Assessment of diaphyseal long bone fracture healing in cats using radiography, ultrasonography and doppler impedance index
Year 2024,
Volume: 9 Issue: 3, 173 - 182
Nihan Avcı
,
İrem Ergin
,
Yusuf Şen
Abstract
Color Doppler ultrasonography evaluates blood flow and neovascularization in vessels, assessing Pulsatility Index (PI) and Resistive Index (RI) values. The primary objective of this study is to monitor the healing periods of fractures using color Doppler ultrasonography index values, thereby preventing complications through objective data. The emphasis is particularly on establishing the foundation for studies aimed at early detection of delays in vascularization associated with fracture healing. The research involved 20 cats of various breeds and genders, aged 1 to 4 years, diagnosed with femur and tibia diaphyseal fractures. Mediolateral and anteroposterior radiographs were taken on postoperative days 0, 10, 20, and 30. The fracture site was examined using color Doppler ultrasonography. As a result of the study, using Doppler ultrasonography and radiography, neovascular areas from fracture formation to callus formation were converted into objective data through vascular indices. Particularly noteworthy was a significant increase in RI and PI values observed on the postoperative 10th day. It was deduced that the detection of fracture healing could occur earlier with the assistance of these index values when compared to radiographs taken on the 10th and 30th days. In conclusion, PI and RI values may be important parameters in evaluating the healing process in complex fractures, especially in determining complications and monitoring the progress of healing. Moreover, Doppler indices might be employed to complement traditional diagnostic approaches in the early detection of pathological bone conditions
Ethical Statement
This study was approved by the Ankara University Animal Experiments Local Ethics Committee, Ankara, Türkiye (Approval no: 2020-5-36).
References
- Bude, R. O., & Rubin, J. (1999). Relationship between the resistive index and vascular compliance and resistance. Radiology. 211(2), 411-7. https://doi.org/ 10.1148/radiology.211.2.r99ma48411
- Caruso, G., Lagalla, R., Derchi, L., Iovane, A., & Sanfilippo, A. (2000). Monitoring of fracture calluses with color doppler sonography. Journal of Clinical Ultrasound. 28(1), 20–27. https://doi.org/10.1002/ (SICI)1097-0096(200001)28:1<20::AID-JCU3>3.0.C O;2-W
- Chung, J., Lee, Y. J., Choi, Y. J., Ha, E. J., Suh, C. H., Choi, M., Beak, J. H., & Na, D. G. (2020). Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology. Ultrasonography. 39(4), 315-330. https://doi.org/10.14366/usg.20072
- Decamp, C., Johnston, S., Dejardin, L., & Schaefer S. (2016). Brınker, piermatteı, and flo’s handbook of small animal orthopedics and fracture repair (5th ed.). USA, Elsevier.
- Ginther, O. J. (2007). Ultrasonic imaging and animal reproduction: color-doppler ultrasonography book 4. (pp. 69-77). Equiservices Publishing.
- Gorgas, D. (2011). Physical principles. In F. Barr, & L. Gaschen (Eds.), BSAVA manual of canine and feline ultrasonography (pp. 1-14). India.
- Gosling, R. G., & King, D. H. (1974). Arterial assessment by doppler-shift ultrasound. Proceedings of The Royal Society of Medicine, 67(1), 447-449.
- Hammond, G. (2016). BSAVA manual of canine and feline fracture repair and management (2nd ed.). England.
Kealy, J. K., Mcallister, H., & Graham, J. P. (2011). Diagnostic radiology and ultrasonography of the dog and cat (5th ed.). Saunders, Elsevier.
- Kim, E., Sharma, A. M., Scissons, R., Dawson, D., Eberhardt, R., Herman, M., Hughes, J., Knight, S., Kupinski, A., Mahe, G., Neumyer, M., Poe, P., Shugart, R., Wennberg, P., Williams, D. & Zierler, R. (2020). Interpretation of peripheral arterial and venous doppler waveforms: a consensus statement from the society for vascular medicine and society for vascular ultrasound. Vascular Medicine, 25(5), 484-506. https://doi.org/10.1177/1358863X20937
- Kramer, M. (2011). Musculoskeletal structures. In F. Barr, & L. Gaschen, (Eds.), BSAVA manual of canine and feline ultrasonography. India.
- Maffulli, N., &Thornton, A. (1995). Ultrasonographic appearance of external callus in long bone fractures. Injury: International Journal of The Care of The Injured, 26(1), 5-12.
- Michel, E. & Zernikow, B. (1998). Gosling’s doppler pulsatility index revisited. Ultrasound in Medicine & Biology, 24(4), 597–599. https://doi.org/10.1016/ S0301-5629(98)00024-6
- Rawashdeh, Y. F., Djurhuus, J. C., Mortensen, J., Horlyck, A., & Frokiaer, J. (2001). The intrarenal resistive index as pathophysiologycal marker of obstructive uropaty. The Journal of Urology. 165, 1397-1404.
- Risselada, M., Kramer, M., Bree, H., Chiers, K., Duchateau, L., Verleyen, P., & Saunders, J. (2006). Evaluation of nonunion fractures in dogs by use of b-mode ultrasonography, power doppler ultrasonography, radiography and histologic examination. American Journal of Veterinary Research, 67(8), 1354-1361. https://doi.org/10.2460/ajvr.67.8.1354
- River, J. B., Walter, A. P., Finlay, E. D., King, L. V., & Polzin, J. D. (1997). Duplex doppler estimation of resistive index in arcuate arteries of sedated, normal female dogs: Implications for use in diagnosis of renal failure. Journal of The American Animal Hospital Association, 33(1), 69-75. https://doi.org/10. 5326/15473317-33-1-69
- Roe, S. C. (2005). External fixators, pins, nails, and wires. Johnson, A. L, Houlton, J., & Vannini, R., (Eds.), AO principles of fracture management in the dog and cat (pp.60), Thieme, Switzerland.
- Su, H. Q., Zhuang, X. Q., Bai, Y., Ye, H. H., Huang, X. H., Lu, B. B., Lu, S. L., Nong, D. Y., Wan, W. (2013). Value of ultrasonography for observation of early healing of humeral shaft fractures. Journal of Medical Ultrasonics. 40(3), 231–236. https://doi.org/10. 1007/s10396-012-0426-z
- Thrall, D. (2013). Textbook of veterinary diagnostic radiology (6th ed.). Elsevier.
- Varshney, J. P., & Chaudhary, P. S. (2022). Doppler ultrasonography. In J. P. Varshney (Eds.), Fully illustrated ultrasound in veterinary medicine fundamentals and applications (pp. 47-50). Nipa.
- Wawrzyk, C. M., Sokal, J., Andrzejewska, W., & Przewratil, P. (2015). The role of ultrasound imaging of callus formation in the treatment of long bone fractures in children. Polish Journal of Radiology. 17(80), 473-478. https://doi.org/10.12659/PJR.894548
- Wielicka, M., Nubauer-Geryk, J., Kozera, G., & Bieniaszewski, L. (2020). Clinical application of pulsatility index. Medical Research Journal., 5(3), 201–210. https://doi.org/10.5603/MRJ.a2020.0016
Year 2024,
Volume: 9 Issue: 3, 173 - 182
Nihan Avcı
,
İrem Ergin
,
Yusuf Şen
References
- Bude, R. O., & Rubin, J. (1999). Relationship between the resistive index and vascular compliance and resistance. Radiology. 211(2), 411-7. https://doi.org/ 10.1148/radiology.211.2.r99ma48411
- Caruso, G., Lagalla, R., Derchi, L., Iovane, A., & Sanfilippo, A. (2000). Monitoring of fracture calluses with color doppler sonography. Journal of Clinical Ultrasound. 28(1), 20–27. https://doi.org/10.1002/ (SICI)1097-0096(200001)28:1<20::AID-JCU3>3.0.C O;2-W
- Chung, J., Lee, Y. J., Choi, Y. J., Ha, E. J., Suh, C. H., Choi, M., Beak, J. H., & Na, D. G. (2020). Clinical applications of Doppler ultrasonography for thyroid disease: consensus statement by the Korean Society of Thyroid Radiology. Ultrasonography. 39(4), 315-330. https://doi.org/10.14366/usg.20072
- Decamp, C., Johnston, S., Dejardin, L., & Schaefer S. (2016). Brınker, piermatteı, and flo’s handbook of small animal orthopedics and fracture repair (5th ed.). USA, Elsevier.
- Ginther, O. J. (2007). Ultrasonic imaging and animal reproduction: color-doppler ultrasonography book 4. (pp. 69-77). Equiservices Publishing.
- Gorgas, D. (2011). Physical principles. In F. Barr, & L. Gaschen (Eds.), BSAVA manual of canine and feline ultrasonography (pp. 1-14). India.
- Gosling, R. G., & King, D. H. (1974). Arterial assessment by doppler-shift ultrasound. Proceedings of The Royal Society of Medicine, 67(1), 447-449.
- Hammond, G. (2016). BSAVA manual of canine and feline fracture repair and management (2nd ed.). England.
Kealy, J. K., Mcallister, H., & Graham, J. P. (2011). Diagnostic radiology and ultrasonography of the dog and cat (5th ed.). Saunders, Elsevier.
- Kim, E., Sharma, A. M., Scissons, R., Dawson, D., Eberhardt, R., Herman, M., Hughes, J., Knight, S., Kupinski, A., Mahe, G., Neumyer, M., Poe, P., Shugart, R., Wennberg, P., Williams, D. & Zierler, R. (2020). Interpretation of peripheral arterial and venous doppler waveforms: a consensus statement from the society for vascular medicine and society for vascular ultrasound. Vascular Medicine, 25(5), 484-506. https://doi.org/10.1177/1358863X20937
- Kramer, M. (2011). Musculoskeletal structures. In F. Barr, & L. Gaschen, (Eds.), BSAVA manual of canine and feline ultrasonography. India.
- Maffulli, N., &Thornton, A. (1995). Ultrasonographic appearance of external callus in long bone fractures. Injury: International Journal of The Care of The Injured, 26(1), 5-12.
- Michel, E. & Zernikow, B. (1998). Gosling’s doppler pulsatility index revisited. Ultrasound in Medicine & Biology, 24(4), 597–599. https://doi.org/10.1016/ S0301-5629(98)00024-6
- Rawashdeh, Y. F., Djurhuus, J. C., Mortensen, J., Horlyck, A., & Frokiaer, J. (2001). The intrarenal resistive index as pathophysiologycal marker of obstructive uropaty. The Journal of Urology. 165, 1397-1404.
- Risselada, M., Kramer, M., Bree, H., Chiers, K., Duchateau, L., Verleyen, P., & Saunders, J. (2006). Evaluation of nonunion fractures in dogs by use of b-mode ultrasonography, power doppler ultrasonography, radiography and histologic examination. American Journal of Veterinary Research, 67(8), 1354-1361. https://doi.org/10.2460/ajvr.67.8.1354
- River, J. B., Walter, A. P., Finlay, E. D., King, L. V., & Polzin, J. D. (1997). Duplex doppler estimation of resistive index in arcuate arteries of sedated, normal female dogs: Implications for use in diagnosis of renal failure. Journal of The American Animal Hospital Association, 33(1), 69-75. https://doi.org/10. 5326/15473317-33-1-69
- Roe, S. C. (2005). External fixators, pins, nails, and wires. Johnson, A. L, Houlton, J., & Vannini, R., (Eds.), AO principles of fracture management in the dog and cat (pp.60), Thieme, Switzerland.
- Su, H. Q., Zhuang, X. Q., Bai, Y., Ye, H. H., Huang, X. H., Lu, B. B., Lu, S. L., Nong, D. Y., Wan, W. (2013). Value of ultrasonography for observation of early healing of humeral shaft fractures. Journal of Medical Ultrasonics. 40(3), 231–236. https://doi.org/10. 1007/s10396-012-0426-z
- Thrall, D. (2013). Textbook of veterinary diagnostic radiology (6th ed.). Elsevier.
- Varshney, J. P., & Chaudhary, P. S. (2022). Doppler ultrasonography. In J. P. Varshney (Eds.), Fully illustrated ultrasound in veterinary medicine fundamentals and applications (pp. 47-50). Nipa.
- Wawrzyk, C. M., Sokal, J., Andrzejewska, W., & Przewratil, P. (2015). The role of ultrasound imaging of callus formation in the treatment of long bone fractures in children. Polish Journal of Radiology. 17(80), 473-478. https://doi.org/10.12659/PJR.894548
- Wielicka, M., Nubauer-Geryk, J., Kozera, G., & Bieniaszewski, L. (2020). Clinical application of pulsatility index. Medical Research Journal., 5(3), 201–210. https://doi.org/10.5603/MRJ.a2020.0016