Jenkins Georgia, Moores Andy P
Anderson Moores Veterinary Specialists, Winchester, UK.
Vet Surg. 2022 May;51(4):600-610. doi: 10.1111/vsu.13800. Epub 2022 Apr 5.
To report the incidence of medial epicondylar fissure fracture (MEFF) after medial-to-lateral transcondylar screw placement in dogs with humeral intracondylar fissure (HIF) and to identify risk factors for MEFF.
Retrospective study.
Seventy-four client-owned dogs (88 elbows).
Medical records of dogs surgically treated for HIF, and postoperative imaging studies were reviewed for demographics, fracture characteristics, and repair techniques. The width of the transcondylar screw was expressed relative to the height of the condyle. Screw angle and degree of countersinking were recorded. Information from case records and follow-up radiographs were used to identify complications.
Medial epicondylar fissure fracture was identified in 10 elbows (11.4%) following medial-to-lateral transcondylar screw placement: 4 cases were detected intraoperatively, 2 on immediate postoperative radiographs, 1 during routine radiographic follow up, and 3 when radiographs were reviewed for this study. A larger relative screw size was found to increase the risk of MEFF (P = .004, OR = 1.5). Fifteen additional complications were identified in 13/80 elbows at a median of 6 weeks postoperatively (range 1-56 weeks). Screw loosening was the most frequent complication (n = 9) and was the only complication in dogs with MEFF (n = 3); MEFF tended to increase the risk of perioperative screw loosening (P = .06).
Medial epicondylar fissure fracture occurred in 10/88 elbows treated for HIF and was more common in elbows treated with a larger screw size relative to the height of the condyle.
Placing transcondylar screws with a diameter inferior to 41% of the height of the condyle is recommended to avoid MEFF. Medial epicondylar fissure fracture appears to have a low clinical significance in the perioperative period, although its effect on long-term outcome remains unknown.
报告在患有肱骨髁间裂（HIF）的犬只中，经髁螺钉从内侧向外侧置入后内侧上髁裂隙骨折（MEFF）的发生率，并确定MEFF的危险因素。
回顾性研究。
74只客户拥有的犬只（88个肘部）。
对接受HIF手术治疗的犬只的病历以及术后影像学研究进行回顾，以获取人口统计学、骨折特征和修复技术等信息。经髁螺钉的宽度相对于髁的高度表示。记录螺钉角度和埋头程度。病例记录和随访X光片的信息用于识别并发症。
在经髁螺钉从内侧向外侧置入后的10个肘部（11.4%）中发现内侧上髁裂隙骨折：4例在术中检测到，2例在术后即刻X光片中发现，1例在常规X光随访期间发现，3例在为本研究复查X光片时发现。发现相对较大的螺钉尺寸会增加MEFF的风险（P = 0.004，OR = 1.5）。在术后中位时间6周（范围1 - 56周）时，在13/80个肘部中又发现了15例并发症。螺钉松动是最常见的并发症（n = 9），并且是患有MEFF的犬只（n = 3）中的唯一并发症；MEFF倾向于增加围手术期螺钉松动的风险（P = 0.06）。
在接受HIF治疗的88个肘部中，有10个发生了内侧上髁裂隙骨折，并且在使用相对于髁高度较大尺寸螺钉治疗的肘部中更常见。
建议置入直径小于髁高度41%的经髁螺钉以避免MEFF。内侧上髁裂隙骨折在围手术期的临床意义似乎较低，尽管其对长期结果的影响仍未知。
