Radius's dog surgery

Approaches in osteoarticular surgery Lateral approach to head and diaphysis of the radius

MOREL-VIDAL Lou & VILCOT-LAMBERT Lily

Index

Follow up

Approach

Clinical case

Material

Bibliography

Clinical case

Clinical case

Name: Rex sexe: male Age: 5 years old Without medical antecedent. Came after being run over by a scooter and is laming from the front left leg. An X-ray was performed.

Clinical case

Diagnosis

X-ray of the left front leg of Rex (lateral view)

We can observe 2 problems: - A luxation of the radial head - A fracture of the diaphysis of the radius

X-ray of a normal left front leg of a dog (lateral view)

Material

We need to perform a surgery. In that intetion, we need: Surgery instruments: - Scalpel - Haemostatic forceps - Retractor - Bone plate - Screw Suture material - Needle holder - Needle - Suture threads - Mayo forceps

mayo forceps

scalpel

bone plate

retractor

needle holder

needle with the thread

haemostatic forceps

Problema

Surgical Approach

Surgical Approach

For this surgery, we need to do two different incisions on the injured limb.

2. Approach of the radius' diaphysis by Lateral incision

1. Approach of the radius' head by Lateral incision

1. Approach of the radius' head by Lateral incision

1.The animal is lying on the side, on the healthy limb. A. An incision starting above the lateral epicondyle of the humerus, follow the lateral aspect of the radius, until the upper quarter of the radius is made. The subcutaneous fascia is incised along the same route. B. The brachial and antebrachial fascia, located deeper, are incised along the same route. C. The fascia of the triceps brachii is incised and retracted. which allows the lateral head of the triceps brachii to be retracted and the origin of the anconus muscle to be incised along the lateral epicondylar ridge. The tendon of origin and the proximal part of the lateral ulnar muscle are separated from the lateral extensor digitorum muscle, along the intermuscular septum. The tendon of the lateral ulnar muscle is divided, leaving a sufficient tendon stump proximally to allow its subsequent repair by suture.

D. Subperiosteal separation of the anconeus muscle exposes the caudo-lateral humeroulnar joint compartment. E. The remaining extensor muscles are lifted cranially with a retractor, which must remain on the radius to avoid injury to the radial nerve. Sectioning of the collateral and annular ligaments may be necessary to expose the head of the radius. The goal is to put the head of the radius back in the articular joint.

1. Approach of the radius' head by Lateral incision

2. Approach of the radius' diaphysis by Lateral incision

common digital extensor

2. The animal is still lying on the side, on the healthy limb. A. An incision centered on the lateral border of the radius is made. The subcutaneous adipose tissue and the superficial antebrachial fascia are incised along the same route. B. The deep antebrachial fascia is incised along the cranial edge of the common extensor digitor muscle.

2. Approach of the radius' diaphysis by Lateral incision

C. The common extensor digitor and lateral extensor digitor muscles are inclined caudally. Then medially reclining the extensor radial carp muscle. Then the long abductor muscle is incised near its origin on the ulna. D. The extensor muscles are retracted to expose the entire diaphysis of the radius and ulna The goal is to srew a bone plate on the radius to fix the fracture.

Product

Patient monitoring

during the next 2 months

now

during the 6 first post-operational weeks

then he has to do physiotherapy, at least once a week to build muscle and get back in shape

He is recovered and can do whatever he wants

he must be in a rest state and keep his cast while the bone reforms and heals

BIBLIOGRAPHY

Thanks for your attention

- Kenneth J. (2014) Voies d'abord en chirurgie ostéo-articulaire du chien et du chat (5e edition). Les Editions udu Point Vétérinaire (Paris la Défense)