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Plates
Although fractures of humerus, radius and ulna, and tibia can be successfully treated either with external or internal fixation, plate osteosynthesis remains the treatment of choice for femoral diaphyseal fractures in juvenile dogs, particularly in large and athletic breeds.
In spite of the strict adherence to the classic AO principles, catastrophic implant failures due screw pull out during the early growth phase has been a commonly reported complication.
Your Singapore, the Tropical Garden City
WSV18-0195
CARDIOLOGY
STATE-OF-THE-ART LECTURE MANAGEMENT OF PRECLINICAL HEART DISEASE IN DOGS – THE EPIC TRIAL
A. Boswood1
1Royal Veterinary College, Clinical Science and Services, Hatfield, United Kingdom
Management of preclinical heart disease in dogs – the EPIC Trial
Professor Adrian Boswood, The Royal Veterinary College London
The results of the EPIC study were published in 2016. The full report of the clinical trial is available as an open access publication at the following link
http://onlinelibrary.wiley.com/doi/10.1111/jvim.14586/full
In brief summary – the aim of the trial was to evaluate whether or not dogs with enlarged hearts, secondary to myxomatous mitral valve disease, that had not yet developed signs of congestive heart failure, would benefit from the administration of pimobendan.
We tested our hypothesis by conducting a double blind placebo controlled trial in which 360 dogs were randomly allocated to one of two treatment groups: pimobendan or placebo.
The primary endpoint of the study was a composite of the onset of signs of congestive heart failure or cardiac related death (which ever occurred first).
The study demonstrated a clear benefit associated with the administration of pimobendan. The likelihood of
a dog reaching the primary endpoint was reduced by approximately one third if it received pimobendan.
The median time to the primary endpoint was approximately 15 months longer in the treated group indicating, on average, a prolongation of the time to the development of clinical signs by over a year.
  The critical evaluation of these failures contributed to the evolution of internal fixation of fractures with a change of emphasis from mechanical to biological priorities. A more flexible fixation encourages the formation of callus while less precise indirect reduction and minimally invasive techniques reduce the operative trauma.
A biological internal fixation avoids the need for precise reduction, especially of the intermediate fragments, and takes advantage of indirect reduction, it also involves the use of long-span bridging plates (locking or non) and fewer screws for fixation in order to achieve a “flexible fixation.”
The two techniques that suite this requisite are the Elastic Plate Osteosynthesis (EPO) and Plate and Rod Osteosynthesis. Both techniques can be combined either with an “Open But Do Not Touch” approach, in order to preserve the hematoma and decrease the surgical trauma or with minimally invasive percutaneous plate application (MIPO) in an effort to further decrease the postoperative morbidity.
Suggested Readings
Torzilli PA, Takebe K, Burstein AH, Zika JM, Heiple KG. The material properties of immature bone. J Biomech Eng. 1982 Feb;104(1):12-20.
Torzilli PA, Takebe K, Burstein AH, Heiple KG. Structural properties of immature canine bone. J Biomech Eng. 1981 Nov;103(4):232-8
Cabassu J.P. Elastic plate osteosynthesis of femural shaft fractures in young dogs. VCOT 2001 14:40-45.
Perren S. M. Evolution of the Internal Fixation of Long Bones Fractures. The Jour- nal of Bone and Joint Surgery (Br). 2002,November, VOL 84-B: 1093-1110.
Dejardin L.M. Cabassu J. P. Femoral Fractures in Young Dogs. AO Dialogue, 2008, 3: 39-43.
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