Exam 3: Lecture 28 - Ortho SA Case Studies Flashcards
Sasha, a 4 month old intact female Rottweiler presents with a 3 day history of left forelimb lameness, The owner also reports she is not being as active as usual. How should we work up the case?
Take a good history, full PE, gait analysis, and ortho exam
Sasha the 4 month old Rottweiler has the following PE:
Baseline PE WNL
Ortho PE showed 2/4 left forelimb lameness and pain on long bone palpation.
What is your preliminary ddx? What further diagnostics should we do
DDx : Canine panosteitis, green stick fx, HOD, FCP, OCD
Next step should be radiographs and/or bloodwork for base levels
These are Sasha the 4 month old Rottweiler radiographs.
What is our diagnosis and treatment plan?
Canine panosteitis
It is a self-limiting disease so we can treat with NSAIDs, exercise restriction, no surgery, and tell owner that this may reoccur.
Sasha the Rottweiler you originally saw at 4 months old is back 3 months later. She is now having lameness of the right hindlimb. What should our plan be?
History, PE, gait analysis, ortho exam and rads
These are the radiographs from Sasha 3 months after her original visit. Should we change the treatment plan or diagnosis at all?
She has canine panosteitis in a different limb. This is a common reoccurrence. There is no need to change the treatment plan
Bandit, a 4 month old intact male border collie presents to you. He has a history of 3 week long progressive difficulty walking.
How should we work up the case?
History, PE, gait analysis, ortho exam
Bandit the 4 month old border collie has the following PE:
PE/ortho - WNL other than painful and swollen carpal joints bilaterally.
What diagnostics should we do?
Bloodwork and radiographs
These are the rads of Bandit the 4 month old boarder collie.
What is our diagnosis and treatment?
Diagnosis - hypertrophic osteodystrophy
treatment - Disease is usually self limiting but requires supportive care like analgesics for pain control (NSAIDs, tramadol, +/- opioids)
How should we treat bandit who has HOD if he is severely debilitated
IV fluid support, hospitalization, corticosteroids, antibiotics, and vit C
If very bad can also consider euthanasia
What is the prognosis for HOD
most fully recover in 7-10 days but relapses may occur
If severely debilitated or if there are multiple relapses you should consider euthanasia
Spotty is a 5 month old male neutered great dane. He presents to you with a history of 2 weeks of mild right forelimb lameness. The owner reports that he has been acting “goofy” on his forelimb for a few weeks prior to being for sure lame.
What should we do?
Get full history, PE, gait analysis, and ortho exam
Spotty the 5 month old danes PE is as follows:
PE - WNL
Ortho - grade 1-2/4 lameness on the right forelimb and is painful on manipulation of his distal right antebrachium
What should we do next?
Baseline bloodwork and bilateral radiographs of the carpus
These are the radiographs from Spotty the 5 month old dane.
What is the diagnosis?
Retained ulnar cartilaginous core
What should our treatment plan be for Spotty the 5 month old dane?
If he has no forelimb deformity we do not have to do anything for treatment
If he has moderate to marked forelimb deformity then surgical correction of the deformity should be evaluated
Marmalade a 9 month old male Pomeranian presents to you with being irritable and obsessively chewing at his left hip.
What should we do?
History, PE, gait analysis, ortho exam
Marmalade the 9 month old pomeranian has the following PE:
PE - WNL
gait analysis has left hindlimb lameness
Ortho - pain on extension of the left coxofemoral joint
What should we do next?
Radiographs of the pelvic limbs bilaterally
These are the radiographs of Marmalade the 9 month old pomeranian.
What is our diagnosis?
Legg-Calve-Perthes disease
How should we treat Marmalade the 9 month old pomeranian
Medical management or surgery
how do we medically manage Legg-Calve-Perthes disease
if the diagnosis is made prior to collapse of the femoral head we can restrict the weight bearing limb to prevent collapse of femoral head, give NSAIDS, limited leash walks or non-weight bearing exercises like swimming
IN MOST CASES : Diagnosis is often made after collapse of epiphysis so we must do a femoral head osteotomy
What is the post op care for an FHO?
encourage limb usage immediately after surgery, NSAIDs, passive flexion-extension of hip performed 2x a day and physical therapy
When do we see good and poor prognosis of Legg-Calves-Perthes disease
good - after FHO
poor - NWB prior to surgery, severe preoperative muscle atrophy, or incorrect surgical technique
There is a 2 year old male intact lab that presents to you with NWB left hindlimb lameness after potentially being hit by a car.
What is our plan?
Stabilization if needed, History, PE, gait analysis, ortho exam
Upon examination of the 2 year old lab, we see this.
What is our diagnosis and are there any further diagnostics we need to do?
Open grade 2 fracture
Should do radiographs and surgical repair
