Dog and Cat 8 Flashcards
Carpus arthrodesis how common, indications and what need to identify beforehand
- Most frequently arthrodesed joint • Indications: - Carpal hyperextension injury - high-rise syndrome - Joint luxation - Chronic, severe OA • Identify the LEVEL of injury - Palpation - Stress Radiography • Identify concurrent injury: - Collateral ligaments - Metacarpal fracture
Pancarpal arthrodesis what use
- plate fixation
- ESF
- Cross pinning (small animals only)
- THEN at least 8 weeks of a cast or splint
• Evolution of implant design: - DCP (dynamic compression plate) -> Hybrid -> Castless PCA
- Compression holes
Partial carpal arthrodesis what involved and why and the 2 main techniques used
- 80% of carpal motion at antebrachiocarpal joint
- Partial carpal arthrodesis – fusion of intercarpal and carpo- metacarpal joint
- Ensure no involvement of the antebrachiocarpal joint (difficult)
- Cats requirement for supination?
• Techniques: - Plate Fixation - T plate
- Pins (Very small animals only)
Stifle athrodesis indications and technique
• Indications: - Severe degenerative joint disease: - Intra-articular fractures - OCD - Instability from collateral or multiple ligament injury • Technique: - Plate fixation (pin techniques in small animals) - Maximise bone contact area by removal of intra-articular structures: ○ Cranial & Caudal Cruciates ○ Menisci - Long Lever arms – bone fracture - Compression
Stifle arhrodesis complications
1) Implant failure: ○ Insufficient bone contact ○ Cycling 2) Fracture: ○ Long Lever Arms ○ Plate Span 3) Infection: ○ Strict asepsis Consequences - implant removal
Hock arthrodesis how common, indications and what need to idetnfiy
• Indications: - Severe degenerative joint disease: - OCD - Joint Instability - Shearing Injury - Calcanean Tendinopathy - Hyperextension Injury • Identify LEVEL of injury: - Palpation - Stress Radiography • Identify concurrent injury
Hock arthrodesis technqiues and complications
Techniques: - Plate fixation (Cranial vs Medial) -> medial - ESF - Pin and Tension Band Wire - Pantarsal vs Partial Tarsal Arthrodesis: ○ Calcaneoquartal ○ Tarso-metatarsal • Complications - Plantar necrosis
Total hip replacement indications, outcome and complications
Indications:
- Severe degenerative joint disease (CHD) -> due to hip dysplasia
- Fractures of the femoral head/neck
- Salvage following acetabular fracture repair
- Avascular necrosis of the femoral head
- CONSIDERED - gold standard
Outcomes
- Good to excellent outcomes in 80-98% cases
Complications:
- Coxo-femoral Luxation - can revise the surgery and change the head size
- Sciatic neuropraxia
- Aseptic loosening
- Infection - require removal
Total hip replacement what are the 2 main techniques what provides stability
- Cemented:
- Polymethylmethacrylate - cohesive interface btn implant and bone
- Good early stability
- Aseptic loosening:
○ Enzymatic osteolysis
○ Cytokine induction of osteoclasts - > Bone Resorption - Uncemented:
- Press-fit or monocortical screws (early stability)
- Meticulous preparation
- Osseous integration with micro-interlock (Late stability)
Elbow total replacement indications, 2 techniques and 4 complications
Indications: - Severe bi-compartmental disease: - OCD - Coronoid process disease - Not luxation • Techniques - Lowa - TATE • Complications: - may result in amputation or arthrodesis 1. •Fracture 2. • Luxation 3. • Persistent lameness 4. • Infection
Stifle total replacement indications and complications
• Indications: - End-Stage OA: ○ OCD ○ Cruciate disease - Combination System: ○ Press-fit Femoral component ○ Cemented Tibial component • Complications: - Luxation - Infection - Aseptic loosening
Stifle total replacement outcomes
- Improved ROM - RANGE OF MOTION
- Improved objective functional data:
○ PVF 80% normal contralateral
○ Impulse 90% normal contralateral
Femoral head and neck excisional arthroplasty indications
- Fractures of the femoral neck or head
- Slipped capital physis (cats)
- Avascular necrosis of the femoral head (dogs)
- Chronic coxofemoral luxation
- Failed total hip arthroplasty
- Severe OA secondary to CHD & not palliated by medical management)
Femoral head and neck excisional arthroplasty technique and what equipment used and what done at the end
- Craniolateral approach to the hip joint
- Disarticulation if required
- External rotation of the femur
- Parallel to sagittal plane of neck:
○ Prevent caudal spur formation - limits the range of motion
1. • Oscilating Saw (preferred)
2. • Gigli Wire
3. • Osteotome & Mallet - Check cut surface of proximal femur before you close -> need to ensure take whole neck out
4. Rasp if spur present
5. Post-operative radiograph - to ensure you take enough
Femoral head and neck excisional arhtroplasty what are the 7 complications
- Infection
- Seroma
- Persistent lameness (leg shortening)
- Muscle atrophy
- Decreased ROM (extension and abduction)
- Patellar luxation
- Sciatic neuropathy
Femoral head and neck excisional biopsy outcome and how modified
- Never return to normal function based on PVF (PEAK VERTICAL FORCE) and impulse.
- Modified by:
○ Surgical technique (failure to remove all femoral neck)
○ Duration of clinical signs (muscle atrophy)
○ Age (immature vs mature)
○ Post-operative care (physiotherapy)
○ Body weight/condition
• Published outcomes: - Largely subjective
- Acceptable function
Excision arthroplasty of the glenoid when used, indications and outcomes
- Salvage for severe OA of the glenohumeral joint in small dogs
• Indications: - Glenoid dysplasia
- Chronic shoulder luxation
• Acceptable outcomes in limited numbers of cases in small dogs
Intraoesseous transcutaneous amputation prosthesis what are they, used for and complications
- Osseous and dermal integration of implants – robust prosthetic integration
- Partial amputation
• Complications: - Infection
- Epidermal ingrowth
- Marsupialisation
- Peri-prosthetic fracture
Oncologic limb sparing 2 main indications what is involved
• Indications: - Neoplasia of the extermities (OSA) - Distal radius • The affected bone is resected with appropriate margins (3cm) • Antebrachiocarpal disarticulation • Replacement of the missing segment: - Cortical allograft (bone bank) - Metal endoprosthesis - Ulnar rollover - Bone transport osteogenesis
Axial skeleton disease what commonly lead to and conditions involved
- Diseases that affect the axial skeleton frequently cause dysfunction of the bone or nervous system (brain and spinal cord)
- These conditions include congenital malformation, neoplasia, infection, and trauma resulting in fracture / luxation.
Congenital malformation and neoplasia of axial skeleton what involved
- Congenital malformation
- Atlantoaxial luxation/subluxation
- Cervical vertebral malformation (Wobbler) -
stenosis - Neoplasia
- Oral and skull neoplasia (MLOs)
- Primary and metastatic neoplasia of vertebral body
Infection of axial skeleton what called, common infection, how arrive, what leads to
Discospondylytis
- Infection in vertebral endplates
- Most commonly bacterial infection but can be fungal infection
- Haematogenous spread -> from urinary tract infection
- Lumbosacral disc space
- Loss of structural stability of the vertebrae and impingement of the spinal cord causing pain and neurological dysfunction
Instability/degeneration/trauma of oxial skeleton what are the 3 main diseases and what result in
1) Vertebral fracture / luxation
○ Severe trauma results in unstable vertebral column and varying degrees of spinal cord compromise
○ Can result in complete core transection -> BAD
2) Lumbosacral disease / instability
○ Can lead to budging of the disc - putting pressure on nerve
§ Lumbosacral pain and ataxia can result
3) Intervertebral disc disease
Musculoskeletal neoplasia what is the most common form and some other causes
- The most common form of primary bone cancer (85% of all cases) in dogs and cats is osteosarcoma (OSA).
- Other types of primary bone cancer
○ Chondrosarcoma
○ Fibrosarcoma
○ Haemangiosarcoma - Metastatic (secondary) neoplasia of the bone is less common in companion animals than it is in people.