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SA Surgery > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Pre-operative Assessment of Ortho Patients

A

EVERY orthopedic patient requires
o a complete physical exam

o orthopedic exam

o neurological assessment

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2
Q

Pre-operative Management of Ortho Patients

A

o IV fluids
o Analgesia
o Opioids
o NSAIDs (avoid until hydrated)
o CBC/Chem
o UA
o Rads of affected area
o Ultrasound (if trauma)

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3
Q

Pre-op Antibiotics

A

o Staph & E. coli are most common bacteria in surgical wound
o Must give Ab 30-60 mins before surgery

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4
Q

Bandages & Splints for Leg Fractures

A

Fractures below the elbow and stifle are best coapted with
* Robert Jones,
* splint
* cast 


Fractures above the elbow or stifle, IF COAPTED, are best stabilized using
* spica splint 


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5
Q

Soft padded bandage Vs Modified Robert Jones Vs Robert Jones

A

Soft padded bandage
* Cover wounds or abrasions
* Post-surgery for incision protection

Modified Robert Jones
* Post-surgery
* Control edema & swelling
* Cover wounds & abrasions

Robert Jones
* Temporary fracture stabilization below elbow or knee
* Controls edema & swelling

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6
Q

Splint/Cast Vs Spica Splint

A

Splint/Cast
* Temporary fracture stabilization, below the elbow or stifle 

* Post-surgery stabilization 

* Permanent stabilization (cast or splint) 


Spica Splint
* Fracture stabilization above the elbow/stifle

* Lateral shoulder luxation
* Elbow luxation

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7
Q

Ehmer Sling Vs Velpeau Sling

A

Ehmer
* Pelvic limb
* Craniodorsal hip luxation 

* Support of acetabular fracture (post- surgery) 


Velpeau
* Thoracic limb
* Medial shoulder luxation
* Scapular fracture

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8
Q

Order of Fracture Description

A

o Open vs closed
o Salter-Harris
o Orientation
o Location w/in bone
o Bone & side
o Displacement

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9
Q

Open Fractures; what are they, grading

A

o Open wounds communicating w/ fracture
o May see air or gas on rads

Grade 1
* Bone penetrates thru skin but covered by soft tissue
* Minimal soft tissue trauma

Grade 2
* Soft tissue trauma over fracture -> bone exposed

Grade 3
* Severe bone fragmentation
* extensive soft tissue injury, with or without skin loss

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10
Q

Salter-Harris Classifications

A

SALTER – Separated – Above – Lower – Through Everything – Rammed

I
* Physis

II
* Physis & some into long bone

III
* Physis & into epiphysis

IV
* Through epiphysis, physis, & long bone

V
* Physis crushed into long bone

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11
Q

Orientation of Fracture

A

Transverse
* Horizontal line through bone

Oblique
* Diagonal line through bone

Spiral
* Almost like a ribbon wrapped around the bone

Comminuted, reducible
* Two breaks that cause one separate chunk of bone

Comminuted, non-reducible
* Many chunks of bone

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12
Q

Describe Displacement of Fracture

A

movement of distal aspect of distal fragment from proximal fragment

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13
Q

Post-op Follow-up Assessment

A

Alignment
* Look at joint above & below

Apposition
* Are fracture fragments apposed
* Must overlap at least 50%

Apparatus
* What apparatus did you use
* Is it working
* Is there anything you would change

Activity
* How is the fx healing
* Is the healing appropriate

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14
Q

Fixation & Forces they Neutralize

A

Cast
* Bending
* Some rotational

IM pin
* Bending

Cerclage Wire
* Torsion

Plate, External Fixator, & Interlocking Nail
* Bending
* Axial compression
* Torsion

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15
Q

Fracture Assessment Score

A

High
* fracture that allows immediate load bearing and enhanced healing
* young dog, simple fx

Moderate
* Older dog w/ transverse fracture
* Load sharing or delayed healing
* Young dog w/ non-reducible fracture

Low
* Non-reducible fx in older dog
* Compromised healing
* Fixation must be VERY rigid & maintained for >6wks

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16
Q

Closed Reduction

A

o Preserve soft tissue and blood supply
o Decrease risk of infection
o Reduce surgery time

Cast
* Nondisplaced long bone,
* fractures below elbow and stifle

External Fixator
* Comminuted nonreducible diaphyseal fx of long bones
* open but do not touch

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17
Q

Open Reduction

A

o Visualization and direct contact
o Ideally minimal manipulation of fracture fragments
o Direct placement of implants
o Direct manipulation
o Placement of bone graft
o Articular fx
o Comminuted nonreducible diaphyseal fx of long bones
o IM pin/locking plate

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18
Q

Direct Vs Indirect Reduction

A

Direct
* Use tools to place bones back into correct position

Indirect
* Suspend fracture limb to help bones align on own
* Place IM pin through bone to allow pieces to align

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19
Q

Definition & Example Bone Grafts; Osteogenesis, Osteoinduction, Osteoconduction, Osteointigration

A

Osteogenesis
* New bone development and support. Osteoblasts.
* cancellous autograft

Osteoinduction
* Ability to induce migration and differentiation from mesenchymal stem cells into osteoblasts
* demineralized bone matrix (bone morphogenic proteins)

Osteoconduction
* Ability of a material to provide a scaffold for host bone invasion
* cortical allograft

Osteointegration
* Surface bonding between graft and host bone

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20
Q

Where to Source Autogenous Cancellous Bone

A

o Proximal humerus
o Proximal tibia
o ilium

Now replaced w/ demineralized bone matrix

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21
Q

Definitive Stabilization; Types, Reasons to Use, Monitoring

A

Types
* Bi-valve cast
* Maybe splint

Reasons to use
* Neutralize bending & rotational forces in minimally displaced fx
* Axial compression
* Should have a high overall fracture score

Monitoring
* Evaluate in 24 hours then every 7-10 days
* Monitor for pressure sores and abrasions
* Monitor toes
* Foul Smell
* Cast must be changed if change in limb use
* Young growing dog, fiberglass will need to be changed 1-2 weeks
* Bandage care instructions to owner

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22
Q

Definitive Stabilization; Pros & Cons

A

Advantages
* Cheap
* Little equipment needed
* Noninvasive

Cons
* Limited use of the limb -> muscle atrophy 

* Loss of range of motion in constrained joints 

* Not overly rigid- may delay healing or may not heal 

* Doesn’t neutralize all forces 

* Wound management is 
difficult 

* Costs of bandage changes

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23
Q

External Fixation; Pros & Cons

A

Pros
* Allows rigid fixation with minimal invasion 

* Adjustable and versatile 

* Leaves wounds accessible 

* Can maintain limb length 

* Gradual increase of load bearing 

* Minimal inventory, minimal instrumentation 


Cons
* Need client buy in 

* Pin and pin tract management 

* Pin tract discharge normal but often mistaken for infection
* Infection does occur 

* Frame management 

* Fracture through pin tract

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24
Q

External Fixation; Indications, Pin Placement, Post-op Care

A

Indications
* Primary fracture fixation
* Adjunct stabilization

* Corrective osteotomy

* Limb lengthening
* Open and infected fractures
* Trans-articular stabilization
* Delayed or non-union
* Avian fractures

Pin Placement
* Pin diameter <25% bone diameter
* No closer than1-2cm from fracture line
* No need to angle threaded pins
* If using smooth pins angle 70 degrees from long axis of thebone
* Minimum 2 pins per segment
* Maximum 4 pins per segment
* Span the entire bone

Post-op care
* Clean pin-skin interfaces ->
* Pack w/ gauze/sponges ->
* Full bandage immediately ->
* Bumper bandage 3-4d post op

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25
Q

“Tie-in”

A
  • External fixation tying into intramedullary pin
  • Aid in reduction
  • Control bending
  • Aid rigidity
  • Humeral & femoral fxs
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26
Q

Free Form & Hybrid External Skeletal Fixation

A

Free Form External Fixator
o Use Epoxy resin or methyl methacrylate 

o Can be used to replace the whole connecting 
bar 

o Or just replace the clamps 

o Cheaper than commercial clamps and connecting bars 

o Particularly useful if don’t use ESF very often 

o Just need threaded pins for fixation 


Hybrid External Skeletal Fixation
o Combine linear & circular
o Fractures w/ short juxta articular bone segment
o Can be used on radius, tibia, humerus, & femur

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27
Q

Goals of Internal Fixation

A

o Adequate reduction
o Rigid fixation
o Early active motion & weight bearing

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28
Q

Implant Characteristics

A

o Biocompatible
o Resist corrosion
o Same alloy to prevent corrosion when implants are mixed
o 316L stainless steel
o Never reuse

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29
Q

Intramedullary Pin Types

A

Steinmann pins
* most common in vet med
* Range in size from 1/16 to 1⁄4 inch
* Used for diaphyseal fractures
* Humerus, femur, tibia, metatarsals and metacarpals
* Contraindicated for the radius because pin insertion interferes with the carpus and elbow

Kirschner wires (K-wires)
* range in size from 0.035 to 0.062-inch
* can be used as cross pins to stabilize metaphyseal and physeal fractures in young animals

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30
Q

Pros & Cons of IM Pins

A

Pros
* Resist applied bending loads

Cons
* Poor resistance to axial & rotational loads
* Lack of fixation (don’t interlock w/ bone)
* Should be combined w/ something else to negate these cons

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31
Q

IM Pins; What to combine with, pin size

A

Combine with:
* Cerclage wire
* Plates
* External fixators
* Cross-pins

Pin Size
* 70% of diameter of medullary canal if used with cerclage wires
* 30-40% of diameter of medullary canal if used with a plate or external fixator

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32
Q

Interlocking Nails

A
  • Medium cheap
  • Inserted in medullary canal
  • locked into place using screws or cross-locking bolts placed in the proximal and distal fragments at least 2 cm from the fracture line
  • Interlocking nails resist all types of forces placed on the fracture.
  • Humeral, femoral and tibial fractures.
  • Contraindicated for radial fractures
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33
Q

Orthopedic Wire

A

o Anatomically reconstruct long oblique or spiral fractures.
o Length of the fracture line should be two to three times the diameter of the medullary cavity
o Max of two fracture lines
o The fracture must be anatomically reduced
o Cerclage wire is always supplemented by additional implants (IM pins, ex fix, plate)

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34
Q

Tension Bands

A

o Used to neutralize tension when it is the predominant force.
o Avulsion fractures (groups of muscle originate or insert on bone)
o Tension bands convert the distraction of tensile forces into compressive forces.

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35
Q

Bone Plates & Screws; Use

A
  • Can stabilize any type of long bone fracture
  • Fractures of the axial skeleton
  • Imperative for fractures of the joint surface
  • Provide postoperative comfort and early limb use.
  • Used to treat animals with a high, medium and low fracture-assessment score
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36
Q

Screw Types

A

Plate
* Anchor a plate to bone

Positional
* Hold bone fragments in anatomical position

Lag or Compression
* Compress 2 bone fragments

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37
Q

Lag Screw; Use & Method

A

Use
* Used to compress fragments
* Articular fractures

* Oblique fractures

* Spiral fractures

Method
* Over drill the near cortex
->
* Drill the far cortex
->
* Screw slides through near cortex ->
* Pulls far cortex into compression

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38
Q

Bone Plates Sizes & Holes

A
  • Plate length is designated by the number of screw holes
  • Plate size is determined by the cortical screw that the plate hole will accept

Hole configuration
* Round hole (Veterinary Cuttable Plate)
* Oblong hole (Dynamic Compression Plate, DCP)

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39
Q

Method for Applying Bone Plates

A
  • Select a plate that spans the bone length for diaphyseal fractures. ->
  • Accurately contour the plate. ->
  • Place a minimum of three bicortical screws, or secure six cortices above and below the fracture. ->
  • Use a longer and stronger plate as a bridging plate or augment it with an IM pin
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40
Q

Reasons to Use Locking Pins

A
  • Screw head locks into the plate
  • Locking mechanism between the screw and plates provides fracture fixation
  • Contouring unnecessary
  • Neutral position, no stress on the bone
  • Increase construct yield strength
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41
Q

Method for Applying Locking Screws

A
  • Locking screws must be perpendicular to the plate.
  • Reduce the fracture before locking screws are tightened.
  • Use a longer plate with fewer screws.
  • Ideally you fill 50% of the plate holes in each fragment
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42
Q

Blood & Nerve Supply of Bone; Normal Vs Fracture

A

Normal
 Long bone afferent nerve
 Nutrient artery
 Proximal & distal metaphyseal arteries
 Periosteal arteries

Fracture
 Medullary supply disrupted
 Metaphyseal vessels enhanced
 Extraosseus vasculature comes in to play
 Closed reduction will have least amount of disruption
 Stable implants allow new medullary circulation

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43
Q

Direction of Blood Flow in Bone; Normal Vs Fracture

A

Normal
 Centrifugal
 Medullary canal to periosteum

Fracture
 Centripetal
 From surrounding soft tissue

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44
Q

When to take Rads for Fracture Healing

A

o Post operative
o 2-8wks post
o 10, 12, or 16wks post
o 1wk for every month of age up to 6mo

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45
Q

Strain

A

o Change in gap width / total gap width
o Decreases w/ increased fracture rigidity
o Fracture first bridge by tolerant tissue but becomes less tolerant to strain over time

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46
Q

Intramembranous Bone Healing

A

o Type of direct bone healing
o Differentiation of mesenchymal cells into osteoblasts
o Can occur with up to 5% strain
o Bone is deposited directly on bone away from the fracture site
o Combined with indirect bone healing

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47
Q

Delayed Union; What? Reasons

A

o Slow healing than anticipated
o Progressive signs of bone activity visible on rads

Reasons
 Immune system
 Nature of the trauma
 Inappropriate fracture management/repair
 Steroids or NSAIDs

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48
Q

NonUnion; What?, Causes, Types

A

o Arrested fracture repair
o Requires surgical intervention
o Result of failure on part of surgeon
o Instability at fracture site is most common cause

Vascular
 Lucent line through the fracture site on rads
 Cartilage, fibrous tissue and ineffective callus formation

Hypertrophic
 Large amounts of non-bridging callus
 Treated w/ debridement, grafting, stabilization

Atrophic
 Biologically inactive pseudoarthrosis
 No evidence of bone reaction
 Bone ends appear sclerotic
 Treated w/ debridement, grafting, stabilization

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49
Q

Malunion

A

o Healed fractures where anatomic bone alignment is not achieved or maintained during healing.
o Can have a deleterious affect on function.
o Severe malunions can cause arthritis
o Treat w/ corrective osteotomy

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50
Q

Osteomyelitis; Causes, Clinical Signs, Diagnosis, Treatment

A

o Inflammatory condition of bone and medullary canal.

Causes
 Bacterial or fungal
 Most post-traumatic osteomyelitis are due to bacterial infection.
 Biofilm on implant protects the bacteria from antimicrobials and host defenses.

Clinical Signs
 Acute pain, tenderness, swelling, erythema
 Chronic drainage

Diagnosis
 Culture
 Periosteal reaction or maybe sequestrum on rads

Treatment
 Surgical debridement to healthy bleeding bone
 Establish drainage
 Re-stabilize if necessary
 Antibiotics based on culture for 4-6 weeks

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51
Q

Implants & Osteomyelitis

A

 If implants are stable leave in place until the fracture heals
 Bone heals in the presence of infection as long as the repair is stable
 Infection will not clear until implants are removed

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52
Q

Indications for Implant Removal

A

o Clinical union
o Radiographic union
o Growing animal/open physis
o Interference with function
o Pain
o Unstable or loose Implants
o If infection is present once healing has occurred, the implant may need to be removed.

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53
Q

Pathologic Fractures; Causes, Rads

A

Causes
 Neoplasia
 Osteomyelitis
 Bone cyst
 Radiation therapy

Rads
 Lytic/prolifrative
 Periosteal reaction
 Soft tissue mass

54
Q

Causes of Fracture Dz

A

o Quadriceps contracture or tie-down
o Sciatic nerve entrapment
o Ankylosis of joints

55
Q

Treatment for Mandibular/Maxillary Fxs

A

 Maxillary fractures often heal on their own

Tape Muzzle
* most common in practice
* minimize movement
* Minimally displaced
* Caudal fractures
* Comminuted fractures

Dental Bonding
* If teeth intact, glue teeth together to hold jaw intact until healed
* Minimally invasive
* Maintains occlusion
* Avoids malocclusion
* Caudal fxs
* Comminuted fxs

Symphyseal wiring
* Use two needles
* Slide wire through needles
* Behind canines
* May use heavy PDS in cats instead of wire

56
Q

Scapular Fx Classifications

A

Stable extra-articular
* Body
* No fixation needed

Unstable extra-articular
* body, neck
* Sx recommended for neck fractures

Intra-articular
* glenoid
* Sx recommended for articular fractures

57
Q

Pelvic Fractures; Basics & Indications for Sx

A

o Usually fractures in 3 places due to box structure

Indications for fixation
 Weight bearing - acetabulum, ilium body, sacroiliac joint
 Articular - acetabulum
 Pelvic inlet narrowing
 Contralateral injury
 Uncontrollable pain (often sacral involvement)

58
Q

Fracture Types to Consider Coaptation or Confinement/rest instead of Surgery

A

o Non-displaced maxillary fracture
o Mandibular symphyseal fractures
o Minimally displaced pelvic/scapular fractures
o Most metacarpal/metatarsal fractures, unless very large dogs
o Tibial or radial fractures in young puppies, especially if the fibula or ulna is intact

59
Q

Fractures that Should Be Referred to Surgeon

A

Humeral and femoral fx
 complex diaphyseal supracondylar fractures
 articular fractures
 physeal fractures

Radial & Tibila Fx
 comminuted
 articular fractures
 physeal fractures
 distal radius (especially toy breeds)
 geriatric

60
Q

Toy/Small Breed Radial Fractures

A

o Commonly fracture distal radial diaphysis
o Higher rate of non-union or delayed union with external coaptation
o Shown to have poorer blood supply to the distal 1/3 of the radius compared to larger breed dogs
o Rigid surgical fixation gives the best chance of uncomplicated healing
o Always recommend surgery for these cases
o Only use external coaptation if client declines surgery and note in your records

61
Q

Cryotherapy; Physiologic Effect; How To, Contraindications

A

Physiologic Effects
 Aids in pain free exercise (PROM)
 +/- decrease need for pain meds
 Vasoconstriction
 Analgesia
 Reduce edema/inflammation
 Reduce muscle spasms

How To
 Use in first 72hrs of injury
 Don’t use too much of a barrier
 10-20 mins q 2-4hrs in first 24-48hrs

Contraindications
 Check skin every 5-10 minutes for redness or blanching
 Areas of previous frostbite
 Areas of nerve impairment
 Open wounds or superficial nerves
 Areas of decreased to absent sensation
 Patients with hypertension (may increase BP)
 Very young or very old patients

62
Q

Superficial Heat Therapy; Physiologic Effect; How To, Contraindications

A

Physiologic Effects
 Vasodilation
 Increased soft tissue flexibility
 Pain relief
 Relaxation of muscles

How To
 After the acute inflammatory period (>72 hours)
 Apply prior to stretching, PROM, massage and exercises
 10-20 minutes 3-4 times daily
 Greater than 45o C (113 F) -> painful and can cause irreversible damage

Contraindications
 Pregnancy
 Obesity
 Impaired circulation
 Bleeding
 Acute inflammation
 Poor thermal regulation
 Cardiac insufficiency
 Young and old patients
 Malignancy
 Thrombophlebitis
 Pyrexia

63
Q

PROM Vs AROM; How to & Contraindications of PROM

A

AROM
 Motion of a joint that may be achieved by active muscle contraction

PROM
 Motion of a joint that is performed without muscle contraction within the available range of motion

How to
* Relaxed patient
* Gentle
* Support bones proximal & distal to joint
* 10-20 reps 2-4 times/day

Contraindications
* Unstable fx
* External coaptation

64
Q

Stretch; Definition, How to

A

 Additional force applied at the end of the available range of motion
 elongate tissues, increase flexibility of normal and abnormal tissues, and help increase joint motion

How to
* Perform opposite action of target muscle
* Two joint muscles require to action stretches
* Hold for 10-30secs and repeat
* After PROM
* May apply heat prior

65
Q

Healing times for Skin, SQ, Fascia, Muscle, Tendons, Ligaments, Bone

A

o Skin: 4d – 1y
o SQ: 4d – 5wk
o Fascia: 3wk – 2mo
o Muscle: few hrs – 6mo
o Tendon: 3wk - >1yr
o Ligament: 4d – 1yr
o Bone: 5wk – 3mo

66
Q

Exercises for Strengthening Front or Hind Limbs

A

Front
 Down-hill walking
 Digging
 High Fives/Shake
 Sit to Down
 Push-ups

Hind
 Up-hill walking
 Stairs
 Backward walking
 Side-stepping
 Sit to stand

67
Q

Hydrotherapy; How to, contraindications

A

How to
 Underwater treadmill or swimming
 Ideal water temp: 86-92F
 Uses buoyancy, hydrostatic P, viscosity, resistance, surface tension

Contraindications
 Cautious w/ cardiac or resp dysfunction
 Skin Infections
 Post-operative incisions
 Diarrhea

68
Q

Therapeutic Lasers; Use, Contraindications

A

o Penetrates up to 5cm

Use
 Decreases inflammation and edema,
 improve blood flow,
 decrease pain,
 improve healing

Contraindications
 Neoplasia
 Active bleeding
 Epiphyseal plate (Risk vs Benefit)
 Eyes
 Photosensitization medications
 Reproductive organs/Pregnancy

69
Q

Therapeutic Ultrasound; Use, Contraindications

A

o Penetrates up to 5cm

Use
 Modality of choice for deep tissue heating
 Improves blood flow,
 increases tissue flexibility,
 decreases pain,
 improves healing
 Good for contractures, tendinopathies, muscle spasms

Contraindications
 Directly over the heart in animals with pacemakers
 Over areas that have risk of emboli
 Over the epiphyseal area of bones
 Over the spinal cord in post- laminectomy patients
 Pregnancy (over the abdomen)
 Plastic and metal implants
 Infected areas and neoplasia

70
Q

Electrical Stimulation; use for NMES Vs TENS, contraindications

A

NMES (neuromuscular electrical stimulation)
 Help prevent muscle atrophy
 Help facilitate muscle contraction to retrain muscles

TENS (transcutaneous electrical nerve stimulation)
 Help with pain- gate theory
 stimulate acupuncture points
 Reduction of edema

Contraindications
 Over the heart in patients with pacemaker
 Patients with seizure disorders
 Over areas of reduced sensation/infection/neoplasia
 Over the trunk of patents that are pregnant

71
Q

Results of Degeneration of articular cartilage and underlying subchondral bone

A

o chondromalacia
o fibrocartilage
o osteophyte development
o synovitis
o effusion
o subchondral sclerosis, microfractures (cancellous)

72
Q

What causes Joint Pain

A

o Synovitis (Inflammatory mediators)
o Microfractures of Subchondral Bone
o Osteophytes (Mechanical)
o Joint Effusion (joint distention) most painful

73
Q

Most Common Joints Effected by Osteoarthritis & Why?

A

o Elbow
o Carpus
o Hock

Why?
 Carry 60% weight on front limb
 40% weight on hind
 Have most stress/strain

74
Q

Pathogenesis of OA

A

o Loss of hyaline cartilage matrix (mechanical) ->
o Progressive catabolic process by synoviocytes & chondrocytes ->
o Subchondral bone and periarticular changes ->
o Pain development focuses origins from subchondral bone; effusion

75
Q

Diagnosis of OA

A

o Gait analysis
o Exam of musculoskeletal system localization
o Rads
o Ultrasound
o CT
o MRI
o Arthroscopy/arthrotomy
o Contralateral leg lift (tries to put down quickly)

76
Q

Treatment of OA

A

Surgical
 Corrective osteotomy
 Chondroplasty
 Excisional arthroplasty
 Total joint replacement
 Arthrodesis
 Amputation

Non Surgical
 Weight reduction (HUGE for comfort)
 Exercise modification
 NSAIDs / DMOAs
 Fish oil!!!

77
Q

Canine Elbow Dysplasia; Causes

A

 OCD of the Medial Side Humeral Condyle
 Ununited Anconeal Process (UAP)
 Medial coronoid disease (MCD)
 “Medial Compartment Disease” (Ulnar-radius incongruency)

78
Q

Elbow OCD; Pathogenesis, Treatment

A

Pathogenesis
* Hypertrophic cartilage ->
* Chondromalacia ->
* Incomplete ossification ->
* Weight bearing forces ->
* Cartilage flap formation

Treatment
* arthroscopy/arthrotomy to remove flap

79
Q

Medial Coronoid Process Disease (MCPD); Pathogenesis, Treatment

A

Pathogenesis
* Overloading of medial coronoid process ->
* Fragmentation ->
* Chondromalacia/ Osteomalacia ->
* Incomplete fissure ->
* Erosions ->
* OA

Treatment
* arthroscopy/arthrotomy to remove osteochondral fragment

80
Q

Medial Compartment Disease (MCD); Pathogenesis, Treatment

A

Pathogenesis
* overloading of medial articular compartment ->
* cartilage erosions ->
* OA
* can be concurrent with MCPD

Treatment
* Arthroscopy
* Sliding Humeral Osteotomy
* Proximal Ulnar Abduction Osteotomy
* Canine Unilateral Elbow

81
Q

Elbow OCD, MCPD, MCD; Signalment, Signs, Diagnosis

A

Signalment
* Retrievers
* Bernese Mountain dogs
* Rottweilers
* Males > Females
* Usually not apparent before 5-8 mos of age

Signs
* Slight - moderate lameness
* worse after exercise & prominent after resting
* discomfort on marked elbow flexion/extension
* synovial “popping” with flexion/extension
* +/- pain with deep palpation over MCL (flexed elbow)
* +/- “positive” modified Campbell’s test”
* mild joint effusion
* externally rotated paw when standing or sitting

Diagnosis
* CT (best)
* Rads

82
Q

Ununited Anconeal Process (UAP); Signalment, Signs, Treatment

A

Signalment
* Large Breeds with separate centers of ossification of the anconeal process:
* German Shepherds
* Basset Hounds
* St. Bernard
* Mastiffy things

Signs
* Usually not apparent before 7- 8 mos of age
* Slight - moderate lameness
* Circumducted forelimb gait
* Externally rotated paw when standing or sitting
* Crepitus
* Joint effusion

Treatment
* high osteotomy of the ulna
* excise UAP

83
Q

Last Resort Treatments for Elbow Dysplasia

A

 Elbow replacement
 Arthrodesis
 Amputation

84
Q

Hip Dysplasia; Causes, Signs, Rad Views, Non-Surgical Treatment

A

o Very common finding on rads
o USUALLY subclinical

Causes
 Genetics
 Nutrition
 Laxity of round ligament & joint capsule

Clinical Signs
 Stiff to rise but warm up
 Suddenly stops & sits
 Uncomfortable at night
 Narrowed pelvic limb stance
 Pelvic swing on opposite side
 Bunny hop
 Pain on hip extension & abduction (or no pain)
 +/- positive ortilani maneuver in young

Rads
 VD
 PennHIP, extended/compression/distraction views

Non-surgical Treatment
 Multi-modal OA treatment (weightloss, NSAIDs, exercise mod)
 Physical rehab

85
Q

Hip Dysplasia; Surgical Treatment

A

 All sx is salvage
Juveniles
* Triple Pelvic Osteotomy
* Double Pelvic Osteotomy
* Pubic Symphysiodesis

Adult
* Femoral Head and Neck Ostectomy
* Total Hip Replacement

86
Q

Patellar Luxation; Cats

A

 Mostly medial but sometimes lateral
 Rarely clinical
 Clinical are usually obese
 Often bilateral

87
Q

Patellar Luxation; Grading

A

I
* Infrequent luxation
* self-reducing,
* no/rare/infrequent lameness

II
* Luxation occurs more frequently
* patella easily reduces
* mild musculoskeletal abnormalities
* infrequent/intermittent lameness
* aclinical or subclinical

III
* Patella luxated most of the time
* Manual reduction infrequently reduces patella,
* frequent lameness
* advanced musculoskeletal developmental abnormalities

IV
* Ectopic patella
* severe/persistent lameness
* severe musculoskeletal abnormalities

88
Q

Patellar Luxation; Clinical Signs

A

 intermittentor persistent lameness (“acrobatics”)
 Non-painful patellar manipulations (usually)
 +/- mild crepitus
 variable abnormalities of tibia, femoral condyles, “patella alta”
 (+) sit test
 Walk/run on forelimbs only

89
Q

Patellar Luxation; Surgical Principles, Procedures

A

 Realign quadriceps tendon and patella to trochlear groove
 Stabilize the patella to stay reduced in the trochlear grove during stifle movement

Procedures
* Imbrication of joint capsule and periarticular tissues
* Trochlear chondroplasty
* Excisional trochleoplasty
* Wedge recession trochleoplasty
* Block recession trochleoplasty
* Tibial tubercle transposition

90
Q

OCD; Signalment, Affected Joints

A

Signalment
o 5-7mo
o Larger breeds
o Genetic & nutritional
o Bilateral

Affected Joints
o Shoulder,
o elbow,
o stifle,
o tarsus

91
Q

Shoulder OCD; Clinical Signs, Rads

A

Clinical Signs
 Unilateral Weight-bearing Lameness worse w/ exercise
 Mild muscle atrophy over shoulder/scapular region
 Pain/discomfort on flexion or extension of shoulder bilaterally

Rads
 osteophytes on caudal humeral head, caudal glenoid cavity
 focal subchondral bone flattening of caudal humeral head
 +/- mineralized OCD flap

92
Q

Elbow OCD; Clinical Signs, Rads

A

Clinical Signs
 Elbow pain during flexion w/ medial collateral ligament pressure
 Effusion/synovial popping
 Joint thickening/Resistance to Flex/Ext
 Externally rotated paw

Rads
 osteophytes
 focal subchondral defect medial side of humeral condyle

93
Q

Stifle OCD; Clinical Signs, Rads

A

Clinical Signs
 Stifle pain on flexion and extension
 Effusion
 Thickening

Rads
 osteophytes
 focal subchondral defect: lateral side of medial femoral condyle or medial side of lateral femoral condyle

94
Q

Tarsal OCD; Clinical Signs, Rads

A

Clinical Signs
 Tarsal pain on flexion and extension
 Hyperextended when standing
 Marked effusion/thickening medial side of joint

Rads
 osteophytes
 Subchondral defect medial trochlear ridge of talus
 Lateral trochlear ridge in Rottweilers

95
Q

OCD; Initial & Post-op Treatment

A

o Arthrotomy or arthroscopy to remove OCD flap
o +/- curettage
o Conservative management of shoulder if no mineral present

Post-op
 Restrict to leash walks only for 4 weeks
 NSAIDs for 5-7 days
 Ice incision for 2-3 days

96
Q

Traumatic Coxofemoral Luxations; Directions, Diagnosis

A

Direction
 Craniodorsal (most)
 Caudoventral

Diagnosis
 Orthogonal view rads

97
Q

Traumatic Coxofemoral Luxations; Clinical Signs

A

 History of trauma
 Non weight bearing lame
 pain/discomfort at hip

Craniodorsal
* stifle externally rotated; limb adducted
* loss of “hip triangle”
* short limb

Caudoventral
* stifle internally rotated and limb abducted
* increased triangle + decreased greater trochanter
* longer limb

98
Q

Traumatic Coxofemoral Luxations; Treatment

A

Closed reduction:
* best of done within 5-7 days
* 50% success
* Ehmer sling bandage: 10-14 days
* restrict activity: 4-6 weeks

Open Reduction
* performed if femoral head does not stay reduced, > 7 days post trauma, or avulsion fracture
* 85%-90% success
* restrict activity: 4-6 weeks

Failure of Open Reduction
* Femoral head & neck osteotomy
* Total hip replacement

99
Q

Shoulder Luxations; Directions, Diagnosis

A

Directions
 Traumatic small breeds – medial
 Traumatic large breeds – lateral
 Congenital toy breeds - medial

Diagnosis
 Traumatic - 2 view rads
 Congenital - malformation of glenoid and humeral head on 2-view rads

100
Q

Shoulder Luxations; Clinical Signs

A

 Altered anatomy between acromion and greater tubercle of humerus
 Pain on palpation/manipulation of shoulder joint
 Joint instability on palpation (traumatic cases)

traumatic:
* toe touching
* shoulder flexed and non- weight bearing

congenital:
* weight-bearing +/- intermittent lameness

lateral luxation:
* thoracic limb foot internally rotated,
* greater tubercle lateralized

medial luxation:
* thoracic limb foot externally rotated;
* greater tubercle medialized

101
Q

Shoulder Luxations; Treatment

A

Traumatic

Closed Reduction
o Valpeau sling for 2wks on medial lux
o Spica splint 2wks on lateral lux

Open Reduction
o Used if unstable, can’t reduce, concurrent fractures, or recurrence

Congenital
* excisional arthroplasty of humeral head
* arthrodesis

102
Q

Medial Shoulder Instabilities; Cause, Signalment, Signs, Treatment

A

Cause
 Sprain of medial glenohumeral ligament
 Strain of subscapularis tendon

Signalment
 Athletic working dogs

Clinical Signs
 chronic/persistent weight-bearing lameness
 pain on flexion or extension
 marked abduction angle
 ±“lateral drawer sign”
 Often have arthritis on rads

Treatment
 diagnostic and therapeutic arthroscopy
 radiofrequency-based capsular shrinkage if “minor”
 open MGHL reconstruction if “major”
 restrict 4-6 weeks w/ hobbles

103
Q

Traumatic Elbow Luxations; Clinical Signs

A

 toe touching lameness/non- weight bearing
 antebrachium and foot are abducted, elbow flexed
 pain and increased elbow width on palpation
 resistance to flexion

104
Q

Traumatic Elbow Luxations; Treatment

A

Closed reduction (if recent injury)
* modified Robert Jones (reinforced) bandage, 5-7 days
* restricted leash activity 2+ weeks

Open reduction
* if not stable post closed reduction (esp. with collateral ligament constraint loss)
* cannot reduce (chronic)
* associated fractures

105
Q

Traumatic Luxation of the Stifle; Cause, Clinical Signs, Diagnosis

A

Cause
 derangement of passive stifle joint stabilizers
 collateral ligaments
 cruciate ligaments
 +/- menisci
 usually, joint capsule intact

Clinical Signs
 weight-bearing to non-weight bearing lame
 cranial/caudal drawer
 genu valgus and/or varus
 +/- crepitus
 marked joint swelling
 pain on palpation

Diagnosis
 Orthogonal rads

106
Q

Traumatic Luxation of the Stifle; Treatment

A

Small dogs and cats
* temporary trans-articular pinning 5-7 weeks
* expect reduction of 30- 40 degrees in range of motion
* poor function following surgery: arthrodesis

Small and large dogs, cats
* reconstruction of ligamentous constraints
* trans-articular ESF w/ adjustable articulating clamps, 6 weeks
* prognosis for lame- free function can be good (rehab required)

107
Q

Carpal Sprains & Luxations; Clinical Signs, Diagnosis

A

Clinical Signs
 weight-bearing to non-weight bearing lameness
 palmigrade during gait and standing
 swelling over carpus
 pain on extension of carpus,
 +- crepitus
 hyperextendable carpus
 producible carpal valgus and/or varus

Diagnosis
 Rads +/- stressed views

108
Q

Carpal Sprains & Luxations; Treatment

A

1st or 2nd Degree sprains with no instability
* splinting/bracing for 3-4 weeks,
* leash restraint for 6 weeks
* if palmigrade or remains lame, consider arthrodesis

Instability or carpal fractures (expected with 3rd degree sprains)
* Pancarpal arthrodesis
* Coaptation w/ bivalvecast 6-10 weeks

109
Q

Tarsal Sprains & Luxations; Clinical Signs, Diagnosis

A

Clinical Signs
 swelling of tarsus
 malalignment of tarsocrural joint or other areas of tarsus
 if shearing injury, exposure of tarsal bones
 instability and pain on palpation
 may ambulate and stand with a plantigrade position

Diagnosis
 Rads +/- stressed view

110
Q

Tarsal Sprains & Luxations; Clinical Signs, Diagnosis

A

 swelling of tarsus
 malalignment of tarsocrural joint or other areas of tarsus
 if shearing injury, exposure of tarsal bones
 instability and pain on palpation
 may ambulate and stand with a plantigrade position

Diagnosis
 Rads +/- stressed views

111
Q

Tarsal Sprains & Luxations; Treatment

A

1st degree or 2nd degree sprains with no gross instability
* coaptation for 3-4 weeks
* if unstable after treatment, surgery

3rd degree sprains w/ or w/o shearing injuries w/ instability
* Open wound management (shearing injuries)
* temporary transarticular ESF
* pantarsal arthrodesis (tarsocrural joint)
* partial arthrodesis (proximal, distal intertarsal joint, tarsometatarsal joint)
* coaptation (bivalve cast) 8-12 weeks

112
Q

Collateral Ligament Injury; Classifications

A

Grade 1:
* minor stretch (internal substance disruption)

Grade 2:
* moderate stretch (major internal substance disruption with external tear of fibers

Grade 3:
* complete fiber tearing/rupture, avulsion

113
Q

Collateral Ligament Injury; Locations, Signs, Diagnosis

A

Locations
 tarsus
 carpus

Signs
 Joint effusion
 Discomfort over affected area of joint capsule
 Non weight bearing
 Varus or valgus instability

Diagnosis
 Stress view rads
 May see avulsion

114
Q

Collateral Ligament Injury; Treatment

A

Grade 1 or 2
* Ice 24-72hrs post
* Heat >72hrs post
* NSAIDs 5-7d
* Splint or cast 4-6wks
* Restrict activity 6-8wks

Grade 3
* Primary repair
* Splint/coapt for 4-6wks
* Restrict activity 6-8wks
* Arthrodesis if severe disruption of supporting ligaments
* Delay definitive treatment until soft tissue healed

115
Q

Cranial Cruciate Ligament Injury; Classifications

A

Grade 1
* stretched

Grade 2
* partial rupture

Grade 3
* Complete tear/ “rupture”

116
Q

Cranial Cruciate Ligament Injury; Pathogenesis, Signalment, Signs, Diagnosis

A

Pathogenesis
 Usually due to degeneration (unknown cause)
 Trauma (rare)

Signalment
 2-3 years old
 Labs, rottweilers, Newfoundlands

Signs
 Acute lameness w/ 1-2 wks recovered
 OR
 Acute progressive lameness worse w/ activity
 Common to have previous rupture on other side
 Mild to moderate weight bearing
 Enlarged stifle joint
 Muscle atrophy due to disuse
 Meniscal click or clunk

Diagnosis
 Positive cranial drawer test
 Mild-severe OA, joint effusion, medial buttress on rads

117
Q

Cranial Cruciate Ligament Injury; Treatment

A

Conservative
* No sx needed for cats
* Often no sx needed for dogs <15kg
* restrict to leash walks only for 6 weeks
* NSAIDs for 5-7days
* If no improvement by 3weeks -> surgery

Surgery
* Lateral imbrication
* TPLO (best)
* TTA

Post-op
* Restrict activity 8-12wks
* 8wk post op rads
* Rehab 2wks after sx

118
Q

Caudal Cruciate Ligament Rupture; Pathogenesis, Signs, Treatment

A

Pathogenesis
 Often occurs w/ cranial cruciate
 Trauma

Signs
 Lameness more pronounced w/ activity
 Caudal drawer sign
 Joint effusion

Treatment
 Most ok w/ conservative management
 Athletic dogs may need sx

119
Q

Meniscal Injury; Pathogenesis, Types, Diagnosis, Treatment

A

Pathogenesis
 Often occurs w/ chronic cranial cruciate instability
 Can happen due to cranial cruciate repair

Diagnosis
 meniscal click or clunk on flexion or extension
 discomfort on medial collateral palpation
 direct visualization w/ endoscope
 arthroscopy or arthrotomy for definitive

Treatment
 Partial meniscectomy (or total)

120
Q

Muscle Strain; Areas, Signs, Diagnosis

A

Areas
 myofascial (fiber interface)
 myotendinous
 teno-osseous

Signs
 Lameness
 Heat
 Tenderness
 Fibrosis (chronic)
 Loss of tissue continuity

Diagnosis
 Rads show avulsion and underlying bone pathology
 Pair rads w/ ultrasound

121
Q

Muscle Strain; Treatment

A

Acute Stage
* Cryotherapy 1-3d
* NSAIDs 7-10d
* Restrict activity
* Gentle massage

After resolution of swelling
* Deep friction massage & stretching
* Therapeutic laser or ultrasound (heat)

Surgery
* Myofascial repair if athletic animal
* Myotendinous repair if loss of complete tissue continuity & function

122
Q

Supraspinatus Myopathy; Signalment, Signs, Diagnosis

A

Signalment
 Sporting & rescue dogs

Signs
 Lameness that progresses w/ activity
 Discomfort on flexion/extension of shoulder
 Discomfort on palpation of biceps

Diagnosis
 Rads
 Ultrasound!

123
Q

Supraspinatus Myopathy; Treatment

A

Non-mineralized
* NSAIDs
* Shock Wave therapy (ESWT)
* Platelet rich plasma injections
* Restrict activity 6wks
* Physical rehab

Mineralized
* ESWT
* Partial tenectomy +/- arthroscopy
* Restrict activity 6wks
* Physical rehab

124
Q

Tenosynovitis of Biceps Brachii Tendon; Anatomy, Signs, Diagnosis

A

Anatomy
 Supraglenoid tubercle
 Intra-articular

Signs
 Weight-bearing lameness worse w/ activity
 Shifting lameness is bilateral
 Shoulder/elbow extension upon pressure to the lesser tubercle

Diagnosis
 Rads
 Loss of fiber detail, sheath enlargement, & increased tendon fluid on ultrasound
 Arthroscopy

125
Q

Tenosynovitis of Biceps Brachii Tendon; Treatment

A

Tenosynovitis
* NSAIDs
* Adequan IM
* Restrict activity 4-6wks

Partial rupture
* Arthroscopy
* Tendon transection/release
* Restrict activity 4wks

126
Q

Fibrotic Myopathy of Infraspinatus; Cause, Signalment, Signs, Treatment

A

Cause
 Trauma
 Compartment syndrome

Signalment
 Sporting/hunting breeds

Signs
 Acute activity related lameness
 adducted elbow
 paw externally rotated/abducted
 circumducted swing phase of gait

Treatment
 surgical transection of the fibrotic tendon and muscle segment
 restrict activity for 2-3 wks

127
Q

Iliopsoas Muscle Myopathy; Signalment, Signs, Diagnosis, Treatment

A

Signalment
 Rottweiler, Doberman Pincher, Sheltie, Lab, Chow, Greyhound, (many others!)

Signs
 Moderate to severe persistent or intermittent lameness
 discomfort/pain on internal rotation w/ extension of coxofemoral joint
 discomfort/pain on deep palpation ventromedial to ilium (fasciculations, spasticity)
 discomfort on deep palpation of lesser trochanter
 discomfort/pain on rectal palpation

Diagnosis
 Rads may be unremarkable or have mineralization at lesser trochanter
 Hypoechoic pattern of muscle

Treatment
 NSAIDs 7-10days
 Methocarbamol 7-10days
 acupuncture
 restricted activity and physical rehab for 4-6wks
 myotenectomy for non-responsive cases (very rare)

128
Q

Calcaneal Tendon Disease; Tendons Involved, Cause, Signs, Diagnosis

A

Tendons Involved
 Common calcaneal tendon
 Gastrocnemius
 Superficial digital flexor

Cause
 Trauma
 Degeneration in labs, dobies, collies
 Metabolic dz

Signs
 lameness,
 flexed hock, plantigrade
 +/- flexed digits
 pain
 thickening of tendon

Diagnosis
 Rads
 Ultrasound

129
Q

Calcaneal Tendon Disease; Treatment

A

Grade 1-2 Acute
* brace/splint- 4-6 weeks
* rehab

Grade 3 Acute
* primary repair
* staged coaptation – 6 weeks

Grade 2-3 Chronic
* resect and re-anchor calcaneus
* prosthetic materials
* autographs, small intestinal submucosa, calcaneal tendon allograph
* staged coaptation for 12+ wks

130
Q

Myopathies of Gracilis & Semitendinous; Signalment, Signs, Treatment

A

Signalment
 Shepherds & Dobies

Signs
 Distinct lameness
 short stride,
 medial rotation of paw
 external rotation of hock
 internal rotation of stifle
 pain on palpation
 limited range of motion
 “slaps” foot down during swing phase

Treatment
 Surgical resection with medical management not rewarding
 redevelopment in 100% of patients

131
Q

Panosteitis; Signalment, Signs, Diagnosis, Treatment

A

Signalment
 Young rapdly growing dogs
 German Shepherds
 Basset hounds

Signs
 Shifting leg lameness
 Reoccurs
 Pain on deep palpation of long bones

Diagnosis
 Rads

Treatment
 diet (large-breed puppy food)
 NSAIDs, PRN
 time

SA Surgery (2 decks)

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