Textbook of Veterinary Orthopaedic Surgery

Preface
Contents
About the Authors
1: Basic Considerations
Learning Objectives
Summary
1.1 Structure and Types of the Bone
1.1.1 Components of the Bone
1.1.1.1 The Bone Cells
1.1.1.2 Organic Matrix
1.1.1.3 Inorganic Mineral
1.1.2 Structure of the Bone
1.1.3 Circulation of the Bone
1.2 Bone Development and Growth Regulation
1.2.1 Development of the Bone
1.2.2 Calcium Regulation
1.2.2.1 Dietary Calcium and Phosphorus
1.2.2.2 Calcium-Regulating Hormones
1.3 Fracture Biomechanics and Classification
1.3.1 Mechanical Properties of the Bone
1.3.2 Fracture Forces
1.3.3 Classification of Fracture
1.3.4 Incidence of Fractures
1.4 Fracture Healing and Methods to Enhance Healing
1.4.1 Fracture Healing
1.4.2 Methods to Enhance Fracture Healing
1.4.2.1 Nutrition
1.4.2.2 Anabolic Steroids
1.4.2.3 Herbal/Homeopathic Drugs
1.4.2.4 Exercise
1.4.2.5 Other Physiotherapy Modalities
1.5 Implants Used for Fracture Fixation
1.5.1 Stainless Steel
1.5.2 Titanium
1.5.3 Cobalt-Chrome
1.5.4 Aluminum Alloy
1.5.5 Non-biodegradable Polymers
1.5.6 Biodegradable Metals
1.5.7 Bioresorbable Polymers
1.5.7.1 Polyglycolide (PGA)
1.5.7.2 Polylactide (PLA)
1.5.7.3 Co-polymers
1.6 Instrumentation for Fracture Fixation
1.6.1 Basic Instruments (Fig. 1.20)
1.6.2 Instruments for Bone Plating
1.6.2.1 Screwdrivers (Fig. 1.22)
1.6.3 Instruments for Intramedullary Pinning (Fig. 1.23)
1.6.4 Instruments for Interlocking Nailing (Fig. 1.24)
1.6.5 Instruments for Rush Pinning (Fig. 1.25)
1.6.6 Instruments for Kuntscher Nailing (Fig. 1.26)
1.6.7 Instruments for Bone Stapling (Fig. 1.27)
1.6.8 Instruments for Orthopedic Wiring (Fig. 1.28)
1.6.9 Instruments for External Skeletal Fixation (Fig. 1.29)
1.7 Examination of the Animals with Fracture
1.7.1 Things we Should Avoid while Examining an Injured Animal
1.8 Emergency Treatment of Fracture and First Aid
1.9 Anesthesia and Pain Management in Animals with Fracture
1.9.1 Anesthesia in Cattle
1.9.1.1 General Anesthetic Techniques
1.9.1.2 Local/Regional Anesthetic Techniques
Anesthetics Used for Local/Regional Analgesia
Techniques of Local/Regional Anesthesia
1.9.2 Anesthesia in Sheep/Goat
1.9.2.1 General Anesthetic Techniques
1.9.3 Anesthesia in Horse
1.9.3.1 General Anesthetic Techniques
1.9.3.2 Local/Regional Anesthetic Techniques
1.9.4 Anesthesia in Pig
1.9.4.1 General Anesthesia
1.9.4.2 Intravenous Techniques
1.9.5 Anesthesia in Dog
1.9.6 Anesthesia in Cat
1.9.7 Management of Pain
1.9.7.1 Treatment of Pain
Analgesic Drugs
1.10 Methods of Fracture Reduction
1.11 Timing and Selection of Fracture Fixation Technique
1.11.1 Timing of Definitive Fixation
1.11.2 Selection of Fixation Technique
Chapter 1: Sample Questions
References
2: Principles of Fracture Fixation Techniques
Learning Objectives
Summary
2.1 External Fixation Techniques
2.1.1 Bandages
2.1.2 Splints
2.1.3 Slings
2.1.4 Plaster Cast
2.1.4.1 Indications and Contraindications
2.1.4.2 Biomechanics
2.1.4.3 Technique
2.1.4.4 Post-application Care and Management
2.1.5 Fiberglass Cast
2.1.5.1 Advantages over Plaster Cast
2.1.5.2 Drawbacks
2.1.5.3 Technique
2.1.5.4 Post-application Care and Management
2.1.6 Modified Thomas Splints
2.1.6.1 Indications and Contraindications
2.1.6.2 Materials Required
2.1.6.3 Technique of Application
2.1.6.4 Application of Traction
2.1.6.5 Postoperative Care
2.1.7 Thomas Splint-Cast Combination
2.1.7.1 Indication
2.1.7.2 Biomechanics
2.1.7.3 Technique
2.1.7.4 Postoperative Care, Management, and Complications
2.2 Internal Fixation Techniques
2.2.1 Intramedullary Pin/Nail
2.2.1.1 Single IM Pin
2.2.1.2 Stack Pins
2.2.1.3 Rush Pins
2.2.1.4 Cross IM Pins
2.2.1.5 Kuntscher Nail
2.2.1.6 Interlocking Nail
2.2.1.7 Interlocking Nails for Bovine
2.2.2 Bone Plate and Screw Fixation
2.2.2.1 Dynamic Compression Plate
2.2.2.2 Veterinary Cuttable Plate (VCP) and Reconstruction Plates
2.2.2.3 Special and Mini Plates
2.2.2.4 Locking Plate-Screw Systems
Locking Compression Plate
Locking Plate (UniLock)
String of Pearls (SOP) Plate
Clamp-Rod Internal Fixator (CRIF)
2.2.2.5 Contoured Locking Plates for Bovines
2.2.2.6 Minimally Invasive Percutaneous Plate Osteosynthesis (MIPO)
2.2.3 Ancillary Fixation Devices
2.2.3.1 Screws
2.2.3.2 Wires
2.2.3.3 Postoperative Care and Management with Internal Fixation
2.3 External Skeletal Fixation
2.3.1 Indications
2.3.2 Advantages of ESF
2.3.3 Disadvantages of ESF
2.3.4 Fixator Configurations and Types
2.3.5 Biomechanics of ESF
2.3.5.1 The Material Characteristic of the Bone and Fracture Configuration
2.3.5.2 The Material Properties of the ESF Components
2.3.5.3 The Design of the ESF
2.3.6 Linear External Skeletal Fixation Systems for Small Animals
2.3.6.1 Frame Configurations
2.3.6.2 Fixation Pins
2.3.6.3 Linkage Devices (Fixation Clamps/Pin Grippers)
2.3.6.4 General Principles of ESF Application
2.3.6.5 Postoperative Care and Management
2.3.7 Transfixation Pinning and Casting in Large Animals
2.3.7.1 Hanging Limb Pin Cast
Principle of Hanging Limb Pin Cast
Technique
Postoperative Care and Management
Limitations/Disadvantages
2.3.7.2 Transfixation Pinning and Casting (TCP) as an ESF
Technique
Advantages
Disadvantages
2.3.8 Linear External Skeletal Fixation Systems for Large Animals
2.3.8.1 Fixator Components
2.3.8.2 Indications
2.3.8.3 Advantages
2.3.8.4 Principles and Guidelines for Application
2.3.8.5 Postoperative Care and Management
2.3.8.6 Removal of Fixator
2.3.9 Circular External Skeletal Fixation
2.3.9.1 Fixator Components
2.3.9.2 Indications
2.3.9.3 Application of CEF
2.3.9.4 Postoperative Care and Management
2.3.9.5 Removal of Fixator Assembly
2.3.10 Acrylic- or Epoxy-Pin Fixation Systems
2.3.10.1 Fixator Components
2.3.10.2 Indications
2.3.10.3 Advantages
2.3.10.4 Technique of Application
2.3.10.5 Construction of ESF Frame Using Acrylic
2.3.10.6 Construction of Pin Scaffold for Epoxy-Pin Fixation
2.3.10.7 Application of Epoxy Dough Along the Pin Scaffold
2.3.10.8 Postoperative Care and Management
2.3.10.9 Removal of Fixator Assembly
2.3.11 Complications of ESF
Chapter 2: Sample Questions
References
3: Management of Specific Fractures in Small Animals
Learning Objectives
Summary
3.1 Fractures of Scapula
3.2 Fractures of Humerus
3.2.1 Fractures of the Proximal Humerus
3.2.2 Diaphyseal Fractures of Humerus
3.2.3 Fractures of the Distal Humerus
3.3 Fractures of Radius-Ulna
3.3.1 Fractures of the Proximal end of Radius/Ulna
3.3.2 Diaphyseal Fractures of Radius-Ulna
3.3.3 Fractures at the Distal Radius and Ulna
3.4 Fractures of Femur
3.4.1 Femur Head-Neck and Subtrochanteric Fractures
3.4.1.1 Surgical Approach
3.4.1.2 Surgical Fixation
3.4.1.3 Postoperative Care and Possible Complications
3.4.2 Femoral Diaphyseal Fractures
3.4.2.1 Surgical Approach
3.4.2.2 Surgical Fixation
3.4.2.3 Postoperative Care and Possible Complications
3.4.3 Distal Femoral Fractures
3.4.3.1 Surgical Approach
3.4.3.2 Surgical Fixation
3.4.3.3 Postoperative Care and Possible Complications
3.5 Fractures of Tibia-Fibula
3.5.1 Proximal Physeal Fractures
3.5.2 Diaphyseal Fractures
3.5.3 Distal Tibial/Malleolar Fractures
3.6 Fractures of Metacarpus and Metatarsus
3.7 Fractures of Mandible
3.7.1 External Fixation
3.7.2 Internal Fixation
3.7.3 External Skeletal Fixation
3.7.4 Complications and Prognosis
3.8 Fractures of Pelvis
3.8.1 Surgical Approach
3.8.2 Surgical Management
3.8.2.1 Ilial Fractures
3.8.2.2 Acetabular Fractures
3.8.2.3 Fracture of Sacroiliac Joint
3.8.2.4 Fractures of the Ischium and Pubis
3.8.3 Postoperative Care and Complications
3.9 Fractures of Spine
3.9.1 Nonsurgical Stabilization of the Spine
3.9.2 Surgical Stabilization of the Spine
3.9.3 Thoracic and Lumbar Fracture/Luxations
3.9.3.1 Hemilaminectomy
3.9.3.2 Dorsal Laminectomy
3.9.4 Reduction and Surgical Fixation
3.9.4.1 Spinal Process Fixation
3.9.4.2 Vertebral Body Fixation
3.9.5 Lumbosacral Fractures
Chapter 3: Sample Questions
References
4: Management of Specific Fractures in Large Animals
Learning Objectives
Summary
4.1 Fractures of Scapula and Humerus
4.2 Fractures of Radius-Ulna
4.3 Fractures of Femur
4.4 Fractures of Tibia
4.5 Fractures of Metacarpus, Metatarsus, and Phalanges
4.6 Fractures of Pelvis
4.7 Fractures of Mandible
Chapter 4: Sample Questions
References
5: Fractures in Young, Osteoporotic, and Avian Bones
Learning Objectives
5.1 Fractures in Young Animals
5.1.1 Open Reduction and Internal Fixation
5.1.2 Fractures Involving the Growth Plate
5.2 Fractures in Osteopenic/Osteoporotic Bones
5.3 Fractures in Avian Bones
5.3.1 Methods of Fracture Repair
Chapter 5: Sample Questions
References
6: Open Fractures
Learning Objectives
Summary
6.1 Classification of Open Fractures
6.2 Soft Tissue Infection, Osteomyelitis, and Antibiotic Therapy
6.3 Management of Soft Tissue Injuries and Wound Closure
6.4 Treatment of Open Fractures
6.5 Postoperative Care of Open Fractures
Chapter 6: Sample Questions
References
7: Bone Grafts and Scaffolds in Fracture Repair
Learning Objectives
Summary
7.1 Functions of Bone Grafts or Implants
7.2 Types of Bone Grafts
7.2.1 According to Origin
7.2.2 According to Composition
7.3 Processing of Bone Grafts
7.4 Process of Bone Graft Incorporation
7.5 Bone Substitutes
7.5.1 Demineralized Bone Matrix
7.5.2 Calcium Phosphate Synthetic Substitutes
7.5.3 Synthetic Polymers
7.6 Bone Inducers
7.6.1 Bone Morphogenic Protein (BMP)
7.6.2 Transforming Growth Factor-β
7.6.3 Insulin-like Growth Factor
7.6.4 Growth Hormone
7.7 Stem Cells
Chapter 7: Sample Questions
References
8: Complications of Fracture Fixation
Learning Objectives
Summary
8.1 Delayed Union
8.2 Nonunion
8.3 Malunion
8.4 Fixation Failure
8.5 Soft Tissue Infection and Osteomyelitis
8.6 Fracture Disease
8.7 Supporting Limb Laminitis
Chapter 8: Sample Questions
References
9: Metabolic Bone Diseases
Learning Objectives
Summary
9.1 Nutritional Secondary Hyperparathyroidism
9.2 Rickets
9.3 Hypertrophic Osteodystrophy
9.4 Osteochondrosis
9.5 Retained Cartilage Core
9.6 Metaphyseal Chondrodysplasia
9.7 Panosteitis
9.8 Hip Dysplasia
9.9 Prevention and Control of Bone Disorders
Chapter 9: Sample Questions
References
10: Antebrachial Bone Deformities
Learning Objectives
Summary
10.1 Closure of Distal Ulnar Growth Plate
10.2 Closure of Distal Radial Growth Plate
10.3 Closure of Proximal Radial Physis
10.4 Closure of Both Growth Plates: Distal Radius and Ulna
10.5 Postoperative Care, Management, and Prognosis
Chapter 10: Sample Questions
References
11: Joint Luxations
Learning Objectives
Summary
11.1 Small Animals
11.1.1 Shoulder Luxation
11.1.1.1 Transposition of Biceps Brachii Tendon
11.1.1.2 Shoulder Arthrodesis and Excision Arthroplasty
11.1.2 Elbow Luxation
11.1.3 Carpal Luxation
11.1.4 Hip (Coxofemoral) Luxation
11.1.4.1 Open Reduction and Fixation of the Femoral Head
11.1.4.2 Femoral Head and Neck Excision (Ostectomy)
11.1.5 Stifle Luxation
11.1.6 Patellar Luxation
11.1.7 Tarsal Luxation
11.2 Large Animals
11.2.1 Shoulder Luxation
11.2.2 Elbow Luxation
11.2.3 Coxofemoral Luxation
11.2.4 Patellar Luxation
11.2.5 Carpal and Tarsal Luxations
11.2.6 Metacarpophalangeal and Metatarsophalangeal Luxations
Chapter 11: Sample Questions
References
12: Arthritis
Learning Objectives
Summary
12.1 Traumatic Arthritis
12.1.1 Clinical Signs
12.1.2 Diagnosis
12.1.3 Treatment
12.2 Septic (Infectious) Arthritis
12.2.1 Causes of Infection
12.2.2 Clinical Signs
12.2.3 Diagnosis
12.2.4 Treatment
12.2.5 Follow-Up Care, Management, Complications, and Prognosis
12.3 Osteoarthritis
12.3.1 Pathophysiology
12.3.2 Predisposing Factors
12.3.3 Clinical Signs
12.3.4 Diagnosis
12.3.5 Management
12.4 Rheumatoid Arthritis
12.4.1 Clinical Signs
12.4.2 Diagnosis
12.4.3 Treatment
Chapter 12: Sample Questions
References
13: Common Tendon and Ligament Injuries
Learning Objectives
Summary
13.1 Tendon Injuries
13.1.1 Achilles Tendon
13.1.2 Superficial and Deep Digital Flexor Tendons
13.1.3 Contracted Flexor Tendons
13.1.4 Principles and Techniques of Tendon Suturing
13.2 Ligament Injuries
13.2.1 Cranial Cruciate Ligament
13.2.2 Patellar Ligament
13.2.3 Collateral Ligaments
13.2.4 Postoperative Care and Management of Tendon/Ligament Injuries
Chapter 13: Sample Questions
References
14: Bone Tumors
Learning Objectives
Summary
14.1 Dogs and Cats
14.1.1 Clinical Signs
14.1.2 Diagnosis
14.1.3 Treatment
14.1.3.1 Use of Analgesics
14.1.3.2 Radiation Therapy
14.1.3.3 Bisphosphonates
14.1.3.4 Chemotherapy
14.1.3.5 Excision of Tumor (Limb-Sparing Surgery)
14.1.3.6 Amputation of the Limb
14.1.4 Prognosis
14.2 Large Animals
Chapter 14: Sample Questions
References
15: Physiotherapy and Rehabilitation of Orthopedic Patients
Learning Objectives
Summary
15.1 Techniques
15.1.1 Cryotherapy
15.1.2 Thermotherapy
15.1.3 Passive Range of Motion
15.1.4 Massage
15.1.5 Hydrotherapy
15.1.6 Therapeutic Exercise
15.1.7 Other Modalities
15.2 Rehabilitation in Chronic Cases and Muscular Contracture
15.3 Assessment and Monitoring
Chapter 15: Sample Questions
References
Chapter-Wise Answers for Objective Questions
Chapter 1: Sample Questions
Chapter 2: Sample Questions
Chapter 3: Sample Questions
Chapter 4: Sample Questions
Chapter 5: Sample Questions
Chapter 6: Sample Questions
Chapter 7: Sample Questions
Chapter 8: Sample Questions
Chapter 9: Sample Questions
Chapter 10: Sample Questions
Chapter 11: Sample Questions
Chapter 12: Sample Questions
Chapter 13: Sample Questions
Chapter 14: Sample Questions
Chapter 15: Sample Questions