Amputation and Arthrodesis

Question 1

What is: a surgical treatment leading to joint fusion?

Answer 1

Arthrodesis

Question 2

What is: a non-surgical condition leading to joint fusion?

Answer 2

Ankylosis

Question 3

What is: the removal of an appendage, or a portion thereof?

Answer 3

Amputation

Question 4

What are the 4 major indications for arthrodesis?

Answer 4

1. Irreparable fracture of the joint
2. A chronically unstable joint
3. Chronic, severe degenerative joint disease
4. Neurologic injury causing partial paralysis of the limb

Question 5

Which joint is NOT amenable to arthrodesis?

Answer 5

Hip joint

Question 6

What are 4 alternatives to arthrodesis?

Answer 6

1. Medical management
2. Total joint replacement
3. Excision arthoplasty
4. Amputation

Question 7

What are the 4 major principles to a successful arthrodesis?

Answer 7

1. Articular cartilage removal
2. Bone graft
3. Joint fusion at an anatomic standing angle
4. Rigid fixation

Question 8

For a successful arthrodesis, you’ll want to remove the articular cartilage and expose the ___ ___.

Answer 8

Subchondral bone

Question 9

Bone grafts are used in arthrodesis to speed the formation of what?

Answer 9

Callus

Question 10

What is the advantage to callus formation in an arthrodesis joint?

Answer 10

Decrease of implant fatigue and implant failure

Question 11

Which of the following stimulates bone healing and inducting other cells to come into the area: osteogenesis, osteoconduction, osteoinduction, osteopromotion?

Answer 11

ALL OF THE ABOVE

Question 12

What are the 4 sources from which you can get an autogenous cancellous bone graft?

Answer 12

1. Proximal humerus
2. Distal femur
3. Proximal tibia
4. Ilial wing

Question 13

What is the name of the instrument used intraoperatively to measure the anatomic standing angle of a joint?

Answer 13

Goniometer

Question 14

True or False: The arthrodesis will not heal if it is not rigidly fixed.

Answer 14

TRUE

Question 15

Following an amputation, for how long should you support that limb with external coaptation?

Answer 15

6-8 weeks

Question 16

For how long should that limb be in a splint?

Answer 16

The first 4-6 weeks

Question 17

For how long should that limb be in a soft padded wrap?

Answer 17

The remaining 2-4 weeks

Question 18

What are the 3 indications for a carpal arthrodesis?

Answer 18

1. Carpal hyperextension injury
2. Shearing injury
3. Carpal luxation

Question 19

What are 3 indications for a pantarsal arthrodesis?

Answer 19

1. Severe loss of bone and soft tissues
2. Rupture of the common calcaneon tendon
3. Talocrural luxation

Question 20

A tourniquet may not be applied for more than ___ hours.

Answer 20

1.5 hours

Question 21

True or False: A tourniquet has no effect on infection rate.

Answer 21

FALSE: A tourniquet can increase infection rate

Question 22

What are 4 complications associated with arthrodesis?

Answer 22

1. Infection
2. Implant loosening
3. Fracture of bone above or below implant
4. Irritation by the plate

Question 23

True or False: The owner should expect a gait abnormality following an arthrodesis.

Answer 23

TRUE

Question 24

What are 4 specific indications for amputation?

Answer 24

1. Neoplasia
2. Severe vascular injury (gangrene, trauma)
3. Neurological injury
4. Intractable pain

Question 25

What are the 5 important principles of amputation?

Answer 25

1. Gentle tissue handling 2. Careful hemostasis 3. Respect to nervous tissue 4. Closure of dead space 5. Aggressive pain management

Question 26

Prior to an amputation, which 2 examinations must you complete, in addition to the general physical exam?

Answer 26

1. Orthopedic exam | 2. Neurologic exam

Question 27

What is a full amputation of the front limb called?

Answer 27

Forequarter amputation

Question 28

What is a full amputation of the hindlimb called?

Answer 28

Coxofemoral disarticulation

Question 29

A mid-femoral amputation requires a ____ of the femur.

Answer 29

Osteotomy

Question 30

What are 4 reasons for a digit amputation?

Answer 30

1. Neoplasia 2. Trauma 3. Infection 4. Mutilation

Question 31

Is declawing considered to be an amputation, yes or no? Why or why not?

Answer 31

Yes - P3 has the nail bed, so you are removing P3 and the ungual crest

Question 32

What 3 analgesics might you use IV for an amputation?

Answer 32

1. Ketamine 2. Opioids (morphine, hydromorphone, fentanyl) 3. Lidocaine

Question 33

Describe the care for an amputation post-operatively.

Answer 33

1. Pain management 2. Weight management 3. Exercise restriction 4. Sling for support 5. Ice/warm pack 6. AND address other orthopedic conditions

Question 34

What are 4 general complications associated with an amputation?

Answer 34

1. Hemorrhage 2. Seroma 3. Incision site infection 4. Incisional dehiscence

Question 35

What are the general outcomes of an amputation? What will you tell a client?

Answer 35

Most dogs have excellent function and quality of life. They may be limited by other orthopedic, neurologic, or medical conditions, but the amputation will not be the life-limiting factor in these dogs!

Question 36

Neoplasia limits lifespan. In this case, amputations are best used in conjunction with ____.

Answer 36

Chemotherapy

Question 37

The risk of complications can ___ with careful patient selection and by following good surgical principles.

Answer 37

Decrease