John Kiefer, BS, DVM Resident in Small Animal Surgery. The Veterinary Forum, Leesburg, VA October 18 th, 2015

Transcription

1 John Kiefer, BS, DVM Resident in Small Animal Surgery The Veterinary Forum, Leesburg, VA October 18 th, Facebook.com/AnimalSurgeons

2 Hind Limb Trauma Why this topic matters to you Triaging patients Warning signs to watch for Treatment concerns Prognosis

3 Hind Limb Trauma What we ll cover Triage General Exam Neurologic Exam Orthopedic Exam Imaging and diagnostics Treatment concerns

4 Hind Limb Trauma A client walks in carrying their dog

5 Triage History Cause of trauma / witnessed? Time since trauma occurred? Hemorrhage? Ambulatory status? Urination / defecation?

6 History Triage

7 Trauma Cases Multicenter prospective evaluation of dogs with trauma. Hall KE, Holowaychuk MK, Sharp CR, et al. Am Vet Med Assoc. 2014; 244: Prospective analysis of all trauma cases presenting at 4 institutions over two month period. Trauma score via Animal Trauma Triage (ATT) Scale or Modified Glascow Coma Scale (MGCS) was predictive for survival. Other factors: lactate, surgery, type of trauma.

8 Trauma Cases Evaluation of vehicular trauma in dogs: 239 cases (January-December 2001). Streeter EM, Rozanski EA, Laforcade A, et al. Am Vet Med Assoc. 2009; 235: Evaluated all dogs presented at referral hospital following vehicular trauma over one year period. Assessed signalment, ATT score, treatments, length of hospital stay, costs and outcomes. Higher ATT significantly associated with death, euthanasia, and cost of care.

9 Trauma Cases Evaluation of vehicular trauma in dogs: 239 cases (January-December 2001). Streeter EM, Rozanski EA, Laforcade A, et al. Am Vet Med Assoc. 2009; 235:

10 Trauma Cases Evaluation of vehicular trauma in dogs: 239 cases (January-December 2001). Streeter EM, Rozanski EA, Laforcade A, et al. Am Vet Med Assoc. 2009; 235:

11 Triage General Assessment Temp / Pulse / Resp / CRT / Memb Blood Pressure / EKG Visual Assessment Mental status Rate / effort of breathing Bruising / swelling / asymmetries

12 Triage Initial Exam Thoracic auscultation Lung Sound Assessment Cardiac Assessment Borborygmi

13 Triage Initial Exam Abdominal Assessment Distension / fluid wave Decreased abdominal size Urinary bladder Rectal Exam Bloodwork

14 Triage Initial Diagnostics Thoracic Radiographs Contusions Fractures Diaphragmatic Hernia Pneumothorax / hemothorax

15 Thorax

16 Triage Initial Diagnostics Abdominal Radiographs Fractures Hernias Hemoperitoneum / pneumoperitoneum Retroperitoneal space Urinary bladder

17 Triage Initial Diagnostics Contrast Radiographs Excretory urogram Retrograde cystourethrogram Abdominal ultrasonography Abdominocentesis

18 Abdomen

19 Initial Steps Neurologic Exam

20 Neurologic Injury C1-C5 C6-T2 T3-L3 L4-S1 S1-S3

21 Neurologic Injury NEUROPETVET

22 Neurologic Injury NEUROPETVET

23 Neurologic Injury NEUROPETVET

24 Neurologic Injury NEUROPETVET

25 Neurologic Injury NEUROPETVET

26 Neurologic Injury LOSS OF FUNCTION Proprioception, paresis, motor, bladder, sensation RETURN TO FUNCTION Adapted from Withrow SJ: Localization and diagnosis of spinal cord lesions in small animals: Part I. The compendium on Continuing Education for Practicing Veterinarians 2:466, 1980

27 Spinal Fractures Tobias and Johnston, Veterinary Surgery: Small Animal 2012

28 Spinal Fractures Tobias and Johnston, Veterinary Surgery: Small Animal 2012

29 Spinal Fractures Tobias and Johnston, Veterinary Surgery: Small Animal 2012

30 Borzoi Intermission

31 Orthopedic Injury Types of Orthopedic Injuries Fractures Joint Luxations Ligamentous Injuries Soft Tissue / Muscle Trauma

32 Initial Steps Orthopedic Exam

33 Orthopedic Injury

34 Orthopedic Injury Tobias and Johnston, Veterinary Surgery: Small Animal 2012

35 Orthopedic Injury Tobias and Johnston, Veterinary Surgery: Small Animal 2012

36 Orthopedic Injury Tobias and Johnston, Veterinary Surgery: Small Animal 2012

37 Orthopedic Injury

38 Orthopedic Injury

39 Orthopedic Injury

40 Orthopedic Injury

41 Orthopedic Injury

42 Orthopedic Injury

43 Orthopedic Injury

44 Orthopedic Injury

45 Orthopedic Injury

46 Orthopedic Injury

47 Borzoi Intermission

48 Sacral Fractures Classified fractures as axial (17) or abaxial (15). 69% of dogs had neurologic deficits at presentation. Axial fractures were more likely associated with tail and perineal denervation, as well as urinary deficits. Abaxial fractures more likely associated with pelvic limb deficits. Axial fractures were associated with more severe neurologic deficits ( )

49 Sacral Fractures

50 Sacral Fractures Sacral fractures in dogs and cats: a classification scheme and review of 51 cases. Anderson A, Coughlan AR. J Small Anim Pract. 1997; 38: I. Alar: Oblique fracture of the juxta-articular notch and terminating on the articular surface of the sacral wing. II. Longitudinal: Longitudinal or oblique fracture through the 1 st or 2 nd sacral foramina. III. Transverse: Transverse sacral body fracture IV. Avulsion: Fracture of the caudal origin of the sacrotuberous ligament V. Comminuted: Comminuted sacral fracture

51 Sacral Fractures Sacral fractures in dogs and cats: a classification scheme and review of 51 cases. Anderson A, Coughlan AR. J Small Anim Pract. 1997; 38:

52 Sacral Fractures Characteristics of pelvic fractures in the cat: A 10- year retrospective study. Bookbinder PF, Flanders JA. Vet Comp Orthop Traumat. 1992; 5: cats with 264 pelvic fractures reviewed in 7 year period. Most cats <12m of age. Equal sex distribution. Majority included pelvic floor (90%) Sacroiliac luxations in 60% Association between ilial body fractures and sciatic nerve deficits.

53 Pelvic Fractures Pelvic fractures in the dog and cat: a classification system and review of 556 cases. Messmer M, Montavon PM. Vet Comp Orthop Traumat. 2004; 17: Review of 556 pelvic fractures over 10 years different fractures identified. 76% of animals had >3 fractures. Developed novel AO-based classification system for pelvic fractures in small animals.

54 Pelvic Fractures Pelvic fractures in the dog and cat: a classification system and review of 556 cases. Messmer M, Montavon PM. Vet Comp Orthop Traumat. 2004; 17:

55 Pelvic Fractures Pelvic fractures in the dog and cat: a classification system and review of 556 cases. Messmer M, Montavon PM. Vet Comp Orthop Traumat. 2004; 17:

56 Sacroiliac Luxations

57 Sacroiliac Luxations Minimally invasive repair of sacroiliac luxation in small animals. Tomlinson J. Vet Clin Small Anim 42 (2012) Fluoroscopically-assisted iliosacral lag screw placement technique. Same screw position and length guidelines as open technique. Decreased patient morbidity associated with MI approach.

58 Sacroiliac Luxations

59 Sacroiliac Luxations Minimally invasive repair of sacroiliac luxation in small animals. Tomlinson J. Vet Clin Small Anim 42 (2012)

60 Sacroiliac Luxations Minimally invasive repair of sacroiliac luxation in small animals. Tomlinson J. Vet Clin Small Anim 42 (2012)

61 Sacroiliac Luxations

62 Sacroiliac Luxations

63 Sacroiliac Luxations

64 Sacroiliac Luxations Limited open reduction and stabilization of sacroiliac fracture-luxations using fluoroscopically assisted placement of a trans-iliosacral rod in five dogs. Leasure CS, Lewis DD, Sereda CW, et al. Vet Surg. 2007; 36: Retrospective case series of 5 dogs treated for SI luxation. Mean reduction of the SI joint was 92.9+/-6.6%. All dogs healed without significant complications. Owners assessment of recovery good or excellent.

65 Sacroiliac Luxations

66 Sacroiliac Luxations

67 Pelvic Fractures The role of computed tomography in the classification and management of pelvic fractures. Draffan D, Clements D, Farrell M. et al. Vet Comp Orthop Traumat. 2009; 22: Prospective study of 25 pelvic trauma cases. CT Interpretation matched consensus 80% of time. Radiology matched consensus 70% of time. CT changed fracture classification in 60%, and treatment course in 29% of cases.

68 Pelvic Fractures Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analysing sacral and pelvic fractures in dogs. Stieger-Vanegas SM, et al. Vet Comp Orthop Traumatol. 2015; 28: Radiographs had 70-73% accuracy for sacral fractures. CT had 83%-97% accuracy for diagnosing sacral fractures. Sensitivity of 14-20% for radiographs, % for CT. Radiographs had 75-84% accuracy for pelvic fractures. CT 84-95% accuracy for diagnosing pelvic fractures. Sensitivity of 47-68% for radiographs, 70-90% for CT.

69 Pelvic Fractures Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analyzing sacral and pelvic fractures in dogs. Stieger-Vanegas SM, et al. Vet Comp Orthop Traumatol. 2015; 28:

70 Pelvic Fractures

71 Pelvic Fractures Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analyzing sacral and pelvic fractures in dogs. Stieger-Vanegas SM, et al. Vet Comp Orthop Traumatol. 2015; 28:

72 Borzoi Summary

73 Care and Treatment Concerns for Technicians Monitoring Analgesia Cleanliness Positioning and Movement Urination and Defecation

74 Care and Treatment Concerns for Technicians Owner Education Rehabilitation Follow-up

75 Care and Treatment

76 Questions? Thank You! Vienna / Leesburg / Winchester / Woodbridge Contact us at VSC@VSCVets.com Facebook.com/AnimalSurgeons

77 References 1. Anderson A, Coughlan AR. Sacral fractures in dogs and cats: a classification scheme and review of 51 cases. J Small Anim Pract. 1997; 38: Bookbinder PF, Flanders JA. Characteristics of pelvic fractures in the cat: A 10-year retrospective study. Vet Comp Orthop Traumat. 1992; 5: Draffan D, Clements D, Farrell M. et al. The role of computed tomography in the classification and management of pelvic fractures. Vet Comp Orthop Traumat. 2009; 22: Hall KE, Holowaychuk MK, Sharp CR, et al. Multicenter prospective evaluation of dogs with trauma. Am Vet Med Assoc. 2014; 244: Kuntz, CA, et al. Sacral fractures in dogs: a review of 32 cases. J Am Anim Hosp Assoc. 1995; 31:

78 References 6. Lantz OI. Lumbosacral and Pelvic Injuries. Vet Clin Small Anim. 32. (2002) Leasure CS, Lewis DD, Sereda CW, et al. Limited open reduction and stabilization of sacroiliac fracture-luxations using fluoroscopically assisted placement of a trans-iliosacral rod in five dogs. Vet Surg. 2007; 36: Messmer M, Montavon PM. Pelvic fractures in the dog and cat: a classification system and review of 556 cases. Vet Comp Orthop Traumat. 2004; 17: Neuropetvet Stieger-Vanegas SM, et al. Evaluation of the diagnostic accuracy of four-view radiography and conventional computed tomography analyzing sacral and pelvic fractures in dogs. Vet Comp Orthop Traumatol. 2015; 28:

79 References 11. Streeter EM, Rozanski EA, Laforcade A, et al. Evaluation of vehicular trauma in dogs: 239 cases (January-December 2001). Am Vet Med Assoc. 2009; 235: Tobias K, Johnston KA. Veterinary Surgery: Small Animal Tomlinson J. Minimally invasive repair of sacroiliac luxation in small animals. Vet Clin Small Anim 42 (2012)