J G Grand1, J A Roig, M de Swarte. 1. Section of Veterinary Clinical Sciences, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland.
Abstract
CASE REPORT: We describe an unusual complication of a routine arthroscopic procedure to treat fragmentation of the medial portion of the coronoid process in a 1-year-old Labrador Retriever. While the lesion was being curetted, the tip of the arthroscopic curette broke off. Attempts were made to remove it, but failed, and the broken fragment migrated out of the arthroscopic field. Conversion from arthroscopy to arthrotomy was unsuccessful. On intraoperative radiographs, the metallic fragment was detected in the radial fossa of the humeral condyle. A limited surgical approach to this area, guided by ultrasound, also proved ineffective. Finally, the broken curette tip was left in situ. The dog made an uneventful recovery and 6 months after surgery it showed no lameness except after rest and there was no evidence of migration of the metallic fragment on radiographs. CONCLUSIONS: On such occasions, we recommend: (1) stop both the inflow and outflow of fluids; (2) attempt arthroscopic retrieval with a magnetic retriever and large forceps; (3) use diagnostic imaging to localise the broken fragment if it migrates out of the arthroscopic field; and (4) leave in situ if it is no longer accessible to arthroscopic extraction. This is the first report of an instrument breakage during arthroscopy in a dog.
CASE REPORT: We describe an unusual complication of a routine arthroscopic procedure to treat fragmentation of the medial portion of the coronoid process in a 1-year-old Labrador Retriever. While the lesion was being curetted, the tip of the arthroscopic curette broke off. Attempts were made to remove it, but failed, and the broken fragment migrated out of the arthroscopic field. Conversion from arthroscopy to arthrotomy was unsuccessful. On intraoperative radiographs, the metallic fragment was detected in the radial fossa of the humeral condyle. A limited surgical approach to this area, guided by ultrasound, also proved ineffective. Finally, the broken curette tip was left in situ. The dog made an uneventful recovery and 6 months after surgery it showed no lameness except after rest and there was no evidence of migration of the metallic fragment on radiographs. CONCLUSIONS: On such occasions, we recommend: (1) stop both the inflow and outflow of fluids; (2) attempt arthroscopic retrieval with a magnetic retriever and large forceps; (3) use diagnostic imaging to localise the broken fragment if it migrates out of the arthroscopic field; and (4) leave in situ if it is no longer accessible to arthroscopic extraction. This is the first report of an instrument breakage during arthroscopy in a dog.