Principles of orthopaedic surgery

image of Principles of orthopaedic surgery
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For any animal, motion is required for it to function and enjoy a reasonable quality of life; the aim of orthopaedic surgery is to restore this function with minimal associated pain. This chapter details patient assessment, clinical decision-making, surgical principles, preparation for surgery and execution of a range of articular surgeries.

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13.2 Example of a theatre checklist used for orthopaedic surgeries at the Small Animal Teaching Hospital, University of Liverpool. These lists are routinely used in human hospitals and provide important safety checks to minimize mistakes relating to patients undergoing surgical procedures. BP = blood pressure; CRI = constant rate infusion; HR = heart rate; ICU = intensive care unit; RR = respiratory rate; Temp = temperature.
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13.3 Two large, multi-bulb surgical lights facilitate better illumination of the surgical site.
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13.4 Headband-mounted LED headlamp.
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13.5 Instrument set double-wrapped with impermeable drapes and clearly identified, along with a sterilization expiry date.
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13.6 Large non-autoclavable instruments may be used in a sterile manner by shrouding in a sterile, custom-made drape. (a) In this case, an orthopaedic drill is enclosed in a drill-specific shroud which, along with the removable chuck, has been autoclaved separately. (b) The chuck is connected after enclosing the drill in the shroud. The shroud can be secured to the protruding chuck by gently wrapping with sterile Vetrap or similar. (Courtesy of Richard Hewitt, Helen McCrorie and Cat Burdett)
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13.7 Instrument store room with ample space to prevent inadvertent damage to sterile covers due to overloading. Inset: smaller individual instruments can be stored in sterile double autoclavable bags.
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13.10 Four-quarter draping of the limb with the limb supported to prevent inadvertent contamination of the sterile field. (a) The limb can be draped in a four-quarter manner with the limb suspended to allow all around access. The paw should be protected with a cohesive dressing such as Vetrap. (b) After partial draping, (c) the paw can be transferred from a non-sterile assistant to a sterile surgeon in an aseptic fashion, i.e. the surgeon takes the foot in either a small surgical drape or in a hand that is double-gloved. (d) A final layer of sterile cohesive bandage (e.g. sterile Vetrap) and the fourth ‘quarter’ drape can then be placed. (e) Ideally a further large drape covering the four quarter drapes can be placed to expand the sterile surgical field. In some cases it is suitable to use a single large drape alone without the need for four-quarter draping.
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13.11 An adhesive drape can be further secured to the skin using either skin staples or monofilament suture material to prevent inadvertent lifting of the drape and exposure of the adjacent skin.
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13.13 Stifle arthrodesis performed as an alternative to amputation due to severe concurrent pathology of the contralateral pelvic limb.
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13.15 Application of a sterile adhesive transparent dressing to the foot allows correction of angulation or rotation prior to performing a carpal arthrodesis.
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13.16 A sterile cohesive bandage used as a tourniquet to minimize bleeding at the surgical site for distal limb surgery.
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13.17 A small selection of joint-specific arthrodesis plates.
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