Figure 1. This radius-ulna fracture healed in a miniature pinscher but caused a malunion that required a corrective osteotomy. What is a classic scientific article? In my mind, it changes the way you think. It is a paper that changes the status quo. It is research that changes the way you practice the very next day. Here are four summaries of classic articles chosen from a list that is necessarily subjective. 1) Canine Fractures Distal antebrachial (radius/ ulna) fractures in toy-breed dogs are often sustained after seemingly minimal trauma, such as jumping or falling. Complications after conservative treatment of these fractures include delayed union and nonunion. This is critically important because they may lead to limb amputation. Several studies have shown decreased vascular supply and reduced bone formation in the distal radius compared with larger dogs. One classic article on 26 toy-breed dogs such as toy poodles, Pomeranians and Chihuahuas was written by University of Wisconsin Professor Peter Muir, a board-certified surgeon. He confirms that successful healing of this type of fracture is obtained via rigid stabilization with bone plating—not pinning and not splinting—in combination with cancellous bone autograft. Conclusion: Don’t try to be nice or cheap by recommending splinting of radius-ulna fractures in small and toy-breed dogs. Your liability could be involved if the dog ends up with a nonunion (Figure 1). Instead, strongly recommend plating. 2) Back Pain Hanif Sukhiani, a board-certified surgeon in Victoria, British Columbia, Canada, wrote a classic article on how to handle dogs suffering from back pain. Figure 2. MRI showed significant T12-13 compression in a 3-year-old Doxie that presented with back pain only. Twenty-five dogs with back pain only, but without neurologic deficits, underwent myelograms. In spite of their mild symptoms, 80 percent had substantial compression of the spinal cord. All dogs had surgery, either decompressive (about three-fourths) or prophylactic (i.e. fenestration only). All but one dog improved after surgery. So, most patients who present for back pain only are very likely to have spinal cord compression, even with no neurological deficits. Should an owner elect conservative medical management rather than surgical options, the patient must be strictly confined for an extended period, in addition to medical treatment, to help prevent further problems. Conclusion: Significant spinal cord compression may exist even when dogs do not have neurologic deficits. Advanced imaging (Figure 2) should be recommended to determine whether decompressive surgery might be needed. 3) Feline Fractures Thomas McNicholas, a board-certified surgeon in Dallas, wrote a classic article about a specific type of spontaneous femoral fracture that seems to occur in young adult cats—over 1 year old, with an average of almost 2 years. These fractures occur with no trauma and can be bilateral (in one-third of cats in this sample). They most often happen in heavy males neutered before 6 months old. After the fracture, the femoral neck is subject to lysis, leading to a typical “apple core” lesion. The severity of femoral neck osteolysis increases with the duration of the injury. It’s assumed that this occurs because the growth plates are not fully closed at the time of sterilization. This is likely due to hormonal influence, causing delayed physeal closure. Conclusion: Young, big cats suffering from hip pain may have a hip fracture. 4) Wound Lavage It seems that every practice, or even every practitioner or technician, has a favorite way to flush an open wound. Figure 3. A pressure bag, saline bag, IV line and needle create the ideal lavage system. Trent Gall, a board-certified surgeon in Northborough, Mass., showed in a classic article that the best way to lavage a wound to remove debris and bacteria is to use an IV fluid bag placed in a pressure bag (Figure 3). The fluid bag is connected to an IV line and injection needle. This system was shown to deliver more reliable pressure than does squeezing an IV bag manually, using a 35-milliliter syringe and needle, or squeezing a hard plastic bottle that has holes in the lid. More specifically, “The most consistent delivery method to generate 7 to 8 PSI was use of a 1-liter plastic bag within a cuff pressurized to 300 mm Hg.” One important finding is that the pressure generated by various people is operator-dependent. Too little pressure, and lavaging is not very effective. Too much pressure, and you can damage soft tissue. Strangely, although textbooks recommend using an 18-gauge needle to deliver the fluids, the needle size did not have a significant effect in this study. This is in spite of Poiseuille’s law, which states that flow of a fluid is directly proportional to the internal radius of the object it’s going through, to the power four. So, in theory, the bigger the needle, the faster the flow. Conclusion: Every practice should have a pressure bag, not only to deliver IV fluids to patients in shock but also to lavage wounds. These four articles provide timeless information that can be used in daily practice for the benefit of your patients. References P. Muir. “Distal Antebrachial Fractures in Toy Breed Dogs.” Compendium 1997, Vol 19, N 2, p. 137-145. HR Sukhiani et al. “Intervertebral Disk Disease in Dogs With Signs of Back Pain Alone: 25 Cases (1986-1993).” JAVMA 1996, Vol 209, N 7, 1275-1279. WT McNicholas et al. “Spontaneous Femoral Capital Physeal Fractures in Adult Cats: 26 Cases (1996-2001).” JAVMA 2002, Vol 221, N 12, 1731-1736. TT Gall et al. “Evaluation of Fluid Pressures of Common Wound-Flushing Techniques.” AJVR 2010, Vol. 71, N. 11, p. 1384-1386. Dr. Phil Zeltzman is a board-certified veterinary surgeon and author. You may visit his website at www.DrPhilZeltzman.com or follow him at www.facebook.com/DrZeltzman. Columnists’ opinions do not necessarily reflect those of Veterinary Practice News. Nikki Schneck, a veterinary technician near Pottsville, Pa., contributed to this article. Originally published in the July 2016 issue of Veterinary Practice News. Did you enjoy this article? Then subscribe today!
