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Topic:Diagnostic Technique

Diagnostic techniques in equine medicine encompass a range of procedures and tools used to identify diseases, injuries, or other health conditions in horses. These techniques include imaging methods such as radiography, ultrasonography, and magnetic resonance imaging (MRI), as well as laboratory tests like blood work and tissue biopsies. Each diagnostic method provides specific information that can aid in the assessment and management of equine health issues. Radiography is commonly used for evaluating bone structures, while ultrasonography is useful for soft tissue examination. MRI offers detailed images of both soft and hard tissues, though its use is limited by cost and availability. Laboratory tests can detect biochemical and hematological changes indicative of disease. This page compiles peer-reviewed research studies and scholarly articles that explore the development, application, and efficacy of various diagnostic techniques in equine veterinary practice.
Molecular monitoring of the bacterial community structure in foal feces pre- and post-weaning.
Anaerobe    December 4, 2013   Volume 25 61-66 doi: 10.1016/j.anaerobe.2013.11.010
Faubladier C, Sadet-Bourgeteau S, Philippeau C, Jacotot E, Julliand V.This study assessed the time-scale variability of bacterial community structure in foal feces from birth to 365 days of age using Automated Ribosomal Intergenic Spacer Analysis (ARISA). Fecal samples were collected from five foals 2 h after birth (meconium) and in the morning at days 1, 2, 5, 10, 30, 60, 120, 179, 183, 194 and 365. The ARISA profiles were compared using an analysis of similarity (ANOSIM). Although both the age effect and the foal effect were highly significant (P < 0.010), the R-ANOSIM value for the foal effect was very low (R-ANOSIM = 0.089), while that of the age eff...
Identification and treatment of osteochondritis dissecans of the distal sagittal ridge of the third metacarpal bone.
Equine veterinary journal    December 4, 2013   Volume 46, Issue 5 585-588 doi: 10.1111/evj.12187
Wright IM, Minshall GJ.Osteochondritis dissecans (OCD) of the distal sagittal ridge of the third metacarpal bone (McIII) has not previously been described in the literature. Objective: To describe the clinical, radiological and arthroscopic features of OCD of the distal sagittal ridge of the McIII and to report outcome in a series of cases. Methods: Retrospective case series. Methods: Case records and images of horses with OCD of the distal sagittal ridge of the McIII admitted to a single referral centre between February 2006 and February 2013 were reviewed. Follow-up information was obtained by telephone questionna...
Ureteropyeloscopic anatomy of the renal pelvis of the horse.
Equine veterinary journal. Supplement    December 1, 2013   Issue 45 31-38 doi: 10.1111/evj.12167
Pasquel SG, Agnew D, Nelson N, Kruger JM, Sonea I, Schott HC.Although the equine renal pelvis and terminal recesses have been described post mortem, little information exists about the endoscopic appearance of these structures in the living horse for guiding ureteropyeloscopy. Objective: To further document the anatomy of the upper urinary collecting system, specifically the renal pelvis and terminal recesses, of the horse. Methods: Descriptive study of cadaver material. Methods: Kidneys were harvested from 10 horses. Magnetic resonance imaging was performed after distension of the renal pelvis with an elastomer casting material, followed by visual insp...
An inertial sensor-based system can objectively assess diagnostic anaesthesia of the equine foot.
Equine veterinary journal. Supplement    December 1, 2013   Issue 45 26-30 doi: 10.1111/evj.12158
Maliye S, Voute L, Lund D, Marshall JF.In order for changes in lameness to be accurately and repeatably detected and recorded during diagnostic investigations, an objective measure of lameness is required. Objective: To ascertain whether an inertial sensor-based system can distinguish between a positive and negative response to diagnostic anaesthesia of the foot and objectively assess the effect of a positive response on the trot. Methods: Restrospective clinical study. Methods: Data obtained during lameness investigations undertaken between August 2011 and December 2012 in which either a palmar digital or abaxial sesamoid nerve bl...
Comparison of transverse facial venous sinus and jugular blood values in healthy and critically ill horses.
Equine veterinary journal. Supplement    December 1, 2013   Issue 45 15-19 doi: 10.1111/evj.12163
Hunter BG, Schlipf JW, Cebra C.The transverse facial venous sinus (TFVS) can be used for blood collection in horses, but information on the validity of blood values from this site is limited. Objective: To determine if packed cell volume (PCV), total solids (TS) and blood lactate concentrations in blood drawn simultaneously from a TFVS and jugular vein of critically ill horses are correlated and determine the effect of serial TFVS sampling on the same parameters in healthy horses. Methods: Prospective observational study. Methods: Critically ill horses had simultaneous blood samples drawn from a TFVS and jugular vein. Blood...
Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study.
Equine veterinary journal. Supplement    December 1, 2013   Issue 45 2-7 doi: 10.1111/evj.12165
Borchers A, Wilkins PA, Marsh PM, Axon JE, Read J, Castagnetti C, Pantaleon L, Clark C, Qura'n L, Belgrave R, Schwarzwald C, Levy M, Bedenice D....Evaluation of serial blood lactate concentrations [LAC] are of prognostic value for morbidity and mortality in critically ill human patients and neonatal foals, but have not been prospectively evaluated in a large multicentre study of critically ill neonatal foals. Objective: To prospectively evaluate the prognostic value of sequential [LAC] analysis in critically ill neonatal foals with risk of mortality. Methods: Prospective, observational study. Methods: Thirteen university and private equine referral hospitals enrolled 643 foals over the 2008 foaling season and [LAC] was measured at admiss...
Epidemiological investigation of equine piroplasmosis in China by enzyme-linked immunosorbent assays.
The Journal of veterinary medical science    November 29, 2013   Volume 76, Issue 4 549-552 doi: 10.1292/jvms.13-0477
Wang M, Guo W, Igarashi I, Xuan X, Wang X, Xiang W, Jia H.The objective of this study is to investigate the seroprevalence of equine piroplasmosis in China. A total of 1990 sera were collected from clinically healthy horses in various districts located in ten different provinces of China and examined by using indirect enzyme-linked immunosorbent assays (ELISAs) with recombinant Theileria equi (T. equi) merozoite antigen 2 (rEMA-2) and Babesia caballi (B. caballi) 48-kDa rhoptry protein (rBc48), respectively. The results showed that 1,018 (51.16%) and 229 (11.51%) samples were positive for B. caballi and T. equi infection, respectively. The number of ...
How ultrasound technologies have expanded and revolutionized research in reproduction in large animals.
Theriogenology    November 28, 2013   Volume 81, Issue 1 112-125 doi: 10.1016/j.theriogenology.2013.09.007
Ginther OJ.Gray-scale ultrasonic imaging (UI) was introduced in 1980 and initially was used to examine clinically the reproductive tract of mares. By 1983 in mares and 1984 in heifers/cows, UI had become a tool for basic research. In each species, transrectal gray-scale UI has been used extensively to characterize follicle dynamics and investigate the gonadotropic control and hormonal role of the follicles. However, the use of transrectal UI has also disclosed and characterized many other aspects of reproduction in each species, including (1) endometrial echotexture as a biological indicator of circulati...
The evaluation of a nucleoprotein ELISA for the detection of equine influenza antibodies and the differentiation of infected from vaccinated horses (DIVA).
Influenza and other respiratory viruses    November 28, 2013   Volume 7 Suppl 4, Issue Suppl 4 73-80 doi: 10.1111/irv.12195
Galvin P, Gildea S, Arkins S, Walsh C, Cullinane A.Antibodies against equine influenza virus (EIV) are traditionally quantified by haemagglutination inhibition (HI) or single radial haemolysis (SRH). Objective: To evaluate an ELISA for the detection of antibodies against influenza nucleoprotein in the diagnosis and surveillance of equine influenza (EI). Methods: The ELISA was compared with the SRH and HI tests. Serial serum samples from 203 naturally and 14 experimentally infected horses, from 60 weanlings following primary vaccination with five different vaccines (two whole inactivated vaccines, two ISCOM-based subunit vaccines and a recombin...
Identification and characterization of methicillin-resistant Staphylococcus aureus (MRSA) from Austrian companion animals and horses.
Veterinary microbiology    November 28, 2013   Volume 168, Issue 2-4 381-387 doi: 10.1016/j.vetmic.2013.11.022
Loncaric I, Künzel F, Licka T, Simhofer H, Spergser J, Rosengarten R.The aim of this study was to investigate the antimicrobial resistance, resistance gene patterns and genetic relatedness of a collection of Austrian methicillin-resistant Staphylococcus aureus (MRSA) isolates from companion animals and horses. A total of 89 non-repetitive MRSA isolates collected during routine veterinary microbiological examinations from April 2004 to the end of 2012, and one isolate from 2013 were used for this study. The presence of mecA and other resistance genes was confirmed by PCR. Isolates were genotyped by spa typing, two multiple-locus variable-number tandem repeat ana...
Design and validation of a computer-aided learning program to enhance students’ ability to recognize lameness in the horse.
Journal of veterinary medical education    November 28, 2013   Volume 41, Issue 1 1-8 doi: 10.3138/jvme.0213-040R1
Barstow A, Pfau T, Bolt DM, Smith RK, Weller R.The ability to recognize lameness in the horse is an important skill for veterinary graduates; however, opportunities to develop this skill at the undergraduate level are limited. Computer-aided learning programs (CALs) have been successful in supplementing practical skills teaching. The aim of this study was to design and validate a CAL for the teaching of equine lameness recognition (CAL1). A control CAL was designed to simulate learning by experience (CAL2). Student volunteers were randomly assigned to either CAL and tested to establish their current ability to recognize lameness. Retesting...
CatSper and the relationship of hyperactivated motility to intracellular calcium and pH kinetics in equine sperm.
Biology of reproduction    November 27, 2013   Volume 89, Issue 5 123 doi: 10.1095/biolreprod.113.111708
Loux SC, Crawford KR, Ing NH, González-Fernández L, Macías-García B, Love CC, Varner DD, Velez IC, Choi YH, Hinrichs K.In vitro fertilization does not occur readily in the horse. This may be related to failure of equine sperm to initiate hyperactivated motility, as treating with procaine to induce hyperactivation increases fertilization rates. In mice, hyperactivated motility requires a sperm-specific pH-gated calcium channel (CatSper); therefore, we investigated this channel in equine sperm. Motility was assessed by computer-assisted sperm motility analysis and changes in intracellular pH and calcium were assessed using fluorescent probes. Increasing intracellular pH induced a rise in intracellular calcium, w...
Heritable equine regional dermal asthenia.
The Veterinary clinics of North America. Equine practice    November 26, 2013   Volume 29, Issue 3 689-702 doi: 10.1016/j.cveq.2013.09.001
Rashmir-Raven A.Hereditary equine regional dermal asthenia is a form of Ehlers-Danlos syndrome, and has an autosomal recessive mode of inheritance. Affected horses are typically born normal and develop lesions within the first 2 years of life. The most common symptoms of the disease include stretchy, loose skin that feels doughy or mushy. More severely affected horses experience spontaneous skin sloughing and extensive lacerations, hematomas, and seromas from minor trauma. Affected horses have a higher than expected incidence of corneal ulcers. DNA testing can normal, establish carrier and affected status. Pa...
Illumina sequencing of the V4 hypervariable region 16S rRNA gene reveals extensive changes in bacterial communities in the cecum following carbohydrate oral infusion and development of early-stage acute laminitis in the horse.
Veterinary microbiology    November 26, 2013   Volume 168, Issue 2-4 436-441 doi: 10.1016/j.vetmic.2013.11.017
Moreau MM, Eades SC, Reinemeyer CR, Fugaro MN, Onishi JC.In the equine carbohydrate overload model of acute laminitis, disease progression is associated with changes in bacteria found in the cecum. To date, research has focused on changes in specific Gram-positive bacteria in this portion of the intestinal tract. Metagenomic methods are now available making it possible to interrogate microbial communities using animal protocols that sufficiently power a study. In this study, the microbiota in cecal fluid collected from control, non-laminitic horses (n=8) and from horses with early-stage acute laminitis induced with either oligofructan (n=6) or corns...
Expression and activity of collagenases in the digital laminae of horses with carbohydrate overload-induced acute laminitis.
Journal of veterinary internal medicine    November 25, 2013   Volume 28, Issue 1 215-222 doi: 10.1111/jvim.12252
Wang L, Pawlak EA, Johnson PJ, Belknap JK, Alfandari D, Black SJ.Matrix metalloproteinases (MMP) are hypothesized to degrade structurally important components of the laminar extracellular matrix (ECM) in horses with laminitis. Objective: To compare levels of expression of stromelysin-1 (MMP-3), collagenases (MMP-1, -13), and membrane type-MMPs (MMP-14, -15, -16), and the distribution of their ECM substrates, in laminae of healthy horses and horses with carbohydrate overload laminitis. Methods: Twenty-five adult horses. Methods: Gene and protein expression were determined in extracts of laminae using real-time quantitative polymerase chain reaction and Weste...
Clinical signs, treatment, and prognosis for horses with impaction of the cranial aspect of the base of the cecum: 7 cases (2000-2010).
Journal of the American Veterinary Medical Association    November 23, 2013   Volume 243, Issue 11 1596-1601 doi: 10.2460/javma.243.11.1596
Sherlock CE, Eggleston RB.To determine the clinical signs, treatment, and prognosis for horses with impaction of the cranial aspect of the base of the cecum (cecal cupula). Methods: Retrospective observational case series. Methods: 7 horses with colic attributed to cecal cupula impaction. Methods: Medical records were reviewed and horses that underwent exploratory celiotomy from 2000 through 2010 were identified. Horses with cecal cupula impaction and without other abdominal problems to which colic could be attributed were selected for inclusion in the study. Information regarding history, clinical findings, diagnostic...
Distal limb desensitisation following analgesia of the digital flexor tendon sheath in horses using four different techniques.
Equine veterinary journal    November 21, 2013   Volume 46, Issue 4 488-493 doi: 10.1111/evj.12186
Jordana M, Martens A, Duchateau L, Vanderperren K, Saunders J, Oosterlinck M, Pille F.Controversy exists about the desensitisation obtained after diagnostic analgesia of the digital flexor tendon sheath (DFTS) during lameness examinations. Objective: To determine whether DFTS analgesia results in inadvertent desensitisation of the palmar/plantar digital nerves and whether this depends on the injection technique used. Methods: Crossover experimental study. Methods: The DFTS of 9 horses were injected with local anaesthetic solution and radiodense contrast medium using one of the following techniques: Proximal (at lateral proximal recess of the DFTS), Axial (axial to the lateral p...
Use of two conventional staining methods to assess the acrosomal status of stallion spermatozoa.
Equine veterinary journal    November 20, 2013   Volume 46, Issue 4 503-506 doi: 10.1111/evj.12179
Runcan EE, Pozor MA, Zambrano GL, Benson S, Macpherson ML.The acrosome is a highly specialised region of the spermatozoon that is essential for fertilisation. Defects or dysfunction of this structure have been associated with fertility problems in man and various domestic species including stallions. Current methods of evaluating the acrosome of stallion spermatozoa are time consuming and require specialised equipment, which is cost prohibitive to the average practitioner. Objective: To evaluate 2 conventional stains (Dip Quick and Spermac) and determine their usefulness in assessing acrosome integrity in stallions as compared with specific acrosomal...
Clinical course of ophthalmic findings and potential influence factors of herpesvirus infections: 18 month follow-up of a closed herd of lipizzaners.
PloS one    November 20, 2013   Volume 8, Issue 11 e79888 doi: 10.1371/journal.pone.0079888
Rushton JO, Kolodziejek J, Tichy A, Nowotny N, Nell B.To date the influence of herpesviruses on the development of equine ocular diseases has not been clearly determined. Objective: The purpose of this study was to illustrate the course of equine ocular findings over a period of 18 months at 6 month intervals, in correlation with the results of herpesvirus detection. Methods: 266 Lipizzaners in 3 federal states of Austria underwent complete ophthalmologic examination 4 times. Blood samples, nasal- and conjunctival swabs were obtained at the same time and used for the detection of the equid gammaherpesviruses EHV-2 and EHV-5 using consensus herpes...
A high throughput screen for 17 Dermorphin peptides in equine and human urine and equine plasma.
Drug testing and analysis    November 20, 2013   Volume 6, Issue 9 909-921 doi: 10.1002/dta.1585
Steel R, Timms M, Levina V, Vine J.The Dermorphins are a family of peptides that act as potent agonists of the opioid μ receptor. Originally identified as a seven amino acid peptide on the skin of the South American Phyllomedusa frog, peptide chemists have since developed a large number of Dermorphin variants, many with superior opioid activity to the original peptide. Dermorphins are unique among the peptide opioid agonists as they appear to have a limited ability to cross the blood brain barrier, producing effects on both the central and peripheral nervous systems. It is this ability of Dermorphins to provide central anaesth...
In vitro comparison of V-Loc™ versus Biosyn™ in a one-layer end-to-end anastomosis of equine jejunum.
Veterinary surgery : VS    November 20, 2013   Volume 43, Issue 1 80-84 doi: 10.1111/j.1532-950X.2013.12081.x
Nelson BB, Hassel DM.To compare a unidirectional barbed suture (V-Loc™) to its suture material equivalent (Biosyn™) in a single-layer end-to-end anastomosis of equine jejunum. Methods: Experimental in vitro study. Methods: Jejunal sections from adult horses (n = 5) without gastrointestinal disease. Methods: Jejunal end-to-end anastomoses (n = 9) were performed for each group (V-Loc™, Biosyn™) with a continuous Lembert pattern with an interruption every 120°. Anastomosis construction time, luminal diameter, and number of suture bites were recorded. Anastomosis constructs were distended with fluid at 1 L/mi...
Effect of turn direction on body lean angle in the horse in trot and canter.
Veterinary journal (London, England : 1997)    November 19, 2013   Volume 199, Issue 2 258-262 doi: 10.1016/j.tvjl.2013.11.009
Brocklehurst C, Weller R, Pfau T.Turning is commonly used as a diagnostic aid in equine lameness examinations. Forces experienced on the circle differ from those in a straight line, necessitating an inward lean of the body and asymmetric head/pelvic excursion, which are important parameters for lameness investigations. To better understand gait adaptations to lungeing in normal horses, the effect of turn direction on body lean in trot and in canter warrants further investigation. In this study, it was hypothesised that, on average and independent of gait, the observed body lean angle would be consistent with the ratio between...
Computed tomographic features of apical infection of equine maxillary cheek teeth: a retrospective study of 49 horses.
Equine veterinary journal    November 18, 2013   Volume 46, Issue 4 468-473 doi: 10.1111/evj.12174
Bühler M, Fürst A, Lewis FI, Kummer M, Ohlerth S.Computed tomographic (CT) studies evaluating the relevance of individual CT features of apical infection in maxillary cheek teeth are lacking. Objective: To study the prevalence and relationship of single CT features in horses with and without clinical evidence of apical infection in maxillary cheek teeth. Methods: Retrospective case-control study. Methods: Multislice CT scans of the head of 49 horses were evaluated retrospectively. Changes of the infundibulum, pulp, root, lamina dura, periodontal space and alveolar bone in maxillary cheek teeth were recorded. Results: Single CT changes were m...
A multigene approach for comparing genealogy of Betacoronavirus from cattle and horses.
TheScientificWorldJournal    November 17, 2013   Volume 2013 349702 doi: 10.1155/2013/349702
Barros IN, Silva SO, Nogueira Neto FS, Asano KM, Souza SP, Richtzenhain LJ, Brandao PE.Gastroenteritis is one of the leading causes of morbidity and mortality among young and newborn animals and is often caused by multiple intestinal infections, with rotavirus and bovine coronavirus (BCoV) being the main viral causes in cattle. Given that BCoV is better studied than equine coronaviruses and given the possibility of interspecies transmission of these viruses, this research was designed to compare the partial sequences of the spike glycoprotein (S), hemagglutinin-esterase protein (HE), and nucleoprotein (N) genes from coronaviruses from adult cattle with winter dysentery, calves w...
Urinary PCR as an increasingly useful tool for an accurate diagnosis of leptospirosis in livestock.
Veterinary research communications    November 13, 2013   Volume 38, Issue 1 81-85 doi: 10.1007/s11259-013-9582-x
Hamond C, Martins G, Loureiro AP, Pestana C, Lawson-Ferreira R, Medeiros MA, Lilenbaum W.The aim of the present study was to consider the wide usage of urinary PCR as an increasingly useful tool for an accurate diagnosis of leptospirosis in livestock. A total of 512 adult animals (300 cattle, 138 horses, 59 goats and 15 pigs), from herds/flocks with reproductive problems in Rio de Janeiro, Brazil was studied by serology and urinary PCR. From the 512 serum samples tested, 223 (43.5 %) were seroreactive (cattle: 45.6 %, horses: 41.3 %, goats: 34%and pigs: 60 %). PCR detected leptospiral DNA in 32.4 % (cattle: 21.6 %, horses: 36.2 %, goats: 77.4 % and pigs: 33.3 %. To our knowledge t...
Validation of a novel technique for creating simulated radiographs using computed tomography datasets. Mendoza P, d'Anjou MA, Carmel EN, Fournier E, Mai W, Alexander K, Winter MD, Zwingenberger AL, Thrall DE, Theoret C.Understanding radiographic anatomy and the effects of varying patient and radiographic tube positioning on image quality can be a challenge for students. The purposes of this study were to develop and validate a novel technique for creating simulated radiographs using computed tomography (CT) datasets. A DICOM viewer (ORS Visual) plug-in was developed with the ability to move and deform cuboidal volumetric CT datasets, and to produce images simulating the effects of tube-patient-detector distance and angulation. Computed tomographic datasets were acquired from two dogs, one cat, and one horse....
Ultrasound-guided atlanto-occipital puncture for cerebrospinal fluid analysis on the standing horse.
The Veterinary record    November 13, 2013   Volume 174, Issue 2 45 doi: 10.1136/vr.101758
Depecker M, Bizon-Mercier C, Couroucé-Malblanc A.The atlanto-occipital site (AO) is convenient for retrieving an adequate volume and quality of cerebrospinal fluid (CSF) in the diagnosis of neurological disease in horses. However, general anaesthesia is not always possible for horses displaying severe neurological signs, or for economical reasons. The objectives of the present work were to determine the feasibility and safety of ultrasound-guided CSF puncture at the AO site on the standing horse. Seven horses (six healthy and one mildly ataxic) were sedated with acepromazine (0.02 mg/kg bodyweight intravenously or 0.04 mg/kg bodyweight intra...
Cardiovascular, colloid osmotic pressure, and hemostatic effects of 2 formulations of hydroxyethyl starch in healthy horses.
Journal of veterinary internal medicine    November 13, 2013   Volume 28, Issue 1 223-233 doi: 10.1111/jvim.12245
Epstein KL, Bergren A, Giguère S, Brainard BM.Lower molecular weight and molar substitution formulations of hydroxyethyl starch (HES) solutions might maximize cardiovascular function and colloid osmotic pressure (COP) and minimize adverse effects on coagulation. Objective: To compare effects of 1 low and 1 high molecular weight and molar substitution HES solution on cardiovascular variables, COP, and hemostasis in normal horses. Methods: Eight healthy adult horses. Methods: Randomized, crossover designed study: 10 mL/kg bolus of 6% HES (600/0.75) (hetastarch) (HS), 6% HES (130/0.4) tetrastarch (TS), and 0.9% NaCl (NS). Variables recorded ...
3 tesla magnetic resonance imaging of the occipitoatlantoaxial region in the normal horse. Gutiérrez-Crespo B, Kircher PR, Carrera I.The aim of this study was to describe the appearance of the ligamentous structures of the occipitoatlantoaxial (OAA) region in the normal horse by 3 tesla (3T) magnetic resonance imaging (MRI). The MRI images of the longitudinal odontoid ligament, tectorial membrane, dorsal and ventral atlantoaxial ligaments, dorsal atlantooccipital membrane with its reinforcing ligaments, and the lateral atlantooccipital ligaments of 10 horse cadavers were evaluated. All ligaments and membranes were identified in all planes, except for the lateral atlantooccipital ligament in the sagittal plane due to its cra...
Hinged circular fixator construct for correction of congenital metatarsal deformity in a foal.
Veterinary and comparative orthopaedics and traumatology : V.C.O.T    November 13, 2013   Volume 27, Issue 1 74-79 doi: 10.3415/VCOT-13-01-0007
Porter EG, Cuddy LC, Graham AS, Reese DJ, Porter MB, Morton AJ, Lewis DD.A five-week-old American Quarter Horse colt was presented for evaluation of a left hindlimb deformity and lameness. Radiographs of the left hindlimb revealed a varus deformity with recurvatum originating in the mid-diaphysis of the third metatarsal bone. Surgical correction was undertaken by performing an osteotomy through the centre of rotation of angulation located within the mid-diaphysis of the third metatarsal bone, and a four-ring hinged circular external fixator construct was applied. Distraction of the osteotomy site was performed over an 11 day period. Notable complications included f...