01 - fractures of skull and mandible

Question 1

(atlantoaxial instability)

1. Cx

Answer 1

1. vary from pain to ataxia or tetraplegia

(if spinal cord compression really bad can cause resp arrest and death)

Question 2

(atlantoaxial instability)

(dx)

1. how do you dx?

Answer 2

1. radiographs (widened space between dorsal arch of C1 and dorsal spine of C2)

Question 3

(atlantoaxial instability)

1. objectives?

Answer 3

1. remove fracture or ununited dens, stabilize C1-C2 articulation, and prevent spinal cord injury

Question 4

(caudal cervical spondylomyelopathy)

1. aka what?

Answer 4

1. wobbler syndrome

Question 5

(caudal cervical spondylomyelopathy)

1. two populations of dogs that get?

Answer 5

1. young great danes with osseous malformations

middle aged to older dogs with acquired dz 2° to cervical vertebral instability (lots of dobermans in this group)

Question 6

(caudal cervical spondylomyelopathy)

(pathologic changes)

1. congenital osseous malformation (malformation or malarticulation) C3, C7 most common
2. vertebral tipping in middle aged to older patients

C5-6 and C6-7 most affected

3. chronic degenerative disc dz in dobermans

Question 7

(caudal cervical spondylomyelopathy)

(Cx)

1. neck pain, hypermetria, ataxia, tetraparesis
2. compression worse with neck extension
3. ataxia is worse in front or hind limbs?

Answer 7

3. hind

Question 8

(caudal cervical spondylomyelopathy)

(dx)

1. lots of differentials
2. what helps identify site of compression?
3. what is the gold standard for imaging of the spine?

Answer 8

2. myelography
3. MRI

Question 9

(caudal cervical spondylomyelopathy)

(sx procedures)

1. ventral decompression
2. ventral distraction
3. dorsal decompression

Question 10

(caudal cervical spondylomyelopathy)

(post-op care and complications)

1. fentanyl patch
2. abx
3. restrict activity for 3 to 6 months

Question 11

(spinal fractures and dislocations)

1. most are due to what?
2. two most common sites?

Answer 11

1. trauma
2. thoracolumbar and lumbosacral junctions

Question 12

(spinal fractures and dislocations)

(causes)

1. hyperextension due to direct trauma to dorsal spine
2. hyperflexion reusults in wedge compression, these fractures are usually stable
3. compression occurs with an axial load force
4. rotation is usually associated with hyperextension

Question 13

(spinal fractures and dislocations)

(Cx)

1. range from pain or propioception loss to loss of motor fxn

Question 14

(spinal fractures and dislocations)

(dx)

1. complete px with neurologic examination
2. best for boney pathology?

for soft tissue visualization?

Answer 14

2. CT, MRI

Question 15

(spinal fractures and dislocations)

1. what is the most important prognostic indicator?

Answer 15

1. presence of deep pain

(if present 85% change of recovering normal neurologic fxn)

Question 16

(spinal fractures and dislocations)

(preoperative considerations)

1. if the fracture is stable with minimal displacement and the patient has good motor fxn - manage how?
2. if fracture is unstable or significantly displaced, if motor fxn is diminished, or if there is evidence of neurlogic fxn?

Answer 16

1. patient can be managed without sx
2. go to sx!