Basic surgical techniques

James Grierson

doi:10.22233/9781910443279.11

British Small Animal Veterinary Association , 88 (2016); https://doi.org/10.22233/9781910443279.11

/content/chapter/10.22233/9781910443279.chap11

Basic surgical techniques

GBP

BSAVA Library Pass Buy a pass

Author: James Grierson
From: BSAVA Manual of Canine and Feline Fracture Repair and Management
Item: Chapter 11, pp 88 - 105
DOI: 10.22233/9781910443279.11
Copyright: © 2016 British Small Animal Veterinary Association
Publication Date: January 2016

Abstract

This chapter aims to outline the general organizational approach to the surgical fixation of fractures, along with describing some of the basic surgical techniques involved in fracture reduction and fixation. Fracture surgeries are often demanding in terms of technical skill needed, equipment requirements, time and also concentration by the surgeon. Preparation is vital for all aspects of the operation. Operative techniques: Fracture reduction; Insertion of intramedullary pins; Insertion of interlocking nail; Application of cerclage wire; application of tension-band wiring; Placement of external skeletal fixators; Insertion of positional screw; Application of lag screw; Application of dynamic compression plate; Application of neutralization plate; Application of bridging plate; Pin-plate stabilization.

Preview this chapter:

Full text loading...

/content/chapter/10.22233/9781910443279.chap11

Figures

/content/figure/10.22233/9781910443279.chap11.ch11fig1

11.1

10.22233/9781910443279/fig11_1_thumb.gif

10.22233/9781910443279/fig11_1.png

11.1 A surgical safety checklist to be used when performing orthopaedic surgery.

/content/figure/10.22233/9781910443279.chap11.ch11fig2

11.2

10.22233/9781910443279/fig11_2_thumb.gif

10.22233/9781910443279/fig11_2.png

11.2 Reduction using countertraction. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig3

11.3

10.22233/9781910443279/fig11_3_thumb.gif

10.22233/9781910443279/fig11_3.png

11.3 Toggling technique. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig4

11.4

10.22233/9781910443279/fig11_4_thumb.gif

10.22233/9781910443279/fig11_4.png

11.4 Levering technique. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig5

11.5

10.22233/9781910443279/fig11_5_thumb.gif

10.22233/9781910443279/fig11_5.png

11.5 Use of pointed reduction forceps to complete reduction. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig6

11.6

10.22233/9781910443279/fig11_6_thumb.gif

10.22233/9781910443279/fig11_6.png

11.6 Pusher pin technique. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig7

11.7

10.22233/9781910443279/fig11_7_thumb.gif

10.22233/9781910443279/fig11_7.png

11.7 Use of a reduction device. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig8

11.8

(a) Normograde pin insertion. (b) Retrograde pin insertion. (c) Fracture is reduced and pin driven across the fracture site. (d) Pin is impacted into the distal metaphysis, taking care not to penetrate the joint. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association

10.22233/9781910443279/fig11_8_thumb.gif

10.22233/9781910443279/fig11_8.png

11.8 (a) Normograde pin insertion. (b) Retrograde pin insertion. (c) Fracture is reduced and pin driven across the fracture site. (d) Pin is impacted into the distal metaphysis, taking care not to penetrate the joint. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig9

11.9

10.22233/9781910443279/fig11_9_thumb.gif

10.22233/9781910443279/fig11_9.png

11.9 Application of an interlocking nail. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig10

11.10

Cerclage wiring using a twist knot. (a) Full cerclage. A secure, even twist knot is created. This is usually bent over whilst continuing to twist the wire, to maintain tension, and is then cut short. The wire must be fully tightened and should be perpendicular to the bone. (b) Hemicerclage. The wire is applied through a bone tunnel. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association

10.22233/9781910443279/fig11_10_thumb.gif

10.22233/9781910443279/fig11_10.png

11.10 Cerclage wiring using a twist knot. (a) Full cerclage. A secure, even twist knot is created. This is usually bent over whilst continuing to twist the wire, to maintain tension, and is then cut short. The wire must be fully tightened and should be perpendicular to the bone. (b) Hemicerclage. The wire is applied through a bone tunnel. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig11

11.11

10.22233/9781910443279/fig11_11_thumb.gif

10.22233/9781910443279/fig11_11.png

11.11 Application of a single loop cerclage. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig12

11.12

10.22233/9781910443279/fig11_12_thumb.gif

10.22233/9781910443279/fig11_12.png

11.12 Application of a double loop cerclage. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig13

11.13

10.22233/9781910443279/fig11_13_thumb.gif

10.22233/9781910443279/fig11_13.png

11.13 Application of a tension-band wire. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig14

11.14

Application of a modified type 2 (type 2b) external skeletal fixator to a tibial fracture. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association

10.22233/9781910443279/fig11_14_thumb.gif

10.22233/9781910443279/fig11_14.png

11.14 Application of a modified type 2 (type 2b) external skeletal fixator to a tibial fracture. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig15

11.15

Insertion of a positional screw: (a) drill, (b) measure, (c) tap and (d) place screw. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association

10.22233/9781910443279/fig11_15_thumb.gif

10.22233/9781910443279/fig11_15.png

11.15 Insertion of a positional screw: (a) drill, (b) measure, (c) tap and (d) place screw. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig16

11.16

Insertion of a lag screw. The screw direction should be as close as possible to perpendicular to the fracture line. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association

10.22233/9781910443279/fig11_16_thumb.gif

10.22233/9781910443279/fig11_16.png

11.16 Insertion of a lag screw. The screw direction should be as close as possible to perpendicular to the fracture line. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig17

11.17

Application of a pre-stressed plate. (a) Exact contouring of a plate to a bone can result in a narrow gap in the trans cortex after screw tightening. (b) The plate can be pre-stressed to create a slight curve in the plate over the fracture line. (c) Following screw tightening the trans cortex is compressed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association

10.22233/9781910443279/fig11_17_thumb.gif

10.22233/9781910443279/fig11_17.png

11.17 Application of a pre-stressed plate. (a) Exact contouring of a plate to a bone can result in a narrow gap in the trans cortex after screw tightening. (b) The plate can be pre-stressed to create a slight curve in the plate over the fracture line. (c) Following screw tightening the trans cortex is compressed. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig18

11.18

10.22233/9781910443279/fig11_18_thumb.gif

10.22233/9781910443279/fig11_18.png

11.18 Application of a compression plate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig19

11.19

10.22233/9781910443279/fig11_19_thumb.gif

10.22233/9781910443279/fig11_19.png

11.19 Application of a neutralization plate in conjunction with lag screws. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig20

11.20

10.22233/9781910443279/fig11_20_thumb.gif

10.22233/9781910443279/fig11_20.png

11.20 Application of a bridging plate. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.

/content/figure/10.22233/9781910443279.chap11.ch11fig21

11.21

10.22233/9781910443279/fig11_21_thumb.gif

10.22233/9781910443279/fig11_21.png

11.21 Application of a pin–plate construct. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.