DIAG IM3 - Page 202

15Joint 5 Dental Surgery Equipment & Instrumentation www.vetinst.com Triple Tibial Osteotomy A cruciate management technique combining tibial plateau levelling and tibial tubercle advancement. Based on the work of Slocum, Tepic and Montavon, the Triple Tibial Osteotomy has been developed by Dr Warrick Bruce to overcome some of the problems encountered in the Slocum TPLO technique, the Montavon TTA (Tibial Tubercle Advancement) and the closing wedge TPLO technique. Case Warrick Bruce Osteometer and Saw Guide 90˚ Three Osteotomies TPLO + TTA Triple Tibial Osteotomy Some of the problems include: Some instrumentation is required to make the procedure easier and to minimise errors. Warrick Bruce’s original instrument Set comprises a Saw Guide, Measuring/ marking Gauge (Osteometer) and a Bone Manipulation Device (Wedgie). The Saw Guide works with flat oscillating blades with a maximum cut thickness of 1mm (thickness at the teeth). See Chapter 9. Work by Tepic suggests that the tibial plateau should be perpendicular to the patella ligament to minimise shear strain at the CrCL. The Slocum technique does not always address this issue. The bi-radial Slocum blade is inefficient and difficult to resharpen resulting in the generation of significant amounts of heat which leads to delayed healing and other complications. The original Set (Code TTO008) is very reasonably priced and offers the surgeon a very cost effective route to management of CrCL rupture by tibial plateau levelling surgery. Warrick’s new, more sophisticated designs are shown below. Available as a Set (Code TTO009). The Montavon TTA technique creates a large defect in the cranial tibia which requires an expensive titanium cage and plate to prevent collapse during the healing phase. The closing wedge TPLO shortens the tibia and creates a defect in the tibia which has to be protected from the pull of the straight patella ligament by a figure of eight wire. The TTO technique deals with all of these problems: A long osteotomy is made in the tibial crest to allow the tibial tubercle to move forward. The angle correction is made by making a small wedge osteotomy in the caudal tibia which, when closed creates a small tibial tubercle advancement. A free instructional DVD is available which fully describes and explains the procedure through video, stills and text files. TTO014 TTO002 The DVD also includes an instrument check list. Multi Saw Improved TTO instrumentation TTO009 One of the advantages of the TTO (and TWO) procedure is that it uses simple flat blades which are easily replaced when they become blunt. The TTO uses a saw guide to direct the saw very accurately ensuring a ‘good fit’ once the osteotomy is complete. Surgical air or &GFW'G&fV6w2&PFVf"FR&6VGW&R'WBFRVF6rvF7FW&R6&VBB6fW'F v&2fW'vVR7W&RFBFR&FP6VV7FVBfG2F&VvFR6rwVFR7W@F6W72W72FҐEDED5E%TTDDEDED`ED@ED EDDEdD%%ED𐠥6VR6FW"rf"&RFWF26w0B&FW0`&62ED7G'VVG2@6F2EDbEDBED"bEdD’&627FVWFW 6r7WGFrwVFR7FF&Bc&ҐvVFvR6VvVBVF 6r7WGFrwVFRrsfҐEdBW7G&FrFR&6VGW&PED7FW'7FWwVFP*3#3sP*3"S*3"S*3rP*3rP*4d0*4d0