DIAG IM3 - Page 194

15Joint 5 Dental Surgery Equipment & Instrumentation Tibial Plateau Levelling Operation by Wedge Osteotomy www.vetinst.com stock as possible, and to minimise size discrepancies of the osteotomised surfaces of the proximal and distal tibia. - Use a cranial K-wire and tension band to make osteotomy reduction easier and more stable. - Plan and pre-place the holes for the distal K-wire and proximal tension band prior to making the osteotomy. This will make implant placement and osteotomy reduction simpler later. TPLO closing wedge or Closing Wedge Ostectomy Tibial Plateau Levelling Osteotomy (CWO-TPLO) was the original version of TPLO surgery that preceded the curved osteotomy Slocum TPLO procedure; the latter has since gained widespread use worldwide. CWO-TPLO was originally popular in some territories when availability of the Slocum TPLO procedure training courses, equipment and implants was limited and difficult to access. CWO-TPLO surgery offers advantages and disadvantages compared to TPLO surgery. - Once the ostectomy is complete, place the K-wire in the cranial cortex of the distal fragment, aim into the proximal segment, hold the osteotomy in reduction and drive the K-wire into the proximal segment. This will stabilise the reduction. - Ensure that reduction and alignment are good, particularly that there is no axial malalignment of the tibia. Then place the cranial tension band, placing it through the hole in the tibial tuberosity proximally and the K-wire distally. Advantages of CWO-TPLO surgery compared to TPLO surgery: - Place the medial plate; various options are possible including a DCP, T plate, TPLO plate and locking plates. Remember that this is an inherently unstable osteotomy in the cranial to caudal plane. Coupled with a short proximal tibial segment, this makes stable fixation more of a challenge. Using locking screws proximally and/or as long a plate as possible should help to stabilise the osteotomy as good as possible. - CWO-TPLO is simpler to perform, there is more room for error in terms of osteotomy positioning, it requires less specialised equipment and there is arguably less risk of damage to the popliteal artery. - CWO-TPLO can be performed in any dog, regardless of Tibial Plateau Angle (TPA). Conversely, for TPLO surgery the higher the TPA, the higher the required rotation of the tibial plateau segment for TPLO surgery therefore the less contact at the osteotomy site post rotation and reduction, and the larger the amount of tibial tuberosity that is left exposed that could potentially fracture. CWO-TPLO is arguably simpler, safer and more appropriate in dogs wi FvE2ࠤ5tEvVV27BखvW2B66R6W'FW7bv&WF'FW'2E%tTDtR5DTDՒDU0vWfW"F6GfFvW2b5tE7W&vW'6VFS7B&VGV7FFRG&7fW'6R5tE7FVFגV'2F&PW&VFǒW727F&RFFR7W'fVB5tE7FVFג5tEfW2FRF7FF&&VFfRFFRVF&R&F&RFRFVR2BF6766FVBg&FRF&GV&W&6GFW&Vf&PvFFRw&VFW"7FfRfWFB277VVBfvr5tEFPF&GV&W&6G77VW2&RF7FfWVB6F&VFfRFFPfV&G&6V"7V7W2GW&FRFV6VV2FfR&RF7F6FFRG&6V"7V7W2FB6VB&6FV&FVvF2FW2B6VVF&R6Ɩ6ǒ6vf6B&&V&wV&ǒF06VB&R6FfRfVGW&R2FRFVVvvRFRfV&G&6V 7V7W2&R&VƖ&ǒrFV"WFW72ƖVǒFVvF20V&fVB2B76&RF6'&V7B67W'&VB7'V6FRƖvVBF6V6R@FV"WFvF5tE7W&vW'2FR&VF6&WGvVVFRF&GV&W&6GBFRF&FVR2B6vVB6G&7BE7W&vW'6W&FW2FRFVRg&FRGV&W&6GFW&Vf&RB276&PFG&VB67W'&VBFV"WFB7&7'V6FRF6V6SFPFVR2&FFVBF&VGV6RFREB67W'&VFǒFRF&GV&W&6G2&FFVBVFǒ"&&VǒFW&ǒࠥF2BG&62f"5tE7W&vW'FW&R&RFffW&VBv2FW&f&F2W&FvF7V'FPFffW&V6W2FV6VRW&R&R6RF2FRB27G&vFf'v&@276&SvVrFRvVFvRFRvRbFRvVFvR267VFVBg&FPE'WBFR6RbFRvVFvR6VB&R6W"FgV7&6VFvVFvRb&Rg&R&F&F22F&W6W'fR2V6&PsE###`E##3E#C#C3@E#C#CCE#s#s3E#s#sCPE#s3S3E#s3SCPE3S3SSPE3S3SSpE3S3SSE3S3Sc "D5#ffW&VwF"D53fW&VwF"FD53FfW&VwF"FD5CfW&VwF"vD53fW&VwF"vD5CVfW&VwF"r2RD53fW&VwFw2W6Rb2R66VW267&WrVB"r2RD5CVfW&VwF"VF62VD5SVfW&VwF2VD5SvfW&VwFVgGWG2VD5SfW&VwF2VD5c&fW&VwF*33*33*33bP*33bP*33bP*33bPE3S3ScPE3S3SspE3S3SsuE3S3SsE3SCSsE3SCScSsECScS3ECScS3PECScSCPE𐠣2VD5cVfW&VwF*3SCp2VD5svfW&VwF*3SCp2VD5svfW&VwFWG&6gBP *3SCp2VD5sfW&VwFVgGWG*3SRS2RBRD5sfW&VwFVgGWGw2BR67&Ww2VB*3SBSsfW&VwFVgGWGw2BRbR67&Ww2VB*3Ss@BVD5fW&VwFv66WBbR66VW267&Ww2V@2F6*3C0BVD5fW&VwFv66WBbR66VW267&Ww2V@2VF6*3C0BVD5fW&VwFv66WBbR66VW267&Ww2V@BVF6*3C0vRfFW"bFRfW&*4d0*33bP*3Cp*3SCp*3SCp*3SCp*3SCp