eChapters

Aim

To know the use of Conjoined ‘U’ Plate with Padded ring for fracture side immobilization.

Site to be immobilized

Upper 3^rd metacarpus, Carpo - meta carpo joint dislocation, Radio - Carpal Joint dislocation. Lower Radius & Ulna fracture are can also be immobilised with this device

Definition

Handing pin cast is used for management of longbone fracture. Pin which is used for immobilisation of fracture of proximal radial and tibial bones is called hanging pin cast.

Special equipment

Intramedullary pin, hand driven drill, plaster of paris bandage Procedures :,

Definition

Humerus is long selender and has slight spiral twist.

Oblique type of fracture is most common in diaphyseal region.

It come under higher level of fracture.(Fig. No-1)

Appropriate method of fixation is by intramedullary pinning and modified thomas splint.

Definition

Fracture of femur comes under higher level fracture (Fig. 1) where the appropriate treatment is intramedullary pinning and modified Thomas Splint.

Requirement

Parentral sedative

Local anaesthesia

6mm 1fit long intramedullary pin (Fig.No-3)

Electric bone drill

Bone hammer

Pin cutter

Clsssification

Fracture of upper third humerus, shoulder dislocation and scapula has been grouped under highest level fracture. (Fig.1)

Purpose

To know the method of casting the highest level fracture by modified valeau sling application.

Requirement

Thick 8 layer cotton padding, adhesive gum, 6"-8" long bandage rolls.

Indication: Highest level fracture (femur fracture) (Fig. 1)

Treatment: Modified Velpeau Sling application

Requisite

Adhesive gum

Damage Cloth

Strong bamboo

4 feet long of 4 inch diameter

Gl.Wire

6 mm diameter of 34 kg G.l. wire

Aim:- To know the measurement for preparation of an appropriate size of ring of Thomas splint for a large animal.

Objective: Measurement of an appropriate size Thomas splint essential to avoid complications like tight fitting which may affect bone healing.

Materials required: 6mm G.l. wire, jute thread

Aim

To know the methods of preparation of side bars for large animal Thomas splint fabrication

Procedure

Two strong dry matured bamboo splints are of more than actual length of Thomas splint are prepared, (figure 1)

Three nicks at a distance of 2 inch are grooved on the side of the side of the splint at one end of the splints for keeping the tying end of the ropes in position (figure -2)

The bamboo splints at the lateral ends are thinned to some extent. For knob kniiting of splint to the metal ring by making an arc (figures).

All the steps are depicted in figure 1 -4.

Before fixing the metal ring with the bamboo extention splint the thinned ends are emersed inside water for easy arching of the bamboo splint.

Purpose

Method of tying with bamboo splint with ring is very important because of the following points.

A string fitting with the bamboo splint is required as with loose fitting with it may come up at any stage before actual bone healing.

Aim

To knw the method of softening the ring of the perpendicular Thomas splint to avoid direct trauma of the metal wire with the skin.

Materials required

Jute /thin gunny bag,bandage roll,cotton threads

Aim: Bending of the lower half of the ring of Thomas splint to an angle 45- 60degree to comfort the limb and to provide free circulation.

Importance

After tieing the ring with bamboo splint and padding the ring with jute and cotton .bending the lower half of the ring upto more than 45 degree angle is highly essential because of placement of the fractured limb within the ring of Thomas splint comfortably, so as to the flow of blood circulation in fractured limb uninterruptedly.

Aim: To know the actual length of a Thomas splint & measurement for an animal.

Procedure

Animal is kept in lateral recumbancy with affected limb upward.

After padding & medical bending of Thomas splint, it is fitted upon the fractured limb.

At the time of measurement, the limb should be kept vertical to body for accurate measurement, otherwise the length of Thomas splint may be shorteror longer if the limb is kept forward or backward respectively.

The ring of the Thomas splint is kept close to the axilla (forelimb), groin (hind limb).

Limb is put downward & Thomas splint is pushed upward keeping both the extension bamboo of Thomas splint in crossed manner, measurement of length of Thomas splint is taken up to the bulb of the heel & mark is recorded.

The excess length is trimmed short (figure-1). Two nicks are made on the distal end for retaining the thread in position.

Both the distal ends are tied together with thread, soft padding is placed at the site where hoof is to be kept & retained in position with bandage (figure-3).

Indicaion

To know the importance and method of net fabrication in large animals thomas splint. Objective;

To make the application of thomas splint lightest.

To avoid use of plaser of pahs bandage.

To prevent possible all direction of the immobilised limb in thomas splint.

Aim: To know the method of securing thomas splint, in the forelimb.

Description

After immobilising the fracture site covering the distal as well as proximal end properly the thomas splint is fitted over the forelimb.

The foot is immobilised to the distal end of Thomas splint.

The immobilised forelimb kept closed and straight with the posterior extension of bamboo of the thomas splint. The limb is fixed with posterior bamboo splint with bandage roll at several place to avoid anterior, posterior movement of the limb.

At the time of fixing the limb with posterior extension bamboo of the Thomas splint, bandage are rapped along with the netting of thomas splint, to avoid medullary lateral movement of the immobilised limb.

Finally the immobilised forelimb is rapped along with the bandage roll including both the anterior and posterior extension of bamboo splint.

To avoid outside movement of the immobilised limb, the method of immobilisation of fracture of forelimb has been shown in fig-1.

Purpose:- To know the method of fitting the immobilised fractured hind limb in Thomas splint.

Description

The fractured site is immobilised properly covering the area joint below and joint above from the fractured site.

The immobilised limb is kept within the prepared Thomas splint.

The immobilised limb is kept straight and come close with the front extension bamboo of the Thomas splint.

The foot is fixed to the distal end of the Thomas splint with bandage roll.

In the first attempt the immobilised limb is secured with the front bamboo splint with bandage roll at several places to avoid posterior movement of the immobilised limb.

At the time of fixing the immobilised limb with anterior extension bamboo of Thomas splint, the limb is fixed with the netting of Thomas splint to avoid medial movement of immobilised limb.

Finally the immobilised limb is covered with bandage roll wrapping around both the anterior and posterior extension bamboo of the Thomas splint to avoid outer movement of the immobilised limb.

The method of immobilisation of the hind limb with Thomas splint has been shown in the figure.

Definition : These are the splints made out of light metal rods or bamboo for correction and immobilization of middle and higher level fracture in animals.

Aim: To secure the foot on the distal end of Thomas splint.

Procedure

1. Foot is placed upon the distal end of Thomas splint.
2. The foot of the animal is wrapped V’- two round with bandage cloth.(Fig.1)
3. 2^nd round of bandage cloth is wrapped around the distal end of Thomas splint.(Fig.2)
4. In 3^rd attempt, the bandage roll is taken from the ground level of the foot & including the distal end of foot.(Fig.3)
5. The bandage roll is taken through the gap between anterior end of Thomas splint.(Fig.3)
6. In 4th attempt, the bandage roll is taken from the volar or plantar aspect of the limb and passed upon the ground level of foot as well as the distal end of Thomas splint.(Fig.4)
7. Final 2 rounds of bandage cloth is wrapped through entire surface of foot.

Reference: Tyagi R.P.S. and Singh J, (2013), Ruminant Surgery, CBS Publishers, New Delhi, pp-353,354

Large animal orthopedic patients are often managed with modified Thomas splints and to achieve an acceptable outcome with this device the following points should be kept in mind.

Animals initially find discomfort with the splint and try to reject it by kicking and often show violent movements. Hence initial acclimatization with the device by close observation and supervision of the patient is essential.

Recumbent animals should be supported in standing position by a sling and they should be managed with the principle “12 hrs on sling and 12 hours on floor”.

Movement of the animal should be restricted.

Aim

Purpose: As there is no institution for preparation ofthomassplintfor large animal till date for which physician are preparing thomas splint hear the patient at the time of need.

These thomas splint are generally prepared with useof bamboo, Gl wire, jute of cottonbandages. These thomas splint are generally weak. These thomas splint work for (2-3) month.

For this reason there is necessity of fabrication of large animal thomas splint with us e of other strong and lightest material for long time stonage and use.

Defination

Dislocation of carpometarcarpus and tarso metatauses along with upper fracture of MC and MT bone (Fig. 1 and Fig.2). It is considered as difficult fracture and may not be healed appropriately by the usual procedure of lower level fracture repair method. Due to constant movement of fracture ends its treatment should be similar to middle level fracture repair method.

Materials Required

Thick padded cloth

Adhesive gum (fevicol)

Netted bamboo splint

Thomas splint

Defination

Dislocation of carpometarcarpus and tarso metatauses along with upper fracture of MC and MT bone (Fig. 1 and Fig.2). It is considered as difficult fracture and may not be healed appropriately by the usual procedure of lower level fracture repair method. Due to constant movement of fracture ends its treatment should be similar to middle level fracture repair method.

Materials Required

Thick padded cloth

Adhesive gum (fevicol)

Netted bamboo splint

Thomas splint

Purpose

As the immobilisation of upper third part of radius ulna is very difficult ,the purpose of the immobilisation tech. Is to fix the upper third of radius-ulna with the posterior half of ring of Thomas splint with bandages are very important for achieving no movement of fracture fragment during healing.

Indication

Correction of upper third fracture of radius-ulna by Thomas splint application indicated in higher level fracture.

Definition

Fracture of Upper 3rd of tibio-fibula Presence as a difficult Problem for the Surgeon to immobilise it Perfectly. As the fracture site generally moves within the imobiliser. Its healing becomes difficult. The aimof immobilisation technique of upper 3rd tibio-fibula fracture is to fix the upper 3rd of tibio-fibula with the anterior half of ring of thomas splint with bandages. This is an important step for achieving no movement of fracture fragment during healing.

Indication

Correction of upper 3rd fracture of tibio-fibula (Fig.1) by thomas splint application.

Use of conjoined Thomas splint for bilateral tibia fibula fracture for large animal.

Aim

To know the immobilization technique for both tibia-fibula fracture in large animal practice.

Instruments

Conjoined Thomas splint (Fig 1).

Definition: Mandible forms the skeleton of lower jaw and comprises of a body and two rami. The two halves of this bone fuse incompletely at the mandibular symphysis, situated at the midline within the body.

Indication: Immobilization of fractured mandible, minimally or non displaced fractures with an intact opposite hemimandible, vertical ramus fracture.

Anasthesia: Local anaesthesia for large animals. A20 gauze 2.5 cm needle is used to deposit 5-1 Omi of lidocaine at the exit site and into the canal.

Objectives

Immobilization of fracture of mandible.

Requirements

‘U’ Plate 4 Pins Electric drill Orthopaedic hammer Pin cutter

Procedure

Under local infiltration of an anesthetic & parenteral sedatives the 4 pins are drilled 2 on either side of the fracture site from one side mandible to other side mandible. During drilling the pin, the holes, importance should be given for the passage of the pin through prefix of the drill hole in metal frame

The fracture end should come accurate apposition during pinning procedure & the symmetry of the fractured mandible should be as norma! as possible.

Sterilised antiseptic gauge bandages are covered, the pin between frame and the body. The pins are retained in position either with nut-bolt or by passing a plastic tube after which the hole of the plastic tube is filled with resin.

Aim: To know the method of immobilization of the limb after repair of the flexor tendon.

Procedure

The immobilization procedure of limb after flexor tendon repair is done in 2 stages.

Definition

Digital tender include superficial digital flexor, DDF & suspensory ligament which is situated in volar & plantar upset of metacarpus and metatarsus. These tendons are generally transected during ploughing or intensional approach (Fig.1).

Sign

After cutting of these tendon the foot became flat and animal bears weight on fetlock is can’t able to walk freely.

Aim

To depict the detail method of tendon suturing of transected gastrocnemious tendon for union.

Procedure

After cleaning, debriding and flushing the transected site thoroughly local antiseptic and antibiotic is applied.

1. To expose the tendon ends clear visual as well as proper exposer the site was enlarged by two vertical incision placed at dorsal and ventral part of the transected site.(Fig.1).
2. The three different tendons and their locations is identified. The both end of tendon of a particular group are brought close together and joins end to end and retained with strong polyester suture putting to interrupted knots at 90 degree to each other.(Fig. 2).
3. Their peritendon cover are pulled over the suturing site from their either ends and are also retained in position with additional interrupted suture running at 90 degree to each other.(Flg. 3). In this way 4 interrupted suture are required for approaching one tendon.
4. In this way all the 3 tendons are joined with their respective other ends with suture. Total no of 12 interrupted suture are required for joining all the 3 structure of the gastrocnemious tendon. At the end the suture tendons are strengthened by placing to interrupted stainless steel suture. (Fig. 4).

Finally a flushing catheter was placed at higher level and the suture site is covered with a thick dry antiseptic absorbent cotton padding.

To know the method of immobilization of the limb after repair of the transected gastrocnemius tendon (tendo achiles).

Procedure

The immobilization procedure of limb after gastrocnemius tendon repair is done in 2 stages.

1^ST Stage

Immobilization of limb for avoiding movement at tendon suture site.

It is done by placing the sutured area within a pre- fabricated metal frame so as to keep the limb undisturbed at the suture site.

The frame is given in Figure 1.

The purpose of addition of the metal frame is to immobilize the limb keeping the fetlock and foot away from in a flexed manner to avoid weight bearing during healing period.

The limb is immobilized with netted bamboo splint (Fig. 2).

The immobilized limb is placed within the metal frame keeping the fetlock and foot in a flexed manner

Hip joint is a ball and socket joint which involves cotyloid cavity of os-coxae and head of femur. Hip dislocation can be corrected by external immobilization of the area with POP cast and keeping the animal in a mobile sling for several weeks.

The dislocation involves cotyloid cavity and head of femur and the affected limb deviate outward. (Fig.1)

The fracture site is immobilized extending joint below and joint above level initially with plaster of Paris.(Fig.2)

Cloth bandage is applied over it for support involving joint above and joint below which should not be too tight or too loose.(Fig.3)

Second layer of cloth padding is provided over the first layer to provide more strength and further immobilization.(Fig.4)

Final immobilization is done by application of rubber belt or suspensory bandage. (Fig.5)

At the end the entire animal is kept in mobile sling for proper immobilization for some weeks and housed in limited space(Fig.6)

Contracted Leg in Calves

Definition

A shortening or contraction of the deep and superficial digital flexor tendons and associated muscles, sometimes also the carpal flexors, leading to abnormal flexion of the fetlock, possibly also of the pastern and carpal joint.

Management of Compound Fracture

An open fracture is an injury that occurs when a broken bone is exposed through the skin. This may mean that the bone is actually sticking out of the skin, or it may mean that the skin and soft-tissue is disrupted and exposes a path to the site of the fracture. Often called a compound fracture, an open fracture necessitates different treatment from the usual closed fracture.

Surgically Cleaning the Bone

Surgically cleaning the bone is one of the first steps for treating an open fracture. Most patients who sustain an open fracture undergo a surgery called “irrigation and debridement.” Irrigation means washing the bone and the site of the injury. Debridement is described in the next step.

Determining the extent of injury can be difficult just by looking at an open fracture. This is especially true in high-energy injuries including automobile collisions and gunshot wounds. With these types of injuries, even small penetrations in the skin can cover very large areas of soft-tissue damage around an open fracture. Therefore, when surgically cleaning the bone, it is important to do this in the operating room (OR) under anesthesia — trying to sufficiently assess and clean the bone in the emergency room, without adequate anesthesia, may be insufficient.

Aim: Regular flushing of compound and fracture using topical antibiotic or antiseptic required to bring the open wound and fracture either to a aseptic stage or to reduce the degree of infection and pus formation.

Procedure

After through cleaning the exposed bone as well as the wound of the compound fracture the wound is placed inside its part.

A thick walled rubber tube / plastic tube threaded with two end of a suture with a straight needle is carried to a higher site from the fracture within the wound.

The suture and needle is brought out, the sutures separated and again threaded and the flushing catheter is fixed with suture. Fig.1.(a) and Fig. 2. (a), (b).

The wound is protected with a thick absorbant sterile cotton padding, keeping the flushing catheter out through a small hole within the bandage. Fig. 1 (b) and Fig.2.(c)

The limb is immobilized as per the recommended procedure depending the level of fracture, outer end of the flushing catheter is kept outside, of the immobilization for carrying out regular flushing of the wound.

Definition

Wound with infection with 6 hours of occurrence can be brought to non infected stage by flushing.

Procedure

The infected wound at fracture site is cleaned / flushed thoroughly using sufficient quantity with antiseptic solution.

The site is applied with topical antiseptic / antibiotic and the size of the wound is reduced by placing interrupted stitches for skin closure.

For drainage of inflammatory fluid, the counter opening is made as the distal part of the swelling of the dependent part of flushing catheter is placed inside to carry out regular flushing of the wound without removing the immobilizer.

The fracture site is immobilized as per the conventional procedure using POP cast leaving two window over the opening of counter opening site.

1. True bone tumours. Neoplasms arising from cells of mesenchymal origin, derived from a common ancestry and whose function is primarily skeletal boen formation. These tumours fall into four main groups according to the predominant cell type present. By reason of the mutability of the cells metaplasia is common and intermediate stages are found.

Amputation of Claw in Cattle

Objetive

To completely exercise a cancerous hoof in presence with cauliflower like growth with regular bleeding & myosis.

Material Required

Amputation saw, thick padded with bandage roll, a mixture of powder containing resin and naphthalene ball powder, bicycle tube protection sleeper (Fig-3), local anesthesia.

Indication

Bilateral digital cancerous growth cauliflower like(fig-1),cancerous growth with continuous bleeding and myasis.

Aim

To remove the cancerous growth from healthy side by surgery. (Fig. 1-2)

Material Required

Amputation saw, thick padded with bandage roll ,a mixture of powder containing resin and naphthalene ball powder, bicycle tube protection sleeper(Fig-3),local anesthesia.

Aim: Amputation of limb by bone section technique.

Indication: Irreparable injury; Gangrene; Malignant disease.

Site:

Fore-limb: Common site is junction of the lower and middle third of the radius(fore-arm).

Hind-limb: common site is the middle third of the leg region(tibia).

Anaesthesia and control: Fore-limb: general anaesthesia; Hind-limb: epidural anaesthesia. Operated in lateral recumbent position.

Aim

Study about method of apposing muscle, fascia, skin over amputed stump.

Indication

Proper healing of amputed stump, avoiding infections.

Description

Limb is amputed generally through diaphysis or by disarticulation method. Whatever is the amputation,the surgeon should always keep as much soft tissue as possible to cover the bone extrimities. It is difficult to achieve in large animal, when amputation is immediately below carpus or tarsus.