PMC10109445_01
Timeline with relevant data from the episode of care. CT, computed tomography; MRI, magnetic resonance image.
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F1
An 8-year, 8-month-old castrated male bulldog weighing 29.2 kg was referred to our hospital with a primary complaint of lameness with intermittent inability to bear weight in the left hind limb for 2 months (Figure 1).
Radiographic images of the stifle joints at the time of initial examination: computed tomography (CT), magnetic resonance (MR), and histological images. (A) Mediolateral image of the left stifle; (B) Craniocaudal image of the left stifle; (C) Mediolateral image of the right stifle; (D) Craniocaudal image of the right stifle; (E) The left stifle joint midsagittal section on CT; (F) The left stifle joint midsagittal section in MR T2-weighted image; (G) Microscopic findings of hematoxylin-eosin staining (scale bar: 50 mum).
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F2
Radiography revealed increased radiolucency of the proximal left tibia (Figures 2A, B). The right stifle showed mild cranial displacement of the tibia and findings suggestive of osteoarthritis (Figures 2C, D). CT showed bone resorption in the left proximal tibia (Figure 2E). In addition, the same region showed a high signal intensity in the MR T2-weighted images (T2WI; Figure 2F). Although tissue biopsy revealed a suspected chondroma or CSA, a definitive diagnosis could not be made due to the small amount of material collected (Figure 2G).
Intraoperative images. (A) Cranial view after removing soft tissue around the tibia; (B) Medial view after removing soft tissue around the tibia; (C) Resected proximal tibia; (D) proximal tibia frozen using liquid nitrogen; (E) Tibial tuberosity collapsed after freezing. (F) Fixation of the tibiofemoral joint with K-wire; (G) Arthrodesis with two plates.
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F3
The patellar tendon was resected at the patellar apex (Figures 3A, B). T2WI (Figure 3C). Thereafter, the removed proximal tibia was immersed in liquid nitrogen for 20 min, at room temperature for 15 min, and in a 30 C-physiological saline solution for 15 min, according to previous reports (Figure 3D). The subsequent process resulted in the collapse of the tumor lesion (tibial tuberosity) (Figure 3E). Subsequently, the cross-pin method was used to fix the tibiofemoral joint using a 1.6-mm diameter Kirschner wire (Johnson & Johnson, New Brunswick, NJ, USA; Figure 3F). A 3.5-mm diameter string of pearls plate (Veterinary Orthopedic Implants, Saint Augustine, FL, USA) was placed laterally (Figure 3G).
Postoperative radiographs of the left stifle; (A) Mediolateral image after surgery; (B) Craniocaudal image after surgery; (C) Mediolateral image at 20 months postoperatively; (D) Craniocaudal image at 20 months postoperatively.
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F4
Postoperative radiographs are shown in Figures 4A, B. Although circumduction gait remained during the postoperative period, the weight-bearing status was good, and the owner was satisfied with the results (Figures 4C, D).