Term
| 5 ways Fractures are classified |
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Definition
1. Bone Location
2. Open or Close
-Open: penetrated through the skin
-Closed: has not penetrated through skin
3. Location of the fracture on the bone
4. Type of fracture
-Oblique, Spiral, Transverse, Comminuted
5. Reducible or Non-reducible
-Reducible: pieces can be put back together |
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Term
| Considerations for taking Radiographs |
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Definition
-Sedation (if animal is painful)
-Bandages/splints
-Long Bones (include the joint above and below)
-Articular (centered with minimal manipulation)
-Views (AP, VD, Pre & Postoperative)
-Horse Views (Dorsal-palmar/plantar, Oblique's) |
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Term
| Considerations of History when dealing with Orthopedic Surgery |
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Definition
Can determine if patient is a good candidate for surgery
-Age (the young heal faster than the old)
-Activity Level
-Overall health status
-Size (obese and large breed patients create more difficulty)
-Owner Compliance |
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Term
|
Definition
Fixation:
-Internal
-Directly on or in the bone
-Use of plate/screws, interlocking nails, IM pins, wire
Fixatives:
-External
-Applied through the surface of the limb
-Use of casts, splints, KE fixation, ring fixation |
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Term
| Complication with Orthopedic Surgeries |
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Definition
I/E fixation:
-Non-union (due to bones always moving)
-Malunion (misaligned healing)
-Delayed union
-Aseptic loosening (pieces of metal/plastic flaking off from material used that then causes inflammation)
-Infection
-Opposite limb injury (compensating on another limb)
Splint/Casts:
-Skin irritation
-Skin ulcers
-Non-union
-Malunion
-Delayed union
-Infection |
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Term
| Arthrotomy vs. Arthroscopy |
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Definition
Arthrotomy: Incision made into the joint to visualize an injury
-Surgical joint explore
Arthroscopy: Using a arthroscope to visualize and treat the injury
-OCD fragments
-Fractured coronoid processes
-Meniscal repair
-Tenotomies
-Biopsies |
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Term
|
Definition
OCD = Osteochondritis Dissecans
-Disease in which a flap of cartilage develops on the head of a long bone
-Can detach and float in the joint
-Arthroscopy is usually treatment of choice
-Arthroscopy supplies include a scope, camera, light source, tower, sterile fluids for flushing, iodine impregnated sticky drape, hand tools
-Additional needs include the ability to lower and raise limb as well as multiple techs |
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Term
Explain FHO
(Diagnostics, Preop treatments, Clip/prep, prep positioning, operative positioning) |
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Definition
FHO = Femoral Head Osteotomy
-Salvage procedure that removes the femoral head and neck
-Development of fibrous false joint
-Clinical function is unpredictable
Diagnostics:
-MDB, and Pelvic Radiographs
Preop Treatments:
-Restricted Activity, as well as preemptive pain meds & antibiotics
Clip:
-from dorsal midline to mid tibia
Prep positioning:
-Lateral recumbency with affected limb up
Operative positioning:
-Lateral recumbency with affected leg up |
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Term
FHO
(Special Instruments, Management, At home care) |
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Definition
Instruments (specialized):
-Retractors (ring, gelpi, hand), Oscillating saw, osteotome & mallet, periosteal elevators, rongeurs
Management:
-Post op rediographs
-weight support
-pain management
At home care:
-weight support
-controlled activity (PT encouraged)
-Pain management |
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Term
Explain a TPO
(Diagnostics, Pre-op, Clip, Prep positioning, Operative positioning) |
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Definition
TPO = Triple Pelvic Osteotomy
-Procedure that makes a cut through the pubic brim, ischial floor and iliac body
-Rotates the cut bone to allow the acetabulum to articulate with the head of the femur better.
-Involves 3 cuts into the pelvis, considered a MAJOR surgery, and usually reserved for working dogs.
Diagnostics:
-MDB, Pelvic Radiographs
Pre-Op treatment:
-Preemptive pain meds and antibiotics
Clip:
Umbilicus, to caudal margin along the inguinal region, and dorsal midline down the limb
Prep Positioning:
-Lateral recumbency with leg hung
Operative Positioning:
-Lateral recumbency with leg hung |
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Term
TPO
(Special instruments, management, and at home care) |
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Definition
Instrumentation:
-Retractors (ring, gelpi, hand), oscillating saw, osteotome & mallet, TPO plate/screw, air drill.
Management:
-Radiographs, weight support, pain management
At Home Care:
-Weight support, restricted activity (3months), pain management |
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Term
| Explain a Cruciate Injury |
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Definition
Damage to the cranial or caudal cruciate ligament
-torn or ruptured
-can't see injury on radiography, but you will see inflammation of the joint, arthritis, displacement of the joint or bones
-Check drawer & thrust
-drawer: some movement of the ligaments when manual movement is applied (should not move)
-thrust: you flex the hock and feel to see if the tibia pops in and out (which is bad) |
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Term
|
Definition
MRIT = Modified Retinacular Imbrication Technique
-performed to prevent unnecessary motion within the knee
-also called the Flow method
-suture is put in to help stabilize the joint, not fix it, just hold things together till scar tissues develops
-Heavy non-absorbable suture is put into place to allow scar tissue to develop to hold the knee stable
(small breed dogs) |
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Term
MRIT
(diagnostics, pre-op, clip, prep positioning, operative positioning) |
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Definition
Diagnostics:
-MDB, Stifle Radiographs
Pre-op treatments:
-restricted activity
-preemptive pain meds and antibiotics
Clip:
-from hip to tarsus
Prep positioning:
-lateral recumbency with affected limp up
-hung for prepping
Operative positioning:
-dorsal or dorsolateral recumbency with affected leg up |
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Term
MRIT
(Special instruments, Management, At Home Care) |
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Definition
Instruments:
-Drills a and pins, nylon suture (based on weight), cruciate needles, suture crimps, crimpers, retractors (ring, gelpi, hand), antimicrobial impregnated film, bandage material
Management:
-radiographs, weight support, possible urinary catheter, pain management
At Home Care:
-weight support, restricted activity (2months), bandage care, pain management |
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Term
Explain TPLO
(Diagnostics, pre-op, clip, prep positioning, operative positioning) |
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Definition
TPLO = Tibial Plateau Leveling Osteotomy
-Procedure involves changing the slope of the tibia by cutting the proximal head and leveling the plateau.
Diagnostics:
-MDB, Stifle Radiographs (right lateral and 90% angle)
Pre-Op Treatment:
-Restricted activity, preemptive pain meds and antibiotics
Clip:
-From hip to tarsus
Prep Positioning:
-lateral recumbency with affected limb up (hung for prepping)
Operative Positioning:
-dorsal or dorsolateral recumbency with affected leg up |
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Term
TPLO
(Special Instruments, Management, At Home Care) |
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Definition
Instruments:
-Plates and screws, plate bender (press), air drill, oscillating saw, C-arm, retractors, antimicrobial impregnated film, bandage material
Post-Op Management:
-Radiographs, weight support, possible urinary catheter, pain management
At Home Care:
-weight support, restricted activity (2months), bandage care, pain management |
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Term
Explain TWO
(diagnostics, pre-op treatments, clip, prep positioning, operative positioning) |
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Definition
TWO = Tibial Wedge Osteotomy
-Procedure involves changing the slope by cutting a wedge of bone out of the tibia and reducing the segments to alter the tibial plateau
-performed in younger dogs (because TPLO would cut through their growth plate, TWO doesn't)
Diagnostics:
-MDB, Stifle Radiographs
Pre-op treatments:
-restricted activity, preemptive pain meds and antibiotics
Clip:
-from hip to tarsus
Prep positioning:
-lateral recumbency with affected limb up
Operative positioning:
-dorsal or dorsolateral recumbency with affected leg up |
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Term
TWO
(Instruments, Post-op management, At Home Care) |
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Definition
Instrumentation:
-plates and screws, plate bender (press), air drill, oscillating saw, C-arm, retractor, antimicrobial impregnated film, bandage material
Post-op management:
-radiographs, weight support, possible urinary catheter, pain management
At Home Care:
-weight support, restricted activity (2months), bandage care, pain management |
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Term
Arthrodesis
(complications, diagnostics, pre-op) |
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Definition
Arthrodesis = Joint fusion
-remove all cartilage, use of plates and screws to immobilize the joint
-uses cancellous bone graft
Complications:
-Infection, delayed or nonunion, implant irritation or migration, fracture of bone at ends of plates
Diagnostics:
-MDB, joint radiographs to locate problem
Pre-op treatments:
-restricted activity, preemptive pain meds and antibiotics, determine angel of the joint |
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Term
Arthrodesis
(clip, prep positioning, operative positioning, management, at home care) |
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Definition
Clip:
-from joint above surgical site to joint below
-bone graft donor site (on same leg if possible)
Prep positioning:
-recumbency dependent on affected limb
-leg hung for prepping
Operative positioning:
-recumbency dependent on affected leg
-Stretch down leg towards nose on horses to prevent radially nerve paralysis
Management:
-radiographs, weight support, possible urinary catheter, pain management
At Home Care:
-weight support, restricted activity, bandage care (needs to help immobilize joint), pain management |
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Term
Joint Replacement
(complications, diagnostics, pre-op) |
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Definition
Tend to be Total Hip or Elbow
-considered a salvage procedure when the joint can't be repaired
-joint replaced with prosthesis
-usually done in older patients because the replacement is only temporary
Complications:
-septic arthritis, nerve damage, aseptic loosening
Diagnostics:
-weight reduction (diet), MDB, joint rediographs, Neuro exam to determine if it is the joint or not
Pre-op treatments:
-restricted activity, preemptive pain meds and antibiotics |
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Term
Joint Replacement
(clip, prep positioning, operative positioning, management, at home care) |
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Definition
Clip:
-midline to tarsus (hip)
-midline to carpus (elbow)
Prep positioning:
-recumbency dependent on affected joint
-hung for prepping
Operative positioning:
-recumbency dependent on affected limb
Management:
-weight support, possible urinary catheter, pain management
At Home Care:
-weight support, extremely restricted activity (3months), pain management |
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Term
Amputation
(diagnostics and pre-op) |
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Definition
Can be either forequarter, hindquarter, or tail
-limb is removed by joint disarticulation (can cut in middle of bone and leave joint to avoid cutting nerve bundles)
-when involving neoplasia (cut wide margins to avoid spreading) or trauma extremely painful pre-op
-excellent pain management protocol needed (epidural and nerve blocks)
Diagnostics:
-weight reduction (diet), MDB, Radiographs
Pre-op treatments:
-restricted activity, preemptive pain meds and antibiotics |
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Term
Amputation
(clip, prep positioning, operative positioning, management, at home care) |
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Definition
Clip:
-dorsal midline to ventral midline down limb to tarsus/carpus
Prep/Operative positioning:
-lateral recumbency with affected leg up
-leg hung for prepping
Management:
-weight support, possible urinary catheter (may need to place if epidural catheter is placed due to hind limb weakness), pain management
At Home Care:
-weight support, encouragement and help relearning tasks, restricted activity, pain management |
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Term
| Orthopedic Surgery on Horses |
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Definition
-all the same rules apply
-restrict activity by putting them in stalls
-worry about radial nerve damage/paralysis when in lateral recumbency for too long
-always bandage to reduce contamination and proud flesh |
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Term
| Rehabilitation and Therapy with Orthopedic Surgeries |
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Definition
The goal of rehab is to maintain ROM, limit fibrosis tissue and allow time for adequate bone healing to support more active weight-bearing exercise.
Types of therapies:
-ROM and stretching
-therapeutic exercise
-aquatic therapy
-Superficial thermal modalities
-electric stimulation
-massage
-therapeutic ultrasound
-acupuncture/pressure |
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Term
| Things to consider in our Neuro patients when is comes to signalment, PE, and a Neuro EExam... |
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Definition
Signalment:
-breed and age
Physical Exam:
-complete PE
-many disorders can mimic neurologic disease (cardiovascular, Addison's, toxic pyometra, bilateral cruciate ruptures)
Neurologic Exam:
-should be performed in a quiet area that has good footing
-do not give sedatives or analgesics prior to performing
-Methodical approach (nothing gets overlooked)
-involves evaluating mentation, movement, behavior, musculature, conscious proprioception, pain sensation, cranial nerves, spinal reflexes |
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Term
| Things to consider and look at when taking a history in neuro patients... |
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Definition
Helps to characterize if the disorder is:
-acute or chronic
-progressive or static
-persistent or intermittent
Behavior Changes?
-seizures, head tilt, circling
-presence of pain, absence of feeling, signs of other cranial nerve damage
If there is spinal pain then determine:
-location
-duration
-progression
-persistence
-character |
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Term
|
Definition
IVDD = Inter-vertebral Disc Disease
-Chondroid: degeneration of nucleus pulposus
or
-Fibrinoid: degeneration of the annulus pulposus
-Degeneration makes the disc weak but the extrusion of the disc fragments happens from secondary trauma
-Seen in dachshunds, beagles, poodles
-Middle aged
-Most common site of the disease is C2-C3
-Sometimes causes Tetraparetic |
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Term
Intervention of IVDD
(Conservative and Surgical) |
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Definition
Conservative:
-strict cage rest (allows for resolution of inflammation and stabilization of the ruptured disc to fibrosis)
-Conjunctive anti-inflammatory therapy
Surgical:
-goal is to remove extruded contents of the disc from the nerves and spinal cord
-procedure depends on the type of injury (herniated or discogenic)
-Herniated:
rupture of the disc into the inter-vertebral space
-Discogenic Pain: pain stemming from inter-vertebral space itself |
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Term
| IVDD Perioperative/postoperative needs |
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Definition
Preoperative treatment:
-fluids and steroids
Anesthetic considerations:
=appropriate protocol per patient
-mechanical ventilation on hand
-transfusion supplies on hand as well as hypertonic solutions in case of hypotension
Postoperative care:
-monitoring
-therapeutics
-hygiene (may need a urinary catheter)
-Environment
-Physical activity |
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Term
Explain Dorsal Laminectomy
(diagnostics and pre-op) |
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Definition
Removal of the dorsal lamina from the vertebrae to expose the spinal cord
-indicated when lesions are located dorsally or dorsolaterally
-scar tissue develops over time to protect portion of the spine missing
Diagnostics:
-MDB
-PE & Neuro Exam
-Imaging (radiographs, CT/MRI, CSF analysis, myelogram
Pre-op Treatments
-restricted activity/immobilized
-preemptive pain meds, steroids, and antibiotics |
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Term
Dorsal Laminectomy
(clip, prep positioning, Operative Positioning, management, at home care) |
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Definition
Clip:
-midline, cranial and caudally 2-3 vertebrae and lateral out past scapula
Prep/Operative Position:
-sternal recumbency
-padding under neck to level vertebrae if needed
-arms tied back or to side of patient dependent on location of lesion (scapula out of the way)
Management:
-monitor respiratory and incase of seizures
-possibly urinary catheter, pain management, physical therapy, regular radiographs
At Home Care:
-Restricted activity, Physical Therapy (immediately post op), pain management |
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Term
Explain Hemilaminectomy
(diagnostics and pre-op) |
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Definition
Unilateral removal of the lateral lamina, and removal of the pedicles and articular facets
-indicated for patients with lesions of the lateral aspect of the vertebrae canal and intervertebral foramen
-positioning is dependent on location of lesion in the vertebrae column
Diagnostics:
-MDB, PE, Neuro Exam
-spinal radiographs, CT/MRI, CSF analysis, myelogram
Pre-Op treatment:
-restricted activity/immobilized
-preemptive pain meds, steroids, and antibiotics |
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Term
Hemilaminectomy
(clip, prep positioning, operative positioning) |
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Definition
Clip:
-midline cranial and caudally 2-3 vertebrae and lateral well past incision site
Prep/operative positioning:
-sternal recumbency
-padding under neck to level vertebrae if needed
-arms tied back or to the side of patient dependent on location of lesion |
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Term
Hemilaminectomy
(management and at home care) |
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Definition
Management:
-monitor respiratory and for seizures
-possible urinary catheter
-pain management
-physical therapy
-regular radiographs
At Home Care:
-restricted activity
-physical therapy
-weight support
-pain management |
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Term
Explain Disc Fenestration
(diagnostics and pre-op) |
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Definition
Most commonly performed in disc spaces C2 through C7, not for patients with disc material herniated into the vertebral canal or intervertebral foramen
Diagnostics:
-MDB, PE, Neuro Exam
-Imaging (radiographs, CT/MRI, CSF analysis, myelogram)
Pre-op treatment:
-restricted activity/immobilized
-preemptive pain meds, steroids, and antibiotics |
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Term
Disc Fenestration
(clip, prep positioning, operative positioning) |
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Definition
Clip:
-midline to caudal manubrium sterni out laterally (cervical)
-dorsal midline, 2-3 vertebrae cranial and caudal
Prep/operative positioning:
-dorsal recumbency
-patient in V-trough
-tape front legs caudally and head cranially
-sternal recumbency for thoracic vertebrae
-arms pulled out of way
-lateral approach with incisions when doing surgery with thoracic/lumbar spine |
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Term
Disc Fenestration
(management and at home care) |
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Definition
Management:
-monitor respiratory and for seizures
-possible urinary catheter
-physical therapy
-regular radiographs/neuro exam
At Home Care:
-Restricted activity
-physical therapy (hydro)
-pain management
*disc space will be weaker, so we need to be careful of collapse of the space or luxation* |
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Term
Explain Ventral Slot
(diagnostics and pre-op) |
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Definition
Used to gain entrance and visualize the ventral cervical vertebral canal
-operating time is less than with dorsal approach
-less invasive
Diagnostics:
-MDB, PE, Neuro Exam
-Imaging (radiographs, CT/MRI, CSF analysis, myelogram)
Pre-op treatment:
-restricted activity/immobilized
-preemptive pain meds, steroids, and antibiotics |
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Term
Ventral Slot
(clip, prep positioning and operative positioning) |
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Definition
Clip:
-mid mandible to caudal to manubrium sterni and out laterally
Prep/operative positioning:
-dorsal recumbency
-arms tied caudally
-tie head cranially |
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Term
Ventral Slot
(management and at home care) |
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Definition
Management:
-monitor respiratory and for seizures
-possible urinary catheter
-pain management
-physical therapy
-regular radiographs
At Home Care:
-restricted activity
-physical therapy
-pain management |
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Term
Why is conservative and surgical intervention helpful?
(Neuro) |
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Definition
Conservative:
-confine
-stabilization
-anti-inflammatories to reduce any immediate swelling
Surgical:
-relief of compression
-stabilization of instabilities
-surgery is dependent on location and cause of stenosis |
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Term
| In general, what are some surgical and post-operative complications that can occur with neurosurgeries? |
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Definition
Surgical:
-instability
-collapse of vertebral space
-laceration of vertebral venous sinus
-spinal cord trauma
-subluxation
-incomplete extraction of causative nucleus
-seroma
-infection
Post Operative:
-UTI
-pain
-decubitus ulcers
-urine scald
-incontinence
-non ambulatory
-weakly ambulatory |
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Term
| Define Wobbler's Syndrome, Atelectasis, and list the 9 complications that can occur with paralysis/recumbency? |
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Definition
Wobbler's Syndrome = cervical spondylomyelopathy. Can be caused by anatomic malformation, vertebral tipping, degenerative disk disease and hourglass compression.
Atelectasis = partial or full collapse of the lungs
Complications with paralysis/recumbency:
-skin
-muscle and connective tissues
-bone
-respiratory
-circulatory
-urinary
-digestive
-immunity
-mental health |
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Term
| Skin Management Post-Op Neurosurgery |
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Definition
-hygiene (clean and dry)
-padding (not too much cause it can cause pressure points)
-turn Q2-4h
-massage (starting distal and moving proximal)
-local heat
-whirlpool/hydrotherapy |
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Term
| Muscle and Connective Tissue Management Post-op Neurosurgery |
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Definition
-massage
-therapeutic ultrasound
-stretching and passive ROM (don't go past point of resistance)
-Electro-stimulation
-Active exercise (as tolerated)
-Can use Hydrotherapy and test reflexes |
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Term
| Bone and Circulatory Management Post-op Neurosurgery |
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Definition
Bone Management:
-exercise involving weight bearing and gravitational resistance
-stop at first signs of fatigue!
-can use hydrotherapy
Circulatory Management:
-IV catheters (preventative)
-Prevent vascular pooling and edema with massage (effleurage and wringing) and hot packing
-ROM
-Watch out for Cardiac Disease |
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Term
| Respiratory Management for Post-op Neurosurgery |
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Definition
-turning
-coupage
-segmental breathing (gentle pressure on cranial abdomen forces use of costal breathing within 6 respiratory cycles)
-exercise
-watch out for pneumonia |
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Term
| Urinary and Digestive Management of Post-op Neurosurgery |
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Definition
Urinary Management:
-Manual expression or urethral catheterization to prevent retention or incontinence
-Watch and measure urine volume
Digestive Management:
-constipation, obstipation, incontinence, and diarrhea can occur
-anorexia and emesis can occur
-prevent with proper hygiene, hydration, nutrition, and eliminations |
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Term
| Mental Health Management for Post-op Neurosurgery, also explain the use of rehabilitation? |
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Definition
Mental Health Management:
-keep to regular schedule
-attention
-variety and distractions
-familiar faces and things
Rehabilitation:
-used to maximize recovery, increase overall function and well being, decrease pain, and prevent atrophy, fibrosis and contracture
-Exercise include: dynamic mobilization, core strengthening, and balancing |
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