Full text of DOI:10.1111/j.1751-0813.2001.tb10925.x

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chondrosarcoma in a dog. J Am Vet Med Assoc 1987;190:68-70.
11. Saik JE, Toll SL, Diters RW, Goldschmidt MH. Canine and feline laryngeal
neoplasia: A 10-year survey. J Am Anim Hosp Assoc. 1985;22:359-365.
12. Beaumont PR, O’Brien JB, Allen HL, Tucker JA. Mast cell sarcoma of the
larynx in a dog: a case report. J small Anim Pract 1979;20:19-25.
13. Henderson RA, Powers RD, Perry L. Development of hypoparathyroidism
after excision of laryngeal rhabdomyosarcoma in a dog. J Am Vet Med Assoc .
1991;198:639-643.
14. Bright RM, Gorman NT, Goring RL, Calderwood-Mays M. Laryngeal
neoplasia in two dogs. J Am Vet Med Assoc 1984; 184:738-740.
15. McConnell EE, Smit JD, Venter HJ. Melanoma in the larynx of a dog. J
South Afr Vet Med 1971;42:189-191.
18. Brodey RS, O’Brien J, Berg P, Roszel JF. Osteosarcoma of the upper
airway in a dog. J Am Vet Med Assoc 1969;155:1460-1464.
19. Manz D, Frese K. Kehlkopfkrebs beim hund. Kleintierpraxis 1964;9:204-209.
20. Cela M, Grassi F. Tumore laringeo in cane. Neoplasia epiteliale con aspetto
sarcomatoso. Ann Fac Med Vet Pisa 1974; 27:129-139.
21. Crowe DT, Goodwin MA, Greene CE. Total laryngectomy for laryngeal mast
cell tumour in a dog. J Am Anim Hosp Assoc1986; 22:809-816.
22. Barnhart K, Lewis B. Laryngopharyngeal Mass in a Dog with Upper Airway
Obstruction. Vet Clin Pathol 2000;29:47-50.
23. Reams Rivera RY, Carlton WW. Lingual Rhabdomyoma in a dog. J Comp
Pathol 1992;106:83-87.
24. Johansen ECJ, Illum P. Rhabdomyoma of the larynx: a review of the
literature with a summary of previously described cases of rhabdomyoma of the
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(Accepted for publication 11 July 2001)
16. Ndikuwera J, Smith DA, Obwolo MJ. Malignant melanoma of the larynx in a
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J Small Anim Pract 1983;24:753-758.
Surgical correction of carpal valgus deformity in three
alpacas
CK LIVINGSTON, AJ DART, BA DOWLING, CM DART and DR HODGSON
University Veterinary Centre Camden, Department of Veterinary Clinical Sciences, University of Sydney, New South Wales 2570
llamas.1,2,6 This paper describes the surgical management of
three cases of carpal valgus deformity in alpacas.
Two alpaca crias and one 14-month-old alpaca were referred
for treatment of bilateral carpal valgus. In one cria, hemi-
circumferential periosteal transection and elevation combined
with an ulna osteotomy was performed initially without
success, however transphyseal bridging with screws and
wires was used successfully in both crias to straighten the
dorsopalmar and lateromedial radiographs revealed normal
limbs. As the distal radial and ulna growth plates had closed in
the 14-month-old alpaca, bilateral wedge ostectomies of the
distal radius and transfixation casts were used to straighten
and stabilise the limbs. The ostectomy sites healed and the
Case reports
Case 1 — A 2-month-old alpaca cria was referred with
congenital bilateral carpal valgus deformity. Standing
carpal bones with bilateral carpal valgus angulation originating
from the distal radial physis. The degree of angulation was 19°
in the right limb and 18° in the left limb.7 A bilateral HCPTE of
the distal lateral radius and a bilateral ulna ostectomy was
recommended. Benzyl penicillin (20 mg/kg IV every 6 h),
gentamicin sulphate (6.6 mg/kg IV every 24 h), and flunixin
alpaca is ambulatory, although carpal flexion is significantly
reduced. Until the relationship between the growth rate of
crias and the success of hemicircumferential periosteal
transection and elevation and ulna osteotomy is established,
transphyseal bridging may provide a more reliable result in
crias with carpal valgus deformity and open physes. Wedge
ostectomy and application of a transfixation cast can be used
to correct severe carpal valgus deformities in alpacas with
closed physes.
meglumine (1.1 mg/kg IV every 24 h) were administer
immediately prior to surgery.
ed
The cria was premedicated with diazepam (0.2 mg/kg IV) and
anaesthesia was induced with ketamine hydrochloride (1.1
mg/kg IV) administered to effect. The cria was intubated in
sternal recumbency and anaesthesia maintained on isofluorane
in 100% oxygen. The cria was placed in right lateral recumbency
and the left distolateral antebrachium clipped and aseptically
prepared. HCPTE was performed on the distal lateral radial
metaphysis as previously described,5 and a 1 cm section of the
distal diaphysis of the ulna proximal to the physis was removed
using an osteotome. Subcutaneous tissues were closed in a
simple continuous pattern using 3/0 polyglactin 910 and the
skin was closed in a simple interrupted pattern using 2/0
polydioxanone. The cria was rolled into left lateral recumbency
and the surgical procedure was repeated on the right limb. Both
limbs were bandaged. The cria was discharged from hospital
with instructions to remove the bandages in 7 days. Four weeks
post-operatively standing dorsopalmar radiographs showed
bilateral carpal valgus of 22°. The ulna ostectomy sites had
healed. Due to the poor response, bilateral transphyseal bridging
of the distal medial radial physis was recommended.
Aust Vet J 2001;79:821-824
Key words: Angular limb deformity; carpal valgus; alpaca
ALD
IV
Angular limb deformity
Intravenously
SAC
HCPTE
South American camelids
Hemi-circumferential periosteal transection and
elevation
evelopmental orthopaedic diseases reported in South
American Camelids (SAC) include carpal valgus
deformity and flexural deformity of the
D
metacarpophalangeal joints.1-4 Carpal valgus deformity is the
most common ALD reported in llamas.1,2 The cause of ALD in
SAC are unknown, although, as in foals, a multifactorial
aetiology is suspected.1,5
Hemi-circumferential periosteal transection and elevation
(HCPTE) combined with ulna osteotomy, transphyseal
bridging, and wedge ostectomy of the distal radius, have been
described for correction of carpal valgus deformities in
The cria was premedicated and anaesthetised as described
above and placed in right lateral recumbency. The medial aspect
of the distal right antebrachium was clipped, aseptically
prepared, and a tourniquet applied above the surgical site. A 3 cm
Aust Vet J Vol 79, No 12, December 2001
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Clinical
skin incision centred over the medial aspect of the distal radial
physis was made. A 23-gauge 1-inch needle was placed in the
physis using radiographic guidance. Stab incisions through the
periosteum were made proximal and distal to the physis and a
3.5 mm cortical bone screw was placed either side and parallel to
the physis using radiographic guidance. A double loop of 21-
metric-gauge wire was placed in a figure-of-eight pattern around
the screw heads. The screws were then firmly tightened to
achieve a tension-band effect across the physis. After closure of
the skin and subcutaneous tissues, the limb was bandaged, the
cria rolled into left lateral recumbency and the procedure
repeated on the left limb. The cria was discharged from hospital
3 days after surgery.
Eleven weeks postoperatively radiographs showed the carpal
angulation to be 12° and 14° in the left and right limbs
respectively. After a further 2 months radiographs showed both
limbs to be straight and the screws and wires were removed
under general anaesthesia. The time from transphyseal bridging
to implant removal was 19 weeks.
Case 2 — A 3-month-old alpaca cria was referred with a
congenital, bilateral carpal valgus deformity. Standing
dorsopalmar radiographs of both forelimbs showed normal
carpal bones with a carpal valgus originating at the distal radial
physis in the left limb and about 2 cm proximal to the distal
radial physis in the right limb. The degree of angulation was
measured as 6° and 16° in the left and right forelimbs
respectively. Bilateral transphyseal bridging of the distal medial
radial physis was recommended.
Sodium ceftiofur (5 mg/kg IV every 12 h ) and flunixin
meglumine (1 mg/kg IV every 24 h) were administered
immediately prior to surgery. The cria was premedicated with
xylaxine hydrochloride (0.3 mg/kg IV) and anaesthesia was
induced using 5% guaiphenesin and ketamine hydrochloride (3
mg/kg), administered IV in increments to effect. Maintenance
of anaesthesia was as described for Case 1. Transphyseal bridging
was performed using the same procedure described for Case 1.
The cria was discharged from hospital 3 days after surgery.
Seven weeks later, radiographs showed straight forelimbs.
Implants were removed as described for Case 1 and the cria was
discharged from hospital the following day.
Case 3 — A 14-month-old alpaca was referred with a severe
bilateral carpal valgus deformity which had worsened over a
period of 4 months. Standing dorsopalmar radiographs showed
carpal valgus of 40° and 42° in the left and right limbs
respectively. The angulation in each limb was centred
immediately proximal to the distal radial physis. Carpal bones
were normal and the distal radial and ulna physes were closed.
There was no craniocaudal bowing of the distal radius on
lateromedial views.6
Due to the severity of the ALD and the closed distal radial and
ulna physes, bilateral wedge ostectomies of the distal radius were
recommended. Benzyl penicillin (20 mg/kg IV every 6 h),
gentamicin sulphate (6.6 mg/kg IV every 24 h) and flunixin
meglumine (1.1 mg/kg IV every 24 h) were administered
immediately prior to surgery and continued for 5 days after
surgery. Anaesthesia was induced as described for Case 2. Both
forelimbs were clipped circumferentially and aseptically
prepared from the elbow to the metacarpophalangeal joints. Two
hemicircumferential skin incisions were made on the medial
aspect of the limb, one at the level of the antebrachiocarpal joint
and the other 8 cm proximally. These two incisions were
connected by a longitudinal skin incision to create two skin
Figure 1. Postoperative radiographs of the front limbs of Case 3.
Transfixation pins were incorporated into the full limb casts to
stabilise the distal radius following a bilateral wedge ostectomy
to correct a severe valgus deformity.
flaps. The skin, subcutaneous tissue and periosteum were
incised and elevated off the distal radius. A wedge ostectomy
was performed at the level of the radial physis using an
oscillating bone saw. The required dimensions of the wedge
were calculated based on pre-operative radiographic
measurements of the ALD. The distal radial epiphysis and
metaphysis were aligned and 4.7 mm diameter transfixation
pins were placed perpendicular to the long axis of the limb, one
through the radial diaphysis and one through the metacarpal
diaphysis. The periosteum and subcutaneous tissues were closed
using 2/0 polyglactin 910 in an inverted cruciate pattern and
the skin apposed using 2/0 polydioxanone in a simple
interrupted pattern. The transfixation pin ends were then
incorporated into a full limb cast, ensuring the distal radial
epiphysis and metaphysis were aligned and the limb was straight
(Figure 1). The procedure was repeated on the left forelimb.
The alpaca was ambulatory 12 h after surgery but was confined
to a stall. When the alpaca was recumbent it lay in sternal
recumbency with both forelimbs extended.
Radiographs taken 1 month after surgery revealed cranial
displacement of the distal radial epiphyseal fragment in the left
forelimb. The alpaca was anaesthetised and the casts were
removed. Despite the malalignment in the left forelimb, both
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Clinical
ostectomy sites were stable. The transfixation pins were removed
and the limbs placed in casts for a further 2 weeks. When the
casts were removed, the carpus could easily be hyper-extended
due to flexor tendon laxity, so splints were applied down the
back of the legs. The right splint was replaced with a support
bandage 4 weeks later and the left splint removed 6 weeks after cast
removal. Radiographs taken 12 weeks postoperatively revealed
healing of both ostectomy sites despite moderate malalignment
in the left limb. At this time the alpaca was bearing weight on
both forelimbs and was discharged from hospital. Twelve
months post surgery the alpaca was reported to be walking well,
although carpal flexion was significantly reduced.
outcome of this procedure was good in both crias.
Corrective ostectomies are recommended for the treatment of
angular limb deformities in foals with closed physes.14,15 Two
techniques have been described, the closing wedge ostectomy
and the step ostectomy.5 Advantages of the step ostectomy
include maintenance of long bone length, concurrent correction
of rotational deformities, and improved interfragmentary
compression and bone healing. The closing wedge ostectomy is
technically simpler, however disadvantages include limb
shortening and creation of an inherently unstable fracture
configuration, making rigid internal fixation more difficult. A
satisfactory outcome to a closing wedge ostectomy followed by
internal fixation has been described in an 18-month-old llama
with severe carpal valgus deformity.6 We elected to apply a
transfixation cast in preference to the use of internal fixation,
due to economic constraints and minimal bone purchase in the
distal epiphysis of the radius after ostectomy. Transfixation casts
have been shown to be an acceptable method of fracture
fixation in small ruminants and llamas.16 Although the
technique has been reported as successful in a llama,2 a half
wedge ostectomy and wedge inversion to maintain limb length
was not used in association with this non-rigid form of fixation,
due to the potential for sequestrum formation and fragment
migration. While malalignment of the osteotomy in a
craniocaudal direction, limb shortening, flexor tendon laxity
and delayed healing of the bones were undesirable in Case 3,
healing was achieved in 12 weeks and the functional outcome
was acceptable. Rigid anatomical fixation may not be critical in
SAC, as they are non-athletic animals of light body weight.
Further studies on longitudinal growth patterns of the long
bones and a greater number of cases are needed before specific
recommendations on the treatment of carpal valgus deformities
in SAC can be made. However, based on the outcomes of the
cases in this report transphyseal bridging may provide a more
reliable result than HCPTE and ulna ostectomy for treatment
of carpal valgus in young alpacas with open physes. The closing
wedge ostectomy and transfixation cast is a relatively simple and
cost effective means of surgical management of carpal valgus
deformities in mature alpacas with closed physes. Although
rigid anatomical alignment is desirable, this approach to
treatment can still provide a satisfactory outcome.
Discussion
Angular limb deformities have been reported in llamas, but
not alpacas.1-3 The aetiology of ALD in SAC has not been
established, however it has been suggested that carpal valgus in
the llama is inherited,1 and associated with growth disparity
between the distal radial and ulna physes.7 The distal ulna
epiphysis is fused anatomically and functionally to the distal
radial epiphysis so that any slowing of longitudinal growth at the
distal ulna physis may result in carpal valgus deformity. In
advanced cases craniocaudal bowing of the radius may occur.6
Craniocaudal bowing of the radius was not seen radiographically
in any of the alpacas in this study and growth disparity between
the radial and ulna physes as a cause of carpal valgus is yet to be
substantiated by controlled studies. Incomplete ossification and
collapse of the carpal bones as a cause of ALD of the carpus has
been reported in foals,8,9 however has not been reported in SAC’s,7
and was not a feature of the alpacas in this study.
Techniques for surgical correction of carpal valgus deformities
in young llamas have been adapted from those used in foals and
include HCPTE with or without ulna osteotomy, and
transphyseal bridging .1-3,5,10 Some authors have recommended
not performing HCPTE alone because in SAC the distal ulna
epiphysis is fused with the distal radial epiphysis.2,3 Based on
these previous reports we performed HCPTE in combination
with an ulna osteotomy in Case 1. The success of HCPTE is
dependent on active longitudinal bone growth occurring at the
time of the procedure.11,12 Longitudinal growth of the distal
radial physis in foals declines in linear fashion from birth to 150
days, after which growth is non-linear with sporadic growth
periods occurring at 8, 14 and 20 months of age.13 The pattern
of growth of the long bones in SAC has not been described. If
longitudinal bone growth occurs sporadically then the response
to HCPTE and ulna ostectomy may be variable and may have
been responsible for the lack of response in Case 1, despite
favourable outcomes in 10 cases of carpal ALD previously
reported in llamas.2 The mean age of these llamas was 8.0 ± 1.7
(mean ± SD) months, compared to 2 months in the alpaca
described in Case 1. It may be that HCPTE with ulna osteotomy
is a more appropriate treatment in older animals with ALD.
Transphyseal bridging is not adversely affected by sporadic
growth since the implants can be left in place until sufficient
growth has occurred to correct the ALD. Given the possibility
that sporadic longitudinal bone growth occurs in SAC and the
favourable outcomes following transphyseal bridging in Cases 1
and 2, it may be preferable to use transphyseal bridging to
correct carpal valgus deformities in alpaca crias. The
disadvantages of this technique are that it requires two surgical
procedures, and that overcorrection may occur if implant
removal is delayed. However, cosmetically and functionally, the
References
1. Fowler ME. Angular limb deformities in young llamas. J Am Vet Med Assoc
1982;181:1338-1342.
2. Snyder JR, Paul-Murphy J, Bleifer DR et al. Carpal angular limb deformities
in llamas. Proc 15th Annu Conf Vet Orthop Soc,1988;26.
3. Turner AS. Surgical conditions in the llama. Vet Clin N Am 1989;5:81-99.
4. Cashman T, Dart AJ, O’Shea A and Hodgson DR. Management of bilateral
flexural deformity of the metacarpophalangeal joints in three alpaca crias. Aust
Vet J 1999;77:508-510.
5. Auer JA. Angular limb deformities. In: Auer JA, editor. Equine Surgery.
Saunders, Philadelphia, 1999:736-752.
6. Squire KRE, Adams SB. Bilateral wedge ostectomy on an 18-month-old
llama with severe bilateral carpal valgus. J Am Vet Med Assoc 1991;199:1174-
1176.
7. Paul-Murphy JR, Morgan JP, Snyder JR, Fowler ME. Radiographic findings
in young llamas with forelimb valgus deformities: 28 cases (1980-1988). J Am
Vet Med Assoc 1991;198:2107-2111.
8. Auer JA, Martens RJ. Angular limb deformities in young foals. Proc Am
Assoc Equine Pract 1980;26:81-96.
9. Hunt RJ. Angular limb deviations. In: White NA and Moore JN, editors:
Current Techniques in Equine Surgery and Lameness, Saunders, Philadelphia,
1998;323-326.
10. Fowler ME. Surgery. In: Fowler ME, editor. Medicine and Surgery of South
American Camelids. 2nd edn. Iowa State University Press, Ames, Iowa.
1998;108-147.
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Clinical
11. Bertone AL, Turner AS, Park RD. Periosteal transection and stripping for
treatment of angular limb deformities in foals: Clinical observations. J Am Vet
Med Assoc 1985;187:145-152.
deformities of the fetlock in horses. J Am Vet Med Assoc 1983;182:245.
15. White KK. Diaphyseal angular limb deformities in three foals. J Am Vet Med
Assoc 1983;182:272.
12. Jansson N. Angular limb deformities in 4 foals: treatment by periosteal
transection and stripping. Equine Vet Educ 1995;7:70-74.
13.Watkins J. Evaluation of normal and abnormal bone growth in the foal.
Proceedings: AO/ASIF Course on Equine Orthopaedics. Columbus, Ohio.
2000: 30-31.
16. Kaneps AJ, Schmotzer WB, Huber MJ et al. Fracture repair with
transfixation pins and fiberglass cast in llamas and small ruminants. J Am Vet
Med Assoc 1989;195:1257-1261.
(Accepted for publication 11 July 2001)
14. Fretz PB, McIlwraith CW. Wedge ostectomy as a treatment for angular limb
BOOK REVIEW
Indian author reviewing historical descriptions of elephant foot disease.
Again the paper is not so much a useful reference source as an
interesting introduction to the argument that much potential knowledge
on elephant care may reside in those countries that traditionally work
elephants and that this knowledge is largely untapped by western
institutions. Of the book’s 27 chapters, this is the only one by an author
from a country where elephants are traditionally kept. Whether or not
the notion of a largely ignored base of traditional knowledge is realistic
or not, I feel the book would have been strengthened by seeking more
international contributions.
The section does contain some useful descriptions of treatments,
such as step-by-step guides to using epoxy resins for treating nail
cracks and detailed descriptions of the construction and application of
boots and sandals to protect and treat sole lesions. One chapter
describes the use of ultrasound to detect and monitor abscess cavities
in the foot, which appears to have promise as a diagnostic aid. As with
the rest of the book, many of the chapters in this section contain a lot of
conceptual overlap with previous papers.
Section IV of the book, dealing with surgical intervention, contains an
excellent pair of papers by staff from Calgary Zoo, Canada. The first
describes the extensive behavioral conditioning of a bull elephant
necessary to allow aftercare to foot surgery and the second is a detailed
description of the surgery itself. The final paper in this section, which
describes a surgical case that was eventually euthanased, is a very well
written account highlighting the importance of preventative care rather
than heroic surgery in the management of foot problems in elephants.
The final two sections of the book are single papers, the first
reviewing anti-inflammatory and antibiotic dosages for elephants and
the second containing recommendations arising from the conference.
Both are valuable and the review of the drug dosages is very up to date.
This book is a useful addition of the library of elephant veterinarians
and managers for the occasional chapter that provides good reference
material, the identification of research directions, and the thought
provoking nature of case histories describing problems not easily solved.
The Elephant’s Foot: Prevention and Care of Foot Conditions in
Captive Asian and African Elephants. Edited by Csuti B, Sargent
EL and Bechert US, Iowa State University Press, Ames, 2001, 172
pages. Price US$ 59.95. ISBN 08138 2820 1.
his book was produced following the First North American
T
Conference on Elephant Foot Care and Pathology held in Oregon,
USA in 1998. The editors state that the chapters are based on some of
the presentations at the conference supplemented by invited authors.
Although no indication is made as to which sections are taken from the
conference presenters and which from the invited, the book has the
overall feel of a proceedings. Most of the ‘chapters’ take the form of
short papers, many are case reports and there is a large amount of
information overlap. However, the editors state their aim was not to
produce a definitive guide to elephant foot care but rather prompt
discussion on the issues and identify research directions to advance
the field. When the book is read in this spirit rather than as a complete
reference on the subject of elephant foot care, their aims are fulfilled. As
such, it is a useful text for veterinarians and animal managers who are
involved in the care of captive elephants.
The book is divided into six parts plus two appendices and a
glossary. A list of contributors is also included although I would have
preferred some indication of the professional status and relevant
experience of the authors rather than just a list of names and
addresses.
The first part entitled, The Context of Elephant Foot Care contains a
basic introduction to the conference and a good review of elephant foot
anatomy with recommendations for research directions in the area. The
other two chapters in this section address the role of nutrition in
elephant foot health and record keeping of foot problems. They are brief
and contain little useful information.
Part Two of the book deals with current approaches to routine foot
care and presents the elephant management programs at seven
different facilities, six of them in North America and one in Austria. The
first chapter of this section is written by the well-known elephant trainer,
Alan Roocroft and is an excellent and thorough presentation of routine
foot care techniques and predisposing factors. The many photos
demonstrating various foot conditions add to the value of this paper.
Many of the other chapters in the book would have benefited from
suitable diagrams or photos.
M Lynch
Dr Michael Lynch is a veterinarian at the Melbourne Zoo, Parkville 3052.
The remaining six chapters of this section offer little in addition to
Roocroft’s paper. They are useful in the sense that they reinforce
concepts that a total approach to elephant care embracing exercise,
nutrition, and housing is necessary to overcome and prevent foot
problems. One of the chapters in this section is an interesting case
report describing an elephant with osteomyelitis of the phalanges,
which was successfully resolved by the use of trimethoprim-
sulphonamide antibiotics and local flushing with antiseptic solutions.
This case is significant if the author’s interpretations are accurate given
most other elephants with osteomyelitis inevitably require surgery. This
paper highlights the problem with many of the case reports in the book
in that there is often a lack of critical analysis of treatment regimens and
case outcomes and a failure to examine these in relation to the
experiences of others.
CORRECTION
Megaoesophagus in adult dogs secondary to Australian
tiger snake envenomation by K Hopper, C Beck and
RF Slocombe Aust Vet J 2001;79:672-675.
In the footnote on page 672 of the above article, K Hopper’s
address was printed incorrectly
Dr K Hopper’s correct address is:
Veterinary Medical Teaching Hospital, University of
California Davis, One Shields Avenue, Davis CA 95616
The fourth section of the book is concerned with defining common
foot problems and their treatments and opens with a contribution by an
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