Important to think of clinical applications while dissecting. Look at skin and fascial planes and how you would close them surgically. In many circumstances when you have bones and muscles attached to bones, muscle needs to be removed from bone. You want to remove the muscle by coming under the angle push from here ----> \\\\\\\\ DO NOT COME FROM THIS SIDE! ------------- bone ------------- You can also split the muscle belly longitudinally, by going between the fibers. You don't want to transect a muscle in surgery. When dealing with a muscle attachment to bone, you don't want to cut muscle off - too hard to put back. You would cut off the bony process and reflect it, then pin the bone back together. When working around a joint, if the ligament is in the way, again, cut off a bone end, don't cut the ligament, because it's too hard to repair the ligament. Vessels can be ligated - arteries twice, veins once. nerves can be retracted gently with a finger only. You don't want to stretch or damage a nerve. Lots of surgery is "by feel" going by what it "feels" like, when you can't SEE everything you are doing. After car accident, muscles are short, swollen, purplish, etc. Not like "normal." Important to learn structure of bones, compare w/radiographs. Broken scapula common in HBC dogs. So, to repair a scapula, need to think of shoulder anatomy. Incise directly over spine of scapula, and trapezius and deltoid will be there under the fascia. Incise the fascia, but make sure to leave some on there to suture back to. Put elevator under supraspinatus and infraspinatus and elevate them off the scapula, to expose the scapular spine and body. Elevate distally to proximally, he said. Postop, the muscles will snap back, and can be sutured to fascia. Scapula can be plated and screwed, although that is uncommon. IF you know shape of supra and infra spinatus, you would be able to recognize a case of atrophy on PE more quickly, for example, secondary to lameness due to osteochondritis dessicans in the growing dog. If you operate soon, you can have very good results with it! Shoulder joint - lots of muscles/tendons in the way if you need to expose it. You don't want to traumatize any tissues or damage anything, so there are two ways to get there Less used is to cut the origin of the acromial head of the deltoid - incise from the spine of scapula and around the shoulder, put an instrument under the acromion and cut off a piece of that prominence - about 6-10 mm of it, enough to pin back in place. Then, the tendons of infraspinatus and teres minor are still in the way, and you can cut them or not. Many people will palpate the bursa of the infraspinatus and cut it and retract it to expose the joint capsule. Try to cut joint capsule through the middle to leave enough tissue to suture. First time you do that, will take 3 hrs, but it's really a 15 minute job :) Humerus - learn the shapes and prominences. Fractures common, of shaft and condyles. Need to be able to place intramedullary pins, so need to know anatomy! Humeral fx scare people because of potential to damage the radial nerve. Knowing anatomy would prevent the fear. Incise through fascia cranially to the triceps. If triceps are contracted, have someone pull the leg down. If as you start incising, you see muscle, you aren't cranial enough - you want to find the thick layer of fascia cranial to the triceps. Cut the fascia, and in the distal third beneath the triceps you'll see the radial nerve which runs across the surface of the brachialis. Isolate this. To operate on proximal humerus, pull brachialis caudally. To operate on distal humerus, free muscle and pull cranially. Lateral humeral condylar fx very common on dogs. Immature/small dogs jump from arms or something, all the force comes up the radius and breaks off the lat.condyle. Need to screw/pin together. When both condyles break off you need to take joint totally apart to fix - can't do it just coming in medially or laterally. Need to take off olecranon process first, reflect back the triceps, put the condyles back together, put them back on the shaft, then put back the olecranon. This is a big surgery. Most of the animals lose about 50% ROM after this surgery - everything tightens up and scars, can't flex and extend as much. Ununited anconeal process is another common problem. Best answer is to remove it and throw it away - repair is not generally successful.Dx by radiology. Find anconeous muscle under skin incision. Must transect anconeus muscle to reach lateral side of joint to remove anconeal process. DOesn't heal that well. Midshaft fracture of radius and ulna in young animals - need to fix w//o traumatizing the growth plates distally, so usually will only repair ulna, and only by coming in proximally. Just incise over proximal ulna and push muscle out of the way. The radius can be pinned or plated too. In immature animals growth plate can fracture. when they close prematurely, they cause problems w/deformity. Then need to break legs, realign bones, move stuff around, etc etc.