C10014725 / invoice 10000

Reason: PatellarReason: Hind limb lamenessHistory: Couple of weeks ago. No concurrent medical complaints reported. No recent vomiting, diarrhoea, coughing or sneezing. No recent weight loss or change in appetite.  No PU or PD reportedCurrent medications:MeloxicamExamination:  BART:  , HR:   , RR:     , mm: pink, CRT: <2sHeart - nadLungs - nadAbdo - nadMusculoskeletal - Mild hind limb lameness was present. Grade 3 right XXXX medial patellar luxation was present in the left and grade XXX in the right stifle. Neuro - nadBCS: Client communication: The requirement for surgical stabilisationof the patellar was discussed. The potential risks and complications of surgery and anaesthesia including recurrent luxation, tibial crest avulsion, patella tendon injury, post operative infection and anaesthetic related death were discussed and acknowledged. It was elected to proceed with surgery.Anaesthesia: ACP/methadone premedication. Alfaxalone intravenous induction, isoflurane gaseous maintenance anaesthesia. Hartmann's 6ml/kg/hr intravenous fluid therapy during procedure. Cephazolin 22mg/kg intravenously at induction repeated every 2 hours. A            SIZE              transdermal fentanyl patch was applied to metatarsal skin. A Fentanyl CRI was started. Radiographs: Craniocaudal and mediolateral femur, stifle and tibia revealed tibial torsion without any significant femoral varus. Surgery: A craniolateral approach to the stifle was performed with an incision in the fascia lata and lateral arthrotomy. A medial release was performed by incising the medial retinaculum. The trochlear groove was shallow and a rectangular block recession trochleoplasty was performed using a fine toothed hand saw and a sagittal saw. The lateral joint capsule was closed with 4/0 PDS simple continuous. The cranial tibial muscle was separated from the proximal tibia and a tibial crest osteotomy was performed using a saggital saw. The tibial crest was transposed laterally and stabilized with 1x 1.1mm K wire and a 22G tension band wire. The fascia lata was imbricated using 3/0 PDS simple continuous sutures. The skin was closed with 4/0 PDS simple continuous in the subcutaneous fascia andskin staples. Post operative radiographs revealed appropriate osteotomy position, an appropriate position of the patella and fixation pins. Plan:  1) Fentanyl CRI over night2) Clavulox mg BID X 14 days3) Metacam / Carprieve SID X  10 days4) Remove fentanyl patch 4 days5) Remove sutures 10 - 14 days6) Exercise restriction 6 weeks7) Follow up radiographs 8 weeksReason: History: No concurrent medical complaints reported. No recent vomiting, diarrhoea, coughing or sneezing. No recent weight loss or change in appetite.  No PU or PD reportedExamination:  BART:  , HR:   , RR:     , mm: pink, CRT: <2sHeart - nadLungs - nadAbdo - nadMusculoskeletal - nadNeuro - nadWeight - nadAssessment:Client communication:Plan:    Vital Signs