Stanley Eunwoo Kim

Objective: To assess the frequency of aseptic protocol breaches (APBs) among veterinary students scrubbing, gowning, and gloving into surgery and identify factors that may be associated with APBs. Methods: This was an observational cross-sectional study. Students on clinical rotations at an academic small animal teaching hospital from May to July 2023 in the services of Orthopedic, Soft Tissue, Oncologic, and Neurologic Surgery were observed while scrubbing, gowning, and gloving into surgery, and APBs and donning times were recorded. Stage of rotation (early vs late), service type, duration of donning surgical attire, and previous surgical experience were also recorded. The χ² and points biserial tests were used to assess for associations between APBs and the aforementioned factors. Results: At least 1 APB was noted in 45 (46.3%) of the 96 procedures observed. The most common mistakes noted were contact of the sterile towel onto nonsterile surfaces (17.7%), contact of the gown with nonsterile surfaces (17.7%), touching sterile objects with bare hands (12.5%), and improper scrubbing technique (17.4%). There was no association between APBs and service type, previous scrub experience, or stage of rotation. Those who made an APB had longer gowning and gloving times, 4.60 (1.40) minutes, than those who did not make an APB, 3.71 (0.91) minutes. Conclusions: These findings demonstrate that APBs are common among veterinary students and highlight reasons for contamination during scrubbing, gloving, and gowning. Clinical Relevance: The data may be used to help improve asepsis protocols.

OBJECTIVE: To assess the fatigue and load-to-failure mechanical characteristics of an intramedullary nail with a threaded interference design (TID) in comparison to a commercially available veterinary angle-stable nail with a Morse taper bolt design (I-Loc) of an equivalent size. METHODS: 10 single interlocking screw/bolt constructs of TID and I-Loc implants were assembled using steel pipe segments and placed through 50,000 cycles of simulated, physiologic axial or torsional loading. Entry torque, postfatigue extraction torque, and 10th, 25,000th, and 50,000th cycle torsional toggle were assessed. Each construct was then loaded to failure in the same respective direction as fatigue testing. Four complete constructs of each design were then assessed using a synthetic bone analog with a 50-mm central defect via nondestructive torsional and axial loading followed by axial load to failure. RESULTS: All constructs were angle stable at all time points and withstood fatigue loading. Median insertional torque, extraction torque-to-insertion torque ratio, and torsional yield load were 33%, 33%, and 72.5% lower, respectively, for the TID interlocking screws. No differences in torsional peak load, torsional stiffness, axial yield load, axial stiffness, or axial peak load were identified. No differences in complete construct angle stability, torsional stiffness, axial peak load, axial stiffness, or axial yield load were identified. CLINICAL RELEVANCE: The TID had an inferior torsional yield load when compared to I-Loc implants but generated angle stability and sustained simulated physiologic fatigue loading. The TID may be a suitable mechanism for generating angle stability in interlocking nails.

Objective: To describe the use of virtual surgical planning (VSP) and three‐dimensionally (3D) printed surgical guides for corrective osteotomies stabilized with an interlocking nail in a dog with a multiplanar femoral deformity.Study design: Case report.Animals: An 8‐year‐old male neutered mixed breed dog weighing 44 kg.Methods: A dog was presented for a right grade 3 lateral patellar luxation secondary to a multiplanar femoral deformity due to a suspected femoral malunion. A computed tomography (CT) scan was obtained to create virtual femoral models. Corrective osteotomies were simulated with VSP. Custom osteotomy guides and reaming guides were designed to facilitate the correction and the placement of an interlocking nail. The preoperative femoral model, virtually aligned femoral model, custom osteotomy guides, and reaming guides were 3D printed, sterilized, and utilized intraoperatively. A CT scan was performed postoperatively to assess femoral length and alignment.Results: Custom osteotomy and reaming guides were used as intended by the VSP. Postoperative femoral length as well as frontal, sagittal, and axial plane alignment were within 0.7 mm, 2.2°, 0.5°, and 1.6°, respectively, of the virtually planned femoral model. Two months postoperatively, the dog was sound on visual gait examination, and the patella tracked in the trochlear groove throughout stifle range of motion and was unable to be manually luxated. Radiographs obtained 2 months postoperatively revealed static femoral alignment and implants. Both osteotomies were discernable with callus bridging.Conclusion: Virtual surgical planning and custom osteotomy and reaming guides facilitated complex femoral corrective osteotomies and interlocking nail placement.

Objective: To describe the complications and outcomes in dogs with luxoid hip dysplasia (LH) undergoing total hip arthroplasty (THA) and compare complication rates with THA in non‐LH dogs.Study design: Retrospective study.Sample population: Client‐owned dogs (n = 217) undergoing primary THA (n = 238).Methods: Medical records (2010–2022) of dogs undergoing THA were reviewed, and LH was defined as complete dorsal displacement of the femoral head from the acetabulum on lateral projection radiographs. Major or catastrophic complications, revisions, and outcomes were recorded for all dogs and they were compared between LH and non‐LH groups.Results: Eighteen cases met the subcriterion for the LH group and 220 cases met the subcriterion for inclusion in the non‐LH group. There were 14 complications in 13/18 dogs with LH; seven were intraoperative (femoral fissure/fracture) and seven were postoperative (dorsal luxation, n = 5; femoral fracture, n = 1; acetabular cup septic loosening, n = 1). Revisions were performed for all LH dogs that encountered complications; satisfactory outcomes were achieved in 12/13 dogs. Overall, LH dogs had a higher risk of developing complications (p < .001), including intraoperative fracture (p < .001) and postoperative dorsal luxation (p = .019) when compared with non‐LH dogs.Conclusion: Luxoid hip dysplasia was associated with a higher risk of major complications following THA in dogs, specifically intraoperative fissure/fracture and postoperative dorsal luxation. Despite the increased risk, revisions typically yielded satisfactory outcomes.Clinical significance: Luxoid hip dysplasia is an important risk factor for the development of major complications in dogs undergoing THA.

Kim MY, et al. J Vet Sci. 2024 Mar;25:e26. https://doi.org/10.4142/jvs.23298

Objectives: To establish preoperative and postoperative serum C reactive protein (CRP) and serum amyloid A (SAA) levels in dogs undergoing uncomplicated total hip arthroplasty (THA).Study design: Prospective clinical trial.Animals: Eighteen client‐owned dogs.Methods: Dogs undergoing THA were recruited. Serum CRP and SAA levels were measured in all dogs the day prior to surgery, and 3 and 6 months following surgery. All dogs received a physical examination and underwent radiography at each visit, and dogs with complications were excluded from the study. For continuous numeric data, histograms were generated and evaluated for normality. A 1‐way repeated measures ANOVA was performed to find differences between time points.Results: No complications were encountered in any of the recruited dogs. Median age was 30 months (12‐66), and the median bodyweight was 27.3 kg (22.3‐40.2). Mean CRP concentrations in the preoperative, 3‐month, and 6‐month periods were 3.8 mg/L ± 4.4, 0.8 mg/L ± 1.9, and 1.4 mg/L ± 1.4, respectively. The mean SAA concentrations in the preoperative, 3‐month, and 6‐month periods were 13.9 mg/L ± 8.8, 14.1 mg/L ± 12.6, and 18.4 mg/L ± 15.1, respectively. There were no differences for each parameter between time points.Conclusion: C‐reactive protein and SAA levels were consistent with levels previously established for noninflammatory and normal conditions in dogs.Clinical significance: Postoperative CRP and SAA concentrations were low by 3 months following uncomplicated THA.

OBJECTIVE: To report clinical experience using virtual surgical planning (VSP) and surgical application of 3D printed custom surgical guides to facilitate uni- and biapical correction of antebrachial deformities in dogs. ANIMALS: 11 dogs (13 antebrachial deformity corrections). PROCEDURES: Using CT-based bone models, VSP was performed, and surgical guides were designed and 3D printed. The guides were used to execute osteotomies and align bone segments. Postoperative CTs were obtained to compare limb alignment with the VSP. Long-term assessment of lameness and cosmesis were compared with preoperative status. RESULTS: Guides were successfully utilized and postoperative analysis was available for 10 of 13 deformities. Guides were abandoned in 2 deformities due to soft tissue tension. Evaluation of postoperative frontal, sagittal, axial, and translational limb alignment revealed that over 90% of parameters were within the acceptable range of ≤ 5° angulation and rotation or ≤ 5 mm of translation from the VSP. Lameness scores were improved in 7/8 deformities with associated preoperative lameness, and posture was improved in 10/10 deformities in which guides were deployed. Complications included reduced range of carpal motion (n = 2), implant sensitivity (n = 2), fracture (n = 1), and tendon laceration (n = 1). CLINICAL RELEVANCE: VSP and customized surgical guide application facilitated accurate antebrachial limb deformity correction in the majority of deformities in this case series. The use of VSP and 3D printed guides would appear to be a viable and accurate approach for correction of both uni- and biapical antebrachial deformities in dogs.

Objective To evaluate the effectiveness of a novel crescent-shaped tibial plateau-leveling osteotomy (TPLO) saw guide (crescent guide) to assist with saw control in novice participants. Study design Ex vivo study. Sample population Synthetic bones (n = 54) and medium sized dog pelvic limbs (n = 36). Methods The 6 participants (interns and residents) without any prior experience performing a TPLO each performed 9 osteotomies on synthetic tibia models, and 6 osteotomies in cadaveric limbs of medium-sized dogs. Osteotomies made with the crescent guide were compared with those made with a standard jig and a radial saw guide with a jig. Osteotomy angulation, distance of eccentricity (DOE), and medial tibial cortical damage (synthetic bone models only) were measured from calibrated photographs. Participants rated their experiences with each technique. Results There was no difference in the DOE, coronal or axial osteotomy angulation between the 3 alignment devices for synthetic bone models or cadavers. Average medial cortical damage with the crescent guide (3.8 ± 7.3 mm²) was lower than with the radial guide (35.7 ± 27 mm²) and standard jig (51.2 ± 63.2 mm²) guides (P = <.01). Five of 6 participants preferred the crescent guide over the standard jig and radial guide. Conclusion There was no difference in accuracy of osteotomy positioning but using the crescent guide resulted in lower cortical damage and more favorable participant perceptions. Clinical relevance The crescent guide may improve control of the radial saw during TPLO in novice surgeons but does not appear to aid accurate osteotomy positioning.

Objective: A lack of guidance for pain control after otolaryngology surgery can lead to overprescription of opioids. We implemented a postoperative site-specific opioid prescription protocol and analyzed the impact on opioid prescriptions. Methods: This is a retrospective cohort study. A postoperative opioid prescription protocol was implemented within our otolaryngology department at a tertiary academic medical center on January 1, 2020. Retrospective chart review was completed for all patients undergoing otolaryngology surgery from November 1, 2019, to February 29, 2020 (2 months before and after initiation of intervention; n = 1070). The primary outcome was change in the amount of opioid prescribed for the preintervention and postintervention cohorts. Unplanned contact related to pain and opioid refills were tracked to assess pain control. Results: A total of 940 cases were included; adult and pediatric data were analyzed separately. There were 489 pediatric cases, 250 preintervention and 239 postintervention. There was a significant decrease in the amount of opioid prescribed per pediatric patient in the postintervention cohort (2.7 versus 0.32 morphine milligram equivalents, P = 0.02), and 99% of patients were not prescribed opioids at all. There was no significant change in unplanned contact, and no refills were required. There were 451 adult cases, 200 preintervention and 251 postintervention. There was no statistically significant decrease in the amount of opioid prescribed per adult patient (56.8 versus 51.7 morphine milligram equivalents, P = 0.23). There was no significant increase in unplanned contact or refills. Conclusions: A postoperative opioid prescribing protocol can reduce the amount of opioid prescribed without increasing unplanned contact or opioid refills.

Objective To report the use of an ancillary plate spanning from the calcaneus to the common calcaneal tendon to stabilize a comminuted fracture in a dog. Study design Case report Animals Two year old male neutered mix-breed dog. Methods The dog presented for a grade IIIa open highly comminuted fracture of the shaft and tuber of the left calcaneus from a suspected gunshot wound. Plantar and lateral locking plates were applied to the calcaneus, with the lateral plate extending proximally and sutured directly to the common calcaneal tendon. Autogenous cancellous and allogenic corticocancellous bone grafts were placed into the fracture site, and a human placental matrix was injected after closure. A lateral tarsal splint was applied for 17 weeks postoperatively. The lateral bone-to-tendon plate was replaced with a smaller lateral plate spanning only the calcaneus 9 weeks after the initial surgery. Results Radiographic union was documented at 17 weeks. At 25 weeks, both plates were removed due to suspected implant associated infection. At the final follow-up assessment, 36 weeks after initial surgery, the dog had returned to normal function with no observable lameness. Conclusion Incorporation of the common calcaneal tendon as a proximal segment for plate fixation led to successful union of a highly comminuted calcaneal fracture.