Compare and contrast the de-Angelis technique and the ...



Compare and contrast the de-Angelis technique and the tibial Wedge Osteotomy as treatments for anterior cruciate ligament ruptures in the dog.

• Both are surgical treatments that produce extracapsular stabilization

• The De angelis technique consists of: Lateral retinacular stabilization and the lateral imbircation

• The de Angelis Estracapsular is the most common procedure.

o It mimics the direction of ACL

o Anchors around the lateral fabella and tibial crest

o Monofilament non absorbable 2-0, to 0 are used a less expensive material is leader line which just can be autoclaved once.

• Post operative care of the De Angelis encompasses:

o Bandage 5 – 7 d

o Strict rest for 4 -8 weeks

o Leash exercise 4 – 6 weeks

o Slow upgrading of exercise over next 8 weeks 10 – 15min slow walk

o Routine medical therapy for 2 weeks using NSAIDs and chondroprotectives

o Fortnightly recheck for 1st month then monthly rechecks for 3 – 4 months

• Advantages of De Angelis:

o Uncomplicated procedure

o No expensive equipment required

o 85% dogs go well clinically

• Disadvantages of De angelis:

o Tibial thrust is not overcome, and anterior draw can occur

o Progression of DJD

o Infection is a possibility therefore use Vetafil

o Size constraints 28kg,

o Increased tibial slope of any size

o Severe DJD

o A wedge of bone is removed and the rest is reduced and fixed with DCP

• Post Operative Care

o Bandage 1 week to decrease seroma

o Not boisterous activity for 8 – 12 weeks

o Towel walk 2 weeks – no splits

o Leash walk at 4 weeks

o Graded exercise

o Routine medical therapy

o Recheck radiographs at 8 weeks

o Monthly rechecks for 3 – 4montrhs

o Most walk before de angeles

• TWO/TPLO advantages

o Overcomes TT very effectively

o Faster return to weight bearing

o Better long term functions

• TWO/TPLO disadvantages

o Complicated procedure

o Expensive equipment

o Costly

o Anterior draw not neutralized, but not greatly significant with the outcome of the use of the leg, but can injure with instability before.

What neurological signs could be associated with an intervertebral disc protrusion, at the level of T13 and L1 vertebrae in the dog? List the possible treatment options for such a case.

• Causes the most common neurological syndrome in digs.

• Typical sings are due to a focal compressive myelopathy and/or radiculopathy.

• Clinical presentation is variable and depends on

o Site or protrusion/extrusion

o Volume of the mass

o Dynamic consideration: acute high velocity vs chronic low velocity extrusions

• Clinical signs depend upon the location of the lesion, the type and the dynamic force of the rupture

o Stage I Pain - medical

o Stage II pain +/- mild paresis – medical or surgical

o Stage III paresis - surgical

o Stage IV paralysis - surgical

▪ with deep pain

▪ no deep pain 48 hour

• Neurological complications that may occur in order if increasing severity are

o proprioceptive defects,

o paresis,

o nonambulatory paresis, but voluntary motor function,

o plegia,

o loss of voluntary urination and

o loss of deep pain

• Neurological signs with intervertebral dis protrusion:

o Back pain, hindquarter paresis, splining of epaxial and abdominal muscles

o Altered proprioception, nocicption and reflexes (UMN if T3 – L3 or LMN if L4 – S3).

o Pelvic limb signs are usually bilateral but occassionaly unilateral

o Imparied urinary bladder function is common with non-ambulatory parparesis or paraplegia

▪ Damage to UMN tracts will result in a tense full bladder that is diffcult to express

▪ Damage to LMN will result in the bladder overstretching and edetrusor muscle atony. Bladder capacity and urine retention increase progressibely. The bladder is usually flaccid, exhibits overflow incontinence and is easy to express.

• Treatment maybe medical or surgical. Decisions on tx mb made according to the stage if IVDD

o Early decompression and mass removal are strongly recommended for the majority of dogs with paraperesis or paraplegia.

o Surgical therapy can be Fenestration, or decompresive procedures such as dorsal laminectomy or a hemilaminectomy.

Hip dysplasia is thought to be a result of early hip laxity. Describe clinical and radiographic techniques that demonstrate this laxity.

• Vary according to the age of the animal, but two clinical groups are recgonised

o Young dogs from 3 – 8 months of age

o Mature dogs 4 – 5 years

• Dogs may show a sudden onset of uni or bilateral hindleg lameness or they may be unwilling to exercise, jump or climb stairs and they may have trouble getting up from a lying postion.

• Palpation of the hips as the animal walks may reveil laxity or a popping feeling

• Manipulation of the hips is usually resented, esp on extension.

• The suggen onself of C/s is thought to be assoc. with micro-fractures of the acetabular rim as the pressure of rhte dipplaced femoral head overloads this area.

• Olderdogs show all the classical signs of degenerative osteoarthritis.

• Signs maybe uni or bilateral with either an insidious or a sudden onset, usually following vigorous exercise, prolonged rest or cold weather. The joint may have a reduced range of mvvt. Muscle atrophy is apparent, and the greater trochanter seems more prominent. Pain and crepitus may be evident on manipulation of the hips. The shoulders and thorax appear well developed to to compensatory muscular hypertrophy.

• Dx: based on hs and clinical signs and confirmed by observation, palpation, manipulation and radiography.

o Joint laxity checked for by the hip lift and the ortolani tests.

o Ortolani Test –lateral or dorsal recumbency. Femur at a right angle to the pelvis, hand pressure is applied on the flexed stifle up the femoral shaft. In an unstable hip this will cause dorsal subluxation of th3e hip joint. The pressure is sustained while the hiop is slowly abducted. At some point a clunk or click will be heard and felt as the subluxated hip is reduce. This is called the angle of reduction. The pressure is sustained while the hp joint gradually adducted brought back to the startion position. A click will again be felt as the hip subluxates (Barlow sign) and this is called the angel of subluxatioh. These angels may have significance in evaluating patients for triple pelvic osteotomy surgery. Extension, flexion rotation and particularly abduction of the oin are used to evaluate the amount of joint stiffness.

o The std view for radiographic evaluation fot he hiyops is the ventro-dorsal hip extended projection, with the hind legs extended and parallel. Ensuyring that the whole body is straight should prevent rotation of the pelvis. The presence of new bone formation, the shape of the femoral head and the acetabulum aare examed for congruency of the articular surfaces. The dorsal rim of the acetabulum should be intersect the epiphyseal scar of the proximal femur about 2/3 – 1/3 of the distance from its lateral edge. Rotation of the pelvis will give a false impression of the acetabulsar depth. The side showing more of the iliac wing laterally will show a reduction of the acetabular depth and visa versa.

o PennHip scheme – three views are taken

▪ 1 – standard hip extended view for correlation purposes

▪ ventrodorsal viw of the pelis with the hiops flexed into a weight bearing position

▪ the same projection as #2, but with a special plexiglas rod device placed between the femurs wich acts as a fulcrum. This enables a distraction force to be exerted on the hip joints. A distraction index is calculated, which gives a measurement of hiplaxity.

What is a rule that you can use to determine if a boine foetus in posterior presentation, normal position and posture, can safely be delivered vaginally by traction?

• Either longitudinal or transverse – the foetus’s orientation is either cranial or caudal in longitudinal presentation and dorsal or ventral in the transverse presentation

• Position is in relation of the dorsum of the foetus to the quadrants of the maternal pelvis. These quadrants are the sacrum, right iliu,, pubis and left ilium

• Posture is in relation of the foetal extremities to its own body. Edxtremities maybe flexed, extended or retained. Retention can be to the right left above or below the foetus.

• Delivery by traction: guideline sfor vaginal delivery

• Cranial presentation: if one person on leach leg can pull the fetlocks 10 – 15 cm beyond the vulva, the points of the shoulders will pass the maternal iliac shafts and the calf can be delivered vaginally.

• Caudal presentation: if one person on each leg can pull and make the hocks appear at the vulva the greater trochanters will pass the iliac shafts and the cal can be delivered vaginally.

After delivering a calf by foetotomy, briefly describe your available options when a full-thickness tear in the ventral uterine wall is deteced in the post-delivery examination.

Abdominal surgery – left flank paramedian or middling, or iatrogenic uterine prolapse. Preop ab and post op oxytocin. Guarded to poor prognosis

Outline events leading to the development and maintenance of pyometron in the cow where Trichmoniasis is not involved.

• Mainly a postpartum condition

• Dystocia or RFM

• Increase locial duration

• Postpartum ovulation at 16 – 18 d

• Cl formation and progesterone production

• Closure of cervic

• Severe endometrial damage

• Reduced endogenous Pg

• CL persistence

Describe the medical tx of a prepucial prolapse prior to attempting surgery.

Presurgical conservcative tx is usually necessary to reduce swelling and to improve the condition of the tissue. Using a bull sling to reduce venteal oedema is v. successful. Prior to surgery fibrosis and oedema are reduced to a minimal level, decreasing the risk of postoperative infection and failure. Feed is withheld from the bull 24 hours prior to surgery. Surgery is performed with the bull in right-lateral recumbency, either under general anesthesia or with a combo of xylazine sedation and local analgesia. The surgical area is prepared for aseptic surgery in a routine mater.

Compare and contrast the paramedial and left flank caesarean section in the bovine. Your discussion should include:

Indications

Preparation for surgery

Surgical approach and technique (describe one in detail and then indicate how the other one varies)

2003

Briefly describe the pathogenesis of prolapsed vagina in the bovine.

Occurs mid to late gestation, due to high levels of oestrogens which causes laxisitiy of the ligaments and progressive movement of the vaginal to the outside, also bulls with large sheaths have been thought, but not proven to be a contributor. There is the view that breed disposition, heritability, inherited aspeced and in increase of foetal size due to abdominal pressure.

You have just completed vaginal delivery of a calf by traction aned commenced cleaning your gear when you turn around to notice the uterus has prolapsed. In point form outline your tx of the prolapsed uterus.

• Isolater for protection

• Clean and protect with moist towels

• Frob leg position if recumband

• Standing elevate uterus above vula

• Clean and check for tears

• Trin placenta if still present

• Epidural

• Commence adjacent to the vulva

• Use frim kneeding action

• Push cranially and ventrally using fist and arm

• Infuse up to around 10 L of warm saline to evert uterus

• Siphon off excess saline

• Inject 50 IV oxytocin Im

• Penicillin Im

• Consider Ca borogluconate

• Intrauterine oxytetracycline 2 gm minimum

• Consider Bunher suture

Outline events leading to the development and maintenance of pyometron in the bovine where Trichomoniasis is not involved.

Due to chronic purulent metirits. Mainly a post partum condition. Dystocia or Retained FM increase lochial duration, postpartum ovulation at 16 – 18 days and Cl formation oand progesterone production. The cervix closed, endometrial damage occurs. There is a decrease in endogenous Prostaglandin and a pe3rsistent CL.

Corticostroids are an effective tx for foetal mummification in the bovine. False tx with prostaglandin. They stimulate contractility fot eh uterine and other smooth muscels and have the ability to lower blood pressure, regulate acid secreation of the stomach, regulate body temperature and platelet aggregation and control inflammation and vascular permeability.

Describe the surgical technique that you would use to correct a Grade II medial patella luxation in a small breed dog.

• Grade II – IV no one surgical tech is adequate for correction of all grades of patella luxation

• The aims of the surgical therapy are

o to anatomically and functionally re-align the stifle

o improve limb function

o relieve pain

o prevent further skeletal deformity

• Surgical therapy involve

o soft tissue reconstruction

o bony reconstruction

• Surgery is done in a stepwise manner

• Evaluation of patella position and tracking is performed after each corrective procedure

• Additional procedures are performed as necessary

• Soft tissue reconstruction involves the items below and is usually adjunct to all surgical repairs, but can be the sole procedure in very young animals

o Lateral joint capsule and fascia lata imbrication

▪ Tightening joint capsule and fascia on lateral side helps prevent patella slipping medially

o Anti-rotational sutures

▪ Can be used solely in young puppies

▪ Adjunct in other dogs

o Medial releasing desmotomy

▪ Grade III and IV only

• Bone reconstruction involves

o Sulcoplasty

▪ Not in current use

o Chondroplasty

▪ Dogs less than 6 mot old

▪ Preserves articular cartilage

▪ Cartilage only is elevated from subchondral bone

▪ Bone is removed beneath cartilage flat to deepen sulcus

o Tibial tuberosity translocation

▪ Required in most cases of Grade II – IV

▪ aligns insertion of quadricpes mm with sulcus

o Rectus femorus transfer

▪ Extreme Genu Varum

• Femoral bowing

• Staffies

▪ Aligns origin of quadriceps mm with anterior femur and sulcus

o Corrective osteotomy of femur/tibia

▪ Extreme cases of bone deformity only

▪ Poorer prognosis due to the extremem nature of the deformity

Discuss factors that must be considered when selecting a method of cruciate repair in a dog.

• Acute – sudden onset with no previous hs of lameness

• Chronic – lameness for weeks to months, intermittent or constant

• Acute on chronic – chronic lameness with an acute exacerbation

• The orthopaedic examiniation

o Lameness

o Pain on palpation and manipulation

o Decreased range of motion

o Joint effusion

o Periarticular thickening

o Anterior drawer sign

o Tibial thurst

o Meniscal click

o Muscle atrophy

• Types of ACL rupture

o Partial or incomplete

o Complete

o Avulsion

▪ Immature dogs and body fragements

• Conservative tx

o Small dog ................
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