Brinker, Piermattei and Flo's Handbook of Small Animal Orthopedics and Fracture Repair, 5e

876 Pages·2016·140.33 MB·English

by  DeCamp

Brinker, Piermattei, and Flo’s
Handbook of
SMALL ANIMAL
Orthopedics
and
Fracture Repair

Brinker, Piermattei, and Flo’s
Handbook of
SMALL ANIMAL
Orthopedics
and
Fracture Repair
FIFTH EDITION
Charles E. DeCamp, DVM, MS
Diplomate, American College of Veterinary Surgeons
Professor
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
Michigan State University
East Lansing, Michigan
Spencer A. Johnston, VMD
Diplomate, American College of Veterinary Surgeons
James and Marjorie Waggoner Professor
Head, Department of Small Animal Medicine and Surgery
College of Veterinary Medicine
University of Georgia
Athens, Georgia
Loïc M. Déjardin, DVM, MS
Diplomate, American College of Veterinary Surgeons
Diplomate, European College of Veterinary Surgeons
Professor
Head of Orthopedic Surgery
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
Michigan State University
East Lansing, Michigan
Susan L. Schaefer, MS, DVM
Diplomate, American College of Veterinary Surgeons
Clinical Associate Professor—Orthopedics
Section Head—Small Animal Surgery
Department of Surgical Sciences
School of Veterinary Medicine
University of Wisconsin—Madison
Madison, Wisconsin
3251 Riverport Lane
St. Louis, Missouri 63043
BRINKER, PIERMATTEI, AND FLO’S HANDBOOK OF SMALL
ANIMAL ORTHOPEDICS AND FRACTURE REPAIR, FIFTH EDITION ISBN: 978-1-4377-2364-9
Copyright © 2016 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic
or mechanical, including photocopying, recording, or any information storage and retrieval system,
without permission in writing from the publisher. Details on how to seek permission, further
information about the Publisher’s permissions policies and our arrangements with organizations such
as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the
Publisher (other than as may be noted herein).
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described herein. In
using such information or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, 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 practitioners, relying
on their own experience and knowledge of their patients, 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, contributors, or editors,
assume any liability for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products,
instructions, or ideas contained in the material herein.
Previous editions copyrighted 2006, 1997, 1990, 1983.
International Standard Book Number: 978-1-4377-2364-9
Content Strategy Director: Penny Rudolph
Content Development Manager: Jolynn Gower
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Jodi M. Willard
Design Direction: Renée Duenow
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To Wade O. Brinker, Don Piermattei, Gretchen Flo,
and all the surgeons before us, and to the families
behind us.

Preface
Many transitions are embedded in publication of the fifth edition of Brinker, Piermattei, and
Flo’s Handbook of Small Animal Orthopedics and Fracture Repair. For us, the most sig-
nificant transition is that Dr. Wade Oberlin Brinker passed away in 2008 at the age of 95.
We are heartened that this book is one piece of a legacy that reflects a lifetime of dedication
to teaching the principles and procedures of veterinary surgery to generations of students,
house officers, and clinicians. Before publication of the fourth edition, Wade explained
clearly and firmly that his motivation in founding this book was to establish a solid refer-
ence 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 under-
standable manner that will not only challenge the avid veterinary student but also provide
a reasonable, though not exhaustive, reference for the practicing clinical surgeon.
Thirty-three years have passed since publication of the original edition. We note an-
other huge transition in that this is the first time this book will be published without new
contributions from the original authors—Dr. Donald Piermattei, Professor Emeritus at
Colorado State University, and Dr. Gretchen Flo, Professor Emeritus at Michigan State
University. We have endeavored to maintain a balance of new ideas with a deep respect
for their previous work that continues to guide our own professional lives. We cannot ever
hope to replace Dr. Piermattei’s clarity of thought and Dr. Flo’s diagnostic prowess and
surgical courage. It was a huge challenge to go forward without their guidance, and it is
here that we must acknowledge the importance and breadth of their previous contribu-
tions to this work.
With each edition, we note the introduction of many new concepts and fixation strate-
gies, and these developments continue to validate the same principles that Wade Brinker
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 rel-
evant to the optimal healing of our patients. With the fifth edition, sections have been
expanded to reflect common and accepted improvements with interlocking nails, plate
fixations, and minimally invasive surgery. Sections on hip dysplasia, cruciate ligament
rupture, and patella luxation reflect continuous progress in treatments of these common
conditions.
We are fortunate to have a new biomedical artist, Ted Huff, who has made outstanding
contributions to the fifth edition and continues a legacy of quality from our previous art-
ist, F. Dennis Giddings. We are also thankful for all of the work and support provided to
us by the staff of our publisher, Elsevier. In particular, Penny Rudolph, Brandi Graham,
and Linda Wood have been most helpful and patient in bringing the next edition to life.
Readers will also note the addition of three new authors, Dr. Spencer Johnston,
Dr. Loïc Déjardin, and Dr. Susan Schaefer. Each has a deep respect for a place for this text
in the future of our profession. We sincerely strive to move this textbook forward in time,
and Wade, Don, and Gretch will be with us, every step of the way.
Charles E. DeCamp
Spencer A. Johnston
Loïc M. Déjardin
Susan L. Schaefer
vii

PART Diagnosis and Treatment of Fractures, Lameness,
I and Joint Disease
1 Orthopedic Examination
and Diagnostic Tools
GENERAL EXAMINATION
An orthopedic examination must begin with an adequate history and general physical ex-
amination. A systemic approach to the examination ensures that multiple problems are dis-
covered. 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 ruling out categories of orthopedic problems.
This information includes breed, age, gender, occurrence of trauma, owner identification
of limb(s) involved, description of the lameness or gait abnormality, chronological pro-
gression of the problem, efficacy of treatments tried, and variability with weather, exer-
cise, and arising from recumbency. Other features such as fever, inappetance, lethargy, and
weight loss may indicate some systemic problem, such as inflammatory joint conditions
or internal injury from 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 per-
forming additional tests or procedures. For example, a 10-year-old dog that falls down only
two stairs and sustains a fractured radius and ulna should be carefully scrutinized for patho-
logical 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 conditions 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 concur-
rent problems. For example, knowing whether the recumbent animal has been eating, voiding
large pools of urine, or moving the legs spontaneously is helpful. A good appetite probably
does not occur with significant internal injuries. “Urinating” or dribbling small amounts of
urine does not mean the bladder is intact, and voluntary leg movement usually means serious
thoracolumbar spinal injury has not occurred.
Distant Observation and Gait Evaluation
The animal should be observed for general thriftiness and relative weight status. Patient
disposition and potential lack of animal or owner cooperation should be noted. Sedation
1
2 Part I—Diagnosis and Treatment of Fractures, Lameness, and Joint Disease
TABLE 1-1. Causes of Lameness in the Dog (Excluding Fractures and Minor Soft Tissue
Injuries)
Pelvic Limb Forelimb
Growing Dog
1. Hip dysplasia 1. OCD—shoulder
2. Avascular necrosis (Legg-Calvé-Perthes) 2. Luxation/subluxation shoulder—congenital
3. Avulsion of long digital extensor 3. Avulsion supraglenoid tubercle
4. OCD—stifle 4. OCD—elbow
5. OCD—hock 5. UAP
6. Luxating patella complex 6. FCP
7. Genu valgum 7. UME
8. Panosteitis 8. Elbow incongruity
Medium to large breeds 5 1, 3-8 a. Congenital
Toy to small breeds 51, 2, 6 b. Physeal injury
Chondrodystrophied breeds 5 1, 2, 6, 8 9. Radius curvus
10. Retained cartilaginous cores (ulna)
11. Panosteitis
12. HOD
Medium to large breeds 5 1, 4-7, 8b, 9-12
Toy to small breeds 5 2, 8, 9
Chondrodystrophied breeds 5 5, 8a, 8b, 9, 11, 13
Adult Dog
A. Arthritis (or continuum): 1-7 A. Arthritis (or continuum): 1-6, 8, 9
B. Luxating patella complex B. UME
C. Panosteitis C. Panosteitis
D. Cruciate/meniscal syndrome D. Bicipital tenosynovitis/biceps rupture
E. Inflammatory joint disease E. Calcification of supraspinatus tendon
F. Neoplasia F. Contracture of infraspinatus or supraspinatus
Medium to large breeds 5 A1, A 3-7, B, D, F G. Bone/soft tissue neoplasia
Toy to small breeds 5 A2, B, D-F H. Luxation/subluxation—shoulder
Chondrodystrophied breeds 5 A1, B, D-F I. Inflammatory joint disease
J. HO
Medium to giant breeds 5 A, 7, 11, I, J
Toy to small breeds 5 2, G, H, I, J
Chondrodystrophied breeds 5 A-5, A-8, A-9, C, H, I, J
OCD, Osteochondritis dissecans; UAP, ununited anconeal process; FCP, fragmented coronoid process; UME, ununited medial
epicondyle; HOD, hypertrophic osteodystrophy; HO, hypertrophic osteopathy
should not be used if possible, or at least until the area of involvement is known, because
tranquilizers may mask detection of painful regions. The animal should be observed for
body conformation, decreased weight bearing, trembling, asymmetrical joint or soft tissue
swellings, muscle atrophy, and digit and joint alignment. Dogs with tarsocrural osteo-
chondritis dissecans (OCD) tend to be very straight legged in the pelvic limb, whereas
dogs with elbow problems tend to have curvature of the forelimbs (Figure 1-1).
Gait
Observing the lameness is helpful before examining the limb. It helps confirm or contra-
dict owner complaints. Often in an examination room environment, however, a mild
chronic lameness disappears. The gait is observed at a walk and if necessary a trot. Covert
lameness may become apparent during tight circles or stair climbing. Abnormalities
include a shortened stride, dragging of the toenails, “toeing-in” or “toeing-out,” limb cir-
cumduction, hypermetria, stumbling, generalized weakness, ataxia, crisscrossing of the
legs, abnormal sounds (e.g., clicks, snaps), and a head “bob,” which is a bobbing motion
of the head that occurs with foreleg lameness. The head elevates as the painful leg strikes