Ch 44 Coaptation, bandaging Flashcards
vWhat evidence is there for/against the role of bandaging for decreasing post-op swelling?
One report showed that bandaging for 24hr post TPLO did NOT decrease post-op swelling at 24 and 48hr
Another report has shown that bandaging was less effecting than cold compression at reducing post-op swelling 72hr post-op
What is the recommended number of layers of each material for a soft padded/modified Robert Jones bandage?
3-5 layers of cast padding
2-3 layers rolled gauze
1 layer of adhesive tape/vet wrap with 50% overlap
In which direction is it safest to wrap the antebrachium during bandaging?
Wrapping should be directed from lateral to medial over the cranial aspect of the antebrachium. Suppination can easily be induced if wrapped in the other direction.
What is a safer alternative to a Velpeau sling?
A limb sleeve which is wrapped around the chest and limb and fastened with velcro straps dorsally
List the three sling options to prevent weight bearing of the pelvic limb
1 - Ehmer sling - Provides flexion, internal rotation of the femur and abduction
2 - 90-90 bandage - prevents stifle and tarsocrural extension beyond 90 degress. Does not provide internal rotation
3 - Suspension sleeve - Subjectively safer and more convenient
List the negative effects of joint immobilisation
Loss of joint motion
Loss of cartilage thickness and stiffness
Loss of muscle and bone mass
Cartilage degeneration
Define orthosis
What are orthoses used for?
An external device placed on the body to support or protect a body part.
Used to control, guide, protect, limit motion of, or immobilise and extremity, joint or body segment
List the advantages of orthoses over casts
Can be rapidly donned and doffed
The support they provide can be adjusted
They are subjectively safer, more convenient, and may cost less over the duration of the treatment
What are exoprostheses used for?
Exoprostheses (aka socked prostheses) are used to manage incomplete limbs in animals with partial amputations up to the proximal third of the antebrachium or mid-crus
How can you schieve stability with socket prostheses if the carpus/tarsus is gone?
By adding hinges at the elbow/stifle
List some contraindications for socket prostheses (5)
Patient demeanour
Highly mobile skin in relation to underlying tissues
Moderate or severe neurological deficits (cannot place the limb appropriately)
Compromised joint motion
Problems present in the residual stump (neoplasia, infection, stump pain)
What are active/dynamic hinges in relation to prosthesis?
What are they used for?
Active hinges are hinges which apply torque to a joint, usually to stretch it over a long period of time eg to treat a joint contracture
What are the major set-backs of current surgically implanted prosthesis?
Difficulty to establish a stable skin-implant inferface that is not prone to infection
List the methods of bone fixation for surgically implanted prostheses in companion animals (3)
How does this differ from humans?
Fixation with a bone plate or nail with screws or bolts
Press fit into the medullary cavity or outside the cortex
Cemented fixation
In humans, traditionally has relied on titanium rods screwed into the medullary cavity of long bones. The implants are then left unloaded for 12-18 months to allow bone ongrowth. This long period prior to loading the implants is not fesible in dogs
Transdermal osseointegration is a logical choice compared to exoprostheses
(1) The high skin mobility in companion animals (compared to human beings) interferes with the stability of exoprostheses;
(2) there is much more labor involved in maintaining exoprostheses
(3) companion animals do not always readily accept
implant stability should be rapid or immediate.
In a large retrospective study of 60 dogs with casts, what was the reported complication rate?
63% developed soft tissue complications
60% mild
20% moderate
20% severe
More likely in Sighthounds
What are the reported bandage complication rates in dogs with immobilisation post patella tendon repair and PCA?
75% post patella
32% PCA attached to one MC
18% PCS attached to two MCs
What is a Schroeder Thomas splint?
A splint used to apply traction at the fracture site
Largely fallen out of favour
What are flexible orthoses typically made from?
Durable textiles such as breathable neoprene
Provide less support than ridig orthoses but are lighter, less likely to lead to abrasions and are more affordable
What issues can arise in the contralateral limb of dogs who are growing with an incomplete limb?
Thoracic limb:
excessive scapular mobility (dt being a synsarcosis)
Scapular subluxation
excessive rotation of the shoulder
Angulation and torsion of the radius
Pelvic Limb:
Femoral and tibial angulation and torsion
Rotational laxity of stifle
Intertarsal rotational laxity
What is a trunnion?
The external part of a surgically implanted prosthesis to which the prosthetic foot is connected
orthoses functions
restrict joint motion in a given direction > carpal or tarsocrural joint hyperextension
limiting shoulder abduction with medial shoulder joint instability
limiting hip abduction after a ventral luxation of the hip joint.
promote specific motion > maintain carpal extension in dogs with radial nerve injury or to avoid scuffing (i.e., to promote tarsocrural joint flexion) in dogs with sciatic or peroneal nerve injury
Evaluation of the effects of initial water temperature and curing
time on fiberglass cast strength
Perez-Nogues
Fiberglass casts continued to gain strength for at least 24 hours. Use of warm water increased the rate of curing, resulting in stronger constructs at earlier time points.
Clinical significance: Use of warm water is recommended to initiate fiberglass cast curing, especially if the casted limb will be loaded soon after cast application
Evaluating Stiffness of Fibreglass and Thermoplastic Splint Materials and Inter-fragmentary Motion in a Canine Tibial Fracture Model
Constructs based on a FG splint were generally stiffer than
those based on TP. Under the loading conditions employed
in this study, the differences in stiffness were not associated
with significant differences in inter-fragmentary
motion when the two materials were compared. For dogs
with a mid-diaphyseal tibial fracture with an intact fibula,
both FG and TP are appropriate for use, but there may be a
marginal advantage to using a cranial FG splint for these
fractures.
Supercutaneous Plating for the Treatment of Traumatic
Injuries of the Appendicular Skeleton in Dogs
Tommaso Nicetto 2019
retrospective case series, 5 cases
conical coupling locking plates, mean 16kg. one major comlplication implant failure. ALL fractures healed.
advantages of using supercutaneous plating over
external skeletal fixation include the lower profile of the
construct, the possibility for preoperatively contouring the
implant and ease of controlled-dynamization of the plate or
implant removal
