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Internacionalizace výuky veterinární medicíny jako cesta na evropský trh práce 

projekt è. CZ.1.07/2.2.00/28.0288 

Surgery in pet birds Part II – Orthopedic surgeryYvonne R.A. van Zeeland, DVM, PhD, MVR, Dip. ECZM (avian)Division of Zoological Medicine, Utrecht University

Division of Zoological MedicineDepartment of Clinical Sciences of Companion AnimalsFaculty of Veterinary Medicine, Utrecht University

Surgery in pet birds:Part II – Orthopedic surgery

Yvonne van Zeeland

Brno, Czech RepublicMarch 4, 2014

Introduction

• Surgery of the beak

– Congenital deformities

• Thoracic & pelvic limb surgery

– Bandaging techniques

– Fracture repair

– Bumblefoot

Beak surgeryEAAV Madrid 2011

• (Functional) anatomy of the avian skull and beak

• Common procedures

– Correction of scissors beak

• Trans-sinus pinning

• Ramp prosthesis

– Correction mandibular prognathism

• Scaffolding

• Beak prosthesis

Form & function the beak

• Basic anatomy similar in most species– Species-specific differences in shape are related to the diet

• Beak– Upper mandible or bill

• (Pre)maxillary, nasal bones

– Lower mandible or bill

• Two rostrally fused rami

– Composed of keratin, dermis, bone

• Beak movement via prokinesis, rhynchokinesis– Parrots have a craniofacial hinge (synovial joint)

EAAV Madrid 2011 Congenital deformities

Mostly seen in juvenile birds, occasionally adults

Scissors beak deformity Mandibular prognatism

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Scissors Beak Deformity

• Progressive, asymmetric beak growth– Delayed on one side vs. other

– Trauma, bruising of the rictal edges

• Causes may include– Handfeeding technique

– Incubation flaws

– Genetics

– Malnutrition

– Infections (sinusitis)

– Trauma

Scissors beak deformity

Options for intervention

• Conservative treatment– Daily manual manipulation

– Only effective if discovered in very early stages

• Surgical intervention– Ramp prosthesis

– Trans-sinus pinning

– Corrective dremmeling of overgrown keratin

• Temporary relief, mainly in older birds

EAAV Madrid 2011 Ramp prosthesis

• Mainly in juvenile parrots

• Ramp exerts an opposing

force to the scissors deformity

– Fixed to the lower mandible

– Left in place for 2-3 weeks

a. Upper beak deviated to the right

Technique

a. Upper beak deviated to the rightb. Preparations for placing ramp

Corrective dremmeling of beak Roughening of lower beak surface

Technique

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a. Upper beak deviated to the rightb. Preparations for placing ramp

Corrective dremmeling of beak Roughening of lower beak surface

c. Creation of a ramp on the right Wire mesh foundation, cut and shaped

to fit over the entire mandible Attached with 2 cerclage wires Placement of layers of acrylics or

methacrylate to create a functional cap

Technique

a. Upper beak deviated to the rightb. Preparations for placing ramp

Corrective dremmeling of beak Roughening of lower beak surface

c. Creation of a ramp on the right Wire mesh foundation, cut and shaped

to fit over the entire mandible Attached with 2 cerclage wires Placement of layers of acrylics or

methacrylate to create a functional cap

d. End result Left in place for 2-3 weeks

Technique

Trans-sinus pinning

• Tension band exerting lateral pulling force to tip of beak– Fixed to IM pin driven through

frontal bone

– Left in place for 2-3 months

duration

• Mainly subadult parrots of larger species

EAAV Madrid 2011 Techniquea. Place IM pin transversely into

frontal bone • Start at side opposite of deviation• Correct insertion point

Just caudal to naso-frontal hinge Caudal-ventral to the nares

• Seat identically on opposite sideb. Bend pin to 90° angle

• Parallel to longitudinal axis of beakc. Cut pin at length of upper beak d. Curl or bend ends of the pine. Use rubber bands to apply

tension from pin to beak tip

Mandibular prognatism

• Upper beak is placed inside lower beak => malocclusion• Most common in cockatoos• Causes similar to those described for scissors beak

Upper beak extension prosthesis

• Application in young sub-adults

• Prosthesis functionally extends the upper beak– Prevents placement of the

upper into lower beak

– Rapidly enables normal occlusion and normalization of range of motion

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Technique

• Creation of a functional cap– Extending distally from cere

– Encompassing pressure bearing keratin at occlusal ledge of maxilla

– Use acrylic/methacrylate products

– Lower mandible must not extend out and beyond the prosthesis

– Tomium of gnathotheca should be able of applying normal force at occlusal ledge

Scaffolding

• Primarily used in adult birds with marked deformities

• Chronic deformities present– Hyperflexion of the nasal-frontal hinge,

caudal retraction of quadrate,

hyperextended quadrate-mandibular joint

– Muscle contraction, range of motion

• Lacking of significant lower mandibular deformities

• Not recommended as a first-step intervention

Technique

• Non-threaded IM pin placed– Similar to trans-sinus pinning

• Bend pins close to their exit symmetrically on both sides

• Insert second S-shaped pin at distal end of rhinotheca

• Place rubber bands around hooks of the transverse sinus pin and ventral S-pin– Keep traction on band with sutures

Limb surgery

• Treatment of common conditions– Fractures of the thoracic and pelvic limb

– Pododermatitis or bumblefoot

Fractures

• Long bones commonly involved– Thin cortices, little soft tissue

• Most often trauma-related– Malnutrition, neoplasia, infection

• Clinical signs– Wing droop, inability to fly

– Lameness, unequal weight bearing

Note: connection to air sacs!

• Radiographic evaluation

Initial therapeutic plan

• ALWAYS stabilize the patient FIRST!!!

• Stabilize the fracture (bandaging)

• Provide analgesia– Carprofen 2 mg/kg q12h PO

– Meloxicam 1.5 mg/kg q12h PO

• Antibiotics indicated for open fractures

• Adaptations to enclosure– Leg band removal

• Collar to prevent damage?– Provide distraction with tapes

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• Principles of fracture repair & healing– Prevent contamination, treat infections

– Minimize soft tissue damage

– Maintenance of form & function

– Anatomic alignment• 50% contact between fracture ends

– Rigid stabilizat ion

– disturbance of callus formation

– Neutralizat ion of forces

Fracture repair

Bones heal quicker in birds compared to mammals

Sheer Rotation CompressionBending

Methods of fracture repair

• Conservative treatment – external coaptation

• Surgical (osteosynthesis)

– External coaptation• Bandage

• Splint

• Sling

– Stabilization• Bending forces

• Torsional forces

• Axial loading

• Minimal stabilizat ion

– stability with splint

• Minimal stabilizat ion

• Poor stabilizat ion

Fracture repair

• Primary layer (dressing) = in contact with wound

– Non-adherent - Adherent - Occlusive dressings

Bandaging materials

Bandaging materials

• Secondary layer = support and/or absorption

– Artiflex

Bandaging materials

• Splints = provide extra stability

– Articast – Cellacast – Vet-lite

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Bandaging materials

• Tertiary layer = outer covering layer

– Vetrap – Elastikon Figure-of-eight bandage

&Body-wrap

Wing bandaging techniques

• Femur – difficult!

– Schroeder Thomas splint

– Spica splint

Leg bandages

• Tibiotarsus - difficult

– Robert Jones bandage

Leg bandages

• Tarsometatarsus

– Metatarsal bandage

– Tape splint• Useful in smaller birds

Leg bandages

Metatarsal bandage&

Ball bandage

Leg bandages

A ball bandage is used to stabilize the toes

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Ball bandage

The different layers of a ball bandage – Surgical (osteosynthesis)• Internal fixation

• External fixation

– Stabilization• Bending forces

• Torsional forces– IM Pin

– KE & Plates

• Axial loading– IM Pin

– KE & Plates

• Very good stabilizat ion

• Depending on the type of fixation:

– Poor stabilization

– Very good stabilization

• Depending on the type:– Poor stabilization

– Very good stabilization

Fracture repair

Fracture repair

• Surgical (osteosynthesis)

– Intramedullary pins

– Bone plating

– External fixation

• Type I, II, III

– Combination IM-EF (tie-in)

• Intramedullary (IM) pins– Kirschner Pin

Cerclage wire can be used

The combination with a Type-1

KE-Fixator („Tie-in“) is also possible

Osteosynthesis

• Intramedullary (IM) pins– Kirschner Pin

– „Shuttle“ Pin

A wire is threaded through the polypropylene pin

This pin is then inserted into the bone shaft

The pin can be inserted into the other shaft by pulling on the wire

Osteosynthesis

• Intramedullary (IM) pins– Kirschner Pin

– „Shuttle“ Pin

It is possible to place an external fixator through the „Shuttle“ Pin

Osteosynthesis

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• Intramedullary (IM) pins– Kirschner Pin

– „Shuttle“ Pin

• Plate osteosynthesis

Osteosynthesis

• Intramedullary (IM) pins

• Plate osteosynthesis

• External fixator– Type-I

FESSA

Unilateral fixation = Type I

Osteosynthesis

• Intramedullary (IM) pins

• Plate osteosynthesis

• External fixator– Type-I

– Type-II

Bilateral fixation = Type II

Osteosynthesis

• Intramedullary (IM) pins

• Plate osteosynthesis

• External fixator– Type-I

– Type-II– Type-III

= a combination of Type-I and Type-II

Osteosynthesis

Uncertain if this technique is used in birds

• Fractures– Wing

• Humerus

• Radius & ulna

Not enough room for a Type-II K-E

A Type-I K-E or EF-IM tie-in are possible

Osteosynthesis

• Fractures– Femur

Not enough room for a Type-II K-E

Osteosynthesis

A Type-I K-E or tie-in are possible

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• Fractures – Femur

Not enough room for a Type-II K-E

A Type-I K-E or tie-in are possible

When the bone is big enough, a plate osteosynthesis gives the best results

Osteosynthesis

• Fractures– Femur– Tibiotarsus

A Type-I K-E is possible, but is not as stable as a Type-II KE

When using a Type-I KE it is recommended to use threaded pins

Osteosynthesis

• Fractures– Femur– Tibiotarsus

A Type-II KE results in a good outcome and may be used simultaneously on two legs

Osteosynthesis

• Fractures– Femur– Tibiotarsus

A Type-II KE results in a good outcome and may be used simultaneously on two legs

The KE-osteosynthesis can be combined with an IM pin

Osteosynthesis

Type-2 KE Osteosynthesis

Example case• Hawk

– Female– 1.5 years old

• Fracturedleft tibiotarsus due to trauma

Anterior-Posterior Lateral

Two Kirschner pins were placed in the proximal fragment

and three Kirschner pins were placed in the distal fragment

A closed reduction was performed in this bird

Type-2 KE Osteosynthesis

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The pins are bent parallel to the limb

Type-2 KE Osteosynthesis Type-2 KE Osteosynthesis

The pins are bent parallel to the limb

„ESF Putty“ (Epoxy resin) is placed around the pins

Type-2 KE Osteosynthesis

„ESF Putty“ from Veterinary Instrumentation

Type-2 KE Osteosynthesis

The pins on the other side are bent in a similar fashion

Type-2 KE Osteosynthesis

„ESF-Putty“ is also applied on the other side

Type-2 KE Osteosynthesis

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A pressure bandage is applied between the leg and the fixator

Type-2 KE Osteosynthesis

Post operative radiographs were made a day later

Type-2 KE Osteosynthesis

Bumblefoot

• Condition comparable to a bedsore

• Etiology

– Obesity

– Lack of excercise

– Contact with rough surfaces

– Too smooth perches

Bumblefoot

Five stages• Stage I

– Hyperemia and slight sloughing of the skin

• Stage I– Hyperemia and slight sloughing of the skin

• Stage II– Inflammation with crusts

and slight thickening

Bumblefoot

Five stages• Stage I

– Hyperemia and slight sloughing of the skin

• Stage II– Inflammation with crusts and slight thickening

• Stage III– Abscess with obvious

inflammation, includingthickening and pain

Bumblefoot

Five stages

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Bumblefoot

• Stage I– Hyperemia and slight sloughing of the skin

• Stage II– Inflammation with crusts and slight thickening

• Stage III– Abscess with obvious inflammation, incl. thickening and pain

• Stage IV– Deeper structures involved,

but foot function retained

Five stages

Bumblefoot

• Stage I– Hyperemia and slight sloughing of the skin

• Stage II– Inflammation with crusts and slight thickening

• Stage III– Abscess with obvious inflammation, incl. thickening and pain

• Stage IV– Deeper structures involved, but foot function retained

• Stage V– Involvement of deeper structures, loss of function

Five stages

Bumblefoot

TreatmentDonut bandage to decrease pressure on foot

Pressure transferred to toes, evenly divided

• Treatment– Bandage to decrease pressure

• A „doughnut“ bandage

– Antibiotics (often associated with Staphylococcus aureus)• Amoxicillin with clavulanic acid

– TID 100 mg/kg oral; or– BID 125 mg/kg oral

– Surgery required in severe cases

Bumblefoot

• Treatment– Bandage to decrease pressure

• A „doughnut“ bandage

– Antibiotics (often associated with Staphylococcus aureus)• Amoxicillin with clavulanic acid

– TID 100 mg/kg oral; or– BID 125 mg/kg oral

– Surgery required in severe cases– Promote circulation

Bumblefoot Bumblefoot

• Treatment– Bandage to decrease pressure

• A „doughnut“ bandage

– Antibiotics (often associated with Staphylococcus aureus)• Amoxicillin with clavulanic acid

– TID 100 mg/kg oral; or– BID 125 mg/kg oral

– Surgery required in severe cases– Promote circulation– Provide perches with variable diameters

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Questions???

Thank you for your attention!