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Orthopedic Surgery > Final > Flashcards

Final Flashcards

1
Q

Collagen in hyaline cart

A

Type II collagen

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2
Q

What makes hyaline cart

A

ECM and chondrocytes

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3
Q

What makes ECM

A

70% water, type II collagen, proteoglycans

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4
Q

What is aggrecan

A

Major ECM proteoglycan made of chondroitin and karatan sulfate

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5
Q

Fxn type II coll

A

Counteract tensile forces

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6
Q

What is a proteoglycan

A

100 GAGs on a protein core, arranged on a hyaluronan mol

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7
Q

GAG fxn

A

Negative charge attracts water to counteract compressive forces

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8
Q

Functional layer of synovial memb

A

Intimal- cells that perform fxn

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9
Q

Type A synoviocyte

A

In intimal layer, phagocytic

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10
Q

Type B synoviocyte

A

In intimal layer, secretes proteins, filters plasma to make fluids, releases cytokines

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11
Q

Predom cell in normal synovial fluid

A

Mononuclear

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12
Q

Viscosity of syn fluid from

A

Hyaluronan molecules (large)

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13
Q

MMPs

A

degrade ECM, released by chondrocytes and synovio’s in inactive form

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14
Q

Name MMPs

A

collagenase (mmp-13), gelatinase, stromelysin

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15
Q

Stromelysin

A

MMP that degrades proteoglycan part of ECM

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16
Q

MMP inhibitor

A

TIMP and tetracycline

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17
Q

IL-1 and TNFa fxn

A

Inflam cytokines- inc catab (up-reg MMPs, PGs, free radicals and each other)

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18
Q

IL-1 fxn

A

Inhibit TIMP and IL-1Ra (its own inhibitor)

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19
Q

IL-1Ra

A

IL-1 Receptor antagonist

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20
Q

First biomechanical damage in injury

A

loss of proteoglycan leading to collagen degradation, hard to regen

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21
Q

Intrinsic cartilage healing

A

Poor- from chondrocyte synthetic activity

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22
Q

Extrinsic healing-

A

From bone marrow sources, makes fibrocartilage NOT type II

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23
Q

Matrix flow

A

Healing by spread/thin/melt of cartilage

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24
Q

OC is what type of dz

A

Developmental orthopedic disorder (DOD)

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25
Q

Most common CS of OA

A

pain, lameness

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26
Q

OA- type of dz

A

trauma/degen

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27
Q

Tissue changes in OA

A

cartilage damage, synovitis, capsulitis (decreased ROM), ligament/menisc injury (dec stability)

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28
Q

Abnormal force on normal cartilage=

A

intra-artic fx

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29
Q

Normal force on abnormal cartilage=

A

wear and tear (normal)

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30
Q

Anatomy confers___ and physiology confers____

A

mechanics, biology (catab/anab balance, dz response)

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31
Q

OA rads-

A

No joint space=no cartilage!, subchondral bone sclerosis/lysis

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32
Q

Enthesiophyte

A

Formation of bone at capsule and ligamentous attachments

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33
Q

Osteophytes

A

bone form at articular margin

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34
Q

Gold standard dx OA

A

Arthroscopy bc rads may not show changes early

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35
Q

Fluid analysis in OA-

A

Cytology not useful, THIN IS BAD

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36
Q

Microfracture

A

Tx for OA makes holes in subchondral bone to stim extrinsic heal- NOT type II, fibrocart

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37
Q

Arthrodesis Px

A

High motion- poor, salvage; low motion- may return to fxn (distal tarsal, pastern)

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38
Q

Most common NSAID

A

Bute- flunixin not as good

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39
Q

Good long term NSAID

A

Fircoxib- more cox 2 selective so less SE, but less effective

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40
Q

Corticosteroid tx for OA

A

Intra-articular (methylpred for high motion, triamcinolone for low)

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41
Q

Hyaluronan - route

A

IA/IV

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42
Q

What is adequan

A

polysulfated GAGs

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43
Q

IRAP

A

Bio therapy for OA to block IL1 receptors

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44
Q

What is always an emergency

A

Septic arthritis

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45
Q

Types of septic arthritis

A

Traumatic (from wound entry), hematogenous, iatrogenic

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46
Q

Three types of hematogenous septic arthritis in foals

A

SEP: S- synovial memb source, E- subchondral bone of epiphysis into joint, P- physeal

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47
Q

Synovial fluid analysis in septic arth

A

WBC >30k, >90% degenerative neuts, +/- TP >2

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48
Q

Iatrogenic septic arth org

A

Staph Aureus

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49
Q

Trauma septic arth org

A

enteric gram negatives

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50
Q

CS- septic arth, young and adult

A

young- systemic, painful; mature- swollen joint, usually not painful

51
Q

Tx septic arth

A

Synovial lavage with balanced electrolyte solution +/_ DMSO; broad Abx (IA intermittent best concentration at synovium)

52
Q

Describe stopping septic arth tx

A

WBC not accurate, will stay higher, use imporvement in effusion and lameness, stop pain control before Abx to assess fully

53
Q

Hyperextension of canine limb, adduction of elbow, circumduction of distal limb with carpal flip

A

Infraspinatus contracture from fibrosis in working dogs

54
Q

Infraspinatus contrcture tx

A

infraspinatus tenotomy- cut infraspin tendon

55
Q

Scapulohumeral luxations- types, which more common

A

Medial (smaller dogs, congenital), lateral (larger dogs, less common)

56
Q

Scap-hum lux- medial - sx types, which better

A

Open or closed reduction, open better, closed re-lux

57
Q

What makes tx for Scap-hum luxation successful

A

Normal anatomy of glenoid still viable- if not, must arthrodese joint

58
Q

Open scap-hum- medial: reduction- method

A

Use biceps brachii tendon as support to replace ruined collateral ligaments

59
Q

Bandage for scap-hum sx

A

Spica

60
Q

Scap-hum lux- Lateral: Sx

A

Closed with spica possible, open same as medial (biceps brachii tendon replacing lateral collaterals)

61
Q

Bicipital tenosynovitis- signalment, presentation

A

Large breed, working dogs, chronic intermittent forelimb lameness (overdx) (biceps tendon goes through joint, long term wear and tear= lose integrity)

62
Q

Tx bicipital tenosynovitis

A

1-2 steroid inj into tendon within joint, if returns, transect tendon at attachment- Popeye procedure

63
Q

Dx bicipital tenosynovitis

A

U/S helpful for fluid pockets, etc; Pain on direct pressure to tendon while flex shoulder, extend elbow

64
Q

What way do traumatic elbow luxations occur

A

R and U go laterally to humeral condyle bc trochlea more distal than capitulum

65
Q

Dx traumatic elbow luxations

A

Rads- orthogonal view, bc easy to miss on lateral!!!

66
Q

Tx traumatic elbow luxations

A

REDUCE ASAP, closed preferred

67
Q

traumatic elbow luxation sx- describe 4 steps

A

Flex to reduce anconeal, roll radius in, maintain in extension to lock anconeal in- spica to keep in extension (2 weeks)

68
Q

Congenital elbow lux- signalment

A

Small breed and bulldogs

69
Q

Tx Congenital elbow lux

A

early sx

70
Q

Angular limb deformity- etiology, location

A

Premature closure of GP in antebrachium; distal ulnar physis, gives radius curvus due to tethering of paired bones

71
Q

What must you do in elbow trauma of

A

Document want owner back in 3 weeks for rads to ensure no GP damage

72
Q

Canine carpal hyperextension injury- etiology

A

Large, working- trauma > degen, tear carpal ligaments (palmar fibrocartilage plate)

73
Q

tx Canine carpal hyperextension

A

COAPTATION WONT WORK- pancarpal arthrodesis needed in 90%

74
Q

Most common sites of OCD

A

Caudal humeral head! humeral condyle, lateral femoral condyle, talus

75
Q

OC- describe

A

Developmental, disturbance of normal endochondral ossification in young causes THICKENED CARTILAGE where bone not forming, bc so thick, unhealthy bc poor blood supply

76
Q

OCD-

A

Sequelae to OC, crack present, communicates with joint

77
Q

Signs of OC/OCD on rads

A

OC- flattened/concave subchon bone; OCD- no different, flap cant be seen! soft tissue opacity

78
Q

OC- tx

A

NOTHING

79
Q

OCD progression- where is lameness most often

A

Shoulder or elbow

80
Q

Dx OCD in shoulder

A

Pain on flexion and extension

81
Q

Tx OCD

A

Remove the flap- arthroscopy preferred

82
Q

Elbow dysplasia conditions

A

UAP, OC/OCD of hum condyle, FCP

83
Q

Elbow dysplasia from FCP- signalment

A

Rottweiler

84
Q

UAP- describe

A

Failure of fusion of anconeal process to olecranon

85
Q

UAP- dx

A

Extended and FLEXED view of elbow to see anc proc within hum condyle

86
Q

UAP- signalment

A

males, GSD or basetts

87
Q

UAP- causes

A

R/U incongruity- ulna too short

88
Q

Tx UAP

A

caudal arthrotomy (excise A.P), fuse (young, not dz’d), prox. diaphyseal ulnar osteotomy- to allow it to lengthen ulna, relieve pressure, cause fusion

89
Q

OCD of humeral condyl- location, signalment

A

Medial, chocolate labs

90
Q

Dx humeral condyle OCD

A

Cranio-lateral, Caudo-medial oblique rads (with lateral, CC, flexed)

91
Q

Most common elbow dysplasia disease

A

FCP

92
Q

FCP etiology

A

RARELY traumatic- usually repetitive cyclic loading- ulna narrow concavity, step from short radius

93
Q

FCP- dx

A

Biggest clue: DJD of medial elbow compartment (rads not great but lateral view- secondary DJD changes in absence of UAP or OCD

94
Q

Inherited elbow dysplasia conditions-

A

FCP and OCD

95
Q

Panosteitis- signalment, findings

A

young, large, growing dogs; palpation painful at metaph/diaph region

96
Q

Panosteitis- CS

A

Shifting lameness, SYSTEMIC SIGNS

97
Q

Panosteitis- describe, dx

A

hypervascular response in medullary a/v, Rads: increased opacity on rads; IDIOPATHIC, SELF RESOLVING

98
Q

Define hip dysplasia

A

Abnormal development (often too fast) of CF joint causing laxity and leading to OA (

99
Q

Hip dysplasia key initial feature

A

Joint laxity before CS from OA

100
Q

Hip dysplasia - dx

A

Ortolani test

101
Q

OFA vs PennHip

A

OFA subj/min 2yr, Penn- obj, any age

102
Q

TPO- parts

A

Ilium, ischium, pubis

103
Q

Juvenile symphysiodesis

A

Improve acetabular coverage dorsally via premature closure of GP

104
Q

Hip dysp goals

A

Young- prevent DJD, elim pain; Old- elimin OA pain

105
Q

Three major stabilizers of hip

A

Round ligament, joint capsule, dorsal acetabular rim geometry

106
Q

Traumatic hip lux- classification

A

Craniodorsal (SOME ventral)

107
Q

Dx hip lux

A

CrDorsal- needs two views to diff’ate lux from sublux, underlying dysplasia

108
Q

Best Tx hip lux

A

Toggle pin

109
Q

Primary restraints- stifle

A

Cr and Ca cruciates, Mand L collaterals

110
Q

Cr Cruciate job

A

Prevent displacement of tibia cranial to femur

111
Q

Chronic CCL degen rupture- cause

A

Chronic repetitive fatigue of ligament

112
Q

Concurrent injury with CCL

A

Medial meniscus- CAUDAL HORN crushed by femoral condyle sublux

113
Q

Dx CCL rupture on rads

A

JOINT EFFUSION (no longer fat opacity)

114
Q

Patellar lux grades

A

IN/IN, IN/OUT, Out/In, out/out

115
Q

Tibial osteotomy- result

A

For CCL rupture, neutralize tibial thrust

116
Q

TPLO-

A

MOST COMMON CCLr, reduced angulation of plateau

117
Q

Most common patellar lux-

A

Medial, small dogs

118
Q

Sx for patellar lux IF

A

CS at home

119
Q

Trochlear wedge recession

A

Remove osteochondral block, then replace after removing bone underneath- for patellar lux

120
Q

Patellar sx options (2)

A

Tighten laterally or release medially

121
Q

OCD hindlimb- locations

A

Lat fem cond, medial troch ridge of tallus (STILL MORE COMMON IN FORELIMB)

122
Q

Tx- OCD hindlimb

A

Flap excision > conservative mgmt

123
Q

Hip dysplasia sx indications

A

Young:: TPO, JPS; Old: FHO (salvage), total hip

Orthopedic Surgery (2 decks)

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