The purpose of this course is to provide the participant with the basic fundamentals of understanding how to assess the alignment of the forelimb of the dog. These principles will then be applied to a number of conditions that arise from pathologic malalignment of the forelimb, such as growth disturbances, angular limb deformation and joint incongruity. Participants will learn a variety of pre-operative assessments and operative techniques in a highly interactive environment involving lectures, workbook exercises, software-based planning sessions and hand-on laboratory experiences.
*Attendance / completion of an AO VET Principles in Small Animal Fracture Management course is a prerequisite for the Masters level course since familiarity with instrumentation and techniques will be assumed.
REGISTERED PARTICIPANTS ARE REQUIRED TO BRING EITHER A LAPTOP OR IPAD TO THE COURSE IN ORDER TO ACCESS THE COMPUTER SOFTWARE TEMPLATING PROGRAM
Target Audience:
Enrollment is open to Veterinary residents and practicing veterinarians.
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AO North America is a Registry of Approved Continuing Education (RACE) Provider (Number 244).
Designation Statement
This program was reviewed and approved by the AAVSB RACE program for 20.75 hours of continuing education credit in jurisdictions which recognize AAVSB RACE approval. Please contact the AAVSB RACE program if you have any comments/concerns regarding this program’s validity or relevancy to the veterinary profession.
Expected results of AONA's CME activities for surgeons, fellows, and residents are to:
• Increase their knowledge base and surgical skill level
• Improve competence by applying advances of knowledge in patient care in the areas of trauma, degenerative disorders, deformities, tumors, and reconstructive surgical techniques
• Address practice performance gaps by improving management of aspects of traumatic injuries and musculoskeletal disorders (i.e., pre-operative planning to post-operative care)
Define the (3) planes and (6) directions of deformity Define joint orientation Line (JOL) Define axes (anatomic and mechanical) Define joint orientation angle
Determine the location of a CORA Measure the magnitude of a CORA Define the transverse bisecting line Define closing and opening CORAs Define the angulation correction axis (ACA)
Revisit 6 directions of deformities in 3 planes Define the plane of the deformity Define an oblique plane deformity Calculate the magnitude and plane of an oblique plane deformity using the graphical method
Define the three elements to consider when doing a correction: CORA, ACA, osteotomy Define Paley Rule #1 – show generic example and then clinical correlate Define Paley Rule #2 – show generic example and then clinical correlate Define Paley Rule #3 – show generic example and then clinical correlate
Provide an overview of the CESF system and in general, how it works to provide stability Discuss the general applications / uses of the CESF system Define how CESF systems can be used to treat angular and length deformities
Identify the different parts of a CESF device and their uses Outline the appropriate application of a CESF Provide tips and tricks to the effective application and use of a CESF on an appendicular long bone
Identify the different parts of a CESF device and their uses Outline the appropriate application of a CESF Provide tips and tricks to the effective application and use of a CESF on an appendicular long bone
"Define the alignment of the normal forelimb from gross appearance using anatomic landmarks Demonstrate the effect of a uniapical radioulnar deformity on the gross appearance of the forelimb Demonstrate the effect of a biapical radioulnar deformity on the gross appearance of the forelimb Demonstrate the effect of limb shortening on the gross appearance of the forelimb Discuss compensatory postures associated with various forelimb deformities"
"Using the JOL, JOA and axes, define the alignment of a normal canine humerus in the frontal / sagittal planes Using the JOL, JOA and axes, define the alignment of a normal canine radius and ulna in the frontal / sagittal planes Using the JOL, JOA and axes, define the alignment of a normal canine metacarpus in the frontal plane Using the JOL, JOA and axes, define the normal overall forelimb alignment and its relationship to the elbow"
"Review the determination of the JOL, and axes on an angulated radius / ulna using normal JOAs in radiographs Determine the location, magnitude and plane of the deformity on an angulated radius (uniapical)"
"Define bone ‘torsion’ and distinguish it from limb ‘rotation.’ Review methods of quantifying torsional deformities of the radius and ulna from gross examination Review the artifactual miscalculation of angulation measurement in radiographs of torsion-angulation deformities. Present the segmental radiographic technique of estimating CORA magnitude in torsion-angulation deformities"
"Review the interpretation of a CT scan of a normal radius / ulna. Provide technical tips for acquiring an appropriate antebrachial CT scan Review applications of CT scans of the radius / ulna – different viewing and formatting possibilities"
"Review the indications for when to CT scan a radioulnar deformity Review the methodology for determining the location, magnitude and plane of the deformity from CT Provide a method for surgical planning of torsion-angulation deformity correction from CT"
"Define multiapical and biapical deformities Demonstrate how to quantify the location, magnitude and plane of biapical radioulnar deformities Review the most common biapical deformity manifestation of the radius/ulna Review the effect of chondrodystrophic biapcial deformities on the elbow and carpus Review concepts of biapical correction – single level versus double level correction"
"Provide overview of the goals of double level correction of biapical deformities Review technical approach to executing double level closing wedge ostectomies of the radius Review technical aspects of stabilizing the double level correction with open reduction and internal fixation (ORIF) Review aftercare and outcome with double level osteotomy and ORIF"
"Review the advantages of treating biapical deformities with CESF Review the technical approach of designing a CESF frame to correct a biapical deformity via double level osteotomy Review aftercare and outcome with double level osteotomy and CESF"
"Define the ‘short-radius’ elbow incongruity syndrome Discuss accurately diagnosing a shortened radius Review potential sources of a shortened radius Provide treatment options for correction of a short radius to improve elbow incongruity"
"Define the ‘short-ulna’ elbow incongruity syndrome Discuss accurately diagnosing a shortened ulna Review potential sources of a shortened ulna Provide treatment options for correction of a short ulna to improve elbow incongruity"
"Define premature closure of the lateral aspect of the distal radius Demonstrate different clinical presentations and gross appearance of the condition Review diagnostic imaging findings (radiographs and CT) of the condition Review clinical manifestations of the premature closure of the lateral aspect of the distal radial physis Demonstrate treatment options for the condition."
"Provide the system of nomenclature used for classifying the dysostoses Define the most common dysostoses affecting the forelimb of the dog Review the condition of radial hemimelia Review the condition of ectrodactyly Provide overview of surgical reconstruction options including when to and when not to do surgery"
"Provide overview of software planning options to quantitate radioulnar deformities and execute virtual corrections. Review advantages and disadvantages of the different systems including costs, learning curves and accuracy Demonstrate examples of the different systems"
"Provide overview of 3D printing from CT scan technology Review the uses of 3D printing radioulnar deformities Review accessibility and costs of different printing options Demonstrate examples of performing rehearsal surgeries on 3D models prior to surgical correction of radioulnar deformities Review advantages and disadvantages of utilizing 3D printing technology for deformity quantification and surgical planning"
"Review the concept of 3D printed osteotomy guides for radioulnar deformity correction Provide overview of how the guides are fabricated to allow the performance of accurate osteotomies Demonstrate the use of 3D printed guides in the correction of a radioulnar deformity Review the accessibility and costs of pursuing 3D printed guides as a treatment option"
"Define the difference between juvenile and adult patients presenting with radioulnar deformities Discuss treatment strategy differences in the young versus the skeletally mature patient presenting with a radioulnar deformity Review advantages and disadvantages of non-surgical versus surgical management of radioulnar deformities at the different ages Provide overview of decision making when presented with immature patients with emerging deformities."
"Provide definition of medial compartment disease of the canine elbow Review potential etiologies of this condition Review literature on the impact of overall limb alignment and elbow congruity on medial coronoid disease and medial compartment syndrome Review the literature on the efficacy of corrective osteotomies used to treat medial compartment disease of the elbow."
It is the policy of AO North America to abide by the Accreditation Council for Continuing Medical Education Standards for Commercial Support. Standard 2: “Disclosures Relevant to Potential Commercial Bias and Relevant Financial Relationships of Those with Control over CME Content,” requires all planners, including course directors, chairs, and faculty, involved in the development of CME content to disclose their relevant financial relationships prior to participating in the activity. Relevant financial relationships will be disclosed to the activity audience. The intent of the disclosure is not to prevent a faculty with a relevant financial or other relationship from teaching, but to provide participants with information that might be of importance to their evaluation of content. All potential conflicts of interest have been resolved prior to the commencement of this activity.
Some medical devices used for teaching purposes and/or discussed in AO North America’s educational activities may have been cleared by the FDA for specific uses only or may not yet be approved for any purpose. Faculty may discuss off-label, investigational, or experimental uses of products/devices in CME certified educational activities. Faculty have been advised that all recommendations involving clinical medicine in this CME activity are based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients.
All scientific research referred to, reported or used in this CME activity in support or justification of a patient care recommendation conforms to the generally accepted standards of experimental design, data collection and analysis.
AONA does not endorse nor promote the use of any product/device of commercial entities. Equipment used in this course is for teaching purposes only with the intent to enhance the learning experience.
In-Kind Support
AO North America gratefully acknowledges in-kind support for equipment and technical staff from DePuy Synthes, IMEX, and vPOP.
Educational Grant
AO North America gratefully acknowledges funding for its education activities from the AO Foundation. The AO Foundation receives funding for education from Synthes GmbH.