Proximal Ulnar Reinsertion of the Triceps Brachii Tendon with a Synthetic Implant in a Dog with Nonreconstructible Olecranon Fracture

Abstract

Objective Reporting the reinsertion of the triceps brachii onto the proximal ulna as a salvage procedure in a dog with nonreconstructible olecranon fracture.

Case Description A Labrador Retriever was presented with a comminuted olecranon fracture. Initial fracture stabilization was unsuccessful, resulting in implant failure and a nonreconstructible comminuted fracture, thus preventing triceps tendon reattachment. Revision surgery was performed after the implants and bone fragments were removed. A synthetic implant was sutured onto the triceps tendon and fixed on the proximal ulna by an interference screw (IS) in a bone tunnel. A transarticular Jean-Alphonse Meynard external fixator was applied for 3 weeks.

Results After 3 weeks, the dog had moderate lameness with a painless elbow. At 1.5 months, it had severe lameness with a painful elbow and mild osteoarthritis (OA). Nonsteroidal anti-inflammatory drugs were prescribed, and intensive physical therapy was initiated. Lameness improved at 2.5 and 3.5 months despite mild OA. At 9 months, the dog had mild lameness and a swelling of the elbow. Radiographs showed moderate OA and lucency around the IS. Bacteriologic examination was positive. The implants and infected tissues were removed, and antibiotics were prescribed for 1 month. At 18 months, the dog had mild lameness with no pain. At 33 months, it had intermittent mild lameness with no pain, yet severe OA.

Conclusion Triceps tendon re-insertion onto the proximal ulna yielded satisfactory long-term outcome in this dog with nonreconstructible olecranon fracture.

Keywords

comminuted olecranon fracture - elbow - dog - synthetic implant - UHMWPE

Author Contributions

N.E., DVM, and D.J., DVM, ECVS, examined the patient, diagnosed the pathology, performed surgeries, performed follow-up visits, analyzed data, and wrote and revised the manuscript. E.E., DVM, ECVDI resident, analyzed medical images and wrote and revised the manuscript. B.G., PhD, and A.C., PhD, analyzed data and wrote and revised the manuscript.

Publikationsverlauf

Eingereicht: 13. Juni 2024

Angenommen: 16. September 2024

Artikel online veröffentlicht:
19. November 2024

• References

• 1 Fournet A, Boursier J-F, Corbeau S. et al. Stabilization of olecranon fractures by tension band wiring or plate osteosynthesis: a retrospective study of 41 cases. Vet Comp Orthop Traumatol 2018; 31 (01) 53-61
• 2 Muir P, Johnson KA. Fractures of the proximal ulna in dogs. Vet Comp Orthop Traumatol 1996; 09 (02) 88-94
• 3 Evans HE, de Lahunta A. The skeleton. In: Evans HE, de Lahunta A. eds. Miller's Anatomy of the Dog. 4th ed.. St. Louis, MO: Elsevier Saunders; 2013: 80-157
• 4 Armstrong RB, Saubert IV CW, Seeherman HJ, Taylor CR. Distribution of fiber types in locomotory muscles of dogs. Am J Anat 1982; 163 (01) 87-98
• 5 Fischer S, Nolte I, Schilling N. Adaptations in muscle activity to induced, short-term hindlimb lameness in trotting dogs. PLoS One 2013; 8 (11) e80987
• 6 Houlton JEF, Dunning D. Perioperative patient management. In: Johnson AL, Houlton JEF, Vannini R. eds. AO Principles of Fracture Management in the Dog and Cat. 1st ed.. Davos, Switzerland: AO publishing; 2005: 1-25
• 7 Autefage A. Fractures of the ulna. In: Johnson AL, Houlton JEF, Vannini R. eds. AO Principles of Fracture Management in the Dog and Cat. 1st ed.. Davos, Switzerland: AO Publishing; 2005: 260-271
• 8 Dinwiddie EV, Rendahl A, Veytsman S. et al. Evaluation of post-operative complications, outcome, and long-term owner satisfaction of elbow arthrodesis (EA) in 22 dogs. PLoS One 2021; 16 (07) e0255388
• 9 McCarthy J, Comerford EJ, Innes JF, Pettitt RA. Elbow arthrodesis using a medially positioned plate in 6 dogs. Vet Comp Orthop Traumatol 2020; 33 (01) 51-58
• 10 Buttin P, Goin B, Cachon T, Viguier E. Repair of tendon disruption using a novel synthetic fiber implant in dogs and cats: the surgical procedure and three case reports. Vet Med Int 2020; 2020: 4146790
• 11 Millis DL, Mankin J. Orthopedic and neurologic evaluation. In: Millis DL, Levine D. eds. Canine Rehabilitation and Physical Therapy. 2nd ed.. Philadelphia, PA: Elsevier; 2014: 180-200
• 12 Talcott KW, Schulz KS, Kass PH, Mason DR, Stover SM. In vitro biomechanical study of rotational stabilizers of the canine elbow joint. Am J Vet Res 2002; 63 (11) 1520-1526
• 13 Vezzoni A, Benjamino K. Canine elbow dysplasia: ununited anconeal process, osteochondritis dissecans, and medial coronoid process disease. Vet Clin North Am Small Anim Pract 2021; 51 (02) 439-474
• 14 Earley NF, Ellse G, Wallace AM. et al. Complications and outcomes associated with 13 cases of triceps tendon disruption in dogs and cats (2003-2014). Vet Rec 2018; 182 (04) 108
• 15 Echigo R, Fujita A, Nishimura R, Mochizuki M. Triceps brachii tendon injury in four Pomeranians. J Vet Med Sci 2018; 80 (05) 772-777
• 16 García-Fernández P, Quero Martín P, Mayenco A, Gardoqui M, Calvo I. Surgical management and follow-up of triceps tendon avulsion after repeated local infiltration of steroids: two cases. Vet Comp Orthop Traumatol 2014; 27 (05) 405-410
• 17 Yoon H-Y, Jeong S-W. Traumatic triceps tendon avulsion in a dog: magnetic resonance imaging and surgical management evaluation. J Vet Med Sci 2013; 75 (10) 1375-1377
• 18 Yoon J-P, Lee H-B, Jeon Y-J, Kim DH, Jeong SM, Jeong JM. Reconstruction of bilateral chronic triceps brachii tendon disruption using a suture-mediated anatomic footprint repair in a dog. Animals (Basel) 2024; 14 (11) 1687
• 19 Ambrosius L, Arnoldy C, Waller III KR, Little JP, Bleedorn JA. Reconstruction of chronic triceps tendon avulsion using synthetic mesh graft in a dog. Vet Comp Orthop Traumatol 2015; 28 (03) 220-224
• 20 Wood CJ, Cashmore RG. Repair of a chronic triceps tendon rupture in a dog using an autogenous thoracolumbar fascia onlay graft. VCOT Open 2021; 04 (01) e32-e36
• 21 Bennett MP, Silver G, Tromblee T. et al. Case report: nonsimultaneous bilateral triceps tendon rupture and surgical repair in a healthy dog. Front Vet Sci 2024; 10: 1294395
• 22 Choi H-J, Kim J-H, Yoon E. et al. Reconstruction of triceps tendon avulsion using mesh graft and krackow suture in a Border Collie. J Vet Clin 2022; 39 (06) 378-383
• 23 Berg RJ, Egger EL. In vitro comparison of the three loop pulley and locking loop suture patterns for repair of canine weightbearing tendons and collateral ligaments. Vet Surg 1986; 15 (01) 107-110
• 24 Moores AP, Comerford EJ, Tarlton JF, Owen MR. Biomechanical and clinical evaluation of a modified 3-loop pulley suture pattern for reattachment of canine tendons to bone. Vet Surg 2004; 33 (04) 391-397
• 25 O'Byrne KL, Sugiyama T, Robinson D, Woodward AP, Ryan SD. Biomechanical comparison of a 3-loop pulley and a 4-loop pulley suture for tenorrhaphy in the canine gastrocnemius tendon. Vet Comp Orthop Traumatol 2022; 35 (05) 321-330
• 26 Gall TT, Santoni BG, Egger EL, Puttlitz CM, Rooney MB. In vitro biomechanical comparison of polypropylene mesh, modified three-loop pulley suture pattern, and a combination for repair of distal canine achilles' tendon injuries. Vet Surg 2009; 38 (07) 845-851
• 27 Buttin P, Goin B, Crumière AJJ. et al. Ex-vivo biomechanical analysis of an original repair of canine calcaneal tendon rupture using a synthetic implant as mechanical support fixed by sutures in the proximal tendinous part and by an interference screw in the bone distal part. Open Vet J 2023; 13 (05) 645-653
• 28 Barber FA, Herbert MA, Beavis RC. Cyclic load and failure behavior of arthroscopic knots and high strength sutures. Arthroscopy 2009; 25 (02) 192-199
• 29 Smith PA, Bozynski CC, Kuroki K, Henrich SM, Wijdicks CA, Cook JL. Intra-articular biocompatibility of multistranded, long-chain polyethylene suture tape in a canine ACL model. J Knee Surg 2019; 32 (06) 525-531
• 30 Marzougui S, Abdessalem SB, Sakli F. Viscoelastic behavior of textile artificial ligaments. Journal of Applied Sciences 2009; 9 (15) 2794-2800
• 31 Olalde B, Ayerdi-Izquierdo A, Fernández R. et al. Fabrication of ultrahigh-molecular-weight polyethylene porous implant for bone application. J Polym Eng 2020; 40 (08) 685-692
• 32 Dhom J, Bloes DA, Peschel A, Hofmann UK. Bacterial adhesion to suture material in a contaminated wound model: comparison of monofilament, braided, and barbed sutures. J Orthop Res 2017; 35 (04) 925-933