Color Atlas of Surgical

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.lpproaches t o the

Thoracic and Pelvic Limbs

R. Latorre I?. GI1 S. (3iment 0. U p e z R. Henry
M. Ayala G . Ramirez Fw Martinez Jw V-ez
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COLOR ATLAS
OF SURGICAL APPROACHES
TO THE BONES AND JOINTS
OF THE DOG AND CAT
Thoracic and pelvic limbs

R. Latorre
F. Gil
S. Climent
0. L6pez
R. Henry
M. Ayala
G. Ranlirez
F. Martinez
J. Viizquez

XXI - 2009
Buenos Aires - Repljblica Argentina
 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, elec-
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tronic, mechanical, photocopying, recording, or otherwise, without prior written permission from Editorial Inter-Medica S.A.

Deposit was made under the law 11.723

ISBN: 978-950-555-347-1

0 2009 b y Editorial Inter-Medica S.A.I.C.I.

J u n i n 9 1 7 P i s o lo"A"-C1113AAC
Ciudad Autonoma de Buenos Aires - Republics Argentina
Tels.: (54-1 1) 4961-7249 14961-9234 14962-3145
FAX: (54-1 1) 4961-5572
E-mail: [email protected]
E-mail: ventasBinter-medica.com.ar
http://www.inter-medica. com.ar
ww.seleccionesveterinarias.com

Latorre, Rafael
Color atlas of surgical approaches to the bones and joints of the dog and cat: toracic and pelvic. - la ed.
Buenos Aires: Inter-Medica. 2009.
272 p.; 28x20 cm.

I ISBN 978-950-555-347-1
I
I 1. Veterinary medicine. 2. Surgery. I. Tittle
CDD 636.089

Print in Talleres Graficos Valdez

Loyola 1568 - Buenos Aires
Impreso en Argentina - Printed in Argentina
Tirada: 5000 ejemplares
Este libro se termino de imprimir en Enero de 7009.
 leans. elec-
Autores colaboradores
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ARENCIBIA
ESPINOSA,A. MARTINEZ
GOMARIZ,
F.
DVM, PhD. Professor of Veterinary Anatomy, DVM, PhD. Professor of Veterinary Anatomy, University
University of Las Palmas de Gran Canaria, Spain. of Murcia, Spain.

Ma.D.
AYALAFLORENCIANO, ORENESHERNANDEZ,
M.
DVM, PhD. Professor of Veterinary Anatomy, University Technical Specialist of Veterinary Anatomy, University
of Murcia, Spain. of Murcia, Spain.

ALBARRAC~N
LOPEZ,J. R A M ~ R EZARZOSA
Z G.
Auxiliary Technical Specialist of Veterinary Anatomy, DVM, PhD. Professor of Veterinary Anatomy, University
University of Murcia, Spain. of Murcia, Spain.

CLIMENT
PERIS,S. ROJORios, D.
DVM, PhD. Professor of Veterinary Anatomy, University DVM. Professor of Veterinary Anatomy, University of
of Zaragoza, Spain. Murcia, Spain.

CLIMENT
AROZ,M. R o s SEMPERE,J.
DVM. Professor of Veterinary Anatomy, University of DVM. . Professor of Veterinary Anatomy, University of
Zaragoza, Spain. Murcia, Spain.

DRAPE,J. RUIZ, M.
DVM, PhD. Aquivet Veterinary Hospital Director, DVM, PhD. Director of the Mediterranean Veterinary
Eysines, Burdeoux, France. Hospital, Madrid, Spain.

GILCANO,E SANCHEZ
MARGALLO,
F.
DVM, PhD. Professor of Veterinary Anatomy, University DVM, PhD. Scientific Director of Minimally lnvasive
of Murcia, Spain. Surgery Center Jesus Uson, Caceres, Spain.

HENRY,R. SANCHEZCOLLADO,C.
DVM, PhD. Professor of Veterinary Anatomy, University DVM. Professor of Veterinary Anatomy, University of
of Tennessee, USA. Murcia, Spain.

KOSTLIN,R. USON GARGALLO,

J.
DVM, PhD. Professor of Veterinary Surgery, University DVM, PhD. Director of the Foundation Minimally
of Munich, Germany. lnvasive Surgery Center Jesus Uson, Caceres, Spain.

LATORREREVIRIEGO,R. V ~ Q U EAUTON,
Z J.
DVM, PhD. Professor of Veterinary Anatomy, University DVM, PhD. Professor of Veterinary Anatomy, University
of Murcia, Spain. of Murcia, Spain.

LOPEZALBORS,0 . VEREZFRAGUELA,
J.L.
DVM, PhD. Professor of Veterinary Anatomy, University DVM, PhD. Director of the Veterinary Hospital
of Murcia, Spain. Ultramar Clinic, El Ferrol, Spain.

LOSILLAGUUAS,S. ZAERA,J.P.
DVM. Endoluminal Therapy and Diagnosis Unit, DVM, PhD. Professor of Veterinary Surgery, University
Minimally lnvasive Surgery Center Jesus Uson, of Las Palmas de Gran Canaria, Spain.
Caceres, Spain.

...
lll
 Preface
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Many surgeons usually choose to review regional anatomy when planning for surgery. Anatomical review is more likely
while learning new surgical techniques, as identification of anatomical structures is not as routine. This atlas provides an
answer to traumatologists who have been asking for a collection of colour anatomical images of the most common surgical
approaches to the limbs. The selected images have been used in continuing education courses for traumatologists with great
success and availability in text book format is often asked.
The approaches
.. to the thoracic limb are presented in three sections. The first includes the scapula, shoulder and hume-
rus of the dog, the second contains the elbow, radius, ulna and manus of the dog, and a third section includes selections on
the cat. The pelvic limb begins with the hip joint and thigh and continues with the knee, leg and pes of the dog. It conclu-
des with the corresponding approaches in the cat. Images of the articulated bones of the region are presented at the begin-
ning of each section. All approaches were completed on fresh tissue (no fixation) for more natural colour. Cadaver vessels
were highlighted by colour injection. Superficial to deep views of preparations are presented with the relevant muscles, liga-
ments, nerves and vessels identified. Additionally, sevcral videos of the thoracic and pelvic limbs with 3D reconstruction,
obtained from live specimens at the Minimally Inuasiw Surgery CentreJesus Usdn (Ciceres, Spain) with a "BV Pulsera 3D-
RX Option. Philips. S. A." device, are included. Indications for each approach are referenced at the beginning of each chap-
ter. All approaches were carried out on left limbs - with the exception of some in the manus and pes- , and sequenced from
proximal to distal. Footnotes indicate the commonly used protocol for each surgical approach.
We would like to conclude with a very special reference to Prof Dr. Francisco Moreno Medina, who had to leave his care-
er in anatomy early and retire due to illness. He founded the Anatomy and Embryology group at the University of Murcia
and from him we inherited a large part of our anatomical knowledge and passion for working in the dissection room.

THE AUTHORS
"Anatomy without clinic is dead,
clinics without anatomy is deady"
(Platzer)

(None of the specimens was eutharratized for dissection purposes. All cadavers were obtainedfrom the Animal Facility of the
University ofMurcia, which oversees nllprotocols for Animal Healthcare and is accredited by the European Bureau for protection
of research risks i n animals. Most cahuers wereper+sed with coloured chemicalsfor a better identification of arteries and veins).
VetBooks.ir

Section I Mediopalmar approach to the carpal joint . . . . . 95 I

Dog, thoracic limb . .. . . . .. . . . .. I Approach to the metacarpal bones. . . . . . . . . . . . 99
Approach to the phalanges and the
Scapula, shoulder joint and humerus interphulungealjoints . . . . . . . . . . . . . . . . . . . 103
Anatomical considerations . . . . . . . . . . . . . . . . . . . . 3
Approach to the lateral suface, spine Section 2
and acromion of the scapula . . . . . . . . . . . . . . 9 Cat, thoracic limb . . . . .. . . . . . . . 107
Craniolaterul approach to the shoulder
hint hv ~rrnmialnstentnm~~. . . . . . . . . . . . . . 13 Anatomical considerations . . . . . . . . . . . . . . . . . . . . 108

. .

Caudolateral approach to the shoulder joint . . . . 21 Humerus: approach to the distalportion of the
Craniomedialapproach to the shoulder joint . . . . 25 diaphysis by craniolateral incision . . . . . . . . . . 1 19
Approach to the proximal diaphysis of the humerus 31 Approach to the distal humeral diaphysis
" - -roach to the medial humeral diaphysis via a and the humeral supracondylar region
3 c via a medial incision . . . . . . . . . . . . . . . . . . . 123

medial incision . . . . . . . . . . . . . . . . . . . . . . . 47
Section 3
Elbow, ulna and manus
Anatomical considerations . . . . . . . . . . . . . . . . . . . . 51
Dog, pelvic limb .. . . . . . .. . .. . . . 139
The pelvis and hip (coxal) joint
Lateral approach to the humeral condyle
Anatomical considerations . . . . . . . . . . . . . . . . . . . . 14 1

Approach to the humeroulnarpart of the elbow joint Approach to the ventral surface of the sacrum . , . 155

medial aspect of the humeral condyle via Approach to the craniodorsal and caudodorsal
intermuscular incision . . . . . . . . . . . . . . . . . . 67

the trochlear notch . . . . . . . . . . . . . . . . . . . . . 71 Approach to the caudodorsal regions of

Approach to the olecranon tuber . . . . . . . . . . . . . 73 the hip joint with gluteal muscle tenotomy . . . . 165
Approach to the distal ulnar diaphysis and Approach to the os coxae . . . . . . . . . . . . . . . . . . 167

and diaphysis ofthe radius . -. . . . . . . . . . . . . . . 79 Approach to the pubis and the pelvic symphysis . . 175
Approach to the diaphysis of the radius via a Approach to the ischium . . . . . . . . . . . . . . . . . . 179
I I ...

eazal zncznon . . . . . . . . . . . . . . . . . . . . . . . 81
Approach to the diaphysis of the femur . . . . . . . . 187
Dorsal approach to the carpaljoint . . . . . . . . . . 91
 Contents

Stifle. leg and foot Approach to the calcaneus and the plantar surface
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Anatomical considerations .................... 189 ofthe tarsal bones . . . . . . . . . . . . . . . . . . . . . 237

I Approach to tile distalfemur and stzfle joint Section 4
I via a lateral incision . . . . . . . . . . . . . . . . . . .
Approach to the medial collateral ligament and
20 1
Cat. pelvic limb ................ 239
the caudomedial region of the sttjle joint . . . . 205
Anatomical considerations . . . . . . . . . . . . . . . . . . . . 240
Approach to the lateral collateral ligament of the
caudolateral stzjle joint region . . . . . . . . . . . . 209 Approach to the wing of the ilium
Approach to the proximal tibia via by lateral incision . . . . . . . . . . . . . . . . . . . . . . 247
a medial incision . . . . . . . . . . . . . . . . . . . . . . 21 3 Craniodorsal and caudodorsal approaches to the hip
Approach to the tibial diaphysis . . . . . . . . . . . . . 2 19 joint by osteotomy of the major ti-ochanter . . . . 251
Approach to the lateral malleolus Approach to the dyaphisis of the femur . . . . . . . . 255
and tarsocruraljoint . . . . . . . . . . . . . . . . . . . 223 Approach to the stzjle joint by luteral incision . . . 259
Approach to the medial malleolus Approach to the dy~phisisof the tibia . . . . . . . . . 263
and tarsocruraljoint . . . . . . . . . . . . . . . . . . . 227
Approach to the tarsocruraljoint via osteotomy References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
of the medial malleolus . . . . . . . . . . . . . . . . . . 23 1
Approach to the calcaneus . . . . . . . . . . . . . . . . . 235
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Thoracic limb
 Chapter 1
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Skeleton of dog, left view

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Scapula, shoulder joint

and humerus
Anatomical considerations

m a ra r k
L
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Dorsal border ol scapula 1

- IJqlenoid tubercle
'Head of humtrul
' Ntdr of humem

Dorsal border of scapula

Serrated face of scapula

' i

Subscapular fossa

Supnglenoid tubercle

Nedt of / Caramid arr

scapula f

- Major tubercle

Intertubcercular groove

ILateral and medlal vlews ot the lett scapula and humerus.

 Dog - Thornacic limb
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Brachiocephaliis musde, Trapezius musde, cervical and thoracic parts Latissimus dorsi
deidoarvialis musde muscle

Omotransvenarius musde ,

External jugular veir

n'
1 External abdominal
oblique muscle
I

Deltoideus muscle,
spinous part
long head triceps
brachii musde
Deltoideus musde,/
acromial part 1 \ Axilbbrachial vein
Omobrachial vein / \ trteral head triceps

E'
brachii muscle
Bmhiocephalicus musde,
deidobrachialis musde / /'
Cephalic vein ,-' Olecranon tuber

Extensor carpi ndialis musde

IISuperficial muscles of the neck and left thoracic limb.

 Dog - Thoracic limh 7
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Facies mta

Subscapular muscle

/ lupraescapular and
7 Supraspinatus musde
Latissimus doai musch
Subscapular nerve
fiomwiorsal artery and nerve 37 - Hinor tuberde
of humerus
'.
nerve
Long head triceps \ Coracobrachialis
bradrii musde \ muscle
M~~cuIocutaneou~
nerve
Ulnu nerve
4-' \ Biaeps bradii musde
Median nerve
\
Brachi artery
Olecranon tuber

Mdial epicondyle of humerus - Pmnator tens musde

Flexor carpi ulnaris musde Extensor carpi

radialis muscle
Superficial digital flexor musde - ' Median artery
 8 Chapter I
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Exte
(
Cephalic win BnchiocephJicus mu& (Ueidobnchialis)
Superficial pectoral mude,
descending pectoral musde
.., - - .
Superticiat pectoral musde,
transverse w a r d muscle

- External abdominal oblique

Rectus abdominis muscle

-- =
Ventrolateral muscles of the neck and pectoral region.
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Approach to the lateral surface,

spine and acromion of the
scapula

Indications:
Amputation of the thoracic limb with removal of the scapula.
Treatment of fractures of the body of the scapula with fragments and
severe dislocation.
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*
Trapezius musde (ce~adpart)

Inhaspinatus muscle

\
Deltoideus musde (spinous part)

Upper image: the skin incision starts at the proximal end of the scapular spine and extends distally t o the acromion.
Lower image: after skin incision, the superficial muscles of the scapula are identified.These muscles will need t o be
reflected from their spinous attachment.
 Dog - Thoracic limb
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Supraspinatus muscle

Inkpinatus muscle
I - -

A f t e r reflection o f the muscles, the spine, acromion and supraspinous and infraspinous fossae are exposed.
CAUTION: Distally, at the acromion, the suprascapular neurovascular bundle must be preserved as it courses
around the scapular notch. In the cat, the suprahamate process on the acromion makes reflection of the infraspinatus
muscle difficult.
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Craniolateral approach
to the shoulder joint by
acromial osteotomy

Indications:
Treatment of fractures of the glenoid cavity.
Treatment of fractures of the head of the humerus.
Surgical reduction of shoulder luxations.
Relevant deformations in cases of osteochondritis dissecans.
Arthrodesis of the shoulder joint.
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Supraspinatus musde

Deltoiius musde (acromial part)

Supraspinatus musde
\

- lnfraspinatus musde

- Teres minor musde

, Deltoideus musde
(acrom~alpart)

,upper Image: l o r exposure or me cranlolateral snoulaer joint, arter compleuon or m e spmous approacn, m e inclslon may
be extended distally t o the deltoid tuberosity.The acromial part of the deltoideus muscle is freed of the underlying
muscles prior t o acromial osteotorny.
.,I
Lower image: after reflection of the deltoideus muscle, the teres minor muscle and the tendon of the infraspinatus muscle
can be seen and prepared for tenotomy.
 Dog - Thoracic limb
. - -
a 3
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Supraspinatus muscle Infraspinata muscle

joint capsule -I
Axillary nerve 4

Supraspinatus musde

/,
Joint capsule -
Infirspinatus musde

Suprrscapuhr nerve

Tens minor musde

a
- Deltaidea musde (aaomial part)

, Upper image: after infraspinatus tenotomy and caudal reflection o f the tendon, the joint capsule and suprascapular
nerve are exposed.
CAUTION: the suprascapular nerve must be preserved as ~tpasses ventrally t o the acromion.As the cut acromion with
the acromial deltoid attached is reflected ventrally, the branches of the axillary nerve need t o be preserved.
Lower image: for greater joint capsule exposure, the supraspinatus muscle can be retracted dorsally and the teres
minor m ~ ~ s cretracted
le ventrally.
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Suprascapular nerve
1

Supraspinatus musde

I- Infraspinatus musde

Head of humerus -

Deltoideus musde (auomial part)

& Internal rotation

IAfter the incision o f the joint capsule, the humeral head and glenoid labia are exposed, Internal rotation o f the
humerus provides greater exposure o f the joint as illustrated by the osteological image.
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I- Acromion
1- Ha'o! tuberde of humerus
3- ~ d t o l u rnwrde (acromd part)
4- Brachioce halicus muscle
I-A ~ I I ~win ~ & ~
6- Cephal~cvein

Omotransversarius musde

Major tuberde of humerus

Ornobrachial fasaa -
Brachiocephaliws musde -
Upper image: the line of incision is from the major tubercle of the humerus toward the lateral epicondyle of the
humerus. Preserve the cephalic vein and its branches. If necessary, the omobrachial vein may be ligated and transected
for better exposure.
Lower image:The cranial border (dotted line) of the acromial part of the deltoideus muscle is freed for caudal retraction.
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r Dog - Thoracic limb

tlajor tubercle
of humerus - I

joint capsule , I

- Aoomial part of
deltoideus musde
lnfraspinatus muscle -7
Teres minor mude

Brachidis mwde Lateral head of triceps

bracttii musde

Upper image: caudal retraction of the acromial part of the deltoideus muscle exposes the teres minor muscle and the
infraspinatus muscle tendon for tenotomy (dotted line).
lower image: the infraspinatus muscle tendon is reflected dorsocaudally t o expose the joint capsule.
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joint capsule 4

Head of humerus

Glenoid lip .

Supraspinatus musde

joint capsule

Inharpinatus muscle Tern minor musde

Upper image: the joint capsule is incised to examine the joint cavity and articular surfaces.
Lower image: for greater joint capsule exposure, the teres minor muscle is retracted ventrally or transected. Internal
rotation of the humerus provides greater exposure of the articular surface as illustrated by the osteological image.
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Caudolateral approach
to the shoulder joint
 Chapter 1
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Omobnchial fascia

Omobnchial vein
\
lkromial part of Axillobrachial vein
deltoideus musde

I Upper image: the skin incision is from the distal end of the scapular spine curving toward the mid humerus.
I Lower image: in preparation for separation of the two parts of the deltoideus muscle, scapular (spinous) and acromial,
dissect the omobrachial fascia t o delimit the two portions (dotted line).
 Acromial part of
~~ELEA
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deltoideus musde Infraspinatus musde

Teres minor musde

I Caudal arcurnflex
humeral artery
and vein

Teres minor musde Spinous part of del-

Internal rotati toideus musde
i- \

Aaomial pan of
deltoideus musde

Head of humerus
1

joint capsule , Lilted heid triceps brachii

musde

: after retraction of the two parts of the deltoideus muscle, the joint capsule can be viewed. Identify
&r branches of the axillary nerve and caudal circumflex humeral vessels.
: after incising the joint capsule and internal rotation of the humerus as in the osteological image, the
caudal aspect of the humeral head is complete.
reserve the muscular branches of the axillary nerve between the two parts of the deltoideus muscle.
I
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Craniomedial approach
to the shoulder joint

verse humeral ligament.

e articular capsule to correct medial instability of the

of medial luxation of the shoulder joint.

on of the biceps tendon to correct medial luxation of

ures of the medial border of the glenoid cavity.

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 -- Dog - Thoracic limb

-
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Cephalic vein Hajor tubercle of humerus

Supraspinatus muscle \ I /' , Brahiacephalicur murde

i'
Cephalic vein

vein Major tuberdo of humerus

Brachiocephalicus musde
Suprapinatus musde
I I
Bhpr brachii
/ muds

- Superfiaal pectoral
musde

~&rachiocephalicusmuscle is retracted laterally and the attachment of the superficial pectoral mus-
W s has t o be transected (dotted line). Medial view.
@cia1 pectoral muscle is reflected medially and will expose the supraspinatus muscle attaching to the
the deep pectoral muscle attaching t o the humerus wich will need to be transected (dotted line).
m e the cephalic vein.
 Chapter 1
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Tnmverse humed ligamenr tlajor tubercle of humerus

. musde
Biceps brachii

Subscapularis mude Deep peaod mu&

SVmpinaUm ~ d e Joint capsule Head of humerus

Biceps brachii
- musde

. Drop pcctod
muscle

4 C

Subscapular mde

Iupper image: after transection and medial retraction of the deep pectoral muscle, the subscapular and coraco-
brachialis muscles are exposed laying over the joint capsule. Medial view, left shoulder.
Lower image: then the tendon of insertion of -the subscapular muscle and the tendon of origin of the coraco-
brachialis muscle are cut.The joint capsule is now exposed and may be opened t o explore the joint cavity and view
the humeral head.
 -
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Transverse hurneral ligament 1

Biceps brachii
muscle tendon

Glenoid cavity

Head of humerus Joint capsule

1
Deep pectoral muscle

# brachii tendon onto the supraglenoid tubercle.

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Approach to the proximal

diaphysis of the humerus

Indications:
Open reduction and fixation offructures of the proximal third of the
humerus.
Obtaining spongy bone tissue.
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Ornobrachial fasda

I- Auomial part of deltoideus,musde

2- Brachiocephal~wsrnusde
3- Triceps brarhii musde ..
4- Axlllobrach~alvein
5- Cephalic vein

H Upper image: the skin incision starts over the major tubercle of the humerus and extends distally to the mid humerus.
Lower image: separate the skin to identify the course of the cephalic, ornobrachial and axillobrachial veins.The bra-
chiocephalicus and acromial part of deltoideus muscles need to be separated (dotted line).
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Inkaspinatus musde tendon

tl 'or tubercle
OAUmeNI

Bradiocephalicus musde

- .

'7
Superlidal pttoral musde Brachiocephalicus musde
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Ornobrachial vein

BrachiocepKdcus mus

Extensor carpi
-2 r;ad~alamuscle I

@The line of the skin incision is from the major tubercle t o the lateral epicondyle along the body of the humerus. Identify
and preserve the cephalic,axillobrachial and omobrachial veins in the superficial fascia. Distally, preserve the radial nerve
passing between the brachialis, extensor carpi radialis and lateral head of triceps brachii muscles. Lateral view.
CAUTION: radial nerve.
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BradiocepMicur musde

Superficial pectoral , Lateral head trlceps

musde : brachii musdh

( Radial nerve

'
?

Extensor carp1
radialis muscle
6

f the humerus is exposed by medial retraction of the brachiocephalicus muscle and caudal
achialis and lateral head of triceps brachii rnuscles.The axillobrachial vein may be ligated and
cephalic vein for better exposure of the superficial pectoral muscle before freeing the insertion
humerus (dotted line). Craniolateral view.
 Chapter 1
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Deltoideus musde
(acromial part)

Bnchiocephalicur musde ..
I
Superficial pectoral muscle . Lateral head triceps
brachii musde

Biceps brachii musde

- Radial nerve

- radialis
Extensor carpi
musde

After freeing the superficial pectoral muscle, exposure of the humerus is accomplished by lateral retraction of the
brachialis muscle and medial retraction of the biceps brachii muscle. Craniolateral view.
CAUTION: protect the radial nerve.
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aphysis
iumeru I a medial

rations:
redudon and m t i o n o f f k t u r e s in the middle third ofthe humerus.
 Chapter 1
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Brachiocephalicus musdc

Cephalic vein
-S u p.e"t f d pectoral nusde 4

Biceps bnchi nus& -

1

Upper image: the skin incision extends from the major tubercle to the medial epicondyle of the humerus.The bra-
chiocephalicus and superficial pectoral muscles are exposed. The superficial pectoral muscle insertion must be
freed from the humerus (dotted line). Medial view.
ILower image: freeing of the brachiocephalicus and pectoral muscles exposes the biceps brachii muscle which cov-
ers the medial aspect of the humerus.
CAUTION: preserve the cephalic vein.
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Superficial pectoral musde ,

Biceps brachii musde -

Cephalic vein
Superficial pectoral musde

Brachiocephaliau musde

Brachial artery and vein

- Biceps brachii musde
Collateral ulnar artery and vein
tlusculocutaneous nerve
Medial head triceps
brachii musde
I-'
Wedian nerve
Ulnar nerve
I

xpose the craniomedial humeral body, the biceps brachii muscle is retracted medially and the bra-
uscle laterally. Medial view.
rotect the vessels and nerves located caudally t o the biceps brachii muscle.
a distal extension of this approach exposes the distal third of the medial humerus.The brachial vein
~ b dthe musculocutaneous, median and ulnar nerves are caudal t o the biceps brachii muscle.
VetBooks.ir

Superficial pectoral musde

1
Biceps bnchii musde

fledial head triceps

brachii mde

Brachial artery and vein -

Ulnar nerve ---a - Pronator teres musde
Hedian nerve

Superficial pectonl musde

--I
-- Biceps brachii muscle
Bradial artery a d win

Collateral ulnar artery and vein -

Ulnar nerve '
Pronator tens musde

.IUpper image: a more proximal approach to the humerus is facilitated by retracting the biceps brachii muscle cranially.
CAUTION: protect the vessels and nerves located caudally t o the biceps brachii muscle.
Lower image: cranial retraction of the brachial vessels and the median nerve provides the best approach to the medial eF
condyle of the humerus.
CAUTION: protect the vessels and nerves in this area.
VetBooks.ir
 Chapter 1
VetBooks.ir

lateral head triceps

brachii muscle

Upper image: a curved skin incision from the deltoid tuberosity to the lateral epicondyle of the humerus is made.
Lateral view. I
CAUTION: protect the cephalic vein and radial nerve. I
 Dog - Thoracic limb
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Lateral head triceps

'brachii muscle
Humerus-

Superficial pectoral musde -

t Radial nerve

Extensor carpi
radialis musde

Cephalic vein

. Brachialis musde
Biceps brachii musde

Extensor carpi
Radial new radialb musde

de. I Upper image: the distal third of the humerus is exposed by retracting the brachialis muscle and the radial nerve
caudally and the brachiocephalicus muscle cranially. Access to the humerus is improved by freeing the superficial
the pectoral muscle insertion (dotted line). Lateral view.
cle. I Lower image: after separation of the superficial pectoral, retract the superficial pectoral and biceps brachii muscles
cranially for better exposure of the distal third of the humerus.
:AUTION:protect the radial nerve.
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 1 Dog - Thoracic limb
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Collateral ulnar vein

Brachial artery and vein

I
fledid head triceps
brahii musde \1
Biceps brachii musde

Ulnar nerve Humerus

i
- Median nerve

Pronator teres musde

Brachial arte and

Collateral ulnar vein ?'
vein and me tan nerve

Hedial head triceps - r

bracbii musde - Biceps bnchii musde

1 C
Ulnar nerve

musde
Pronator teres

UP p after incision of the deep brachial fascia, the supracondylar region of the humerus, the tendon c
bic Lii and the brachialis vessels are exposed. Medial view.
Lou k the exposure is enlarged by retracting the biceps brachii muscle, the brachial vessels and the median I
CIa [.the medial head of triceps brachii muscle and the ulnar nerve caudally
AU h t e c t the vessels and nerves in this area.
VetBooks.ir

Elbow, ulna and manus

Anatomical considerations

1
I
I
I
I
T""
I
I
I
I
I
I
1
I
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Olecnnon foaa
/
Olecranon tuber

Lateral epicodyle ,
Condyle of fie
humem capttululn -1
Head of radius

Body of radiusA-.
2 1
latenl coronoid process

Antebtachial interosseus space

Radial fossa

Supratrochlear foramen
Medial epicondyle

O l e m o n tuber
\
\

Humeral condyle:
trochlea
Hedial coronoid
process

I Upper image: lateral aspect of the bones of the left elbow joint.
ILower image: medial aspect of the bones of the left elbow joint.
 I
Dog - Thoracic limb
I
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14- Distal phalanx of digit I

IS- Proximal phalanx of digit 2
16- Hi& of digit 2
17- Unguai praarr of did phalanx of t i t 4
18- Pmid seranoid bones of digit 2

aspects of the bones of the left elbow joint.

aspects of the bones of the left manus.
 Chapter 1 I
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Legends
1- lateral cutaneous antebachi nerve
2- h n e u s murdc
3- Extensor carpi r a d i i ~musde
4- Common digital extensor mu$&
5- lateral digital extensor msde
C Body of radius
7- M u d o r pollih longus
8- Extensar carpi dnatis murdc
9- Proximal extensor rttinaalum
10- Accessory carpal h e
II- Extensor carlri ndidh tendon
12- lateral digid atemer tcndoa
13- htemor bran& of i n t e m w muscle
14- tletacupol bans Il and Ill

Legends
I- Accessory head triceps brarhii muscle
2- bng head triceps brahii musde
3- Brathidis musde
4- Extensor carpi radiali rnusde
5- Supinator musde
6- Body of radius
7- Abductor pollids longus
8- Common digital extensor tendon
9- lateral digital extensor tendon
10- Extensor c a ~ iulnaris muscle tendon
II- Pmaimal extensor ntinaculum

Upper image: dorsolateral and dorsal views of the muscles and tendons of the left forearm and the tendons of the I
manus respectively.
Lower image: to view the deep muscles of the left forearm, the common digital extensor and the extensor carpi uln
muscles have been removed.
VetBooks.ir

Legends
I- Hedial epicondyle of humerus II- Biceps brachii muscle -

2- Flexor carpi ulnaris muscle 12- Brachial artery and vein

3- Superficial digital flexor muscle 13- Accesory carpal bone
4- Flexor carpi radialis muscle 14- Superficial digital flexor tendons
5- Pronator teres muscle IS- Digit I
6- Extensor carpi radialis muscle 16- Median artery
7- Median artery 17- Pronator quadratus muscle
8- Radial artery 18- Deep digital flexor muscle
9- Medial border of the body of radius 19- Deep digital flexor tendons
10- Styloid process of radius
VetBooks.ir

Legends
I- Pmnator terer muscle
2- bedian artery
3- Radial artery
4- Common interosseour artery
5- Caudal inierosreous artery
6- Ulnar artery
7- Palmar metacarpal arteries
8- Palmar common digital arteries
9- Axial palmar proper digital arteries
10- Flexor retinaculum
I I - Deep palmar arch
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Triceps bnchii
tendon
Extensor carpi
radialis rnusde -
'4

Upper image: t o explore the olecranon fossa, a curved incision passes between the lateral epicondyle and
olecranon tuber.
Lower image: the fascia of the elbow is incised t o delimit the tendon of the triceps brachii muscle and
the anconeus muscle.The caudal insertion of the anconeus to the ulna must be freed (dotted line).
VetBooks.ir
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 Chapter 1
VetBooks.ir

Olecranon foaa

Anconeal process

Triceps brachii
ka n b n
Olecranon tuber

heoneus muscle

Upper image: the incision extends from the supracondylar region of the humerus distal t o the olecranon tuber.
anconeus muscle is delimited and its insertion cut from the ulna (dotted line). Lateral view.
Lower image: the anconeus muscle is retracted cranially and the triceps brachii tendon as well as the olecranon tu
exposed.The olecranon tuber is transected at a 45" angle (dotted line). tricep
CAUTION: the insertion of the triceps brachii tendon remains with the transected part of the olecranon.Also, du Lower imq
osteotomy, preserve the ulnar nerve on the medial surface of the elbow joint. Aexion of
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Triceps brachii
Anconeus muscle - tendon

Olceranon tuber

lateral
Hedial
epicondyle
/
nerve

Medial

Oleuanon tuber
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 Chapter 1
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Hedial epicondyle of humerus

Ulnar nerve
a Prohator terer
musde

Antebrachial lastia

'
I -
Superficial digital flexor muscle
d
Y

IUpper image: a curved incision over the medial epicondyle extends from the distal third of the humerus cG
proximal third of the forearm. Medial view, left limb.
CAUTION: protect the ulnar nerve.
I Lower image: the antebrachial fascia and the course of the ulnar nerve are shown.The fascia should be incis
expose the flexor muscles of the antebrachium (dotted line).
VetBooks.ir

Triceps brachii muscle

Ulnar nerve

Hedial epicondyle

Sqerlicial digital
flexor musde

>
Flexor carpi Pronator tepes musde
radialis mush

Pronator teres
musde
Flexor cami radialis

Iuperficial digital
kxor musde

Muscular branch
median nrve

or carpi radialis muscle is retracted cranially and the superficial digital flexor muscle together with
the deep digital flexor muscle are retracted caudally, to view the joint capsule.
the median nerve while ligating or cauterizing the numerous blood vessels of the region.
VetBooks.ir

Huscular branch
median nerve

-
Brachialis and biceps brachii
tendons

Superficial digital
3/ radiaiis mude
flexor musde
Medial collateral ligament
/
Trochka ol humeral
condyle

Medial corenoid
process
-
Muscular branch
median nerve Q\, x

Internal rotation
Brachialis and biceps brachii and abduction
musde tendons
VetBooks.ir

'I reduction and fixation of fractures affecting the trochlear incisure

le ulna.
n reduction and fixation of Monteggia fractures.
_.-lotomy to lengthen or shorten the ulna.
 t
Chapter 1
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Triceps brachii
tendon
I

Extensor carpi 3
ulnaris musde

Wexor 'carpi ulnaris musde

Extensor carpi Lateral epicondyle

ulnaris musde of humerus

--Q!MF I_I,~
Ulnar nerve Body of ulna ulnaris carpi
Flexor musde
I
Upper image: the skin is incised over the caudal limit of the ulna, from the olecran tuber t o the mid-third oif the
antebrachium. The deep antebrachial fascia is opened and the anconeus, flexor carpi ulnaris and extensor
ulnaris muscles are identified.These muscles should be freed from the proximal ulna (dotted line).
Lower image: the flexor carpi ulnaris muscle is retracted caudally, the extensor carpi ulnaris muscle cranially a
anconeus muscle proximally.Thus, the trochlear notch of the olecranon and the body of the ulna are expo
CAUTION: protect the ulnar nerve while displacing cranially the flexor carpi ulnaris muscle.

- - -
VetBooks.ir

ach to the olecranon

bction and fixation of fractures ofthe olecranon tuberosity.

and fixation of froctures of the anconeal process.
W-fixation of an ununited anconeal process.
 Chapter 1
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Triceps braaii
Extensor carpi
radialis muscle -- 'tendon

- Olecranon tuber

Upper image: the skin is incised from proximal to distal over the oiecranon fossa. Later iew, lefc limb. I
H Lower image: the lateral fascia of the elbow is opened and the caudal attachment of the anconeus muscl
freed from the olecranon.
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k Triceps brachii
tendon

" Olecranon tuber

lAnconeus musde

-
: Retr transected anconeus muscle cranially, will expose the tendon of the triceps brachii muscles and
the c ~ e and
r foss;a. Lateral view.
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Lateral digital extensol

muscle (tendon)

Body of ulna
\ lateral digital
extensor muscle ,
(tendon)
- ulnaris
txtensor carpi
musde
Body ol ulna
5 loid process
7
o ulna (tendon)

Styloid process
of ulna
'ulnaris
Extensor carpi
musde
(tendon)

B upper image; Lne sKln rrlcrslorl projecrs rrom m e m a a l e rnlra or rrte lareral rorearrn KO rne palpawe wnar
process. Lateral view, left limb.
Lower image: t o expose the distal third of the body of the ulna and the styloid process, the antebrachial
incised and the tendons of the extensor carpi ulnaris and lateral digital extensor muscles are separated.
inset: view of the lateral muscles of the left forearm and manus.
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Extensor carpi
radialii musde

Common digital
extensor musde

Lateral digital
extensor musde

Upper image: the skin incision starts proximally to the lateral epicondyle of the humerus and continues dl
through the proximal third of the antebrachium. Lateral view.
- Lower image: the deep fascia of the forearm is opened and the approach to the radius continues between the e
carpi radialis and the common digital extensor muscles (dotted line).
VetBooks.ir

Extensor carpi
radialis muscle

I Supinatoi muscle

- Body of radius
r

fxtemor carpi
ndiakb muscle \.

YOxtensor carpi radialis muscle is retracted cranially and the common digital extensor caudallyThe
ctremity and the supinator muscle are exposed. If a greater exposure is required, the supinator
the radius (dotted line). Lateral view.
pinator muscle has been freed and retracted caudally.
ue the radial nerve between the su~inatorand the radius.

- -
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Extensor carpi
Common digital ulnaris musde
extensor muscle --m
Abductor oollids I

Extensor carpi
radialis msdc
hmmon digital
extensor musde

Body of radius . ar
ulnaris m u e

Abductor pollids
longus -

W Upper image: the skin incision projects distolaterally from the lateral epicondyle o f the humerus t o the carpus.The
fascia of the forearm is incised and the extensor carpi radialis and common digital extensor muscles are separated
(dotted line). Lateral view.
Lower image: the extensor carpi radialis muscle is retracted cranially and the common digital extensor caudallyThis
exposes the body o f the radius and the long abductor muscle o f the digit I. If more exposure is required, the long
abductor muscle may be displaced, o r even sectioned (dotted line).
VetBooks.ir

Common digital
uttensor musde

Body of radius - - ulnaris

Extern' mu3a'e

A -
h-, ,-

I
Radial nerve

Extensor carpi
radialis musde
7 I Common digital
eKtensor musde

- Extensor carpi
ulnaris musde
Body of radius -

Abductor pollicis
longus musde

,,,$vrirnage: the abductor pollicis longus muscle has been sectioned and displaced cranially.This allows a complete
view of the distal portion of the radius. Lateral view.
.I
Lower image: after freeing the supinator muscle, this approach can be extended proximally towards the head of the
radius for complete exposure o f the radius.
VetBooks.ir

I.:
Indications:
Open reduction and fixation of fractures of the radius.
Corrective osteotomy of the radius with growth disorders or
pseudoarthrosis.
 Chapter 1
VetBooks.ir

Ulnar nerve
Brachial artery and
vein, median nerve
Biceps brachii
tendon

Pronator teres +

musde

Superficial digital
flexor musde

Flexor cami
radialis h s d e

Cephalic vein -

Legends
I- Pronator tens musde
2- Extensor carpi radialis musde
3- Biceps brachii m d e
4- &ahid artery and vein
5- fledian nerve
' 6- Ulnar nerve
7- Cephalic vein
8- flexor carpi radialis musde
9- Supetfiaal digital flexor musde

Upper image: the skin incision of the craniomedial antebrachium extends over the elbow t o the styloid process o
the radius.The antebrachial fascia is incised and the extensor carpi radialis and the pronator teres muscles are iden-
tified t o prepare for separation (dotted line) of these muscles.The insertion of the pronator teres muscles to the
radius will be freed. Medial view, left forearm.
Lower image: the extensor carpi radialis is retracted cranially and the pronator teres (sectioned) caudally t o expose
the proximal third of the radius.
CAUTION: preserve the brachial vessels and the median nerve which are covered by the pronator teres muscle.ln
the distal radius preserve the cephalic and accesory cephalic veins.
VetBooks.ir

Legends
1- Pronator teres muxle
2- Extensor arpi radiali muscle
3- Flucor carpi radialis musde
4- Biup bnchii musde
I-Bnchil arterl and vein
6- Median nerve
7- Ulnar nerve
B- Cephalic vein
9- Supinator muscle
 VetBooks.ir

joint
 I

Chapter 1
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: Abductor pollicis
longus tendon
\

A~essor), cephalic win

Extensor carpi raEis '

tendons

M Lower image: identify the tendons of the abductor pollicis longus, extensor carpi radialis, common digital extensor
lateral digital extensor muscles which lie in the subcutaneous tissue.The superficial carpal fascia and vessels of the
sum of the carpus will be retracted medially by incising the superficial fascia (dotted line).
CAUTION: preserve the accessory cephalic vein.
 Dog - Thoracic limb
VetBooks.ir

I
Abductor pdlicis
longus tendon

6, = digital extensor

t,
Lated digital extensor
/ tendon
!="'
halic vein Radius
I

Abductor pollicis longus

and extensor carpi
radialis musde tendons

joint
'
capsule

Accessory
cephalic vein
- IProximal
' articular surfKe
of the inermediaradial I

' Common digital extensor

tendon

the accessory cephalic vein and fascia have been retracted medially, the joint capsule is exposed
d line) between the extensor carpi radialis and common digital extensor muscle tendons.
r fbe joint capsule has been opened, the abductor pollicis longus and extensor carpi radialis muscle
medially, the common digital extensor muscle tendon is reflected laterally, and the antebrachial
flexed to view the articular surface of the carpal bones.
VetBooks.ir
VetBooks.ir

Carpal pad

Flexor ntinaculum -

Cephalic vein

n flexor retinaculum (dotted line) and double ligate and transect the cephalic vein.
CAUTION: pay attention to the course of the cephalic vein. I
VetBooks.ir

Deep digid Rexor

IRndon

k
1
joint capsule

Hewarpal bone I
Hedian mty
and nerve 1
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VetBooks.ir
 Chapter 1
VetBooks.ir

lateral digital extensor

tendon 1

Metacarpal bone V -

Common digital extensor

tendons
-

Dorsal common digital

arteries and veins

Upper image: the metacarpal bones are approached using two longitudinal skin incisions over the metacarpal bon
II and V.These incisions are interconnected at their midpoint (dotted lines). Dorsal view, right manus.
1 Lower image: in the subcutis, the deep fascia has been incised t o expose the vessels which overlie the tendons of the corn-
mon and lateral digital extensor muscles.
CAUTION: preserve the vessels and tendons.
 Dog - Thoracic limb
VetBooks.ir

fletacarpal bone V .
\ H Metacarpal bone II

Common digital extensor

tend0~

lateral digital extensor 1

tendons

bones the vessels are retracted mediallv to exDose the tendons of the common and lateral digital flexor

e com-
!aterally (right image).
preserve the vessels and tendons.
VetBooks.ir
 Hetacarpophalangeal
VetBooks.ir

joint
Proximal interphlkngeal
joint
joint

/
Proximal phalanx

Proximal interphaslngeal
joint

Extensor branch of
intemsscous tendon

lateral a d ~ r n r n o ndigid
extensor tendons

1 UDber
,r
imaee: the skin incision passes distally from the corresponding metacarpal bone over the dorsal aspect or I
the digit :t the distal phalanx (botted line). Dorsolateral view, right digit IV.
Lower image: in the subcutis, the deep fascia is sectioned t o expose the digital extensor muscle tendons.To expo-
se the metacarpophalangeal joint, the joint capsule and the extensor branch of the interosseous muscle are tran-
sectioned (dotted line).
CAUTION: preserve the vessels and digital tendons.
VetBooks.ir

Metacarpophalangeal
joint

Head of metacarpal
/
bone V
I

Common and lateral digital

A extensor tendons

4' Proximal interphalanged

joint

~ a s eof proximal /
phalanx

SuperfKTal digital flexor /

tendon

Middle phalanx
of digit 4
Dorral ligaments
VetBooks.ir

Cat
Thoracic limb
 7

Chapter 2
VetBooks.ir

Oleaanon tuber

Head of radius -

.- Styloid
. process
. of ulna
Metacarpal bones
Accessory carpal bone

Proximal sesamoid bones

jer image.
~ i d d l eimage
W Lower image:
 c
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Suprahamate process

6-
Head of humerus

Trochlear notch 4 F- Medial epicondyle

Styloid process of radius

lntemedioradial carpal bone

Metacarpal bones /
VetBooks.ir

Suprapinatus musde
\- Infraspinatus muscle

- Tens major muscle

Deltoideus musde
(armmial part) \ u-. Deltoideus musde
(spinous part)

Major tuberde / '

Lateral head triceps

brachii musde

Bmchialis musde

Radial nerve
Biceps brathii mwdc

I Lateral muscles of the left shoulder and arm.

VetBooks.ir

Subscapularis musde
4 - Subscapular nerve

Teres major musde

Suprascapular artery,
vein and nerve

Husculocutamus nerve

b Brachial artery and vein

I-"
F-
Radial nerve

Biceps bnchii musde

\ BdiJ h a d triceos
brachii musde
VetBooks.ir

Supraspinatus musde
b- Infraspinatus musde

Teres major musde

Deltoideus musde F - = Deltoideus musde

(acromial part) (spinous part)

Lateral head triceps

2' -
Major tuberde
K
brachii musde

Brachialis musde Radial nerve

I-2Anconeus muscle
Extensor carpi / 1 lateral digital
radialis muscle
extensor musde
Common digital extensor musde hExtensor carpi
ulnaris musde
VetBooks.ir

Supraspinatus musde
4 Inhpinatus rnwde

Tepes major musde

b--
Caudal circumflex
Hajor tubercle *""I mry
--I
Brachidis musde 4 Accessory head triceps
Biceps bmhii musde brachii musde

Radial nerve
Extensor carpi
radialis musde
7 ' Anconeus muscle
Common digid extensor musde --
Lated digital extensor musde

Extensor carpi ulnaris musde

Flexor carpi ulnaris muscle

VetBooks.ir

Subscapularis musde Subscapular nerve

' .

Suprascapular artery, vein

-P
Teres major musde
and nerve

Median nerve ,- tlusculoataneous nerve

Tensor facia ' Brachial artery and vein

antebrachii musde
Radial nerve
Ulnar nerve
Biceps bradrii musde

Flexor carpi ulnaris +

\ Medial head triceps
musde (ulnar head) brachii muscle

Pronatar teres musde

Flexor carpi radialis musde

Flexor qi uinaris musde
(humeral head)

-
Yedial muscles of the left thoracic limb.
VetBooks.ir
VetBooks.ir

I Omotransversarius muscle

Cephalic vein

Tendon d
Brachiocephalicus mus

Cephalic vein '

Lateral view, left shoulder.

Lower image: the dorsal border of the brachiocephalicus (dotted line) must be freed and retracted cranially to I
the acromial part of the deltoideus muscle.
CAUTION: preserve the cephalic and axillobrachial veins.
 --

Cat - Thoracic limb

1
VetBooks.ir

Omotransvenarius musde
-4
C Acromial part of
deltoideus musde

hitlobrachial win

Cephalic vein
Brachiocephaliws musde /

Tendon of infraspinatus
musde
- Acromial part of
ddtoideus musde

,
lateral head of triceps
brachii musde

which will be transected (dotted line).

N: preserve the cephalic and axillobrachial veins.
 -

Chapter 2
VetBooks.ir

1 Tendon of
infraspinatus
muscle

Joint capsule

Acromial part of 0
deltoideus musde

Head of humerus
-1

Acromial part of 0 Teres minor

deltoideus musde muscle

IUpper image: t o expose the joint capsule, the transected infraspinatus tendon reflected
acromial part of the deltoideus muscle is retracted cranially. Lateral view.
Lower image: The joint capsule is cut to examine the articular surface and the teres minor muscle is r e v l a
tally for greater exposure. In addition, internal rotation of the humerus allows better examination of the J
head.
CAUTION: protect the cephalic and the axillobrachial veins.
VetBooks.ir
VetBooks.ir

Lateral head triceps

Brachiocephalicus muscle Brachialis musde brachii musde

Radial nerve ."-

VetBooks.ir

Brachialis musde Radial nerve Lateral head triceps

1 brachi musde

Extensor carpi
radialis rnusde

Superficial pectoral Brachialis muscle

muscle \ 1

Biceps brachii
musde

x image: cranial retraction of the brachiocephalicus muscle provides greater exposure of the brachialis mus-
steal view.
the brachi*, rhage: the distal one third of the humerus is exposed by caudal retraction of the brachialis muscle and the radial
a. Cutting the insertion of the superficial pectoral muscle (dotted line) provides greater exposure of the distal

protect the radial nerve.

VetBooks.ir

Lateral head triceps

Body of the humerus Brachialis musde brachii musde
\ \

Radial nerve

. Extensor carpi
radialis muscle
Biceps brachii
muscle

Radial nerve Body of the humerus

Brachiahillis
musde h

' 7
Biceps brachii
musde
 VetBooks.ir

the
VetBooks.ir

Brachial artery
kand vein
Ulnar nerve

Y
.r Median nerve

IUpper image: the skin incision extends from the distal third of the humerus to the proximal third of tti
passing over the medial humeral epicondyle. Medial view, left elbow.
Lower image: the skin has been displaced t o demonstrate the medial head of the triceps brachii musc
course of the ulnar nerve over the medial epicondyle.The deep brachial fascia will be cut cranial to the u
(dotted line) and retracted cranially.
CAUTION: protect the ulnar nerve.
 Cat - Thoracic limb
VetBooks.ir

Ulnar nerve Brachial artery and vein

I

Biceps brachii muscle

I
. Median nerve

I
Biceps brachii
rnusde

racondylar brachial fascia, exposes the biceps brachii muscle and the brachial neuro-

n of the biceps brachii muscle, brachial vessels and the median nerve provides great-
1 diaphysis.As well, the triceps brachii muscle and ulnar nerve may be retracted caudally.
head of the triceps brachii muscle (dotted line) may be transected and the muscle also

atwry and median nerve pass through the supracondylar foramen.

 Chapter 2
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Medial head triceps

brachii musde
\

Supracondylar foramen
?' -
olec
Nediin nerve

Brachial artery

Superficial pectoral musde

Triceps brachii
muscle

"4
Ulnar nerve-

I pper image: after the medial head of the triceps brachii muscle has been freed, the supracondylar region
supracondylar foramen and associated structures can be viewed.
Lower image: transecting the proximal attachment of the superficial pectoral muscle, yields greater exp
including the proximal third of the humerus. In addition, the biceps brachii muscle, brachial vessels and the rr.
nerve may be retracted caudally t o enhance this view.
CAUTION: protect the vessels and nerves.
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VetBooks.ir

Lower image: the fascia is dissected to identify and prepare the cranial margin of the triceps brachii musc
for a lateral approach (dotted line).
 -
Cat - Thoracic limb
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Triceps brachii
musde tendon

I!- Olecranon tuber

I' Anconeus musde

Antebrachial Rexor

Triceps brachii
musde tendon

muscle are delimited in preparation for reflection of the tri-

~IILUII~US
I C ~ P SI T I U S C I ~ ~ ~ I I U U~I I I U

the olecranon tuber. Lateral view.

mb is abducted to delimit the triceps brachii tendon from the medial aspect. Medial view.
t the ulnar nerve over the medial aspect of the elbow.
 m
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Chapter 2

Olecranon

Triceps brachii
muscle tendon

Olecranon fossa

lateral epicondyle
,
- I
6
m Triceps brachii
mwde tendon

Unar nerve
4
' -L Medial epicondyle

Anconeal process
/

Upper image: the short portion of the medial head of the triceps brachii muscle is separated t o a l l 0 4
isolation of the tendon and exposure of the olecranon tuber.The osteotomy will be made at a 45" an
the long axis of the ulna. Medial view.
Lower image: the intraarticular structures can be seen after the olecranon tuber is transected and reflected p
Caudodorsal view, left elbow.
CAUTION: keep the triceps brachii tendon attached to the olecranon tuber.
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 Chapter 2
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Extensor carpi
adialis musde \ A
- Common digital
extensor musde

flz extensordigital
musde

1 Upper image: the skin incision over the lateral forearm extends from the lateral humeral epicondyle to
pus. Lateral view, left forearm.
ILower image: the antebrachial fascia is opened to expose the extensor carpi radialis and common digital 6
muscles in preparation to separate them (dotted line).
 Cat - Thoracic limb
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Common digital
Extensor carpi extensor musde
radialis musde
\
Body of radius

digital extensor musde

musde

C Common digital
extensor musde

Extensor carpi
radialis musde - A

Supinator musde

6 Body of radir

Long abductor musde

of digit I

ody and the long abductor muscle of digit 1 are exposed by retraction of the extensor carpi radialis
e common digital extensor muscle caudally. For greater exposure of the distal third of the radius, the
) of the long abductor muscle of digit I to the radius may be incised and reflected. Lateral view.
tion and caudal retraction of the long abductor muscle of digit I, the distal radius is exposed.
ded proximally by separation of the supinator muscle (dotted lines) yielding complete access
 Chapter 2
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Common digital

Extensor carpi ' t extensor musde

Abductor pollicis
lonps murde \A
I- Body of radius

T h e distal radius may be approached by extending the skin incision distally to the carpus. Cranial view.

-
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 Chapter 2
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Uhar nerve -!I

Flexor carpi
G Pronator teres
musde

Extensor carpi
/ radialis muscle
radialis musde

I Upper image: the skin incision on the craniomedial forearm, extends distally from the
process. Medial view, left forearm.
Lower image: the antebrachial fascia is divided and the junction of the extensor carpi
muscles is located (dotted line) in preparation for separation.
CAUTION: preserve the cephalic and accessory cephalic veins.
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Pronator term muscle

I

Extensor carpi

d body are exposed by reflecting the extensor carpi radialis muscle cranially and the pronator
r carpi radialis muscles caudally. Medial view.
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Pelvic limb
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e pelvis and hip (coxal) joint

Anatomical considerations
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Chapter 2
r
-

Patella .

L Fibula 1
Tibia -

----\ Bones d the ps

I
Sartoriu
Sacrum
d tuberosity
S
a / Caudal verttbnc

Intc
obli

Extern
obliqur
,
Body of ilium

Upper image: skeleton of pelvic limb. Left view. Jpper imc

Lower image: close up of skeleton of the pelvis and hip joint. .ower ima
See videos 6 and 7,3D reconstruction of hip joint.
1
7 Dog - Pelvic limh
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Tensor fasciae latae musde

External abdominal
oblique musde

Reaus sheath
4
Crud fascia 1

Tensor fasciae
Iatae muscle Gluteal fascia cwering
middle gluteal murde

,
Superficial gluteal musde
Internal abdominal
oblique muscle
 Chapter 2
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r
I I

Sartoriu:
cranial ,

Legends
I-Ilium: gluteal surface
2- Sartorius musde: cranial art
3- Tensor fwiae latae mus ed
4- Hajor mchanter of femur
5- Quadriceps femoris musde: vastus lateralis

I a
b External abdominal obli ue musde
7- Quadricepi fembris mus e: rectus femoris
8- Piriformis muscle
f
9- Deep uteal musde
10- Gemel us muscle
I I - Quadratus femoris
12- Adductor muscle

I
13- Semimembranosus muscle cranial)
14- Semimembranosus muscle caudal)
IS- Semitendinosus muscle
16- Cranial gluteal artery. vein and nerve
17- Caudal gluteal artery and vein
18- Sacrotuberous ligament
19- Sciatic nerve
20- lschiatic tuberosity
2 1- Internal obturator muscle

per dis
1s femc
le scia
ral vie
 Dog - Pelvic limb
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Gluteal surface of ilium

Saontubemus ligament

\{ Gemelli murdu

,lschiatic tuberosity

'\
Sartorius muscle:
cranial part
Internal abtuntor
Deep gluteal musde muscle tendon
h\
Ha@ trorhanter of femur
Redus femoris musde
I

L
/-

Vastus lateralis musde

I
:les have been I showing the deep muscles of the hipI joint. In additon to the superficial and m
; ligament, cau- cles, the adductor, semimembranosus and semitendinosus muscles have been re
rve and caudal gluteal vessels provide a clear view of the gemelli and internal obtu
 r_ Chapter 2
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Gluteal surface of ilium ,,

Legenc
I- Extet
2- Inter,
3- Sarto
4- Glute
glutei
5- Tenso
Body of kmur (latenl surface) , 6- fasci:
7- Super
8- Vastu!
Bicep:
Quadl
Lateral su~racondrlartuberosity . . Adduc
12- Semin
13- Sernirr
Fossa m. poplitei Popliteal surface 14- Semitf

Extensor h a +
"a Gastrocnemius musde
sesamoid bones
IS- Cauda
16- Crural
17- Gastro
18- Sciatic
19- Tibial
20- Comm~
2 1- Distal
22- Lateral
23- Superfi

IClose up of the bones of the thigh and stifle. Lateral view, left limb.
I The course
Structures
node. Later
 Dog - Pelvic limb
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VetBooks.ir

Leger
I-Sac
2- Ext
3- Pso
4- lliol
5- Sew
6- Bici
7- Vasl
8- Recl
9- Sart
10- Tens
II- Abdl
12- Exte
13- Intel
14- Med
IS- Cauc
16- Intel
17- Obtb
18- Deer
19- Late1
20- Femc
2 1- Proxi
22- Saph
23- Sc~a
24- Medi;
Legends 25- D e w
26- Saphc
I- Levator mi muxle 27- Distal
2- Qcraaudalis musde 28- Poplil
3- Wing of ilium
4- Pelvic symphysis. .
5- Sdatic nerve
b Obarrator nerve
7- Psaas minor musde and iliac fascia
8- h b a r arteries
9- Wdian Ilaal artery Distributior
la-Qludzl g k a l artery been remo\
I I- Cmhl ghiteal artery
12- lnttmal pudaRdal artery the left limt
13- External iliac artery
14- Deep femoral amq
15- RaEtur abdominis muscle
16- Feraord artery
17- Internal iliac artcry
18- Saphenour artery
19- Adductor musde
20- Gmilis mwda
21- Semiinaw n m d e
22- Vastus medialis d e
23- Deseknding gcnicular artery
24- Pcetmi s muscle
-

C - - -- - - - -

IMedial muscles o f left pelvic limb.The right os coxae has been removed except for the right wing of the
facilitate the study o f the medial superficial and deep musculature.The arteries are injected with red la
branches of the internal and external iliac arteries are indicated. Medial view of left thigh and pelvic wall.
VetBooks.ir

Legends
I-Sauocaudalis muscle
2- E~ternalobturator muscle
3- Psoas minor musde
4- Iliopas musde
5- Semitendinosus musde
b Biceps femoris muxle
7- Vastus medialis musde
8- Rear fernoris musde
9- Sartorius musd~:cranial art
4'
IO-Tensor Fasciae latae mus e
II-Abdominal aorta
12- External iliac artery
13- Internal iliac artery
14- Median s a d artery
IS- Caudal gluteal artery
16- Internal pudendal artery
17- Obtuntor nerve
18- Deep femoral arte
7
19- La& circumtlex emoral artery
20- Femoral arte
7
21- Proximal c a ~zl femoral artery
22- Saphenous nerve
23- hatic nerve
24- lidi.11circumflex femoral artery
25- Descending geniculu artery
26 Saphenous artery
27- Distal caudal h r a l artery
28- Popliteal artery
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 I

Chapter 2
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fliddle gluteal muxle

Sartorius musde:
cranial part

Tensor fasciae
la& muscle

IUpper image: the skin incision extends from the iliac crest t o the major trochanter. Lateral view, left limb Upper imagf
Lower image: the gluteal fascia is incised, and the middle gluteal muscle has t o be separated from the tens fasciae latae
lame muscle (dotted line). view, left lirr
CAUTION: t
lame muscle.
7 Lower image:
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Deep gluteal musde

/

4udu branches of
avlY gluteal nerves
+
Middle gluteal m d e

Wing of ilium

Cranial giukzl artery,

vtin and nem

Tensor fasciae
latat musde
4
rnnial gluteal neurovascular bundle passes between the deep gluteal muscle and the tensor fasciae

&ing of the ilium is exposed after elevation and retraction of the middle gluteal muscle dorsally.
VetBooks.ir

Middle gluteal musde

Wing of ilium

1
llims muscle

Tenser .fasciae
latae musde 4
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d o n and fixation of sacroiliac luxations.

e wing
s mus-
acroili-
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liddle gluteal muscle

4
Wing of ilium , /
cranial gluteal nerve

lliacus musde ,

- Deep gluteal
-
musde
Tensor fasciae
latae muscle

t4iddL gluteal m u l e

Wing of ilium
\

lliacus musde J'

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VetBooks.ir

Major trochanter
/

Tensor Iarciae
iatae muscle
-- tliddle gluteal musde
Superficial gluteal musde

Ten
lata

I Upper image: begin the skin incision (dashed line) over the major trochanter and extend it toward the ilia
and to the middle one third of the femur. Lateral view, left limb.
J Lower Image: after opening the gluteal fascia, the middle gluteal and tensor fasciae lame muscles are identifi
VetBooks.ir

Cranial gluteal nr Middle gluteal Deep gluteal muscle

I

\
Vastus lateralis muscle

close up of previous image.The approach t o the cranial aspect of the hip joint is between the middle
r fasciae latae muscles (dotted line). Lateral view, left limb.
retracting the middle gluteal muscle dorsally and the tensor fasciae lame muscle ventrally, the
e hip joint is found (dotted line) between the deep gluteal, rectus femoris and the vastus lateralis

reserve cranial gluteal nerve innervation t o the tensor fasciae latae muscle.
VetBooks.ir

Lateral circumflex Deep gluteal

femoral artery r muscle
branch \

Rectus kmoris musde

- joint capsule

Articularis coxae Vastus lateralis musde

musde

Middfe gluteal musde

Lateral circumflex
femoral artery
branch

\
Tendon of deep
- gluteal mush

\
Head of femur
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and caudodorsal regions of the

hip joint with osteotomy of the
major trochanter
..-

leep
de

rribed and
llaris c o w
 Chapter 2
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Middle gluteal musde

Superiicial gluteal musde

Vastus laterall$ muscle

Middle gluteal musde

I Superiicial gluteal m d e

Sauotuberosus ligament

Caudal gluteal
/ wry i d vein
Tensor fasciae :
labe musde
\'* Sciatic

I(

t -
Biceps

Upper image: a vertical incision extends distally from the iliac crest over the major trochanter t o the
Open the gluteal fascia and demarcate the division between the superficial gluteal and biceps femoris mus
ted line). Lateral view, left limb.
Lower image: retract the biceps femoris muscle caudally t o visualize the tendon of the superficial glu
passing over the major trochanter t o insert on the third trochanter. Divide the tendon (dotted line) t o e
major trochanter.
CAUT1C))rl: preserve the ischiatic nerve and caudal gluteal vessels.
 Middle gluteal muscle
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\
uperficial gluteal musde
I
Iauotuberous ligament
I

le

1 .

1
,;Caudal gluteal nerve Superftdal gluteal muscle

Widdk gluteal muscle

Samtubemus
ligament

Caudal gluteal
artery and vein

is musde

/ \
Major mhanter Gemellus musde Sciatic nerve

r trochanteric osteotomy, at the base o f the trochanter (dotted line), is performed at a 45" from the axis of
mur in a dorsomedial direction. Laterocaudal view, left.
image: close up o f upper image. Observe the course o f the caudal gluteal nerve t o the superficial gluteal
.Note the relationship o f the sciatic nerve t o the caudal gluteal vessels and the sacrotuberous ligament and
IIgroup o f muscles inserting into the trochanteric fossa
VetBooks.ir

- Chapter 2

Middle gluteal muscle

%perfiaJgluteal musde

Major trochanter Caudal gluteal

artery and win

Tensor fircae rec

Vastus lateralis
musde

Wing of ilium
\

Tensor fasciae
latae musde

Vastus lateralis
muscle
-
\
Trochanter~c forsa Internal obturator muscle tendon

IUpper image: the osteotomy is performed (dotted line) and the muscles (middle and deep gluteal and pl
wich insert onto the major trochanter will be displaced with the trochanter dorsally. Laterocaudal view.1
Lower image: the major trochanter and the middle and deep gluteal and piriformis muscles are displam
ly.The joint capsule has been transected t o expose the femoral head. Greater exposure of the articular
is obtained by external rotation of the femur.The sciatic nerve and caudal gluteal vessels lie caudal ku
of osteotomy.
CAUTION: during the osteotomy, envision the course of the sciatic nerve and the insertion of the gernell4.a
nal obturator muscles into the trochanteric fossa.
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, muscle

bgluteal
nd vein

c nerve
 Chapter 2
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fliddle gluteal musde

Vartus lateralis musde

Deep gluteal musde

Hiddle gluteal muscle I
VetBooks.ir

ment I

1
muscle

nerve,
gluteal
and vein

lemons
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C Caudal gluteal
artery and vein

Sciatic ntm I
Win

Tenso
latae
Tensor fasciae l a m e 4
musde

Vastus lateralis rnusde Biceps femoris mude

Wing of ilium

Wing of ili

-- Gluteal rnuril~r
rnusde
Tensor hsaae

1
I* musde

Iliis musde '

1

Rectus femoris musde

The origin of the middle and deep gluteal muscles will be elevated to expose the ilial wing. Lateral vie
Lower image: the origin of the gluteal muscles are retracted dorsally to expose the iliac wing.
 7
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,
Articuhriscoxae Gluteal rnusdes
Major trochanter

Fde 4
of femur

Wing of ilium
i
Tensor fasciae -Sciatic nerve
lalae mwde

I 1
Biceps fernoris muscle

Articubris coxae
Head of femur
&

Sauotuberous
ligament

t Caudal gluteal
artery and vein

I muscle I

Sciatic nerve
I

Tensor fasciae lahe 1danbrkfom Gemelli m u s h lnttrnal oburator

muscle tendon I
-
ed dorsally. 1 e major trochanter is displaced dorsally with the attached gluteal muscles, t o view the central por-

I
V, left limb. tabulum. Lateral view, left limb.
articularis coxae muscle and joint capsule are transected along the dorsal border of the acetabu-

I
aspect of the hip joint will be exposed after transection of the insertions (dotted line) of the gemel-
bturator muscles.
 Chapter 2
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Head of femur Gluteal murdes

Wing of ilium

Gemelli and iatrrar

obturator murder

Biceps femorir
mu&

H After tenotomy of the gemelli and internal obturator muscles and their dorsal reflecticIn, the
acetabulum and part of the body of the ischium are seen. Dorsolateral view, left limb.
CAUTION: preserve the tendon of the external obturator muscle.
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 rn
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- Chapter 2

I Upper image: the patient is placed in lateral recumbency with the contralateral limb in abduction.The line Jpper imc
In passes over the pectineus muscle. Medial view, left limb. :apsule.TI
I L v N image:
~ ~ after freeing the fascia, the femoral artery and vein, plus the pectineus and sartorious mus ~ o w e rimal
identified.To approach the ventral aspect of the hip, the origin of the pectineus from the pubis should border of
tioned (dotted line). head.
CAUTION: preserve the femoral vessels. CAUTION
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Femoral artery
and vein

Ventral border of
H d of femur
\
Pubis

mi 7:

!ry

~uscle Pectineus mu
sk
1 \ p m @and- vein
V

nerve

\
jeint cryburk
femoral artery

ON: attention t o the medial circumflex femoral artery.

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VetBooks.ir

Sperm;

Superficial inguinal
/ lymph nodes

Upper image: the dog is placed in dorsal recumbency with the legs abducted.A ventral midline incision is rn
through the skin. In the male, the penis is displaced laterally.Ventra1 view.
Lower image: the superficial inguinal lymph nodes are identified in the subcutaneous fascia and fat, along with
course of the spermatic cord on the gracilis muscle.

-
VetBooks.ir

Rectus abdominis
0 muscle

I/ Prepubic tendon

I is made Issection of the fat and displacing the penis, identify the common tendon of the right and left gracilis mus-
o the syrnphysis (dotted line) which will be incised to extend the approach deeper. Cranially identify the
bdorninis muscle inserting on the cranial border of the pubis.Ventral view.
VetBooks.ir

Superrficill inguinal
lymph nodes Peritoneum
/

Reau abdominis
musde I- Cranial border
of pubis

I
Spermatic cord
C Gracilis and
adductor musde

Obturator foramen A

lndicat
Open re
lschiatic

I
After bilateral incision of the symphyseal tendons of the gracilis and adductor muscles, retract the muscles to each side
t o expose the pelvic syphysis and the cranial and medial portions of the obturator foramen.To expose the parietal
peritoneum, free the rectus abdominis muscle from the cranial border of the pubis.Ventral view.
CAUTION: preserve the parietal peritoneum.
VetBooks.ir

nd
muscles

~dications:
pen reduction and fixation of ischiatic fractures.
:chiatic osteotomy in the TPO.
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Sauontberous ligament

Biceps femoris musde

IUpper image: the dog is placed in lateral recumbency.The skin incision is made parallel t o the sacrotuberous ligll b Upper imt

1
E
from the sacrum t o the ischiatic tuberosity. Dorsal view, left ischiatic region. nerve anc
1 Lower image: free the subcutaneous tissue overlying the sacrotuberous ligament. Identify the junction betwe Lower imc
superficial gluteal and biceps femoris muscles (dotted line) which permits access t o the body of the ischium. obturator
with the i
AUTtON
VetBooks.ir

Biceps lemoris musde

Sciatic nerve Biceps femoris muscle Gemelli musdes

\ / /

musdr

Caudal nluteal
artery

-
t" Supeficial
gluteal musde

biceps femoris and superficial gluteal muscles exposes the course o f the sciatic
, parallel t o the sacrotuberous ligament. Dorsal view.
nd caudal gluteal vessels are retracted caudally t o view the gemelli and internal
rator muscles passing over the minor ischiatic notch. Identify the junction of the internal obturator muscle
the ischiatic tuberosity which will be separated.

I erve and caudal gluteal vessels.

 Chapter 2
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Minor ischiatic notch ligament

Superficial gluteal
muscle
L (

- Internal
muscle
obturatw

I After the internal obturator muscle is freed from the ischiatic tuberosity, it is retracted cranially to expose the
of the ischium, obturator foramen and minor ischiatic notch. Dorsal view.
VetBooks.ir

luteal

lbturator
 Chapter 2
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Superficial
gluteal musde - Biceps 'femoris

I Tensor bciae
lam m w l e
,

Fascia lata /

mi-'--
fliddle gluteal muscle
, Superficial gluteal nurde

- Trodranter major

Tensor fasciae labe

musde

Vastus lateralis musde -J

Biceps fernoris muscle

pper image: the skin incision starts proximally to the major trochanter and extends distally t o mid-femur. A h
incision of the gluteal fascia, the tendon of the superficial gluteal muscle is identified and prepared for transet
tion (dotted line). Lateral view, left limb.
Lower image: after tenotomy, the superficial gluteal muscle is reflected dorsally; the tensor fasciae latae muscle i
freed caudally and reflected cranially; and the biceps femoris muscle is retracted caudally to expose the map
trochanter.The origin of the vastus lateralis muscle is ready for transection (dotted line).
VetBooks.ir

1 -
Vatus lateralis muscle
Subtrochanteric region

- Biceps kmoris muscle

UP (>f previous image after transection o f the vastus lateralis muscle.The subtrochanteric region is exposed
with the major trochanter and the insertion o f the middle gluteal muscle. Lateral view.
 VetBooks.ir

diaphysis
VetBooks.ir

- Biceps fmrk muscle

's- Body of femur

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I I
I I
I r-›
I I I
 7

Chapter 3
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Legends
I- Lateral femoral condyle
2- Hedial femoral condyle
3- Femoral trorhlea: medial ridge
4- Patella
5- Sesamoid bones gasnoolemius musde
6-Intercondylar fossa
7- Popliteal surface
8- Extensor fowi

14- Fibular head

15- Fibular body
16-Popliteal notch
17- Tibial tuberosity
I& Extensor groove of tibia
19- Latenl sesamoidean articulation
20- Hedial sesamoidean articulation
 Dog - Pelvic l i d
I
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ges: Menisci, meniscal and cruciate ligament details of the left stifle joint. Dorsal view.

:Osteology of the left tibia1 plateau. Dorsal view.

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Ypper image: details of the left stifle joint.The patella and patellar ligament have been luxated rnedially. Craniolau er imc
view,
Lower image: patella is displaced craniodistally to view the patellar articular cartilage and parapatellar fibrocartik er imc
Caudal view.
VetBooks.ir

boge: menisci, ligaments and tendons details of the left stifle. Medial and lateral views.

ge: menisci, ligaments and tendons details of the left stifle. Caudal view.

I
VetBooks.ir

Legends
I- Lateral femoral condyle
2- Patella
3- Lateral gastrocnemius muscle sesamoid
4- lateral tibia1 condyle
5- Fibular head
6- Fibular body
7- Tibial body
8- Lateral fibular malleolus
9- Calcaneus
10- Calcaneal tuber
I I- Trochlea of talus
12- Head of talus

I Detailed osteology of the left crus. Lateral view.

-
 Dog - Pelvic limb
VetBooks.ir

Legends
I- h i d tibial muscle
2- long digid extensor muscle
3- Peroneus fongus musde
4- Peroneus brevis muscle
5- Lslteral digital flexor muscle
6- Superficial digital flexor musde
7- Gastrocnemius musde: lateral head
8- Common cakaneal tendon
9- lateral saphenous vein
10- Superlidal popliteal lymph nodes
I I- Dhd caudal femoral win
12- Common pemneal nerve
13- fibid nerve
14- lnteroaeous musde
IS- Short digital extensor musde
 Chapter 3
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Legends
I- Wedial kmod condyle
2- Patella
3- Medial gastrocnemius musde sesvnokJ
4- Hedial tibia1 condyle
5- Tibial tuberosity
6- Fibular head
7- Fibular body
B Tibial body
9- Hedial tibia1 malleolus
10- Hedial malleolar groove
I I- Qlcaneus
12- Wcand tuber
13- Trochlea of talus
14- Head of talus
15- Central tarsal bone

E Detailed osteology o f the left crus. Medial view.

 Dog - Pelvic limb
,',I! ,
-
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rnedii
d e
don

Details of i-he muscles on the r-ned1,3!a:pi.cc nf the left leg.

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Legends
I- Calcaneur
2- Calcaneal tuber
3- Hedial tibid malleolus
4- Medial malleolar groove
5- Lateral fibular rnalleolur
6- Trochlea of talus
7- H a d of talus
8- 4th t ad bone
9- Central t ad bone
10- 3rd tarsal bone
I I- 2nd tarsal bone
12- 1st tarsal bone
13- Metatarsal bone I
14- Hebtarsal bone II
IS- Metatarsal bone Ill
16- Hetatarsal bone IV
17- Metatad bone V

IUpper images: osteological details of the left tarsus. Lateral and medial views. See videos I0 and I 1,3D reco Details
tion of the tarsal joint.
Lower image: detailed osteology of the left tarsus. Plantar view.
 Do2 - Pelvic limb
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m,,

F
Long medial collateral
-
Superficial digital
flexor muxk tendon

1
U'\ Long
Abductor muscle of
di"
plantar ligament
 Chapter 3
\
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fer

lndic
Diagn
Open
Medic
Cranic
Legends Exploi
I-Long digital extensor musde
2- h r a l extensor retinawlurn
3- Short di ital extensor mush
!
4- Medial lgital flexor muscle tendon
5- lateral d~gitalflexor rnusde tendon
6- Deep di ital flexor musde tendons of insertion
/ 1- hoximaf digital annular ligaments
8- lntmsseous m d e
9- Cut stum of superficial digital flexor musde tendon
!
10- Cranial t~ial musde tendon
II-Lateral digital extensor mude tendon
12- Ealcaneus
13- long plantar li ment
f'
14- Extensor bran es of interosseous musdes

Liganient and tendon detail o f the left pes.The superficial digital flexor muscle tendon has been transected a t the
czlcaneal tuber and removed. Dorsal and planter views.
I
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ications:
p x t i c arthrotomy of the stifle.
I
n reduction and fixation of supra-, inter- and condylar fractures.
lial or lateral patellar luxations.
-tid cruciate ligament repair.
bration and partial removal of the lateral meniscus.
 Chapter 3
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Femora

lnfrap
body

Patella

Quadtireps femotis
musde tendon \

Patellar fascia '

IUpper iml
patellar t c
rhis expc
lower ima
.igament ;
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7 joint capsule

Wkr l i i t

-1 t Long digital extensor

musde tendon

, q 7IF-
Long digital extensor
Femoral mchlea musde tendon
- I- /
I
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Sar
cau

Descending gcniadar artery

Sartorius musde,
caudal portion
- and vein

I
Patellar ligament

Upper image: the dog is placed in lateral recumbency with the contralateral limb abducted.The incision arcs
over the medial femoral epicondyle t o the proximal medial tibia. Medial view, left stifle.
Lower image: the medial patellar fascia is opened t o expose the insertion (dotted line) o f the caudal portiori:
sartorius muscle in preparation for transection.
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4 kmimembnnosus mud+
cranial portion 1

ligament

A- Popliten rnusde

C Semimembranosus muscle,
cranial portion

btmcnemius musde,
medial head
I/ joint capsule
Medial femoral condyle

Redid collateral ligament

I
Poplifeus musde

Image; ai-ter rreerng rne sartorrus muscle (cauaal portion), I[ IS rerracrea cauaarly t o laentlry rne arvlslon (aor-
e) between the two portions of the semimembranosus muscle. Medial view.
image: after separation of the semimembranosus, the stifle joint capsule is exposed and may be cut.
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Semimembranosus muscle,
cranial portion

Gastrocnemius musde,
medial head 4 4 Jolnt capsule

Medial meniicus

Gartrocnemius mude.
medial head
1

Medial meniscus

IUpper image: by retracting distally the caudal part of the semimembranosus muscle, the medial meniscus is
Medial view.
Lower image: close up of the indicated region of the upper image.The medial meniscus can be seen cranlal
caudally t o the medial collateral ligament.
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 Chapter 3 1
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Lateral

Biceps femoris musde

Gastrocn
muscle, I
Vastus lateralis muscle 4

Lateral
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Biceps femoris murde

- Common perontal nerve

lranial tibial musde A

. -

Biceps fernoris mush I

Popliteus musde tendon

Common peroned nerve

- Peroneus longus musde

Cranial tibia1 mu& /
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h e r d wlhttral ligament '

A
4- Lilted meniscus

- Popliteus musde
'Tendon of orij n of
the popliteus muscle

- Lateral ftmonl condyle

Joint capsule

lateral collateral ligament

Upper image: the popliteus muscle tendon is dis~laceddistallv for comolete exDosure of the lateral meniscus. Lateral
view.
1 Lower image: enlargement of the indicated region (dashed lines) of the previous image.
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ipproach to the proximal

iibia via a medial incision
I

n and fixation of proximal tibia1 fractures.

colfateral ligament repair.
technique to repair the cranial cruciate ligament.
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Gradlit muscle tendon -

.- '
Upper image: the dog is placed in lateral recumbency wlth the contralateral limb in abduction. I he incision arcs
tally over the medial femoral epicondyle to the proximal medial tibia. Medial view, left limb.
Lower imoge: the medial patellar fascia is opened and the insertion (dotted line) of the caudal portion of the sa
rius muscle will be transected.

I
dons of d
Lower imc
will be re
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krnirnembranosus musde,
m i d portion

Gradis mvsde tendon 1 \

H~~ collateral ligament

Popliteu musde

kmimembranosus murde,
cranial portion

6\ Popliteus musde

y expose the popliteus muscle insertion.The ten-

ilk and semit-. nos^_ ..iuscles will be transectec .. _ ... -1eir tibia1 attachment (dotted line). Medial view.
er cutting the tendons of insertion of the sartorius, gracilis and semitendinosus muscles, the muscles
ed caudallyThe attachment of the popliteus muscle t o the tibia (dotted line) is ready for separation.
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Gastrocnemius muscle.
medial head

Popliteus muscle -
Course of p o p l i artery
and vein

Sartorius musde,
caudal portion
- Patellar ligament

H Uppr image: after separation of the popliteus muscle from the tibia, the medial border and proximocau
of the tibia are exposed. Medial view, left stifle.
CAUTION: preserve the popliteal artery and vein.
H Lower image: from a cranial view, identify the lateral crural fascia and section it parallel t o the tibia1 tu
ted line).
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long di&d extv~r~or

Patellar l i n t mwde tendon

Tibial tuberosity

I
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+. Hedial saphenous arte

1
and vein, cranial branc es

\
Cr
ud fascia

CpPer image: the skin incision extends from the medial femoral epicondyle to the medial tibia1 malleolus. Medial 44
limb.
Lower image: in the subcutaneous tissue, identify the crural fascia and open it from proximal to distal (dotted'
CAUTION: preserve the medial saphenous vessels and the semitendinosus muscle tendon. 1
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Semitendinosus muscle
tendon

Popheus mwde

muscle &don 2

Sernitendinosus musdc
tendon

Hedial saphenous arte

71
and vein, cranial branc

\
Long digid Cranial ~ hmuscle
l I
extensor musde

age: open the crural fascia to expose the medial surface of the tibia.Along the caudomedial b o r d e x e
ntify the popliteus muscle and medial digital flexor muscle tendon. On the cranial tibial border (dotted line),
bial muscle should be freed t o facilitate the approach. Craniomedial view.
. retract the cranial tibial muscle t o view the cranial border of the tibia.
:preserve the medial saphenous vessels.
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Approach to the lateral

I malleolus and tarsocrural joint

hdications:
j ~ e nreduction and fixation of fractures of the lateral malleolus.
:r len
reduction and fixation of tibia1 supramalleolar fractures.
)pen reduction and fixation of lateral malleolar fmctures of the
~rsocruraljoint.
atera1 collateral ligament tears.
beochondritis of the lateral ridge of the trochlea of the talus.
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3
Chapter 3

Lat

Perone

Perc

Li

Peroneus longus musde tendon

Lateral digital extensor musde tendon

Peroneus brevii musde

Retinaadurn of /
the peroneal muscles

Peroneus longus musde tendon

Peroneus brevis musde tendon -.'

Lateral digital extensor muscle tendon /

m
Upper image: the arced incision extends from the distal crus, passes over the lateral malleolus and continues Jpper
distal tarsus. Lateral view, rigth limb. an arc
Lower image: in the subcutaneous tissue, identify the tendons of the peroneus longus, lateral digital extens of the
peroneus brevis muscles which traverse the lateral malleolar groove covered by the lateral extensor retina I Lower
Divide the retinaculum (dotted line) t o expose the lateral malleolus. CAUTI4
CAUTION: preserve the lateral saphenous vein branches.
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Pewneus longur musde tendon

Lateral digital extensor musde tendon

'., Lateral digital flexor
/ musde tendon

Peroneus brevis musde

1 Crunl extensor rttinaculum

Lateral saphenous vein,

mnial branch

--
\ Long digital extensor
musde tendon

Lateral rnltlleolus

Peroneus longus musde tendon Tanal extensor

-
-
retinacuturn
Peroneus brevis musde tendon

Lateral digital extensor musde tendon

Lateral digital flexor

Rroneus longus musde tendon muscle tendon
1
Lateral digital extensor
rnusde tendon
Peroneus brevis musde .-*, CTural extensor retinaculum

Lateral malleolar groove

q
joint capsule

lateral t r o d h r ridge /
- Tarsal exieisor retinaculum
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Approach to the medial

, malleolus and tarsocrural ioint

. IlJdiCatiOnS:

fixation of frcctures affecting the medial malleolus.

fixation of tibial supramalleolar tibial fractures.
of the tarsocrural joint for malleolar fractures.
ligament tears.
of the medial ridge of the trochlea of the talus.
 Chapter 3
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Medial collateral ligament

/--

joint capsule -
- . Hedial digital flexor
musde tendon

Cranial tibial
musde tendon

Upper image: the arced incision extends from the distal crus, passes over the medial malleolus and continues distal- I Uppel
ly t o the base o f metatarsal II. Medial view, right tarsus. I Lower
Lower image: in the subcutaneous tissue, identify the medial collateral ligament and the tendon o f the cranial tibial digital
muscle. Between this ligament and tendon, incise the joint capsule (dotted line).The medial malleolus is covered by
the medial collateral ligament.

I
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Medial ridr of
trochlea o talus Medial collateral ligament

Medial digital flexor

/ musde tendon

Medial r i d r of Citudal tibia1

trochlea o talus musde tendon

Hedial flexor
b-' muscle tendon

-Medial collateral ligament

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tledial ridge of Medial digital flexor

the trochlea muscle tendon

Cnnial tibial
muscle tendon

Caudal tibial
muscle tendon

Tibia

3
joint capsule

Cranial tibial
musde tendon

Lateral and medial

.
ridges ol trochlea
-
This approach is a continuation of the previous approach (page 228).
-
. Upper image: during a medial approach to the tarsocrural joint, the medial collateral ligament should be isola
retracting the tendons of the caudal tibial and medial digital flexor muscles caudally. Osteotomy (dotted line)
medial malleolus should be done proximal to the attachment of the medial collateral ligament Medial view, right
Lower image: the sectioned malleolus is displaced distally to expose the trochlea of the talus.
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Tibia
1

ridges of trochlea
Hedial collateral

joint capsule
4 ligament

I
1

Cranial tibia1
muscle tendon -

r irrruge; a uose up ur me previous image.The articular cartilage of the trochlea of the talus and the articular
e of the tibia are displayed. Medial view.
Image: Both ridges of the trochlea of the talus can be evaluated by forced internal rotation of the tarsus.
I
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Approach to the calcaneus

t
ndications:
pen reduction and fixation of calcaneal fractures.
vulsion of the gastrocnemius muscle insertion.
 Chapter 3
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Superficial digital flexor

muscle tendon

Lated saphenow '

vein, caudal bnnch

bastrocnemiu - -
musde tendon

Abductor musde of
digit 5

Upper image: the incision extends from the distal crus, passes over the lateral malleolus and continues distoplanta
t o the distal tarsus.The skin is displaced medially t o expose the calcaneal tuber. Lateral view, right tarsus.
Lower image: identify the superficial digital flexor muscle tendon as it passes over the plantar margin of the calcon
tuber.
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Indications:
Arthrodesis of the calcaneoquartal andlor tarsometatarsal joints
associated with long plantar ligament tears.
Open reduction and fixation of calcaneal fractures.
 I
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Superficial digital
flexor musde tendon b

Peronem longus
muscle tendon

Calaneus
Lateral plantar
nerve

Deep digital flexor

musde tendon

Superficial digital
flexor musde tendon

- Peroneur longus
musde tendon

Calcaneus

Lateral plantar
new

Deep digital flexor / '

m u t e tendon

Upper image: this is a continuation of the previous approach (page 236).The plantar fascia and flexor retinaculum
incised over the plantar aspect of the tarsus (dotted line). Lateral view, right tarsus.
Lower image: after cutting the flexor retinaculurn, the tendon of the deep digital flexor can be displaced t o allo
plantar approach t o the calcaneus and the distal row of tarsal bones.
CAUTION: preserve the plantar nerves.
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 Chapter 4
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Major rrochanter of femur -

Ischiatic tuber

Patella - ' Body of femur

Body of the tibia

fibula

L
ILateral view of the left pelvic limb skeleton.
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7Gasmnemius rnusde sesamoid bones

Trochlea of femur 4 Femoral condyle
=

Tibial tuberosity

Medial malleolus of tibia 4

L'
Tarsal bone 4
Talus +--

Central tarsal bone

Tarsal bone I

Metatarsal bone II /\
Proximal phalanx of digit Z
Middle phalanx of digit 2

Distal phalanx of digit 2 (ungal process)

Upper image: detailed lateral view of the bones of the left stifle.
Lower image: detailed dorsal view of the bones of the left pes.
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Middle gluteal musde

Sartorius muscle,
hi/ Giuteofemoral musde
cranial part

Tensor fasciae
latae musde

/
Fascia lata
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Hiddle gluteal musde

/ --
A Sciatic nerve

Major trochanter

Quadriceps femoris
musde: vastus lateralis

Semimembmsvs w s d e
Distal caudal femoral

+-
artery and vein
Superficial popliteal
lymph node

Gastrocnemius musde

k- Common calcaneal tendon

I
After removal of the biceps femoris and superficial gluteal muscles, the course of the sciatic nerve is exposed.The
vessels were injected with colored latex. Lateral view, left limb.
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Deep gluteal musde

Major wchan ter

- Adductor muscle
Quadriceps femoris
musde: vastus lateralis-7iA

Distal caudal femoral

artery qnd yein

Common pemneal nerve 4

Gastrocnemius musde
Tarsal flexor musdes A
Soleus musde

rt'
 Cat - Pelvic limb 245
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Semimembranosus muscle

Vastus medialis muscle

Distal caudal femoral

Wmemius musde

Cranial tibia1 musde

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Gastrocnemius musde

Superficial digital
flexor muscle

Tibial nerve -
Deep digital flexor
musde

Tendon of cranial
tibia1 musde
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Approach to the wing of

the ilium by lateral incision
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Middle gluteal muscle

Sartorius mush

-+
lame muscle

UPI
sor
iliac
Low
pat1
CAU'
 Cat - Pelvic limb

I
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Middle gluteal muscle

Wing of ilium

+
lliacus muscle

-C

lliacus muscle

~
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Craniodorsal and
caudodorsal approaches
to the hip joint by osteotomy
of the major trochanter
 Chapter 4
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Middle gluteal muscle

P
Gluteofemoral muscle
 Cat - Pelvic limb
VetBooks.ir

Middle gluteal muscle

\

--
r Superficial gluteal
muscle

Caudal gluteal artery

- and vein

Quadriceps kmoris
muscle
. Saatic nerve

' Major trochanter and

gluteal musdes

I Head d femur , Internal obturator

Sciatic nerve
i
I C
I

Upper image: after the superficial gluteal muscle tendon has been transected, the muscle is reflected dorsally.The
and osteotomy site of the major trochanter is located (dotted line) and the osteotomy is performed at a 45" angle
from the axis of the femoral diaphysis. Lateral view.
xed Lower image: after completing the osteotomy, the freed trochanter with the middle and deep gluteal and piriformis
muscles are reflected dorsally.The joint capsule will be cut to view the femoral head.To view the caudal portion of
the head, the insertions of the gemelli and internal obturator muscles need t o be transected (dotted line).
CAUTION: protect the sciatic nerve and caudal vessels passing caudal to the hip joint
 Chapter 4
VetBooks.ir

Major trochanter and

gluteal muscles

Internal obturator
- muscle tendon

C Sciatic nerve

.
. Trochanteric lossa

A f t e r tenotomy, the gemelli and internal obturator muscles are reflected to expose the caudal border of the ac
I
tabulum and the body of the ischiurn. Lateral view. I
CAUTION: do not cut the external obturator muscle tendon.
I
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Approach to the dyaphisis

of the femur
VetBooks.ir

- Major trochanter

r(

8'
0
CAI
be li
 Cat - Pelvic limb
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Adductor muscle

Biceps fernoris
muscle

W To view the cranial, lateral and caudal aspects of the femoral diaphysis, the vastus lateralis and biceps femoris muscles are
retracted cranially and caudally, respectively. The adductor muscle inserts on the caudal surface of the diaphysis. For
greater exposure, the incision and retraction can be extended proximally t o the major trochanter andlor distally t o the
condyle. Lateral view.
CAUTION: in the distal part of the incision, branches from the distal caudal femoral vessels can be found and should
be ligated.
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Approach to the stifle

joint by lateral incision
 Chapter 4
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Quadriceps femoris /
muscle tendon of
insertion

Long digitill extensor / -

muscle tendon

IUpper image: the skin incision extends from the distal one third of the femur, over the femoral lateral epicondyle,
to the proximal one third of the crus. Lateral view, left stifle.
Lower image: the lateral fascia is partially dissected t o identify the junction of the biceps femoris muscle and the quad-
riceps femoris muscle tendon (dotted line). Dividing and retracting this aponeurosis will expose the joint capsule.
 r%=C
Cat - Pelvic limb
I
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,
Trochlea of lemur

Quadriceps femoris muscle

tendon of insertion
Jtv joint capsule

'Caudal cruciate ligament

Patella and patellar

ligament lateral meniscus

\ Cranial cruciate ligament

\ Mapatellar fat

L Iody
VetBooks.ir

Approach to the diaphysis

of the tibia
 Chapter 4
VetBooks.ir

1 Upper image: to gain better exposure to the medial crus, the contralateral pelvic limb should be abducted. Medial
view, left crus.
Lower image: skin incision extends from medial femoral epicondyle to the medial tibia1 malleolus.
VetBooks.ir

Saphenous artery and

vein

bA
-
Medial digital
flexor musde \

'-. Medial aspect of

the tibia

Cranial tibial muscle

Medial digital flexor muscle

\ Semitendinorus muscle,
tendon of insertion

Cranial tibia1 musde

Upper image: the crural fascia is opened and the attachment of the cranial tibia1 muscle t o the cranial border of the
tibia is identified (dotted line). For greater exposure, the cranial tibial muscle can be freed from the cranial border
of the tibia. Medial view.
H Lower image: after freeing the muscle, the cranial tibial muscle is retracted laterally and the medial digital flexor mus-
cle retracted caudally t o expose the medial tibia.
CAUTION: preserve the saphenous vessels and the semitendinosus muscle tendon.
 - References
VetBooks.ir

- Climent y colaboradores, Manual de Anatomta y Embriologta de 10s Animales Dodsticos.

Conceptos bzisicos y datos aplicativos. Miembro Torricico y Miembro Pelviano. Sistema
Circulatorio. Esqueleto de la Cabeza. 20M. Ed. Acribia.
- Evans HE, Miller3 Anatomy of the Dog. Tercera Edicibn. 1993. WB Saunders, Philadelphia.

- Nomina anatdmica veterinaria. 5Ih Editorial Committee Hannover, Columbia, Gent, Sapporo,
2005. International Committee on Veterinary Gross Anatomical Nomenclature World Association
of Veterinary Anatomists (W.A.V.A.) (2005), 1-190.
- Piermattei, Johnson: An Atlas of Surgical Approaches to the Bones and Joints of the Dog and Cat.
Cuarta Edicibn; 2006. Elsevier Inc, New York.
- Franch, J y Mpez C., Atlas de Abordajes Quirlirgicos en Traumatologta de Pequeiios Animales.
1999. Temis Phanna, S.L.

- Sandoval, J., Tratado de Anatomia Veterinaria. Tomo 11: Aparato Locomotor. 3" edicibn. 1998.
Imprenta Sorles. Lebn.

Ir

i1 I
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