Preface The concept of amputation, prosthetic, orthotic fitting and orthopedic rehabilitation on large animals is an innovative practice developed by the author. The author has developed several techniques of fitting of prosthetic and orthotic appliances for the large animals. Out of such practice and experience the need for publishing a book on “Large Animal Orthopaedics: An Illustrated Handbook on Prosthetic Fittings and Rehabilitations” was felt. The practical lessions and illustrations included in the book will be of very much of use for the students, teachers and researchers and practitioners in Veterinary Science in general and surgery in particular. In my 33 years of professional teaching and research experience, I feel the absence of such an illustrated book covering details of surgical techniques in teaching in a brief manner with pictorial representation. This prompted me to elaborate my experience gained in my practical fields in surgical treatment of large animals. Apart from that I have consulted a number of fellow faculty and consulted a good number of literature in the field which I wanted to reflect in the book. The basic idea behind writing this book is to publish innovative methods and new affective techniques that are easy successful and cost effective. In orthopaedic treatment in large animals fitting of articificial limbs, prosthetic and orthotic appliances, amputation and rehabilitation appear to be very rare and complicated. Large numbers of hand drawings and photographs have been incorporated in order to visualize the surgical techniques for better understanding. Fabrication of modified Thomas Splint has been demonstrated step wise using illustrations. Use of conjoined ‘U’ plate for better immobilization in case of lower limb fabrication in large animals is claimed as an innovative step. A sling has been fabricated for lifting of downed large animals for making them mobile to facilitate exercise of unused and paralyzed limbs using locally available materials to make it cost effective as well as availability in most rural interiors. The statement “A good surgeon is one who amputates a limb, but a better is one who save a limb”. However blessings of Almighty are always behind a success.

Centre of gravity It is most commonly located is the middle of the rib cage, just caudal to the line separating the cranial and middle third of the body because the CG & located more cranially. The forelimbs bear 60-65% of body weight. This causes an increased stress of forelimb and increase incidence of lameness. The horse that is taller over the group than the wither has an additional disadvantage, because PTS CG is shifted further forwards. 1. Long backed horses may develop a swing in the gait that alters the movement of their limbs. Such horses are prone to speedy cutting. Cross firing & back problem due to muscle ligament strain. 2. Short backed horses may develop a swing in the gait that alters the movement of these limbs. Such horses are prone to speedy cutting, cross firing & back problem due to muscle and ligament strain.

Gait of ANormal Animal This is a four - beat gait. Walking can be of various forms, but regardless of the form, it must be an even four beat gait. When a regular sequence is lost, identified by four hoof beats at precise interyals, the cattle is no longer walking. The walking sequence is lateral because both feet of one side hit the ground before the two feet of opposite side strike. Propulsion primarily results from the hindlimbs, and the forelimbs simply follow. The length of stride in the walk will usually vary between 5 1/2 and 6 ft. This distance is measured between successive imprints of the same foot. The step will vary between 33 and 39 inches and is the measurement made between the imprints made by a pair of forefeet or the imprints made by a pair of hind feet. The sequence of the hoof beats can be described according to this pattern: (1) near - hind, (2) near - fore, (3) off - hind, (4) off - fore. This gait is sometimes described as beginning with a forelirnb as ; (1) off — fore, (2) near - hind, (3) near - fore, and (4) off - hind. This description is not proper according to the way the cattle starts, but it is proper after it is in motion.

Tubercoxae Twelth thoracic vertebra First lumbar vertebra Last rib First coccygeal vertebra Sacrum Tuber ischii T rochanter major Femur Lateral condyle of Tibia Tibia Distal end of fibula Tuber calcis Tarsus Metatarsus Phalanges Patella

1: extensor carpi radialis 2: m. extensor digiti III propr. 2: its tendon 3: m. extensor digiti communis 3: its tendon 4: m. extensor digiti IV. propr. 4’: its tendon : 5: m. ulnaris lateralis

The condition in the young subject is as follows: The two parietals are united with each other and also with the interparietal and supraoccipital. The resulting mass is somewhat horse shoe shaped. Its occipital part (planum occipitale) forms the greater part of the posterior wall of the cranium and bears about its centre the tubersity for the attachment of the ligamentum nuche. From either side of this a line curves outward and divide the surface into an upper smooth area and a lower area which is rough for muscular technique. The upper borderjoins the frontal bone and concurs In the formation of the frontal eminence. The temperal part (Plana temporalla) are much smaller and are concave externally; they join the frontal above and the squamous temporal below. A median occipital crest extends ventrally from the external occipital protuberance.

Foramen magnum Occipital condyle Paramastoid process Condyloid foramen Foramen lacerum Basilar part of occipital condyle Basilar tubercles Bulla tympanica Foramen ovale(concealed by muscular process) Meatus acusticus externus

This vertebra is decidedly atypical in form and structure. The body and spineous process are absent. It has the form of a strong ring, from which two curved plates, the wings, project laterally. The ring incloses a very large vertebral foramen and consistis of two lateral masses connected by dorsal and ventral arches. The lateral masses (Massae laterales) present two deep oval anterior articular cavities (Foveae articulares craniales) which receive the occipital condyles; they are separated by a wide notch above and a narrow one below. The lateral margin is also notched, and a triangular non-articular depression cuts into the medial part of each cavity. The posterior articular surfaces (Facies articulares caudales) are somewhat saddle-shaped; they are confluent on the ventral arch, but are widely separated dorsally, and do not conform in shape to the corresponding surfaces of the axis. The dorsal arch (Arcus dorsali,) presents a median dorsal tubercle (Tuberculum dorsale) and is concave ventrally. It is perforated on either side near its anterior margin by the inter vertebral foramen (Foramen invertebrale). The anterior border is deeply notched, and the posterior border is thin and concave. The ventral arch (Arcus ventralis) is thicker, narrower, and less curved than the dorsal. In its lower surface is the ventral tubercle (Tuberculum ventrale), into which the terminal tendon of the longus colli muscle is inserted. The upper face has posteriorly a transversely- concave articular surface, the fovea dentis, on which the dens or odontoid process of the axis rests. In front of this is a transverse rough excavation and a ridge for the attachment of the ligamentirm dentis.

The cervical vertebrae are 7 in number. The first and second cervical vertebrae are highly modified in conformity with the special function of support and movements of the head. The third, fourth and fifth have the following characters: The body is long. Ventral surface present a median ventral spine. The dorsal surface has a flat central area which is narrow in the middle of the vertebrae, and wide at either end. On either side of this area there is a groove which lodges the longitudinal spinal vein. The anterior extremity or head has an oval articular surface which faces forward and downward; it is strongly convex and wider above than below. The posterior extremity is larger and has a nearly circular cotyloid cavity. The arch is large and strong. It is perforated on either side by foramen which communicates with the foramen transverse hum. The vertebral notches are large. The articular process are large. Their articular surface are extensive, oval in outline, and slightly concave.

LUMBAR VERTEBRAE (Fig. 1) Lumbar vertebrae, six in number, are much longer than in the horse. The body is much constricted in the middle, expanded at either end, and bears a rudimentary ventral crest. The articular processes are large, and their facets are more strongly cun/ ed than in the horse. The transeverse processes ail’curve foPA/ard, borders a.^e thin and irregular and often bear projections of variable size and form.. The spinous processes are relatively low wide, the last being the smallest; their summits are moderately thickened.

The scapula is more regularly triangular than in horse, relatively, wider at the vertebral end and narrower at the distal end. The scapular index is about T.0.6. The spine is more prominent and is placed further forward, so that the supras- pinous fossa is narrow and does not extend to the lower part of the bone. The spine is sinuous, bent backward in its middle, forward below. Its free border is somewhat thickened in its middle, but bears no distinct tuber. Instead of little more prominent, and is prolonged by a pointed production, the acromion, from which part of the deltoid muscle arises. The sub scapular fossa is shallow. The areas for the attachment of the stratus muscle are not very distinct. The nutri- ent foramen is usually in the lower third of the posterior border. The glenoid cavity is almost circular and without any distinct notch. The tuberosity is small and close to the glenoid cavity. The coracoid process is short and rounded. The cartilage resembles that of the horse. The tuberosity unites with the rest.

Fia.1. Left carous and adjacent bones of Ox: Front view:- Ulna Radius Fused second and tliird carpals Ulnar carpal Radial carpal Fourth carpal Fused second and third carpals Metacarpal tuberosity Vascular groove ???????Intermediate carpal bone

DIGITS Four digits are presents in the ox of these two the third and forth -are fully developed and have three phalanges and three sesamoid each.The second and fifth are vestiges. FRIST PHALANX- (Fig.No.1) The interdigital surface is flattened and its volor parts bears a prominence for the attachment of the interdigital ligaments. The proximal extremity is relatively large and somewhat compressed from side to side. The articular surface is concave from before backword and is divided by sagittal groove in two areas, of which the aboxial one is the larger and higher. Behind tese are two facets for articulation with the sesamoid bones. The distal extremity smaller than the proximal.

The ilia are almost parallel to each other and form a much smaller angle with the horizontal plane than in the horses.they are relatively small. The glutei line is prominent and nearly parallel to the lateral border,it joins the ischiatic spine.A rounded ridge separates the two parts of pelvic surface.The surface for articulation with sacrum is triangular. The tuber coxae is relatively prominent and not so oblique as in horses, wide in middle,smaller at either end.Shaft is short and compressed from side to side. Ischium is large.Its long axis is directed obliquely upward and downward forming an angle of 5o to 60 degree with horizontal plane.The transverse axis is obliquely downward and inward at similar angle so concave from side to side.Ventral surface has rough ridge for muscular attatchment. The ischiatic spine is high and thin and bears a series of vertical rough line. lschiuatic arch is narrow and deep.The tuber ischii is large and three sided bearing dorsal ,ventral, lateral tuberosities.The symphysis bears a ventral ridge which fades out at ischial arch.The acetabular branch of pubis is narrow and is directed laterally,and a little forward.The anterior border is marked by a transverse groove which ends below rough iliopectineal eminence. The symphyseal branch is wide and thin. The acetabulum is smaller than in horses. Rim is rounded and usually marked by two notches. One is directed to deep acetabular fossa and and converted to foramen. The other is anteromedial and small also replaced by foramen or absent.

ILIUM The ilium are almost parallel to each other and form a much smaller angle with the horizontal plane than in the horse. They are relatively small. The gluteal line is prominent and is nearly parallel to the lateral border; it join the ischiatic spine. A rounded ridge separates the two parts of the pelvic surface. The surface for articulation with the sacrum is triangular. The tuber sacrale is truncated, does not extend so high as the vertebral spines, and is separated from the opposite angle by a wider interval than in the horse. The tuber coxae is relatively large and prominent; it is not so oblique as in the horse, and is wide in the middle, smaller at either end. The shaft is short and compressed from side to side.

FEMUR The femur has a relatively small shaft, which is cylindrical in its middle. The trochanter minor has the form of a rough tuberosity. The trochanteric ridge connects it with the trochanter major. The third trochanter is absent. The supracondyloid fossa is shallow. The proximal extremity is very wide. The fovea capitis is a small depression on the middle of the heacKfor the attachment of the round ligament. The trochanter major is very massive and is undivided; its lateral surface is very rough. The trochanteric fossa is deep. The ridges of the trochlea are less oblique.

M.mMedial malleolus M.I., Lateral malleolus T, Tibia T. t., Tibial tarsal bone T.f., Fibulartarsal bone T.c. + 4, Fused central and fourth tarsal bones. T.1, First tarsal bone T.2+3, Fused second and third tarsal bones Mt.2,Small, or second metatarsal bone Mt.3+4, Large metatarsal or fused third or fourth metatarsal bon

First Aid in Orthopaedic Patient Immediately transfer the animal to a safety place. The place should be well settled, well ventilated, neat and clean. If the fracture site is limb and it is a simple fracture, immediately immobilize the animal with soft cotton padding and plastic scale placed at four sites. If the fracture site is limb and it is a compound fracture, cover the fractured site v/ith th’ck padded clean cotton cloth and few bamboo splint placed on four sides to keep limb straight. Control the bleeding, if bleeding occurs at time of covering of fractured site with thick padded clean cotton cloth. If the fracture site is vertebral column, it is better not to lift the patient vigorously. A patient with vertebral column fracture shouldn’t be allowed for standing.

Complete fracture- It is a fracture in which there is complete loss of bone continuity and the bone is divided into two or more fragments (Fig.1). Green stick fracture- It is the fracture in which, the cortex opposite to the bending force fractures completely, while the cortex under the force remains in tact, commonly seen in immature animals, (Fig-2) Overriding fracture-A fracture in which the fragments lie side by side, causing shortening of limb (Fig-3) Transverse fracture-The fracture line here runs transverse to the long axis of bone. Such type of fracture is caused by bending forces (Fig-4). Oblique fracture- In this the fracture line runs oblique to the long axis of the bone. Such type of fracture is caused by bending with axial compression (Fig-5). Spiral fracture-Here the fracture line spirals along the long axis of bone. Such type of fracture is caused by torsion, twisting or rotational forces e.g. in humorous (Fig-6) Comminuted fracture- In this fracture, at least three fracture lines inter connect each other at one point (Fig-7).

Definition: A fracture is a dissolution of bony continuity with or without displacement of the fragments. Different stages of fracture: Inflammatory phase, reparative phase, and remodelling phase. Fundamental steps

Aim To know the various level of fracture & their appropriate method of immobilisation for large animal fracture. Definition Fracture is a disolution of bony continuity with or without displacement of the fragments.

Fig. 1: Cotton Bandage

Indication -To know the method of POP bandaging technique. Method of preparation of POP bandage rolls- A gauze bandage of 6" or 4" width is spread on a clean floor. Plaster of paris powder is spread uniformly over the entire length of bandage & is folded into roll bandage. In this way 4-6 bandage rolls are prepared.fig-1(a)&(b) Method of preparation of pop bandage splints The length of the prepared pop splint is determined by measuring the entire length of fractured bone along with the joint below and above the fractured site) are measured. This much of length of gauze is spread for splint preparation. POP powder is impregnated upon gauze. The gauze is again spread over this much of length in this manner sprinkling of POP powder & overlapping gauze bandage upto 4-6 layer are continued [fig-1 (b)]

Aim To know the portion of limb to be covered by P.O.P cast bandage for immobilization of fore limb (Fig 1a) & hind limb ( Fig 2a) bone fracture. As per general rule, joint below and joint above should be covered.

Objective The poor quality of Plaster Of Paris makes the cast weak. For its strengthening, 4pieces of padded green bamboo splints are placed within POP cast along its four sides. Requirements 4 green bamboo splints which are padded soft at both the ends

Definition Compound fracture is a type of fracture in which a broken piece of bone protrudes to outside rupturing the skin with a risk of further infection. Procedure of management Clean and flush thoroughly the exposed bone using sterile NS followed by sterile medicated NS (NS with antibiotic or antiseptic). Figure (1) Mop dry the wound thoroughly. Apply topical antiseptic or antibiotic. Put the bone inside the part. With a sterile artery forcep fix a flushing catheter within the wound at its higher level. Figure (2) Cover the wound over fracture site with sterile soft padded absorbent cotton padding. Figure (2) The joint below and above of the fracture site covered with thick layered padded cloth before application of POP cast. Figure (3) POP cast is wrapped as per the conventional procedure over the fracture site covering the joint below and above. Figure (4)

Aim: To prepare a list of materials used for ammobilisation for fractured limb with gum bandage. Materials required

Indication Fracture in case of large animals, act as soft padding Procedure A single piece of long cotton cloth is taken which is separated into two equal halves on the middle line (Fig. 1). One of the 2 parts is taken and folded to form a bilayer padded cloth (Fig 2) The bilayer padded cloth to further folded to form 4 layer padded cloth and subsequently to S and 16 layer padded cloth (Fig. 3). The 16 layer padded cloth is thus used around the fractured limb from the joint above to joint below. The other half of the doth from Fig 1 is then separated into further 2 parts horizontally (Fig. 4) The pieces thus formed are folded to form 2 layer, 4 layers and 8 layers Cloth paddings in order to cover the ends of netted bamboo splints longitudinally and retention Is done with ropes.

Procedure for Netted Padded Bamboo Splint Marking of the bamboo splints is done maintaining equal distance (Fig.1). At both the edges of the marking, grooving of the bamboo splints is done for perfect tieing of the plastic rope (Fig.2). The bamboo splints are tied with the help of plastic rope maintaining 1 finger space between each bamboo splint (Fig.3). Soft 8 layer padding of cotton is provided at both the ends of the netted bamboo splint in order to avoid injury (Fig.5). The width of the netted padded bamboo splint should be upto one and half times of the limb’s circumference (Fig.6).

Purpose-To now the technique of application of thick layer sterile absorbent protective cotton padding over fractured site and its retention with thread ligature in order to protect the bone from further damage Site-Generally area joint above and joint below of fractured site of bone needs to be covered with a thick layer for perfect immobilization of fractured bone.

Aim: To know the technique of application of first layer padded cloth and its thread

Purpose To strengthen gum bandage in order to keep the fracture perfectly immobilized. Materials required Soft cotton padding, Adhesive gum, netted bamboo with soft padding, retention ligature.

CORPUS Fixation of rubber slipper over the foot, after application of fracture, immobilising devices the foot is protected with rubber slipper to avoiding soiling and affection of foot (Fig. No-1). The foot protection the protective rubber slipper is applied given to both their foot (Fig No.2). Gum bandage, immobilised limb (Fig No.3). As well as POP cost application (Fig No. 4). The rubber could be given anterior to posterior derection to avoid entering of soiling towards the foot. The slipper retain in position with due to splint.

Classification of fracture and its repair in large animal practice by external completion method. Aim To know the different level of fracture limbs. In order to access their method of repair (Fig.1).

DEFINITION Lower level fracture in animals include any fracture of the region from knee joint to foot in forelimb and from hock joint to foot in hind iimbs. CFERA’nVE PROCEOURE-H ere the principle of treatmient is application of cast and conjoint metal ‘U’ plate over the fractured site. Permanent immobilization of the limb should be done only after 7 days to subside. Length to be covered-Forelimb-above knee joint and below foot. Hind limb-above hock joint and below foot, (as shown in fig.1) Padding-6-12 layer thick padded cloth should be vmapped applying gum.s throughout the doth area, over the fracture, it should not be too tight but it should be strong. Sloughing off the hoof may result due to hypostatic congestion; hence the hooves should not be left open. (Cotton pad as shown in fig.2)

Aim To know the immobilization technique for fractured metatarsus. The fractured metatarsus comes under lower level fracture whose immobilisation is cast as well as conjoined U-Plate application. (Fig. 1). Requirements Thick padded cloth (Fig. 2(a) Padded netted bamboo splint (Fig. 2(b) Conjoined U plate (Fig. 2(c)

Fracture of meta-carpals and meta-tarsals comes under lower level fracture. Padded cloth and netted bamboo splint along with conjoint U plate has been considered as standard method of repair. The fractufe is a lower level fracture involving the meta-carpal and meta- tarsal bones. (Fig.1 & Fig.2) The fracture site is immobilized extending joint below and joint above level initially with cloth or cotton padding.(Fig.3) Netted bamboo splint Is applied over it for support involving joint above and joint below which should not be too tight or too loose.(Flg.4) Splints are retained in position by thread with knots. The ends of bamboo splint kept padded to avoid skin damage.(Fig.4) More strength is given to immobilisation by application of conjoint U- plate.Conjoint U-plate is a U shaped metallic plate used for lower level fracture immobilisation. (Fig.5 & Fig.6) At the end the entire bandage is covered with cloth or a bandage roll.The hoof should also be bandaged to avoid damage due to improper blood circulation.(Flg.6)

Definition Fracture of radius-ulna & tibia-fibula comes under middle level fracture. Methods of Fracture Repair External coagtation bandage along with thomas splint application. Technique for Fracture Repair Animal controlled with lateral recumbency with fractured limb upward.

Fracture of radius-ulna & tibia-fibula comes under middle level fracture. Pop caste application or bandage along with Thomas splint has been considered as standard method of repair. The fracture site is immobilized extending between joint below and joint above level with either gum bandage or pop caste bandage (Fig.1). Pop caste bandage is generally applied after 7 days. Hence gum bandage is preferred than pop caste bandage because of immediate application after occurrence of fracture (Fig.2). For gum bandage application, a 8-16 layer thick cloth is wrapped over the fracture region covering the joint above & joint below of the site after liberal application of fevicol gum. The cotton cloth Is placed in position with few cotton thread knots (Fig.3). 4 bamboo splints are kept on the 4 sites of the limb over cotton padding. The end of bamboo splints kept padded to avoid skin damage. Splints are retained in position by thread with knots (Fig.4). A 2nd layer fevicol gum is applied over entire bandage & finally the entire bandage cloth is covered with bandage roll (Fig.5). At the end the immobilized limb is over strengthened with Thomas splint (Fig. 6).

Definition Fracture of humerus bone and femur bone are generally categorised under higher level fracture. Methods Used For Fracture Repair These level fractures are repaired appropriately by intramedullary pinning and Thomas splint application. Only pinning or only Thomas splint are not the method for its repair as the distal fragments of bone get tourqed by pinning only and the fracture fragments get distracted by simple Thomas splint application. Hence after pinning a humerus or femur bone, the limbs are kept immobilised perfectly by Thomas splint application. When pinning as well as Thomas splint application are not possible the fractured bones are kept immobilised with fevicol gum bandage only. So for this purpose modification of velpeau sling is generally adopted and animal is restrained within limited space for 21 days.

Definition Fracture of humerus and femeur bone has been grouped under higher level fracture. Pinning as well as Thomas splint application are considered to be the approved method of immobilization for repair of these bone fracture. Both method of repair are highly essential. Any one method of repair has been considered dangerous for the animal. Only pinning of the bone makes the limb to be turked where as only Thomas splint application disturbes the bone alignment at fracture site. Hence leaving one method of repair other method is not possible. When above method of repair is not possible a modification of velpue sling can be attempted.

Definition Any fracture or discontinuity in bony structure like scapula and pelvic girdle present above the shoulder joint and hip joint respectively are called as highest level fracture. Aim To know the method of repair of highest level fracture. Procedure As there is no satisfactory method of external immobilisation till date, generally animal is kept under restricted movement. Sometimes application of charge (glue bandage) externally may give some satisfactory result.

Fracture of scapula, shoulder dislocation, fracture of pelvic girdle, hip dislocation have been grouped under highest level fracture. For large animal, immobilization of bone & joint have not been developed satisfactorily/ till date. Hence after correction of dislocation or rearrangement of fractured the site Is kept immobilized with application of gum bandage.

Aim To know the use of Conjoined ‘U’ Plate with Padded ring for fracture side immobilization. Site to be immobilized Upper 3rd metacarpus, Carpo - meta carpo joint dislocation, Radio - Carpal Joint dislocation. Lower Radius & Ulna fracture are can also be immobilised with this device

Definition Handing pin cast is used for management of longbone fracture. Pin which is used for immobilisation of fracture of proximal radial and tibial bones is called hanging pin cast. Special equipment Intramedullary pin, hand driven drill, plaster of paris bandage Procedures :,

Definition Humerus is long selender and has slight spiral twist. Oblique type of fracture is most common in diaphyseal region. It come under higher level of fracture.(Fig. No-1) Appropriate method of fixation is by intramedullary pinning and modified thomas splint.

Definition Fracture of femur comes under higher level fracture (Fig. 1) where the appropriate treatment is intramedullary pinning and modified Thomas Splint. Requirement Parentral sedative Local anaesthesia 6mm 1fit long intramedullary pin (Fig.No-3) Electric bone drill Bone hammer Pin cutter

Clsssification Fracture of upper third humerus, shoulder dislocation and scapula has been grouped under highest level fracture. (Fig.1) Purpose To know the method of casting the highest level fracture by modified valeau sling application. Requirement Thick 8 layer cotton padding, adhesive gum, 6"-8" long bandage rolls.

Indication: Highest level fracture (femur fracture) (Fig. 1) Treatment: Modified Velpeau Sling application Requisite Adhesive gum Damage Cloth

Strong bamboo 4 feet long of 4 inch diameter Gl.Wire 6 mm diameter of 34 kg G.l. wire

Aim:- To know the measurement for preparation of an appropriate size of ring of Thomas splint for a large animal. Objective: Measurement of an appropriate size Thomas splint essential to avoid complications like tight fitting which may affect bone healing. Materials required: 6mm G.l. wire, jute thread

Aim To know the methods of preparation of side bars for large animal Thomas splint fabrication Procedure Two strong dry matured bamboo splints are of more than actual length of Thomas splint are prepared, (figure 1) Three nicks at a distance of 2 inch are grooved on the side of the side of the splint at one end of the splints for keeping the tying end of the ropes in position (figure -2) The bamboo splints at the lateral ends are thinned to some extent. For knob kniiting of splint to the metal ring by making an arc (figures). All the steps are depicted in figure 1 -4. Before fixing the metal ring with the bamboo extention splint the thinned ends are emersed inside water for easy arching of the bamboo splint.

Purpose Method of tying with bamboo splint with ring is very important because of the following points. A string fitting with the bamboo splint is required as with loose fitting with it may come up at any stage before actual bone healing.

Aim To knw the method of softening the ring of the perpendicular Thomas splint to avoid direct trauma of the metal wire with the skin. Materials required Jute /thin gunny bag,bandage roll,cotton threads

Aim: Bending of the lower half of the ring of Thomas splint to an angle 45- 60degree to comfort the limb and to provide free circulation. Importance After tieing the ring with bamboo splint and padding the ring with jute and cotton .bending the lower half of the ring upto more than 45 degree angle is highly essential because of placement of the fractured limb within the ring of Thomas splint comfortably, so as to the flow of blood circulation in fractured limb uninterruptedly.

Aim: To know the actual length of a Thomas splint & measurement for an animal. Procedure Animal is kept in lateral recumbancy with affected limb upward. After padding & medical bending of Thomas splint, it is fitted upon the fractured limb. At the time of measurement, the limb should be kept vertical to body for accurate measurement, otherwise the length of Thomas splint may be shorteror longer if the limb is kept forward or backward respectively. The ring of the Thomas splint is kept close to the axilla (forelimb), groin (hind limb). Limb is put downward & Thomas splint is pushed upward keeping both the extension bamboo of Thomas splint in crossed manner, measurement of length of Thomas splint is taken up to the bulb of the heel & mark is recorded. The excess length is trimmed short (figure-1). Two nicks are made on the distal end for retaining the thread in position. Both the distal ends are tied together with thread, soft padding is placed at the site where hoof is to be kept & retained in position with bandage (figure-3).

Indicaion To know the importance and method of net fabrication in large animals thomas splint. Objective; To make the application of thomas splint lightest. To avoid use of plaser of pahs bandage. To prevent possible all direction of the immobilised limb in thomas splint.

Aim: To know the method of securing thomas splint, in the forelimb. Description After immobilising the fracture site covering the distal as well as proximal end properly the thomas splint is fitted over the forelimb. The foot is immobilised to the distal end of Thomas splint. The immobilised forelimb kept closed and straight with the posterior extension of bamboo of the thomas splint. The limb is fixed with posterior bamboo splint with bandage roll at several place to avoid anterior, posterior movement of the limb. At the time of fixing the limb with posterior extension bamboo of the Thomas splint, bandage are rapped along with the netting of thomas splint, to avoid medullary lateral movement of the immobilised limb. Finally the immobilised forelimb is rapped along with the bandage roll including both the anterior and posterior extension of bamboo splint. To avoid outside movement of the immobilised limb, the method of immobilisation of fracture of forelimb has been shown in fig-1.

Purpose:- To know the method of fitting the immobilised fractured hind limb in Thomas splint. Description The fractured site is immobilised properly covering the area joint below and joint above from the fractured site. The immobilised limb is kept within the prepared Thomas splint. The immobilised limb is kept straight and come close with the front extension bamboo of the Thomas splint. The foot is fixed to the distal end of the Thomas splint with bandage roll. In the first attempt the immobilised limb is secured with the front bamboo splint with bandage roll at several places to avoid posterior movement of the immobilised limb. At the time of fixing the immobilised limb with anterior extension bamboo of Thomas splint, the limb is fixed with the netting of Thomas splint to avoid medial movement of immobilised limb. Finally the immobilised limb is covered with bandage roll wrapping around both the anterior and posterior extension bamboo of the Thomas splint to avoid outer movement of the immobilised limb. The method of immobilisation of the hind limb with Thomas splint has been shown in the figure.

Definition : These are the splints made out of light metal rods or bamboo for correction and immobilization of middle and higher level fracture in animals.

Aim: To secure the foot on the distal end of Thomas splint. Procedure Foot is placed upon the distal end of Thomas splint. The foot of the animal is wrapped V’- two round with bandage cloth.(Fig.1) 2nd round of bandage cloth is wrapped around the distal end of Thomas splint.(Fig.2) In 3rd attempt, the bandage roll is taken from the ground level of the foot & including the distal end of foot.(Fig.3) The bandage roll is taken through the gap between anterior end of Thomas splint.(Fig.3) In 4th attempt, the bandage roll is taken from the volar or plantar aspect of the limb and passed upon the ground level of foot as well as the distal end of Thomas splint.(Fig.4) Final 2 rounds of bandage cloth is wrapped through entire surface of foot. Reference: Tyagi R.P.S. and Singh J, (2013), Ruminant Surgery, CBS Publishers, New Delhi, pp-353,354

Large animal orthopedic patients are often managed with modified Thomas splints and to achieve an acceptable outcome with this device the following points should be kept in mind. Animals initially find discomfort with the splint and try to reject it by kicking and often show violent movements. Hence initial acclimatization with the device by close observation and supervision of the patient is essential. Recumbent animals should be supported in standing position by a sling and they should be managed with the principle “12 hrs on sling and 12 hours on floor”. Movement of the animal should be restricted.

Aim Purpose: As there is no institution for preparation ofthomassplintfor large animal till date for which physician are preparing thomas splint hear the patient at the time of need. These thomas splint are generally prepared with useof bamboo, Gl wire, jute of cottonbandages. These thomas splint are generally weak. These thomas splint work for (2-3) month. For this reason there is necessity of fabrication of large animal thomas splint with us e of other strong and lightest material for long time stonage and use.

Defination Dislocation of carpometarcarpus and tarso metatauses along with upper fracture of MC and MT bone (Fig. 1 and Fig.2). It is considered as difficult fracture and may not be healed appropriately by the usual procedure of lower level fracture repair method. Due to constant movement of fracture ends its treatment should be similar to middle level fracture repair method. Materials Required Thick padded cloth Adhesive gum (fevicol) Netted bamboo splint Thomas splint

Defination Dislocation of carpometarcarpus and tarso metatauses along with upper fracture of MC and MT bone (Fig. 1 and Fig.2). It is considered as difficult fracture and may not be healed appropriately by the usual procedure of lower level fracture repair method. Due to constant movement of fracture ends its treatment should be similar to middle level fracture repair method. Materials Required Thick padded cloth Adhesive gum (fevicol) Netted bamboo splint Thomas splint

Purpose As the immobilisation of upper third part of radius ulna is very difficult ,the purpose of the immobilisation tech. Is to fix the upper third of radius-ulna with the posterior half of ring of Thomas splint with bandages are very important for achieving no movement of fracture fragment during healing. Indication Correction of upper third fracture of radius-ulna by Thomas splint application indicated in higher level fracture.

Definition Fracture of Upper 3rd of tibio-fibula Presence as a difficult Problem for the Surgeon to immobilise it Perfectly. As the fracture site generally moves within the imobiliser. Its healing becomes difficult. The aimof immobilisation technique of upper 3rd tibio-fibula fracture is to fix the upper 3rd of tibio-fibula with the anterior half of ring of thomas splint with bandages. This is an important step for achieving no movement of fracture fragment during healing. Indication Correction of upper 3rd fracture of tibio-fibula (Fig.1) by thomas splint application.

Use of conjoined Thomas splint for bilateral tibia fibula fracture for large animal. Aim To know the immobilization technique for both tibia-fibula fracture in large animal practice. Instruments Conjoined Thomas splint (Fig 1).

Definition: Mandible forms the skeleton of lower jaw and comprises of a body and two rami. The two halves of this bone fuse incompletely at the mandibular symphysis, situated at the midline within the body. Indication: Immobilization of fractured mandible, minimally or non displaced fractures with an intact opposite hemimandible, vertical ramus fracture. Anasthesia: Local anaesthesia for large animals. A20 gauze 2.5 cm needle is used to deposit 5-1 Omi of lidocaine at the exit site and into the canal.

Objectives Immobilization of fracture of mandible. Requirements ‘U’ Plate 4 Pins Electric drill Orthopaedic hammer Pin cutter Procedure Under local infiltration of an anesthetic & parenteral sedatives the 4 pins are drilled 2 on either side of the fracture site from one side mandible to other side mandible. During drilling the pin, the holes, importance should be given for the passage of the pin through prefix of the drill hole in metal frame The fracture end should come accurate apposition during pinning procedure & the symmetry of the fractured mandible should be as norma! as possible. Sterilised antiseptic gauge bandages are covered, the pin between frame and the body. The pins are retained in position either with nut-bolt or by passing a plastic tube after which the hole of the plastic tube is filled with resin.

Aim: To know the method of immobilization of the limb after repair of the flexor tendon. Procedure The immobilization procedure of limb after flexor tendon repair is done in 2 stages.

Definition Digital tender include superficial digital flexor, DDF & suspensory ligament which is situated in volar & plantar upset of metacarpus and metatarsus. These tendons are generally transected during ploughing or intensional approach (Fig.1). Sign After cutting of these tendon the foot became flat and animal bears weight on fetlock is can’t able to walk freely.

Aim To depict the detail method of tendon suturing of transected gastrocnemious tendon for union. Procedure After cleaning, debriding and flushing the transected site thoroughly local antiseptic and antibiotic is applied. To expose the tendon ends clear visual as well as proper exposer the site was enlarged by two vertical incision placed at dorsal and ventral part of the transected site.(Fig.1). The three different tendons and their locations is identified. The both end of tendon of a particular group are brought close together and joins end to end and retained with strong polyester suture putting to interrupted knots at 90 degree to each other.(Fig. 2). Their peritendon cover are pulled over the suturing site from their either ends and are also retained in position with additional interrupted suture running at 90 degree to each other.(Flg. 3). In this way 4 interrupted suture are required for approaching one tendon. In this way all the 3 tendons are joined with their respective other ends with suture. Total no of 12 interrupted suture are required for joining all the 3 structure of the gastrocnemious tendon. At the end the suture tendons are strengthened by placing to interrupted stainless steel suture. (Fig. 4). Finally a flushing catheter was placed at higher level and the suture site is covered with a thick dry antiseptic absorbent cotton padding.

To know the method of immobilization of the limb after repair of the transected gastrocnemius tendon (tendo achiles). Procedure The immobilization procedure of limb after gastrocnemius tendon repair is done in 2 stages. 1ST Stage Immobilization of limb for avoiding movement at tendon suture site. It is done by placing the sutured area within a pre- fabricated metal frame so as to keep the limb undisturbed at the suture site. The frame is given in Figure 1. The purpose of addition of the metal frame is to immobilize the limb keeping the fetlock and foot away from in a flexed manner to avoid weight bearing during healing period. The limb is immobilized with netted bamboo splint (Fig. 2). The immobilized limb is placed within the metal frame keeping the fetlock and foot in a flexed manner

Hip joint is a ball and socket joint which involves cotyloid cavity of os-coxae and head of femur. Hip dislocation can be corrected by external immobilization of the area with POP cast and keeping the animal in a mobile sling for several weeks. The dislocation involves cotyloid cavity and head of femur and the affected limb deviate outward. (Fig.1) The fracture site is immobilized extending joint below and joint above level initially with plaster of Paris.(Fig.2) Cloth bandage is applied over it for support involving joint above and joint below which should not be too tight or too loose.(Fig.3) Second layer of cloth padding is provided over the first layer to provide more strength and further immobilization.(Fig.4) Final immobilization is done by application of rubber belt or suspensory bandage. (Fig.5) At the end the entire animal is kept in mobile sling for proper immobilization for some weeks and housed in limited space(Fig.6)

Contracted Leg in Calves Definition A shortening or contraction of the deep and superficial digital flexor tendons and associated muscles, sometimes also the carpal flexors, leading to abnormal flexion of the fetlock, possibly also of the pastern and carpal joint.

Management of Compound Fracture An open fracture is an injury that occurs when a broken bone is exposed through the skin. This may mean that the bone is actually sticking out of the skin, or it may mean that the skin and soft-tissue is disrupted and exposes a path to the site of the fracture. Often called a compound fracture, an open fracture necessitates different treatment from the usual closed fracture. Surgically Cleaning the Bone Surgically cleaning the bone is one of the first steps for treating an open fracture. Most patients who sustain an open fracture undergo a surgery called “irrigation and debridement.” Irrigation means washing the bone and the site of the injury. Debridement is described in the next step. Determining the extent of injury can be difficult just by looking at an open fracture. This is especially true in high-energy injuries including automobile collisions and gunshot wounds. With these types of injuries, even small penetrations in the skin can cover very large areas of soft-tissue damage around an open fracture. Therefore, when surgically cleaning the bone, it is important to do this in the operating room (OR) under anesthesia — trying to sufficiently assess and clean the bone in the emergency room, without adequate anesthesia, may be insufficient.

Aim: Regular flushing of compound and fracture using topical antibiotic or antiseptic required to bring the open wound and fracture either to a aseptic stage or to reduce the degree of infection and pus formation. Procedure After through cleaning the exposed bone as well as the wound of the compound fracture the wound is placed inside its part. A thick walled rubber tube / plastic tube threaded with two end of a suture with a straight needle is carried to a higher site from the fracture within the wound. The suture and needle is brought out, the sutures separated and again threaded and the flushing catheter is fixed with suture. Fig.1.(a) and Fig. 2. (a), (b). The wound is protected with a thick absorbant sterile cotton padding, keeping the flushing catheter out through a small hole within the bandage. Fig. 1 (b) and Fig.2.(c) The limb is immobilized as per the recommended procedure depending the level of fracture, outer end of the flushing catheter is kept outside, of the immobilization for carrying out regular flushing of the wound.

Definition Wound with infection with 6 hours of occurrence can be brought to non infected stage by flushing. Procedure The infected wound at fracture site is cleaned / flushed thoroughly using sufficient quantity with antiseptic solution. The site is applied with topical antiseptic / antibiotic and the size of the wound is reduced by placing interrupted stitches for skin closure. For drainage of inflammatory fluid, the counter opening is made as the distal part of the swelling of the dependent part of flushing catheter is placed inside to carry out regular flushing of the wound without removing the immobilizer. The fracture site is immobilized as per the conventional procedure using POP cast leaving two window over the opening of counter opening site.

1. True bone tumours. Neoplasms arising from cells of mesenchymal origin, derived from a common ancestry and whose function is primarily skeletal boen formation. These tumours fall into four main groups according to the predominant cell type present. By reason of the mutability of the cells metaplasia is common and intermediate stages are found.

Amputation of Claw in Cattle

Objetive To completely exercise a cancerous hoof in presence with cauliflower like growth with regular bleeding & myosis. Material Required Amputation saw, thick padded with bandage roll, a mixture of powder containing resin and naphthalene ball powder, bicycle tube protection sleeper (Fig-3), local anesthesia.

Indication Bilateral digital cancerous growth cauliflower like(fig-1),cancerous growth with continuous bleeding and myasis. Aim To remove the cancerous growth from healthy side by surgery. (Fig. 1-2) Material Required Amputation saw, thick padded with bandage roll ,a mixture of powder containing resin and naphthalene ball powder, bicycle tube protection sleeper(Fig-3),local anesthesia.

Aim: Amputation of limb by bone section technique. Indication: Irreparable injury; Gangrene; Malignant disease. Site: Fore-limb: Common site is junction of the lower and middle third of the radius(fore-arm). Hind-limb: common site is the middle third of the leg region(tibia). Anaesthesia and control: Fore-limb: general anaesthesia; Hind-limb: epidural anaesthesia. Operated in lateral recumbent position.

Aim Study about method of apposing muscle, fascia, skin over amputed stump. Indication Proper healing of amputed stump, avoiding infections. Description Limb is amputed generally through diaphysis or by disarticulation method. Whatever is the amputation,the surgeon should always keep as much soft tissue as possible to cover the bone extrimities. It is difficult to achieve in large animal, when amputation is immediately below carpus or tarsus.

Joint disarticulation: Unwanted limb is amputed by joint disarticulation method. Site of amputation along with skin-muscle flap ratio Fore limb: Elbow disarticulation Carpo-metacarpal disarticulation Fetlock disarticulation

Indicaton: Irreversible damage of both the bovine digits & to provide a foot pad for comfortable walking of animal

Indication: Irreparable damage of metacarpal bone.

Definition : It is a technique in which foreiirnb is amputed from elbow joint. Indication : Incurable damage of radius ulna.

Indication Irreparable injury. Frost bite, burn. Malignant neoplasia. Incurable peripheral vascular disease. Necrosis, gangrene, extensive injury of nerve of fore limb.

Indication: Irreparable damage of the meta tarsal joint.

Indication Necrosis, Gangrene, Extensive injury of nerve of hind limb. Malignant neoplasm Frost bite. Burns Incurable peripheral vascular disease.

Bone section method Advantage Recommended for artificial limb fitting. Non-weight bearing of stump is marked. Fig- 2a.

1. The plaster-bandage wrap cast :(Negative cast) The amputee was restrained on lateral recumbency keeping the amputed leg upwards. A thin, moistened stockinet was pulled over the stump and it was maintained snugly in place by tying with a string at the top. The moistened cast stockinet was marked with indeliable pencil indicating prominences with a cross and other sensitive areas with a circle (Fig.1). Plaster bandages were then wrapped as pen requirement unit I the shell has a thickness of approximately 3mm in proximal third. After plaster hardened, it was removed either by pulling out or longitudinal splitting with a cutter (Fig.2).

Introduction A downer cow is an animal In sternal recumbency and isn’t showing obvious clinical sign of hypocalcemia,hypomagnesmia or any limb or spinal Injury. Most causes are related to parturition, occurring in few days before or upto a week after calving. Causes for Making an Animal Downer Animals Inability to stand may be caused by illness or injury. Following may be the reasons

Purpose To make a list on the requisites on materials required for preparation of rehabilitation mobile sling for large animals.

It consists of 2 parts-A) fabrication of fixed supporting frame B) fabrication of animal swing frame. Fabrication of fixed supporting frame - Materials required - Bamboo pole and rope Fabrication Technique - Size a frame 3m for large animals, 2.5m for medium sized and 2 ml for small sized animals. Fabrication of animal swing frame- Materials required - Strong fixed rectangular iron frame Fabrication technique - The required no. of bicycle tyres are fastened upon the frame. All individual tyres are tied with jute threads at 3-4 places.

Indication: Rehabilitation of downer animal

Recommended Duration for Slinging Large Animal Aim: To know slinging duration for large animal. Indication: Downer cow, sternal redumbency, hypocalcemia, hypomagnesemia, limb or spinal injury, cases,related to parturition.

Aim of Rehabilitation To assist the animal to stand. To facilitate normal respiration in animal. To ensure normal feed and water Intake. To ensure that rumination,defaecation and urination are normal.

Aim To know the method of rehabilitation of downed animal within exercise wheel cart. Indication Irreparable trauma to vertebral column,permanent paralysis, downed animal.