Handbook of Small Animal Orthopedics and Fracture Repair 4th Edition 2006.pdf

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BRINKER, PIERMATTEI, AND FLO’S HANDBOOK

ISBN-13: 978-0-7216-9214-2

OF SMALL ANIMAL ORTHOPEDICS AND FRACTURE

ISBN-10: 0-7216-9214-1

REPAIR, Fourth Edition

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Notice

Knowledge and best practice in this field are constantly changing. As new research and experience

broaden our knowledge, changes in practice, treatment and drug therapy may become necessary or

appropriate. Readers are advised to check the most current information provided (i) on procedures

featured or (ii) by the manufacturer of each product to be administered, to verify the recommended

dose or formula, the method and duration of administration, and contraindications. It is the

responsibility of the practitioner, relying on their own experience and knowledge of the patient, to

make diagnoses, to determine dosages and the best treatment for each individual patient, and to

take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor

the Authors assume any liability for any injury and/or damage to persons or property arising out

or related to any use of the material contained in this book.

The Publisher

ISBN-13: 978-0-7216-9214-2

ISBN-10: 0-7216-9214-1

Publishing Director: Linda Duncan

Senior Editor: Liz Fathman

Developmental Editor: Shelly Stringer

Publishing Services Manager: Patricia Tannian

Senior Project Manager: Anne Altepeter

Senior Book Designer: Julia Dummitt

Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

P REFACE

The publication of the fourth edition of Brinker, Piermattei, and Flo’s Handbook of

Small Animal Orthopedics and Fracture Repair comes soon after the ninety-third

birthday of Wade O. Brinker. Wade will receive the “Founder’s Award” from the

American College of Veterinary Surgeons this year in celebration of a lifetime of

contributions to our profession. This book is but one small contribution of the

many he has made. Recently, Wade explained very clearly and firmly that his moti-

vation in founding this book was to establish a solid reference for veterinary students

and practicing veterinary surgeons. Through the years we have tried to maintain a

balance of information in a straightforward, well-illustrated, and understandable

manner that will not only challenge the avid veterinary student, but also provide a

reasonable, though not exhaustive, reference for the practicing clinical surgeon.

Twenty-three years have passed since publication of the first edition. With each

edition, we note the introduction of many new concepts and fixation strategies (e.g.,

biologic osteosynthesis). These new developments validate the very same principles

that Wade has stressed from the first pioneering days of veterinary surgery. Surgical

values of respect for tissue, surgical efficiency, aseptic technique, and appropriate

planning will always be relevant to the optimal healing of our patients. Although

Wade’s active participation ended with the second edition, his influence continues to

permeate every page of this text.

With the fourth edition, sections have been expanded to reflect common and

accepted improvements with external fixators, interlocking nails, and plate fixations.

An introductory chapter on canine arthroscopy has been added to introduce the

student to the value of minimally invasive joint surgery. Sections on hip dysplasia,

cruciate ligament rupture, and patella luxation reflect continuous progress in treatments

of these common conditions.

We continue to be blessed with the artwork of F. Dennis Giddings. Our publisher

has changed from W.B. Saunders to Elsevier. This conversion has been seamless, and

we thank the new publishing staff for their patient efforts.

Readers will also note the addition of a new author, Charlie DeCamp, who has

worked diligently to balance the wealth of information from the first 20 years to

that which will be most relevant to students and surgeons in the next 10 years. Two

of us (GF and DP) are making our final contribution to this work, which we started

with Wade in 1981. We sincerely strive to move this textbook forward in time, and

Wade will be with us, every step of the way.

D ONALD L. P IERMATTEI

G RETCHEN L. F LO

C HARLES E. D E C AMP

To Wade O. Brinker and all the surgeons before us,

and to the families behind us.

Orthopedic Examination

and Diagnostic Tools

GENERAL EXAMINATION

An orthopedic examination must begin with an adequate history and general

physical examination. A systemic approach to the examination ensures that multi-

ple problems are discovered. The animal’s general health should be ascertained

before focusing on the orthopedic complaint. The entire examination varies with

case complexity, a history of recent trauma, the intended use of the animal (e.g.,

breeding, showing, racing, hunting), and economics dictated by owners. Severely

traumatized animals with hemorrhaging wounds and unstable fractures that

could become open fractures obviously need different immediate steps; these

animals are not discussed in this chapter. This chapter focuses on the examination

for orthopedic problems (Table 1-1) and presents some of the diagnostic tools

available.

History

Specific historical information is useful for categorizing orthopedic problems to

rule out. This information includes breed, age, gender, occurrence of trauma, owner

identification of limb(s) involved, chronological progression of the problem, efficacy

of treatments tried, and variability with weather, exercise, and arising from recum-

bency. Other features, such as fever, inappetance, lethargy, and weight loss, may

indicate some systemic problem, such as inflammatory joint conditions, or a rup-

tured bladder after trauma.

Certain historical facts and deviation from the “normal” presentation of certain

orthopedic conditions alert the clinician to investigate further by asking appropriate

questions or performing additional tests or procedures. For example, a 10-year-old

dog that falls down two stairs and sustains a fractured radius and ulna should be

carefully scrutinized for pathological fracture. Normally, chronic luxating patellas

usually do not suddenly cause a carrying-leg lameness, and cruciate ligament

rupture may have become the more recent problem. Chronic osteoarthritic condi-

tions usually do not cause severe pain. In older animals with severe progressive

pain, neoplasia must always be considered. With pelvic fractures, trauma to the

chest, abdomen, or spine often occurs. Answers to specific questions help assess con-

current problems. For example, knowing whether the recumbent animal has been

eating, voiding large pools of urine, or moving the legs spontaneously is helpful.

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