Orthopedic surgery

Extracapsular lateral suture approach for CCL repair

The Lateral fabella technique is the oldest surgical correction for cruciate ligament injury in dogs. The name of the procedure comes from the fact that the joint is stabilized outside the joint capsule with non-absorbable suture. A loop of a special type of suture (an artificial ligament) is placed from the back of the knee joint around fabella to the front, where it is passed through drilled hole in upper portion of tibial bone. This suture stabilizes the joint and prevents the shin bone{tibia} from slipping back and forth after the cruciate ligament has been injured. This procedure typically requires less surgical time but has no reliability in large breed dogs

TTA/Tibial Tuberosity Advancement/KYON Certified Surgeon

Tibial Tuberosity Advancement (TTA) is an orthopedic surgery to repair injured cranial cruciate ligament in dogs and cats. This procedure was developed by Dr. Slobodan Tepic and Professor Pierre Montavon at the School of Veterinary Medicine, in Zurich, Switzerland beginning in the late 1990s. The cranial cruciate ligament (CCL) in dogs, provides the same function as the anterior cruciate ligament (ACL) in humans. It stabilizes the knee joint, and limits the shin bone from sliding forward in relation to the femur. It is attached to the cranial (anterior) medial side of the tibia at one end and the caudal side of the lateral femoral condyle at the other end. It also helps to prevent the stifle joint from over-extending or twisting. The origin of the injury is very different in dogs. This difference is the primary reason why the treatment options recommended for cruciate ligament injury in humans are so different from the treatment options recommended for dogs. Vast majority of dogs, the cranial cruciate ligament (CCL) tears as a result of long-term degeneration, where the fibres within the ligament weaken in time. The actual cause of that is not known, but genetic factors are likely important, with certain breeds being predisposed (including Labradors, Rottweilers, Boxers, West Highland White Terriers and Newfoundlands). Other factors such as overweight, individual conformation, hormonal disbalance and certain inflammatory conditions of the knee joint may also play a role. Untreated CCL deficiencies have been associated with medial meniscal damage and joint diseases such as osteoarthritis. TTA is a surgery designed to correct CCL deficient knee joints. The procedure is to advance the tibial tuberosity, which changes the angle of the patellar ligament to neutralize the tibia-femoral shear force during weight bearing. A sagittal saw is used to cut the Tibial Tuberosity off then a special titanium plate and cage is used to advance the tibial tuberosity. By neutralizing the shear forces in the stifle, the joint becomes more stable without compromising joint congruency. TTA appears to be a less invasive procedure than some other techniques such as TPLO (Tibial Plateau Leveling Osteotomy), as TTA does not impair the primary loading axis of the tibia.

Intramedullary Pinning/Cerclage

IM pin fixation with cerclage wires is an approach for young small breed dogs for long oblique or spiral fractures. The fracture have to be completely reconstructable and the long bone must share the axial load. It is not a good option for heavy older patients, where rigidity needs and adequately confinement postoperatively can not be committed. Failure to choose the correct fracture repair and patient size and age for this repair will likely lead to loss of reduction of the fracture.

LC-DCP Plating

Limited Contact Dynamic Compression Plates is a stainless or titanium plating system used to repair certain types of canine fractures. The system utilizes self-tapping or locking screws to optimize strength and ease application, the curves of the plates allow for less bone contact and reduces vascular damage and may accelerate healing time. Some of the plates can be bent in both planes to accommodate a variety of fractures. This type of fracture fixation we utilize when rigid stabilization of fragments is necessary. Majority of these patients does not require plate removal. Follow up radiography with your regular veterinarian in a few weeks will determine bone callus formation in proper implant position.

Femoral Head Ostectomy/FHO

FHO, or femoral head ostectomy, is a surgical technique that aims to restore pain-free mobility of the DJD or damaged hip joint, by removing the head and neck of the femur. Dogs and cats can have issues with hips due to genetics, joint inflammatory diseases or osteoarthritis where surgical intervention is needed to restore normal function of the rear limbs. Young pets can suffer from "Legg-Calve-Perthes"condition where blood supply to the neck and head of femur is impaired and FHO surgery is immediate treatment. Most pets recover fully within six weeks, some delayed cases will need formal physical therapy or rehabilitation.

Toy Breeds Fracture Repair

Small size pets are fun to own but not so much for surgeons to fix when they come with fractured bones. Our special mini-plates fit every miniature pet and we are fully equipped for every challenge. It is not uncommon your small pet to jump of your hands and that to result in a fracture. Most seen are: *Radius-ulna distal fracture (just above wrist), *Lateral humeral-condyle (elbow), *Distal femoral fractures (above knee). Gentle handling of small pets during procedure is crucial for success, post operative weekly instructions also are important part of quick recovery.

Amputation

Amputation involves the surgical removal of a body part that is injured or damaged beyond salvage. In pets, the parts more commonly removed are a limb, toe(s), or the tail. It should be known that docking the tail of newborn pups is an act of amputation. The aim of amputation is to prevent pain or suffering by removing a damaged body part or to prevent the spread of certain forms of cancer. Amputation may seem a radical option to us, dogs do not seem to show the same mental sense of loss as humans, and majority adapt well to the loss of a limb.

K-wire /cross pinning

Kirschner wire (K-wire) and figure eight wire technique is usually used for fracture reduction like tibial crest avulsion, supracondylar distal femur fractures or digital bones. The K-wire holds the bone fragment in place while the orthopedic wire provides compression. K-wires are actually very small pins coming in sizes of 0.035, 0.045, and 0.062 inches. They can also be used in very small bones or for fracture repair across a physis.