Northwest Orthopaedic Specialists

(1) To report surgical repair techniques for common calcaneal tendon injuries in cats; (2) to describe both short-term and long-term complications; (3) to investigate the long-term outcome following temporary postoperative immobilisation of the tarsocrural joint; and (4) to evaluate how all three objectives, as well as patient signalment and type of tendinous injury, compared to previously reported studies. A multicentric, retrospective study reviewing cases from 11 referral veterinary centres. Data collected included patient demographics, common calcaneal tendon injuries characteristics, repair techniques employed and postoperative immobilisation methods. Based on the temporary tarsocrural joint immobilisation methods, the cases were divided into internal fixation group: calcaneo-tibial screws or plate and tibiometatarsal plate, and external immobilisation group: trans-articular external skeletal fixation or external coaptation. Complications were classified as minor, major or catastrophic. Long-term outcomes were assessed through clinical follow-up examination and owner-reported questionnaires. A total of 39 cases of common calcaneal tendon repair were analysed. The internal fixation and external immobilisation groups showed a complication rate of 13% and 54.2%, respectively. Catastrophic complications (5.2%) occurred only in the external immobilisation group. Long-term follow-up indicated that 82% of cases regained full or acceptable clinical function, with a higher rate of unacceptable outcomes observed in the external immobilisation group. This study suggested that temporary internal fixation may be a more suitable method for postoperative immobilisation of the tarsocrural joint in cats compared with temporary external immobilisation, and it can be associated with lower complication rates.

Percutaneous fixation of anterior pelvic ring injuries using a trans-symphyseal curved intramedullary implant offers a minimally invasive solution for challenging fracture patterns, particularly in patients with fragility fractures or compromised parasymphyseal bone. This technical report outlines key steps and intraoperative pearls for successful execution of the procedure, including fluoroscopic positioning, precise trajectory planning, safe passage across the pubic symphysis, and strategies to navigate the contralateral anterior osseous corridor. Techniques such as guide wire double-bending, cortical blocking wire placement, and elevator-assisted redirection are described in detail to address common challenges including narrow bony corridors and acute pelvic angulation. The described method avoids reliance on poor-quality ipsilateral bone and eliminates the need for extensive surgical exposure. Our early experience highlights the importance of attention to key anatomical landmarks, imaging guidance, and technical adaptability to ensure consistent implant passage, seating, and stability. This report serves as a guide for surgeons adopting the trans-symphyseal curved fixation approach.

Abstract Trapezoid fractures are rare injuries with few descriptions of surgical treatment in the literature. We present a case of trapezoid nonunion in a 23-year-old male who injured his hand at work. Initial radiographs did not demonstrate a fracture. However, a bone scan and computed tomography (CT) scan revealed a nonunion 6 months after the initial injury. The patient had continued pain and therefore open reduction and internal fixation with distal radius bone grafting was performed. Postoperatively, he underwent immobilization with a short arm cast and used a bone stimulator. After 6 months of surgery, the patient was pain-free and was back to work without restrictions. After a review of 21 isolated, minimally displaced trapezoid fractures reported in the current literature, we speculate delayed diagnosis and a lack of early immobilization can put relatively young and healthy individuals at risk for fracture nonunion. We therefore suggest early diagnosis with CT scans, magnetic resonance imaging (MRI), early treatment with immobilization, and close follow-up when there is high suspicion of occult trapezoid fracture.

Loss of redundant soft tissue over the proximal interphalangeal joint (PIPJ) may be a reason for the failed restoration of PIP motion. This study aimed to quantify the area of redundant skin over the PIPJ in normal subjects. Measurements of 200 healthy volunteers were obtained using a novel technique. Redundant skin over the PIPJ was pinched and marked in a radial-to-ulnar, then proximal-to-distal direction with the PIPJ extended. The area of skin overlying the PIPJ was calculated for the index, middle, ring, and small fingers. A standardized ratio was developed to provide a normative scale to compare post-traumatic skin redundancy. The study population included 82 men and 118 women. Demographics including average height, weight, body mass index (BMI), smoking status, and hand dominance were collected. Skin redundancy or area of skin (mm2) overlying the PIPJ was calculated for bilateral index, middle, ring, and small fingers. Skin redundancy was greater in ring fingers of men compared with those of women. Skin redundancy was examined between BMI greater than 30 and less than 30 and found to be statistically different in the middle, ring, and small fingers. Normative values for skin redundancy by percentiles for each gender and BMI were generated. Establishment of normative values may enable surgeons to explain the lack of progress after surgical joint release, determine progress with hand therapy, and choose the optimal timing of surgical intervention once soft-tissue equilibrium is achieved. Prognostic III.

The French bulldog (FBD) is a brachycephalic breed prone to several neurological conditions, of which intervertebral disc herniation (IVDH) is considerably prevalent. Gastrointestinal (GI) disease is a reported complication in dogs surgically treated for IVDH. The objective of this study was to describe GI signs and their outcome in FBDs surgically treated for IVDH. Data regarding the GI signs (vomiting, diarrhoea and regurgitation), their frequency and short-term outcome in FBDs surgically treated for IVDH (cervical, thoracolumbar or lumbar) between January 2017 and April 2023 were obtained from medical records at one institution. Categorical variables were compared using Fisher exact tests, and ordinal/continuous data between categorical groups using Kruskal-Wallis or Mann-Whitney tests. Ninety-seven FBDs were included for analysis. GI signs occurred in 74/97 (76.3%) FBDs while hospitalised, with 33.8% and 66.2% developing GI signs pre- and post-operatively, respectively. FBDs that developed GI signs had a mean of 4.9 episodes. Diarrhoea was the most common GI sign encountered (51/74) compared to regurgitation (38/74) and vomiting (22/74). Resolution of GI signs occurred within a mean of 2.2 days. Mean duration of hospitalisation post-surgery was 4.6 days in FBDs that developed GI signs versus 3.7 days in FBDs that did not (p = 0.033). Anaesthesia length was associated with developing GI signs (p=0.037). Neurological severity, neuroanatomical localisation and surgical procedure were not associated with development of GI signs (p = 0.42, p = 0.794 and p = 1, respectively). GI signs were commonly encountered in FBDs surgically treated for IVDH and associated with length of anaesthesia and prolonged hospitalisation.

Registered veterinary nurses (RVNs) are integral to maintaining patient safety during transfusions. Their knowledge spans appropriate donor criteria, interpreting blood typing and cross-matching tests, mastering blood collection and administration, and providing comprehensive post-procedure care. This article concisely explores the basics of feline transfusion medicine for RVNs. Although these cases can be complex, a solid understanding of nursing care and safety precautions empowers RVNs to contribute significantly to positive outcomes, fostering job satisfaction and clinical fulfillment.

When sea urchin puncture injuries occur during coastal recreation or work activities, they often affect extremities, such as hands and feet. There is a plethora of information on treatments for these puncture injuries, with the most common among medical professionals being the removal of all partially embedded spines and the removal of as many fully embedded spines as possible. When the spines are deeply embedded and/or fragmented, they might not be removed, especially when they are not located in critical areas such as tendons or joints. This reflects the generally held notion that smaller spines and spine fragments will eventually dissolve or be absorbed. Here we report an unusual case where the tip of a sea urchin spine became embedded in the soft tissue of the sole of the foot of a 21-year-old male after he stepped on one after falling off a kayak off the coast of Oahu, Hawai'i. The deeply embedded spine was not removed. By three weeks after the injury, the patient did not have any symptoms, and eight years later, he was still symptom-free. Radiographs taken one year after the injury showed that the spine had fragmented into two pieces. The smaller piece was about 15% of the size of the original embedded spine, and it had apparently been absorbed (it was not seen on final radiographs eight years later). Analysis of radiographs eight years after the injury showed that the main or large spine fragment was still distinctly detectable in the soft tissue; there was no visible evidence that it had undergone significant absorption or migrated from the original location. The absence of any obvious radiographic rarefaction over eight yearsis contrary to the lore that sea urchin spines that remain in human soft tissue will exhibit significant, or complete, absorption or dissolution overmonths to a few years.

Background Quantum computing and quantum machine learning (QML) are promising experimental technologies that can improve precision medicine applications by reducing the computational complexity of algorithms driven by big, unstructured, real-world data. The clinical problem of knee osteoarthritis is that, although some novel therapies are safe and effective, the response is variable, and defining the characteristics of an individual who will respond remains a challenge. In this study, we tested a quantum neural network (QNN) application to support precision data-driven clinical decisions to select personalized treatments for advanced knee osteoarthritis. Methodology After obtaining patients' consent and Research Ethics Committee approval, we collected the clinicodemographic data before and after the treatment from 170 patients eligible for knee arthroplasty (Kellgren-Lawrence grade ≥3, Oxford Knee Score (OKS) ≤27, age ≥64 years, and idiopathic aetiology of arthritis) treated over a two-year period with a single injection of microfragmented fat. Gender classes were balanced (76 males and 94 females) to mitigate gender bias. A patient with an improvement ≥7 OKS was considered a responder. We trained our QNN classifier on a randomly selected training subset of 113 patients to classify responders from non-responders (73 responders and 40 non-responders) in pain and function at one year. Outliers were hidden from the training dataset but not from the validation set. Results We tested our QNN classifier on a randomly selected test subset of 57 patients (34 responders, 23 non-responders) including outliers. The no information rate was 0.59. Our application correctly classified 28 responders out of 34 and 6 non-responders out of 23 (sensitivity = 0.82, specificity = 0.26, F1 Statistic = 0.71). The positive and negative likelihood ratios were 1.11 and 0.68, respectively. The diagnostic odds ratio was 2. Conclusions Preliminary results on a small validation dataset showed that QML applied to data-driven clinical decisions for the personalized treatment of advanced knee osteoarthritis is a promising technology to reduce computational complexity and improve prognostic performance. Our results need further research validation with larger, real-world unstructured datasets, as well as clinical validation with an artificial intelligence clinical trial to test model efficacy, safety, clinical significance, and relevance at a public health level.

Somatic nerve pain is one of the most common complications following surgery of the foot and ankle but may also arise following traumatic injury or chronic nerve compression. The sural nerve is a commonly affected nerve in the foot and ankle; it is at risk given the proximity to frequently used surgical approaches, exposure to crush injuries, and traction from severe ankle inversion injuries. The purpose of this study is to investigate the outcomes of sural nerve neurectomy with proximal implantation for sural neuromas (SN) and chronic sural neuritis (CSN). Patients that underwent neurectomy with proximal implantation (20 muscle, 1 adipose tissue) by 2 foot and ankle specialists for isolated SN- and CSN-related pain at a single tertiary institution were included. Demographic data, baseline outcomes including 36-Item Short Form Health Survey (SF-36), Foot and Ankle Ability Measure (FAAM), and visual analog scale (VAS) were recorded. Final follow-up questionnaires using Patient Reported Outcomes Measurement Information System (PROMIS) lower extremity function, pain interference (PI), and neuropathic pain quality, FAAM, and VAS were administered using REDCap. Perioperative factors including neuropathic medications, diagnostic injections, the use of collagen wraps, and perioperative ketamine were collected from the medical record. Descriptive statistics were performed and potential changes in patient-reported outcome measure scores were evaluated using Wilcoxon signed-rank tests. The 21 patients meeting inclusion criteria for this study had a median age of 47 years (interquartile range [IQR], 43-49) and had median follow-up duration of 33.7 months (IQR, 4.5-47.6). Median FAAM activities of daily living score improved from 40.6 (38.7-50.7) preoperatively to 66.1 (53.6-83.3) postoperatively, P = .032. FAAM sports scores improved from 14.1 (7.8-21.9) to 41.1 (25.0-60.9) postoperatively, P = .002. VAS scores improved from a median of 9.0 (8.0-9.0) to 3.0 (3.0-6.0), P < .001. At final follow-up, patients reported PROMIS lower extremity function score median of 43.8 (35.6-54.9), PROMIS neuropathic pain quality score of 54.1 (43.6-61.6), and PROMIS PI of 57.7 (41.1-63.8). Patients with both anxiety and depression reported less improvement in pain and physical. Other perioperative factors lacked sufficient numbers for statistical analysis. Sural nerve neurectomy and proximal implantation (20 muscle, 1 adipose) provided significant improvement in pain and function for patients with sural neuromas and chronic sural neuritis at median follow-up of 33.7 months. Anxiety and depression were associated with significantly poorer outcomes following surgery. Patients with CRPS as well as recent nicotine use tended to report less improvement in pain and worse function after surgery, although this sample size was too limited for statistical analysis of these variables. Further research is needed to identify the ideal surgical candidates and perioperative factors to optimize patient outcomes. Level IV, retrospective case series.

Preoperative narcotic use is associated with poor postoperative pain management and worse outcomes after total joint arthroplasty (TJA). Therefore, identifying controlled substance use preoperatively is necessary. Electronic medical records (EMRs), prescription monitoring programs (PMP), or urine toxicology screening (UTS) are most commonly used. This study aims to compare the accuracy of EMR and PMP versus UTS to determine whether UTS should be implemented as standard of care in TJA preoperative assessment. Preoperative UTS was performed for primary or revision TJA from November 1, 2018, to March 31, 2019. Patient demographics, medical history, prescription history, and UTS results were retrospectively recorded. Prescription monitoring program and EMR were queried for prescription history in the past 2 years. The accuracy of EMR and PMP compared with UTS was calculated. Multivariable logistic regression analysis was performed to identify patient predictors associated with UTS+. Thirty of 148 patients had UTS+. Positive urine toxicology screening was more common in patients younger than 58 years, White race, and undergoing revision surgery. Electronic medical record and PMP documentation had the highest sensitivity (73.3%), specificity (92.4%), positive predictive value (71.0%), and negative predictive value (93.2%). Patients with higher odds of UTS+ include current/former smokers, those with a history of alcohol abuse, drug abuse, hepatitis C diagnosis, and mental illness. For patients without any risk factors for having a UTS+, the use of EMR and PMP may be sufficient to evaluate for controlled substance use; however, UTS should be considered in patients who present with one of the risk factors for UTS+.