Advanced Surgery-Lecture 5 (Orthopedic Surgery)

Front 1

When is orthopedic surgery usually considered life threatening?

Back 1

If it involves the spine or the skull (patient should be given pain meds and stabilized prior to sx).

Front 2

Give an example of 2 orthopedic surgeries that are elective procedures.

Back 2

Patella, FHO (femoral head osteotomy, used to relieve pain), CCL (cranial cruciate ligament, most common orthopedic sx in dogs), OCD (Osteochondritis dissecans).

Front 3

Doing this with fractures will help to prevent blood loss and help with pain management.

Back 3

Stabilizing them

Front 4

True or False

Goals of orthopedic sx are:

Reconstruction/restoration of normal form, mobilization of all joints involved, immobilization of bone fragments, rehabilitation of the patient within a reasonable time.

Back 4

True

Front 5

Give me 2 types of fractures

Back 5

Transverse, oblique, spiral, comminuted reducible, comminuted non-reducible

Front 6

Articular fractures involve the ______.

Back 6

joint (aka physeal fractures)

Front 7

Who are articular fractures commonly seen in?

Back 7

Young growing dogs

Front 8

Any fracture that involves the physis or the growth plate can harm the development of the bone.

True or False

Back 8

True

Front 9

How many types of Salter Harris type fractures are there?

Back 9

5 types

type 1: fracture through physis

type 2: fracture through metaphysis and physis

type 3: fracture through physis and epiphysis

type 4: fracture trough physis, metaphysis, and epiphysis

type 5: crushing injury to the physis

(see pg. 202 in your book)

Front 10

How would you assess a fracture?

Back 10

Which bone is involved

is it open or closed

where is the fracture located (distal/midshaft etc)

what type of fracture is it (oblique/transverse etc)

is it reducible or nonreducible

Front 11

When taking a radiograph of a fracture, where do you want to aim the beam?

Back 11

aim it to get the joint above and the joint below the fracture if applicable. (they are often taken after surgery if implants were used to ensure proper positioning)

Front 12

How many views should you always take?

Back 12

2

Front 13

What is a problem with open fractures?

Back 13

The complications can be worse because the bone and blood supply have been exposed to air (and whatever else)

Front 14

What are some complications that can occur with open fractures?

Back 14

skin necrosis/infection (leads to bone death), bleeding/blood loss, soft tissue damage and swelling, contamination and vascular compromise.

Front 15

How many methods of fixation (groups) are there?

Back 15

5 groups

closed reduction w/external fixation (splint, cast)

open reduction w/out internal fixation (plates, screws, etc)

open reduction w/ internal fixation

external skeletal fixation (may be open or closed)

closed reduction w/ internal fixation

Front 16

where is a closed reduction most commonly seen?

Back 16

with radius, ulna, and tibia (usually done with external fixation such as casts, or splints. Must mobilize joint above and below fracture for best income)

Front 17

How soon should a closed reduction be done?

Back 17

as soon as possible (before swelling and hematoma formation)

Front 18

When should a closed reduction not be done?

Back 18

on unstable fractures, fractures that can't be reduced, or angular limb deformities

Front 19

When would external skeletal fixation be contraindicated?

Back 19

avoid with large muscle areas

Front 20

this type of fracture repair allows the anatomical reduction of fracture fragments with complete control over their immobilization.

Back 20

open reduction and internal fixation

Front 21

what are bone plates made from?

Back 21

Titanium or stainless steel (designed to be used with various sizes of screws)

Front 22

Where are IM pins put?

Back 22

directly into the bone and medullary cavity. (can be done open or closed, can be single or stacked(this prevents rotation) and is the most inexpensive technique).

Front 23

What are some post-op considerations for internal fixation?

Back 23

strict rest 6-8 weeks, follow up rads taken q 4-6 weeks (determine bone healing), external fixation devices can often be left in place.

Front 24

What are some complications with external fixation?

Back 24

Both internal and external, non union, malunion, delayed union, aseptic loosening of implant, infection, fracture of implant.

Front 25

This is a big thick bandage that provides good stabilization and is a temporary dressing for immobilization of fractures.

Back 25

Robert Jones

Front 26

This is a sling that is used to reduce anterior dorsal coxofemoral luxations in the dog and cat. Has its advantages, but doesn't immobilize hip joint, only places femoral head into a position in the acetabulum where it is most stable.

Back 26

Ehmer sling

Front 27

how is the ehmer sling applied?

Back 27

figure of eight dressing, should shorten the leg by flexing the knee and hock. usually left in place for a 10 day period

Front 28

this sling is used as a shoulder bandage to relieve the forelimb of weight bearing, and keeps carpus, elbow and shoulder joints in a flexed position.

Back 28

velpeau sling

Front 29

when would use of the velpeau sling be indicated?

Back 29

when you need to immobillize a scapular fracture, if a shoulder is dislocated, if the foreleg needs to have no weight on it, it the animal is comfy with the sling. (leave for 10 days)

Front 30

custom made external immobilization that lies in contact with the skin and is made to conform to the injured part to act as a method of immobilization is called a ______.

Back 30

cast

Front 31

what are some materials that casts are made from?

Back 31

plaster, plastics,fiberglass, polyurethane-impregnated cotton polyester

Front 32

this splint is used for the humerus and femur

Back 32

spica splint

Front 33

what are some things that should be done at home to take care of bandages?

Back 33

Bandages/splints should be checked 3-4 times daily for swelling, slippage, moisture, or soiling (change it if any of these happen), bandage needs to be changed about q 2 weeks, if there are no other complicating factors, also you need to keep bandages dry (send home a bag)

Front 34

most people think that splints or bandages are cheaper than other more specialized things used. What can make them more costly?

Back 34

Repeat sedation/anesthesia, bandage material cost, repeat rads, recheck fees

Front 35

What are some things to monitor for when dealing with casts/splints?

Back 35

skin irritation, ulcers, non-union, mal-union, delayed union, infection, a poorly placed bandage can cause the patient to lose the limb.

Front 36

What are some complications in the following patients?

Young animals

old animals

how does size factor in?

overweight animals

Back 36

young animals:heal quickly, more difficult to keep quiet and confined.

old animals: heal slowly, may have problems in other joints (makes for a slow/difficult recovery)

Size: small animals and cats tend to do better.

Overweight animals: can cause excessive stress to joints and fx can impede healing.

Front 37

What is the biggest problem with any pre-op considerations?

Back 37

Owner compliance

Front 38

casts and splints should be checked every ______ weeks, and be monitored for what?

Back 38

1-2 weeks, check for mutilation, swelling and odor

Front 39

This is complete removal of a limb from the body due to trauma, non repairable fractures, neurologic injuries, neoplasia, necrosis, and congenital deformities.

Back 39

Amputation

Front 40

Which leg amputations are harder because they carry about 2/3 of the animal's weight.

Back 40

Front legs (also, animals with dysplasia won't do well with rear leg amputations)

Front 41

What are some things that need to be done during an amputation?

Back 41

muscles-dissected/cut at origin or across muscle belly

nerves-located and injected with local block

arteries/veins located and ligated

Front 42

What are some types of medications that can be used for amputations?

Back 42

morphine (opioid)

lidocaine (local blocks)

ketamine

Front 43

what are some things needed for post op care with amputations?

Back 43

sling or vest to help with balance, treat for phantom limb pain, monitor PCV, monitor for infection

Front 44

The most important stabilizer inside the stifle is the:

A. ACL

B. CDL

C. CCL

D. DUI

Back 44

C. CCL (rupture of ccl is most common reason for hind limb lameness and arthritis)

Front 45

what are some reasons for ccl rupture?

Back 45

aging ligament/degeneration, obesity, confirmation

Front 46

what are two breeds that are predisposed to a CCL rupture?

Back 46

Rotties, newfies, Staffordshire terriers, mastiffs, retrievers

Rarely affects cats

Female and neutered dogs are at higher risk.

Front 47

True or False:

Clinical signs of CCL rupture vary widely depending on the dog and whether it is acute or chronic.

Back 47

True

Front 48

What is a very common problem in small breed dogs, and sometimes large breed dogs and cats?

Back 48

Luxating patella (this is where the patella "pops out" of the natural groove that it is supposed to sit in.

Front 49

What does the constant popping out of the patella eventually cause in these dogs with luxating patella?

Back 49

DJD (degenerative joint disease)

Front 50

What are some causes of luxating patella?

Back 50

malformed tibia, deviation of tibial crest, abnormal hip joint confirmation (like hip dysplasia), malformed femur, tightness/atrophy of the quadriceps (thigh) muscles acting as a bowstring, patellar ligament may be too long.

Front 51

What are the grades of a luxating patella?

Back 51

1-4

Grade 1: knee cap can be manipulated out of its groove, but goes back to normal position on its own.

Grade 2: Knee cap rides out its groove occasionally, can be replaced with manipulation

Grade 3: Knee cap rides out of groove most of the time, replaced via manipulation.

Grade 4: Knee cap rides out of groove all the time, cannot be replaced inside the groove.

Front 52

How would you fix luxating patella surgically?

Back 52

Deepen the femoral groove so that the knee cap can sit deeply in its spot, so you pretty much cut into the bone, correct its deformation, and immobilize it with a bone plate.

Front 53

What are some post op considerations for a luxating patella?

Back 53

Bandage (24-48 hours), exercise restriction (6 weeks), short leash walks, no running jumping, stair climbing, or rough play, rehabilitation program.

Front 54

What is an elective surgery?

Back 54

referring to a sx case that can wait to be scheduled

Front 55

What is CCL?

Back 55

Cranial cruciate ligament

Front 56

What is ACL?

Back 56

Anterior cruciate ligament

Front 57

What is MPL?

Back 57

Medial Patellar ligament

Front 58

What is HOD?

Back 58

Hypertrophic Osteodystrophy (developmental disease that causes disruption of metaphyseal trabeculae in long bones of young, typically lg breed, rapidly growing dogs)

Front 59

What is OCD?

Back 59

Osteochondritis dissecans (cartilage pieces which start to come off the bone and disrupt normal joint funtion.)

Front 60

When the piece comes off the bone (with OCD), and is freely "floating" in the joint, it is called a ______.

Back 60

Mouse

Front 61

What is IVDD?

Back 61

Intervertebral Disk Disease

Front 62

Abnormal development of the hip (coxofemoral) joint which causes luxation or subluxation and causes degenerative disease is called ______.

Back 62

Hip dysplasia

Front 63

1. Subluxation

2. Luxation

3. Dislocation

A. Complete separation of the bone from its articulation

B. Complete separation of the articular surfaces

C. Partial or incomplete separation of a joint

Back 63

1. C

2. A

3. B

Front 64

An unorganized network of woven bone formed at the ends of a broken bone which adds support to the healing process, and will often be resorbed is called______.

Back 64

Callus

Front 65

1. Non union

2. Malunion

3. Delayed union

A. Delayed renewal of continuity in a broken bone or between the edges of a wound.

B. Failure of the fx bones to unite

C. Poor alignment of the fractured bones

Back 65

1. B

2. C

3. A

Front 66

What is the difference between open and closed reduction surgery?

Back 66

Open reduction: surgical opening and exposing the bone to properly realign the bones

Closed reduction: nonsurgical realignment of the fracture or joint

Front 67

What is a TPLO?

Back 67

Tibial Plateau Leveling Osteostomy (this is often used in large dogs)

Front 68

What is TTA?

Back 68

Tibial tuberosity advancement