Orthopedic Surgeries Notes

Technician’s Responsibilities

  • Understand fracture management and repair thoroughly, including the implications of different fracture types and the healing process.

  • Triage patients efficiently, evaluating their conditions to determine urgency and appropriate referrals.

  • Prepare patients for orthopedic surgery, which includes obtaining consent, performing pre-op assessments, and ensuring all necessary equipment and materials are available.

Coaptation

  • Definition: Application of an external appliance (e.g., splint or cast) to stabilize a fractured bone or joint, providing immobilization to promote healing. Coaptation also helps manage pain and prevent further injury during the recovery phase.

Types of Bandages

  • Robert Jones Bandage: Provides compression and support; primarily used for temporary immobilization of injured limbs.

  • Modified Robert Jones Bandage: Similar to the Robert Jones but with reduced padding, used for less severe injuries.

  • Ehmer Sling: Used to immobilize a hind limb that has suffered a hip or stifle injury; prevents weight-bearing.

  • Spica Splint: Immobilizes limbs by encircling and supporting the limb and adjacent body parts, often used for fractures or severe sprains.

  • Velpeau Sling: Supports a forelimb during healing and keeps it from bearing weight, commonly used for shoulder injuries.

Preoperative Considerations

  • Size and weight of the patient play critical roles in determining appropriate surgical techniques and implant choices.

  • Evaluate general health and temperament to identify any pre-existing conditions that may complicate surgery.

  • Age of the animal influences healing capacity and recovery expectations; younger animals may heal faster, while geriatric patients may have increased complications.

  • Owner compliance is critical for successful outcomes, as post-operative care and adherence to activity restrictions are necessary for recovery.

Key Orthopedic Terms

  • CCL - Cruciate Ligament: Key stabilizer in the knee joint.

  • ACL - Anterior Cruciate Ligament: Plays a vital role in preventing hyperextension and rotation of the knee.

  • MPL - Medial Patellar Luxation: Common condition in small breeds where the kneecap dislocates towards the inside of the leg.

  • HOD - Hypertrophic Osteodystrophy: A developmental bone disease in young, rapidly growing animals.

  • OCD - Osteochondritis Dissecans: Joint condition where cartilage becomes loose, causing pain and inflammation.

  • IVDD - Intervertebral Disc Disease: Condition where disc material compresses spinal nerves, causing pain or neurologic dysfunction.

  • Subluxation - Partial separation of a joint, can lead to instability and pain.

  • Luxation - Complete separation of bones from articulating surfaces, usually requiring surgical intervention.

  • Dislocation - A severe form of luxation where the joint surfaces are entirely displaced.

  • Aseptic loosening - Loss of fixation of an implant without infection, a common concern in joint replacements.

  • Open/Closed Reduction - Open reduction involves surgical intervention to reposition fractured bones, while closed reduction is done non-surgically.

Fracture Repair

  • Assessment Components:

    • Bone location: Specifying which bone is fractured for targeted treatment.

    • Open or closed fracture type: Open fractures expose bone to the environment, increasing infection risk.

    • Specific location of the fracture on the bone affects healing and treatment plans.

    • Type of fracture: reducible fractures can be aligned without surgical intervention, whereas non-reducible fractures often need surgical methods.

Open Fracture Grades

  • Grade I: Small puncture hole in skin around fracture, with minimal contamination risk.

  • Grade II: Larger puncture or tear in the skin, considerable soft tissue damage, requiring careful management to prevent infection.

  • Grade III: Large tears with significant soft tissue loss, severe damage often necessitating extensive surgical intervention and critical care.

Types of Fractures

  • Articular Fractures: Always involve a joint, critical to assess due to the involvement of the articular cartilage, which can affect joint function. Common in growing animals (e.g., Salter-Harris fractures).

    • Type I: Through the physis (growth plate), typically has a good prognosis if treated successfully.

    • Type II: Through metaphysis and physis, gaining more commonality and requiring careful management.

    • Type III: Involves the epiphysis; more complex as it affects joint surfaces.

    • Type IV: Extends through metaphysis, physis, and epiphysis, can lead to significant dysfunction.

    • Type V: Crushing to physis; can halt growth and lead to deformities.

Fracture Patterns

  • Transverse Fractures: Straight across the bone, usually resulting from a direct blow.

  • Oblique Fractures: Break occurs at an angle; often indicative of a twisting force applied to the bone.

  • Spiral Fractures: Curves around and may require surgical intervention for realignment due to their complexity.

  • Comminuted Fractures: Numerous fragments complicating repair;

    • Reducible: Repairable if fragments can be aligned.

    • Non-reducible: Unable to repair due to multiple fragments, often needing complex surgical intervention.

Surgical Options for Fracture Repair

  • Internal Fixation: Rigid devices (plates, screws) are placed inside or on the bone for stabilization -

    • Devices include:

      • Plates and screws for bone stabilization.

      • Interlocking nails providing intramedullary support.

      • Intramedullary (IM) pins (e.g., Steinmann pins, Kirshner wires), useful for simpler fractures.

      • Cerclage wires are for added stability in complex fractures.

  • External Fixation: Applied externally using various devices, allows for support while minimizing soft tissue trauma -

    • Devices include:

      • Casts and splints for immobilization.

      • Kishner-Ehmer (KE) fixation provides stabilization for fractures.

      • Ring fixation typical for certain fractures in large animals.

      • Acrylic fixation support for stable and effective immobilization.

Complications with Fixation

  • Non-union, malunion, delayed union are common concerns impacting recovery timelines and outcomes.

  • Aseptic loosening and infection remain significant risks, especially for implants, necessitating careful monitoring post-surgery.

Amputation

  • Complete removal of a limb is indicated in situations like:

    • Trauma where the limb cannot be salvaged.

    • Neurologic injuries leading to irreversible damage.

    • Neoplasia (tumors) beyond surgical intervention.

    • Ischemic necrosis causing tissue death.

    • Unmanageable arthritis with chronic pain not responsive to medical management.

    • Congenital deformities that impair the quality of life.

Cranial Cruciate Ligament (CCL) Repair

  • CCL injuries are commonly diagnosed hind limb conditions, with various surgical techniques available to restore function.

  • Traumatic injuries account for 20% of CCL tears, highlighting the need for preventive measures and education for pet owners.

  • Surgical repair approaches include:

    • Intracapsular techniques which involve ligament reconstruction.

    • Extracapsular techniques utilizing tension bands for stabilization.

    • Tibial Plateau Leveling Osteotomy (TPLO), altering the biomechanics of the knee to prevent instability.

    • Tibial Tuberosity Advancement (TTA) focusing on realigning the tibial tuberosity to restore normal function.

Total Hip Replacement (THR)

  • Considered a salvage procedure for severe hip conditions, three systems available include:

    • Kyon system designed for both dogs and cats.

    • BFX system known for its versatility in different breeds.

    • CFX providing options for complex cases that require tailored approaches.

Medial Patellar Luxation (MPL)

  • Commonly seen in small breed dogs, surgically treated depending on the severity of displacement.

  • Surgical options include:

    • Trochleoplasty to deepen the femoral groove, aiding proper tracking of the kneecap.

    • Tibial Crest transposition to adjust the angle of the patellar tendon.

    • Lateral imbrication or medial release procedures to correct soft tissue imbalances leading to luxation.