Front Matter
Brinker, piermattei, and flo’s handbook of small animal orthopedics and fracture repair
Copyright page
Dedication
Preface
1 Orthopedic examination and diagnostic tools
General examination
History
Distant observation and gait evaluation
Gait
Standing observation and palpation
Foreleg
Scapulohumeral region
Elbow and forearm
Carpus and paw
Neurological examination
Pelvic limb
Pelvis
Stifle
Hock
Recumbent examination
Forelimb
Paw and elbow
Shoulder
Long-bone palpation
Rear limb
Paw and hock
Stifle
Patellar luxation.
Cruciate ligament instability.
Interpretation of instability.
Collateral ligament instability.
Meniscal injury.
Hip joint and pelvis
Diagnostic tools
Radiography
Fluoroscopy
Arthrography
Myelography
Computed tomography
Magnetic resonance imaging
Nuclear imaging
Diagnostic ultrasonography
Arthroscopy
Force plate analysis and kinematic gait analysis
Exploratory surgery
Arthrocentesis
References
2 Fractures: Classification, diagnosis, and treatment
Classification of fractures
Causal factors
Presence of communicating external wound
Location, fracture morphology, and severity
Stability after replacement in normal anatomical position
Blood supply and healing of bone
Normal vascularization of bone
Response of vascularization after fracture
Bone healing
Diagnosis of fractures and principles of treatment
Clinical signs
Radiographic examination
Treatment
Return to function
Biological fixation and bridging osteosynthesis
Minimally invasive osteosynthesis
Reduction and fixation
Rate of bone union and clinical union
Reduction of fractures
Closed reduction
Methods of closed reduction
Open reduction
Disposition of bone fragments at fracture site
Methods of open reduction
Indirect reduction
Methods of indirect reduction
Immobilization (fixation)
Methods of fixation
Temporary splintage
Coaptation splints and casts
Indications for coaptation
Long-leg cylinder cast
Indications.
Short-leg cylinder cast
Indications.
Spica splint
Indications.
Lateral and/or medial splint
Indications.
Schroeder-thomas splint
Short caudal splint—foreleg
Indications.
Metacarpal, metatarsal, phalangeal splint with walking bar
Velpeau sling
Carpal flexion bandage
Ehmer sling
Robinson/aspca sling
Robert-jones bandage
Padded bandage or “light” robert-jones bandage
General considerations
External skeletal fixation** The authors gratefully acknowledge the contributions of a colleague, Dr. Erick Egger, to this ...
Indications or uses2,24-39
Components of external skeletal fixator
Fixation pins
Connecting bars
Clamps
Classification of frame configurations
Type I/unilateral (figure 2-33, A and B)
IA/one plane
Double clamp.
Single bar.
Double bar.
IB/two plane
Type II/bilateral one plane (figure 2-33, C)
IIA/full pins
IIB/full and half pins (figure 2-42, B)
Type III/bilateral two plane (figure 2-33, D; figure 2-36)
Ring (figure 2-33, e)
Biomechanical considerations (figures 2-43, 2-44, and 2-42)
Overall frame stiffness
Fixation pin number, spacing, and angle of insertion
Fixation pin design, size, and type
Connecting bars and clamp configuration
Fundamentals of application
Aftercare
Complications
Removal of frames
Acrylic frames27,39,53,61,62
Fundamentals of application
Liquid-stage application
Moldable-stage application
Removal or revision
Ring fixators
Bone healing with external skeletal fixation
Intramedullary pins**The authors gratefully acknowledge the contributions of a colleague, Dr. S.J. Withrow, to this section.
General considerations
Advantages of intramedullary fixation
Disadvantages of intramedullary fixation
Biomechanical factors
Pin types
Steinmann pins and kirschner wires
Rush pins
Küntscher nail
Interlocking nail
Indications for intramedullary fixation
Steinmann pin
Interlocking nail
Methods of application
Steinmann pins
Pin chucks and power drills
Pin diameter
Stack pinning
Seating of pin
Cutting of pin
Pin placement in long bones
Interlocking nail
Cerclage wire
Indications
Technique
Twist method
Bent eyelet wire method
Double-loop cerclage
Double-wrap cerclage
Loop/twist cerclage
Interfragmentary wire
Tension-band wire
Technique
Bone screws
Indications and principles of insertion
Primary fixation in certain fractures
Aid in reduction and auxiliary fixation
Bone plates
Terminology
Compression (tension band) plate
Neutralization plate
Bridging or buttress plate
Plate and intramedullary pin combination for bridging osteosynthesis
Application of bone plates
Number of screws
Placement of screws
Length and size of bone plate
Contouring the plate
Insertion of a lag screw through the plate
Dynamic compression plate
Selection of proper bone plate and screw sizes
Additional plate types
Limited-contact dynamic compression plate
Locking compression plate
Veterinary cuttable plate
Reconstruction plates
Removal of bone plates in small animals
Indications for removal
Suggested policy in regard to plate removal
Suggested timing of plate removal
Surgical removal of implant
Refracture
Postoperative care after plate removal
Selection of fixation method
Fracture treatment planning
Choice of fixation
Open fractures
Classification
Treatment
Principles
Emergency treatment
Definitive surgical treatment
Cleansing and debridement
Fracture fixation
Bone grafting
Wound closure
Aftercare
Case studies
Gunshot fractures
Pathophysiology
Surgical protocol131
Initial evaluation and wound treatment
Fracture fixation
Type 1 and 2 fractures
Type 3 fractures
Healing time and prognosis
References
3 Bone grafting
Indications for grafting
Characteristics of bone grafts
Sources and terminology
Structure
Functions of bone grafts
Bone grafts and bone graft substitutes
Clinical application of bone grafts
Collection of bone for grafting
Autogenous cancellous bone
Autogenous corticocancellous bone
Allograft/bone banking
Types of grafts and placement
Pure cancellous fragments
Corticocancellous and cortical bone chips
Tubular intercalary diaphyseal graft
Autogenous free vascularized bone graft
References
4 Delayed union and nonunion
Delayed union fractures
Nonunion fractures
Treatment
Viable nonunion
Nonviable nonunion
Future treatment possibilities
References
5 Treatment of acute and chronic bone infections
Routes of infection
Tissue changes
Necrotic bone
New bone
Old, living bone
Clinical approach
Acute infection
Chronic infection
References
6 Arthrology
Structure and function of joints
Classification of joints
Components of synovial joints
Synovium and joint capsule
Synovial fluid
Articular cartilage
Cells
Fibers
Matrix
Subchondral bone
Healing of the articular cartilage
Cartilage and joint abnormalities
Definitions
Arthritis
Osteoarthritis
Classification of joint disease
Noninflammatory joint disease
Osteoarthritis
Degeneration of the articular cartilage
Changes in bone
Osteophytes
Subchondral bone
Changes in synovial membrane
Changes in cartilage
Histological changes
Clinical signs
Pain
Stiffness
Crepitus
Obesity
Osteoarthritis in dogs
Treatment
Objectives
Nonsurgical methods
Rest.
Heat.
Exercise.
Medications.
Diet.
Acupuncture.
Surgical methods
Debridement.
Arthrodesis.
Arthroplasty.
Osteotomy.
Neurectomy.
Amputation.
Conclusion
Traumatic joint disease
Dislocation (luxation)
Fracture
Instability
Inflammatory joint disease
Osteochondrosis
Pathology
Histopathology
Etiopathogenesis
Radiographic appearance
Treatment
References
7 Principles of joint surgery
Principles of arthrotomy
Ligament injury
Sprains
Diagnosis
Treatment
First-degree (mild) sprains
Second-degree (moderate) sprains
Third-degree (severe) sprains
Surgical repair of ligaments
Muscle-tendon injuries
Open wounds of joints
Immobilization of joints
Transarticular skeletal fixation
Arthrodesis
Surgical principles of arthrodesis
Principles of joint fracture treatment
Principles of surgical treatment
Intraarticular surgery
Extraarticular surgery
Cancellous bone grafting
Repair of soft tissue injuries
Aftercare
References
8 Arthroscopy in joint surgery
Arthroscopic principles and instrumentation
Arthroscope, camera, and light source
Cannulas
Fluid systems for ingress and egress
Manual instrumentation
Motorized shaver
Electrocautery and radiofrequency
Image documentation
Arthroscopic surgery of specific joints
Elbow joint
Shoulder joint
Stifle joint
Coxofemoral, carpal, and tarsal joints
References
Introduction
Forelimb lameness
Forelimb lameness in large-breed, skeletally immature dogs
General/multiple
Shoulder region
Elbow region
Carpal region
Paw region
Forelimb lameness in large-breed, skeletally mature dogs
General/multiple
Shoulder region
Elbow region
Carpal region
Forelimb lameness in small-breed, skeletally immature dogs
General/multiple
Shoulder region
Elbow region
Carpal region
Forelimb lameness in small-breed, skeletally mature dogs
General/multiple
Shoulder region
Elbow region
Carpal region
9 Fractures of the scapula
Classification
Treatment
Conservative treatment
Internal fixation
Acromion
Scapular body and spine
Neck
Articular fractures
Supraglenoid tubercle
Glenoid rim
Glenoid and neck: T–Y fracture
Prognosis for intraarticular fracture
References
10 The shoulder joint
Dorsal luxation of scapula
Surgical technique
Aftercare
Luxations of shoulder
Medial luxation
Surgical technique
Aftercare
Prognosis
Lateral luxation
Surgical technique
Aftercare
Prognosis
Cranial luxation
Surgical technique
Aftercare
Caudal luxation and subluxation
Surgical technique - luxation
Surgical technique - subluxation
Aftercare
Shoulder joint subluxation/instability
Examination
Imaging
Medial shoulder instability
Conservative treatment
Surgical treatment
Aftercare
Prognosis
Lateral shoulder instability
Conservative treatment
Surgical therapy
Aftercare
Prognosis
Excision arthroplasty
Surgical technique
Aftercare
Prognosis
Arthrodesis of shoulder joint
Surgical technique
Aftercare
Osteochondritis dissecans of humeral head
Clinical signs and history
Radiology
Diagnosis
Treatment
Osteochondroplasty of humeral head
Open surgery
Arthroscopy
Aftercare
Prognosis
Supraspinatus tendinopathy
History and clinical features
Physical examination
Imaging
Diagnosis
Surgical treatment
Aftercare
Prognosis
Tenosynovitis of biceps tendon
Anatomy and pathophysiology
History and clinical signs
Radiographic findings
Diagnosis
Treatment
Surgical technique
Aftercare
Prognosis
Rupture of tendon of biceps brachii muscle
Supraspinatus impingement of the biceps tendon
Treatment
Fibrotic contracture of infraspinatus muscle
Treatment
Aftercare and prognosis
Fibrotic contracture of supraspinatus muscle
References
11 Fractures of the humerus
Fixation techniques
Coaptation
Intramedullary pins and wires
Interlocking nails
External skeletal fixators
Bone plates
Lag screws
Proximal fractures
Fracture type 1-1-A; proximal, nonarticular simple (figure 11-10, A)
Closed reduction and fixation
Open reduction and fixation
Fracture type 1-1-B; proximal, nonarticular multifragmentary (figure 11-10, B)
Open approach
Internal fixation
Diaphyseal fractures
Fracture type 1-2-A; diaphyseal simple or incomplete (figure 11-19, A)
Closed reduction and fixation
Open approaches
Internal fixation
Fracture type 1-2-B; diaphyseal wedge (figure 11-19, B)
Type B1, one reducible wedge
Type B2, several reducible wedges
Type B3, nonreducible wedges
Fracture type 1-2-C; diaphyseal complex (figure 11-19, C)
Type C1 reducible wedge and C2 segmental
Type C3 nonreducible wedges
Distal fractures
Fracture type 1-3-A; distal, nonarticular (figure 11-25, A)
Open approaches
Internal fixation
Type A1, simple
Type A2, wedge
Type A3, complex
Fracture type 1-3-B; distal, partial articular (figure 11-25, B)
Reduction and internal fixation
Aftercare
Fracture type 1-3-C; distal, complete articular (figure 11-25, C)
Open approaches
Reduction and fixation
Type C1 fracture
Type C2 fracture
Type C3 fracture
Aftercare
References
12 The elbow joint
Traumatic luxation of the elbow
Clinical signs
Diagnosis
Treatment
Closed reduction
Examination of collateral ligaments
Open reduction
Repair of ligaments
Aftercare
Closed or open reduction with no ligament damage
Closed reduction with ligament damage
Ligament damage surgically repaired
Developmental abnormalities affecting the elbow joint
Congenital luxation
Type I: Congenital luxation of radial head
Clinical signs
Physical examination
Radiographic findings
Pathogenesis
Treatment
Type II: Lateral rotation of the ulna
Elbow dysplasia
Ununited anconeal process
Clinical signs
Diagnosis
Treatment
Surgical excision
Screw fixation
Ulna osteotomy
Aftercare
Osteochondritis dissecans of medial humeral condyle
Clinical signs
Radiographic signs
Diagnosis
Treatment
Surgical technique
Aftercare
Fragmented medial coronoid process
Clinical signs
Diagnostic imaging
Surgical technique
Aftercare and prognosis
Elbow incongruity
Diagnostic imaging
Surgical alternatives
Short ulna/long radius
Long ulna/short radius
Aftercare and prognosis
Flexor enthesopathy of the elbow⁵⁵
Clinical examination
Radiographic findings
Diagnosis
Treatment
Aftercare and prognosis
Arthrodesis of the elbow
Surgical technique
Bone plate fixation
Lag screw fixation
Aftercare
References
13 Fractures of the radius and ulna
Fixation techniques
Coaptation
Splinting
Casts
Intramedullary pins and wires
External skeletal fixation
Bone plates
Lag screws
Proximal fractures
Open approaches
Fracture type 2-1-A; proximal, extraarticular (figure 13-6, A)
Type A1, ulnar fracture
Monteggia fracture dislocation20
Reduction and fixation.
Types I, II, and III; proximal radioulnar joint intact.
Types I, II, and III; proximal radioulnar joint luxated.
Type iv.
Type A2, radial fracture
Type A3, radial and ulnar fracture
Fracture type 2-1-B; proximal, simple articular (figure 13-6, B)
Type B1, ulnar fracture
Reduction and fixation
Aftercare
Type B2, radial fracture
Type B3, one bone articular and one bone nonarticular
Fracture type 2-1-C; multifragmentary articular (figure 13-6, C)
Diaphyseal fractures
Open approaches19
Fracture type 2-2-A; diaphyseal, radial simple or incomplete (figure 13-13, A)
Type A1, incomplete or of one bone only
Type A2, simple, distal zone; and type A3, simple, proximal zone
Closed reduction and fixation
Open reduction and fixation
Fracture type 2-2-B; diaphyseal, radial wedge (figure 13-13, B)
Internal fixation by bone plate
Fixation by external skeletal fixator
Fracture type 2-2-C; diaphyseal, radial complex (figure 13-13, C)
Type C1, C3
Type C2
Distal fractures
Fracture type 2-3-A; distal, extraarticular (figure 13-18, A)
Type A1, ulnar fracture
Type A2, simple radial fracture, and type A3, multifragmentary radial fracture
Closed reduction and fixation
Open reduction and fixation
Bone plates.
External skeletal fixation.
Fracture type 2-3-B; distal, partial articular (figure 13-18, B)
Fracture type 2-3-C; distal, complete articular (figure 13-18, C)
References
14 Fractures and other orthopedic conditions of the carpus, metacarpus, and phalanges
Overview of the forepaw
Anatomy of the forepaw
Surgical approaches and technique
Clinical signs and diagnosis of injury
The carpus
Luxation of antebrachiocarpal joint
Subluxation of antebrachiocarpal joint
Surgical technique
Aftercare
Luxation of radial carpal bone
Treatment
Closed reduction
Open reduction and fixation
Aftercare
Fracture of radial carpal bone
Treatment
Closed reduction
Open reduction and fixation
Prognosis
Aftercare
Fracture of accessory carpal bone
Classification
Intraarticular fractures
Type I, distal basilar.
Type II, proximal basilar.
Extraarticular fractures
Type III, distal apical.
Type IV, proximal apical.
Combined intraarticular and extraarticular fractures
Type V, comminuted fracture of the body.
Clinical signs
Treatment
Open reduction and internal fixation, type I
Treatment of other fracture types
Aftercare
Subluxation of accessory carpal bone
Fracture of ulnar and numbered carpal bones
Middle carpal luxation
Middle carpal subluxation
Treatment
Closed reduction and external skeletal fixation
Open reduction and stabilization
Aftercare
Hyperextension of the carpus
History and clinical signs
Diagnosis
Treatment
Partial arthrodesis
Pin fixation method.
Bone plate.
Aftercare.
Prognosis.
Panarthrodesis
Dorsal plate technique.
Aftercare.
Palmar plate technique.
Aftercare.
External skeletal fixator technique.
Aftercare.
Shearing injury of the carpus
Treatment
Reconstruction
Aftercare.
Prognosis.
Arthrodesis
Metacarpus and phalanges
Fractures of the metacarpus
Fracture of the base
Closed reduction
Open reduction and internal fixation
Aftercare
Fracture of the shaft
Closed reduction
Open reduction and internal fixation
Intramedullary pins.
Aftercare.
Cerclage wires.
Lag screws.
Bone plates.
Aftercare.
Fracture of the head
Treatment
Aftercare
Fractures of the phalanges
Treatment
Aftercare
Fracture of proximal palmar sesamoids
Treatment
Aftercare
Fracture of dorsal sesamoids
Luxation of metacarpophalangeal and interphalangeal joints
Clinical signs
Diagnosis
Treatment
Suture reconstruction
Aftercare.
Amputation of toe
Aftercare.
Arthrodesis
Aftercare.
References
Introduction
Hindlimb lameness
Hindlimb lameness in large-breed, skeletally immature dogs
General/multiple
Hip region
Stifle region
Tarsal region
Hindlimb lameness in large-breed, skeletally mature dogs
General/multiple
Hip region
Stifle region
Tarsal region
Hindlimb lameness in small-breed, skeletally immature dogs
General/multiple
Hip region
Stifle region
Tarsal region
Hindlimb lameness in small-breed, skeletally mature dogs
General/multiple
Hip region
Stifle region
Tarsal region
15 Fractures of the pelvis
Anatomy
Fracture categories
History and examination
Principles of treatment
Nonsurgical group
Surgical group
Sacroiliac fracture-luxation
Open approach and reduction
Internal fixation
Sacral anatomy of the dog for placement of fixation
Sacral anatomy of the cat for placement of fixation
Minimally invasive procedure for sacroiliac fixation
Ventrolateral open approach
Sacral fracture
Surgical treatment of sacral fracture
Ilial wing fracture
Ilial body fracture
Open approach and reduction
Internal fixation
Bone plates
Lag screws
Pins and compression wire
Fractures of the acetabulum
Conservative treatment
Surgical treatment
Open approach and reduction
Internal fixation
Bone plates
Lag screws
Tension-band wire
Screws, wires, and polymethyl methacrylate
Multiple fractures
Closure of soft tissues
Fractures of the ischium
Open approach and reduction
Internal fixation
Ischial body
Ischiatic ramus and tuberosity
Fractures of the pelvic floor
Malunion fractures with collapse of pelvic canal
Postoperative management of pelvic fractures
References
16 The hip joint
Luxations of the hip
Clinical studies
Craniodorsal luxation
Caudodorsal luxation
Ventral luxation
Diagnosis
Treatment
Closed reduction
Aftercare
Prognosis
Open reduction—dorsal luxations
Synthetic capsule technique
Toggle-pin fixation
Triple pelvic osteotomy⁹
Transarticular pinning¹⁰
Aftercare
Prognosis
Open reduction—caudoventral luxations
Hip dysplasia
Incidence
Pathogenesis
History and clinical signs
Diagnosis
Radiographic signs
Physical examination
Additional diagnostic methods for hip dysplasia
Norberg angle²⁹
Distraction stress radiography
Dorsolateral subluxation
Treatment
Conservative therapy
Surgical therapy
Pelvic osteotomy
Patient selection.
Radiographic examination.⁴⁷′⁴⁸
Palpation.
Contraindications.
Surgical technique.
Aftercare.
Prognosis.
Femoral neck lengthening
Indications.
Surgical technique.
Aftercare.
Pubic symphysiodesis
Surgical technique.
Aftercare.
Intertrochanteric varus osteotomy of femur
Preoperative planning.
Surgical technique.
Aftercare.
Prognosis.
Total hip replacement
Indications.
Contraindications.
Surgical technique: Cemented total hip replacement.
Surgical technique: Cementless total hip replacement.
Aftercare.
Prognosis.
Femoral head and neck excision
Patient selection.
Surgical technique.
Aftercare.
Prognosis.
Pectineal myectomy
Surgical technique.
Aftercare.
Legg-calvé-perthes disease
Clinical signs
Treatment
References
17 Fractures of the femur and patella
Fixation techniques
Coaptation
Intramedullary pins and wires
Steinmann pin
Pin insertion
Pin diameter
Complications
Postoperative management
Interlocking nail
Technique
Kirschner wires
Pins and tension-band wire
Cerclage wires
External skeletal fixators
External skeletal fixator and intramedullary pin
Technique
Postoperative management
Bone plates
Lag screws
Proximal fractures
Fracture type 3-1-A; proximal, trochanteric region (figure 17-13, A)
Open approaches
Type A1, avulsion
Reduction and internal fixation
Aftercare.
Type A2, intertrochanteric simple
Reduction and internal fixation
Aftercare.
Type A3, multifragmentary
Reduction and fixation
Aftercare.
Fracture type 3-1-B; proximal, simple cervical (figure 17-13, B)
Open approaches
Type B1, basicervical; type B2, transcervical
Reduction and fixation
Lag screw fixation.
Kirschner wire fixation.
Aftercare.
Minimally invasive osteosynthesis
Type B3, cervical with trochanteric avulsion
Fracture type 3-1-C; proximal, capital or multifragmentary cervical (figure 17-13, C)
Type C1, articular simple
Avulsion fracture of femoral head
Closed reduction.
Surgical excision of bone fragment and reduction of femoral head.
Open reduction and fixation.²´³
Total hip replacement.
Excision of femoral head and neck.
Fracture of femoral capital physis
Surgical approaches.
Kirschner wire or pin fixation.
Aftercare.
Lag screw fixation.
Prognosis.
Fracture of femoral physis and trochanter major
Type C2, articular multifragmentary
Type C3, multifragmentary cervical and trochanteric
Bone plate and lag screws
Aftercare.
Complications in proximal femoral fractures
Radiographic signs
Treatment
Diaphyseal fractures
Open approach and reduction
Fracture type 3-2-A; diaphyseal simple or incomplete (figure 17-42, A)
Type A1, incomplete
Type A2, oblique
Reduction and fixation
Type A3, transverse
Internal fixation
Steinmann pin.
Steinmann pin and external skeletal fixator.
Interlocking nail.
Bone plate.
Aftercare.
Fracture type 3-2-B; diaphyseal wedge (figure 17-42, B)
Type B1, one reducible wedge
Internal fixation
Bone plate and lag screws.
Steinmann pin, cerclage wires, and external skeletal fixator.
Interlocking nail and cerclage wires.
Plate and intermedullary pin combination.
Type B2, several reducible wedges
Internal fixation
Type B3, nonreducible wedge
Reduction and internal fixation
Bone plate.
Interlocking nail.
Plate and intermedullary pin combination.
Steinmann pin and type IA external skeletal fixator.
Aftercare.
Fracture type 3-2-C; diaphyseal complex (figure 17-42, C)
Type C1, reducible wedges
Reduction and internal fixation
Bone plate.
Interlocking nail.
Plate and intermedullary pin combination.
Steinmann pin and type IA external skeletal fixator.
Type C2, segmental
Reduction and internal fixation
Bone plate.
Interlocking nail.
Plate and intermedullary pin combination.
Steinmann pin and type IA external skeletal fixator.
Type C3, nonreducible wedges
Reduction and internal fixation
Bone plate.
Plate and intramedullary pin.
Steinmann pin and type IA or ib external skeletal fixator.
Interlocking nail.
Aftercare of diaphyseal fractures
Distal fractures
Open approaches
Closed approaches
Fracture type 3-3-A; distal, extraarticular (figure 17-58, A)
Type A1, simple; type A2, wedge
Closed reduction and fixation
Open reduction
Internal fixation
Transfixation pins or kirschner wires.
Rush-like pins.
Lag screws.
Aftercare
Prognosis
Type A3, complex
Reduction and fixation
Bone plate.
External skeletal fixator.
Fracture type 3-3-B; distal, partial articular (figure 17-58, B)
Type B1, lateral condyle, sagittal; type B2, medial condyle, sagittal
Reduction and fixation
Aftercare.
Type B3, frontal unicondylar
Reduction and fixation
Aftercare.
Fracture type 3-3-C; distal, complex articular (figure 17-58, C)
Type C1, simple, metaphyseal simple or wedge
Reduction and fixation
Aftercare.
Type C2, simple, metaphyseal complex; type C3, multifragmentary
Patellar fractures
Undisplaced fissure fracture
Transverse fracture
Multifragmentary fracture
Postoperative care
References
18 The stifle joint
Patellar luxation
Medial luxation in toy, miniature, and large breeds
Grade 1
Grade 2
Grade 3
Grade 4
Clinical signs
Surgical repair of patellar luxation
Soft-tissue reconstruction procedures
Desmotomy and partial capsulectomy
Quadriceps release
Overlap of lateral or medial retinaculum
Fascia lata overlap
Patellar and tibial antirotational suture ligaments
Bone reconstruction procedures
Trochleoplasty
Trochlear chondroplasty.⁹´¹⁰
Wedge recession sulcoplasty.¹¹
Trochlear block recession.¹³
Trochlear sulcoplasty.¹⁴
Transposition of tibial tuberosity15,16
Femoral osteotomy for medial luxation in large-breed dogs.
Patellectomy
Aftercare for all surgical techniques
Prognosis
Medial luxation treatment plan
Grade 1
Grade 2
Grade 3
Grade 4
Lateral luxation treatment plan
Grade 1
Grades 2 and 3
Combined medial and lateral luxation treatment plan
Medial luxation resulting from trauma
Clinical signs
Treatment
Lateral luxation in young large and giant breeds
Clinical signs
Treatment
Femoral osteotomy for lateral luxation in large-breed dogs
Rupture of cranial cruciate ligament
Clinical signs and diagnosis
Modes of therapy
Extracapsular techniques
Imbrication techniques
Retinacular technique
Modified retinacular imbrication technique
Surgical technique.
Three-in-one technique
Surgical technique.
Postoperative care.
Tightrope technique
Surgical technique.
Aftercare.
Fibular head transposition
Surgical technique.
Aftercare.
Tibial osteotomy techniques
Tibial plateau leveling osteotomy
Cranial tibial thrust.
Surgical technique.52
Aftercare.
Tibial tuberosity advancement
Surgical technique.
Aftercare.
Meniscal release.
Techniques for release.
Intracapsular techniques
Paatsama technique
Over-the-top technique
Aftercare.
Under-and-over technique
Intracapsular and extracapsular technique
Four-in-one over-the-top technique
Surgical technique.
Evaluation of over-the-top procedures
Partial rupture of cranial cruciate ligament
Avulsion of cranial cruciate ligament
Surgical technique
Aftercare
Rupture of caudal cruciate ligament
Clinical signs
Diagnosis
Surgical treatment
Technique for ruptured ligament
Aftercare
Technique for avulsion
Aftercare
Meniscal injuries
Clinical signs and diagnosis
Treatment
Meniscectomy
Indications
Technique
Aftercare
Meniscal release
Collateral ligament injuries
Clinical signs
Surgical treatment
Aftercare
Luxation of the stifle joint
Osteochondritis dissecans of femoral condyle
Clinical signs
Radiographic findings
Diagnosis
Surgical treatment
Aftercare and prognosis
Rupture of patellar ligament
Avulsion of proximal tendon of long digital extensor muscle
Clinical signs
Diagnosis
Surgical treatment
Aftercare
Luxation of proximal tendon of long digital extensor muscle
Surgical treatment
Aftercare
Arthrodesis of the stifle joint
Surgical technique
Bone plate
Aftercare
Screw and pin fixation
Aftercare
References
19 Fractures of the tibia and fibula
Fixation techniques
Coaptation
Intramedullary pins
Normograde intramedullary pin technique
Intramedullary pin and cerclage wires or lag screws
Interlocking nail
Interlocking nail technique
External skeletal fixators
Bone plates
Lag screws and cerclage wires
Proximal fractures (figure 19-9)
Open approaches
Fracture type 4-1-A; proximal, extraarticular (figure 19-9, A)
Type A1, avulsion
Closed reduction and fixation
Open reduction and internal fixation
Aftercare
Complications
Type A2, simple, physeal
Closed reduction and fixation
Open reduction and internal fixation
Aftercare
Type A2, simple, nonphyseal
Closed reduction and fixation
Open reduction and fixation
Aftercare
Type A3, multifragmentary
Fracture type 4-1-B; proximal, partial articular (figure 19-9, B)
Fracture type 4-1-C; proximal, complete articular (figure 19-9, C)
Diaphyseal fractures (figure 19-15)
Closed reduction
Open approach
Fracture type 4-2-A; diaphyseal, simple or incomplete (figure 19-15, A)
Type A1, incomplete tibial or fibula intact
Type A2, simple oblique tibial and fibular
Open reduction and fixation
Intramedullary pin.
Intramedullary pin and auxiliary fixation.
Interlocking nail.
External skeletal fixator.
Bone plate.
Type A3, simple transverse tibial
Closed reduction and fixation
Reduction and internal fixation
Steinmann pin.
Interlocking nail.
External skeletal fixator.
Bone plate.
Aftercare
Fracture type 4-2-B; diaphyseal, tibial wedge (figure 19-15, B)
Type B1; one reducible wedge
Type B2; several reducible wedges
Type B3; nonreducible wedges
Reduction and internal fixation
Bone plate.
Bone plate and pin combination.
External skeletal fixator.
Interlocking nail.
Aftercare
Fracture type 4-2-C; diaphyseal, tibial complex (figure 19-15, C)
Type C1, reducible wedges
Type C2, segmental
Type C3, nonreducible wedges
Aftercare
Distal fractures
Open approaches
Fracture type 4-3-A; distal tibia, extraarticular (figure 19-23, A)
Type A1, simple
Closed reduction and fixation
Reduction and internal fixation
Transfixation pins.
Aftercare
Type A2, wedge
Type A3, complex
Bone plate
External skeletal fixator
Fracture type 4-3-B; distal, partial articular (figure 19-23, B)
Reduction and internal fixation
Lateral malleolus
Medial malleolus
Fracture type 4-3-C; distal, complex articular (figure 19-23, C)
References
20 Fractures and other orthopedic injuries of the tarsus, metatarsus, and phalanges
Overview
Anatomy of the hindpaw
Surgical approaches and technique
Clinical signs and diagnosis of injuries
The tarsus
Tarsocrural luxation and subluxation
Clinical signs
Treatment
Aftercare
Shearing injury of the tarsus
Reconstruction
Prognosis
Aftercare
Arthrodesis
Fractures of the calcaneus
Open approach
Treatment
Tension-band wire fixation
Tension-band wire and lag screw fixation
Bone plate
Aftercare
Luxation of tendon of superficial digital flexor muscle
Clinical signs
Surgical repair
Aftercare
Prognosis
Avulsion of gastrocnemius tendon
Diagnosis
Clinical signs
Radiographic signs
Surgical repair
Aftercare
Prognosis
Laceration of calcanean/achilles tendon and superficial digital flexor tendon
Treatment
Chronic calcanean/achilles tendonitis
Osteochondritis dissecans of the talus
Diagnosis
Clinical signs
Radiographic signs
Surgical technique
Aftercare
Prognosis
Fractures of the talus
Fracture of trochlear ridges
Internal fixation
Aftercare.
Prognosis.
Fracture of talar neck
Closed reduction
Internal fixation
Aftercare.
Prognosis.
Fracture of talar body
Internal fixation
Aftercare.
Prognosis.
Luxation of base of talus
Diagnosis
Internal fixation
Aftercare.
Talocrural arthrodesis
Screw fixation
Aftercare
Bone plate fixation
Aftercare
External skeletal fixator
Type II fixator and steinmann pin
Type iib fixator
Aftercare
Pantarsal arthrodesis
Surgical techniques
External skeletal fixator
Bone plate fixation
Fractures of central tarsal bone
Type 1 fracture
Type 2 fracture
Type 3 fracture
Type 4 fracture
Type 5 fracture
Aftercare
Prognosis
Fracture-luxation of central tarsal bone
Diagnosis
Internal fixation
Aftercare
Fractures of numbered tarsal bones
Hyperextension with subluxation of proximal intertarsal joint
Diagnosis
Arthrodesis
Aftercare
Hyperextension with luxation of proximal intertarsal joint
Diagnosis
Arthrodesis
Bone plate fixation
Aftercare.
External skeletal fixator
Aftercare.
Proximal intertarsal subluxation with dorsal instability
Diagnosis
Treatment
Arthrodesis
Aftercare.
Distal intertarsal subluxation with dorsomedial instability
Diagnosis
Treatment
Arthrodesis
Aftercare.
The metatarsus, phalanges, and sesamoids
Hyperextension with subluxation of tarsometatarsal joints
Diagnosis
Treatment
Arthrodesis
Intramedullary pin and tension-band wire.
Intramedullary pin and transfixation pins.
Bone plate.
External skeletal fixator.
Aftercare.
Tarsometatarsal subluxation with dorsomedial instability
Diagnosis
Treatment
Arthrodesis
Aftercare.
Tarsometatarsal subluxation with dorsal instability
Diagnosis
Treatment
Arthrodesis
Aftercare.
Luxation and subluxation of metatarsophalangeal and interphalangeal joints
References
21 Fractures and luxations of the mandible and maxilla
Diagnosis and general treatment
Fractures of the mandible
Mandibular symphysis
Fixation methods
Interdental wiring
Cerclage wire
Transfixation pin or lag screw
Transfixation pin and figure-of-8 wire
Aftercare
Mandibular body
Open approach
Fixation
Tape muzzle coaptation
Interarcade wire
Interdental wire
Interfragmentary wire
Intramedullary pinning
Intraoral splint
External skeletal fixator
Surgical procedure.
Acrylic bar external skeletal fixator
Surgical procedure.
Bone plates
Surgical procedure.
Aftercare
Vertical ramus
Fractures of the condyles
Luxation of temporomandibular joint
Diagnosis
Reduction
Aftercare
Ankylosis of the temporomandibular joint
Spontaneous locking open of temporomandibular joint
Diagnosis
Reduction
Aftercare
Fractures of the maxilla
Maxillary fractures of facial region
Intraoral maxillary fractures
References
22 Fractures in growing animals
Diaphyseal fractures
External fixation
Internal fixation
Intramedullary pin
External skeletal fixator
Bone plate
Physeal fractures
Incidence
Treatment of salter-harris type I to IV injuries
Principles of treatment
References
23 Correction of abnormal bone growth and healing
Osteotomy
Common indications for corrective osteotomy
Types of corrective osteotomy
Transverse osteotomy
Opening wedge osteotomy
Closing wedge osteotomy
Oblique osteotomy
Stair-step lengthening osteotomy
Surgical principles of corrective osteotomy
Determination of deformity
Treatment of premature physeal growth arrest
Distal ulnar physis closure
Clinical and radiographic signs
Surgical correction
Skeletally immature
Carpal valgus less than 25 degrees.
Carpal valgus greater than 25 degrees.
Dynamic proximal ulnar osteotomy.
Skeletally mature
Distal ulnar and eccentric distal radial closure
Surgical correction
Skeletally immature
Skeletally mature
Retained cartilaginous cores in distal ulnar physis
Proximal or distal radial physis closure
Clinical and radiographic signs
Proximal closure
Distal closure
Surgical correction
Skeletally mature
Dynamic partial ulnar ostectomy.
Bone bridge resection.
Dynamic lengthening osteotomy of the radius.
Static lengthening osteotomy of the radius.
Skeletally mature
Distal tibial deformity
Surgical correction
Valgus deformity
Varus deformity
Malunion
Clinical considerations in common malunions
Femur
Other long bones
Pelvis
Mandible
References
24 Disease conditions in small animals
Panosteitis
Clinical signs
Examination
Radiographic signs
Early phase
Middle phase
Late phase
Histopathology
Differential diagnosis
Treatment
Nutritional disorders
Clinical problems
Obesity
The all-meat diet
Hypernutrition and oversupplementation
Retained cartilaginous cores
Hypertrophic osteodystrophy
Clinical signs
Radiographic signs
Pathogenesis
Treatment
Renal osteodystrophy
Hypertrophic osteopathy
Clinical signs
Radiographic signs
Pathogenesis
Craniomandibular osteopathy
Occurrence
Clinical signs
Diagnosis
Radiographic signs
Histopathological appearance
Treatment
Synovial chondrometaplasia
Surgical aspects of long-bone neoplasms
References
Index
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Z
