Create your own awesome maps

Even on the go

with our free apps for iPhone, iPad and Android

Get Started

Already have an account?
Log In

Wing tips surgery by Mind Map: Wing tips surgery
0.0 stars - 0 reviews range from 0 to 5

Wing tips surgery

D147 - complication fracutre repair

Disturbed fracture healing

causing, delayed union, non union

due to, local physical factor, instability, vascular impairmant, large gap - smooth tissue imposition, infection, metallosis, allergic rean to metal, systemic factor, immune reaction w cortial alloimplant, nutrtitional, Ca:P imbalance, cancer cachexia

clincal signs, persistance, pain, warmmth, motion at #, relucatance to use limb, disuse muscle atrophy, joint stiffness, in nonunion - pain can be absent dt psudoarthroiss form

diagnosis, sequential rads, bone scintigraphy, 5MT, osteomedullography

classification, viable still has blood supply, hypertrophic, large hypervasculised callus, slightly hypertrophic, inadaquate callus, dt rotational instability, oligotrophic, devoid callus, major displacement/distraction, nonviable incalable biological response - blood supply poor absent, dystrophic, intermediate fragment heal w one edge attatched, not other, necrotic, comminuted fracture - extensive cascular compromise - fragment dead, defect, dt signifigant bone loss through open fracture - incapable producing bone, atrophic, as sequale to above, bone end round off, scar tissue full gap

treatment, want heal bone AND return function, ID primary cause and fix, post op physiotherapy, Sx repair, restore stability, rigid stabilisaion, bone graft, improve anatomic aligments, eliminate infection, debride necrotic tissue, culture and sensitivity, abs, rigid fixation w compression, stimulate vasculisation and bone production

Malunion

fracture that healed in abnormal position causing functional impairment

cause, limb shortengin, limb angulation, limb rotation, uneven weight distrobution over joint surface, restriction adjacent joint movement

classification/Sx treat, overriding, tranverse osteotomy and distraction, angular, wedge osteotomy, rotational, tranverse osteotomy, intra articular, excisional arthroplasty, artifical joint replace, arthrodesis

Osteomyelitis

inflamation bone and marrow, slow recovery, protracted, unrewarding

abs treatment, should be present at fracture sitea at time contamination -start preop, culutre sensitivity, aerobic anaerobic, sewuesterum and loose implant, weeks to months

forms, haematogenous, rare dog cat comon shildres, young animal at metaphyses, can be multifocal lesion, CS - tenderness swelling lamneness, rad changes week later, bone biopsy for culture - blood culture if bacteriamia, acute, complication of open fracture, open reduction closed fracture, bite wouds, CS pyrexia, lameness, pain over #, rads proliferative new bone, gas, FNA culture, aerobes, staph, strep, ecoli, anerobes, bacteroides, clostridium, fusobacterium, chronic, sequale to shit treated acute - allow bacterial colonisation, bacteria, adhesion - bind fibronectin (body coat implants), persistence - produce slime/biofilm, virulence - biofilm induce phenotypic transformation, CS, persistant draining tract, lamenness, dissuse atrophy, rads - bony proliferation/lysis, Rx, early aggresive, surgical debridement, broad spectrum bacteriocidal abs, remove implant when clinical bone union achived - eliminate infection

Fracture disease

complications of fracture repair, atrophy, mm, dissuse mm atrophy, within 3 - 5 days, worse at day 5-10., quadriceps contracture, dt Rx distal femoral #, young dogs, extension splinting, delayed/non union dt inadequate internal fixation, digid hyperextension of limb, reduced flexion in hock stifle, firm atrophied quads, prox displacement patella, poor prognosis complete recovery, guarded return to function, early - excise vastus intermedium, late - stifle arthrodesis, limb ampiutiation, bones, dissuse osteoporosis, joints, articular/periarticular degeneration, change cartilage, ligament, synovium

Implant failure

stainless suseptable to cyclic stress

take load of limb while bone heal, delayed healing, innapropriate implant selsction - weak

areas predilection, plate - screw hole, pins - jn thread, cerclage wire - bend twist, screws - shank or head

loosening, technical error, innapropriate implant, shit preparation - hole too big for tap, technique, fail aseptic

D148 - Surgical conditions of the skull

Dispatch

good blood - rapid heal

need to establish normal dental occlusion

pharyngostomy/tracheostomy allow more space to work

tension freee closure gingiva

feeed soft post op/stomach tube

mandibular fracture

common cat - open fracture dt trauma hbc

muzzle, stable mid body unilateral, maintain reduction - lock canien together, shit in cats brachycephalic dog, mouth shut if feedign tube, use non elastic tape, avoid heat stress

wiring, symphaseal, encircle both rami just cadal to canines, good for symphasealk #, interdental wiring, for transverse mandibular body fractures, wire loop around teeth - must be intact solid., dont over tighten - distraction opposite cortex, interfragmentary wiring, simple tranverse and short oblique mandibular fracture, wire thru holes either side #, aboid teeth root, perpindicular to # line, multiple wire - avoid pivot, short twist minimise mucosal irritation, min 3, interarcade wiring, bilateral loop wire passed bt mandible and maxilla, like muzzle but work brachy dogs and cat, feed tube/allow lapping, intermedullary pins, shit - narrow medullary cavity w teeth roots, high rate malocclusion, plate, excellent stabilisation, avoid teeth roots, human moulding plates, external fixators, complex comminuted open fracture w bone loss., 2 - 3 fixation pins per fragment, fracture reduction, join fixation pin w clamps connecting bar/acrylic column - multiple angles

maxillary fracture

most non displaced - treat conservative w soft feed

thin cortices - shit screw

same principle mandibular

beware, airway obstruct, nasal, major vesels nn

Temperomandibular luxations

isolated or w mandibular #

mandibular condyle displace rostrally or caudall

dx - rads

closed reduction - use fulcrum pivot bakc in, dog - dowell, cat pencil

acute injury stable after reeuction, soft diet weeks, unstable - muzzle/intercade wire

chronic luxation, open reduction, suture imbrication of joint capsule, dondylectomy

mandibulectomy

indicated w non union fracture w infection, neoplasia

differing amounts

tumor - 1 cm margin

complications, wound dehicience, droolin, tongue deviation, malocclusion

maxillectomy

similar to mandibulectomy

multiple approach.

allow sufficient labial/buccal mucosa to close deficit

complication, oronasal fistula, ulceration upper labial mucosa dt impingment by lower canine

neoplasm oral cavity

common

fibrosarc, histologically low, biologically high, invasive, mets to lung, 1 year, radiation resistant

malignant melanoma, dont all contain melanina, mets to LN, lung, bigger worse

SCC, feline, shit, rostral better, radical sx

epulides, fibrous ossifiing - slow grow, not invasive, acanthomatous locally invesive, dont met, radical sx - wide margin

osteosarc, radical sx

cranial #

extracranial, rare Sx

intercranial, decompression, remove fragment, cover w temporalis mm, avoid tear meningies

Rx concussion and cerebral oedema - increased ICP

D149 - Forelimb Fractures

Scapula

dispatch, uncommon - concurrent thoracic, difficult to immobilise, external - sicca splint , non weight bear sling, internal - intra articular - v unstable

spine and body, most comon, conservative treat w cage rest, heal 4 - 6 weeks, open reduction coaptation, gorssly unstabel, cerclage wire, smitubular plate where spine join scap

neck, watch suprascapular nn

glenoid cavity, lag screw and tension band

humerus

dispatch, not common but difficult, most shaft and distal, coaptation hard - cant immobilise shoulder, radial nn/brachial plexus involve, bone surface - contour plates over musculospiral groove.

proximal #, prox physeal, infrequent, type 1 or 2, young, two k wires perpindicular to growth plate, old, cancellous bone screw, prox metaphyseal, path dt osteosarc., internal fixation, intermedullary pin, introduce normograde from greater tubercle to lodge in medial condyle

diaphseal #, taper - weaker, prox - transverse, distal - oblique/spiral dt muculospiral groove., plating, external fixation, thru IM pin - stop rotation

distal #, supracondylar, type I or II, IM pin up each condyle, unicondylar, lateral type IV (perpindicular across physis), K wire up epicondyle to penetrate opposite cortex, w inter condylar lag screw, bicondylar, frequent mature, T or Y based, trans olecranon approach, osteotomy, stabillise intercondyle w lag screw, supracondyle w crossed pins, or IM, or Plate, lateral condyle more likely, all require reduction and fixation - proximity to elbow joint

radius ulna

dispatch, distal third radius common, commonly both radius ulna, prox to skin - open common, immoblilise joint above belox - external captation, non/minimally displaced., closed reduction - heabvily sedation, ulna dont need fixation if radius intact, except olecroanon, IM pins shit - compromise articular surface., concientric articular surface, plate radius - cranial side - tension

radius, proximal, prox physeal, rare type I, w lateral elbow luxation, Kwire fix, premature closure common, radial head, rare - humeral condyle go first, radial diaphaseal, external coaptation - stable in young, external fixation - comminuted/open #, plates - good in toy minature, distal, physeal, closed reduction if minimal displaced, Kwires placed caudally, metaphyseal, non union complication of IM/external coaptation, plates better, fracture styloid process, dt attatch collateral - need to align, kwire and tension band

ulna, proximal, physeal, uncomon immature type I, displaced dt trisep pull, internal fix w 2 kwires, premature closure plate dont affect, olecranon #, avulsion - Kwire tension band, comminuted - plate on caudal/lateral surface, monteggia fracture, prox ulna # with luxation radial head, reduce radial head then IM/plate ulna, watch annular lig rupture - need to fix radius to ulna., ulnar diaphaseal #, dont require fixation if radius ok, can IM ulna to splint minimally displaced radius, dont lock ulna to radius distally - some rotation., distal physeal, cone shaped - suseptable type V (Compressive), suspect - cant see on rads will month, angular deformity dt ansynchronous growth

carpus

dispatch, comon working, uncomon pets., conservative - external coaptation, ok small, shit large - reffer, complex anatomy, good rads - multi view., reduction fragments w k wire or lag screw., must counter sink - articular surface

radial carpal bone #, jump fall - slabs off articular surface., become joint mice - spontaneus heal rare, large bits - stabilise, small - remove

accesory carpal bone #, racing greyhound, avulsion - grade system, lag screw chicks in, comminuted - cast in 20 degree flexxion

metacarpus

dispathc, young, stood on/trapped, MC III IV main weight bear - can use to splint others, external coaptation, heal 6-8 week.

normograde pin from distal to prox w smaller IM pin best., protect metacarpophalangeal

phalanges

dispatch, P1,2 common, splint/short cast, intra articular - performance animals - open reduction

D150 - Pelvic and Hindlimb Fractures

Pelvic #

dispatch, common HBC, full hx - bladder bowel, spinal cord,, symetry - pelvic bones triangle, biomechanics, pelvis like box - single # rare., lots muscle, good support, hard reduce dt mm contracture

managment, conservative, indicate, economic, small breeds, minimally displaced, realign w percutaneus/digital manipulation, cage confine 4 weeks longer, nursing, passive physiotherapy/hydrotherapy, surgery, indicate, narow pelvic canal, impinge vital, sciatic, pelvic urethera, acetabular involve, hip instability, fixation - if intraarticular or weight transfer from hind

sacroiliac seperation/frcature, occur w other pelvic # unless bilatera;, normally ilium goes craniodorsal, fibrocartilage and synovial joint, heal better w little movement, dont need rigid fixation, options, lag screw, two srews, largest possible, one at least 50% into sacrum, overdrill ileum, use full threaded to get compressive, transilial bolt, in combination w lag - overweight,, through ilial wings and dorsal spinous process - extra support

acetabular #, dispatch, most req internal fixation, esp if cranial part acetab., pain and crepitus -, small dogs conservative - watch DJD., anatomy, dorsolateral lip - fibrous - in tension - shit screw, watch sciatic course over ishiatic notch, plate fixation, special plate conform, applied to tension side - lateral aetabular lip

iliac #, dispatch, oblique ilial shaft., caudal part - hip joint. displaced medailly cranially, sciatic nn damage, hard w muscle builk, conservative - tape stifel together to pull out., wing shit screw, engage sacrum, plate, contour to lateral side ilium, one screw through to sacrum, stable fixation and restore pelvic canal important

ischial #, in accompany w other #, fix it, fix ishium, internal fix, if large, unstable, pinch nn, pins, wire, plate, conservative, confine, non weight bear sling in neutral position, hamstring pull fragment caudoventral

pubic #, reduction other # fix pubis, watch genitourinary, obturater nn, ventral herniation, cranial displacement pubic rim - avulsion of prepubic tendon, internal fixation w wire suture/small plate

femur #

dispatch, comon hbc, ext coaptation hard, heavy mm,, cant stabilise hip, ext fixation w new plates, IM pin good, proximal ecentric articular surface., lateral side tension - flat - good plate, salvage w excision head neck/hip replace

proximal, physeal #, capital physeal, common type I immature, see on flexed VD (frog) view, internal fix w multiple pins, good prognosis if fixed early, avulsion femoral head, common w coxofemoral luxation, samml - excise, large frag - lag screw, femoral neck fracture, internal fix - lag srew, greater trochanter #, k wire and tension band, compressive srew, premature closure not issue

diaphaseal #, short oblique and interdigitating (reduce rtation) can do IM, normograde better for sciatic, if must retrograde, pin on lateral surface medullary cavity, hip joint extend when puncture - lift sciatic out way, better to bury in cancellous bone of condyle, watch pucnture stifle/migration, if rotation, IM and external skeletal fixation, IM pin and cerclage wire, plates, interfragmentary compression screw and neutralisation plate.

distal #, distal physeal, common young - 1 2 3 4, 2 most tommon, epiphysis displaced dt pull gastroc, premature closure common - ok if entire - short leg, avulsion of long digital extensor, bone fragment visible rads

tibia #

dispatch, comon, open, can immobilise joint above below, external coaptation, cast, make sure hock slightly flexed, allow weight bearing, prevent cast slipping, watch cast sores, IM pin - normograde, medtension on medial side - plate

proximal, avulsion tibial tuberosity, internal fixation, k wire and tension band, proximal physeal #, 1 2 3, internal fix w small k wire

diaphaseal #, easy - good intro to orthapaedics, IM pin - not articular surface stifle or hock, nto too rigid, external skeletal fixation, plate

distal, distal physeal, 1 or 2, crossed pins, malleolar #, unstable tarsocrural joint, fix w K wire and tension band/large screw

tarsus

dispatch, osseus/ligamentous, palpation, rads, fibial and tibial tarsal bones most common., need internal fixation for return to function, k wire, tension band, no torniquet during sx, delay cast post op - swelling

# fibial tarsal bone - calcaneus, apophyseal # at tuber calcanei, stabilise w kwire and tension band

# tibial tarsal bone - talus, intrarticular, small pins srew, coutersunk, neck, lag screw body talus to calcaneus.

D151 - Growth plate injuries

anatomy

bt epiphysis metaphysis

cartilagenous, reserve zone, proliferative zone, column dividing cells, produce collagen matrix, hypertrophic zone, enlarge size, degenerate, WEAKEST, ossification zone, form framework for endochondral ossification

classification - salter harris

type I, along growth plate only, young dt shearign forces, good prognosis

type II, partway along epiphysis an dinto metaphysis., >6months - angulated shearing forces., bone frag on side opposite to shearign force, most common type

type III, partway along physis and into epiphysis, intra articular, uncommmon, need anatomic reduction - smooth articular surface

type IV, through metaphysis, across physis, into epiphysis - intracrticular, >9 months - growth plate totally closed, compressive force - damage to germinal cells, prognosis guarded, need perfect apposition to prevent osteoarthrosis and bony union across growth plate preventing growth

type V, compressive/impacted fracture to physis, damage germinal cells, no displacement, poor prognosis, limb deformity, mebbe ok if old

rang type VI, injury soft tissue adjacent to physis, result in bony union across plate, uncommon - across distal radius and tibia

apopphseal #, immature dt trauma, traction seperate apophyses from parent bone, eg supraglenoid tubercle, greater trochanter femur

principle repair

reduction, ASAP, gentle manipulation, watch damage germinal cells.

fixation, external coaptation shit, close joint, young excited, small diamater non threaded pins, allow continual growth, remove as soon healed, screw plates all restrictive

complications

interupt normal bone growth

premature close entire growth plate - shortened, can repair w osteotomy, distraction, bone graft and internal fixation, distraction osteogenisi - external distractor increased .5 mm twice daily

asymmetric, angular deformity, distribute load unevenly across joint, fix, immature, slow fast side - staple/wire across growth plate, mature, corrective osteotomy, closed wedge, shorten, stabilise wplate, open wedge, lengthen, best w bone graft, dome osteotomy, surved osteotomy w drill holes, technically difficult, oblique, parrale to joint surface, better w bone graft

closure of one bone in pair - angulra deformity and joint incongruity, esp antebrachium, closure distal ulnar, lateral deviation, cranial bowing, external rotation, immature, ulnar osteotomy, slow radial growth plate w staple wire, mature, closed wedge osteotomy, humeroulnar sublux, lengthen ulnar rather than shorten already short radius, slide up pin, closure distal radius, normally in conjunction with distal ulnar plate close, lengthen radius, immature - progressive distraction, mature - radial osteotomy an dplating

D152 - Joint injuries Fractures

principle

aseptic

adequote visualisation, osteotomy

incisions parrale to axis limb, not over tendon - adhesions

into joint capsule- watch l igaments

monofilament sutur

tendon

dense ittegular collagen tissue

bundle colalgen surrounded by enotendon - carry vessels nerves, vessels from musculotendinous jn

entire tendon covered in epitendon

paratenon - areas local pressure form sheath, more vescular than synovium coverent tendon

mech helaing, paratenon heal faster - extrinsic blood supply, time - fibroblast amke collagen then rearange longitudinally, increase in tensile strength dt 2ndry remodel - max strength 20 weeks

type injuries, lacerations, avulsions, strain - injury at myotendinous junction

Sx, dont trasect tendon - retract, partial tentotomy better than trnasvers myotomy, better suture holding of tendon, osteotomy tendon, fasten w kwire and tension band, end end tarsorhaphy, monofilament, locking lop pattern, close paratendon

ligament

pure collagen w long parrale fibres, some elastic

relatively hypovascular

mech healing, diff lig better, inflamation, repair and regen, remodel/regeneration, 12 months, weaker

type injuries, sprains, result in abnormal joint mobility, type 1, minimal tear, internal haemmhorage, rest splintage, type 2, partial tear, internal periligmant haemorrhage, suture tear, unload tendon w screw anchor and figure 8 wire, type 3, complete rupture, avulsion point attatchment, sx, suture, replace, autogenous, fascia, synthetic, wire

Sx, slow heal, breakdown, dont transect, osteotomy, unload sutured tendon w screw anchor and figure 8 wire

articular cartilage bone

chondrocytes embed in colalgen matrix

4 zones

lack BV - low metabolic activity

subchondral bone - vascular

healing, confined to cartilage, heal poorly, chondrocytes cont migrate in, to subchondral bone, access to marrox cells, reparitive fibrocartilage not same, by 6 months 50% shit

type injuries, trauma, slter harris type 3 and 4, chip fractures - avulsion bone

Sx, need perfect anatomic reduction - articular congruity, lag screw - compression - bone heal without callus, screw, cancellous, cortical, full threaded, must overdrill on near frag, Kwires, hold frag, continous passive motion, better cartilage heal, gentle flexionextension for 20 mins 2id, cage rest/external coaptation, NSAIDS, chondroprotective drugs - glucosamine

meniscus

extensions of tibia to accomodate femoral condyles

circumfrential and radial collagen fibre

blood vessels from medial and lateral genicular vessels - supply peripheral 30%

held in position by 6 meniscial ligaments

fn, load transmission, lubrication, improve joint stability

pertial meniscectomy increased load

healing, peripheral supply, fibrous scar, becomes fibrocartilage, unknown properties

type injuries, common secondary to joint instability, cruciate and colalteral lig, medial more common, longitudinal, radial tears, folding injury

Sx, meninsectomy, degenerative changes to joint, partial, depend zone, pink zone - vascular better, cna extend into white zone - vascular channel

joint

open fractures, shearign injuries to tarsus carpus, contamination, tret early, aggresive debride, stabilisation, external coaptation, reconstruction/arthrodesis, once infection controlled

D153 - Osteochondrosis and Arthritis

Osteochondrosis

disturbance of endochondral ossification leading to retention of cartilage, cartilage become thick, Articular, nutrition via diffusion, basal layer become necrotic, fissure reach joint surface, undermine thickened cartilage - OCD - flap, seepage synovial fluid into subchondral bone, inflamatin, pain, growth plate, reatrdation growth, only issue in paired bones, radius ulna, OCD of medial condyle, dt increased load, fragmentation of medial coronoid proces, dt increased load, ununited anconeal process, overgrowth radius more pressure on anconeal process, delay/prevent endochondral ossificatino, OCD - manifectation of OC - flap of cartilage lift from articular surface

aritilogy, rapid growth in large breeds, hereditory, overnutrition - high intake calcium

common sites, shoulder, caudal part humeral head, male large, lameness worse after exercise, mm atrophy deltoids, spontaneus healing if flap dislorge, become joint mouse, tenosynovitis if into bicipital bursa, sx, arthrotomy via caudo lateral approach, edges perpindicular - bevel slow heal, can forage deficit - multiple holes to stimulate healing, normally bilaters, elbow, OC leading to, OCD, w FAP, medial condyle muhmerus, FAP, base ulna articulation, UAP, AP in olecranon fossa, normally by self, see radiolucent line, young big breed male, lame @ 6 months, medcal, older, lame, severe rad change, chondroprotectiv drug, surgical, severe lame, young, stifle, lateral femoral condyle, flattening, osteoarthosis develop no matter what treatment, hock, medila ridge talus (lateral ridge), widened joint space on dorsoplantar RAD, flattened medial ridge, arthrotomy via caudomedial approach

osteoarthritis

or DJD or osteoarthritis, progressive destruction irreversible adamage to articular cartilage, inflamation - osteoarthritis

dt, instability, incongruity, OC, trauma

dx, RAD, joint capsule distencion, periarticula soft tissue swell, periarticular osteophyte, arthrocentesis, inflamatory, osteoarthrosis

Rx, relive pain, NSAID, improve joint fun, minimise progression, weight loss, exercise modification, no chasing ball, medical, glucoasamine, chondroprotective, id treat inciting cause, surgical, salvage, excision arthroplasty, arthrodesis, prosthetic joint replace

Inflamatory arthritides

septic, bacterial, haematogenous, penetrating injury, local extension, dx, acute onset w pyrexia, joint painful swollen warm, left shift on haemogram, arthrocentisis, degenerative neuts, positive culture, meat broth, Rx, Sx, quick, good exposure, debride necrotic synovium, lavage, drainage, delay closure, daily lavage, until clear fluid and helathy granulation, monofilament, abs - continue 6 weeks, passice range of motion, then slowly weight bearing

Immune mediated, Rheuatoid arthritis, intermitient shifting lameness multiple joint, esp distal joints, RAD, joint capsul swell, subchondral bone loss, periarticular osteophyte, SLE, multisystmeic, polyarthritis, multiple joint effusion, periarticula fibrosis, periosteal new bone, idiopathyic polyarthritis, cyclic lameness, pyrexia, anorexia, Rx, glucocorticoid, azothiaprin

D154 - Surgery of Hip joint

Luxation of hip

comon, no colaterals, only ball socket, round lig

craniodorsal, dt external trauma, blow to rump, tear round and dorsal joint capsule, held out w gluteal, CS, thigh adducted, stifle rotate out, hock in, pain crepitus on palpation, altered landmark, cattle triangle, pich test, finger bt greater trochanter and tuber ischi, not pushed out, check predisposing factor, hip dysplasia, closed reduction, fresh injury without ships, EARLY, like cow, sling under leg attatch table, twist out - disengage femoral head, pull down - plop back in, take through full rnage of motion to force clots out joint space, support w ehmer sling, open reduction, very unstable, avulsion fracture, cant sling, craniolateral approach w trochanteric osteotomy, remove hameatoma, ship, round lig, if joint capsul ok, no capsule, replace round lig, toggle pin fixation, wire anchor drillinto acetabulum, tunnel through femur neck, braided polyester replace round lig, reinforce surroudningsoft tisse, synthetic capsule, anchor screw in dorsal rim acetabular, spiked washer prevent slippage suture, trancverse tunnel through femoral neck, heavy guage non absorbable link up, dorsal reinforcement, tranarticular pin, unthreaded steinman pin, though head, out third trochanter, in through acetabulmum, rectal palpation ensure in pelvic, de vita pin, threaded steinman under tuber ischi, dorsal to femoral neck, anchor in wing ilium, watch sciatic

caudoventral, trauma from landing, carrly leg abducted an dinward rotate, closed reduction and hobbles, or open reductio n- came technique caraniodorsal

Canine hip dysplasia

disparity bt primary muscle ass and rapid skeletal growth

development, large breeds, genetic, environment, normal at birth, joint instability and subluxation, retard normal joint development, predispose DJD

CS, pain lameness, joint laxity on palpation, ortolani sign, pain dt microfracture on dorsal acetabular rim

Rx, may not be clinical, RAD changs severe, conservative, non concussive exercise, weight control, NSAID, carprofen - rimadyl, meloxical - metacam, cartophen - pentosan, slow progression, treat DJD, sx, triple pelvic osteotomy, reduce biomechanical forces on hip, allow normal development, tilt acetabulum down to vetter hold femoral head, axial rotation acetabulum, osteotomy of pubis, ischium and ilium, stabililse ileum w special palte, canine pelvic osteotomy, skkilledd, total hip replacement, DJD thats unresponsive to medical managment, polyethelene cup and stainless femoral head and neck, cemented, porus under develop - better longevity, 95% success, cost and skill, femoral head and neck excision, excision arthroplasty, relive pain form functional false joint supported w mm, pseudoarthrosis, remove head neck smooth so no rub in acetabulum, early physiotherapy and walking 4 days post op, restricted range movement, denervation of craniodorsal joint capsule, destroy sensory fn, remove periosteum, cranial gluteal, sciatic, femoral, sensory nn fn lost, pectineus myectomy, transect and remove section, relive pain - relief mm spasm, change stress on joint, doesent affect progression CHD

Legg calve perthes disease (Avascular necrosis of femoral head)

1 yo minature toy breeds - similar condition in children, inherited

ichaemic necrosis, acellular subchondral bone, articular cartilage collapse, replace w fibrovascular repair tissue, asymetric new bone formation, mishshapen femoral head, DJD hip joint

CS, weight bearing lameness, restricted joint move, disuse mm atrophy, early RAD, woden joint space, decreased density epipysis, sclerossis femoral neck, late, moth eaten femorla head, flattening, DJD

Rx, excision arthroplasty - femoral head and neck excision, early, conservative - protracted

D155 - Orthapaedic conditions of stifle and tarsus

steifel

patellar luxation, acquired traumatic, developmental, small breeds, medial lux, casue secondary changes in hip, grade, grade 1, can be manually luxated, reduces by self, not lame, no sx, grade 2, luxate when patella flex, reduces with extension, intermitent leg lame until click back in, severe lame dt wearing articular cartilage, sx, lateral retinacular imbrication, take slack out of fascia, when close, overlap layer w mattress suture, vest over pants, tibial derotational suture, suture around lateral fabella, through bone tunnel in tibila crest, tied with stifle rotated rotated laterally, tendancy for foot ot rotate out, grade 3, permanent luxated, can be popped back in manually in extension, shallow trochlea, poor stifle extension - crouched position, sx, tibial tuberosity/crest transposition, realign quads relative to trochlea, decide befor GA, cut out tibial tuberosity and replace laterally w kwire, do tunnel for pin before remove tuberosity, trochlear groove deepening, trochleoplasty, helps keep patelle in, should be 50% height patella, abrasion trocheoplasty, remove articular cartilage and 2 mm subchondral bone, heal w fibrocartilage, periosteal graft speed, recession trocheoplasty, wedge or block resection, remove articular cartilage, burr out bone beneath, replace cartilage, no fixation - patella pressure, retinacular reinforcement, grade 4, permannet luxatiuon, cant reduce, tibial crest deviation, bony deformities, trochlea shallw absent, sever non weight bearign lame, mm wasting, surgery restore some function, prognosis guarded, sx, retinacular reinforcement, trochlear groove deepening, tibial crest transposition, medial desmotomy, incicison into medial joint capsuile, allow patella replace into trochlear groove, cut edge not closed, corrective osteotomy, open/closed wedge correct deformitis of femur and tibia, salvage, patellectomy, lateral approach, preserve ligament, defect reinforce w locking loop non absorbable, imobilise limb post op 2 weeks, stifle arthrodesis, sequale, cranial crusiacte rupture, sx, lateral retinacular imbrication, take slack out of fascia, when close, overlap layer w mattress suture, vest over pants, trochlear groove deepening, trochleoplasty, helps keep patelle in, should be 50% height patella, abrasion trocheoplasty, remove articular cartilage and 2 mm subchondral bone, heal w fibrocartilage, periosteal graft speed, recession trocheoplasty, wedge or block resection, remove articular cartilage, burr out bone beneath, replace cartilage, no fixation - patella pressure, tibial derotational suture, suture around lateral fabella, through bone tunnel in tibila crest, tied with stifle rotated rotated laterally, tendancy for foot ot rotate out, tibial tuberosity/crest transposition, realign quads relative to trochlea, decide befor GA, cut out tibial tuberosity and replace laterally w kwire, do tunnel for pin before remove tuberosity, medial desmotomy, incicison into medial joint capsuile, allow patella replace into trochlear groove, cut edge not closed, corrective osteotomy, open/closed wedge correct deformitis of femur and tibia, salvage, patellectomy, lateral approach, preserve ligament, defect reinforce w locking loop non absorbable, imobilise limb post op 2 weeks, stifle arthrodesis, after care, rapid heal dt young, restrict activity, joint - passive physiotherapy in first 2 weeks, active physiotherapy, 'encourage' w sling other leg

Cranial cruciate rupture, dispatch, acute - trauma, hyperextension, forceful internal rotation, younger - lig stronger than bone therefore get avulsion of tibial insertion, acute sudden lameness, posititve cranial drawer, week - lame subside but still instable, chronic, larger aging - poss dt poorter blood supply, cruciate diseas - progressive partial tear, lameness, joint effusion, intermitent lamenness, acute deteriorate dt total rupture/menisci involve., anatomy, from caudal medial surface of lateral femoral condyle, sspiral distal and medial, insert cranial intercondyloid tibial plateau, fn, limit cranial displacement, prevent stifle hyperextension, prevent rotation tibia, concurrent meniscial injury, contralateral cruciate injury, dx, trauma, hx, cranial drawer, cranial drawer, lateral recum, under deep sedation, push tibia cranially, normal 2 mm move, compare to contra lateral - watch bilateral, perform in flexion and extension, discern craniomedial/caudo lateral band, tibial compression, slight flexion of stifle, hock flex extrend, positive if movement tibial crest, rads, check avulsed frag, ecploratory arthoscopy, Rx, conservative, small, weight reduction, short leash walk, chondroprotective drugs, pentosan.cartophen, do sx if not better in month, primary repair, difficult, heal shit, most rupture dt preexisting path, can repair avulsion in young, tension band and K wire, Intra-capsular reconstruction, replace w functional lig, patella ligament, fascia lata, synthetic, tibial derotation suture to stabilise, need months to regain strength, extra-capsular reconstruction, extra capsular sutre - tibial derotation, fibular head transposition, transpose fibular head w attatched lateral collatarel cranially, anchor to lateral tibia w steinman pin, prevent cranial drawer, tibial levelling osteotomy, reduce cranial tbial thrust, overcome need to replace cranial cruciate, Tibial plateau levelling osteotomy, TPLO, patented - jack for incision, cut out circular, rotate and fix w plate, tibial wedge levelling osteotomy, TWLO, angle tibia back, must assess menisci integrity

Caudal cruciate rupture, dispatch, isolated rare - multiple lig dt trauma, experimental stifel fine, therefore observe 1 month, unless avulsion - Sx immediate, from lateral surface medial femoral condyle, to lateral edge popliteal notch tibia, prevent caudal draw, stop hyperextension, dx, caudal draw, asses in neutral position, tibial sag, loss tibial crest on cranial surface stifle, Rx, avulsion - similar CrCL, interstital tears - extracapsular technique

Femorotibial collateral lig injuries, stabilise stifle from valgus/varus movement, dx, adduction/abduction limb., compare intact contralateral, laxity w abrupt endpoint - grade 1 2, laxity w gradual endpoing - grade 3, RADS - avulsion, stress views, Rx, grade 1, conservative - cast, grade 2, sugical, heal of stretched loose, grade 3, surgical repair, locking loop for interstitial rupture, avulsion, reattatche w k wire, protect joint w lateral splint

stifle luxatin, multiple ligaments, capsular, meniscal damage, global instability - rotate through 180 degrees, cats small dog, transarticular pin, allow fibrocartilagenous support to form, large dogs, each injury as above, treat menisci, suture if pink, trim damaged, protect w lateral splint and rest 6 weeks

tsar

tarsocrural collateral, clsoe skin - shearing, shit heal conservative, medial - from medial malleolus, short - to talus, long - to first tarsal and metatarsal, lateral - from lateral malleolus, short - to talus calcaneus, long - to 5th metatasal, dx, test short in flexion, long in extension, rads - avulsion, Rx, avulsion - lag screw, tension band, interstital - locking loop, protect w figure 8 loop round screw, replace - prosthetic ligment, stabilise w transarticular external skeletal fixation, shearing - debride, leave open then repair lig, can function on periarticular fibrosis

Plantar ligament fracture, present w plantigrade stance, conservative shit dt contant tension, 3 lig, middle important, calcaneus and 4th tarsal, Rx w arthrodesis

D156 - Orthapaedic conditions of the Shoulder elbow carpus

shoudler luxation

medial lateral more comon cranial caudal

stabilised w medial lateral glenohumeral lig

congenital

traumatic, medial, non weight bear lame, limb flexed, foot rotate out, lateral, limb flexed, foot rotate in

rx, recent traumatic, closed reduction w external coaptation, medial - velpeau sling, lateral 0 spica splint, ctabilise w square suture thru scapular neck and humeral head, tranposition biceps brachi tendon, salvage - excision arthroplasty/arthrodesis

Bicipital tenosynovitis

dt repeated stress, OCD fragments

dx, pain over craniomedial palpation, rads - exostosis of intertubercular groove and minerlaisation tendon, us - thickenign and increased fluid, arthroscope

rx, acute, rest, sling, NSAID, intrarticular steroid injection, asepsis, Sx, transect tendon, resect bursa, reattatch through bone tunnel in greater tubercle, suture back on self

Mineralisation of supraspinatous tendon

large breed, chronic intermittnet unilateral lameness

dx, pain palpation, rads, mineralisation, cranioproximal craniodistal skylie view

rx, surgical removal mineralised tendon

infraspinatus contracture

hunting working dogs

abnormal gait, elbow adduct, foot abduct, lateral swing limb, mm atrpphy infraspinatous

scapular dislocation

tear serratus ventralis dt trauma, dorsal border scapula higher

small - velpau sling

large - wire suture around rib

elbow luxation

normally good stability, lateral luxa tion most common

3 joints, humeroradial, most stability, humeroulnar, restrict saggital plane, proximal radioulnar, limited rotation

congenital, humeroulnar, lateral rotation proximal ulna, cant support weight - cant extend, held flexed, craniocaudal rads, humerus normal, radius ulna rotated - lateral view, lateral luxation radial head, reduced flexion, palpated lateral to joint, rad show abnormal position

traumatic, radius and ulna go lateral, antebrachium abducted and externally rotated, rads, lateral displacement, avulsion of collaterals

Rx, closed better, cant if chronic/severe bony deformation, hook anconeal process into olecranon fossa and fulcrum in, support w spica splint, Sx, unstable or irreducible, ligament repair/replace, congenital humeroulnar, stabilise w transarticular pin, congenital lateral luxation radial head, proximal oblique osteotomy, manual reduction, imbrication of lateral collateral, salvage, radial head escision arthroplasty

carpal ligament injury

trauma, shearing

conservative w external coaptation only good for inactive

3 joints, multiple short collaterals

collateral lig injury, radial collateral most common, distal radius, across antebrachiocaropal joint, insert radial carpal bone, assess w valus/varus stress test, rads - widen joint space, rprimary repair lig and take load w synthetic thru bone tunnel

shearing injury, similar tarsus

Hyperextension injury, fall jump from height, pupture palmar lig, palmigrade stance, external coaptation shit, rad asses which joint worst, arthodesis mifddle carpal and carpometacarpal, pins, plate, antebrachiocarpal - most movement, arthrodesis, protect w cast or palmar splint

sesamoid disease, racing greyhound fracture, rotty sesamoid disease, dx w rads show bony proliferation, rx - sx resection affested ses, hard visualise - rad escised tissue, early physiotherapy

D157 - Salvage procedures

arthrodesis

dispatch, removal motion in joint, cf ankyloiss - abnormal mobilit dt peri/intra articular pathology, indications, continued motion of joint counterproductive, relive pain - dt instabillity, anatomical repair not poddible, improve mechanical fn, lower better faster stronger, more than ever after over, neurological problems - e.g radila nn paralasis, limb spare - neoplesai w allogenic bone graft

sx, asepsis, remove articular cartilage down to bone, promote early bony union, watch heat from burr, contact area subchondral bone, follwo normal contour bone, create flat surface, normal angle, measure contralateral pre op, absaloute stability w compresion, autogenous bone graft, external coaptation, appropriate time, check w rad, remove fixers post op, fatigue fractures, loosening

complications, increase stress to adjacent joint, DJD, esp multi joint - carpus hock, if doing most mobile, do all, infection, failure stabilise, shorten/lengthen limb dt incorrect angle

specifics, carpus/hock, most common, rad stress vie wto determine what joint, panarthrodesis, or partial, plating better if big enough, dorsal, 3 screws in each bone, panarthrodesis good, stifle, watch deragned limb fn, remove menisci and cruciates, remove articular cartilage, shoulder, need severe problem, rigid fixation w plate along cranial aspect spine scapula and humerus, scapular provides adequate mobility, elbow, plate on caudal surface, olecranon soteotomy fascilitate placement, watch derange limb fn

amputation

quadrapeds adapt very well, test w sling, more for owner sake

'exercise in regional anatomy, not butcher'

level, scapular good, mid thigh protect package, middle/distal IP joint preserve digital pad, digit 3 4 major weight bearing

joint mm, amputate at bone end, form callous, atrophy., muscle origon - minimise haemmhorage

vessels nn, aa double ligate, not aa vv together - anastomosos, watch air emboli vein, if neoplasia, vein first then artery quick, top spread, neuroma not problem

close stump, haemostasis and cosmetics, planning, 'like closing the petals of flower', deep short, superficial long - fold over

post op, blood loss in limb, pain, phantom limb?, pressure bandage