Orthopedic surgery

Orthopedic surgery is a specialized branch of surgery focused on the diagnosis, treatment, and
management of musculoskeletal conditions in animals. It encompasses a wide range of surgical procedures
aimed at correcting deformities, alleviating pain, restoring function, and improving the quality of life for
animals with orthopedic issues. Here are key aspects of orthopedic surgery:

Diagnosis and Evaluation:

Orthopedic surgeons perform thorough physical examinations, diagnostic imaging (such as X-rays, CT
scans, MRI), and laboratory tests to accurately diagnose musculoskeletal conditions.

Assessment of gait, joint range of motion, and pain response is important in evaluating orthopedic
problems.

Surgical Procedures:

Orthopedic surgery involves a variety of procedures to address conditions affecting bones, joints,
ligaments, tendons, and muscles.

Common orthopedic surgeries include fracture repair, joint stabilization (such as cruciate ligament repair),
joint replacement (arthroplasty), correction of angular limb deformities, and treatment of spinal disorders.

Fracture Repair:

Fracture repair techniques include open reduction and internal fixation (ORIF), external fixation,
intramedullary pinning, and bone plating.

The choice of technique depends on factors such as fracture location, severity, stability, and the patient's
overall condition.

Soft Tissue Surgery:

Orthopedic surgeons may also perform soft tissue procedures to address conditions such as tendon and
ligament injuries, muscle tears, and soft tissue tumors affecting the musculoskeletal system.

Techniques such as tendon or ligament repair, muscle transfer, and tumor excision may be employed.

Joint Surgery:

Joint surgeries aim to restore stability, function, and range of motion in affected joints.

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Procedures may include joint stabilization (e.g., cruciate ligament repair), joint replacement (e.g., total hip
replacement), arthroscopy, and joint fusion (arthrodesis).

Minimally Invasive Techniques:

Minimally invasive orthopedic techniques, such as arthroscopy and minimally invasive fracture repair,
offer the benefits of smaller incisions, reduced tissue trauma, faster recovery times, and decreased
postoperative pain.

Rehabilitation and Physical Therapy:

Rehabilitation and physical therapy play an integral role in the recovery and rehabilitation of animals
undergoing orthopedic surgery.

Physical therapy modalities may include therapeutic exercises, hydrotherapy, massage, cold laser therapy,
and electrical stimulation to improve strength, mobility, and function.

Postoperative Care:

Comprehensive postoperative care protocols involve pain management, wound care, activity restriction,
medication administration, and rehabilitation.

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 Fracture its types and management

What is fracture?

A fracture is a break in the continuity of a bone. It may also be defined as a fracture is a partial or
complete break in the bone.

Types of fracture:

1. On the Basis of Communication of Fractured Site to the Environment

a. Simple fracture : The fracture site does not communicate with the environment.

b. Compound fracture : The fracture site communicates with the environment. This type of fractures is
more prone to infection.

c. Complicated fracture : A closed fracture in which there is considerable injury to important

neighboring vessels or nerves or accompanied by the opening of a joint or vascular cavity.

2. On the Basis of Extent of Bone Damage

a. Complete fracture: It is a fracture in which there is complete loss of bone continuity and the bone is
divided into two or more fragments.

b. Incomplete fracture: An incomplete fracture is one where the bone has not completely lost its
continuity.

3. On the Basis of Number of Fractured Fragments

a. Single : When the bone is broken at one place only

b. Double : When there are two fracture in same bone

c. Multiple/comminuted : When the bone is broken into more than two pieces.

Management of fractures:

Fracture management depends on various factors, including the type and severity of the fracture, the
patient's age and overall health, and the presence of any associated injuries. Overall, the management of

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fractures requires a multidisciplinary approach involving orthopedic surgeons, emergency physicians,
physical therapists, and other healthcare professionals to ensure optimal outcomes and recovery for the
patient. Treatment options may include:

Immobilization: Immobilization of the fractured bone is often achieved using casts, splints, braces, or
traction. Immobilization helps to stabilize the bone fragments and promote proper alignment during the
healing process.

Reduction: Reduction refers to the realignment of displaced bone fragments to restore proper anatomical
alignment. Reduction can be achieved through closed reduction (manipulation of the bone fragments
without surgery) or open reduction (surgical realignment of the bone fragments).

Surgery: In some cases, particularly with complex fractures or open fractures, surgical intervention may
be necessary to stabilize the fracture and promote healing. Surgical techniques may include the use of
internal fixation devices such as plates, screws, rods, or wires to hold the bone fragments in place.

Physical Therapy: Physical therapy is often an integral part of fracture management, especially during
the rehabilitation phase. Physical therapy helps to restore strength, mobility, and function to the affected
area following immobilization or surgical intervention.

Medication: Pain management and prevention of infection are important aspects of fracture management.
Pain medications, anti-inflammatory drugs, and antibiotics may be prescribed as needed to manage pain
and prevent infection.

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 Injuries and diseases of joints:
Joint:

Joints are places where two or more bones come together to allow movemet. Study of joints is called
syndesmology or orthrology.

Types of joints:

Joints are classified into following three groups.

1. Fibrous joints (synarthrosis)

2. Cartilaginous joints (Amphiarthrosis)

3. Synovial joints (Diarthrosis)

1. Fibrous joints:
 They do not contain joint cavity
 These are immobile joints
 The bones are united by fibrous tissues
 Example: Skull joints

2. Cartilaginous joints:
 They do not contain joint cavity
 They permit limited movement
 They bones are united by cartilages.
 Example: Pelvic symphysis

3. Synovial joints:
 They are true joints
 These are moveable joints
 They contain joint cavity or articluar cavity
 Joint cavity is surrounded by the joint capsule which consists of an exterbal fibrous layer and
internal synovoial membrane.
 The synovial membrane secretes a lubricant fluid known as synovial fluid

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  Ligament binds the joints. These are placed around the joints
 Example: Knee joint, Hock joint

Injuries and diseases related to joints:

Osteoarthritis. Arthritis may cause joint pain and swelling. There are many types of this disease. Over
time, arthritis can cause severe joint damage. It can affect people of all ages. A joint injury when you're
young may cause osteoarthritis later in life.

Lupus. This autoimmune disease affects many parts of the body and can cause joint and muscle pain.
Some types of lupus often cause arthritis.

Sprains and strains. Sprains are stretched or torn ligaments. Acute strains are stretched or torn muscles or
tendons that happen from a sudden injury or movement, such as lifting a heavy object.

Dislocated joints. A joint is dislocated when the bones are pushed or pulled out of position. A joint
dislocation is a medical emergency.

Bursitis. The bursa is a small fluid-filled sac. It works as a pad between the bones of a joint and the
moving parts around it, such as muscles, tendons and skin. With bursitis, the bursa becomes irritated and
swollen with extra fluid. Overuse is the most common cause, but injuries, infections and other conditions,
such as arthritis, can cause bursitis.

Tendinitis. This condition happens when you overuse a tendon. It swells and makes the joint painful to
move.

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 STAGES OF ANESTHESIA

Stages of anesthesia were given by Guedel and there are four stages depending upon neuromuscular signs.
upon neuromuscular signs.

Stage–I (stage of voluntary excitement/ Analgesia):

 This stage extends from beginning of anesthetic to loss of consciousness

 Characterized by in-coordination and analgesia.
 Dilatation of pupils, voiding of urine or faeces are other signs of excitement.
 In ultra short acting anesthetics like thiopentone, this stage passes off unnoticed.

Stage–II (stage of involuntary excitement/ Dilirium):

 It is characterized by unconsciousness.
 Begins with loss of consciousness.

Stage–III (stage of surgical anesthesia):

 Characterized by unconsciousness abolition of sensation and neuromuscular reflexes, slow and

regular breathing and loss of swallowing reflex.
 The cerebral cortex is affected first and is always last to recover from the effects of anesthesia.

Stage–IV (stage of medullary paralysis or over doses):

 The animal is in anesthetic shock. If corrective measures are not adopted, the animal is likely to
die.
 Paralysis of vital regulatory centres of medulla oblongata.
 There is complete absence of reflexes and complete dilation of pupils.

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 Postoperative care of orthopedic animals

Postoperative care of orthopedic animals is crucial for ensuring successful recovery and optimal healing
following surgical procedures. Here are key aspects of postoperative care:

Pain Management:

 Pain management is essential for promoting comfort and facilitating recovery.

 Analgesic medications, both systemic (oral or injectable) and local (epidural or intra-articular),
may be prescribed to alleviate pain.
 Regular assessment of pain levels and adjustment of analgesic protocols may be necessary based
on the animal's response.

Activity Restriction and Immobilization:

 Restricted activity and immobilization are often necessary to prevent further injury and promote
healing of the surgical site.
 Confinement to a small area or crate, and controlled exercise regimens may be recommended to
limit movement and stress on the surgical site.
 Use of supportive devices such as slings, splints, or orthopedic braces may be necessary to
stabilize the affected limb.

Wound Care:

 Proper wound care is essential to prevent infection and promote wound healing.
 Surgical incisions should be monitored regularly for signs of inflammation, swelling, discharge, or
dehiscence.
 Cleanliness and hygiene are critical, and instructions regarding wound cleaning, dressing changes,
and bandaging should be followed diligently.

Nutrition and Hydration:

 Adequate nutrition and hydration are important for supporting the healing process and maintaining
overall health.
 A balanced diet with appropriate protein, vitamins, and minerals is essential for tissue repair and
regeneration.
 Encouraging water intake and providing easy access to fresh water is important to prevent
dehydration.

Physical Therapy and Rehabilitation:

 Physical therapy and rehabilitation programs may be recommended to improve mobility, strength,
and function following orthopedic surgery.

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  Exercises, stretching, massage, hydrotherapy, and other modalities may be incorporated into the
rehabilitation plan to promote recovery and prevent muscle atrophy and joint stiffness.

Regular Follow-up and Monitoring:

 Regular follow-up appointments with the veterinarian are important to monitor progress, assess
healing, and address any concerns or complications that may arise.
 Diagnostic imaging, such as X-rays or ultrasound, may be performed to evaluate bone healing and
surgical outcomes.

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 Fracture healing

Fracture healing is a complex process that involves several stages, and complications can arise at various
points during this process. Some of the complications of fracture healing include:

Delayed Union: Delayed union occurs when there is a prolonged period of time required for the fracture
to heal. This can be caused by factors such as poor blood supply to the fracture site, inadequate
immobilization, or certain medical conditions like osteoporosis.

Nonunion: Nonunion occurs when the fracture fails to heal completely, resulting in a persistent gap
between the fractured bone ends. This can happen due to factors such as severe soft tissue damage,
infection, or inadequate stabilization of the fracture site.

Malunion: Malunion occurs when the fractured bone heals in an incorrect position, leading to deformity
or functional impairment. This can happen if the fracture is not properly reduced (aligned) before
immobilization or if the immobilization device fails to maintain alignment during the healing process.

Infection: Infection can occur at the fracture site, particularly if the fracture is open (compound fracture)
or if surgery is performed to stabilize the fracture. Infection can delay healing, increase the risk of
nonunion, and lead to systemic complications if left untreated.

Compartment Syndrome: Compartment syndrome occurs when increased pressure within a muscle
compartment impairs blood flow and nerve function. Fractures associated with significant soft tissue
injury or swelling can increase compartment pressure, leading to tissue ischemia and neurovascular
compromise.

Avascular Necrosis: Avascular necrosis, also known as osteonecrosis, occurs when the blood supply to a
segment of bone is disrupted, leading to bone cell death. This can occur as a complication of fracture
healing, particularly in fractures that disrupt the blood supply to the affected bone segment.

Joint Stiffness: Prolonged immobilization or inadequate rehabilitation following fracture healing can lead
to joint stiffness and loss of range of motion. This can impair functional recovery and increase the risk of
future injury.

It is important for healthcare providers to monitor patients closely during the fracture healing process and
to address any complications promptly to optimize outcomes and prevent long-term sequelae.

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 Lameness its diagnosis and its treatment

Lameness refers to an abnormal gait or movement due to pain or structural abnormalities in the limbs or
musculoskeletal system. It can be caused by a variety of factors and may range from mild to severe. Here's
an overview of the diagnosis and treatment of lameness in horses:

Diagnosis:

Physical Examination: A thorough physical examination is the first step in diagnosing lameness. The
veterinarian will observe the horse's gait, stance, and movement, and palpate the limbs to identify areas of
pain, swelling, or abnormality.

Lameness Evaluation: Lameness may be assessed through trotting in hand, lunging, or ridden exercise on
different surfaces to observe the horse's movement and identify the affected limb(s).

Diagnostic Imaging: Radiography (X-rays), ultrasonography, and magnetic resonance imaging (MRI)
may be used to assess bony and soft tissue structures, identify fractures, joint pathology, tendon or
ligament injuries, and other abnormalities.

Nerve Blocks: Nerve blocks involve injecting local anesthetic into specific nerves or joints to temporarily
block sensation and localize the source of lameness.

Treatment:

Rest and Controlled Exercise: Depending on the underlying cause and severity of lameness, rest or
controlled exercise may be prescribed to allow healing and reduce strain on affected structures.

Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as phenylbutazone (bute) or flunixin

meglumine (Banamine) may be prescribed to alleviate pain and inflammation.

Physical Therapy: Physical therapy modalities such as cold therapy, heat therapy, massage, stretching
exercises, and hydrotherapy may help improve flexibility, reduce inflammation, and promote healing.

Joint Injections: Intra-articular injections of corticosteroids, hyaluronic acid, or other medications may be
used to reduce inflammation and pain in affected joints.

Foot Care: Proper trimming and shoeing are essential for maintaining balanced hoof conformation and
supporting the horse's weight distribution.

Surgery: In cases of severe lameness or structural abnormalities, surgical intervention may be necessary.
Surgical procedures may include arthroscopy, fracture repair, tendon or ligament surgery, or joint fusion.

Follow-Up and Rehabilitation:

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Lameness is a complex and multifactorial condition that requires careful evaluation, diagnosis, and
individualized treatment strategies tailored to the specific needs of the horse and the underlying cause of
lameness. Collaboration between veterinarians, farriers, trainers, and other equine professionals is
essential for optimizing outcomes and ensuring the horse's welfare and soundness.

Infectious and metabolic bone diseases

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Metabolic diseases

Rickets:

Rickets is a childhood disorder characterized by impaired mineralization of growing bones, primarily due
to inadequate vitamin D, calcium, or phosphate.

Clinical Signs: Clinical manifestations of rickets include bowed legs, knock knees, delayed growth,
delayed tooth eruption, skeletal deformities (such as widened wrists and ankles), muscle weakness, and
bone pain.

Treatment: Treatment of rickets involves correcting vitamin D deficiency through supplementation and
ensuring an adequate intake of calcium and phosphate. Sun exposure and dietary modifications are also
important. In severe cases, oral or intramuscular vitamin D supplementation may be necessary under
medical supervision.

Osteomalacia:

Osteomalacia is a metabolic bone disorder characterized by softening of the bones due to defective
mineralization of the bone matrix, usually caused by vitamin D deficiency or impaired vitamin D
metabolism.

Clinical Signs: Clinical features of osteomalacia include bone pain, muscle weakness, difficulty walking,
fractures (especially in weight-bearing bones), and skeletal deformities.

Treatment: Treatment involves correcting vitamin D deficiency or metabolic abnormalities through

vitamin D supplementation and increasing dietary intake of calcium and phosphate. Sun exposure and
pharmacological interventions (such as bisphosphonates) may be necessary in severe cases.

Osteoporosis:

Osteoporosis is a systemic skeletal disorder characterized by low bone mass and microarchitectural
deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures.

Clinical Signs: Osteoporosis is often asymptomatic until a fracture occurs. Fractures, particularly of the
hip, spine, and wrist, are the hallmark clinical manifestation. Chronic back pain, loss of height, and
stooped posture (kyphosis) may also occur.

Treatment: Treatment of osteoporosis aims to reduce fracture risk, preserve bone mass, and improve bone
strength. Strategies include lifestyle modifications (weight-bearing exercises, smoking cessation, adequate

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calcium and vitamin D intake), pharmacological interventions (bisphosphonates, selective estrogen
receptor modulators, denosumab), and fall prevention strategies.

In summary, rickets, osteomalacia, and osteoporosis are metabolic bone disorders characterized by
abnormalities in bone mineralization, structure, and strength. Early recognition and treatment are essential
to prevent long-term complications and optimize bone health. Treatment approaches vary depending on
the underlying cause, severity of the condition, and individual patient factors, and should be tailored to
each patient's specific needs under the guidance of a healthcare professional.

Postoperative care of orthopedic animals is crucial for ensuring successful recovery and optimal healing
following surgical procedures. Here are key aspects of postoperative care:

Infectious diseases of bones

Infectious diseases of bones, also known as osteomyelitis, occur when microorganisms such as bacteria,
fungi, or viruses invade the bone tissue, leading to inflammation, bone destruction, and potential systemic
complications. Osteomyelitis can arise from direct bone trauma, surgical procedures, or hematogenous
spread from distant infections. Here are some common infectious diseases of bones:

Bacterial Osteomyelitis:

Bacterial osteomyelitis is the most common form of infectious bone disease and is typically caused by
pathogenic bacteria such as Staphylococcus aureus, Streptococcus species, or Enterobacteriaceae.

It can occur as a result of open fractures, contaminated wounds, surgical procedures, or bloodstream
dissemination.

Symptoms include localized pain, swelling, warmth, redness, fever, chills, and restricted movement of the
affected area.

Diagnosis involves clinical evaluation, imaging studies (such as X-rays, CT scans, or MRI), blood cultures,
and bone biopsy.

Treatment usually includes prolonged courses of systemic antibiotics, surgical debridement, and drainage
of abscesses

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