After a long gap, I am back with more success stories . I had to go through a rough phase of career dealing with circumstances and individuals that I hardly found time to spare to contribute to my blog. Apologies for this delay and many many thanks to those wonderful mails and inspirations which came across all over the world to continue blogging on surgical cases.
In this session I would love to blog on something on which I was spending one whole year in the form of a project .I was the principal investigator of a project of the university "Developing field based protocol for the management of congenital and musculoskeletal disorders in ruminants" .It gave me immense satisfaction working for the ailing calves and kids bringing them back to productive life which other wise are disposed or culled causing huge economic loss to the farmers.
All the cases which responded and came back as success stories belonged to some wonderful animal owners who took pain and care attending the operated animals and brought their animals for timely check ups. I am indebted to my colleagues and my university for putting their trust on me. 56 cases selected put of 112 congenital anomalies were subjected to studies and at he end of or project the results were rewarding relieving many crippled animals .
Flexural limb deformities in young calves and kids are a common orthopedic problem of calves and kids . Large number of crippled calves , kids and lambs are referred to college hospital for treatment due to inadequate field level diagnostic and treatment options. Incidence of crippled kids are compared to be more than in calves mainly due to poor nutritional status and concurrent congenital affections . A systematic approach considering the general health ,presenting staus of animal and a treatment plan with deliberate follow ups gives satisfactory results in managing musculoskeletal disorders in calves and kids.
KNUCKLING / FLEXURAL DEFORMITY
Knucking is the contracted tendon commonly identified as an early congenital musculo skeletal abnormality in kids and calves. Occasionally Calves and kids are born with crooked legs or contracted or lax tendons. Some of these straighten out on their own with time and exercise, while others require intervention to resolve the condition.
Congenital flexural deformities usually involve the carpal or fetlock joints and range in severity from mild flexion of one joint to severe flexion of several joints. The affected animals show severe difficulty in standing and ambulation. Knuckling is divided in three degrees. The first degree knuckling involve mild goniometric changes of less than 10 degree, Second degree involves knuckling of 10-40 and Thrd degree knuckling with more than 45 degree .
The common tendons that knuckles in fetlock region are Superficial Digital Flexor tendon and Deep digital flexor tendon.
At the level of carpal the structures are more complicated like Ulnaris lateralis, Flexor carpi ulnaris and Superficial deep digital flexor tendons move close to the carpal sheath . any of these tendons can get contracted leading to complete flexion leading to non weight bearing in new born animals .
Behind the carpal joint we get synovial sheaths of all these tendons. Depending up on the degree of knuckling one or group of tendons may be involved. Thorough knowledge on anatomy of the joint and aseptic precautions are the pre requesites for a successful tenotomy .
When examining a neonatal animal affected with flexural limb deformities, it is important to determine if it can stand without assistance. If it can stand/ bear the body weight , specific therapy for flexural limb deformities is often unnecessary. Such cases respond well to Zinc supplements which strengthen the tendon and ligaments in animals. The main joints that involved are carpal and fetlock and the incidence is more in Forelimb than hind limb. This may be attributed to the foetal presentation during terminal pregnancy in third trimester with forelimb close to the narrow pelvis . Minor degree of knuckling (less than 5 degrees) get corrected with time. But more than 10 degree goniometric angle demands palmar/ plantar support and external coaptation for 3 – 4 weeks . Extensive knuckling cases involving more than 50 degree also can be corrected with two stage tenotomy by complete severing the superficial and deep flexors followed by external coaptation for 6 weeks .
Incidence of Knuckling is common in GOATS fed on poor ration especially cattle ration . Ca:P ratio of the knuckling affected goats showed marked variations altering the ratio to 1.2: 1 to 2.2:1 with hypocalcemia . The goniometric evaluation showed effective in predicting the success rate of surgical corrections in knuckling .
TENOTOMY
Surgery to transect restrictive ligaments, tendons, or joint capsules is often reserved for calves /kids that fail to respond to other therapy. However, palmar carpal joint capsule transection may be needed for animals with severe flexural limb deformities of the carpus. Tenotomy of the ulnaris lateralis and flexor carpi ulnaris 2 cm may be also indicated in severe flexural contactions more than 60 degree. Arthrodesis may be the treatment of choice for animals with severe fetlock deformities with marked flexion and abnormally shaped bones. Metacarpophalangeal (fetlock) joint flexural limb deformities occur most commonly in rapidly growing animals and are often bilateral. The angle of the affected joint increases from a normal angle of about 140° (measured from the dorsal surface of the limb) to 180° and greater.
BANDAGING TECHNIQUES
If the kid/ calf cannot stand, splinting the limb in extension is necessary to allow the body weight to load and stretch the tendons and palmar soft tissues. Splints should be applied carefully as they can easily cause pressure sores due to the fragility of the integument and the pressure that is sometimes Necessary to extend the limb. Any strong, light material is suitable for a splint, however, polyvinylchloride (PVC) pipe is readily available and easily cut and shaped to the required size. For neonates, 4-inch diameter thick-walled pipe, cut longitudinally into thirds or halves, is appropriate. The ends of the splint are padded with roll cotton covered with elastic tape. When applying a splint, the limb is bandaged amply, and the splint is positioned over this bandage on the palmar or plantar aspect of the limb. The splints are left on for a maximum of eight h. If re-application of the splints is necessary, the limb should be unsplinted for several hours before the splints are applied again.
A straight splint should be used if the deformity is severe. When the deformity improves, a bend can be placed in the splint at the level of the fetlock joint to further extend this joint. PVC splints can be bent easily by notching each side of the splint and heating it over a flame.
Cooling the splint with cold water will hasten hardening of the splint in the bent position. The use of splints should be discontinued when joint angles approach normal and the animal can stand unassisted. At this point, controlled exercise will usually result in complete correction of the deformity
FIBER GLASS CAST APPLICATION
A fiberglass cast is the plaster cast made from fiberglass material. Traditionally, plaster cast has been made of plaster of Paris. A fiberglass cast is a lighter, synthetic alternative plaster of Paris. Fiberglass is also called glass-reinforced plastic[GRP] or glass fiber reinforced plastic [GFRP] is a fiber reinforced polymer made of a plastic matrix reinforced by fine fibers of glass. Fiberglass cast is a lightweight and extremely strong material. As compared to traditional plaster of Paris cast, it is light in weight and more durable. It is three times stronger and but is only one third in weight. Major orthopaedic ailments encountered in field condition can be effectively addressed using External Coaptation techniques of which FIBER GLASS CASTS can be regarded as the best availiable external coaptation aid.
USE OF ADJUNCT THERAPY
Correction of the flexural deformity may take several days due to restriction of extension by joint capsule, ligaments, and periarticular tissues. Pain may be marked and analgesics should be administered in the postoperative period. Nonsteroidal anti-inflammatory drugs should be used in the treatment of flexural deformities because the limbs are often painful from stretching the palmar soft tissues. These drugs may cause ulcers, although ketoprofen may be less ulcerogenic than either phenylbutazone or flunixin meglumine. Reducing limb pain and promoting exercise will aid recovery. Balanced nutrition should be ensured for all affected animals. Energy intake should be reduced when much higher than minimal requirements, particularly in rapidly growing kids/ calves
I am sharing some success stories in the form of videos
All these surgeries can be performed in field condition. The main purpose of sharing these videos are to reach the care and attention of healing hands to more number of needy crippled animals, relieve their sufferings and bring back their production life and in turn to make a difference in the life of marginal and small scale farmers.
In this session I would love to blog on something on which I was spending one whole year in the form of a project .I was the principal investigator of a project of the university "Developing field based protocol for the management of congenital and musculoskeletal disorders in ruminants" .It gave me immense satisfaction working for the ailing calves and kids bringing them back to productive life which other wise are disposed or culled causing huge economic loss to the farmers.
All the cases which responded and came back as success stories belonged to some wonderful animal owners who took pain and care attending the operated animals and brought their animals for timely check ups. I am indebted to my colleagues and my university for putting their trust on me. 56 cases selected put of 112 congenital anomalies were subjected to studies and at he end of or project the results were rewarding relieving many crippled animals .
Flexural limb deformities in young calves and kids are a common orthopedic problem of calves and kids . Large number of crippled calves , kids and lambs are referred to college hospital for treatment due to inadequate field level diagnostic and treatment options. Incidence of crippled kids are compared to be more than in calves mainly due to poor nutritional status and concurrent congenital affections . A systematic approach considering the general health ,presenting staus of animal and a treatment plan with deliberate follow ups gives satisfactory results in managing musculoskeletal disorders in calves and kids.
KNUCKLING / FLEXURAL DEFORMITY
Congenital flexural deformities usually involve the carpal or fetlock joints and range in severity from mild flexion of one joint to severe flexion of several joints. The affected animals show severe difficulty in standing and ambulation. Knuckling is divided in three degrees. The first degree knuckling involve mild goniometric changes of less than 10 degree, Second degree involves knuckling of 10-40 and Thrd degree knuckling with more than 45 degree .
The common tendons that knuckles in fetlock region are Superficial Digital Flexor tendon and Deep digital flexor tendon.
At the level of carpal the structures are more complicated like Ulnaris lateralis, Flexor carpi ulnaris and Superficial deep digital flexor tendons move close to the carpal sheath . any of these tendons can get contracted leading to complete flexion leading to non weight bearing in new born animals .Behind the carpal joint we get synovial sheaths of all these tendons. Depending up on the degree of knuckling one or group of tendons may be involved. Thorough knowledge on anatomy of the joint and aseptic precautions are the pre requesites for a successful tenotomy .
When examining a neonatal animal affected with flexural limb deformities, it is important to determine if it can stand without assistance. If it can stand/ bear the body weight , specific therapy for flexural limb deformities is often unnecessary. Such cases respond well to Zinc supplements which strengthen the tendon and ligaments in animals. The main joints that involved are carpal and fetlock and the incidence is more in Forelimb than hind limb. This may be attributed to the foetal presentation during terminal pregnancy in third trimester with forelimb close to the narrow pelvis . Minor degree of knuckling (less than 5 degrees) get corrected with time. But more than 10 degree goniometric angle demands palmar/ plantar support and external coaptation for 3 – 4 weeks . Extensive knuckling cases involving more than 50 degree also can be corrected with two stage tenotomy by complete severing the superficial and deep flexors followed by external coaptation for 6 weeks . Incidence of Knuckling is common in GOATS fed on poor ration especially cattle ration . Ca:P ratio of the knuckling affected goats showed marked variations altering the ratio to 1.2: 1 to 2.2:1 with hypocalcemia . The goniometric evaluation showed effective in predicting the success rate of surgical corrections in knuckling .
TENOTOMY
Surgery to transect restrictive ligaments, tendons, or joint capsules is often reserved for calves /kids that fail to respond to other therapy. However, palmar carpal joint capsule transection may be needed for animals with severe flexural limb deformities of the carpus. Tenotomy of the ulnaris lateralis and flexor carpi ulnaris 2 cm may be also indicated in severe flexural contactions more than 60 degree. Arthrodesis may be the treatment of choice for animals with severe fetlock deformities with marked flexion and abnormally shaped bones. Metacarpophalangeal (fetlock) joint flexural limb deformities occur most commonly in rapidly growing animals and are often bilateral. The angle of the affected joint increases from a normal angle of about 140° (measured from the dorsal surface of the limb) to 180° and greater.
BANDAGING TECHNIQUES
If the kid/ calf cannot stand, splinting the limb in extension is necessary to allow the body weight to load and stretch the tendons and palmar soft tissues. Splints should be applied carefully as they can easily cause pressure sores due to the fragility of the integument and the pressure that is sometimes Necessary to extend the limb. Any strong, light material is suitable for a splint, however, polyvinylchloride (PVC) pipe is readily available and easily cut and shaped to the required size. For neonates, 4-inch diameter thick-walled pipe, cut longitudinally into thirds or halves, is appropriate. The ends of the splint are padded with roll cotton covered with elastic tape. When applying a splint, the limb is bandaged amply, and the splint is positioned over this bandage on the palmar or plantar aspect of the limb. The splints are left on for a maximum of eight h. If re-application of the splints is necessary, the limb should be unsplinted for several hours before the splints are applied again.A straight splint should be used if the deformity is severe. When the deformity improves, a bend can be placed in the splint at the level of the fetlock joint to further extend this joint. PVC splints can be bent easily by notching each side of the splint and heating it over a flame.
Cooling the splint with cold water will hasten hardening of the splint in the bent position. The use of splints should be discontinued when joint angles approach normal and the animal can stand unassisted. At this point, controlled exercise will usually result in complete correction of the deformity
FIBER GLASS CAST APPLICATION
A fiberglass cast is the plaster cast made from fiberglass material. Traditionally, plaster cast has been made of plaster of Paris. A fiberglass cast is a lighter, synthetic alternative plaster of Paris. Fiberglass is also called glass-reinforced plastic[GRP] or glass fiber reinforced plastic [GFRP] is a fiber reinforced polymer made of a plastic matrix reinforced by fine fibers of glass. Fiberglass cast is a lightweight and extremely strong material. As compared to traditional plaster of Paris cast, it is light in weight and more durable. It is three times stronger and but is only one third in weight. Major orthopaedic ailments encountered in field condition can be effectively addressed using External Coaptation techniques of which FIBER GLASS CASTS can be regarded as the best availiable external coaptation aid.
USE OF ADJUNCT THERAPY
Correction of the flexural deformity may take several days due to restriction of extension by joint capsule, ligaments, and periarticular tissues. Pain may be marked and analgesics should be administered in the postoperative period. Nonsteroidal anti-inflammatory drugs should be used in the treatment of flexural deformities because the limbs are often painful from stretching the palmar soft tissues. These drugs may cause ulcers, although ketoprofen may be less ulcerogenic than either phenylbutazone or flunixin meglumine. Reducing limb pain and promoting exercise will aid recovery. Balanced nutrition should be ensured for all affected animals. Energy intake should be reduced when much higher than minimal requirements, particularly in rapidly growing kids/ calves
I am sharing some success stories in the form of videos
All these surgeries can be performed in field condition. The main purpose of sharing these videos are to reach the care and attention of healing hands to more number of needy crippled animals, relieve their sufferings and bring back their production life and in turn to make a difference in the life of marginal and small scale farmers.
SURGICAL MANAGEMENT OF BILATERAL FETLOCK KNUCKLING IN CALF
This case was that of a calf presented with bilateral fetlock knuckling . Flexor tenotmies of SFDT was performed on both limbs on the same day of presentation followed by POP bandage. Animal recovered in one week with complete weight bearing. you can watch this video below
SURGICAL MANAGEMENT OF CARPAL KNUCKLING IN CALF
Carpal knuckling is a difficult one to correct in field condition. generally calves affected with carpal joints are culled with ho hope by the farmer and the vets often don't try to attempt the condition owing to the complicated carpal joint. This case was reffered from Palakkad district and the condition was corrected by a superficial digital flexor tenotomy , ulnaris lateralis partial section and flexor carpi ulnaris tenotomy . Supportive bandage was applied on palmar aspect using modified palmar PVC casts .You can watch this challenging case belpw.
BILATERAL CARPAL KNUCKLING IN A GOAT KID
Flexural limb deformities in young calves and kids and Joint Ill are a common orthopedic problem of calves and kids . Deformities of the metacarpophalangeal and distal interphalangeal joints can be mild to severe and no single treatment regime is always successful. A systematic approach considering the general health ,presenting staus of animal and a treatment plan with deliberate follow ups gives satisfactory results in managing musculoskeletal disorders in calves and kids.
Bilateral carpal knuckling is a difficult condition to treat in field owing to the high degree of flexion of carpal joints resulting in complete contracture of the carpal joints. The tendon of SFDT and Ulnaris lateralis and Flexor carpi ulnaris needs to be severed to save the animal. This case was a challenging one in which the first surgery was performed on the day of presentation on left fore limb follwed by that the second surgery on day 10 and the complete correction of the carpal knuckling and weight bearing achieved by fourth week of presentation.
Miracles happen every day if we allow it . With a wholehearted dedicated effort, Sincere trials never fail !
Best wishes to all readers of my blog !
Great job Dr sb. it need sound skill and sincere efforts.
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