Dog and Cat 5 Flashcards

Question

Grade 3 injury for greyhounds what is involved, clinical signs and what muscles occur in

Answer 1

- Major disruption of muscle fibres and haematoma formation – - Clinical signs ○ Pain, swelling and palpable disruption of the normal tissue ○ bruising and dependant oedema often developing. ○ Clearly falter during galloping, but dogs aren’t always lame at walk. - Occur in the long head of triceps, gracilis and tensor fascia lata mm.

Answer 2

- Many treatments modalities exist - Surgical repair of fractures ○ generally increased likelihood of successful return to racing, - Grade 3 muscle injuries ideally surgically repaired if major ○ but rarely are and often return successfully - Time/Patience - Physiotherapy - Graded exercise program - Return to normal function as soon as possible. - Drug-free racing

Answer 3

- Test full range of movement -> should be able to push neck to the sky, head down to the chest - Palpate neck musculature and spinous processes - Inability or disinclination to move the neck usually indicates injury to this area and may originate from collisions or race falls.

Answer 4

- Examine with muscles relaxed and then under tension ○ Supraspinatus and infraspinatus, Deltoid, Triceps group, Esp. origin of long head, Pectorals - OCD - osteochondritis dissecans ○ Withering of the deltoid ○ Pain on extension ○ Humeral head - Scapula - Place pressure on the spine of the scapula. - Scapula fractures from race falls will result in immediate swelling of the infra/supraspinatus - Examination ○ Check biceps brachii and the transverse humeral ligament ○ Drawing leg caudally with the elbow extended and rotating the shoulder joint inwards. ○ Rupture will result in an increase in the 90° angle

Answer 5

Thoracic and Lumbar Spine - The spinal column is examined for hypomobility, pain, and muscle spasm. - Indicative of the presence of either a “spinal mechanical fault” or injury to the associated muscles, ligaments and tendons. Muscles of the Trunk and Abdomen - Canine Exertional Rhabdomyolysis ○ Marked pain through the thoracic and lumbar muscles - can die from this ○ History -> PU/PD, - Grade 2 injury of the latissimus dorsi m. (fan) is common. - Rupture of the external abdominal oblique m. or the rectus abdominis m. ○ Swelling and bruising of the caudal ventral aspect of the abdomen.

Answer 6

- Fractures of the wing of the Ilium or acetabulum ○ Lameness, swelling and crepitus - Gluteal mm. (hip) common area of myositis - Palpate lumbosacral and sacro-iliac areas for signs of discomfort. ○ Dorsal process of 7th lumbar vertebra can fracture (lateral instability) § Slow acceleration, shortened stride - When examining the tail - elevate and rotate ○ Tail base injuries - common § Exceedingly painful and causes pain while defecating and loss of performance § Sign - will see a drop in the tail

Answer 7

Stifle - Collateral ligament injury is uncommon. - Cruciate ligament injury is extremely rare - compared to other breeds which is relatively common Fibula - Careful palpation of the fibula along its entire length - Fractures at lateral saphenous vein. ○ swollen and painful - 4-6 weeks rest is usually adequate for healing

Answer 8

- High incidence of injury ○ Esp. central tarsal bone of right hock - can be career ending - Most fractures of the tarsus are readily apparent ○ May not be present until the greyhound cools down, esp. for 3rd tarsal bone fractures. ○ Crepitus if severe - Tarsal joint flexion will also test for stifle, gastrocnemius muscle, achilles tendon, tarsal and metatarsal injuries. - The tarsus is palpated carefully to detect pain, callus production or swellings. - The joint is then fully extended checking for pain on the dorsal surface

Answer 9

``` - Firm thumb pressure - needs to be weight bearing (lift the contralateral limb up) ○ metatarsals ○ flexor tendons ○ interosseus muscles. - Metatarsal periostitis - Stress fractures/Callus formation ○ not as common as metacarpals - Fracture of the 3rd or 4th metatarsal - MAIN WEIGHT BEARING DIGITS ```

Answer 10

1) split webbing 2) corns- occurs in teh pad - unknown cause - FB or trauma, needs surgical removal 3) sandburn - digital flexor tendons 4) foreign bodies 5) papillomas - highly contagious and painful Flexion loss - sesamoid or collateral ligament injuries

Answer 11

- High incidence of injury ○ Left 5 and Right 2 - WEIGHT BEARING DIGITS - Palpated by firm pressure with the thumb along the entire length Injury is related to age, track bend radius and frequency of runs - treatment with plates Carpus - Accessory carpal bone fracture - most common, generally evulsion fractures ○ Different types - most common is type 5 which is the only one surgery cannot fix

Answer 12

- A disorder affecting the normal process of endochondral ossification occurring in growing animals. Locations of osteochondrosis - shoulder, elbow, lumbosacral, stifle, hock Pathogenesis - As vessels from bone marrow anastomose with cartilage canal vessels they are susceptible to microtrauma ○ Microtrauma -> obstruction / necrosis - Cartilage infarct prevents endochondral ossification - Surrounding blood vessels proliferate and try to grow in to the infarcted region. ○ This creates thickening of cartilage adjacent to the region - Thickened cartilage is degenerate, metabolically deprived and susceptible to mechanical stress

Answer 13

Normal endochondral ossification ○ Chondrocytes undergo proliferation, differentiation and calcification. ○ Chondrocytes at metaphyseal vasculature die via apoptosis ○ Osteoclasts remove dead chondrocytes and allow osteoblasts to invade ○ Osteoblasts lay down woven bone Articular cartilage 1. Superficial zone 2. Transitional zone 3. Radial zone 4. Calcified zone - separated via the tide mark

Answer 14

1. Heal - replace by granulation tissue, which is then converted to bone 2. Form subchondral bone cyst 3. Fissure, which extends to joint surface, and creates OCD lesion, creating a flap (osteochondritis dissecans) - THE PROBLEM a. Release of inflammatory mediators leads to synovitis/effusion and clinical signs b. Flaps may become mineralized c. Flaps either remain in situ attached to a pedicle or break off and become free within the joint to create a joint mouse d. Joint mice can enlarge e. If flaps lodge in a synovial recess they may not cause clinical signs

Answer 15

- Focal interruption of the metaphyseal blood supply - Endochondral ossification failure - growth plate ossification failure - Persistent hypertrophic chondrocytes ○ Retained cartilaginous core ○ UAP - ununitedanconeal process ○ IOHC? - incomplete officiation of humoral condyle § Don't unite well -> NOT OFFICIALLY PART OF PATHOGENESIS

Answer 16

1. Heredity: polygenetic trait 2. Nutritional ○ Rapid growth: seen in large/giant breeds ○ Over-feeding ○ Supplementation with Vit. D and Calcium in Great Danes 3. Microtrauma/increased load: always in specific locations - IMPORTANT TO REMEMBER ○ Caudal humeral head ○ Medial humeral condyle ○ Lateral femoral condyle ○ Medial (70%) or lateral trochlear ridge of the talus ○ Lumbosacral joint: Craniodorsal corner of the sacral body(90%) and endplate of L7 (10%)

Answer 17

``` Clinical signs - Signalment ○ Young growing large/giant breed dogs - Lameness and reluctant to walk ○ Can be different in the morning when first waking up - worse - Joint swelling - joint effusion Radiography - Flattening of subchondral bone - Unremarkable in elbows ○ Subtrochlear sclerosis ○ OA in chronic disease - Contrast arthrogram ○ Enhance cartilage surface - Radiograph of contralateral joint ```

Answer 18

Computed tomography - 3D analysis of the joint - good for complex joints such as the elbow - Superior to radiographs ○ Visualisation of the coronoid process in the elbow - Assessment of subchondral bones which cannot be assessed by arthroscopy - The condition of the articular cartilage cannot be assessed Arthroscopy - Cannot assess subchondral bone - Visualisation of articular surface and magnification - Assessment of the articular cartilage (modified Outerbridge scoring system) - Treatment at the same time of diagnosis ○ Debride surface and removal of joint mice

Answer 19

1) conservative management - rest, weight loss, NSAIDS, nutraceuticals (glocosamine) 2) surgical treatment - atrhtrotomy vs arthroscopy, removal of OCD mouse, curettage 3) tissue engineering - resurfacing - osteochondral grafting, stem cell therapy, platelet rich plasma

Answer 20

- Caudal part of the humeral head - ALWAYS ○ May also have elbow issues - Young growing large/giant breed - Unilateral lameness - Radiograph of contralateral joint - 50-70% bilateral lesions - Treatment ○ Conservative treatment § Surgery not always necessary if subclinical ○ Flap excision, currette, microfracture - Prognosis is excellent with surgery ○ Large defect gets benefit of resurfacing - OA (osteoarthritis) progression will occur - TRY TO SLOW IT DOWN

Answer 21

- Lateral femoral condyle - ALWAYS - Prognosis ○ More guarded than shoulder OCD ○ Grafting good option - OA (osteoarthritis) progression

Answer 22

- Medial (70%) or lateral trochlear ridge - Rottweilers are overrepresented - Prognosis -> Guarded - WORST ○ Even surgical debridement doesn't work as well ○ Severe osteoarthritis - Pantarsal arthrodesis in severe cases - Option> -> amputation

Answer 23

Syndrome of multiple diseases - IMPORTANT - Can have multiple diseases occurring at the same time 1. UAP -> ununited anconeal process 2. FMCP (fragmented medial coronoid process) or medial coronoid disease 3. OCD of the medial humeral condyle 4. Elbow incongruity - Medial coronoid disease vs medial compartment disease

Answer 24

``` Elbow dysplasia - Separate ossification centre in large breed - Unite at 20 weeks in GSD ○ Therefore have to wait until after 20 weeks until radiograph - Bilateral in 20-35% - Unknown etiology ○ Genetic trait in German Shepherds - Manifestation of non-articular OCD ```

Answer 25

Diagnosis - Clinical signs - Radiography ○ Flexion of the elbow - CT/arthroscopy for concurrent medial coronoid disease (up to 25%) - Bilateral up to 20-35% Treatment 1. Re-attachment using a screw and K-wire - tricky 2. Removal if chronic or too small fragment 3. Proximal ulnar osteotomy - Prognosis good - OA (osteoarthritis) progression ○ Leads to Residual lameness after the surgery

Answer 26

- 6-18 months of age - Males > females - Bilateral up to 80% Disease in the medial coronoid 1. Microcracks 2. Fissures 3. Fragmentation - then should remove Cartilage 1. Chondromalacia - softening of the cartilage 2. Fibrillation - wavy abnormal shape of articular surface 3. Fissures 4. Erosion

Answer 27

``` Etiology - Similar to those of OCD - Incongruity (incompatibility) ○ Trochlear notch dysplasia ○ Elliptical notch that is mismatched - Proximodistal incongruence: Due to short radius and short ulna - Medial coronoid disease can develop without apparent incongruity Clinical signs - Lameness, muscle atrophy over shoulder - Resting with elbow adducted - Joint effusion - Pain on manipulation of the elbow ○ Hyperextension ○ Supination/pronation - Decreased ROM ```

Answer 28

- Clinical signs - Radiology ○ May be normal ○ Subtrochlear sclerosis ○ Di35M-PrL oblique - CT for subchondral bone - Arthroscopy for articular cartilage START WITH CT SCAN AND THEN DO ARTHROSCOPY - complement each other

Answer 29

``` 1. Conservative management – Rest – NSAIDs – Chondroprotectants – nutraceuticals 2. Surgical management – Arthroscopy vs arthrotomy – Fragment removal – Subtotal coronoidectomy – Curette – Assessment of the articular cartilage status ○ Localised medial coronoid disease ○ Medial compartment disease ○ Bilateral compartment disease ```

Answer 30

``` Elbow dysplasia - Fragment removal ○ Curetage ○ Microfracture - Tissue engineering ○ Not so good in this location - CUE ○ See medial compartment disease - Prognosis fair ```

Answer 31

Elbow dysplasia 1. Proximal ulnar osteotomy for short ulna syndrome (1) 2. Proximal ulnar ostectomy for short radius syndrome (2) 1. medial compartment disease 2. bilateral compartment disease (terminal elbow disease)

Answer 32

- Medial aspect of the articular cartilage erosion of the elbow joint ○ Exposure of the subchondral bone - Terminal disease of the medial compartment ○ Medial coronoid disease ○ OCD ○ Elbow incongruity ○ Kissing lesion

Answer 33

- HAS TO TREATED SURGICALLY 1. BURP 2. PAUL 3. SHO 4. BODPUO 5. Resurfacing procedure

Answer 34

Medial compartment disease 1. BURP - Transection of the biceps ulnar insertion - Unknown outcome 2. PAUL - Less aggressive than SHO - need to cut the ulna - Clinically well - Little evidence 3. SHO - Changes geometry of the humerus - Works well - Aggressive, high complication rate - not done too much

Answer 35

4. BODPUO - Releasing pressure from the medial coronoid - Maintaining more physiologic congruity 5. Resurfacing procedure - Osteochondral grafting - CUE - Relatively easy compared to total elbow replacement - Clinically good result - No long term outcome - rare procedure

Answer 36

- Salvage procedure ○ Total elbow replacement ○ Arthrodesis ○ Amputation - issue when diseases in multiple limbs

Answer 37

- Lateral and medial parts of the humeral condyle not ossified - Spaniel breeds are overrepresented - Often bilateral - Radiographs vs CT ○ Radiograph - superimposed so do CT - Prophylactic screw placement - can do as prevention ○ The management is more challenging after fracture develops

Answer 38

- Young puppies (5-27 weeks) - May get hyperflexion or hyperextension - History often includes poor nutrition (over-supplementation, inappropriate diet) or inadequate exercise on slippery surfaces - Treatment: improve diet, increased, controlled exercise on grippy surfaces - Prognosis good: dogs typically recover within 1-4 weeks - Splinting reported but no evidence it results in superior outcome and risk of coaptation complications

Answer 39

``` YOUNG ANIMALS - Most common in antebrachium ○ Less in crus, distal humerus or femur Cause 1. Due to physeal injury ○ Conical shape of the distal ulnar physis susceptible to any directional force 2. heritability 3. retained cartilaginous core Pathogenesis - asynchronous growth of paried bones (radius and ulna), external rotation of he carpus, incongruity of carpus and elbow joint ```

Answer 40

``` Diagnosis 1. Clinical signs 2. Radiography ○ Rotation and abnormalities 3. CT ○ Rotation and abnormalities ○ Disruption of the lengths 4. 3D printing Surgery - In young animals with remaining growth potential 1. Distal ulnar osteotomy - cut out part of the ulnar ○ Less invasive ○ May require another surgery to correct limb deformity 2. CORA methodology 3. Acute correction with closing wedge ○ Plate/screws or hybrid/circular ESF 4. Gradual correction with opening wedge ○ CESF with linear motors Other treatment - Addressing to elbow incongruity - AS ABOVE ○ Proximal ulnar osteotomy for short ulna ○ Ulnar ostectomy for short radius ```

Answer 41

``` YOUNG ANIMALS Etiology - Unknown - Multifactorial 1. Genetics ○ Complex, polygenetic trait ○ Subluxation is heritable, risk of OA (osteoarthritis) 2. Environmental ○ Exogenous estrogen (maternal milk) ○ Exercise 3. Nutritional ○ Feeding quality and quantity ○ Obesity Pathogenesis 1. Subluxation - high mobility 2. Synovitis 3. Erosion of subchondral bone 4. Pain ```

Answer 42

- Predominantly large/giant breed dogs - Small breed dogs and cats can be affected - Bunny hopping, spinal sway - Reluctant to run, jump, or climbing stairs - Muscle atrophy of the affected pelvic limb - Bimodal clinical signs - two phases -> acute and chronic ○ Due to laxity/subluxation and synovitis, lame 3-12 moths of age ○ Periarticular fibrosis can make the joint more stable, reducing subluxation and resolving the lameness ○ Long term, progression of OA can lead to lameness/poor hindlimb function - Usually bilateral but can be unilateral

Answer 43

subluxation - doesn't always lead to hip dysplasia - Clinical signs - Palpable click during walk - severe subluxation - Pain on manipulation (hyperextension) of the hip - Muscle atrophy - Orthopaedic tests a. Lordosis test b. Ortolani (and Barlow) maneuver § Two parts □ Barlow - subluxation when abduct □ Ortolani - moving back -> clunk back into place § If severe fibrosis and osteochondrosis then will not feel this § Important to determine stage of the disease c. Bardens test § Hip joint parallel to the ground and pull up femur § Observing how much subluxation is present

Answer 44

- Management of OA - Weight loss - MOST IMPORTANT - Life style modification - not running around on the beach, throwing of ball - Physiotherapy/hydrotherapy - NSAIDs - also important - Disease modifying agents / nutraceuticals (more detail in cruciate disease) preventative surgery

Answer 45

1. Juvenile pubic symphysiodesis (JPS) ○ Arrest the growth of the pubic symphysis ○ Limited to up to 16 weeks of age § At this age will not diagnose hip dysplasia BUT if high risk breed and subluxation possible elective surgery ○ The subluxation continues until sufficient rotation is achieved 2. Double and triple pelvic osteotomy (DPO and TPO) ○ Requirements: § No OA 0 if remodelling starting should not do § Up to 10 month of age § Angle of subluxation <10 degrees - don't need to remember specific numbers § Angle of reduction <30 degrees § Extreme subluxation of hips is not suitable 3. DPO ○ Transection of the ilium and pubis 4. TPO ○ Transection of the ilium, pubis, and ischium

Answer 46

- If refractory to medical management 1. Excisional arthroplasty (femoral head and neck excision) § Able to do in general practice 2. Total hip replacement § Expensive, great outcome however can get surgery complications

Answer 47

- Higher prevalence in Maine Coons, Himalayans and Persians - Often an incidental finding - See subluxation on radiographs - Degenerative changes typically affected the craniodorsal acetabular margin - Unlike dogs, the femoral head and neck are minimally affected. - Treatment options are the same as for dogs but greater likelihood of success with conservative management

Answer 48

Pathogenesis - Cause unknown - Vascular compression - Proven heritable in Manchester terriers - Infarction of epiphyseal and metaphyseal bone leading to bone necrosis and collapse of subchondral bone plate - Deformation of the femoral head and thickening of the articular cartilage. - Changes are more pounced epiphyseal region Signalment - Occurs in young dogs, usually 4-11 months of age - Especially small dogs/terriers - Typically unilateral but can be bilateral (10-15%) - do surgery on one leg and in the future uncommon but may need to do the other

Answer 49

Clinical signs - Dogs usually present with a chronic progressive lameness Radiograph - Radiolucent areas in the femoral head - Increased width of joint space, thickening of femoral neck - Deformation of the femoral head - OA in chronic cases Treatment 1. Conservative management may help, but usually surgery is required 2. Surgery ○ FHNE (Excisional arthroplasty (femoral head and neck excision)) or THR (total hip replacement) ○ Prognosis is usually good, depending on the remaining muscle mass

Answer 50

- Common in small bred dogs and cats Clinical signs - Can vary up to stage 5 lameness Pathogenesis 1. Coxa vara - deformity of the hip where angle of the head and shaft of femur is reduced 2. Genu varum - lower leg is angles inward in relation to femur 3. External rotation of the distal femur 4. Poorly developed medial ridge of the tibia 5. Internal rotation of the tibial tuberosity 6. Internal torsion of the proximal tibia, external torsion of the distal tibia 7. Internal rotation of the foot

Answer 51

- Hypoplastic medial trochlear ridge - trochlea slides down as cannot - Loose stifle joint with redundant soft tissue - Often bilateral - Medial patella luxation is much more common than lateral - Sudden worsening of lameness in dogs with patella luxation is often due to: ○ Full thickness cartilage wear on the patella - ulceration of the cartilage - need to explore joint ○ CCL rupture - cranial cruciate ligament - Patella alta - abnormally high patellar ○ Not significant in toy breeds, but important in medium to large breeds

Answer 52

``` IMPORTANT • Grade 1: - Patella normally in groove - Luxates intermittently - Can be luxated by manipulation but spontaneously pops back into the groove • Grade 2: - Patella normally in groove - Luxates intermittently - Can be luxated by manipulation and stays luxated - Manipulation can return it to the groove • Grade 3: - Patella permanently luxated - Can be manipulated back into groove • Grade 4: - Patella permanently luxated - Cannot be manipulated back into groove ```

Answer 53

- Patella tracking should be assessed in the following way: ○ Assess the relative positions of the patella within the trochlear groove and the tibial tuberosity - AND GRADE ○ By palpating patella while medial/lateral pressure & int/ext rotation is applied ○ Examination under sedation results in worse result ○ Conscious examination with normal muscle tone is optimal - Radiography/CT - osteochondritis, osteophytes ○ Ruling in and out differentials ○ CT may be needed for information for surgery - Assess for femoral/tibial deformity Conservative management - Exercise/life style modification - NSAIDs - Physiotherapy / hydrotherapy

Answer 54

1) Soft tissue techniques a. Imblication § Tightening of the joint b. Medial desmotomy § Medial releasing incision at the medial joint capsule and retinaculum c. Seldom works alone well § Likely fail without realignment of the quadriceps-patellar axis - Need to combine with bone techniques 2) Surgery a. Tibial tuberosity transposition § Align the quadricepspatellar axis by moving the tuberosity § Two Kirschner wires +/- tension band wire b. Wedge trochleoplasty § The proximal part of the wedge does not create sufficient depth to support the patella - DO NOT PERFORM c. Rectangular block trochleoplasty - best one § Preservation of superior articular cartilage surface § Proximal trochlear groove is effectively deepened

Answer 55

- 8-10 weeks controlled exercise - Failure of resolution of lameness can be due to: ○ Implant failure ○ Postoperative infection ○ Recurrence of luxation ○ Luxation in the opposite direction ○ Retropatellar cartilage ulceration ○ Cruciate rupture

Answer 56

``` bone inflammation Pathogenesis - Cause unknown - Mainly large and giant breeds (GSD, Labrador) - Presentation between 5-12 months Clinical signs: - Shifting lameness (different bones may be affected at different times) - Pain on long bone palpation - Waxing and waning in severity ```

Answer 57

Radiographic findings: - ‘thumb-print’ shaped foci of increased medullary opacity severe Treatment: - Rest and NSAID’s - to help with the pain Prognosis - Self-limiting - Excellent

Answer 58

- Fracture:- Medullary circulation disrupted -> leads to fracture haematoma -> has good nutrients so don't want to disrupt 1) direct bone healing - no callus formation, anatomical alignment and absolute stability a. Primary osteonal reconstruction: i. Contact healing - cortical bone contact ii. Gap healing: gap needs to be < 1mm. And IFS< 2%. b. Secondary osteonal reconstruction: § Too much strain for primary § Resorption and callus reduce strain 2) indirect bone healing - too large a gap or too much instability = callus formation

Answer 59

1. Inflammatory: 2. Soft Callus: - granulation tissue - 100% strain 3. Hard callus - fibrocartilage and fibrous tissue - 10% strain § Mineralisation of the soft callus occurs: § This limits deformation § Endochondral ossification then occurs 4. Remodelling - bone - 2% strain

Answer 60

``` High energy: - Massive increase in energy absorbed - Comminution, ST damage - Gunshot - Road traffic accident Low energy: - Normal activity - Jumping from furniture ```

Answer 61

1) Weight bearing creates a ground reaction force ○ This creates bending, compressive and rotational moments on the bone - Front legs -> generally 60% of weight bearing normally 2) Muscle contraction creates tension and rotation -> where muscle attaches is important on where fracture occurs - Types ○ Bending, compressive, rotational (torsional), shear (combination of rotation and compression) Anisotropic property - Bone is anisotropic: ○ Stronger when loaded longitudinally vs transversely ○ Stronger in compression vs tension

Answer 62

- Most bones are not loaded in pure compression ○ If bones loaded concentrically get pure compression ○ If bones loaded eccentrically (e.g. humerus, femur) compression and bending § More load on medial surface, fractures often open at tension side - If bone is curved: ○ compression converted to bending ○ tensile stress on convex side ○ compressive stress concave side - Tension/compression side to bone

Answer 63

PLATE BEST APPLIED TO TENSION SIDE - decrease risk of failure (strongest in tension) ○ Radius: cranial ○ Ulna: caudal ○ Femur, tibia, humerus: craniolateral

Answer 64

- Caused by muscle contraction -> things being pulled apart - Tibia ltuberosity, olecranon, calcaneus, greater trochanter (mm attachment sites) - Net resultant force is compression

Answer 65

- Stress = force/cross sectional area - Strain = Δ length (after applied load) / length - Inter-fragmentary strain = Δ L/L ○ where L = length of fracture gap (after repair and before loading) - So if ΔL = 2mm and L: ○ = 20mm, IFS = 10% -> small change relative to a large area -> LOW STRAIN § Indirect bone healing, heal faster in low strain environment -> not bad to increase fracture length ○ = 2mm, IFS = 100% -> small change relative to a small area -> HIGH STRAIN

Answer 66

1. Mechanical factors (stress applied to implants): 2. Biological factors (how long for callus?): 3. Patient/owner factors (stress applied to implants): - Scored 1-10 for each category, high scores favourable

Answer 67

1) Nature of fracture - Traumatic, Stress - Pathologic - bone neoplasia, primary or secondary 2) Energy level of trauma - low energy (eg. non-displaced fracture) - high energy (eg. comminutedfracture) - very high energy (eg. gunshot injury) 3) Completeness - Complete - all of the corticoices on both views disrupted - Incomplete - not all the cortices disrupted 4) Number of fracture lines - Simple, Multiple, Comminuted, Segmental 5) Direction of Fracture Lines - Oblique, Spiral, Transverse - Fissure, Avulsion, Depressed - skull fractures - “T” and “Y” fractures - distal humerus 6) Location of fracture - Diaphyseal - proximal, distal or mid third - Metaphyseal, Epiphyseal - Articular, 7) Relationship of fracture fragments – - describe the location of major distal fragment relative to the proximal - Degree of end-to-end apposition - Alignment, angulation, rotation, Limb/bone shortening, Luxations 8) Soft tissue injury - Closed - Open

Answer 68

○ gas opacity in soft tissues, ○ bone fragments protruding through skin, and radiopaque debris within soft tissue ○ interposition of soft tissue ○ Types § 1 -> soft tissue mildly confused, small wound from bone fragments § 2 -> more severe, larger size, not extensive soft tissue, external wound possible bone out § 3 -> extensive soft tissue damage - shearing injury (Car accidents), loss of soft tissue, bone, tendons and possible nerve damage

Answer 69

1) carpenters approach - complete anatomical reconstruction, need rigid stability: internal fixation - extensive dissection can be required - loss of extra-osseous blood supply - Indications: simple or three piece fractures or minor comminution 2) Gardeners approach - preservation of extraosseous blood supply - perfect reduction in NOT the goal - Indications: comminuted fractures

Answer 70

1. Fracture reduction to restore anatomical relationships 2. Stability by fixation or splintageas the personality of the fracture or injury requires 3. Preservation of the blood supply to soft tissues and bone by careful handling and gentle reduction techniques. 4. Early and safe mobilisation of the affected limb and patient

Answer 71

``` - External coaptation can be used as: ○ Primary method of immobilisation ○ Temporary immobilisation ○ Adjunctive support/immobilisation ○ To prevent weight bearing - Only good at preventing BENDING - Can potentially reduce ROTATIONAL forces but only if the joint above and below the fracture are immobilised (easier for distal fractures) - CANNOT prevent AXIAL COMPRESSION and shear - CANNOT prevent TENSION ```

Answer 72

1. ROBERT JONES BANDAGE a. Good for temporary support b. Very bulky: creates compression without focal pressure 2. MODIFIED ROBERT JONES BANDAGE a. Useful to limit soft tissue swelling b. Not sufficient for fractures

Answer 73

AD 1) cheap initially but need revisits, hospitalisation, material, sedation 2) no disruption to extra-osseous blood supply 3) reduced risk of infection.osteomyelitis DIS 1) aftercare intensive and expensive 2) fracture disease 3) hard to move around in and bandage related complications - pressure sore, vascular obstruction, moist dermatitis

Answer 74

EARLY RECOGNITION IS VITAL - Change in shape of the splint or cast on the limb. - Excessive chewing of the splint or cast by the animal. - Any sign of excessive discomfort. - Any unusual/bad odours - Unexplained soiling /strikethrough - Skin sores - Swelling of the toes, or the leg above the splint. - Systemic signs

Answer 75

INDIC - some metapodial/phalangeal fractures - SOME long bone fractures below elbow and stigle CONTRA - humeral and femoral fractures (Above the elbow or stifle) - articular fracture or significant force - open fracture or multiple injuries affecting more than 1 limb

Answer 76

1) reinforced modified robert jones bandage - provides superior immonilisation 2) full cylinder cast - most rigid form 3) preformed splints - not custom to dogs leg temporary only 4) spica splints - fit to dogs limb 5) velpeau sling - prevents weight-bearing 6) ehmer sling - prevents weight bearing just not in coxofemoral luxation