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Surgical Nursing > Elbow dysplasia and arthroscopy > Flashcards

Elbow dysplasia and arthroscopy Flashcards

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1
Q

What conditions may cause elbow dysplasia?

A

Fragmented medial coronid process (FCP)
Osteochondrtis dissecans (OCD)
joint incongrutiy
ununited anconeal process (UAP)

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2
Q

When do clinical signs arise for dogs with elbow dysplasia?

A 
from 5 months of age and prior to reaching 2 years of age 
Lameness 
swelling 
decreased ROM
joint pain
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3
Q

What imaging can be used to assess elbow dypslasia?

A

Radiography orthogonal views CrCd view, medio-lateral, flexed lateral

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4
Q

What may oblique elbow views aid in diagnosis of?

A

Fragmented coronid process

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5
Q

When does ununited anconeal process occur and what does it cause?

A

German shepherd dogs
anconeal process should fuse at 4-5 months of age
Elbow stability compromised, osteoarthritis ensues

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6
Q

What are the clinical effects of the ununited anconeal process?

A

Shortened ulna relative to the radius

Humerus pushes onto anconeal process does not fuse with the unla

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7
Q

What are the treatment options of ununited anconeal process?

A

Proximal dynamic ulnar osteotomy (PDUO) (lengthening of the ulna as the radius grows removes shear stress on anconeal process
R-attachment using a lag screw
Fragment removal

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8
Q

What is involved in incongruity and short radius syndrome?

A

Incongruity of the joint surface occurs
Weight bearing on the medial aspect of the joint
fragmentation of the medial coronoid process
sclerosis and cartilage wear of the medial humeral condyle

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9
Q

What is a dynamic partial ulnar ostectomy used for and what is the procedure?

A

Correction of incongruity in the elbow joint
Small proportion of the ulna is removed
improves radius ulnar contact

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10
Q

What is osteochondritis dissecans?

A

Effects medial humeral condyle
subchondral bone defect
can occur in combination with FCP
Appear on the humeral trochlea as a thickened flap of cartilage

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11
Q

How is osetochondritis dissecans treated?

A

Removal of the thickened cartilage flap
Abrasion arthroplasty or microfracture of the sub-chondral bone
Replacement of medial humeral condyle with osetochondral graft

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12
Q

What is a fragmented coronid process?

A

Most common elbow pathology
crainolateral aspect of the medial coronid
Bone fragments dead and yellow
Fragments may be displaced or non displaced

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13
Q

What are the treatment options fro elbow dysplasia?

A 
Arthroscopic debridement 
Abrasion arthroplasty 
Microfracture 
Long bone osteotomy 
Elbow replacement
Elbow arthrodesis
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14
Q

What is involved in arthroscopic debridement in the elbow?

A

Fragments are removed via arthroscopy
Joints treated via abrasion and microfractur
joint is flushed with saline to remove small fragments

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15
Q

How is osteoarthritis managed?

A

Medically (weight loss, NSAIDs, hydro and physio)
Evaluated using an arthroscope
motorised shaver or instruments debride the necrotic cartilage
sclerotic bone is removed
Neovasucularisation recruitment of pluripotent stem cells
Exposed sub-chondral bone is treated via micro pick technique

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16
Q

What is abrasion arthroplasty?

A

Hand burr or power shaver is spun over sub-chondral bone over the area of the lesion
when bleeding is observed the joint is lavaged to remove debris and inflammatory mediators

17
Q

What is microfracture?

A

insert an angled micropick into the joint and press teh tip against the sub-chondral bone surface
apply diffusely across diseased area
check for bleeding
when bleeding occurs lavage the joint

18
Q

What are the three types of long bone osteotomy in elbow dyspepsia treatment?

A

Sliding humeral osteotomy
Prosimal abducting ulnar
Dynamic ulna osteotomy

19
Q

What takes place in the sliding humeral osteotomy?

A

aims to shift the weight to the lateral side of the joint

20
Q

What is a proximal abducting ulnar?

A

Abduction of the ulna by 4 to 6 degrees to the lateral side. Weight shifting to the lateral side of the joint

21
Q

What is a dynamic ulna osteotomy?

A

The bone is cut and left unstabilised

22
Q

What is elbow arthrodesis?

A

Fusion of the elbow joint last resort

23
Q

What is arthroscopy?

A

Endoscopy of the joint

24
Q

When may a animal need arthroscopy?

A 
Exploration of the joint 
Osteoarthritis 
ostecans disseans removal
joint debridement and lavage
Arthroscopic assisted joint stabalisation 
Bone fragment removal
25
Q

What are the advantages of arthroscopy?

A 
Decreased morbidity 
more rapid recovery 
decreased complications
improved outcomes 
Decreased surgery, anaesthesia and hospitalisation times
26
Q

What are the disadvantages of arthroscopy?

A

High skill required
long learning curve
high cost of equipment
increased cost to client

27
Q

What equipment should you prepare for arthroscopy?

A 
Arthroscope
Camera mount 
light post 
cannula
irrigation
Ergess system (a source for removal of fluid) 
Hand instruments
Instrument cannulas
Power tools 
Electrocautery/radiofrequency 
Long needles 
haemostats
fluid bowl
28
Q

What are the usual measurements of the arthroscope and how should it be kept?

A

Diameter for the elbow 1.9-2.7mm
lens angle- 30 degrees
working length 8.5cm to 13cm

29
Q

What is the camera mount for in arthroscopy?

A

Attaches to camera with image projected on screen

Good quality flat screen monitor is required

30
Q

What is a typical light source for an arthroscope?

A

Xenon or halogen

31
Q

What is a cannula for in arthroscopy?

A

All arthroscopes are inserted through a cannula
maintains arthroscope portal
protects the arthroscope
ingress of fluid

32
Q

What is irrigation for in arhtroscopy?

A

Continual flushing is required to keep joint blood free and inflated

33
Q

What hand instruments are available for arthroscopy?

A

probes, hand burrs

34
Q

What power tools are used in arthroscopy?

A

shavers remove soft and hard tissue

35
Q

How do you prepare a patient for arthroscopy?

A

Clip the medial elbow with enough removed to allow for conversion to an open approach
Consider waterproof drapes
Patient is positioned in dorsal or lateral recumbency Elbow needs to be held abducted and pronated
over a sandbag or the edge of the table

36
Q

List the procedure for arthroscopy?

A

Check camera working and white balance is done, fluid is connected
aspirate joint fluid with needle and syringe
place needle at the location when the arthroscope will enter
enlarge the whole with scalpel
place the cannula into the joint
remove cannula and place arthroscope
turn on fluids and light source
inspect the joint
make an instrument portal (using a needle)
enlarge the hole with a scapel
place blunt switching stick through the hole
use a variety of instruments to debride the joint
flush the joint
remove all equipment, place skin sutures
bandage if extravasation

Surgical Nursing (24 decks)

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