by the Department for orthopedic diagnostic, surgery and anesthesia in clinics “Dobro hrumvane” – dr. Kirilov, dr. D. Ivanov, dr. Ts. Ivanov, dr. Nikolov, dr. Kotsev, dr. Bochukova, technician Kirilova
Corrective osteotomies, especially the ones caused by combined and complicated malformations of the antebrachium and the crus are truly challenging surgeries, both for the surgeon, and the implants being used. Except by their design and material (steel/titanium), these implants differ also by their qualities such as elasticity, strength, long term quality of the locking mechanisms. The quality of the surgical titanium or steel, being used, along with their manufacturing technology are significantly important for the overall quality of the manufactured implants. Further below, in this abstract, we present 4 orthopedic cases, which required a maximally rigid fixation to be applied. Working on these cases, allowed us to challenge the strength and locking quality of the Mikromed implants.
Case 1: Male dog, Frodo, mixed breed, aprox. 35 kg
In its early age, the patient suffered a trauma to its elbow and antebrachium, creating a malunion, which in the long term lead to permanent elbow damage, radio-ulnar synostosis and high-grade external torsion and valgus of the distal antebrachium:
Pre-op antebrachial valgus:
Pre-op antebrachial external torsion:
Frodo pre-op video:
A double plating corrective osteotomy was performed, using a 3.5 mm locking DCP Mikromed plate and 3.5 mm locking and non-locking screws (this system also accommodates 2.7 and 4.0 mm screws) and a second, straight, non-loking Mikromed DCP plate with cortical 2.7mm screws. In this kind of surgery, it is crucial to have very strong implants and locking and to do precise calculations for the corrective angles to be achieved. Precise contouring of the medially placed non-locking implant is also very important for the successful outcome.
Post-op X-ray CrCd:
Post-op X-ray LAT:
Frodo 18H post-op video:
Final result: perfect bone healing and normal leg usage
Case 2: Male dog, Michail, mixed breed, aprox. 13 kg
The patient suffers from congenital bilateral antebtachial deformity – high-grade internal torsion and varus.
Pre-op antebrachial varus right leg:
Pre-op antebrachial internal torsion right leg:
Pre-op antebrachial varus left leg:
Pre-op antebrachial internal torsion left leg:
A single plate corrective osteotomy was performed (this was possible due to the low weight of the patient). A straight support 2.4 mm locking Mikromed plate was used, along with 2.7 mm locking and non-locking screws (the system also accommodates 2.4 mm screws). The plates was applied in an oblique fashion, instead of purely cranially, due to the need for excessive contouring, which is a serious challenge for the strength of the plate and the stability of the locking and the whole fixation in the post-op period.
X-ray picture 5 min post-op LAT:
X-ray picture 5 min post-op CrCd:
Final result: perfect bone healing and normal leg usage
X-ray picture 6 months post-op LAT:
Case 3: Male dog, Ares, GSD, aprox. 30 kg
The patient suffered a high-energy trauma to its stifle and curs in its early age, which stopped the development of the proximal portion of the tibial plateau, thus making it “sink” in relation to the tibial crest and leading to a shift of it surface in relation to the femoral condyles. Additionally a synostosis between tibia and fibula was found. The patient demonstrated intensifying lameness and more and more severe pain, especially upon limb extension. In addition, a low-grade lumbo-sacral instability was diagnosed during imaging.
Ares X-ray picture pre-op LAT:
Ares X-ray piicture pre-op CrCd:
A block resection of the tibial plateau was performed, during which the plateau was elevated and leveled. Ilial bone autografts were used to fill the gap, formed between the two tibial fragments. A straight support locking Mikromed 3.5 mm DCP plate plus 4.0 locking screws were used. The correct and adequate leveling of the tibial plateau was crucial, along with strength of the plate and the reliable locking, which were subjected to serious biological forces. In addition to that, the patient had an energetic temper.
Ares X-ray picture 24H post-op LAT:
Ares X-ray picture 24H post-op CrCd:
Ares X-ray picture 6 months post-op LAT:
Ares X-ray picture 6 months post-op CrCd:
Result: perfect healing and limb use, even years after completion of the surgery.
Ares CT 2 y post-op:
Ares video 2 y post-op:
Case 4: Male dog, Nuki, mixed breed,aprox 25 kg
The patient suffered from a rare congenital elbow deformation: the proximal radius and ulna exhibited “mirror view” morphology in the sagittal plane: the ulnar trochlear notch and its coronoid processes were placed at the opposite site. There was no weight baring on the limb due to this, which lead to maximal muscle atrophy. The carpal joint was in permanent flexion and extension was impossible to achieve. All soft tissues related to the elbow joint exhibited atypical morphology.
Nuky X-ray picture pre-op LAT:
Nuky X-ray piicture pre-op CrCd:
In the are moments of leg “usage” Nuky treaded in this way:
An elbow arthrodesis along with a minor (around 25 mm) limb shortening was performed. An angle of 110-130 degrees between the humerus and antebrachium was impossible to be achieved, because of the altered soft tissue morphology and due to the risk of worsening the carpal situation. Due to that, a laterally applied curved non-locking DCP Mikromed plate was used, instead of the typical caudally applied straight plate.
Medial application of the plate is usually recommended, but in this case we decided to once again challenge and trust the Mikromed implant, being laterally applied.
Nuky video 3 days post-op:
Nuky video 1 W post-op:
Nuky video 2 W post-op:
Result: full bone healing and good limb use. Home carried physiotherapy helped the particular patient overcome the permanent carpal flexion and evaluate shoulder muscles.
Nuky X-ray picture 6 months post-op LAT:
Nuky X-ray picture 6 months post-op CrCd:
Nuky video 10 months post-op:
Conclusion: The corrective osteotomies require precise pre-surgical planning, regarding both the osteotomy geometry and the choice of implants to be used. The Mikromed implants possess the required strength and locking quality to withstand even excessive orthopedic challenges, especially in the area of rigid fixation.