Wing tips surgery

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Wing tips surgery by Mind Map: Wing tips surgery

1. D147 - complication fracutre repair

1.1. Disturbed fracture healing

1.1.1. causing delayed union non union

1.1.2. due to local physical factor instability vascular impairmant large gap - smooth tissue imposition infection metallosis systemic factor immune reaction w cortial alloimplant nutrtitional cancer cachexia

1.1.3. clincal signs persistance pain warmmth motion at # relucatance to use limb joint stiffness in nonunion - pain can be absent dt psudoarthroiss form

1.1.4. diagnosis sequential rads bone scintigraphy 5MT osteomedullography

1.1.5. classification viable still has blood supply hypertrophic slightly hypertrophic oligotrophic nonviable incalable biological response - blood supply poor absent dystrophic necrotic defect atrophic

1.1.6. treatment want heal bone AND return function ID primary cause and fix post op physiotherapy Sx repair restore stability improve anatomic aligments eliminate infection stimulate vasculisation and bone production

1.2. Malunion

1.2.1. fracture that healed in abnormal position causing functional impairment

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

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

1.3. Osteomyelitis

1.3.1. inflamation bone and marrow slow recovery protracted, unrewarding

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

1.3.3. forms haematogenous rare dog cat comon shildres young animal at metaphyses CS - tenderness swelling lamneness 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 chronic sequale to shit treated acute - allow bacterial colonisation bacteria CS rads - bony proliferation/lysis Rx early aggresive remove implant when clinical bone union achived - eliminate infection

1.4. Fracture disease

1.4.1. complications of fracture repair atrophy mm bones joints

1.5. Implant failure

1.5.1. stainless suseptable to cyclic stress

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

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

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

2. D148 - Surgical conditions of the skull

2.1. Dispatch

2.1.1. good blood - rapid heal

2.1.2. need to establish normal dental occlusion

2.1.3. pharyngostomy/tracheostomy allow more space to work

2.1.4. tension freee closure gingiva

2.1.5. feeed soft post op/stomach tube

2.2. mandibular fracture

2.2.1. common cat - open fracture dt trauma hbc

2.2.2. 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

2.2.3. 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 # multiple wire - avoid pivot short twist minimise mucosal irritation 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

2.3. maxillary fracture

2.3.1. most non displaced - treat conservative w soft feed

2.3.2. thin cortices - shit screw

2.3.3. same principle mandibular

2.3.4. beware airway obstruct nasal major vesels nn

2.4. Temperomandibular luxations

2.4.1. isolated or w mandibular #

2.4.2. mandibular condyle displace rostrally or caudall

2.4.3. dx - rads

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

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

2.4.6. chronic luxation open reduction suture imbrication of joint capsule dondylectomy

2.5. mandibulectomy

2.5.1. indicated w non union fracture w infection, neoplasia

2.5.2. differing amounts

2.5.3. tumor - 1 cm margin

2.5.4. complications wound dehicience droolin tongue deviation malocclusion

2.6. maxillectomy

2.6.1. similar to mandibulectomy

2.6.2. multiple approach.

2.6.3. allow sufficient labial/buccal mucosa to close deficit

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

2.7. neoplasm oral cavity

2.7.1. common

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

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

2.7.4. SCC feline shit rostral better radical sx

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

2.7.6. osteosarc radical sx

2.8. cranial #

2.8.1. extracranial rare Sx

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

2.8.3. Rx concussion and cerebral oedema - increased ICP

3. D149 - Forelimb Fractures

3.1. Scapula

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

3.1.2. 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

3.1.3. neck watch suprascapular nn

3.1.4. glenoid cavity lag screw and tension band

3.2. humerus

3.2.1. 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.

3.2.2. proximal # prox physeal infrequent type 1 or 2 young old prox metaphyseal path dt osteosarc. internal fixation

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

3.2.4. 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 stabillise intercondyle w lag screw supracondyle w crossed pins lateral condyle more likely all require reduction and fixation - proximity to elbow joint

3.3. radius ulna

3.3.1. 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

3.3.2. radius proximal prox physeal radial head radial diaphaseal distal physeal metaphyseal fracture styloid process

3.3.3. ulna proximal physeal olecranon # monteggia fracture 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

3.4. carpus

3.4.1. 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

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

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

3.5. metacarpus

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

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

3.6. phalanges

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

4. D150 - Pelvic and Hindlimb Fractures

4.1. Pelvic #

4.1.1. 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

4.1.2. managment conservative indicate realign w percutaneus/digital manipulation cage confine 4 weeks longer surgery indicate fixation - if intraarticular or weight transfer from hind

4.1.3. sacroiliac seperation/frcature occur w other pelvic # unless bilatera; normally ilium goes craniodorsal fibrocartilage and synovial joint heal better w little movement options lag screw transilial bolt

4.1.4. 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

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

4.1.6. 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

4.1.7. 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

4.2. femur #

4.2.1. dispatch comon hbc ext coaptation hard 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

4.2.2. proximal physeal # capital physeal 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

4.2.3. diaphaseal # short oblique and interdigitating (reduce rtation) can do IM normograde better for sciatic if rotation IM and external skeletal fixation IM pin and cerclage wire plates

4.2.4. 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

4.3. tibia #

4.3.1. dispatch comon open can immobilise joint above below external coaptation IM pin - normograde medtension on medial side - plate

4.3.2. proximal avulsion tibial tuberosity internal fixation proximal physeal # 1 2 3 internal fix w small k wire

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

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

4.4. tarsus

4.4.1. 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

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

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

5. D151 - Growth plate injuries

5.1. anatomy

5.1.1. bt epiphysis metaphysis

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

5.2. classification - salter harris

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

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

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

5.2.4. 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

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

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

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

5.3. principle repair

5.3.1. reduction ASAP gentle manipulation watch damage germinal cells.

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

5.4. complications

5.4.1. interupt normal bone growth

5.4.2. 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

5.4.3. asymmetric angular deformity distribute load unevenly across joint fix immature mature

5.4.4. closure of one bone in pair - angulra deformity and joint incongruity esp antebrachium closure distal ulnar lateral deviation cranial bowing external rotation immature mature closure distal radius normally in conjunction with distal ulnar plate close lengthen radius

6. D152 - Joint injuries Fractures

6.1. principle

6.1.1. aseptic

6.1.2. adequote visualisation osteotomy

6.1.3. incisions parrale to axis limb not over tendon - adhesions

6.1.4. into joint capsule- watch l igaments

6.1.5. monofilament sutur

6.2. tendon

6.2.1. dense ittegular collagen tissue

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

6.2.3. entire tendon covered in epitendon

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

6.2.5. 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

6.2.6. type injuries lacerations avulsions strain - injury at myotendinous junction

6.2.7. 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

6.3. ligament

6.3.1. pure collagen w long parrale fibres, some elastic

6.3.2. relatively hypovascular

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

6.3.4. type injuries sprains result in abnormal joint mobility type 1 type 2 type 3

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

6.4. articular cartilage bone

6.4.1. chondrocytes embed in colalgen matrix

6.4.2. 4 zones

6.4.3. lack BV - low metabolic activity

6.4.4. subchondral bone - vascular

6.4.5. healing confined to cartilage heal poorly chondrocytes cont migrate in to subchondral bone access to marrox cells reparitive fibrocartilage not same

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

6.4.7. Sx need perfect anatomic reduction - articular congruity lag screw - compression - bone heal without callus screw cancellous cortical Kwires continous passive motion better cartilage heal gentle flexionextension for 20 mins 2id cage rest/external coaptation NSAIDS chondroprotective drugs - glucosamine

6.5. meniscus

6.5.1. extensions of tibia to accomodate femoral condyles

6.5.2. circumfrential and radial collagen fibre

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

6.5.4. held in position by 6 meniscial ligaments

6.5.5. fn load transmission lubrication improve joint stability

6.5.6. pertial meniscectomy increased load

6.5.7. healing peripheral supply fibrous scar becomes fibrocartilage unknown properties

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

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

6.6. joint

6.6.1. open fractures shearign injuries to tarsus carpus contamination tret early aggresive debride stabilisation

7. D153 - Osteochondrosis and Arthritis

7.1. Osteochondrosis

7.1.1. disturbance of endochondral ossification leading to retention of cartilage cartilage become thick Articular growth plate OCD - manifectation of OC - flap of cartilage lift from articular surface

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

7.1.3. common sites shoulder caudal part humeral head male large lameness worse after exercise mm atrophy deltoids spontaneus healing if flap dislorge sx normally bilaters elbow OC leading to young big breed male medcal surgical stifle lateral femoral condyle 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

7.2. osteoarthritis

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

7.2.2. dt instability incongruity OC trauma

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

7.2.4. Rx relive pain NSAID improve joint fun minimise progression weight loss exercise modification medical id treat inciting cause surgical salvage excision arthroplasty arthrodesis prosthetic joint replace

7.3. Inflamatory arthritides

7.3.1. septic bacterial haematogenous penetrating injury local extension dx acute onset w pyrexia joint painful swollen warm left shift on haemogram arthrocentisis Rx Sx

7.3.2. Immune mediated Rheuatoid arthritis intermitient shifting lameness multiple joint RAD SLE multisystmeic polyarthritis idiopathyic polyarthritis cyclic lameness, pyrexia, anorexia Rx glucocorticoid azothiaprin

8. D154 - Surgery of Hip joint

8.1. Luxation of hip

8.1.1. comon no colaterals only ball socket, round lig

8.1.2. 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 check predisposing factor closed reduction fresh injury without ships like cow 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

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

8.2. Canine hip dysplasia

8.2.1. disparity bt primary muscle ass and rapid skeletal growth

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

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

8.2.4. Rx may not be clinical RAD changs severe conservative non concussive exercise weight control NSAID cartophen - pentosan sx triple pelvic osteotomy total hip replacement femoral head and neck excision denervation of craniodorsal joint capsule pectineus myectomy

8.3. Legg calve perthes disease (Avascular necrosis of femoral head)

8.3.1. 1 yo minature toy breeds - similar condition in children inherited

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

8.3.3. 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

8.3.4. Rx excision arthroplasty - femoral head and neck excision early conservative - protracted

9. D155 - Orthapaedic conditions of stifle and tarsus

9.1. steifel

9.1.1. patellar luxation acquired traumatic developmental small breeds, medial lux casue secondary changes in hip grade grade 1 grade 2 grade 3 grade 4 sequale cranial crusiacte rupture sx lateral retinacular imbrication trochlear groove deepening tibial derotational suture tibial tuberosity/crest transposition medial desmotomy corrective osteotomy salvage after care rapid heal dt young restrict activity joint - passive physiotherapy in first 2 weeks active physiotherapy

9.1.2. Cranial cruciate rupture dispatch acute - trauma chronic anatomy fn concurrent meniscial injury contralateral cruciate injury dx trauma hx cranial drawer rads ecploratory arthoscopy Rx conservative primary repair Intra-capsular reconstruction extra-capsular reconstruction must assess menisci integrity

9.1.3. Caudal cruciate rupture dispatch isolated rare - multiple lig dt trauma from lateral surface medial femoral condyle to lateral edge popliteal notch tibia prevent caudal draw, stop hyperextension dx caudal draw tibial sag Rx avulsion - similar CrCL interstital tears - extracapsular technique

9.1.4. 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 grade 2 grade 3 protect joint w lateral splint

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

9.2. tsar

9.2.1. 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 replace - prosthetic ligment stabilise w transarticular external skeletal fixation shearing - debride, leave open then repair lig

9.2.2. Plantar ligament fracture present w plantigrade stance conservative shit dt contant tension 3 lig middle important

10. D156 - Orthapaedic conditions of the Shoulder elbow carpus

10.1. shoudler luxation

10.1.1. medial lateral more comon cranial caudal

10.1.2. stabilised w medial lateral glenohumeral lig

10.1.3. congenital

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

10.1.5. rx recent traumatic closed reduction w external coaptation ctabilise w square suture thru scapular neck and humeral head tranposition biceps brachi tendon salvage - excision arthroplasty/arthrodesis

10.2. Bicipital tenosynovitis

10.2.1. dt repeated stress, OCD fragments

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

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

10.3. Mineralisation of supraspinatous tendon

10.3.1. large breed, chronic intermittnet unilateral lameness

10.3.2. dx pain palpation rads mineralisation cranioproximal craniodistal skylie view

10.3.3. rx surgical removal mineralised tendon

10.4. infraspinatus contracture

10.4.1. hunting working dogs

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

10.5. scapular dislocation

10.5.1. tear serratus ventralis dt trauma dorsal border scapula higher

10.5.2. small - velpau sling

10.5.3. large - wire suture around rib

10.6. elbow luxation

10.6.1. normally good stability lateral luxa tion most common

10.6.2. 3 joints humeroradial most stability humeroulnar restrict saggital plane proximal radioulnar limited rotation

10.6.3. congenital humeroulnar lateral rotation proximal ulna cant support weight - cant extend craniocaudal rads lateral luxation radial head reduced flexion palpated lateral to joint rad show abnormal position

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

10.6.5. 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 congenital lateral luxation radial head salvage

10.7. carpal ligament injury

10.7.1. trauma, shearing

10.7.2. conservative w external coaptation only good for inactive

10.7.3. 3 joints, multiple short collaterals

10.7.4. 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

10.7.5. shearing injury similar tarsus

10.7.6. 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

10.7.7. 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

11. D157 - Salvage procedures

11.1. arthrodesis

11.1.1. 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 neurological problems - e.g radila nn paralasis limb spare - neoplesai w allogenic bone graft

11.1.2. 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

11.1.3. complications increase stress to adjacent joint DJD esp multi joint - carpus hock infection failure stabilise shorten/lengthen limb dt incorrect angle

11.1.4. specifics carpus/hock most common rad stress vie wto determine what joint plating better if big enough 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 watch derange limb fn

11.2. amputation

11.2.1. quadrapeds adapt very well test w sling more for owner sake

11.2.2. 'exercise in regional anatomy, not butcher'

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

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

11.2.5. 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

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

11.2.7. post op blood loss in limb pain phantom limb? pressure bandage