Color atlas of surgical approaches to the bones and joints of the dog and cat

Color Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat Color Atlas of Surgical lpproaches to the Thoracic and Pelvic Limbs R Latorre I? GI1 S (3iment 0 Upez R Henry M Ayala G Ra.

Color Atlas of Surgical lpproaches t o the Thoracic and Pelvic Limbs R Latorre M Ayala I? GI1 S (3iment U p e z R Henry G Ramirez Fw Martinez V-ez Jw COLOR ATLAS OF SURGICAL APPROACHES TO THE BONES AND JOINTS OF THE DOG AND CAT Thoracic and pelvic limbs R Latorre F Gil S Climent L6pez R Henry M Ayala G Ranlirez F Martinez J Viizquez XXI - 2009 Buenos Aires - Repljblica Argentina All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from Editorial Inter-Medica S.A Deposit was made under the law 11.723 ISBN: 978-950-555-347-1 2009 b y Editorial Inter-Medica S.A.I.C.I J u n i n P i s o lo"A"-C1113AAC Ciudad Autonoma de Buenos Aires - Republics Argentina Tels.: (54-1 1) 4961-7249 14961-9234 14962-3145 FAX: (54-1 1) 4961-5572 E-mail: info@inter-medica.com.ar E-mail: ventasBinter-medica.com.ar http://www.inter-medica com.ar ww.seleccionesveterinarias.com Latorre, Rafael Color atlas of surgical approaches to the bones and joints of the dog and cat: toracic and pelvic - la ed Buenos Aires: Inter-Medica 2009 272 p.; 28x20 cm I I ISBN 978-950-555-347-1 Veterinary medicine Surgery I Tittle CDD 636.089 Print in Talleres Graficos Valdez Loyola 1568 - Buenos Aires Impreso en Argentina - Printed in Argentina Tirada: 5000 ejemplares Este libro se termino de imprimir en Enero de 7009 I leans elec- Autores colaboradores ARENCIBIA ESPINOSA,A MARTINEZ GOMARIZ, F DVM, PhD Professor of Veterinary Anatomy, University of Las Palmas de Gran Canaria, Spain DVM, PhD Professor of Veterinary Anatomy, University of Murcia, Spain AYALAFLORENCIANO, Ma.D ORENESHERNANDEZ, M DVM, PhD Professor of Veterinary Anatomy, University of Murcia, Spain Technical Specialist of Veterinary Anatomy, University of Murcia, Spain ALBARRAC~N LOPEZ,J R A M ~ R EZARZOSA Z G Auxiliary Technical Specialist of Veterinary Anatomy, University of Murcia, Spain DVM, PhD Professor of Veterinary Anatomy, University of Murcia, Spain CLIMENT PERIS,S ROJORios, D DVM, PhD Professor of Veterinary Anatomy, University of Zaragoza, Spain DVM Professor of Veterinary Anatomy, University of Murcia, Spain CLIMENT AROZ,M R o s SEMPERE,J DVM Professor of Veterinary Anatomy, University of DVM Professor of Veterinary Anatomy, University of Zaragoza, Spain Murcia, Spain DRAPE,J RUIZ, M DVM, PhD Aquivet Veterinary Hospital Director, Eysines, Burdeoux, France DVM, PhD Director of the Mediterranean Veterinary Hospital, Madrid, Spain GILCANO,E SANCHEZ MARGALLO, F DVM, PhD Professor of Veterinary Anatomy, University of Murcia, Spain DVM, PhD Scientific Director of Minimally lnvasive Surgery Center Jesus Uson, Caceres, Spain HENRY,R SANCHEZCOLLADO,C DVM, PhD Professor of Veterinary Anatomy, University of Tennessee, USA DVM Professor of Veterinary Anatomy, University of Murcia, Spain KOSTLIN,R USON GARGALLO, J DVM, PhD Professor of Veterinary Surgery, University of Munich, Germany DVM, PhD Director of the Foundation Minimally lnvasive Surgery Center Jesus Uson, Caceres, Spain LATORREREVIRIEGO,R V ~ Q U EAUTON, Z J DVM, PhD Professor of Veterinary Anatomy, University of Murcia, Spain DVM, PhD Professor of Veterinary Anatomy, University of Murcia, Spain LOPEZALBORS,0 VEREZFRAGUELA, J.L DVM, PhD Professor of Veterinary Anatomy, University of Murcia, Spain DVM, PhD Director of the Veterinary Hospital Ultramar Clinic, El Ferrol, Spain LOSILLAGUUAS,S ZAERA,J.P DVM Endoluminal Therapy and Diagnosis Unit, Minimally lnvasive Surgery Center Jesus Uson, Caceres, Spain DVM, PhD Professor of Veterinary Surgery, University of Las Palmas de Gran Canaria, Spain lll Preface Many surgeons usually choose to review regional anatomy when planning for surgery Anatomical review is more likely while learning new surgical techniques, as identification of anatomical structures is not as routine This atlas provides an answer to traumatologists who have been asking for a collection of colour anatomical images of the most common surgical approaches to the limbs The selected images have been used in continuing education courses for traumatologists with great success and availability in text book format is often asked The approaches to the thoracic limb are presented in three sections The first includes the scapula, shoulder and hume rus of the dog, the second contains the elbow, radius, ulna and manus of the dog, and a third section includes selections on the cat The pelvic limb begins with the hip joint and thigh and continues with the knee, leg and pes of the dog It concludes with the corresponding approaches in the cat Images of the articulated bones of the region are presented at the beginning of each section All approaches were completed on fresh tissue (no fixation) for more natural colour Cadaver vessels were highlighted by colour injection Superficial to deep views of preparations are presented with the relevant muscles, ligaments, nerves and vessels identified Additionally, sevcral videos of the thoracic and pelvic limbs with 3D reconstruction, obtained from live specimens at the Minimally Inuasiw Surgery CentreJesus Usdn (Ciceres, Spain) with a "BV Pulsera 3DRX Option Philips S A." device, are included Indications for each approach are referenced at the beginning of each chapter All approaches were carried out on left limbs - with the exception of some in the manus and pes- , and sequenced from proximal to distal Footnotes indicate the commonly used protocol for each surgical approach We would like to conclude with a very special reference to Prof Dr Francisco Moreno Medina, who had to leave his career in anatomy early and retire due to illness He founded the Anatomy and Embryology group at the University of Murcia and from him we inherited a large part of our anatomical knowledge and passion for working in the dissection room THE AUTHORS "Anatomy without clinic is dead, clinics without anatomy is deady" (Platzer) (None of the specimens was eutharratized for dissection purposes All cadavers were obtainedfrom the Animal Facility of the University ofMurcia, which oversees nllprotocols for Animal Healthcare and is accredited by the European Bureau for protection of research risks i n animals Most cahuers wereper+sed with coloured chemicalsfor a better identification of arteries and veins) Section I Dog, thoracic limb I Scapula, shoulder joint and humerus Anatomical considerations Approach to the lateral suface, spine and acromion of the scapula Craniolaterul approach to the shoulder hint hv ~rrnmialnstentnm~~ Mediopalmar approach to the carpal joint Approach to the metacarpal bones Approach to the phalanges and the interphulungealjoints Section Cat, thoracic limb Anatomical considerations 21 25 31 Humerus: approach to the distalportion of the diaphysis by craniolateral incision Approach to the distal humeral diaphysis and the humeral supracondylar region via a medial incision c medial incision 47 Elbow, ulna and manus Anatomical considerations 51 medial aspect of the humeral condyle via intermuscular incision Section Dog, pelvic limb 19 123 139 Approach to the ventral surface of the sacrum Approach to the humeroulnarpart of the elbow joint 108 The pelvis and hip (coxal) joint Anatomical considerations Lateral approach to the humeral condyle 103 107 13 Caudolateral approach to the shoulder joint Craniomedialapproach to the shoulder joint Approach to the proximal diaphysis of the humerus " - -roach to the medial humeral diaphysis via a 95 99 14 , 155 Approach to the craniodorsal and caudodorsal 67 the trochlear notch Approach to the olecranon tuber Approach to the distal ulnar diaphysis and 71 73 Approach to the caudodorsal regions of the hip joint with gluteal muscle tenotomy Approach to the os coxae 165 167 and diaphysis ofthe radius - Approach to the diaphysis of the radius via a 79 Approach to the pubis and the pelvic symphysis Approach to the ischium 175 179 81 Approach to the diaphysis of the femur 187 I I eazal zncznon Dorsal approach to the carpaljoint 91 I Contents Stifle leg and foot Anatomical considerations I I Approach to tile distalfemur and stzfle joint via a lateral incision Approach to the medial collateral ligament and the caudomedial region of the sttjle joint Approach to the lateral collateral ligament of the caudolateral stzjle joint region Approach to the proximal tibia via a medial incision Approach to the tibial diaphysis Approach to the lateral malleolus and tarsocruraljoint Approach to the medial malleolus and tarsocruraljoint Approach to the tarsocruraljoint via osteotomy of the medial malleolus Approach to the calcaneus 189 20 205 209 21 19 223 Approach to the calcaneus and the plantar surface ofthe tarsal bones 237 Section Cat pelvic limb 239 Anatomical considerations 240 Approach to the wing of the ilium by lateral incision Craniodorsal and caudodorsal approaches to the hip joint by osteotomy of the major ti-ochanter Approach to the dyaphisis of the femur Approach to the stzjle joint by luteral incision Approach to the dy~phisisof the tibia 247 251 255 259 263 227 References 23 235 266 Thoracic limb Chapter Skeleton of dog, left view Scapula, shoulder joint and humerus Anatomical considerations m a r k L Craniodorsal and caudodorsal approaches to the hip joint by osteotomy of the major trochanter Chapter Middle gluteal muscle P Gluteofemoral muscle Cat - Pelvic limb Middle gluteal muscle \ r Superficial gluteal muscle Caudal gluteal artery - and vein Quadriceps kmoris muscle Saatic nerve ' Major trochanter and gluteal musdes I i I Head d femur , Internal obturator C Sciatic nerve I and xed Upper image: after the superficial gluteal muscle tendon has been transected, the muscle is reflected dorsally.The osteotomy site of the major trochanter is located (dotted line) and the osteotomy is performed at a 45" angle from the axis of the femoral diaphysis Lateral view Lower image: after completing the osteotomy, the freed trochanter with the middle and deep gluteal and piriformis muscles are reflected dorsally.The joint capsule will be cut to view the femoral head.To view the caudal portion of the head, the insertions of the gemelli and internal obturator muscles need t o be transected (dotted line) CAUTION: protect the sciatic nerve and caudal vessels passing caudal to the hip joint Chapter Major trochanter and gluteal muscles Internal obturator - muscle tendon C Sciatic nerve Trochanteric lossa A f t e r tenotomy, the gemelli and internal obturator muscles are reflected to expose the caudal border of the ac tabulum and the body of the ischiurn Lateral view CAUTION: not cut the external obturator muscle tendon I I I Approach to the dyaphisis of the femur - Major trochanter r( 8' CAI be li Cat - Pelvic limb Adductor muscle Biceps fernoris muscle W To view the cranial, lateral and caudal aspects of the femoral diaphysis, the vastus lateralis and biceps femoris muscles are retracted cranially and caudally, respectively The adductor muscle inserts on the caudal surface of the diaphysis For greater exposure, the incision and retraction can be extended proximally t o the major trochanter andlor distally t o the condyle Lateral view CAUTION: in the distal part of the incision, branches from the distal caudal femoral vessels can be found and should be ligated Approach to the stifle joint by lateral incision Chapter Quadriceps femoris / muscle tendon of insertion Long digitill extensor muscle tendon / - IUpper image: the skin incision extends from the distal one third of the femur, over the femoral lateral epicondyle, to the proximal one third of the crus Lateral view, left stifle Lower image: the lateral fascia is partially dissected t o identify the junction of the biceps femoris muscle and the quadriceps femoris muscle tendon (dotted line) Dividing and retracting this aponeurosis will expose the joint capsule r%=C Cat - Pelvic limb I , Trochlea of lemur Quadriceps femoris muscle tendon of insertion Jtv joint capsule 'Caudal cruciate ligament Patella and patellar ligament lateral meniscus I \ Cranial cruciate ligament \ Mapatellar fat L Iody Approach to the diaphysis of the tibia Chapter Upper image: to gain better exposure to the medial crus, the contralateral pelvic limb should be abducted Medial view, left crus Lower image: skin incision extends from medial femoral epicondyle to the medial tibia1 malleolus Saphenous artery and vein Medial digital flexor musde bA \ - '- Medial aspect of the tibia Cranial tibial muscle Medial digital flexor muscle \ Semitendinorus muscle, tendon of insertion Cranial tibia1 musde Upper image: the crural fascia is opened and the attachment of the cranial tibia1 muscle t o the cranial border of the tibia is identified (dotted line) For greater exposure, the cranial tibial muscle can be freed from the cranial border of the tibia Medial view H Lower image: after freeing the muscle, the cranial tibial muscle is retracted laterally and the medial digital flexor muscle retracted caudally t o expose the medial tibia CAUTION: preserve the saphenous vessels and the semitendinosus muscle tendon - Ir i1 References - Climent y colaboradores, Manual de Anatomta y Embriologta de 10s Animales Dodsticos Conceptos bzisicos y datos aplicativos Miembro Torricico y Miembro Pelviano Sistema Circulatorio Esqueleto de la Cabeza 20M Ed Acribia - Evans HE, Miller3 Anatomy of the Dog Tercera Edicibn 1993 WB Saunders, Philadelphia - Nomina anatdmica veterinaria 5Ih Editorial Committee Hannover, Columbia, Gent, Sapporo, 2005 International Committee on Veterinary Gross Anatomical Nomenclature World Association of Veterinary Anatomists (W.A.V.A.) (2005), 1-190 - Piermattei, Johnson: An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat Cuarta Edicibn; 2006 Elsevier Inc, New York - Franch, J y Mpez C., Atlas de Abordajes Quirlirgicos en Traumatologta de Pequeiios Animales 1999 Temis Phanna, S.L - Sandoval, J., Tratado de Anatomia Veterinaria Tomo 11: Aparato Locomotor 3" edicibn 1998 Imprenta Sorles Lebn I ... http://www.inter-medica com.ar ww.seleccionesveterinarias.com Latorre, Rafael Color atlas of surgical approaches to the bones and joints of the dog and cat: toracic and pelvic - la ed Buenos Aires: Inter-Medica.. .COLOR ATLAS OF SURGICAL APPROACHES TO THE BONES AND JOINTS OF THE DOG AND CAT Thoracic and pelvic limbs R Latorre F Gil S Climent L6pez R Henry M Ayala... manus of the dog, and a third section includes selections on the cat The pelvic limb begins with the hip joint and thigh and continues with the knee, leg and pes of the dog It concludes with the