Medial versus lateral transcondylar screw placement for canine humeral intracondylar fissures: A randomized clinical trial

Darren Carwardine, Alastair Mather, Imogen Schofield, Sorrel Langley-Hobbs, Elena Carbonell-Buj, Alex Belch, Nicolas Barthelemy, Kevin Parsons
Vet Surg. 2023 Jul 12. doi: 10.1111/vsu.13993.

Objective: To determine the influence of screw direction on complications following transcondylar screw placement for the treatment of canine humeral intracondylar fissures (HIFs).

Study design: Equivalence, parallel group, randomized clinical trial.

Sample population: Fifty-two client owned dogs (73 elbows).

Methods: Transcondylar screw placement was randomized to either a medial or lateral approach. The primary outcome was the incidence of postoperative complications.

Results: There were 37 cases in the lateral approach group and 36 cases in the medial approach group. There was a significantly greater proportion of postoperative complications following placement of transcondylar screws from a lateral to medial direction (p = .001). There were seven cases with complications (19%) in the medial approach group versus 23 cases with complications (62%) in the lateral approach group. The majority of complications were seromas (n = 13) and surgical site infections (n = 16) with 4 complications requiring further surgery. Implant area moment of inertia (AMI), normalized to bodyweight, was lower in dogs with a major complication (p = .037).

Conclusion: Transcondylar screws placed from lateral to medial for canine HIFs had a greater proportion of postoperative complications in this randomized clinical trial design. Implants with a lower AMI, relative to bodyweight, were more likely to lead to major complications.

Clinical significance: We recommend placing transcondylar screws from medial to lateral for canine HIFs to reduce the risk of postoperative complications. Relatively small diameter implants had an increased risk of major complications.