аЯрЁБс>ўџ )+ўџџџ(џџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџьЅС П@jbjbjЊjЊ ШШ@ џџџџџџ]ЂЂЂЂЂЂЂццццц ђ ц{ъ        8::::::,eєY~fЂ     fЂЂ     Ђ Ђ 8ЖЮЂЂЂЂ 88ЂЂ8ў €Зцц 8Management Plan: Since this is a large dog surgical management is needed. Large dogs if left untreated can develop degenerative joint disease resulting in a permanent lameness. Surgical intervention will consist of intracapsular reconstruction using the under and over technique. A strip of fascia lata and the lateral third of the patellar tendon will be use to replace the cranial cruciate ligament. This technique has a 78 to 95% success rate and is indicated for acute cruciate ruptures in athletic dogs over 25 kilograms. Harvesting the graft is technically demanding so advanced skills and competent knowledge of the procedure are required. The left rear leg will be clipped and prepped for surgery. A lateral patellar approach will be preformed with the incision being made from mid femur to the tibial crest. A lateral arthrotomy will be preformed to allow access to the joint. A strip of fascia lata and the lateral third of the patellar tendon are dissected leaving the distal attachment in place. Once visualized, the remnants of the ruptured ligaments and any injured meniscal tissue will be removed and the joint will be lavaged. Right angle forceps are passed under the intermeniscal ligament and the graft is pulled through the fat pad and into the joint. A curved bile duct forceps is placed behind the fabella and in between the femoral condyles and into the joint. The graft is then grasped with the bile duct forceps and retracted through the forceps path of entrance. A small incision is made between the fabella and femur and the graft is threaded through it using the curved forceps. A screw and spiked washer are placed in the femur and the graft is pulled tight around the screw. The screw is then secured with tension on the graft. The end of the graft is looped back around a screw and sutured to itself. The joint capsule is closed followed by the skin layer. The animal should be rested/ confined to a crate for six weeks to allow scar tissue, healing and repair. Two weeks post surgery controlled exercise such as leash walking and swimming can be started. At twelve weeks post surgery the dog can return to normal activity. At this point the scar tissue and the graft are supporting the joint adequately. At six months the screw and washer can be removed. The two main complications of the procedure are irritation by the screw and graft failure. There are numerous other surgical techniques for both extracapsular and intracapsular repair. If the owner does not opt for the surgery conservative therapy would consist of rest in close confinement for four to eight weeks. Analgesics such as aspirin 20mg/kg every 12 hours for 2-3 days can be administered. It is very likely that the instability of the joint will lead to progressive degenerative joint disease. Etogesic or Rimadyl can be used to minimize pain and inflammation. If the owner chooses conservative therapy and the dog is still lame after 8 weeks surgery can still be preformed at this time. Weight reduction is important with either treatment in order to prevent reinjury or injury on the contralateral leg. @§CJt Т @§§§§t Т @Аа/ Ар=!А"А# $ %А [4@ёџ4NormalCJOJPJQJmH <A@ђџЁ<Default Paragraph Font@ џџџџ џџ џџ} @ У@ @ @B B џџ Math EmporiumKMacintosh HD:Desktop Folder:Student's Folder:AutoRecovery save of Document2 Math EmporiumIMacintosh HD:Desktop Folder:Student's Folder:final_Management Plan_08.txt Math EmporiumIMacintosh HD:Desktop Folder:Student's Folder:final_Management Plan_08.txtџ@€!!ќќж!5@ @@GTimes New Roman5€Symbol3 Arial3Times"ёˆаh]ЋTЦ•ЋTЦ)ЗЪ !ЅРДД€r0d @ аџџManagement Plan: Math Emporium Math Emporiumўџ р…ŸђљOhЋ‘+'Гй0pˆЌИамь  , 8 DPX`h'Management Plan:rdanaMath Emporiumn:athNormalpMath Emporiumn:2thMicrosoft Word 8.0d@6FК@8ˆЪР@NтаЪРЗЪ ўџ еЭеœ.“—+,љЎ0 hpˆ˜  ЈАИР Ш х'Virginia TechP Ќ Management Plan: Title ўџџџўџџџўџџџ!"#$%&'ўџџџ§џџџ*ўџџџўџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџRoot Entryџџџџџџџџ РFb•NnЪР,€1TableџџџџџџџџWordDocumentџџџџџџџџSummaryInformation(џџџџDocumentSummaryInformation8џџџџџџџџџџџџ CompObjџџџџџџџџџџџџXџџџџџџџџџџџџџџџџџџџџџџџџўџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџџўџџџџџ РFMicrosoft Word DocumentўџџџNB6WWord.Document.8