplasty and lateral transposition of the crest to drive the patella into the correct anatomical alignment. Postoperative complications for this procedure are estimated to be between 18-29% of cases, with up to 48% of complications involving reluxation. It was previously hypothesized that in cases of medial luxation involving patella alta, the addition of a distal component to the lateral tibial crest transposition will result in repositioning of the patella into its proper position in the trochlear groove, thus reducing the recurrence of luxation. We performed this modified procedure on 14 dogs (17 limbs) that were suffering from medial luxation combined with patella alta, and our results led to favourable clinical outcomes. This modified surgical procedure places the patella into a more normal proximo-distal anatomical position, is simple to perform, and may become common practice for surgical treatment of medial patellar luxation with an alta component.
Closed reduction and stabilisation of coxofemoral luxations can be achieved using this minimally invasive technique. Refinements to the technique may be needed for its application in clinical cases due to relative high incidence of femoral head cartilage damage.
In this case report, we describe the use of a cylindrical titanium mesh cage combined with cancellous bone graft to surgically manage large segmental bone defects in a dog. A seven-year-old, neutered male cross-breed dog, with highly comminuted fractures of the right femur and the left radius and ulna, was referred for treatment. Previous open reduction and internal fixation of these fractures had failed. Following implant removal and debridement of each bone, a 71 mm segmental femoral defect and a 27 mm segmental radial defect were present. A commercially available cylindrical titanium mesh cage was filled with ss-tricalcium phosphate crystals mixed with an equal volume of autogenous cancellous bone graft. The mesh cage was aligned with the proximal and distal parts of each bone using an intramedullary pin passing through the cage, and a locking plate was applied to the proximal and distal fracture fragments to produce compression against the titanium cage. The dog had a successful long-term clinical outcome, and radiographic examination at 22 and 63 weeks after surgery showed the formation of remodelling bridging callus that was continuous across the titanium cage in each of the fractures. Due to the relative simplicity of the technique and the favourable outcome in this case, it should be considered an option when managing comminuted fractures with large bone defects.
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