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Article ; Online: Computed tomography and fluoroscopy versus radiographic guidance for internal fixation of simulated dorsomedial‐plantarolateral central tarsal bone fractures in nonracehorses

Smanik, Lauren E. / Selberg, Kurt T. / Kawcak, Christopher E. / Stewart, Holly L. / Goodrich, Laurie R.

Veterinary Surgery. 2024 Jan., v. 53, no. 1 p.155-166

2024

Abstract: OBJECTIVE: The aim of this study was to assess screw placement in simulated dorsomedial‐plantarolateral central tarsal bone (CTB) fractures using two imaging guidance techniques – computed tomography (CT) with fluoroscopy compared to digital radiography ... ...

Abstract	OBJECTIVE: The aim of this study was to assess screw placement in simulated dorsomedial‐plantarolateral central tarsal bone (CTB) fractures using two imaging guidance techniques – computed tomography (CT) with fluoroscopy compared to digital radiography alone (DR). STUDY DESIGN: Experimental study. SAMPLE POPULATION: Equine cadaver hindlimbs (n = 10 pairs). METHODS: One tarsus per pair was randomly assigned to have a 4.5 mm cortical screw placed across the CTB using CT and fluoroscopy (CT/F group) or digital radiography alone (DR group). Postoperative CT was performed on all limbs. Variables related to marker placement, procedure time, and screw positioning were recorded and compared using a paired t‐test for dependent means (p < .05). RESULTS: Time for marker placement was longer for the CT/F group (p = .001), with no difference in total procedure time (p = .12). CT/F was not superior to radiography alone (p > .05) for parameters related to screw positioning. Based on the 95% CI, there was greater range in relative screw length using radiography (76.5%–91.2%) versus CT/F (78.4%–84.0%). CONCLUSION: Internal fixation of CTB fractures can be successfully performed using either technique for imaging guidance. CT and fluoroscopy did not result in faster or more accurate screw placement compared to radiographs alone, except in determining screw length. CLINICAL SIGNIFICANCE: Mild adjustments in fluoroscopic or radiographic angle appeared to be a point of variability in the perception of screw placement. While CT is recommended for improved understanding of fracture configuration and surgical planning, radiographic guidance may be a suitable alternative for internal fixation of dorsomedial‐plantarolateral fractures.
Keywords	cadaver ; computed tomography ; hindlimbs ; horses ; radiography ; surgery ; t-test
Language	English
Dates of publication	2024-01
Size	p. 155-166.
Publishing place	John Wiley & Sons, Inc.
Document type	Article ; Online
Note	JOURNAL ARTICLE
ZDB-ID	1491071-8
ISSN	1532-950X ; 0161-3499
ISSN (online)	1532-950X
ISSN	0161-3499
DOI	10.1111/vsu.14035
Database	NAL-Catalogue (AGRICOLA)

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Article ; Online: Cone-beam computed tomography produces images of numerically comparable diagnostic quality for bone and inferior quality for soft tissues compared with fan-beam computed tomography in cadaveric equine metacarpophalangeal joints.

Stewart, Holly L / Siewerdsen, Jeffrey H / Selberg, Kurt T / Bills, Kathryn W / Kawcak, Christopher E

Veterinary radiology & ultrasound : the official journal of the American College of Veterinary Radiology and the International Veterinary Radiology Association

2023 Volume 64, Issue 6, Page(s) 1033–1036

Abstract: Cone-beam computed tomography (CBCT) is an emerging modality for imaging of the equine patient. The objective of this prospective, descriptive, exploratory study was to assess visualization tasks using CBCT compared with conventional fan-beam CT (FBCT) ... ...

Abstract	Cone-beam computed tomography (CBCT) is an emerging modality for imaging of the equine patient. The objective of this prospective, descriptive, exploratory study was to assess visualization tasks using CBCT compared with conventional fan-beam CT (FBCT) for imaging of the metacarpophalangeal joint in equine cadavers. Satisfaction scores were numerically excellent with both CBCT and FBCT for bone evaluation, and FBCT was numerically superior for soft tissue evaluation. Preference tests indicated FBCT was numerically superior for soft tissue evaluation, while preference test scoring for bone was observer-dependent. Findings from this study can be used as background for future studies evaluating CBCT image quality in live horses.
MeSH term(s)	Animals ; Horses ; Prospective Studies ; Tomography, X-Ray Computed ; Cone-Beam Computed Tomography/veterinary ; Bone and Bones ; Metacarpophalangeal Joint/diagnostic imaging ; Cadaver ; Horse Diseases
Language	English
Publishing date	2023-11-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2142058-0
ISSN	1740-8261 ; 1058-8183
ISSN (online)	1740-8261
ISSN	1058-8183
DOI	10.1111/vru.13309
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Computed tomography and fluoroscopy versus radiographic guidance for internal fixation of simulated dorsomedial-plantarolateral central tarsal bone fractures in nonracehorses.

Smanik, Lauren E / Selberg, Kurt T / Kawcak, Christopher E / Stewart, Holly L / Goodrich, Laurie R

Veterinary surgery : VS

2023 Volume 53, Issue 1, Page(s) 155–166

Abstract: Objective: The aim of this study was to assess screw placement in simulated dorsomedial-plantarolateral central tarsal bone (CTB) fractures using two imaging guidance techniques - computed tomography (CT) with fluoroscopy compared to digital radiography ...

Abstract	Objective: The aim of this study was to assess screw placement in simulated dorsomedial-plantarolateral central tarsal bone (CTB) fractures using two imaging guidance techniques - computed tomography (CT) with fluoroscopy compared to digital radiography alone (DR). Study design: Experimental study. Sample population: Equine cadaver hindlimbs (n = 10 pairs). Methods: One tarsus per pair was randomly assigned to have a 4.5 mm cortical screw placed across the CTB using CT and fluoroscopy (CT/F group) or digital radiography alone (DR group). Postoperative CT was performed on all limbs. Variables related to marker placement, procedure time, and screw positioning were recorded and compared using a paired t-test for dependent means (p < .05). Results: Time for marker placement was longer for the CT/F group (p = .001), with no difference in total procedure time (p = .12). CT/F was not superior to radiography alone (p > .05) for parameters related to screw positioning. Based on the 95% CI, there was greater range in relative screw length using radiography (76.5%-91.2%) versus CT/F (78.4%-84.0%). Conclusion: Internal fixation of CTB fractures can be successfully performed using either technique for imaging guidance. CT and fluoroscopy did not result in faster or more accurate screw placement compared to radiographs alone, except in determining screw length. Clinical significance: Mild adjustments in fluoroscopic or radiographic angle appeared to be a point of variability in the perception of screw placement. While CT is recommended for improved understanding of fracture configuration and surgical planning, radiographic guidance may be a suitable alternative for internal fixation of dorsomedial-plantarolateral fractures.
MeSH term(s)	Horses/surgery ; Animals ; Fractures, Bone/diagnostic imaging ; Fractures, Bone/surgery ; Fractures, Bone/veterinary ; Fracture Fixation, Internal/veterinary ; Fracture Fixation, Internal/methods ; Fluoroscopy/veterinary ; Tomography, X-Ray Computed/veterinary ; Tomography, X-Ray Computed/methods ; Tarsal Bones/diagnostic imaging ; Tarsal Bones/surgery ; Horse Diseases
Language	English
Publishing date	2023-09-28
Publishing country	United States
Document type	Randomized Controlled Trial, Veterinary ; Journal Article
ZDB-ID	1491071-8
ISSN	1532-950X ; 0161-3499
ISSN (online)	1532-950X
ISSN	0161-3499
DOI	10.1111/vsu.14035
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: The Importance of Subchondral Bone in the Pathophysiology of Osteoarthritis.

Stewart, Holly L / Kawcak, Christopher E

Frontiers in veterinary science

2018 Volume 5, Page(s) 178

Abstract: Subchondral bone plays a critical role in the pathogenesis of osteochondral disease across veterinary species. The subchondral bone is highly adaptable, with the ability to model and remodel in response to loading stresses experienced by the joint. ... ...

Abstract	Subchondral bone plays a critical role in the pathogenesis of osteochondral disease across veterinary species. The subchondral bone is highly adaptable, with the ability to model and remodel in response to loading stresses experienced by the joint. Repetitive stress injuries within the joint can result in primary or secondary pathologic lesions within the subchondral bone, which have been recognized to contribute to the development and progression of osteoarthritis. Recent advances in diagnostic imaging, particularly volumetric imaging modalities have facilitated earlier identification of subchondral bone disease. Despite these advancements, limitations in our knowledge about subchondral bone makes treatment and prevention of these conditions challenging. The purpose of this report is to review our current understanding of subchondral bone and its relationship to osteoarthritis across veterinary species, with a specific focus in the research that has been performed in horses. It can be concluded that our current understanding of subchondral bone is advancing, and future experimental, clinical and pathologic studies will provide additional insight about subchondral bone and its relationship to joint disease.
Language	English
Publishing date	2018-08-28
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2834243-4
ISSN	2297-1769
ISSN	2297-1769
DOI	10.3389/fvets.2018.00178
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Article ; Online: Use of cone-beam computed tomography for advanced imaging of the equine patient.

Stewart, Holly L / Siewerdsen, Jeffery H / Nelson, Brad B / Kawcak, Christopher E

Equine veterinary journal

2021 Volume 53, Issue 5, Page(s) 872–885

Abstract: Access to volumetric imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT), has increased over the past decade and has revolutionised the way clinicians evaluate equine anatomy. More recent advancements have resulted ... ...

Abstract	Access to volumetric imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT), has increased over the past decade and has revolutionised the way clinicians evaluate equine anatomy. More recent advancements have resulted in the development of multiple commercially available cone-beam CT (CBCT) scanners for equine use. CBCT scanners modify the traditional fan-shaped beam of ionising radiation into a three-dimensional pyramidal- or cone-shaped beam of radiation. This modification enables the scanner to acquire sufficient data to create diagnostic images of a region of interest after a single rotation of the gantry. The rapid acquisition of data and divergent X-ray beam causes some artifacts to be more prominent on CBCT images-as well as the unique cone-beam artifact-resulting in decreased contrast resolution. While the use of CT for evaluation of the equine musculoskeletal anatomy is not new, there is a paucity of literature and scientific studies on the capabilities of CBCT for equine imaging. CBCT units do not require a specialised table for imaging and in some cases are portable for imaging in the standing or anaesthetised patient. This review article summarises the basic physics of CT technology, including how CBCT imaging differs, and provides objective information about the strengths and limitations of this modality. Finally, potential future applications and techniques for imaging with CT which will need to be explored in order to fully consider the capabilities of CT imaging in the horse are discussed.
MeSH term(s)	Animals ; Cone-Beam Computed Tomography/veterinary ; Horses ; Tomography, X-Ray Computed/veterinary
Language	English
Publishing date	2021-07-14
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	41606-x
ISSN	2042-3306 ; 0425-1644
ISSN (online)	2042-3306
ISSN	0425-1644
DOI	10.1111/evj.13473
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Article ; Online: The clinical and histopathologic effects of potentiated chlorhexidine in the upper respiratory tract of horses.

Stewart, Holly L / Engiles, Julie B / Richardson, Dean W / Levine, David G

Veterinary surgery : VS

2021 Volume 50, Issue 6, Page(s) 1209–1217

Abstract: Objective: To describe the bactericidal and fungicidal properties of a 0.0005% chlorhexidine (CHD) solution potentiated with EDTA-Tris buffers (CHD-EDTA-Tris) and evaluate the safety of 0.0005% CHD-EDTA-Tris in the upper respiratory tract (URT) of ... ...

Abstract	Objective: To describe the bactericidal and fungicidal properties of a 0.0005% chlorhexidine (CHD) solution potentiated with EDTA-Tris buffers (CHD-EDTA-Tris) and evaluate the safety of 0.0005% CHD-EDTA-Tris in the upper respiratory tract (URT) of normal horses. Study design: Clinical, prospective study. Animals: Eight healthy, skeletally mature horses. Methods: In vitro-serial dilutions of CHD-EDTA-Tris and EDTA-Tris alone were evaluated for bactericidal and fungicidal activity against Aspergillus fumigatus, Escherichia coli, Staphylococcus aureus, Streptococcus equi subspecies ssp. equi, Streptococcus equi ssp. zooepidemicus, and Pseudomonas aeruginosa. In vivo-eight healthy horses were topically treated twice with 30 ml of 0.0005% CHD-EDTA-Tris. Mucosal samples from each location were evaluated for the presence of inflammation or pathologic lesions. Results: Solutions containing CHD were superior in fungal and bacterial killing to those without. In vitro-a 0.005% CHD-EDTA-Tris was 100% effective against all bacterial and fungal species evaluated, while a 0.0005% CHD-EDTA-Tris was less efficacious against A. fumigatus and S. equi ssp. equi. In vivo-a 0.0005% CHD-EDTA-Tris did not cause any clinical, gross, or histologic abnormalities when topically applied to the equine URT. Conclusions: A 0.0005% CHD-EDTA-Tris was highly effective for killing of common bacterial and fungal isolates in the equine upper respiratory tract. Short-term topical treatment of the equine URT with dilute CHD did not cause gross or histological inflammation in the tissue. Clinical significance: A 0.0005% CHD solution with EDTA-Tris should be considered for treatment of clinically relevant inflammatory or infectious conditions or in the URT of the horse.
MeSH term(s)	Animals ; Chlorhexidine/pharmacology ; Horse Diseases/drug therapy ; Horses ; Nose ; Prospective Studies ; Streptococcal Infections/veterinary ; Streptococcus equi
Chemical Substances	Chlorhexidine (R4KO0DY52L)
Language	English
Publishing date	2021-05-11
Publishing country	United States
Document type	Clinical Trial, Veterinary ; Journal Article
ZDB-ID	1491071-8
ISSN	1532-950X ; 0161-3499
ISSN (online)	1532-950X
ISSN	0161-3499
DOI	10.1111/vsu.13649
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Article ; Online: Comparison of a Thiolated Demineralized Bone Matrix Hydrogel to a Clinical Product Control for Regeneration of Large Sheep Cranial Defects.

Townsend, Jakob M / Kiyotake, Emi A / Easley, Jeremiah / Seim, Howard B / Stewart, Holly L / Fung, Kar-Ming / Detamore, Michael S

Materialia

2023 Volume 27

Abstract: Regeneration of calvarial bone remains a major challenge in the clinic as available options do not sufficiently regenerate bone in larger defect sizes. Calvarial bone regeneration cases involving secondary medical conditions, such as brain herniation ... ...

Abstract	Regeneration of calvarial bone remains a major challenge in the clinic as available options do not sufficiently regenerate bone in larger defect sizes. Calvarial bone regeneration cases involving secondary medical conditions, such as brain herniation during traumatic brain injury (TBI) treatment, further exacerbate treatment options. Hydrogels are well-positioned for severe TBI treatment, given their innate flexibility and potential for bone regeneration to treat TBI in a single-stage surgery. The current study evaluated a photocrosslinking pentenoate-modified hyaluronic acid polymer with thiolated demineralized bone matrix (i.e., TDBM hydrogel) capable of forming a completely interconnected hydrogel matrix for calvarial bone regeneration. The TDBM hydrogel demonstrated a setting time of 120 s, working time of 3 to 7 days, negligible change in setting temperature, physiological setting pH, and negligible cytotoxicity, illustrating suitable performance for
Language	English
Publishing date	2023-01-17
Publishing country	England
Document type	Journal Article
ISSN	2589-1529
ISSN (online)	2589-1529
DOI	10.1016/j.mtla.2023.101690
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Article ; Online: Evaluation of a modified subchondroplasty technique in an equine full-thickness cartilage defect model: a pilot study.

Smanik, Lauren E / Selberg, Kurt T / Mason, Gary L / Brock, Maria / Stewart, Holly L / Goodrich, Laurie R / Kawcak, Christopher E

American journal of veterinary research

2023 Volume 84, Issue 4

Abstract: Objective: To perform a pilot study with the intent of assessing the feasibility of a modified subchondroplasty (mSCP) technique in a validated preclinical equine model of full-thickness articular cartilage loss and evaluate the short-term patient ... ...

Abstract	Objective: To perform a pilot study with the intent of assessing the feasibility of a modified subchondroplasty (mSCP) technique in a validated preclinical equine model of full-thickness articular cartilage loss and evaluate the short-term patient response to the injected materials. Animals: 3 adult horses. Procedures: Two 15-mm-diameter full-thickness cartilage defects were created on the medial trochlear ridge of each femur. Defects were treated with microfracture and then filled by 1 of 4 techniques: (1) autologous fibrin graft (FG) via subchondral injection of fibrin glue (FG), (2) autologous fibrin graft via direct injection of FG, (3) subchondral injection of a calcium phosphate bone substitute material (BSM) with direct injection of FG, and (4) untreated control. Horses were euthanized after 2 weeks. Patient response was evaluated via serial lameness examination, radiography, magnetic resonance imaging, computed tomography, gross evaluation, microcomputed tomography, and histopathology. Results: All treatments were successfully administered. The injected material perfused through the underlying bone into the respective defects without adversely affecting the surrounding bone and articular cartilage. Increased new bone formation was seen at the margins of the trabecular spaces containing BSM. There was no treatment effect on the amount or composition of tissue within defects. Clinical relevance: The mSCP technique was a simple, well-tolerated technique in this equine articular cartilage defect model without significant adverse effects to host tissues after 2 weeks. Larger studies with long-term follow-ups are warranted.
MeSH term(s)	Animals ; Horses ; Pilot Projects ; X-Ray Microtomography ; Cartilage, Articular/surgery ; Cartilage, Articular/pathology ; Magnetic Resonance Imaging/veterinary ; Fibrin
Chemical Substances	Fibrin (9001-31-4)
Language	English
Publishing date	2023-02-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	390796-x
ISSN	1943-5681 ; 0002-9645
ISSN (online)	1943-5681
ISSN	0002-9645
DOI	10.2460/ajvr.22.12.0219
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Article ; Online: Feasibility of bone marrow edema detection using dual-energy cone-beam computed tomography.

Liu, Stephen Z / Herbst, Magdalena / Schaefer, Jamin / Weber, Thomas / Vogt, Sebastian / Ritschl, Ludwig / Kappler, Steffen / Kawcak, Christopher E / Stewart, Holly L / Siewerdsen, Jeffrey H / Zbijewski, Wojciech

Medical physics

2024 Volume 51, Issue 3, Page(s) 1653–1673

Abstract: Background: Dual-energy (DE) detection of bone marrow edema (BME) would be a valuable new diagnostic capability for the emerging orthopedic cone-beam computed tomography (CBCT) systems. However, this imaging task is inherently challenging because of the ...

Abstract	Background: Dual-energy (DE) detection of bone marrow edema (BME) would be a valuable new diagnostic capability for the emerging orthopedic cone-beam computed tomography (CBCT) systems. However, this imaging task is inherently challenging because of the narrow energy separation between water (edematous fluid) and fat (health yellow marrow), requiring precise artifact correction and dedicated material decomposition approaches. Purpose: We investigate the feasibility of BME assessment using kV-switching DE CBCT with a comprehensive CBCT artifact correction framework and a two-stage projection- and image-domain three-material decomposition algorithm. Methods: DE CBCT projections of quantitative BME phantoms (water containers 100-165 mm in size with inserts presenting various degrees of edema) and an animal cadaver model of BME were acquired on a CBCT test bench emulating the standard wrist imaging configuration of a Multitom Rax twin robotic x-ray system. The slow kV-switching scan protocol involved a 60 kV low energy (LE) beam and a 120 kV high energy (HE) beam switched every 0.5° over a 200° angular span. The DE CBCT data preprocessing and artifact correction framework consisted of (i) projection interpolation onto matched LE and HE projections views, (ii) lag and glare deconvolutions, and (iii) efficient Monte Carlo (MC)-based scatter correction. Virtual non-calcium (VNCa) images for BME detection were then generated by projection-domain decomposition into an Aluminium (Al) and polyethylene basis set (to remove beam hardening) followed by three-material image-domain decomposition into water, Ca, and fat. Feasibility of BME detection was quantified in terms of VNCa image contrast and receiver operating characteristic (ROC) curves. Robustness to object size, position in the field of view (FOV) and beam collimation (varied 20-160 mm) was investigated. Results: The MC-based scatter correction delivered > 69% reduction of cupping artifacts for moderate to wide collimations (> 80 mm beam width), which was essential to achieve accurate DE material decomposition. In a forearm-sized object, a 20% increase in water concentration (edema) of a trabecular bone-mimicking mixture presented as ∼15 HU VNCa contrast using 80-160 mm beam collimations. The variability with respect to object position in the FOV was modest (< 15% coefficient of variation). The areas under the ROC curve were > 0.9. A femur-sized object presented a somewhat more challenging task, resulting in increased sensitivity to object positioning at 160 mm collimation. In animal cadaver specimens, areas of VNCa enhancement consistent with BME were observed in DE CBCT images in regions of MRI-confirmed edema. Conclusion: Our results indicate that the proposed artifact correction and material decomposition pipeline can overcome the challenges of scatter and limited spectral separation to achieve relatively accurate and sensitive BME detection in DE CBCT. This study provides an important baseline for clinical translation of musculoskeletal DE CBCT to quantitative, point-of-care bone health assessment.
MeSH term(s)	Humans ; Bone Marrow/diagnostic imaging ; Feasibility Studies ; Cone-Beam Computed Tomography/methods ; Algorithms ; Phantoms, Imaging ; Edema ; Cadaver ; Water ; Scattering, Radiation ; Image Processing, Computer-Assisted/methods
Chemical Substances	Water (059QF0KO0R)
Language	English
Publishing date	2024-02-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	188780-4
ISSN	2473-4209 ; 0094-2405
ISSN (online)	2473-4209
ISSN	0094-2405
DOI	10.1002/mp.16962
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Article ; Online: A missed opportunity: A scoping review of the effect of sex and age on osteoarthritis using large animal models.

Stewart, Holly L / Gilbert, Derek / Stefanovski, Darko / Garman, Zoe / Albro, Michael B / Bais, Manish / Grinstaff, Mark W / Snyder, Brian D / Schaer, Thomas P

Osteoarthritis and cartilage

2024 Volume 32, Issue 5, Page(s) 501–513

Abstract: Objective: The objective was to critically analyze the published literature accounting for sex differences and skeletal age (open vs. closed physis) in preclinical animal models of OA, including the disaggregation of data by sex and skeletal maturity ... ...

Abstract	Objective: The objective was to critically analyze the published literature accounting for sex differences and skeletal age (open vs. closed physis) in preclinical animal models of OA, including the disaggregation of data by sex and skeletal maturity when data is generated from combined sex and/or multi-aged cohorts without proper confounding. Method: A scoping literature review of PubMed, Web of Science, EMBASE, and SCOPUS was performed for studies evaluating the effect of sex and age in experimental studies and clinical trials utilizing preclinical large animal models of OA. Results: A total of 9727 papers were identified in large animal (dog, pig, sheep, goat, horse) models for preclinical OA research, of which 238 ex vivo and/or in vivo studies disclosed model type, animal species, sex, and skeletal age sufficient to analyze their effect on outcomes. Dogs, followed by pigs, sheep, and horses, were the most commonly used models. A paucity of preclinical studies evaluated the effect of sex and age in large animal models of naturally occurring or experimentally induced OA: 26 total studies reported some kind of analysis of the effects of sex or age, with 4 studies discussing the effects of sex only, 11 studies discussing the effects of age only, and 11 studies analyzing both the effects of age and sex. Conclusion: Fundamental to translational research, OARSI is uniquely positioned to develop recommendations for conducting preclinical studies using large animal models of OA that consider biological mechanisms linked to sex chromosomes, skeletal age, castration, and gonadal hormones affecting OA pathophysiology and treatment response.
MeSH term(s)	Female ; Male ; Swine ; Animals ; Sheep ; Horses ; Dogs ; Disease Models, Animal ; Osteoarthritis/veterinary ; Goats ; Bibliometrics ; Growth Plate
Language	English
Publishing date	2024-02-24
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1167809-4
ISSN	1522-9653 ; 1063-4584
ISSN (online)	1522-9653
ISSN	1063-4584
DOI	10.1016/j.joca.2024.02.009
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