Block 5 Flashcards
What are the 4 categories of osteoarthritis management?
Nonpharmacological
Pharmacological
Complementary and alternative
Surgery
Within pharmacological, what are 3 methods?
Weight management
Activity modification / PT
Husbandry
What is primary OA?
Septic
What is secondary OA?
All other types
What is the goal of weight loss with OA?
Reduction in clinical signs
What 2 things play into a weight loss program for dogs with OA?
Client eduction (diet)
Exercise regime
What is a diet that can be used for OA?
Complete diet with Omega 3 FAs
What is a common reason for euthanasia with OA?
Cats urinating/deficating outside litterbox because it hurts to step in
What is important about exercise with OA?
Need to find happy medium. Too much will hurt joints
What are examples of husbandry changes for OA?
Bedding, stairs/ramps, litterbox adjustments
What is an example of symptom-modifying?
NSAIDs
What are 2 broad categories of drugs used for OA management?
symptom-modifying
structure-modifying
What are 3 types of joint injections for OA?
Cortcosteroids
Hyaluronic acid
Biocushions
What is the downside to corticosteroids?
Potential harmful on articular cartilage
What is the preferred corticosteroid?
Triamclinolone
What is the data on biocushions?
No objective data
What are the 2 broad categories of complementary?
Orthobiotics
Physical therapy/rehab
What are the 2 types of orthobiotics?
Platelet rich plasma (PRP)
Stem-cells
What type of stem cells are used to stem-cell therapy?
mesenchymal stem cells
Which of the orthobiotics has more objective efficacy?
PRP
What are 5 physical therapy/rehab methods?
Shock wave
Photobiomodulation (laser)
Acupuncture
Chiropractic
Ultrasound
What are the 4 surgeries that can be performed for OA?
Resurfacing
Joint replacement
Arthrodesis
Excision (FHO)
What is the best surgery for low motion joints?
Arthrodesis
How do you treat septic arthritis?
Antibiotics (ceflesporin)
How long do you treat a septic arthritis?
Minimum of 28 days
How often do you retap a septic joint?
Monthly until normal cytology is returned
What is the MOA of NSAIDs?
Inhibit COX (decrease prostaglandins)
What are 3 adverse effects of NSAIDs?
GI, hepatic, renal
What is the only NSAID labeled for cats?
Onsior
What is a non-NSAID option that acts similarly?
Grapiprant (galliprant)
What is the MOA of galliprant?
non-COX-inhibiting prostaglandin receptor antagonist
What receptor does grapiprant block?
EP4
What are adverse side effects of galliprant?
GI?
What is MOA of gabapentin?
mimics GABA
Inhibits Ca flow to halt release of excitatory neurotransmitters
What is MOA of tramadol?
weak mu-opioid action
Acts on noradrenergic and serotonergic systems
What are 5 side effects of tremadol?
Sedation
constipation
excitation
tremors
seizures
What is MOA of amantadine?
Antiviral
NMDA inhibitor
How long does amantadine take to become fully effective?
3-6 weeks
Amantadine is her 2nd choice to NSAIDs
What are teh 2 types of monoclonal antibody therapy?
Librela (dog) Solensia (cat)
What is the general MOA of monoclonal antibodies?
Decreased signal transduction in cell types involved in pain
What should be kept in mind with using librela in dogs?
Possible progression of OA, potentailly a progression of neurological disorders. Better for end stage dogs
What are 2 other supplements that may help with OA?
Glucosamine and chondroitin
What is the only supplement that has been proven to help with inflammation?
Omega 3
What needs to be considered when prescribing adequan?
Made from bovine trachea, beware of food allergies
What is a unique adverse side effect of cartrophen?
Coagulation issues (may improve subchondral and synovial membrane blood flow)
How do you treat an OCD lesion?
Arthroscopic or open open arthrotomy
What does the open arthrotomy entail?
Debride flap and shave to healthy bone
What are 3 medical treatments of tendiopathies?
PT/rehab
shockwave
PRP
What does post-op care look like for OCD lesion?
Pain management
Activity restriction for 8-8 weeks
What are 2 options for tendiopathies?
Medical treatment
Surgical treatment
What are 2 main surgeries for tendiopathies of bicep?
Tenotomy (cut tendon)
Tenodesis (put tendon back where it was)
What is surgical treatment of supraspinatus?
Tendonectomy
What is treatment for a traumatic LATERAL shoulder luxation?
External support in spica splint for 2-3 weeks if lateral
NO Velpeau
What is treatment for a traumatic MEDIAL shoulder luxation?
Velpeau sling
What disease is often caused by FCP?
Medial compartment disease
What is coronoid disease?
FCP - fragmented coronoid process
What does surgery of FCP look like?
Arthroscopic removal of “pebble in shoe”
What is goal of medial compartment disease?
Load-shifting procedure. Takes pressure off the medial joint compartment.
What is UAP?
Ununited anconeal process
What are 3 surgical options for UAP?
Lag-screw fixation
Ulnar osteotomy
Fragment removal
What surgical procedure of UAP is needed with a short ulna?
Ulna osteOtomy
What surgical procedure is needed for long ulnas or short radius (FCP)
Ulna osteCtomy
What is needed for ALL elbow dysplasia cases?
on-going medical management
What is an arthrodesis?
Permanently join 2 joints
What are 2 options for traumatic elbow luxation?
Closed reduction (spica splint)
Open reduction (transarticular fixator 6-8 weeks)
What is the treatment if carpal hyperextension at the antebrachiocarpal joint?
Pancarpal arthrodesis
What is the treatment of carpal hyperextension at the middle carpal joint?
Partial carpal arthrodesis (preserves antebrachiocarpal joint)
What are the 4 steps to an arthrodesis?
- Removal of all articular cartilage
- Functional anatomical alignment
- Bone graft
- Rigid fixation and compression
What might you see if a partial carpal arthrodesis over time?
Breakdown requiring pancarpal arthrodesis
What can you do for a mild collateral ligament injury?
Splint for 4 weeks
What is surgery for collateral ligament injury?
Ligament reconstruction
How do you treat acute flexor tendon laceration?
Splint in flexion for 6-8 weeks with passive ROM
What should you NOT do with carpal laxity syndrome?
Splint it
What are some managements of carpal laxity syndrome?
Appropriate diet and good footing
What is medical management of sesamoid disease?
Rest (4-6 weeks)
Pain management
Injections
What is surgical management of sesamoid disease?
Debridement
What is IMPA
Immune mediated polyarthropathy
What range of joints are most commonly affected by IMPA?
Distal joints
What is a less obvious sign of IMPA?
Fever of unknown origin with no obvious lameness or joint swelling yet
What does CBC of IMPA look like?
Non specific
How many stages of FUO (fever of unknown origin) diagnosis is there
3
What is the definitive diagnosis of IMPA?
Arthrocentesis (multiple joints)
What is the normal WBC count of joint fluid?
<3000
What percent is normally neutrophils?
<10%
What are the 4 subgroups of IMPA?
I - absence of defined association
II - association with infection
III - Associationed with GI disease
IV - associated with neoplasia
What is the most common subgroup for IMPA?
I
What is the most common cause of fever of unknown origin in dogs?
IMPA!!!
What is max amount of pred per day!!!???
2 mg/kg/day
What is treatment of IMPA?
Pred (try to keep under 1mg/kg/day
What are 4 potential side effects of pred?
Polyurea/polydipsia/polyphagia
Muscle atrophy
Insulin resistance
Be cautious with HCM cats
If you dont use pred, what is the other option that should be considered?
Cyclosporine
What is the best way to monitor signs of IMPA?
Rectal temps
What is another way to monitor IMPA from blood?
C reactive protein
Do cats get IMPA?
Yeah, rare
What are 3 times to apply a bandage?
Soft tissue injury
Bone and joint injury
Surgical wounds
What is the first layer of a bandage?
Primary layer
When do you skip the primary layer?
If no wound
What is the purpose of the secondary layer?
Absorb and hold exudate
Immobilize and support
Can you place the secondary layer too tight?
No, it will rip before it’s too tight
What is the tertiary layer?
Outer, protective layer
***What is the Robert Jones bandage used for?
Immobilization DISTAL to ELBOW or STIFLE
What is Robert Jones used for?
Short term immobilization
What bandage is most commonly used?
Modified Robert Jones
You can use Modified Robert Jones for post-op surgical wounds, orthopedic injuries, and open wounds
What 3 things does modified robert jones provide?
Compression
Mild immobilization
limb support
Which direction do you wrap with robert jones
Distal to proximal
Should you include toes in the badange?
Yes!
Where do you cast an animal/
Distal to elbow or stifle
What are the two types of fracturs where a cast is indicated?
Incomplete fractures
Fractures with intact adjacent bone
Should you ever cast proximal to stifle/elbow
no…
What type of fractures are contraindicated for cast?
Complete oblique, spiral, avulsion, or comminuted fractures
What breeds are not great for casting?
Toy breeds
How thick should the bandage under a cast be?
Not too thick, the closer the cast is, the more resistant to forces it can be
When should an Ehmer sling be used?
Post hip reduction/surgery
How do you apply the Ehmer sling?
Figure 8 patter (NEVER OVER TIBIA)
What is the splica splint used for?
Immbolization of scapula, shoulder, humerus, elobow
What must be ensured with the splica splint
Patient can still breath
What is the velpeau sling used for?
Prevent weight baring on thoracic limb
How are the joints oriented in velpeau sling/
Carpus, elbow, shoulder in flexed position
How often do bandages need changed?
Open wounds - daily
Closed incisions - 3-7 days
How often do casts/splints need changed?
10-14 days
Sorry… What 7 things must be monitored and warrant a bandage change?
Toe swelling
Toes cold
Irritation above bandage
slippage
wet bandage
Patient licking at bandage
change in limb usage
What are the 5 forces on a fracture?
Bending
Torsion
Tension
Compression
Shear
What is bending?
force in middle of bone
What is tension?
pull bone apart
What is torsion?
twisting of bone
What is compression?
Obvious (crushing at fracture site)
What is shear?
Compression on oblique fracture line
What type of force are splints and casts best at reducing?
Bending
(Bad at all others)
What is the rule of thumb for casts at joints?
Extend a joint above and a joint below fracture
What are IM pins?
Intramedullary pins
What is the only force that IM pins reduce?
Bending force
What are 2 modifications to increase IM pin strength?
Stack pinning (more than one pin)
Interlocking nails (put nails through pin)
What forces do external fixaters neutralize?
Compression
Torsion compression
What do lag screws provide?
Compression
How can you make a external fixater stronger?
“Transfixation pin cast”
Basically gets all forces
What do positional screws provide?
Maintain the position of the 2 fragments
What direction are lag screws?
Perpendicular to the fracture
When should you not use lag screws?
When there are multiple fragmented pieces
What is the cis and what is the trans side of the bone?
Cis is near, trans is far
What do lag screws provide?
Interfragmentary compression
What sides do the positional screw engage?
Both cis and trans
**PLATES ARE STRONGER IN TENSION THAN COMPRESSION
What is a dynamic compression plate?
Holes in plate have tapered edge that function as inclined plane
What are locking plates?
Screw heads lock into place
What do locking plates function as?
Internal fixators
What is a locking compression plate?
Can act as both
What is the weight baring axis of the pelvis?
Acetabulum
Ilium body
Sacroiliac joint
Sorry again… What are the 7 indications of surgical fixations of pelvis?
Fracture along the 3 weight baring parts of axis
Articular fracture (acetabulum)
>50% narrowing of pelvic canal
Neuro compromise (sciatic or femoral nerve)
Bilateral involvement
Multiple limb fractures
Intended use of animal
Repair of fracture becomes much harder after 5 days
How do you diangose SI fracture-luxation?
Should be able to follow one contiguous line along inside of ilium into sacrum
How do you do surgery on SI fracture-luxation?
Lag screw using largest possible
Other than a lag screw for SI fracture-luxation, what is another option?
Bolt - larger surgical approach
Do all SI fracture-luxations need to be surgically addressed?
No
Do ilial wing fractures need surgically addressed?
No
What is the lateral approach of an ilial body fracture called?
Gluteal rull up
What is most commonly used to surgically treat the ilial body fracture?
Bone plate
What are 3 options for acetabular fracture repair
Primary
Femoral head and neck ostectomy (FHO)
Conservative treatment
What is most common in acetabular fracture repair?
Plates
What are indications for FHO for acetabular repair?
Money
Highly comminuted
Heavy arthritis after surgery
What should you do if sciatic nerve is severed?
Consider amputation
Will ischial fractures normally repair on their own?
Yes
How do you repair a pubic fracture?
Commonly left untreated
What does conservative management look like?
Cage rest for 6-8 weeks
Controlled exercise on all 4 limbs
ANALGESIA
What is the indication for surgical repair in pelvis?
Along 3 weight baring points
What is special about toy breed radius and ulna fractures?
ALWAYS surgical!
Why are they always surgical?
Blood supply to distal radius compromised compared to large breed dogs
What is a good rule about fixation of bone plates?
6 proximally and distally
What is goal of compression plating?
Compression at fracture site to assure contact of bone fragments
Primary bone healing
What type of fracture is necessary for compression plating?
Transverse fractures
What is the goal of a neutralization plate?
Neutralize disruptive forces at the fracture site
Where do you find neutralization plates?
Where you find lag screws or wires
What is the goal of buttress plating?
Bear entire functional load (no load sharing)
Indicated in non-reconstructable long bone fractures, lots of comminuted zones.
Focus on preserving blood flow
Prolonged casting causes DJD
What is the timeline for surgery of articular fracture repair?
1-2 days
What makes the size of a bone screw?
Diameter of screw with threads
How do you put in a lag screw for 3.5mm?
You drill a 3.5mm hole in the cis side then a 2.5mm hole on trans side for it to pull together
What are the 4 steps to a lag screw?
- Drill
- Measure
- Tap
- Screw
Is inside-out or outside-in drilling more accurate? (aka medial-lateral)
Inside-out
What 2 things do you want to see alignment of before reducing medial condyle?
Anconeal process and semilunar notch
K wire is also used to help reduce chance of migrating distally or creating seroma
What approach should you take to the elbow?
Caudolateral
What are the 2 things used to repair the condyle?
Transcondylar lag screw and anti-rotational K-wire
What is a stifle derangement?
Disruption of multiple ligaments within the stifle
What is often affected within stifle derangements?
Menisci
What is more common, medial collateral or lateral collateral?
Medial collateral
What is the medial repair of collateral stifle derangement?
Locking loop suture
What is done before repair of stifle deraingements?
Debridement of torn meniscii
What is the lateral repair of collateral stifle derangement?
Prosthetic augmentation
What is proximal intertarsal luxation?
Disruption of plantar ligaments
How do you treat proximal intertarsal luxation?
Partial tarsal arthrodesis
What is recovery for partial tarsal arthrodesis?
Lateral splint for 2 weeks
What is recovery for superficial digital flexor tendon luxation?
Lateral splint 3-4 weeks
In hoof trimming, do you take more off the toe or the heal?
Toe!
How many inches should it be from coronary band to the toe tip?
3-4 inches
What leg is usually lame in the cow?
The hind limbs
What claw is usually lame in the hind limbs of a cow?
Lateral claw
How should the block be aligned on a cow claw?
The toe should be aligned with the front edge of the block
What is the treatment protocol for laminitis?
Analgesia
Cold water therapy
Corrective trimming
What must be done with a sole abscess to progress healing?
Remove all dead tissue down to healthy tissue
What is important to note about corkscrew claws?
Possible genetic component
What is treatment for corkscrew claw?
Corrective trimming
Normal anatomy is never achieved with corkscrew claws
What are teh 3 point blocks of corns?
Axially
Medially
Laterally
What is interdigital hyperplasia also known as?
Corn
Do you need to remove corns?
Not unless causing lameness
How to treat interdigital hyperplasia?
Wedge shaped incision
Peel working dorsal to palmar
Wire toes together
Place bandage
What is the technical term for footrot?
interdigital dermatitis
What is treatment of interdigital dermatitis?
Debride with betadine
Topical antibiotics
What is footrot called when it gets into the deeper layers?
Interdigital phlegmon
How is treatment different for interdigital phlegmon?
Need systemic antibiotics and introduce food bath
Give 4 antibiotics that are labeled for footrot
Excenel (ceftiofur)
Naxcel
Excede
LA 200 (oxytet)
What are 2 drugs that are labeled for beef cattle/non-lactating cattle
Nuflor
Draxxin
What is the medical name for hairy heel wart?
Digital dermatitis
What is treatment for digital dermatitis?
Tetracycline powder/paste
Systemic oxytet (LA 200)
Need footbaths and good biosecurity
What are likely involved in hairy heel wart cases?
Spirochetes
What is the block of the cattle foot?
Bier block
How does the bier block work?
Tourniquet and enter the dorsal common digital vein right on midlin
What is the salvage surgery for the digit?
Digit amputation
What si the restoration surgery for the digit?
Facilitated ankylosis
What is important to consider when amputating a digit?
Try not to have articular exposure
What is the disadvantage of digit amputation?
Usually reduction of production life
How do you approach for facilitated ankylosis/
Follow the draining tract
What should you expect up to 2 months after facilitated ankylosis?
Lameness for a while (need block for 2 months)
What is something really important to booster when you have a horse with a foot abscess?
Booster tetanus!
Other than tetanus, what is the treatment for a foot abscess?
Establish drainage
Soak foot to draw out fluid
Foot bandage
NSAIDs
What is a way to protect the sole other than bandaging?
A hospital plate (the metal plate thing)
Where does a hoof abscess usually come out?
At the coronary band
What are teh 3 potential causes of laminitis?
Endocrine laminitis (Cushings or equine metabolic)
Sepsis/endotoxemia
Supporting limb laminitis
Sorry… Give 6 treatments of laminitis
Address underlying cause
Remove standard shoe soon in treatment
Pain management
Give acepromazine for better digital blood flow
Ice the hoof
Put on therapeutic shoes
What is a crazy treatment for chronic laminitis?
Deep digital flexor tenotomy
What is type 1 of distal phalanx fracture?
Non articular, palmar process
What is type 2 of distal phalanx fracture?
Articular, palmar process
What is type 3 of distal phalanx fracture?
Sagittal, articular (down the middle)
What is type 4 of distal phalanx fracture?
Extensor process
What is type 5 of distal phalanx fracture?
Comminuted
What is treatment of P3 fractures?
Lag screw for II and III
Long term stall rest
Bar shoe
Where does bone growth occur?
Metaphyseal growth plate
What is varus?
Splayed legs (Knees out)
What is valgus?
“Knocking knees”
What does HPTE stand for?
Hemicircumferential periosteal transection and elevation
What does HPTE do?
Slows down growth on one limb to straighten deformity (must be done on growing animal)
How would you treat carpal valgus deformity?
Segmental distal ulnar ostectomy (remove bone so it grows out and straightens)
What does PCDUGP stand for?
Premature closure of distal ulnar growth plate
What is the #1 deformity in dogs?
PCDUGP
What does the dynamic proximal ulnar osteotomy not address?
Angular or torsional deformity
What is normal angle for femur?
4-6 degrees
What is the threshold for the femur?
15-20 degrees
How do you surgically correct femur angle?
TPLO jig
What is the C in LBCWO?
Closing
What is the O in LBOWO?
Opening
These are used for opening vs closing wedges (honestly can’t really tell the difference in pictures) Closing seems to be on the medial and opening seems to be on the lateral side tho!!
Is an opening or closing needed for varus?
Opening
Is an opening or closing needed for valgus?
Closing
What is distraction osteogenesis?
Mechanical induction of new bone formation between osteotomy surfaces that are gradually pulled apart
How often does it need to be pulled apart?
2x a day
What is type 1 salter harris?
Through physis
What is type 2 salter harris?
Through metaphysis
What is type 3 salter harris?
Through epiphysis
What is type 4 salter harris?
Through both
What is type 5 salter harris?
Compression of physis
What is something important to consider when repairing a Salter Harris fracture?
Avoid bridging physis with pins
What type of pins do you want across physis if needed?
Smooth fixation pins
What needs to occur during Salter Harris fractures?
Continuous movement
What do you need to be aware of with plates in growing patients?
May need to remove plate to allow for contiued growing
What is a synonym for DJD?
OA
What are teh 3 primary stabilizers of hip?
Ligament of head of femur
Joint capsule
Dorsal acetabular rim
What is the most common luxation?
Hip! 90% of luxations
What is the most common direction that the hip luxates?
Craniodorsal
Functional loss of 2 or more of these = luxation
What causes craniodorsal (and medial) to be so common?
Pull of the gluteal muscles
What is the characteristic stance that luxated hips have?
External rotation and adduction
What are the palpable landmarks for orthopedic exam?
Tuber ischia
Greater trochanter
Craniodorsal ilium
When should a closed reduction not be attempted?
Signs of severe hip dysplasia
Articular fractures
Avascular necrosis of femoral head
Chronic presentation
What does a closed reduction require
General anesthesia to relax muscles
How do you perform a closed reduction?
Lateral recumbancy
Externally rotate
Pull slightly caudally
Gentle internal rotation
What do you do immediately after you believe the hip is reduced?
Feel for landmarks
After you feel landmarks, what should you do?
Push on greater trochanter in medial direction for 5 min
Put limb through full range of movements to displace blood clots
Retake rads
For a ventral luxation, which direction do you pull to reduce it?
Distal traction
Abduction of limb
What is the point of an Ehmer sling after hip luxation?
Maximize acetabular coverage of femoral head
What is a way to help with ventral luxations after you send them home/
Hobbles (like cows)
What are 4 indications of open reduction?
Chronic luxation
Recurrent luxations after closed reduction
Severe instability of collateral ligaments
Bilateral coxofemoral luxations
What 2 things should you primarily base your decision on for open stabilization?
Presence of fractures, hip dysplasia or OA
Extent of cartilage injury
What is the most common approach for open stabilization?
Toggle-rod stabilization
What is toggle-rod stabilization?
Replace ligament of head of femur with a synthetic prosthesis
It looks like you drill through femur head and acetabulum to put a string through to act as teh ligament