16. Arthrodesis

Partial carpal arthrodesis - ________ injury - Affects _________ +/- CMC joint - ________ joint not compromised This type of arthrodesis is __________ done! - Hard to protect ROM of the ________ joint - Procedure: _________ plate or pins, _________ middle & CMC joints, ______ joint is spared

Acute Middle ABC Rarely ABC Dorsal Debride ABC

Pancarpal arthrodesis Debride _____ of the joints - remove all of the ________________ cartilage Generally use a _________ plate Hybrid plate: 3.5mm proximal and relatively _________ screws in radius with ________ screws in metacarpus

All Articular Dorsal Large Small

Principles of arthrodesis Correct procedure at the ___________________ time __________________ surgical approach Fix in _________-_____________ position - Best to get a goniometer out and measure correct angle on the healthy leg

Appropriate Atraumatic Weight-bearing

Proximal intertarsal luxation Calcaneoquartal _________________ - Fusion of the ______________ to the ____ tarsal bone Pin and _________-___ Tension band wire If more __________ we can stabilize with plate and screw

Arthrodesis Calcaneus 4th Figure-8 Chronic

Tolerance of arthrodesis Well tolerated - ____________: ABC, MC, and CMC joints - __________: PIT and TMT joints Less well tolerated 1. ________________ 2. Talocrural joint 3. ___________ 4. __________ Never: _______ joint

Carpus Tarsus Shoulder Stifle Elbow Hip

Complications Failure of ___________ - Overtime implant will fail Implant ___________ Incorrect _________ _______ alteration - Common, esp in carpal cases (circumduction) DJD of other joints - When you eliminate movement of one joint you accelerate OA in _________ joints, may need to manage other joints more __________________ Fracture: particularly at the ends of plates or situations with long lever arms ____________

Fusion Failure Angle Gait Other Aggressively Infection

Proximal intertarsal luxation Most common in the racing __________________ and the obese _________ type dog - Proximal ______________ luxation due to rupture of the ____________ ___________ ligament For good result, we need to _______ the joint

Greyhound Collie Intertarsal Plantar tarsal Fuse

Carpal ______________________ - Often in dogs leaping from height particularly if dog is on the heavy side - If foot is flat on floor (completely _________________): it will never be up-right with _________ management, arthrodesis is treatment of choice

Hyperextension Plantigrade Splint

Indications for arthrodesis Joint ________________ that cannot be addressed by ___________________ - Do not have ligament reconstruction processes we can use - Other management also not available Intractably ___________ joint due to ____ Inability to maintain joint ____________ - Mechanical: more common (___________________ tears) - Neurological

Instability Reconstruction Painful OA Posture Gastrocnemius

Arthrodesis _________________ surgical osseous ___________ of a joint to restore limb function - Eliminates joint _____________, goal is to maintain _____________ of limb, not the joint - Cannot do this in a _______: it will completely decrease functional ability

Irreversible Fusion Motion Function Hip

Tolerance of arthrodesis Joints of the ____________ and ____________: well-tolerated - ________-load, ________ motion joints - Eliminating motion in these will not create significant degree of dysfunction _______ motion joints: arthrodesis will have a significant impact - Ex. shoulder, hip, stifle

Tarsus Carpus High Low High

Principles of arthrodesis ________ articular cartilage - Want to expose ____________ subchondral bone - If you leave cartilage the joint will not _________ Cancellous ______ ________ - Helps promote fusion - Usually harvest from the _____________ ____________ ________ internal fixation - ____________ fixation is not robust enough Post-operative ____________ - Prevents complications Exercise ___________ _______________ - Ensure progression to arthrodesis before returning to _________ function

Debride Bleeding Fuse Bone graft Proximal humerus Rigid External Coaptation Restriction Radiographs Normal

Radiography Good quality ________________ views ____________ radiographs

Orthoganol Stressed