Equine Orthopaedic Surgery and Perioperative Care Flashcards
(35 cards)
what elective surgery can be done?
– Arthroscopy/tenoscopy
- osteochondritis dissecans lesions
- Tendon sheath disease
– Angular limb deformities
(foals)
– Soft tissue surgery
- Neurectomy / fasciotomy
- Desmotomy e.g. palmar annular ligament
what emergency surgery might be done?
- Arthroscopy/tenoscopy
- Synovial sepsis
- Intra-articular fracture repair
- Fracture repair
- +/- sequestrum removal
what would an arthroscopy/tenoscopy be done for?
intra-articular fracture repair, osteochondritis dissecans, synovial sepsis
what is synovial sepsis?
– Bacterial infection leading to septic arthritis
what is Osteochondritis dissecans (OCD)?
–Development defects in cartilage and bone
why is sequestrum removal indicated?
Trauma resulting in damage to the periosteum can result in death of the bone in
this region and necrotic bone separates (sequesters)
and becomes a “foreign body” so the sequestrum is often infected
what are angular limb deformities?
bendy legs - lateral or medial bend
who often gets angular limb deformitites?
foals
what are the different factors for angular limb deformity?
nutrition, incomplete ossification, tendon/ligament laxity
what sugical techniques can fix angular limb deformities/
– Growth arresting techniques e.g. transphyseal screw, plating
– Growth accelerating techniques e.g. periosteal transection
what are the considerations for fracture repair?
- average weight of a horse is 500kg so lots of stress on fracture
- athletes need repair to be strong
- recovery from GA, flight animal
- lack of soft tissue on distallimb so potential for contamination
what are the considerations for the emergency patient?
- Clinical examination
– When in doubt, treat like a fracture…
– Is the patient stable? - Sedation?
– a2 agonist e.g. detomidine and butorphanol - IV catheter
- Wound care
– Clippers, swabs, chlorhexidine, warm water, sterile isotonic fluids, needles/syringes
what pre-op considerations are there for the emergency patient?
– Medications e.g. antimicrobial drugs, tetanus
antitoxin, analgesia
- Have these been given prior to referral?
- Is limb support required? - Do we suspect a
fracture?
what are the goals for fracture stabilisation?
– Stabilize fracture
– Reduce discomfort and distress
– Minimize further trauma to bone ends, soft tissues and vasculature
– Prevent further contamination
what is the nurses role during surgery?
- Scrub nurse – run table/anticipate next step during procedure
- Orchestrate – run the room
– This starts pre-operatively
how do you prep theatre for surgery??
- Clippers
- Antibacterial preparations
- Fluids
- Medication
- Urinary catheter
- Shoe removal?
- Anaesthetic machine, circuit etc
howdo you repare the patient for surgery?
- Patient is primary source of
pathogens - Cover feet and tail
- Clip hair Preferably outside operating theatre
- At least 10-15 cm away from
intended surgical site - 1st Clean skin
- 2nd Disinfect skin
how can you prepare the skin for surgery?
- Chlorhexidine
– Residual activity (binds to protein in skin)
– Low toxicity (but can be toxic for fibroblasts) - Iodine compounds
– Stains, radiopaque, smells.
– Only free iodine is bactericidal - Povidone iodine:
– No free iodine unless diluted or combined with detergent
– Low toxicity (individual sensitivity reported) – Inactivated in presence of organic debris - Synergistic effect with alcohol
what are the uses for alcohol as a skin prep?
- Only effective against bacteria
- Inactivated by organic debris
- No residual activity
- Commonly used as rinse after surgical scrub
what specific requirements are there for preparing the theatre?
- ropes/support stands, cushioning/padding for positioning
- instruments required?
- imaging equipment required?
- post-op bandaging/casting materials
what surgeon considerations are there for positioning of the patient?
– Comfort
– How accessible is the surgical site?
– Is there more than one surgical site?
what positioning considerations are there for the horse?
– Comfort
– Myopathy/neuropathy risk
what types of recovery can you do for horses?
- Unassisted
- Rope recovery
- Sling recovery
- Pool recovery
what are the risks with pool recovery?
infection/ pulmonary oedema
