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WSV18-0120
ORTHOPEDIC SURGERY
PATELLAR LUXATION – WHEN TO & HOW TO BALANCE SOFT TISSUE TENSION
R. Palmer1
1Colorado State University, Clinical Science, Fort Collins, USA
The key to successful management of patellar luxations is to identify and correct each of the factors contributing to mal-tracking of the patella in the specific patient being treated. No single treatment nor collection of treatments will be consistently effective in all patients. Bony contributions to patellar luxation may include a shallow and/or shortened trochlear sulcus, a displaced tibial tubercle or other skeletal malformations. Similarly, chronic and persistent patellar luxation (grade 3 and grade 4 luxation) tend to distort the proper balance
of soft tissue tension surrounding the patella. Often, especially with grade 3 and grade 4 luxations, soft tissue reconstructions are required to balance the tension in the soft tissues that surround the patella.
Soft Tissue Reconstructionsinclude capsular/retinacular/ muscular release, imbrications, and anti-rotation sutures. Soft tissue reconstructions, by themselves, will not correct bony conformational abnormalities. Soft tissue reconstructions are most commonly performed
in conjunction with skeletal reconstructions. Release
of thickened and contracted medial joint capsule/ retinaculum is achieved by their incision from the tibial plateau to the suprapatellar recess. In most grade 4 and some grade 3 MPL cases, the quadriceps muscle group is medially displaced (Fig 1) and must be elevated from the suprapatellar region to the proximal femur, being careful to protect the descending genicular vessels (this, alone, is a good reason to refer these cases to a trained orthopedic surgeon). The pes anserinus muscle group (sartorius, gracilis, and semi-tendinosus muscles) can be released by elevation of their insertions on the medial aspect of the proximal tibia if their tension is causing internal rotation of the stifle. Stretched lateral joint capsule/retinaculum often need to be tightened
to achieve balanced soft tension upon the patella. In grade 4 MPL cases, redundant joint capsule lateral to the patella must usually be excised. Reconstruction of the lateral joint capsule helps to properly balance the tension in the peri-patellar tissues. Extracapsular lateral fabello-tibial anti-rotation sutures can be placed to limit excessive stifle rotation and are particularly beneficial in dogs with combined MPL and cranial cruciate ligament rupture. The tibial anchor point of the extracapsular suture can either be to paired bone tunnels at the level of the extensor sulcus of the tibia (adjacent to the long digital extensor) or to a pre-formed eyelet in a tibial tension band wire.
Your Singapore, the Tropical Garden City
WSV18-0237
VECCS
USE OF TFAST AND AFAST IN EMERGENCY PATIENTS
Y. Bruchim1
1Senior Lecturer of Veterinary Medicie,
The Hebrew University of Jerusalem, Jerusalem, Israel
The use of ultrasound has developed over the past 50 years as an indispensable first-line diagnostic tool for traumatic patients and cardiac/respiratory evaluation
of symptomatic patients. AFAST focused examination
of four sites in the abdomen designed to evaluate presence of free abdominal fluid, while TFAST is used to detect the presence of air or fluid in the pleural and pericardial space. The Blue VET (beside lung evaluation) was developed in as emergency lung ultrasound to detect interstitial- alveolar lung injury.
AFAST- Abdominal Focused Assessment with Sonography for Trauma
There are 2 applications of AFAST in dogs experiencing abdominal trauma:
1. AFAST- focused examination of four sites in the abdomen designed to quickly (5 minutes) to rule in or rule out the presence of free abdominal fluid (typically indicative of hemorrhage) in 4 quadrants of the abdomen. (figure 1) FAST examinations are very sensitive and specific for detection of free abdominal fluid, even when performed by non-radiologists, but are less sensitive at detecting intra-abdominal injury following penetrating trauma than following blunt trauma.
(Boyen & Rozanski JAVMA 2004).
2. Serial AFAST (Lisciandro et al, JVECC 2009) - Serial AFAST examinations was designed to detect changes
in the quantity of fluid present in the abdomen over
time, especially when combined with determination of abdominal fluid score (AFS). Serial AFAST examinations should be performed every 2 - 4 hours, or more frequently as dictated by clinical findings. Some dogs with negative results on the initial AFAST examination had positive findings on serial AFAST examinations. Abdominal fluid score- semiquantitative evaluation of the degree of free fluid (typically hemorrhage) performed by recording the number of sites among the four standard views. Animals with an AFS of 0, 1, 2, 3, and 4 would show negative findings at all sites, positive results at
one site, positive findings at any two sites, positive results at any three sites, and positive findings at all four sites, respectively. The study indicate that AFS of 3&4 is associated with higher risk of anemia, blood transfusion and increased alanine aminotransferase (PCV<25%) (Lisciandro et al, JVECC 2009).
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