MPD

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Upward Fixation of Patella (UFP)-A Practical Approach- : 

Upward Fixation of Patella (UFP)-A Practical Approach- Dr. R. P. Pandey Professor, Surgery College of Veterinary Sciences, Mathura

UFP : 

UFP A condition of stifle joint. May be recurrent or permanent in nature. Can be categorized as cold lameness. Mostly occurs in buffaloes. Can occur in bullocks, bulls and cows as well. Names in local dialects are Jhanak, Jhanka, Rangad, Tanch, Tanak etc. Identified by occasional jerky movement of stifle or locking of the limb in hyper-extension.

The Stifle : 

The Stifle A joint between femur and tibia. Other structures are maniscus, cruciate ligaments, joint capsule, and Patella.

UFP-the concept : 

UFP-the concept

-Attention- : 

-Attention- 2 1 8 7 6 3 4 5 9 10

Mechanism of locking and after effects : 

Mechanism of locking and after effects Patella is lifted upward due to relaxation of patellar ligaments or asynchronous contraction of thigh muscles (m.q.f. & m.b.f.) Outward circumduction and abduction lead to mobilization of MPL medial to medial ridge of trochlea. The MPL gets stretched over the trochlea and stifle is locked in this state. Stifle and hock are locked in extension; only fetlock is fixed in flexed form in a way that inner wall of hoof drags on the ground if animal is forced to move. HQ muscles show wasting in chronic cases due to animal’s inability to bear weight. Aggravation of condition occurs in Pregnancy, Hilly tract, Congenital conformational defects (straight hock), prolonged rest and cold weather.

The Remedy : 

The Remedy Exerting push in upward and inward direction on distal end of patella and simultaneously forcing the animal to take a forward step. The problem recurs

Slide 8: 

Deposition of counterirritant in the course of MPL causes inflammation, ligament relaxation and dislodging of patella. The Remedy An obsolete method. If CI goes in the joint, aseptic arthritis results. Results too are unpredictable

Slide 9: 

The Definitive Remedy-MPD Discussion of Open vs Closed (semiopen technique) Principle is exposure or identification of MPL and its sectioning under LA leads to dislodging of patella from trochlea and thus enables free movement of stifle. Front view Medial view

Slide 10: 

Lateral recumbency restraint in a way that the affected limb is on the ground and remaining three limbs are tied together. Affected limb is pulled backward to expose medial aspect of stifle (udders in females and scrotum in males). Pushing the point of hock towards ground has a rotating effect on the stifle in a way that the area of interest is exposed properly. Approach the joint from caudal side of the animal. Carefully palpate the anatomic landmarks. The MPD - the tips

Anatomic landmarks : 

Anatomic landmarks The most important is anterior tibial tuberosity (A). Second is medial condyle of tibia (B) If possible palpate the distal end of patella (C) also. Palpate the groove between MPL & APL (D) A C B D

Slide 12: 

Locate anatomic landmarks. Locate groove between MPL & APL. Identify and locate cutaneous veins. Palpate the APL and if possible MPL carefully. Identify the insertion of MPL at ATT. Prepare the site with A/S sol. Infiltrate S/C tissue with LA. Mobilize the skin from medial stifle (quite loose) to a more cranial direction. Use # 12 or 11 BP blade on handle # 3. Relocate groove and the distal end of MPL and insert blade in direction shown by arrow. Cut the MPL while allowing the skin to roll back medially from where it was mobilized. The technique of MPD

Slide 13: 

A palpable depression develops in the course of tough MPL. Free stifle flexion becomes possible on flexing the fetlock. If the animal is freed from restraint, stifle moves softly and without catching at locomotion. Signs to identify correct sectioning Results are spectacular, lame animal becomes sound immediately post operatively.

Slide 14: 

Beware of:- Sectioning of APL. Sectioning of or injury to collateral ligaments. Opening of joint capsule and / or intra-articular injury. Damage to genu artery (an articular branch) Sepsis

Slide 15: 

Less spectacular result-the causes Incomplete sectioning of MPL. Case having degenerative joint changes (ref. synovia characters). Wrong case selection (No UFP or frozen stifle, malunited distal femur, exostosis development. Wasting of HQ muscles (slow recovery). Too tough insertion of grecillis and sartorius at ATT.

Slide 16: 

Once expertise develops: MPD can be done even in standing animals (easily if locking is complete!). Even when the affected limb is not the one on the ground. Even with large sized BP blades. The condition is that one should have thorough knowledge of stifle anatomy and be capable of palpating different structures correctly. thanks

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