VCOT March 2026 – Ortho Part 3: Feline Maxillofacial Trauma & Lateral Total Ankle Replacement

In this Simini Small Animal Surgery Podcast episode, we conclude our orthopedic coverage from the March 2026 issue of Veterinary and Comparative Orthopaedics and Traumatology (VCOT) by exploring two studies that emphasize an essential surgical principle: successful orthopedic reconstruction depends on understanding anatomy—not simply repairing bones. 

From complex craniomaxillofacial trauma in cats to an alternative surgical approach for canine total ankle replacement, these papers demonstrate how thoughtful preoperative planning and detailed anatomical knowledge can dramatically improve patient outcomes.

In this episode:

✅ Weichert et al. — A retrospective CT study of 48 cats with craniomaxillofacial trauma following high-rise syndrome or motor vehicle accidents. Although mandibular fractures occurred in 40 cats, the authors found that 75% of patients (36/48) had injuries involving multiple functional systems. Notably, all cases of nasal airway obstruction were associated with oral cavity injuries, while 25 cats sustained fractures of the pterygoid hamular process, creating occult airway compromise despite minimal external soft tissue damage. The findings highlight the importance of CT-based evaluation and comprehensive surgical planning that addresses airway, mastication, vision, and temporomandibular joint function simultaneously. 

✅ Zingel et al. — A cadaveric study evaluating a lateral surgical approach for canine total ankle replacement (CTAR) when the standard medial approach is not feasible. Both approaches achieved excellent implant positioning, with 96% of bone-implant interfaces measuring less than 1 mm. Although the lateral approach increased angular laxity (15.5° vs. 9.5°) and required fibular osteotomy with meticulous protection of the lateral collateral ligament, overall joint stability remained acceptable. The authors conclude that the lateral approach represents a valuable alternative for revision cases or patients with severe medial scarring, while emphasizing the importance of precise center-of-rotation post placement and soft tissue preservation. 

Together, these studies reinforce a central lesson in orthopedic surgery: the best reconstruction begins with understanding anatomy in three dimensions before making the first incision.

🎓 Journal Articles Discussed

• Weichert et al. — Assessment of Fracture Distribution and Involvement of Functional Systems Following Craniomaxillofacial Trauma in 48 Cats
• Zingel et al. — Implantation of a Canine Total Ankle Replacement Prosthesis Using a Lateral Surgical Approach is Accurate and Leads to a Stable Joint 

📚 From the March 2026 issue of VCOT

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Transcript

SPEAKER_00 0:03

Hi, I'm Carl Demiani, and this is the Simony Small Animal Surgery Podcast, your fast focused update on what matters most from the latest small animal surgical literature. In each episode, we break down key articles from the veterinary journals and translate them into Surgical Insight You Can Use, today, not someday. This episode continues our orthopedic coverage from issue 2, 2026 of Veterinary and Comparative Orthopedics and Traumatology, with two studies that challenge the way we approach complex orthopedic problems, from traumatic injuries of the feline skull to the future of canine joint replacement. First, we'll look at a study by Weichert et al. who used CT imaging to map fracture patterns in cats with craniomaxillofacial trauma. Rather than viewing these injuries as isolated fractures, the authors show how multiple functional systems are often affected simultaneously, with important implications for airway management, mastication, vision, and surgical planning. Then we turn to an exciting step forward in reconstructive orthopedics with Zingel et al, who evaluated a lateral surgical approach for canine total ankle replacement. We'll discuss whether this alternative approach can achieve accurate implant placement while maintaining joint stability, and what it could mean for expanding the surgical options available for managing end-stage tarsocoral disease. Two very different studies. One common message successful orthopedic surgery depends not only on fixing bones, but on understanding anatomy, preserving function, and continually refining our surgical techniques. Let's dive in.

SPEAKER_01 1:49

Welcome to today's deep dive. We are taking your sources to extract exactly what you need to know. Um, so today we're unpacking a highly actionable study for veterinary surgeons.

SPEAKER_02 1:59

Yeah, we're looking at Weigert et al. 2026 to find the real clinical punchline regarding CMF trauma in cats.

SPEAKER_01 2:07

Right. Okay, let's unpack this because you know when a cat comes in with facial trauma, it is so easy to focus on the obvious broken jaw. But what else is hiding right in front of us?

SPEAKER_02 2:17

Exactly. And uh the study design here really establishes that that clinical context. It's a retrospective CT study of 48 cats.

SPEAKER_01 2:25

And these are all cats suffering from high-rise syndrome or traffic accidents, right?

SPEAKER_02 2:30

Yeah, exactly. High impact stuff. And the quantitative data is wild. Mandible fractures were the most common. We're talking 40 out of the 48 cats.

SPEAKER_01 2:38

Wow, that's almost all of them. Just massive force.

SPEAKER_02 2:40

Aaron Powell Right. And of those, 25 involve the temporomandibular joint, you know, the TMJ.

SPEAKER_01 2:45

Yeah, it's like seeing a cracked windshield and completely ignoring the bent frame underneath.

SPEAKER_02 2:49

Aaron Powell That is a perfect analogy. The surface damage is just the beginning.

SPEAKER_01 2:52

Because I mean, if the jaw is broken, what is happening to the rest of the functional systems? The energy has to go somewhere.

SPEAKER_02 2:58

Aaron Powell Right. Well, what's fascinating here is that 36 of those 48 cats had multiple functional systems involved. It wasn't just the jaw.

SPEAKER_01 3:06

Wait, 36? Yeah. So um that is the vast majority of cases.

SPEAKER_02 3:10

Yeah. And here is the kicker. Nasal airway obstruction always coincided with oral cavity involvement.

SPEAKER_01 3:17

Aaron Powell Always. Like 100% of the time. That's a huge red flag.

SPEAKER_02 3:21

Completely. Specifically, 25 cats had fractures of the pterygoid bone.

SPEAKER_01 3:26

Oh, right. The hamular process.

SPEAKER_02 3:27

Exactly. The hamular process. When that breaks, it causes this medial dislocation.

SPEAKER_01 3:32

Which basically means an invisible airway blockage, doesn't it?

SPEAKER_02 3:35

Right. Because on a standard visual exam, the tissue looks totally intact, but the structural support is gone, so it just collapses inward.

SPEAKER_01 3:43

Here's where it gets really interesting. Yeah. Because it means a standard jaw fixation just isn't enough.

SPEAKER_02 3:47

Not at all. You have to assume there's more damage.

SPEAKER_01 3:50

Right. Surgeons must look for these hidden airway obstructions. And uh didn't they also find orbital fractures in like 30 cats?

SPEAKER_02 3:57

They did, yeah. 30 cats. So if we connect this to the bigger picture, this mandates a multimodal therapeutic approach.

SPEAKER_01 4:05

Aaron Powell Right. You can't just wire the jaw and send them to recovery.

SPEAKER_02 4:08

Exactly. You might actually need endostopically assisted airway reconstruction right then and there. And uh follow-up CTs are basically essential.

SPEAKER_01 4:16

Aaron Powell That makes total sense. And speaking of reinforcing your baseline protocol, especially when you're doing these really complex orthopedic jaw closures, you have to consider your lavage.

SPEAKER_02 4:25

Oh, definitely. The contamination risk in that area is massive with these injuries.

SPEAKER_01 4:29

Aaron Powell Right, because normal saline it actually leaves about 42% of bacteria behind in those tissues.

SPEAKER_02 4:35

Which is the exact opposite of what you want near a compromised airway.

SPEAKER_01 4:38

Aaron Powell Exactly. But using SeminiProtect lavage before a closing, well, that leaves 0% behind. It's just a simple 60-second step to remove resistant bacteria, and you don't even need antibiotics.

SPEAKER_02 4:49

Aaron Powell That is incredibly useful. So the real take-home message for feline CMF trauma is to always assume multifocal injury.

SPEAKER_01 4:56

I assume the worst, essentially. Look for the hidden damage.

SPEAKER_02 4:59

Aaron Powell Basically, yeah. You have to look past the mandible to the pterygoid and the airway. This raises an important question regarding how we approach those initial trauma scans.

SPEAKER_01 5:08

Aaron Powell Absolutely. So what does this all mean for you? Consider this. Since TMJ fractures and those hidden pterygoid injuries are so intrinsically linked here, how might the altered biomechanics of a repaired joint permanently change a cat's swallowing and feeding behavior years down the line? Something to think about the next time you're in the OR.

SPEAKER_00 5:32

Now let's take a look at what the next paper shows us.

SPEAKER_02 5:40

So imagine you're opening up a canine ankle for a total joint replacement, but uh the standard medial approach is just completely blocked by dense fibrosis or maybe old implants.

SPEAKER_01 5:51

Right. Your usual entry point is just gone.

SPEAKER_02 5:53

Exactly. So it's like needing to enter a house through a side door because the front porch is blocked. Today we are looking at Zingalol 2026 to figure out if taking the lateral route for a canine total ankle replacement or CTAR is actually a viable lifesaver or just a surgical trap.

SPEAKER_01 6:10

Yes, Zingalittle tested exactly that scenario. They did a cadaveric study using 10 limbs from five large breed dogs. And uh the goal was to compare the lateral approach directly against the standard medial one.

SPEAKER_02 6:22

To see if the joint mechanics actually hold up when entering from the opposite side of it.

SPEAKER_01 6:25

Exactly.

SPEAKER_02 6:25

But wait, if you're osteotomizing the fibula and disrupting the lateral collateral ligament complex, I mean that has to come with a biomechanical cost. You're removing lateral stabilizers before you even place the implant.

SPEAKER_01 6:36

Oh, absolutely. And the data really reflects that structural loss. Now the good news is both approaches were highly accurate. They yielded bone implant gaps of under one millimeter about 96% of the time.

SPEAKER_02 6:51

Wow, 96%? That's solid.

SPEAKER_01 6:53

It is. But the lateral approach resulted in a mean angular laxity of 15.5 degrees, that is compared to just 9.5 degrees medially. They also noted a slight increase in external rotational laxity.

SPEAKER_02 7:06

Okay, let me push back on calling this a viable lifesaver then. Because if we're accepting a jump to 15.5 degrees of angular laxity, isn't that a massive compromise? Like, why would a surgeon accept that much instability?

SPEAKER_01 7:19

Well, because despite the increased laxity, the lateral approach still yields a rotationally stable joint overall. It's a calculated compromise, right?

SPEAKER_02 7:26

Right. Because what is the alternative, right?

SPEAKER_01 7:27

Exactly. When the medial side is completely unworkable, a stable joint with 15.5 degrees of angular laxity is clinically acceptable compared to, you know, abandoning the CTAR entirely for a pantarsal orthodesis.

SPEAKER_02 7:39

Okay, fair point. But accepting the laxity is one thing. Achieving that stable implant laterally introduces significant intraoperative hurdles. Just reflecting the osteotomized fibular fragment seems like a nightmare in that tight space.

SPEAKER_01 7:54

Oh, it definitely is. In fact, in one of the lateral cases in the study, they had to fully transect the tibiofibular ligaments just to retract the fragment enough to see the joint. Yeah. But the paramount risk during the procedure is actually to the short lateral collateral ligament.

SPEAKER_02 8:10

Aaron Ross Powell Right, because given the tight anatomy over there, milling the bone must put that ligament directly in the line of fire. I mean, its footprint sits much closer to the taller articular surface laterally than the equivalent medial structures do.

SPEAKER_01 8:24

Spot on. The milling process interfered with that specific insertion site in four out of the five lateral surgeries.

SPEAKER_02 8:30

Wait, four out of five? That's huge.

SPEAKER_01 8:32

Yeah, it's significant. So surgeons have to actively isolate and protect it. And then uh you run into the challenge of drilling the center of rotation or COR post.

SPEAKER_02 8:41

Because the talus is proxima distally shorter on the lateral aspect.

SPEAKER_01 8:46

Precisely.

SPEAKER_02 8:46

So the landing zone for the drill bit is significantly compressed. It is like trying to anchor a heavy cantilever into a narrow, shallow stud.

SPEAKER_01 8:56

That's a great way to put it.

SPEAKER_02 8:57

If your placement is even a millimeter ventral, you blow out the bottom cortex and hit empty space between the talus and the calcaneus.

SPEAKER_01 9:05

Yeah, that margin for error is razor thin. So for surgeons stepping into the OR tomorrow, the ultimate takeaway from Zingle et al. 2026 is that the lateral approach for a CTAR is definitively a valid, stable backup when the medial side carries high risks.

SPEAKER_02 9:21

But you have to prepare for it.

SPEAKER_01 9:23

Right. You must prepare for a highly demanding COR post-placement, and you absolutely have to meticulously protect that short lateral collateral ligament during milling?

SPEAKER_02 9:32

Since the lateral talus provides such a tight margin for error, and we know human total ankle replacements frequently utilize patient-specific guides to increase accuracy, it raises a really compelling question.

SPEAKER_01 9:44

Oh, I see where you're going with this.

SPEAKER_02 9:45

Could custom 3D printed surgical guides be the ultimate solution to mastering this tricky lateral COR placement in dogs? It is definitely something for you to consider before mapping out your next complex CTAR. Full article links are in the show notes for you.

SPEAKER_00 10:04

That's it for this episode of the Semini Small Animal Surgery Podcast. This show is brought to you by Semini Protect Livage, our interoperative lavage developed to target resistant bacteria and biofilms where traditional solutions of saline and post op antibiotics fall short. If you're interested in learning more or trying out your own procedures, you'll find information and links in the show notes. Thanks for listening, and we'll see you in the next episode.