Small animal orthopedic surgical instruments: multiple pelvic fractures and sacroiliac joints

Writer：admin Time：2023-04-03 22:36 Browse：℃

Multiple pelvic fractures

If unilateral fractures of the ilium, hip, and ischia occur simultaneously, the best method to expose these areas is to combine the methods described in "Lateral iliac surgical access" on page 133 and "Dorsal hip surgical access" on page 145-151.

Orthopedic plate fixation

A Tendon amputation was performed at the femoral insertion point of the superficial gluteal muscle, and it was turned dorsally, while greater trochanteric osteotomy was performed. When flipping the greater trochanter, the gluteus medius and gluteus profundus muscles are peeled off from the iliac wing and iliac body, and the internal obturator and double muscles are cut to expose the posterior part of the acetabulum. The acetabulum was further exposed by transecting part of the starting point of the biceps femoris muscle from the sacral tubercle ligament

B Reduction of the fractured end and fixation with an orthopedic plate. The trochanter was reattached and fixed to the femur using tensile steel wire and Kirschner wire, and the transverse muscle attachment point was sutured to its original position. Other tissues were routinely sutured

C uses the same surgical approach to temporarily fix multiple fractures of the pelvis and acetabulum with Kirschner's fixation.

D Then use an orthopedic steel plate to firmly fix the broken end of the fracture. Use tensile steel wire and Kirschner wire to reposition and fix the greater trochanter on the femur. Suture the severed muscle attachment point back to its original position, and perform routine sutures on other tissues

Annotated intramedullary nails, orthopedic steel wires, compression screws, and external fixators can all be used for the fixation of pelvic fractures. However, for most cases, orthopedic plates are more convenient, fast to use, and have the best fixation effect.

Separable fracture of sacroiliac joint

The separation, dislocation, and/or fracture of the sacroiliac joint are often related to pelvic fractures, with pubic and ischial fractures being the most common.

The instability caused by fractures often causes the iliac bone connected to the sacrum to rotate forward and backward. The affected limb often feels uncomfortable, especially when the lumbar sacral nerve trunk is affected. Treatment usually involves using double screws for fixation after reduction.

Dorsal sacroiliac joint through the surgical pathway

A skin incision is made from a point beyond the anterior side of the iliac bone, extending rearward along the iliac spine, and finally terminating on the iliac body. Cut the subcutaneous tissue along the same tangent to expose the iliac spine and the origin of the gluteus medius muscle

Cut the starting point of the gluteus medius muscle, separate the periosteum, and lift the muscle from the upper edge of the outer side of the iliac bone. The tangent line extends rearward to the junction of the posterior border of the iliac spine and the anterior border of the iliac body. The blood vessels and nerves in front of the buttocks run from the inside to the outside at this junction, and attention should be paid to protecting them. Cutting the medial muscles of the iliac bone will facilitate exposure of the corresponding surfaces between the sacrum and iliac bone

Tension screw fixation

C Use bone holding forceps to tighten the iliac wing and exert force backwards and downwards to restore the sacroiliac joint surface to its normal position

When observing the iliac wing from the side, the joint surface located on its inner side is exactly at the center of the posterior half of the iliac wing, basically in the middle position between the dorsal and ventral edges of the iliac bone. Insert a Kirschner wire from the iliac wing to the sacral body for temporary fixation. Note that the Kirschner wire must pass through both joint surfaces, but cannot penetrate the medullary canal. Therefore, the needle can be deflected 25 ° ventrally.

E will drill a tension screw through the surface of the iliac bone into the sacral body, remove the Kirschner wire, and drill another tension screw into the sacral body near the front of the first screw.

Closure restores the gluteus medius muscle to its normal position and sutures the superficial fascia at the beginning of the previously cut muscle. If possible, the fascia can also be sutured onto the sacrospinalis muscle, which typically passes between the inner side of the iliac wing and the dorsal spine of the sacrum. Routine suture of gluteal muscle membrane, subcutaneous tissue, and skin.

Two tension screws provide the best fixation for sacroiliac joint separation fractures. For small dogs and cats, the joint surfaces of the ilium and low bone may be too small to implant two screws. At this time, the end of the Kirschner wire protruding from the surface of the ilium can be bent and not removed. Carefully control the activity of the diseased animals within 4-6 weeks after surgery.