SASx - Surgery Lab Quiz Material Flashcards
Which bandage layer is in direct contact with the wound or the patient surface?
primary layer
This is the most common adherent bandage:
wet to dry
What are the 3 primary components of bandages?
primary layer, secondary layer, tertiary layer
What method of bandage anchoring is shown below?
torso strap
figure 8 bandage material around forelimbs further helps to hold the chest bandage in a cranial position
What method of bandage anchoring is shown below?
tie over bandage
A Spica Splint is a temporary splint for fractures or luxations at what location?
proximal to, or including the elbow or stifle
provides immobilization of upper extremities
-
Materials used:
- Porous tape
- Roll cotton
- Conforming bandage
- Elastikon
- Splint rod
What sling would be recommended to create a non-weightbearing forelimb?
Velpeau Sling
- Creates non-weightbearing forelimb
- immobilization after reduction of shoulder luxation
- Primary stabilization for some scapular fractures
- Materials: cast padding, conforming gauze, elastikon
What sling would be recommended to create a non-weightbearing hindlimb with inward hip rotation?
Ehmers Sling
- Figure of Eight sling
- Creates non weight bearing hind limb
- Provides femoral abduction
- Inward hip rotation
- Indication after reduction of cranial dorsal hip luxation
What are some indications for a Robinson Sling (pelvic limb sling)?
- Tibial or femoral fracture repair
- Post-op coxofemoral or stifle surgery
T/F: When applying the secondary bandage layer on small animal patients, it is important to always apply the rolled material proximal to distal on the limb
False
It is important to apply the material _distal_ to _proximal_. If we go proximal to distal, we almost always cause venous congestion in the distal limb and swelling of the paw
What orthopedic examination is being performed in this image?
cranial drawer test
What is shown here?
coxofemoral luxation
What diagnostic modality is being used here?
nuclear imaging
-
Indications for Nuclear Imaging
- Normal radiographs in presence of clinical lesion
- Unable to localize the lesion
- Evaluation for suspected metastasis
- Monitor response to therapy
- CT has replaced this diagnostic in many instances
What materials are used for a Modified Robert Jones bandage?
porous tape, cast padding, conforming bandage, elastikon or vet wrap
What are some indications for a full leg cast?
-
Indications
- Minimally displaced stable fractures
- Distal to the elbow or stifle
- Young fast healing patients
- Used as adjunct following internal fixation or arthrodesis
What are some contraindications for a full leg cast?
- Don’t apply over wounds
- Don’t apply with significant inflammation
- Don’t cast femur or humerus
When using radiography for diagnosis of orthopedic limb disorders, __________ views are a necessity for making a proper diagnosis.
orthogonal views
What fracture configuration is ideal for the use of cerclage wire?
Long oblique
How far apart from the fracture ends should cerclage wires be placed?
0.5 cm
Name the cerclage wiring technique used on short oblique fractures in conjunction with a K-wire:
Skewer pin
Which fixation technique would be ideal for treatment for the fracture shown in this radiograph (avulsion fracture)?
Tension band
What two types of Salter Harris fractures might go undiagnosed on initial radiographs?
SH-1 and SH-5
What type of fixation would be best for treatment of a Grade IIIA open fracture?
External Skeletal Fixation
What determines the bending strength of a screw?
Core diameter
What fractures must always be anatomically reconstructed?
Articular fractures
Name at least three ways to increase the rigidity of an external skeletal fixator construct:
- Frame type (I-III)
- Double bar
- Interconnecting bars
- Reduce bone-connecting bar distance
- Pin distribution à Pins close to ends of bone & fracture = most stable
- Increased number of pins
- Larger diameter of pins and connecting bar
Name the condition that can occur when a young animal’s comminuted femoral fracture is treated with rigid immobilization for an extended period of time
Quadriceps contracture
Of the four A’s that are evaluated in post-op fracture repair radiographs, which term relates to the positioning of the joints?
Alignment
In biomechanics, what is the term for the point at which a material transitions from elastic to plastic deformation?
Yield Point
What antibiotic is the best first choice for treatment of an open fracture?
Cefazolin
What is the most common complication associated with external skeletal fixation?
Pin tract morbidity/drainage/infection
What percentage of the medullary canal should be filled by a Steinmann pin if it is the primary means of fixation?
70%
What fixation methods (2) cannot be used in the radius?
Interlocking nail and intramedullary pin
When placing cerclage wires, how should they be positioned in reference to the long axis of the bone?
Perpendicular
After achieving compression of a short oblique fracture using a lag screw, you also place a plate to protect the compression and apposition achieved lag screw. What plating mode is demonstrated in this example?
Neutralizing plate
Briefly describe this fracture. What immobilization method is recommended (external coaptation or surgical fixation)?
closed transverse comminuted laterally displaced fracture of the radius and ulna
- Repair with surgical fixation (could use DCP plate, LC-DCP plate in bridging mode, external fixator)*
- You would not use external coaptation on a comminuted fracture*
This is a closed transverse comminuted laterally displaced fracture of the radius and ulna. How quickly do we expect this fracture to heal once it is stable?
~6-8 weeks
This radiograph is from a 5-month-old, male intact mixed breed dog. He presented with a left hindlimb lameness after jumping off the couch.
What type of fracture is this? What immobilization/fixation metho is recommended for this fracture?
closed, proximally displaced left tibial avulsion fracture
Pin and tension band is recommended for this fracture.
This is Sadie, an 8 month old, FS, Labrador Retriever. What kind of fracture is present here?
Why is external coaptation not recommended for this type of fracture?
Salter Harris 4 fracture of the right lateral humeral condyle with proximal and lateral displacement
External coaptation is not recommended for this type of fracture because this is a fracture that involves a joint surface
The image below shows a Salter Harris 4 fracture of the right lateral humeral condyle with proximal and lateral displacement. What type of repair must be acheived in this patient?
anatomical reduction
What type of screw was likely used to maintain reduction across the condyle? Most likely a cancellous screw placed as a lag screw
This is Stuart, an 8 month old, MN Yorkshire terrier. Describe the fracture. Can external coaptation be recommended in this patient?
transverse fracture of the radius and ulna
External coaptation can be recommended for this fracture. It is a transverse fracture, and is not comminuted. You should be able to reduce this and it should be able to bear weight
Any surgical incision into the abdominal cavity is termed:
celiotomy
Laparotomy refers to a flank approach. The terms are often used interchangeably
What procedure has been performed here?
enteroplication
for prevention of intussusception
__________ refers to a foreign object, such as a mass of cotton gauze or a sponge, that is left behind in a body cavity during surgery
gossypiboma
What is the most common surgical approach to a celiotomy?
ventral midline
What surgical approach is indicated by the red dotted line?
paramedian approach
- This approach is usually done by accident. Ideally you don’t want to go paramedian because you would be cutting through muscle tissue, which bleeds a whole lot more than the linea alba. It also carries higher surgical complications.*
- AVOID A PARAMEDIAN APPROACH WHENEVER POSSIBLE*
What surgical approach is indicated by the blue dotted line?
paracostal approach
Incision is made ~1-2 cm caudal to the last rib. This approach is useful when you’re managing surgical structures in the cranial ventral abdomen (ex: liver, diaphragm, stomach, etc.)
What surgical approach is indicated by the dark green dotted line?
flank approach
helps for visualization of more dorsal structures (ovaries, kidneys, adrenal glands)
When performing a ventral midline approach, the aim is to incise through the ________ and avoid the ________ muscle
When performing a ventral midline approach, the aim is to incise through the linea alba (visualized best at the umbilicus) and avoid the rectus abdominus muscle
For a ventral midline approach, if you make your initial stab incision cranially, what would you use for the rest of your incision?
scalpel and groove director
For a ventral midline approach, if you make your initial stab incision caudally, what would you use for the rest of your incision?
scissors
When performing a ventral midline approach, you may run into a structure called the falciform ligament, primarily composed of adipose tissue. What options do you have for moving past the falciform ligament?
- Simply push it out of the way
- Remove it
- Electrocautery
- Ligation and resection
Identify this structure in the cranial quadrant of the abdomen:
ruptured diaphragm
Identify this structure in the cranial quadrant of the abdomen:
stomach
it’s being held out of the abdominal cavity with babcock forceps
Identify this structure in the cranial quadrant of the abdomen:
gall bladder and liver
Identify this structure in the cranial quadrant of the abdomen:
pancreas
Identify this structure in the right quadrant of the abdomen:
duodenum
Identify this structure in the right quadrant of the abdomen:
right kidney
Identify this structure in the right quadrant of the abdomen, just below the hemostats:
ureter
This structure is bigger than normal - this is a hydroureter
Identify this structure in the left quadrant of the abdomen:
descending colon
- IMPORTANT: This is the structure that you would have to retract in order to visualize a ruptured left ovarian pedicle*
- The procedure shown is a colopexy*
Identify this structure in the central quadrant of the abdomen being held in the fingers?
cecum
Identify this structure in the central quadrant of the abdomen:
jejunum and mesentery
Identify this enlargement in the mesentery in the central quadrant of the abdomen:
mesenteric lymph node
Identify this structure in the central quadrant of the abdomen:
ascending colon
Identify this structure in the central quadrant of the abdomen:
ventral ligament of the bladder
(remnant of the urachus)
What scalpel grip provides the best accuracy and stability for long incisions?
fingertip grip
What is the layer of strength (holding layer) for abdominal wall closure?
external rectus sheath
How many layers of closure should be used for the urinary bladder?
TWO
- First layer - simple continuous
- Second layer - inverting pattern (Cushing or Lembert)
What suture should be avoided when closing the abdomen after a celiotomy?
chromic gut, silk, vicryl rapid, polymerized caprolactam
When performing a subcutaneous closure, why do we bury the knot?
minimizes chance of suture tags or knots being exposed through skin
What are the acceptable suture patterns for skin closure after a celiotomy?
simple interrupted, simple continuous, cruciate, ford interlocking
Removal of both testicles, regardless of location is termed:
castration
What surgical approach is most often used for routine elective castration?
pre-scrotal
What surgical approach is most often used for castration of mature, large breed dogs?
scrotal approach
scrotal approach is used when also removing scrotum (scrotal ablation)
When performing a pre-scrotal castration, you want to incise over the testicle on midline through the skin, subcutaneous tissue, and spermatic fascia to expose the __________ tunic
parietal vaginal tunic
When performing a pre-scrotal castration, you want to incise over the testicle on midline through the skin, subcutaneous tissue, and spermatic fascia to expose the _parietal vaginal tunic_
Be careful not to cut through the parietal tunic
When positioning the testicle for incision (for a pre-scrotal castration), what is the name of the incisional landmark?
median raphe
For a closed castration, a three-clamp technique is typically used and the pedicle is double ligated. What ligatures are typically used?
- Miller’s knot in proximal crush
- 2nd ligature: transfixing
- Absorbable, monofilament suture
- 2-0 suitable for most dogs
T/F: For an open castration, it is important not to incise through the parietal tunic
False
For an closed castration, you will not incise through the parietal tunic. For an open castration, you will incise through the parietal tunic to expose the testicle (NOT the visceral tunic - if you incise into the visceral tunic, you’re actually incising into the testicle)
When performing an open castration, it’s important to ligate the vascular and non-vascular components separately. What are the vascular components? What are the non-vascular components?
- Vascular: artery, nerve, pampiniform plexus
- Non-vascular: parietal tunic, cremaster muscle, ductus deferens
For feline castration, if you incise through the spermatic fascia, this is considered a(n) ________ castration. If you incise through the parietal tunic, this is considered a(n) ________ castration
For feline castration, if you incise through the spermatic fascia, this is considered a closed castration. If you incise through the parietal tunic, this is considered an open castration
What procedure is shown below?
feline open castration
What are some complications associated with castration?
- Scrotal bruising or hematoma (most common)
- Hemorrhage - inadequate ligation
- Infection
- Dehiscence
