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VMS 3010 > Approach to Bone and Joint Diseases in the Horse > Flashcards

Approach to Bone and Joint Diseases in the Horse Flashcards

1
Q

What is periosteal new-bone formation?

A

Blunt trauma can lead to sub-periosteal haemorrhage
* Lifting of periosteum away from bone
* Stimulates production of periosteal new bone
* Initially less dense and irregular outline
* Becomes more radiopaque with smooth outline
* Splint bone exostoses, healing fractures, infection,
inflammation, neoplasia, osteoarthritis

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2
Q

What is Sclerosis?

A
  • Densification
  • Localised formation of new bone within bone
  • Stress
  • Protection of a weakened area
  • Walling off infection
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3
Q

What is bone lysis?

A
  • Destruction of an area of bone
  • Infection
  • Neoplasia
  • Keratoma
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4
Q

What is osteophyte formation?

A

Spur of bone on a joint margin
* Joint instability
* Intra-articular disease (eg Osteoarthritis)

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5
Q

What is enthesophyte formation?

A
  • New bone formation at attachment of tendon/ligament/joint capsule to bone
  • Bone’s response to stress applied through these structures
  • Soft tissue injury
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6
Q

What are the three characteristics of aggressive bone disease?

A
  • Destruction of the cortex
  • Character of the perisoteal lesion
  • Lack of distinctness of boundary between the bone lesion and normal bone (transition zone)
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7
Q

What can ultrasonography be useful for?

A

assess the bone surface
* should appear smooth
* useful to image areas which are difficult to radiograph

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8
Q

What would show the presence of a fracture on a radiograph?

A

Non-displaced break in normal hyperechoic bone
surface
* Displaced fragment
– visualisation of hyperechogenic bony structure distracted from
underlying bone

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9
Q

How does nuclear scintigraphy work?

A
  • Radioisotope is injected intravenously
  • increased IRU in areas where there is increased osteoblastic activity
  • High sensitivity but low specificity imaging modality
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10
Q

What is computed tomography?

A

A 3D image is generated from a large series of 2D radiographic images taken
around a single axis of rotation

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11
Q

What is the advantage of computed tomography?

A
  • Structures are not superimposed on top of each other
  • Facilitates examination of complex structures e.g skull
  • Viewing image in several planes helps to better delineate fracture orientation- useful for planning
    fracture repair
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12
Q

What is the benefit of magnetic resonance imaging?

A

Allows better imaging of soft tissue structures (less detailed examination of bony structures – lower
resolution compared to radiography, CT, U/S)
» Dynamic imaging modality; identifies intra-osseus fluid
» Only distal limb possible in horses

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13
Q

What is the difference between Epiphyseal/Physeal dysplasia and ligamentous laxity?

A

Ligamentous laxity can be corrected manually

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14
Q

What is physitis?

A
  • Inflammation of the growth plate
  • irregularly thickened growth plate
  • metaphyseal sclerosis
  • Periosteal new bone formation
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15
Q

What is the meaning of osteitis?

A

Bone is involved

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16
Q

What is the meaning of osteomyelitis?

A

Bone marrow and bone is involved

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17
Q

What are the clinical signs of osteitis/ osteomyelitis?

A
  • Increased lameness
  • Local swelling
  • paiful response on palpation
  • discharge from the wound/ incision site
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18
Q

What is the meaning of sequestrum?

A

Piece of dead radiopaque bone

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19
Q

What is an involucrum?

A

surrounded by an area of lucent granulation
tissue- Area of sclerosis may be surrounding (to wall off the
infection)

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20
Q

What is a sinus?

A

radiolucent tract between infected bone and skin

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21
Q

How might you treat osteomyelitis/ osteitis?

A

Systemic antimicrobial therapy
* Must have good bone penetration, broad spectrum
* Long course required
» Analgesia
» Wound care: debridement and lavage
» Curettage
* Debridement of bone and soft tissue to remove necrotic debris,
purulent material and avascular bone
» Implant removal if relevant
» Bone graft?
» Intravenous regional perfusion (IVRP) (Amikacin)

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22
Q

When might a hairline fracture become visible?

A

Hairline fracture may not become visible for 10-14
days
* Osteoclastic activity breaks down bone
* The fracture line then becomes visible

23
Q

What is osteoarthritis?

A

Older animal
* Gradual onset
* Lameness mild to moderate to severe depending on stage of disease
* Lameness may improve with exercise
* Reduced ROM and bony changes may be palpable in advanced cases

24
Q

What is septic arthritis?

A
  • Any age
  • Wound near a joint
  • Acutely and severely lame
  • +/- pyrexia
25
Q

What is osteochondrosis?

A
  • Young animal
  • Joint effusion
  • Often do not present with lameness
26
Q

What is magnetic resonance imaging?

A
  • Useful to assess concurrent soft tissue damage which
    may be resulting in joint instability
27
Q

What is synoviocentesis?

A
  • Essential in diagnosis of septic arthritis
  • Also useful to detect inflammation within the joint (synovitis)
  • Aseptic collection
  • NOT through contaminated skin/wound
  • Test
  • Cytology
  • Culture & Sensitivity
28
Q

What is a contrast study?

A
  • Contrast agent injected into joint and radiographs taken
  • Contrast agent will be visible leaking out of wound on radiographs if
    both communicate
29
Q

What is a pressure test?

A
  • Distend joint with sterile saline
  • Saline will exit through the wound if joint and wound communicate
30
Q

What is the normal appearance of synoviacentesis?

A
  • Pale yellow/transparent, high viscosity
  • Low in white bloods cells and total protein
31
Q

What is an abnormal appearance of synoviocentesis?

A

Serosanguinous/turbid/reduced viscosity
* High white blood cells and total protein
* >90 % Neutrophils

32
Q

What is arthroscopy?

A
  • Allows direct visualisation of joint
  • Diagnostic and therapeutic
33
Q

What are the aims of osteoarthritis management?

A
  1. Provide analgesia
  2. Control articular inflammation
  3. Limit damage to articular tissues
  4. Promote healing of damaged cartilage
34
Q

What does a displaced fragment look like?

A

visualisation of
hyperechogenic bony structure distracted from
underlying bone

35
Q

What is the issue with MRI’s in horses?

A

Only possible to view the distal limb

36
Q

What is the benefit of the dynamic imaging modality in horse MRI’s?

A

Identifies intra-osseous fluid

37
Q

What does ‘valgus’ mean?

A

lateral deviation of the limb

38
Q

What does ‘varus’ mean?

A

Medial deviation of the limb ‘windswept foals’

39
Q

What is curattege and what is it used for?

A

Debridement of bone and soft tissue to remove necrotic debris,
purulent material and avascular bone

  • used in cases of osteitis/ osteoarthritis
40
Q

What is IVRP?

A

Intravenous regional perfusion
delivers high concentrations of antibiotics to an area to relieve infection

41
Q

How would you collect the fluid for synoviocentesis?

A

NOT through the contaminated skin/ wound

42
Q

What is synoviocentesis most likely going to be used for?

A

Septic arthritis

43
Q

Name two intra-articular corticosteroids?

A
  1. MPA
  2. TA
44
Q

What are corticosteroid useful for?

A
  • Reduction in inflammation within the joint
  • Should be avoided in laminitis prone individuals
45
Q

What is Hyaluronic acid used for?

A
  • adjunctive treatment
  • injected intra-articularly
  • important component of synovial fluid
  • lubricant, anti-inflammatory, chondroprotective
46
Q

What is Pentosan polysulphate sodium (Cartrophen) - IM used for?

A

Reduction in articular cartilage fibrillation
* Once weekly for 4 weeks

47
Q

What are bisphosphates used for?

A

Bisphosphonates - IV or IM (Tildren or Osphos)
o Inhibitor of bone resorption (osteoclasts)
o Slow down progression of OA
o Licensed for OA of the small tarsal joints & Navicular disease

48
Q

Name 4 more adjunctive treatments (e.g not the hyaluronic acid slide)

A
  • Autologous conditioned serum- Counteracts inflammatory protein IL-1 produced in joint synovitis
  • Platelet rich plasma- Enrichment of platelets and degranulation to release growth factors
  • Bone marrow derived mesenchymal stem cells- Promotes repair and regeneration
  • Polyacrylamide hydrogel- Integrates into the joint capsule
49
Q

What four things may cause septic arthritis?

A
  • Trauma
  • Iatrogenic
  • Haematogenous
  • Extension
50
Q

What is the pathogenesis of septic arthritis?

A
  • Inflammatory response- vasodilation and influx of neutrophils
  • Fibrin clot traps bacteria (reduction in synovial nutrient exchange)
51
Q

What is the gold standard for septic arthritis?

A

Arthroscopic debridement and lavage

52
Q

What is Osteochondritis Dissecans?

A

Fragment separates from adjacent subchondral
bone

53
Q

What is Osseus cyst
-like lesions (OCLLs)?

A

Retention of a focal area of degenerate cartilage
within the subchondral bone (subchondral bone
cyst)

VMS 3010 (102 decks)

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