Bilateral surgery of humeral intracondylar fissures and humeral condylar fractures is associated with increased complication rates

Abstract

Objectives

To compare the postoperative complication rates and outcomes of client-owned dogs treated surgically for humeral intracondylar fissures and/or humeral condylar fractures either as unilateral or bilateral simultaneous procedures.

Materials and Methods

Hospital records from a single referral centre in the United Kingdom were reviewed retrospectively. Dogs were categorised into the unilateral and bilateral groups and then further subdivided according to the surgical procedure performed. Clinical follow-up and a client evaluation scheme were used to identify complications and assess functional outcomes.

Results

Medical records of 75 skeletally mature dogs met the inclusion criteria. The overall complication rate was 36.0%. There was a 1.57-fold increase in the complication rate in bilateral humeral intracondylar fissure compared to unilateral humeral intracondylar fissure and a 2.22-fold increase in humeral intracondylar fissure/humeral condylar fracture compared to unilateral humeral condylar fracture. When minor complications were excluded, the complication rate for bilateral surgeries overall was double that of unilateral procedures. Major surgical complications predominated in the bilateral groups, while major medical complications predominated in the unilateral groups. Surgical site infection was 1.68-fold more prevalent in bilateral humeral intracondylar fissure compared to unilateral humeral intracondylar fissure and 4.45-fold more prevalent in bilateral humeral intracondylar fissure/humeral condylar fracture than in unilateral humeral condylar fracture. Unilateral humeral intracondylar fissure and humeral condylar fracture consistently outperformed the bilateral procedures in functional recovery. Across all bilateral groups, no postoperative complications were detected in the prophylactically treated limb.

Clinical Significance

Single-stage bilateral surgery is associated with markedly increased complication rates, particularly in bicondylar fractures. Delaying intervention on the prophylactic limb until the onset of clinical signs might be considered due to higher complication rates in single-stage procedures.