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Surgery Exam 2 > Lecture 3 Amputation/Arthrodesis > Flashcards

Lecture 3 Amputation/Arthrodesis Flashcards

1
Q

Define arthrodesis:

A

surgical treatment leading to joint fusion

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2
Q

Define ankylosis:

A

non surgical condition leading to joint fusion

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3
Q

Define amputaiton

A

removal of an appendage or a portion thereof

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4
Q

What are the Indications for Arthrodesis?

A

Goal is to improve/eliminate pain
Irreparable fx of joint
chronically unstable joints- carpus/tarsus
chronic, severe, joint disease of any nature
Neurological injury

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5
Q

Why does neural injury usually result in limb amputation?

A

no cutaneous sensation in palmar/plantar region; self mutilation usually occurs-> amputation

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6
Q

What joints are amendable to arthrodesis?

A 
scapulohumeral joint
elbow
carpus at antebrachial joint
Carpo-metacarpal joint
phalanges
stifle
tarsus
vertebal bodies
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7
Q

What are the alternatives to arthrodesis?

A

medical management

total joint replacement

Excision by arthroplasty ie FHO

amputation

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8
Q

What are the principles of arthrodesis?

A

removal of articular cartilage
bone graft
fused at anatomical standing angle
rigid fixation

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9
Q

Why is articular cartilage removed during arthrodesis?

A 
exposes subchondral bone
speeds healing process
blood clot, stem c`ells for bone healing
remove barrier to bone bridging
increases blood flow at site of fusion
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10
Q

Why are bone grafts included in arthrodesis?

A

speed up callus formation -> decrease implant fatigue

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11
Q

What are the functions of bone graft?

A

Ostogenesis
Osteoconduction
Osteoinduction
Osteopromotion

Stimulate bone healing, and induce cells to enter

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12
Q

What are the common graft sources?

A

autogenous- cancellous bone

allograft- demineralization

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13
Q

What are some of the common sources of autogenous bone grafts?

A

proximal humerus- tons here
ilial wing
distal femur
proximal tibia

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14
Q

Whappens if you fuse the joint and it is too flexed or too extended?

A

too flexed-> shortening of the limb

too extended-> lengthening of the limb

puts more stress/strain on the implants, loosening/breaking

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15
Q

T/F

In both internal and external if rigid fixation is not used, the arthrodesis will not heal

A

TRUE

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16
Q

What are the components/goals of external coaptation?

A

Typically 6-8 weeks
4-6 w/ splint
2-4 w/ soft padded wrap

Supplement stability during bone healing

17
Q

What is the primary goal of external coaptation?

A

GOAL is to prevent implant fatigue and failure

18
Q

What are the specific indications for carpal arthrodesis?

A

Carpal hyperextension injuries
shearing injuries
carpal luxation of antebrachial or carpometacarpal

19
Q

What are do you look for on radiographs with regards to evaluation prior to performing arthrodesis?

A

Evaluate for other bony abnormalities

measure for implant size/placement

20
Q

What radiographic views must be included for arthrodesis evaluation and why?

A

Stressed views

help determine where luxation is occurring

may help determine how much of carpus to fuse

pan vs partial carpal arthrodesis

21
Q

What are the specific indications of pantarsal arthrodesis?

A

severe loss of bone and soft tissues

rupture of the common calcaneon tendon

talocrural

22
Q

What is the max time a tourniquet can be applied ?

A

1.5 hours

after that start to devitalized tissue/ increase risk of infection

23
Q

What are the complications of arthrodesis?

A 
infection
implant breakage/loosening
fx of bone above/below implant esp stifle, need long implant to span bone adjacent to the joint
irritation by the plate
removal may be necessary
24
Q

What is the outcome of arthrodesis?

A

pain free
functional limb
will always have gait abnormality

25
Q

When is amputation a considered tx?

A

when other methods are deemed unsuccessful/too risky

a palliative tx for intractable pain

when the owner makes an informed decision for their pet

26
Q

What are the physical indications for amputation?

A

neoplasia- bone tumors, soft tissue tumors

severe vascular injury leading to ischemia- gangrene, frostbite trauma etc

Neurological injury- partial/complete paralysis of limb, self mutilation

intractable pain for other reasons

27
Q

What are the principles of amputation?

A

Gentle tissue handling

careful hemostatsis

respect nervous tissue

close dead space

aggressive pain management

28
Q

What is one of the most important things to consider prior to amputation?

A

the ability of the animal to ambulate after Sx

29
Q

What makes a candidate good for amputation?

A

ability to ambulate of remaining legs-> do orthopedic/neruo exam
educated owners

30
Q

What are the 3 types of amputation?

A

Front limb

Hind limb

Other digit / tail

31
Q

What are the types of front limb amputations?

A

Forequarter amputation- entire limb

Shoulder dis-articulation amputation

Mid humeral amputation

32
Q

What are the types of hind limb amputation?

A

Coxofemoral dis articulation

mid femoral dis articulation- cut femur remove everything below it;

they are both essentially the same functionally

33
Q

T/F

Declawing is not technically considered an amputation

A

FALSE

nailbed is in distal part of bone, take whole thing

34
Q

What essential procedures must completed during limb amputation?

A

double ligation of major arteries and veins

careful closure of dead space

cosmesis

35
Q

What analgesia is provided for ampiutation

A

IV opioids, lidocaine, ketamine

Epidural: provides central analgesia for animal

Direct nerve block: epidural bupivacaine

Local anesthetics- soaker catheters = CRI or intermittent dose of bupivacaine or lidocaine- have fenestrations in catheter that will give constant rate of infusion

36
Q

What are the general complications w/ anesthesia?

A

hemorrhage/ seroma,

incision site infection/incision dehiscence

phantom pain

incomplete tumor excisions

37
Q

T/F

Amputation of a neoplastic limb is usually curative w/o other medical management

A

FALSE

lifespan is limited, must do in conjunction w/ chemotherapy

38
Q

T/F

Both amputation and arthrodesis are viable methods for relieving pain in dogs, and are not viable in cats

A

FALSE

its fine for both

Surgery Exam 2 (8 decks)

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