Ch 44 Coaptation, bandaging

Question 1

vWhat evidence is there for/against the role of bandaging for decreasing post-op swelling?

Answer 1

One report showed that bandaging for 24hr post TPLO did NOT decrease post-op swelling at 24 and 48hr

Another report has shown that bandaging was less effecting than cold compression at reducing post-op swelling 72hr post-op

Question 2

What is the recommended number of layers of each material for a soft padded/modified Robert Jones bandage?

Answer 2

3-5 layers of cast padding
2-3 layers rolled gauze
1 layer of adhesive tape/vet wrap with 50% overlap

Question 3

In which direction is it safest to wrap the antebrachium during bandaging?

Answer 3

Wrapping should be directed from lateral to medial over the cranial aspect of the antebrachium. Suppination can easily be induced if wrapped in the other direction.

Question 4

What is a safer alternative to a Velpeau sling?

Answer 4

A limb sleeve which is wrapped around the chest and limb and fastened with velcro straps dorsally

Question 5

List the three sling options to prevent weight bearing of the pelvic limb

Answer 5

1 - Ehmer sling - Provides flexion, internal rotation of the femur and abduction

2 - 90-90 bandage - prevents stifle and tarsocrural extension beyond 90 degress. Does not provide internal rotation

3 - Suspension sleeve - Subjectively safer and more convenient

Question 6

List the negative effects of joint immobilisation

Answer 6

Loss of joint motion
Loss of cartilage thickness and stiffness
Loss of muscle and bone mass
Cartilage degeneration

Question 7

Define orthosis

What are orthoses used for?

Answer 7

An external device placed on the body to support or protect a body part.

Used to control, guide, protect, limit motion of, or immobilise and extremity, joint or body segment

Question 8

List the advantages of orthoses over casts

Answer 8

Can be rapidly donned and doffed
The support they provide can be adjusted
They are subjectively safer, more convenient, and may cost less over the duration of the treatment

Question 9

What are exoprostheses used for?

Answer 9

Exoprostheses (aka socked prostheses) are used to manage incomplete limbs in animals with partial amputations up to the proximal third of the antebrachium or mid-crus

Question 10

How can you schieve stability with socket prostheses if the carpus/tarsus is gone?

Answer 10

By adding hinges at the elbow/stifle

Question 11

List some contraindications for socket prostheses (5)

Answer 11

Patient demeanour

Highly mobile skin in relation to underlying tissues

Moderate or severe neurological deficits (cannot place the limb appropriately)

Compromised joint motion

Problems present in the residual stump (neoplasia, infection, stump pain)

Question 12

What are active/dynamic hinges in relation to prosthesis?

What are they used for?

Answer 12

Active hinges are hinges which apply torque to a joint, usually to stretch it over a long period of time eg to treat a joint contracture

Question 13

What are the major set-backs of current surgically implanted prosthesis?

Answer 13

Difficulty to establish a stable skin-implant inferface that is not prone to infection

Question 14

List the methods of bone fixation for surgically implanted prostheses in companion animals (3)

How does this differ from humans?

Answer 14

Fixation with a bone plate or nail with screws or bolts

Press fit into the medullary cavity or outside the cortex

Cemented fixation

In humans, traditionally has relied on titanium rods screwed into the medullary cavity of long bones. The implants are then left unloaded for 12-18 months to allow bone ongrowth. This long period prior to loading the implants is not fesible in dogs

Question 15

Transdermal osseointegration is a logical choice compared to exoprostheses

Answer 15

(1) The high skin mobility in companion animals (compared to human beings) interferes with the stability of exoprostheses;

(2) there is much more labor involved in maintaining exoprostheses

(3) companion animals do not always readily accept

implant stability should be rapid or immediate.

Question 16

In a large retrospective study of 60 dogs with casts, what was the reported complication rate?

Answer 16

63% developed soft tissue complications

60% mild
20% moderate
20% severe
More likely in Sighthounds

Question 17

What are the reported bandage complication rates in dogs with immobilisation post patella tendon repair and PCA?

Answer 17

75% post patella

32% PCA attached to one MC

18% PCS attached to two MCs

Question 18

What is a Schroeder Thomas splint?

Answer 18

A splint used to apply traction at the fracture site

Largely fallen out of favour

Question 19

What are flexible orthoses typically made from?

Answer 19

Durable textiles such as breathable neoprene

Provide less support than ridig orthoses but are lighter, less likely to lead to abrasions and are more affordable

Question 20

What issues can arise in the contralateral limb of dogs who are growing with an incomplete limb?

Answer 20

Thoracic limb:
excessive scapular mobility (dt being a synsarcosis)
Scapular subluxation
excessive rotation of the shoulder
Angulation and torsion of the radius

Pelvic Limb:
Femoral and tibial angulation and torsion
Rotational laxity of stifle
Intertarsal rotational laxity

Question 21

What is a trunnion?

Answer 21

The external part of a surgically implanted prosthesis to which the prosthetic foot is connected

Question 22

orthoses functions

Answer 22

restrict joint motion in a given direction > carpal or tarsocrural joint hyperextension

limiting shoulder abduction with medial shoulder joint instability

limiting hip abduction after a ventral luxation of the hip joint.

promote specific motion > maintain carpal extension in dogs with radial nerve injury or to avoid scuffing (i.e., to promote tarsocrural joint flexion) in dogs with sciatic or peroneal nerve injury

Question 23

Evaluation of the effects of initial water temperature and curing
time on fiberglass cast strength
Perez-Nogues

Answer 23

Fiberglass casts continued to gain strength for at least 24 hours. Use of warm water increased the rate of curing, resulting in stronger constructs at earlier time points.

Clinical significance: Use of warm water is recommended to initiate fiberglass cast curing, especially if the casted limb will be loaded soon after cast application

Question 24

Evaluating Stiffness of Fibreglass and Thermoplastic Splint Materials and Inter-fragmentary Motion in a Canine Tibial Fracture Model

Answer 24

Constructs based on a FG splint were generally stiffer than
those based on TP. Under the loading conditions employed
in this study, the differences in stiffness were not associated
with significant differences in inter-fragmentary
motion when the two materials were compared. For dogs
with a mid-diaphyseal tibial fracture with an intact fibula,
both FG and TP are appropriate for use, but there may be a
marginal advantage to using a cranial FG splint for these
fractures.

Question 25

Supercutaneous Plating for the Treatment of Traumatic
Injuries of the Appendicular Skeleton in Dogs
Tommaso Nicetto 2019

Answer 25

retrospective case series, 5 cases

conical coupling locking plates, mean 16kg. one major comlplication implant failure. ALL fractures healed.

advantages of using supercutaneous plating over
external skeletal fixation include the lower profile of the
construct, the possibility for preoperatively contouring the
implant and ease of controlled-dynamization of the plate or
implant removal