Arthrodesis

Lateral plate arthrodesis

A lot fo greyhounds we see tha thave combos of PIT luxaiton w/ other tarsal pathologies are gonna be managed w/. What?

Carpal arhtrodesis These dogs circumduct so they don't catch their nails on a forward motion Tarsal dogs tend not to have significant gait alteration

Alteration of gait due to arhtrodesis is particularly a complication in what situation?

Rarely done bc it's difficult to place these implants w/o compromising ROM of the joint Although ABC joint captures the majority of the ORM, the amount of ROM you salvage w/ a partial carpal arhtrodesis is often very disappointing

How commonly are partial carpal arthrodesis procedures done ? Explain

Pancarpal arhtrodesis This probs should be done instead of partial carpal

Hwo do you revise a partial carpal arhtrodesis due to crappy ROM of hte carpal joint?

1. Joint instability that cannot be addressed by reconstruction 2• Intractably painful joint due to osteoarthritis 3• Inability to maintain joint posture A. *Mechanical* B. Neurological

List indications for arthrodesis

1. Correct procedure at appropriate time 2. Atruamatic surgical approach 3. Fix leg in weight bearing position 4. Debride articular cartilage Essential to expose bleeding subchondral bone 5• Cancellous bone graft To help promote fusion 6• Rigid internal fixation 7• Postoperative coaptation 8• Exercise restriction 9• Radiograph

List the eprinciples of arthrodesis

1. Shoulder 2. Talocrural joint 3. Stifle 4. Elbow 5. Hip Bc theyre high motion joints If you fuse them, we have a Avery significant impact on joint function We CAN do arthrodesis in these joints, but it's our preference NOT to do that

List the joints that do not tolerate arthrodesis well. Explain why htis is the case

1. Failure of fusion 2• Implant failure 3• Incorrect angle 4• Gait alteration 5• DJD of other joints 6• Fracture 7• Infection

Lsit ocmplications that can occur w/ arhtrodesis?

This means you have to understand what the normal standing angle of the dog si This can vary a lil bit dog by do g+ breed by breed Get the goniometer out + record what their standing angle is on the other sid eif they have. A normal leg on the other side

What do yo need yo do in order to fix the limb in a weight beating position when doing arthrodesis ?

We're gonna debride all levels of the joint Antebrachial -> carpal + carpal -> carpal

What does pancarpal arthrodesis mean?

Dog w/ bilateral gastrocnemius tears

What is a classic example of arthrodesis being done on a dog due to a mechanical inability to maintain joint posture?

Spontaneous non-surgical fusion of a joint Most commonly seen in the spine in breeds like the German Shepherd

What is ankylosis ?where is this most commonly seen

Irreversible surgical osseous fusion of a joint to eliminate motion o fate joing Goal: to saver the funciton of the limb

What is arthrodesis? What's the goal of This?

Carpal hyperextension

What is the most common indication for doing carpal arhtrodesis?

Pancarpal arhtrodesis

What is the most ocmmon arhtrodesis procedure we do in the carpus?

Proximal intertarsal luxation Most ocmmon in 1. Racing greyhound 2. Obese collie-type dog (shelties)

What issue is shown here? In what animals is this most ocmmon in?

Carpal hyperextension Since this foot is completely palmigrade, there's no way this is gonna come back to a completely upright position w/ splint management Happens mostly from leaping down from a height

What issue is shown in this Dog? What causes this

1. Proximal intertarsal joint (PIT) 2. tarsometatarsal (TMT) joint

What joint sin the tarsus tolerate arthrodesis well?

1. Carpus 2. Tarsus

What joints tolerate arthrodesis well?

1. ABC joint 2. Metacarpal (MC) joint 3. Carpometacarpal (CMC) joint

What joints w/in the carpus tolerate arthrodesis well?

Partial carpal arhtrodesis Goal: preserve function of the ABC joint which is repsonsible for ab 90% of the ORM of the carpus We fuse + stabilize the middle carpal + CMC joint

What procedure is shown here + what is the goal of this?

Lateral palte arhtrodesis

What procedure was done here?

Calcaneoquartal arthordesis This is fusion of the calcaneus to the 4th tarsal bone This is stabilized by using a pin + figure 8 tension band Or in the case of a more chronic injury, it can be stabilized w/ a plate + screws

What type of arhtrodesis do we do for PIT luxaitons? Describe it

Calcaneoquartal arthrodesis

What type of arhtrodesis is done here?

These are high load + low motion joints They don't move much anyway in a normal dog, so if we eliminate motion of those joints, it's not gonna create a significant degree of functional compromise

What type of joints are the joint s/win the tarsus?

Dorsal palte

What type of plate do we use to fix a pancarpal arhtrodesis?

Hybrid plate How I can tell: Has 3.5 mm screws in proximal portion (RELATIVELY LARGE SCREWS IN RADIUS) ALSO HAS relatively small screws in the metacarpus

What type of plate is used on their limb? How can you tell?

The joint wont fuse + regardless of how big of a plate you put on it , ultimately the plate will break + the arthrodesis will fail

Whathappens if you leave cartilage behind when doing an arhtrodesus?

Particularly at the ends of plates Particularly in situations where you havea. Very long lever arm (like elbow or stifle ) fusion

Where do dogs w/ arthrodesis fracture? In what situations do this occur?

This is never gonna be strong enough to allow weight bearing function. W/o collapse bc They lost their plantar tarsal ligament So rather than trying to engineer some sort of local repair, in order to engineer a good result, we have to fuse the joint

Why do animals w/ proximal intertarsal luxaiton need arhtrodesis?

Ex fix isnt robust enough to. Allow progression of joint fusion

Why do we do internal fixation for arthrodesis?

From proximal humerus

From Where on teh dogs' body do we obtain a cancellous bone graft for arthrodesis?

Non stressed rad: fairly normal line of calcaneus w/ metatarsus Stressed view: can see deviation of the foot + subluxation at the level of the proximal intertarsal joint

Explain rads done of this tarsus

Acute injury that affects the middle +/- CMC joint as long as the ABC joint is not compromised

Partial arthrodesis is only appropriate for what type of situation ?