Veterinary Orthopedics Surgeries Summary

Veterinary orthopedics is a specialty that studies, diagnoses and treats cases of traumatologies (dislocations and fractures) and pathologies related to the bones, muscles, joints and ligaments of pets. This specialization arose with the advancement of the veterinarian and aims to offer better treatment to animals and provide them with pain relief and more quality of life.

Orthopedics in small animals takes care of their skeletal structure, being considered one of the fastest growing specialties. Locomotion is part of the pets' quality of life. These are increasingly present in world homes and have reached a longer life expectancy. What many tutors expect is that these animals will be able to reach old age while maintaining well-being. Thus, there is a very high demand for orthopedic services.

Diseases of the locomotor system in dogs comprise 15% to 35% of the visits in veterinary clinics. We know that many pets are agitated and curious and even the most peaceful are subject to falls. Or in other situations they may get involved in fights, being run over or suffering fractures due to old age.
Professionals who choose to work in this area, need to know in depth about the aspects involving bones, muscles and joints. In addition, you need to have security to perform basic and complex surgeries.

Initial orthopedic examinations


Orthopedics in small animals involves performing tests and techniques that will identify the injury and the degree to which it is found. Thus, the veterinarian will choose the most appropriate method to stabilize fractured bones or reposition joints that have suffered an injury. The most common complaint in offices is patients who suffer from joint diseases and usually have an injury.

The first step in performing the exam is to assess the clinical signs of lameness over obtaining the animal's health history. At this stage, it is important that the animal is free to move from side to side. Thus, the veterinarian is able to observe signs of lameness. Furthermore, possible muscle atrophies should be checked, and if there is abnormal muscle development.

This previous analysis allows to identify which limb was affected, afterwards it is necessary to perform the palpation on the affected limb and leave for the exams. However, to apply the techniques safely, veterinarians need a lot of practical experience. Only through it will it be possible to develop surgical skills and know the most common complications in each procedure. In the next topic, we'll talk about the tests that help with diagnosis.

Main signs of orthopedic problems in pets

In addition to mobility difficulties, there are a number of typical signs that can be noticed in animals with some orthopedic disease, among which we can highlight:

• Loss of appetite
• Pain when moving
• Reluctance to get up or lie down
• Difficulty urinating and / or defecating
• Avoid supporting or using a specific member when moving
• Biting or licking excessively some part of the body
• Do not move or spend too much time in the same position

Main orthopedic surgeries in dogs

• Patella dislocation

Patellar dislocation is one of the most common abnormalities affecting dogs' knees. The condition can be congenital, also referred to as developmental, or traumatic, with dislocation of the congenital medial patella being the most frequently observed. The pathophysiology of congenital dislocation is not fully understood, as there is little objective data to suggest which of the associated deformities contribute to the induction of the dislocation and which develop as a result of patellar dislocation.

The intensity of the deformities depends on the severity of the patellar dislocation and the age of the animal. Another important factor is the permanence of the dislocation; the longer the abnormal forces act on a young dog's physical plaque, the greater the angular and torsional changes.

Clinical signs vary with the degree of dislocation and include intermittent or consistent lameness, conformational defects, pain and reluctance to move. The diagnosis is based on palpation of the affected knee, however radiographic examination is useful to document the degree of limb deformity as well as the degree of osteoarthritis present in the knee joint.

Treatment is dependent on the degree of dislocation, most of which is performed through surgical procedures for soft and bone tissue reconstruction. However, regardless of the techniques, the objective is to ensure that the patella is properly positioned in the trochlear groove and, thus, remains throughout the range of motion.

The specific etiology of patellar dislocation is not fully understood. In most cases, the lesion is considered to be congenital or developmental, but it can also be of traumatic origin. The history and presence of other clinical signs, such as lacerations, abrasions, fractures, can assist in the diagnosis of traumatic patellar dislocation. There are several surgical methods for treating patellar dislocation and the choice depends on the severity of the injury, or even on the surgeon's preference. Combinations of techniques are generally performed to obtain better results. This approach was adopted in the dogs mentioned in the present report, since, in the cases of grades I and II, the treatment used was the technique of superimposing the lateral retinaculum combined or not with trocleoplasty.




Additionally, the transposition of the tibial crest was performed in some grade II knees. In the cases of grades III and IV, the methods included overlapping the lateral retinaculum, trocleoplasty, demotomy, quadriceps release, transposition of the tibial crest and, eventually, the fabella-patella suture. In addition, due to the severity of the injury, in a dog with grade IV, osteotomy of the femur was included.

• Fractures

Vertebral fractures and dislocations (FLV) are caused by traumatic or pathological injuries of the spine, resulting in compression, laceration, concussion and / or section of neural structures.

It is considered a serious condition, due to the high risk of permanent spinal cord damage and corresponds to approximately 7% of neurological disorders in dogs. They are most often caused by automobile accidents. It also occurs due to a fight between animals, kicks, falls, shocks against stationary objects, neoplasms or vertebral infections and nutritional osteopathies. It most frequently affects the thoracolumbar region of the spine (T3-L3).

About 40 to 83% of patients with FLV have intercurrent lesions in other systems.

Therefore, a thorough clinical examination is necessary to recognize these lesions before proceeding with specific investigations. The diagnosis is based on anamnesis, acute clinical and neurological signs and obtaining images of the spine and spinal cord. Clinical signs range from vertebral hyperpathy to paralysis with loss of nociception, depending on the severity of the injury. Conservative treatment consists of the administration of neuroprotectors, analgesics and immobilization of the spine. Surgical treatment aims at decompression of the spinal cord, alignment of the spinal canal, stabilization of the spine and removal of possible bone fragments from within the spinal canal.





The prognosis depends mainly on the assessment of nociception, which indicates the severity of the spinal cord injury, in which its presence indicates a favorable prognosis and the absence, a prognosis reserved for the unfavorable.

Cruciate

ligament Cruciate ligaments are structures that play an important role in the stability of the knee joint. The rupture of these is generally associated with excessive stress on the joint, occurring most often in young dogs of large breeds.

The rupture of the cranial cruciate ligament is one of the relatively common conditions in the dog, having been described for the first time in 1926, and is one of the main causes of degenerative disease of the knee joint.
The cranial cruciate ligament is the most affected, as it is primarily related to joint movement, preventing cranial displacement of the tibia in relation to the femur, limiting internal rotation and, consequently, knee hyperextension. Caudal cruciate ligament rupture, although rare, is associated with rupture of the cranial ligament.

The ligamentous lesion can be a complete rupture, with visible instability, or partial, with secondary instability; however, both exhibit degenerative joint changes within a few weeks. The most common mechanism of rupture of the cranial cruciate ligament consists of a sudden rotation of the knee with the joint in 20 ° to 50 ° of flexion, since in this position the ligaments twist on themselves or on each other to limit the internal rotation of the tibia in relation to the femur.

The diagnosis is based on the clinical history that reveals a picture of acute lameness in the hind limbs, particularly during exercise. Chronic and persistent lameness can also occur, especially in older and heavier dogs.

To confirm the diagnosis, abnormal cranial movement of the tibia should be checked, testing the instability of the joint with the tibia to the maximum extent, in flexion of 15 ° to 30 ° ( Lachman Test ), and in 45 ° to 90 ° of flexion, featuring the so-called "cranial drawer signal". However, as the drawer signal is not always evident in cases of partial rupture, in these cases, the diagnosis must be based on history and instability with joint effusion (STROM, 1990).

Radiographic examination reveals the degree of joint involvement. Dogs with chronic rupture of the cranial cruciate ligament develop medial thickening of the joint capsule. Numerous techniques for repairing the ruptured ligament have been described in the literature, following the original technique developed by PAATSAMA (1952), who used a fascia lata flap to reconstruct the ligament. Surgical treatment was studied by KNECHT (1976) and since then new concepts and techniques have been introduced. Surgery is required to stabilize joint surfaces, minimizing progressive degenerative changes. Herniated disc



Intervertebral disc disease (DDIV) is a frequent condition in the neurological clinic of dogs, representing 45.8% of the neurological cases treated by the Neurology Service of the Hospital Veterinário Universitário of the Universidade Federal de Santa Maria. The sites most affected by the disease are the thoracolumbar (T3-L3) and cranial cervical (C1-C5) segments of the spinal cord, occurring in 69.4% and 19.4% of cases of DDIV, respectively. Dachshunds are 12.6 times more likely to develop DDIV than other breeds.

DDIV is rare in dogs under two years of age. In dogs of chondrodystrophic breeds the average age varies between three and seven years and in non-chondrodystrophic dogs, it usually varies between six and eight years of age. Older dogs have a higher incidence of cervical DDIV. No correlation between age and recovery of dogs with DDIV was found in some studies, but other authors have demonstrated better and faster recovery in young dogs.



The clinical manifestation occurs due to a combination of the compressive effect of the disc material and the impact injury on the spinal cord, mainly resulting from the extrusion of the disc. It varies according to the affected spinal cord segment and the severity of the lesion, which can be evidenced only by spinal hyperesthesia, while the more severe ones can lead to tetraplegia / paraplegia with absence of nociception (deep pain) caudal to the lesion.

The classification of the severity of neurological dysfunction in grades I to V helps the clinician to issue a prognosis when assessing the patient.

The signs of neurological dysfunction for cervical and thoracolumbar DDIV are used for classification, where: Grade I, only spinal hyperesthesia, without neurological deficiencies; Grade II, ambulatory tetraparesis / paraparesis; Grade III, non-ambulatory tetraparesis / paraparesis; Grade IV, quadriplegia / paraplegia with the presence of nociception; and Grade V, quadriplegia / paraplegia with no caudal nociception to the lesion.

The diagnosis of DDIV is based on history and anamnesis, the lesion site defined by neurological examination and imaging tests. Simple radiography is hardly diagnostic for DDIV, however, in addition to excluding certain conditions from the differential diagnosis, it is possible to notice changes suggestive of disc disease. The accurate evaluation of spinal cord compression requires exams such as myelography, computed tomography or magnetic resonance imaging, making it possible to locate the compression. Differential diagnoses include trauma, fibrocartilaginous embolism, degenerative myelopathy, discoespondilitis, neoplasms and meningomyelitis.

Clinical treatment for DDIV is usually indicated for dogs with hyperesthesia associated or not with minimal neurological deficiencies and consists of absolute rest in a cage for four to six weeks, assuming that this time would be the minimum necessary for the repair of the fibrous annulus. Associated with rest, opioid analgesics, muscle relaxants, steroidal and non-steroidal anti-inflammatory drugs and physical therapy are indicated.

Surgery is the treatment of choice for dogs with severe neurological deficiencies (non-ambulatory tetraparesis, quadriplegia, paraplegia with or without nociception in less than 48 hours), in dogs that are refractory to clinical treatment, or that have recurrence of the disease.

Surgical procedures vary according to the injury site and compression position, and aim at decompression of the spinal cord. For cervical DDIV, the ventral slot is the procedure performed routinely and dorsal laminectomy and hemilaminectomy are less frequent. For thoracolumbar DDIV, the procedures frequently performed are hemilaminectomy, minihemilaminectomy and pediculectomy, associated with fenestration of the intervertebral disc

• Coxofemoral Dysplasia