Salvage procedures Flashcards
What are some indications for Amputation?
- Neoplasia
Severe trauma - Peripheral neuropathy
- Ischaemic necrosis
-Intractable infection - Severe disability (Oa, congenital deformity)
What contraindications to amputation?
- Other limb orthopaedic condition
- Other limb neurological condition
- Obesity
Preop Checks for amputation?
- CBC
- Chemistry
- Electrolytes
- UA
+/- Staging
What considerations for amputation surgery?
- analgesia: nerve blocks/ epidural or perineural local analgesics + opioids
- Preop AB
- Proper tissue handling
- Proper wound closure
- Aseptic surgery
What does full thoracic limb amputation involve?
- Scapulectomy
- shoulder joint disarticulation
What is involved for full pelvic limb amputation?
- Coxofemoral disarticulation
- Mid-femur
What can also be done?
Partial amputation
How do we go about incising in an amputation?
- Standard or variation skin incision
- Only transect extrinsic mausculature - electrocautery
- Arteries and veins ->
Individually (avoid arteriovenous fistulas
Triple ligated
Order- contraversial
Long - lasting absorbable suture
What muscles to consider in scapulectomy?
What muscles to consider in hip diarticulation?
Pt 2?
What post-op consideraitons
- Drain & wound soaker catheter
- Cold packs
- Analgaesia – IV & PO
- Urinary management
- Rest → modified exercise
- Physiotherapy
Outcomes of amputation?
- Good to excellent outcome
- Gait exchange
- Uncommon bhvr chnages
What complications from amputation?
- Haemorrhage
- Seroma
- Dehiscence
- Infection
- Neuroma formation
- Phantom pain
- C disc herniation
- Tumour recurrence
What can we do for partial limb amputations?
- Intraosseous endoprostheses
- Exoprostheses
Indications for FHNE?
- Degenerative joint disease
- Femoral head fracture
- Septic arthritis
- Capital physis dysplasia
- Acetabular fractures
- Septic arthritis
where do we cut for FHNE?
Post op consideraitons for FHNE?
- Multimodal analgesia
- 2-3 weeks rest
- Physical rest
Outcomes of FHNE?
- Good 38%
- Satisfactory 20%
-Poor 42%
Goal of THR?
- ‘normal anatomy’
- Good function
- Pain free
Indications for THR?
- degenerative joint dx - hip dysplasia
- Femoral head fractures
Contraindications to THR?
- Obeses patients
- Pyoderma
- Neurologic conditions affecting ambulation function
- Septic arthritis
- Coagulopathies
- Overt renal, hepatic or cardiac dx
What different THR can be used?
- Cemented
- Press fit
- Screwed
- Hybrid
What is arthrodesis?
Surgical immobilisaiton of a joint by fusion of the bones
Indications for arthrodesis?
- End stage OA
- Joint instability
- Non-reparable fractures involving the joint surface
- Shearing injuries
- Joint infection not responding to medical management
- Tumours in or around joints
- Immune-mediated arthritis
- Muscle/ tenodn rupture
What joints cna we do arthrodesis in?
- Carpus
- Tarsus
- Shoulder
- Elbow
- Stifle
What steps involved in arthrodesis?
Joint debridement -> bone graft > rigid stabilisation -> rest
What can be used in Bone grafting?
- Autologous cancellous bone graft
- Allograft
Rigid stabilisation for arthrotdeiss?
Medial plate, dorsal plate ?
How long to rest after arthrodesis?
8-12 weeks
- Crate/room rest
- Short on lead walks
- avoid jumping, running
- Avoid stairs
- avoid climbing furniture
- +/- temporary bandage
Complications of Arthrodesis?
- Infection
- Dehiscence
- Necrosis
- Bone/ implant failure
- Pain
