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TPLO 2 Course - Coggle Diagram

- - - - Usually 8 weeks, as early as 6
    - - Biofilm disruption product
      - Lavage plate for 1 min then rinse
    - - Mix then with antibiotics (Amikacin most common)
      - Place around surgery site
    - - Slowly administers antibiotics
      - Stays in for 30 days
      - Daily administer ATB
- - - - Should be shaped like a trapezoid
      - ~25% of the width of the tibia
  - - - CCWO angle
        
        Can be planned using VPOP (easier)
        
        or manually Y= X(tan 10degrees)
      - Benefits
        
        Preserved bone contact
        
        Less caudal tibial overhanf
        
        Can also manage patellar laxation or torsional deformity
      - Cons
        
        Technically difficult
        
        Higher revision rate - 33% from Tufts surgeons
        
        long healing time - ~18 week
      - Steps:
        
        Make TPLO Cut
        
        Score CWO on tibia - apex of triangle meets base of TPLO rotation
        
        Stabilize TPLO with 2 K wires
        
        Stabilize CWO with 1 K wire
        
        Place 2 tension bands
        
        Place 1-2 plates
    - - Takes a smaller wedge
      - Wedge goes 2/3rds across tibia rather than all the way across
      - Not a TPLO
      - Benefit sight you only need to stabilize 1 cut
        
        May heal only with a plate
        
        Liberty lock plates common
        
        Use a plate that is one size bigger (regular -> broad) if possible
        
        Better to use tension band to appose pull of patellar tendon on cranial aspect :
        
        Can place tension band through little hole in plate if you run out of room
      - Sequentially make cuts
        
        Cleaner
        
        less vibration than if you made one cut completely then the other
      - First line is 3-5mm distal to tibial tuberosity
      - next line is parallel to Tibi plateau - runs from distal point of first line
      - Then we have a line 90 degrees to vertical TPLO planning line
      - Make horizontal line beset parallel line ~2/3rds of the way through the tibia
      - Measurements
        
        Long hypotenuse
        
        Actual Hypotenuse
        
        Distal Cut (horizontal line)
        
        Distal 2: horizontal cut to intersection of long hpotenuse
        
        Base of triangle - runs along tibia tuberosity
      - Can use bone from wedge as bone graft
        
        Crush and place within the osteotomy site to fill in gaps
    - - Basically a double cut TPLO
        
        Each cut adds to enter TPA
        
        Usually based on rotation- makes sense so that it is still able insertion of patellar tendon
      - Selection
        
        Dogs with a wider tibia
      - Want VPOP for this, difficult to plan otherwise
      - Score it first, then alternate cuts as in prev technique
- - - - Do TPLO as normal
      - Add in TTT/tension band
        
        Do NOT place tension band hold underneath plate
        
        Tenson band hole must be proximal to distal screw
        
        Pins likely will be seated in distal fragment of tibia bc of proximal plate screws
      - Increased risk of complications
        
        Delayed healing
        
        Tibial crest fracture/avulsion
      - Start TTT cut right where cranial depression is
      - Where cranial aspect of proximal fragment is
      - When doing TTT, consider cutting slightly more on lateral aspect of cut
        
        Should make lateral translation of TT easier
        
        Go slowly with lateral translation
    - - 3 modifications can be made
        
        Translate distal tibia laterally - best
        
        TPLO as normal
        
        Move distal segment laterally
        
        Important to contour plate accordingly
        
        results in an s bend
        
        Externally rotate distal ibia- bad
        
        abduct distal tibia - worse
        
        better than TPLO + TTT
- - - - Line that touches distal aspects of femoral condyles
      - Then measure lateral angle between the two
    - - Lateral Closing Wedge Osteotomy
        
        Cut is usually just proximal to patellar groove
        
        Lateral approach to distal femur
        
        Pack with gauze- behind femur is femoral artery
        
        Distal cut parallel to joint line ~30-50% through bone
        
        If using wedge - make sure apex is on medial aspect, cut 50% of proximal cut
        
        Place Jig
        
        Mke sure to mark bone in vertical plane so you can ensure that you can align
        
        Finish distal cut first
        
        Finish proximal cut
        
        Place plate- should extend proximal to jig pins to minimize stress risers
        
        Lateral aspect
        
        3 screws above and below
        
        Make sure you don't enter joint or patellar groove