Small Ani. Sx- Ortho- Principles of Joint Surgery

wilsbach's version from 2015-11-27 18:41

Intro + Arthrotomy + ligament sprains

Question Answer
5 possible goals of joint sx(1) Exploration (diagnosis) (like see if meniscus is intact or damaged) (2) Debridement, removal of chips, OCD (3) Stabilization of non-stable joints (4) Fracture treatment (Stability and anatomical reduction) (5) arthrodesis
what things must you be careful of and do when doing arthrotomy?Asepsis (need to lavage a lot- very easy to get spetic joint, and there isnt much blood supply in joints, hard to tx with abx and bact love synovium), Surgical preparation, Protect periarticular soft tissues, provide good hemostasis (blood in joint is not good for it)
how must you care for the cartilage when doing an arthrotomy?keep it wet!
when you do your closure of your arthrotomy, what suture material do you use, and what do you do with the synovial membrane?absorbable suture material, dont include synovial membrane (otherwise there is hard suture material rubbing against the cartilage)
SPRAIN VS STRAIN?Sprain is for ligaments. Strain is for mm.
explain the signs of how you can dx a ligament sprain with palpation and manipulation (always compare to other leg!)PALPATION: there will be swelling and pain. MANIPULATION: there will be instability and crepitus.
explain 3 diff ways to do rads to dx ligament sprain(1) Standard radiographs (2) Stress radiographs (open or close the joints- maybe sedated for this) (3) Rads under Anesthesia- This relaxes them (esp if they are in pain this might be a problem) which allows opening of the joint space and you can Compare contralateral side
what do you think about thing in red circle? what is a species-specific thing about thing in red box? Red circle= mineralization of cr part of meniscus-- not a fragment. fairly normal finding in cats. Red square= there are the fabella, cats have one and dogs have 2 usually
what is a First degree (mild) ligament sprain like?few fibers damaged. Hematoma, edema. *Stable
what is a Second degree (moderate) ligament sprain like?more fibers torn, ligament stretched, partial instability
what is a Third degree (severe) ligament sprain like?completely torn. Severe swelling, quite unstable
what is therapy gonna be like for a 1st degree sprain? 2nd? 3rd?1st- Conservative therapy. 2nd- Conservative or surgical. 3rd- Surgical treatment
what is CONSERVATIVE tx like for a lig sprain? which degree sprain merits conservative therapy?1st degree, maybe 2nd degree. Activity restriction for 2-4 weeks, use Cold-hot packs, and Immobilization
why cold and then hot packs (what does each do?)Cold first helps prevent too much hematoma and reduces amount of swelling. Then Hot packs are used to promote blood flow to the area to carry away excess fluid
sprained lig--> sx tx--> when is Suture plication used?to shorten an overstretched ligament
sprained lig--> sx tx--> if you are going to Suture ligaments, which pattern do you do?tendon pattern- more on this later
what are some things you can do sx to help tx a sprained lig?Exploration, Suture plication (stretched lig), Suture ligaments (tendon pattern), Reattach to bone (commonly an avulsion, screw it back on), Protect (internal sling), Postoperative Immobilization (Splint, external fixator)
**what are the two tendon patterns used to repair a torn ligament (3rd degree) (he said know the names)(1) Locking loop pattern (2) 3 loop-pulley
Collateral ligament repair--> how do you do this? what kinda suture? what must you keep in mind?use Screws / Tunnel to do this (suture goes around screw heads to provide stability)... need Non absorbable suture material, and you must Respect the center of rotation (make a figure 8 bc need a center of rotation to provide stability in the joint)
Joint immobilization--> how long do we want to do this? why do we care about the amount of time we do this? what is the MAX?Usually 3-4 wk, but want it to be as short of a time as possible bc you risk ankylosis (to help prevent this more, when you change splint, flex and extend the joint a bit). Maximal 6 weeks for tendon repair
what are a few ways to provide joint immobilization? explain reasoning behind some of themCould do a cast/splint, OR could do a Transarticular external fixator (usually do these for Serious injuries, Collateral lig. damage)

Articular fractures

Question Answer
what are your main goals of treating a articular fx?Restore function!! pain free, ROM, prevent OA
to accurately dx articular fx, you need...Good radiographs, with Orthogonal projections
Principles of treatment of articular fx- you should repair how soon after incident?Repair within 1-2 days
Principles of treatment of articular fx- how can you make sure you get a good approach? Good approach with arthrotomy
Principles of treatment of articular fx- what should your reduction/fixation be like?provide Anatomical reduction (GO GAPS OR STEPS). Stable fixation
Principles of treatment of articular fx- When should you allow movement in the joint?provide Anatomical reduction. Stable fixation, Early movement
you can perform an Arthrotomy to get Adequate exposure. However, if that isnt enough exposure, you might need to do an osteotomy. where would you do this if the fx is in the... femur? humerus? tarsus?Femur: Greater trochanter. Humerus: Greater tubercle. Tarsus: Medial malleolus. (bone heals faster than tendons/ligs- cut that shit instead. Can apply a tension band to put it back on)
(said in class) more than _________ fx in the acetabulum and you will NEED to reconstruct it.3
you need stable fixation for ___ bone healing. what kinda implants would you want to pick and why?you need PRIMARY BONE HEALING, so you would want to pick things like Screws and Antirotational K-wire in order to accomplish Inter fragmentary compression
what are some reasons you want Early movement of joint in articular fx?(1) Avoid periarticular fibrosis (2) Avoid muscular contracture (3) Keep ROM (4) Protect cartilage (cartilage nourished by synovial fluid ) (5) Ligament laxity in young animals (if put bandage on it, lig gets weaker)


Question Answer
what is Arthrodesis? what is Ankylosis?DESIS: Surgical fusion of a joint. LOSIS: Pathological fusion of a joint
WHEN do you want to do arthrodesis?when there is Irreversible joint trauma (better than nothing, esp if its obliterated, they will be in pain if you do nothing)
goals of an arthrodesis?Reduce pain, Provide stability, Ameliorate (make better) limb function
****4 principles of arthrodesis?(1) Respect alignment (2) Remove articular cartilage (all of it! need to do this so the bones can grow together, bc no BVs in cart) (3) Use bone graft (4) Stable fixation
what joints can you do arthrodesis on? Which joints do you get better function with arthrodesis?Almost every joint, Better function distal joints (carpus/tarsus)
Hyperextension carpus--> what should you know about hyperextension carpus? what is usually the cause? is this painful?very painful! Usually when dogs jump off of things that are too high, so often bilateral. Must remember that this problem can be in any of the carpal rows
how do you tx hyperextension of the carpus? (explain what you have to do)ALWAYS SURGICAL!! need Strong pull in the palmar side,Ligament repair in never enough. Will probably need: Partial carpal arthrodesis OR Pancarpal arthrodesis(fusing all the joints). Healing time is super long.
Surgical technique for arthrodesis(1) Remove articular cartilage (2) Osteostixis (make small holes in subchondral bone to allow BVs through) (3) Bone graft (4) provide Stable fixation
you should splint post-op for arthrodesis long?6-8wk *beware of pressure sores
what other joints aside from the carpus can you arthrodesis? what about partial arthrodesis?also Tarsus. partial.... elbow (not really good to), knee (not good but possible, better than nothing), shoulder
whats Osteostixis?make small holes in subchondral bone to allow BVs through (vascular channels)