Download PDF
Vet Comp Orthop Traumatol 2021; 34(06): 375-385
DOI: 10.1055/s-0041-1731810
Original Research

A Retrospective Study of Postoperative Development of Implant-Induced Osteoporosis in Radial–Ulnar Fractures in Toy Breed Dogs Treated with Plate Fixation

Norihiro Muroi 
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
,
Masakazu Shimada 
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
,
Sawako Murakami 
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
,
Hiroyuki Akagi
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
,
Nobuo Kanno
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
,
Shuji Suzuki
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
,
Yasuji Harada
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
,
Hiromitsu Orima
2   ORM Co, Saitama-shi, Saitama, Japan
,
Yasushi Hara
1   Department of Veterinary Surgery, Nippon Veterinary and Life Science University, Musashino-shi, Tokyo, Japan
› Author Affiliations Funding None.
› Further Information
    Permissions and Reprints

Abstract

Objective This study aimed to evaluate implant-induced osteoporosis (IIO) development in toy breed dogs treated using internal fixation with digital radiographs as the index of pixel values.

Study Design There were 226 cases (236 limbs) of toy breed dogs with radial–ulnar fractures. Pixel values were measured on radiographs immediately, 2 weeks and 1 to 12 months after surgery. The ratio of pixel values (PVR) represented the bone mineral areal density based on the humeral condyle in the same image. The dogs were grouped based on the fixation methods, age and status of destabilization.

Results There was a significant decrease in the PVR at 1 to 12 months postoperatively for all cases. There were not any significant differences in PVR of antebrachial fractures between those repaired with plates using locking head screws, cortex screws or a combination of locking and cortex screws. Implant-induced osteoporosis persisted at 1 to 12 months postoperatively in dogs aged ≧6 months, while the PVR increased after 3 months in dogs aged <6 months. Based on the destabilization method, there was a significant increase in the PVR at 3 months in the plate removal group.

Conclusion This study suggests that IIO occurs in small dogs treated with plates and screws. Moreover, patients aged < 6 months showed an early postoperative recovery of bone mineral areal density. Further, screw and plate removal could contribute to the recovery of bone mineral areal density.

Keywords

implant-induced osteoporosis - radial-ulnar fractures - toy breed dogs - internal fixation - destabilization

Authors' Contributions

All authors contributed to the conception of the study, study design and interpretation. All of them drafted and revised and approved the submitted manuscript.


Supplementary Material



Publication History

Received: 06 October 2020

Accepted: 08 June 2021

Article published online:
03 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Aikawa T, Miyazaki Y, Shimatsu T, Iizuka K, Nishimura M. Clinical outcomes and complications after open reduction and internal fixation utilizing conventional plates in 65 distal radial and ulnar fractures of miniature- and toy-breed dogs. Vet Comp Orthop Traumatol 2018; 31 (03) 214-217
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Gibert S, Ragetly GR, Boudrieau RJ. Locking compression plate stabilization of 20 distal radial and ulnar fractures in toy and miniature breed dogs. Vet Comp Orthop Traumatol 2015; 28 (06) 441-447
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Slätis P, Karaharju E, Holmström T, Ahonen J, Paavolainen P. Structural changes in intact tubular bone after application of rigid plates with and without compression. J Bone Joint Surg Am 1978; 60 (04) 516-522
    CrossrefPubMedGoogle Scholar
  • 4 Field JR. Bone plate fixation: its relationship with implant induced osteoporosis. Vet Comp Orthop Traumatol 1997; 10: 88-94
    Article in Thieme ConnectPubMedGoogle Scholar
  • 5 Uhthoff HK, Boisvert D, Finnegan M. Cortical porosis under plates. Reaction to unloading or to necrosis?. J Bone Joint Surg Am 1994; 76 (10) 1507-1512
    CrossrefPubMedGoogle Scholar
  • 6 Larsen LJ, Roush JK, McLaughlin RM. Bone plate fixation of distal radius and ulna fractures in small- and miniature-breed dogs. J Am Anim Hosp Assoc 1999; 35 (03) 243-250
    CrossrefPubMedGoogle Scholar
  • 7 Gauthier CM, Conrad BP, Lewis DD, Pozzi A. In vitro comparison of stiffness of plate fixation of radii from large- and small-breed dogs. Am J Vet Res 2011; 72 (08) 1112-1117
    CrossrefPubMedGoogle Scholar
  • 8 Perren SM, Cordey J, Rahn BA, Gautier E, Schneider E. Early temporary porosis of bone induced by internal fixation implants. A reaction to necrosis, not to stress protection?. Clin Orthop Relat Res 1988; (232) 139-151
    PubMedGoogle Scholar
  • 9 Jacobs RR, Rahn BA, Perren SM. Effects of plates on cortical bone perfusion. J Trauma 1981; 21 (02) 91-95
    CrossrefPubMedGoogle Scholar
  • 10 Swiontkowski MSenft SD, Taylor Set al. Plate design has an effect on cortical bone perfusion. Trans Orthop Res Soc 1991; 15: 387
    PubMedGoogle Scholar
  • 11 Song SH, Agashe M, Kim TY. et al. Serial bone mineral density ratio measurement for fixator removal in tibia distraction osteogenesis and need of a supportive method using the pixel value ratio. J Pediatr Orthop B 2012; 21 (02) 137-145
    CrossrefPubMedGoogle Scholar
  • 12 Vulcano E, Markowitz JS, Ali S, Nguyen J, Fragomen AT, Rozbruch SR. Assessment of bone healing during antegrade intramedullary rod femur lengthening using radiographic pixel density. J Am Acad Orthop Surg 2018; 26 (18) e388-e394
    CrossrefPubMedGoogle Scholar
  • 13 Field JR, Ruthenbeck GR. Qualitative and quantitative radiological measures of fracture healing. Vet Comp Orthop Traumatol 2018; 31 (01) 1-9
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Unger M, Montavon PM, Heim UFA. Classification of fractures of long bones in the dog and cat: introduction and clinical application. Vet Comp Orthop Traumatol 1990; 03: 41-50
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Vallefuoco R, Le Pommellet H, Savin A. et al. Complications of appendicular fracture repair in cats and small dogs using locking compression plates. Vet Comp Orthop Traumatol 2016; 29 (01) 46-52
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Tillson DM. Open fracture management. Vet Clin North Am Small Anim Pract 1995; 25 (05) 1093-1110
    CrossrefPubMedGoogle Scholar
  • 17 Song SH, Sinha S, Kim TY, Park YE, Kim SJ, Song HR. Analysis of corticalization using the pixel value ratio for fixator removal in tibial lengthening. J Orthop Sci 2011; 16 (02) 177-183
    CrossrefPubMedGoogle Scholar
  • 18 Balakumar B, Jasper A, Livingstone RS, Gangadharan S, Gibikote S, Madhuri V. Can pixel value ratio be used in the assessment of ceramic bone substitute incorporation? Observations from a pilot study. Pol J Radiol 2017; 82: 706-712
    CrossrefPubMedGoogle Scholar
  • 19 DeAngelis M, Olds R, Stoll S. Repair of fractures of the radius and ulna in small dogs. J Am Anim Hosp Assoc 1973; 9: 436-441
    PubMedGoogle Scholar
  • 20 De Arburn Parent R, Benamou J, Gatineau M, Clerfond P, Planté J. Open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs: 102 cases (2008-2015). J Am Vet Med Assoc 2017; 250 (12) 1419-1426
    CrossrefPubMedGoogle Scholar
  • 21 Aikawa T, Miyazaki Y, Saitoh Y, Sadahiro S, Nishimura M. Clinical outcomes of 119 miniature- and toy-breed dogs with 140 distal radial and ulnar fractures repaired with free-form multiplanar type II external skeletal fixation. Vet Surg 2019; 48 (06) 938-946
    CrossrefPubMedGoogle Scholar
  • 22 Welch JA, Boudrieau RJ, DeJardin LM, Spodnick GJ. The intraosseous blood supply of the canine radius: implications for healing of distal fractures in small dogs. Vet Surg 1997; 26 (01) 57-61
    CrossrefPubMedGoogle Scholar
  • 23 Brianza SZ, Delise M, Maddalena Ferraris M, D'Amelio P, Botti P. Cross-sectional geometrical properties of distal radius and ulna in large, medium and toy breed dogs. J Biomech 2006; 39 (02) 302-311
    CrossrefPubMedGoogle Scholar
  • 24 Kessler SB, Deiler S, Schiffl-Deiler M, Uhthoff HK, Schweiberer L. Refractures: a consequence of impaired local bone viability. Arch Orthop Trauma Surg 1992; 111 (02) 96-101
    CrossrefPubMedGoogle Scholar
  • 25 Fox DB. 2017. Radius and Ulna. In: Spencer A, Johnston KMT. eds. Veterinary Surgery: Small Animal Expert Consult. 2nd ed.. Amsterdam: Saunders, Elsevier;
    Google Scholar
  • 26 Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg Br 2002; 84 (08) 1093-1110
    CrossrefPubMedGoogle Scholar
  • 27 Greiwe RM, Archdeacon MT. Locking plate technology: current concepts. J Knee Surg 2007; 20 (01) 50-55
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Kim T, Ayturk UM, Haskell A, Miclau T, Puttlitz CM. Fixation of osteoporotic distal fibula fractures: a biomechanical comparison of locking versus conventional plates. J Foot Ankle Surg 2007; 46 (01) 2-6
    CrossrefPubMedGoogle Scholar
  • 29 Perren SM. The concept of biological plating using the limited contact-dynamic compression plate (LC-DCP). Scientific background, design and application. Injury 1991; 22 (Suppl. 01) 1-41
    CrossrefPubMedGoogle Scholar
  • 30 Lippuner K, Vogel R, Tepic S, Rahn BA, Cordey J, Perren SM. Effect of animal species and age on plate-induced vascular damage in cortical bone. Arch Orthop Trauma Surg 1992; 111 (02) 78-84
    CrossrefPubMedGoogle Scholar
  • 31 Jain R, Podworny N, Hearn T, Richards RR, Schemitsch EH. A biomechanical evaluation of different plates for fixation of canine radial osteotomies. J Trauma 1998; 44 (01) 193-197
    CrossrefPubMedGoogle Scholar
  • 32 Ahmad M, Nanda R, Bajwa AS, Candal-Couto J, Green S, Hui AC. Biomechanical testing of the locking compression plate: when does the distance between bone and implant significantly reduce construct stability?. Injury 2007; 38 (03) 358-364
    CrossrefPubMedGoogle Scholar
  • 33 Biedrzycki AH. 2019. Dynamic Compression vs. Locking Plating - Is One “Better”? A Review of Biomechanical Principles and in vitro Testing. In: Matthew D, Barnhart KCM. eds. Locking Plates in Veterinary Orthopedics. Hoboken, New Jersey: John Wiley & Sons, Inc.; 33
    Google Scholar
  • 34 Lujan TJ, Henderson CE, Madey SM, Fitzpatrick DC, Marsh JL, Bottlang M. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma 2010; 24 (03) 156-162
    CrossrefPubMedGoogle Scholar
  • 35 O'Doherty DM, Butler SP, Goodship AE. Stress protection due to external fixation. J Biomech 1995; 28 (05) 575-586
    CrossrefPubMedGoogle Scholar
  • 36 Zhao X, Jing W, Yun Z. et al. An experimental study on stress-shielding effects of locked compression plates in fixing intact dog femur. J Orthop Surg Res 2021; 16 (01) 97
    CrossrefPubMedGoogle Scholar
  • 37 Mie K, Ishimoto T, Okamoto M. et al. Impaired bone quality characterized by apatite orientation under stress shielding following fixing of a fracture of the radius with a 3D printed Ti-6Al-4V custom-made bone plate in dogs. PLoS One 2020; 15 (09) e0237678
    CrossrefPubMedGoogle Scholar
  • 38 Muroi N, Ochi H, Shimada M, Asou Y, Hara Y. Effects of long-term plate fixation with different fixation modes on the radial cortical bone in dogs. PLoS One 2021; 16 (02) e0247410
    CrossrefPubMedGoogle Scholar
  • 39 von Pfeil DJ, DeCamp CE. The epiphyseal plate: physiology, anatomy, and trauma. Compend Contin Educ Vet 2009; 31 (08) E1-E11 , quiz E12
    PubMedGoogle Scholar
  • 40 Roberts WE, Helm FR, Marshall KJ, Gongloff RK. Rigid endosseous implants for orthodontic and orthopedic anchorage. Angle Orthod 1989; 59 (04) 247-256
    PubMedGoogle Scholar