AD152 – Advance25 Orthopaedics for Advanced Practitioners

Learn in your own time with this fully flexible Advance25TM Course.

Enjoy unlimited access to your course materials for a full 12 months. Ask all the questions you like on the discussion forum – there are no stupid questions! Get the help you need to deal effectively with your Orthopaedic patients.

Complete the course and get your CPD / CE Certificate for 25 Hours of learning.

Use your new knowledge and skills straight away in your practice.
Revisit your course materials at any time during your 12 months’ access to refresh your knowledge whenever you have a relevant patient.

Session 1: Complex Articular Fractures

With articular fractures what you see on the radiograph is the tip of the iceberg. There are many other things to consider besides the obvious damage to the epiphyseal and metaphyseal bone. These include damage to the articular cartilage, the surrounding soft tissues, adjacent physes and the vascular supply. Despite adherence to the principles of treatment of articular fractures, high morbidity is sometimes experienced and these additional injuries may explain this. While rigid fixation and anatomic reduction of articular fractures are critical operative goals to optimise joint function and reduce progression of osteoarthritis, they do not address the musculoskeletal tissues surrounding the fracture that are critical for physiologic movement and range of motion. In this session we will consider commonly encountered articular fractures, and how treatment may be optimised in order to achieve the best possible patient outcomes.

Session 1 – Humeral Condylar Fractures
Role of Humeral Intracondylar Fissure, options for unicondylar fractures, how to approach bicondylar fractures

Session 2 – Other Articular Fractures
Femoral condylar fractures, patellar fractures including patellar fracture and dental anomaly syndrome, tarsal fractures

Session 2: Salvage/Reconstructive Surgery

Salvage surgeries represent various layers of complexity. Firstly, the decision-making in terms of when a salvage surgery is warranted can be challenging; should these be reserved for end-stage conditions, or could earlier surgeries have the potential to improve postoperative outcomes? Secondly, surgical technique is exacting, necessitating careful preoperative planning, meticulous technique and optimal aftercare in order to optimise results. Thirdly, many of these surgeries have limited revision options, which puts even greater emphasis on the importance of points one and two above. During this session we will discuss the decision-making that pre-empts any salvage surgery, how to identify higher risk cases, and how to optimise execution in order to limit complication rates.

Session 1 – Arthrodesis
Shoulder, carpus, stifle, tarsus

Session 2 – Total Joint Replacement
Total hip replacement, Total knee replacement, Total elbow replacement, Total ankle replacement

Session 3: Minimally Invasive Surgery

During the past two decades, the ongoing review of clinical outcomes following fracture stabilisation has led to a radical paradigm shift toward emphasising the biologic component of fracture healing. This has become the foundation of a new philosophic approach known as minimally invasive osteosynthesis (MIO). With MIO, the fracture site is not exposed, which in turn preserves the fracture hematoma and promotes earlier fracture healing. During this session we will explore the clinical benefits which may be associated with this approach, starting with diaphyseal fractures and then progressing to discuss the use of MIO for treatment of physeal and articular fractures. Although potentially clinically rewarding, MIO is also technically challenging. We will discuss ways in which a surgeon may optimise results through fastidious preoperative planning, careful patient positioning, indirect reduction techniques and appropriate choice of stabilisation method.
Arthroscopy is often considered advantageous due to its minimally invasive nature and certainly, the advantages of magnification and illumination are compelling. However, whilst its use is widespread these days, the evidence base supporting improved clinical outcomes is somewhat lacking. During this session we will discuss the controversies and supporting evidence-base, where available, as well as the use of more novel technologies and applications and the role that these may play in clinical practice.

Session 1 – Minimally Invasive Osteosynthesis
Minimally invasive plate osteosynthesis, Minimally invasive elastic plate osteosynthesis, Minimally invasive nail osteosynthesis, percutaneous pinning

Session 2 – Arthroscopy
Elbow arthroscopy controversies, shoulder arthroscopy, stifle arthroscopy, nanoscope utility, fracturoscopy

Session 4: Angular Limb Deformities

Angular limb deformities are some of the most complex cases that we as orthopaedic surgeons deal with. From determining whether an abnormality is a problem, defining the deformity, assessing the contribution of soft tissues to deciding on how to surgically approach the patient, every stage of the decision-making process presents unique challenges.
The literature presents a paucity of evidence as no comparative studies have been conducted so it is difficult to assess whether surgery is required in. the first place, which osteotomy(ies) should be performed and what adjunct procedures should be considered.
During this session we adopt a case-based approach in conjunction with the available literature to help you navigate the decision making process.

Session 1 – Antebrachial Deformities
Assessment challenges, Acute v gradual correction, ESF v ORIF, 3-D guides, soft tissue challenges

Session 2 – Patellar Luxation – when a tibial tuberosity transposition just isn’t enough
Assessment challenges, when to perform a distal femoral osteotomy (DFO), how to perform a DFO, other tibial osteotomies, the role of early intervention

Session 5: When the Routine Joint Surgery is not Routine

It could be argued that no surgery is truly “routine” – however, there are certain surgeries that we perform frequently and become so familiar with that it may seem this way. However, every patient is different, and “routine” surgical technique cannot always be universally applied. Unfortunately, surgical training programs rarely have the capacity to prepare trainees for all such circumstances. This, coupled with the simple fact that these cases occur less frequently, leading to a very limited evidence base, can make the departure from routine very uncomfortable.
It is not only surgeries that get categorised as routine, but also conditions. Simply because we encounter a condition commonly does not mean that we have a definitive answer for how to treat it. It is often said that where multiple treatments are available for a given condition, it is because none of them have been proven superior to another, or, to put it more simply, maybe none of them have proven efficacy.

In this session, we will cover both of these complex situations – when the routine surgery departs from routine, and when the common condition has no universally accepted solution.In both situations, a sound theoretical knowledge, coupled with an ability to review literature is critical – particularly the ability to distinguish eminence from evidence.
In this session we will cover several situations where an apparently everyday consultation can turn into a significantly more complex scenario.

Session 1 – Cruciate controversies
Which high tibial osteotomy, excessive tibial plateau angle, cranial cruciate rupture + medial patellar luxation, the role of the meniscus, feline cranial cruciate disease

Session 2 – Low level evidence what should we do?
Osteotomies for medial coronoid disease, surgeries for osteochondrosis and Achilles tendinopathy

Session 6: High Energy Trauma

When faced with a single fracture, most surgeons have developed a decision-making process which is simple and works well for them. However, in high-energy trauma, the impact of soft tissue injuries, comorbidities and/or polytrauma renders many of the so-called “rules” of preoperative planning somewhat redundant. A comprehensive assessment of the entire patient, which is necessary in all trauma cases, becomes particularly important in high energy trauma where concomitant pathology can significantly alter plan, cost and prognosis. There is a growing acceptance that polytrauma cases are more likely to experience complications associated with each individual stabilization, however, exactly how we should compensate for that remains uncertain. Simply placing “more” or “larger” implants in all cases won’t always be successful and often, previously established “rules” may need to be questioned.
In this session we will consider how decision making may alter in high energy trauma cases. This will include anticipation of potential complications, how to minimise these and where necessary how to address them.

Session 1 – Spinal fractures
Patient assessment and decision making, reduction techniques, stabilisation options- Plates, Pin/screw PMMA, Pedicle screws, SI luxation/fractures

Session 2 –  Polytrauma
Prioritising injuries, Adjusting stabilisation techniques – Orthogonal plating, interlocking nails, disadvantages of ESF, concurrent luxation. Comminuted diaphyseal fractures, pelvic fractures, metabone fractures

What do Vets Say About Advance25 Courses?

“Great that you can study in your own time but still have access to the tutors for asking questions via the discussion forum. Informative, good range of content, ability to ask questions but study in your own time.”

“Really informative course, high standard, loads of useful info and good course notes/ lectures. Really applicable knowledge for difficult cases.”

“Absolutely perfect course! Well presented with all the relevant information. Speaker is a true professional with vast knowledge. Fantastic CPD.”

“Thoroughly enjoyed it and learned an awful lot. The practical stuff I could use in surgery and the understanding of surgeries I’d refer so that I could start to educate clients about options.”

“Will help with surgical planning and increase the number of options I can offer clients.”

“Advanced techniques interesting. Lots of useful hints and tips throughout. It will enable me to approach some advanced cases more confidently and has allowed me to revise some information.”

“Most useful- Being able to do it on my own timescale!”

“Absolutely excellent course. Thoroughly enjoyed all the lectures and have learned so much. Due to time constraints for all sorts of reasons it has taken a bit longer to complete the course but now looking forward to having access to lectures, resources and reading list for some time ahead.”

Tutors

Scott Rutherford BVMS CertSAS DipECVS MRCVS
RCVS Recognised and EBVS European Specialist in Small Animal Surgery

Karen Perry BVM&S CertSAS DipECVS MSc Vet Ed FHEA MRCVS
RCVS Recognised and EBVS European Specialist in Small Animal Surgery

Any Questions? Call us now on 0151 328 0444