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Y4 SA - Orthopaedics > Foot and miscellaneous orthopaedic conditions > Flashcards

Foot and miscellaneous orthopaedic conditions Flashcards

1
Q

Describe the anatomy of the foot

A

Pes/Manus
5 metacarpal/tarsal bones
1st is always medial – not always present (dew claw)
P1, P2 and P3
Sesamoids
Tarsometatarsal joint
Metacarpal phalangeal joint
Proximal phalangeal joint
Extensor tendons on the dorsal aspect

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2
Q

List the main conditions affecting the foot

A
  • Fractures (MTs/MCs/Phalanges)
  • Luxations of joints
  • Pad injuries e.g. corn
  • FBs
  • Nail injuries
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3
Q

What is a corn?

A

Paw pad keratoma
- focal area of hyperkeratosis

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4
Q

Describe the features of a corn

A

Excess keratin
Thickening of hard pad
Lameness
Commonly seen in greyhounds

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5
Q

What is keratin?

A

Structural fibrous protein
Skin, horns, nails, scales etc

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6
Q

Describe some treatments for corns

A
  • Digging out corn -> Incomplete removal - Temporary relief, recurrence common
  • Silicone gel implants
  • Distal amputations
  • Superficial digital flexor tendonectomy
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7
Q

Describe a Superficial digital flexor tendonectomy procedure for corns

A
  • Originally performed when adjacent digit had FT or missing
  • Began as a tenotomy: Incidences of corn recurrence
  • Developed into SDF tendonectomy = removal of 1cm + of tendon
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8
Q

Describe treatment of single fractures of the MCs/MTs

A

External coaptation

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9
Q

Describe treatment of multiple fractures of the MCs/MTs

A

Need internal fixation (plates/wires)

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10
Q

Which bones in the foot are weightbearing?

A

3rd and 4th metacarpal/tarsal bones

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11
Q

What are some complications of fractures of the metacarpals/tarsals?

A

Extensive soft tissue injuries-check viability!
Synostosis between bones-painful!

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12
Q

What type of toe amputation is well tolerated?

A

Single digit

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13
Q

When is toe amputation indicated?

A

Severe luxations/fracture /neoplasia (STAGE)

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14
Q

What type of incision in a toe amputation preserves that pad?

A

‘Y’ shape

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15
Q

List some developmental bone diseases

A
  • Panosteitis
  • Metaphyseal Osteopathy
  • Craniomandibular Osteopathy
  • Legg-Calve-Perthes Disease
  • Slipped Capital Femoral epiphysis
  • Bone Cysts
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16
Q

List some paraneoplastic bone diseases

A

Hypertrophic Osteopathy (Marie’s disease)

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17
Q

List some nutritional bone diseases

A
  • Nutritional Secondary Hyperparathyroidism
  • Renal Secondary Hyperparathyroidism
  • Hypovitaminosis D (Rickets)
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18
Q

Describe the clinical signs of panosteitis

A
  • Self-limiting disease seen in young large breed dogs
  • Classically shifting lameness
  • Varies in severity from mild to non-weight bearing
  • Acute onset, no trauma
  • Forelimb:hindlimb ratio 4:1
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19
Q

Which bones are most commonly affected by panosteitis?

A

Ulna 42%
Radius 25%
Humerus 14%
Femur 11%
Tibia 8%

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20
Q

How is panosteitis diagnosed?

A

Signalment, history and clinical signs
Radiography

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21
Q

How does panosteitis appear on radiography?

A

Lack of definition between the cortex and medulla
‘thumb print’ radiopacities in the long bones
0 – 10 days: may appear normal
10 – 70 days: subtle, poorly marginated increased radiodensity in medullary cavity with some corticomedullary blurring and periosteal and endosteal new bone formation and thickened cortices
70 – 90 days: remodeling of medullary canal. Medullary canal regains normal appearance

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22
Q

How is panosteitis treated?

A

Self-limiting
Exercise control/restriction
Analgesics

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23
Q

Describe the signalment of metaphyseal osteopathy

A

Young rapidly growing medium and large breed dogs
Puppies may present between 2 and 6 months old

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24
Q

Describe the aetiology of metaphyseal osteopathy

A

Unknown
? Vitamin C deficiency
?Distemper Virus
Inherited immunodeficiency in Weimaraners

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25
Q

Describe the clinical signs of metaphyseal osteopathy

A

Vary from mild lameness to severe collapse
Pyrexia, anorexia and depression

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26
Q

How is metaphyseal osteopathy diagnosed?

A

Signalment, history, clinical signs
Radiography

27
Q

Describe the radiographic appearance of metaphyseal osteopathy

A

Common in distal radius and ulna
Radiolucent line and increased radiodensity in metaphysis parallel to physis
Epiphysis and growth plates may appear slightly widened

28
Q

How is metaphyseal osteopathy treated?

A

Most cases are self-limiting
Supportive care
Analgesics

29
Q

What is craniomandibular osteopathy?

A

Non-inflammatory, non-neoplastic proliferative bone disease-immature dogs

30
Q

Describe the signalment of craniomandibular osteopathy

A

Usually present between 4 – 10 months of age
Most common in WHWT, Scottish Terrier and Cairn Terrier

31
Q

Describe the aetiology of craniomandibular osteopathy

A

Autosomal recessive in WHWT

32
Q

Describe the clinical signs of craniomandibular osteopathy

A

Mandibular swelling/thickening
Inability to open mouth/prehend food
Salivation
Anorexia and weight loss
Pain when eating

33
Q

How is craniomandibular osteopathy diagnosed?

A

Signalment
History
Clinical findings
Radiography

34
Q

How does craniomandibular osteopathy appear on radiography?

A
  • Changes usually bilateral
  • Palisading proliferation on the mandible and tympanic bullae
  • Temporal, frontal and maxillary bones can be affected
  • Occasionally affects long bones
35
Q

Describe the treatment of craniomandibular osteopathy

A

Supportive care
Analgesics - ?corticosteroids
Surgery not successful

36
Q

What is the medical condition termed ‘Maries disease’?

A

Hypertrophic osteopathy

37
Q

Describe the signalment of Hypertrophic osteopathy

A

Older dogs and cats
Mean age 9 years (6 month – 15 years))

38
Q

Describe the aetiology of Hypertrophic osteopathy

A
  • Paraneoplastic: secondary to intrathoracic or abdominal neoplasia
  • Increased peripheral blood flow
  • Vascular congestion in periosteum
  • Calcification of periosteum and connective tissue
  • New bone formation on the distal limbs starting from the toes
  • Neural mediated: ?vagus, ?intercostal, other afferents
39
Q

Describe the clinical signs of Hypertrophic osteopathy

A

Lameness can develop over several months
Can be non-ambulatory
Single or multiple limbs
Firm swelling along bone of distal extremities
Pain in early stages
?hyperthermia, weight loss, depression

40
Q

How is Hypertrophic osteopathy diagnosed?

A

History and clinical signs
Thoracic radiographs and abdominal ultrasound
Radiography

41
Q

Describe the radiographic changes seen in Hypertrophic osteopathy

A

Periosteal new bone formation – 90 degrees
Increased bone density

42
Q

How is Hypertrophic osteopathy treated?

A

Symptomatic
Remove primary cause -> resolution of new bone formation

43
Q

Normal bone production but excessive bone resorption lead to?

A

Osteopenia

44
Q

Describe the aetiology of nutritional secondary hyperparathyroidism

A
  • Diets high in phosphorus or low in calcium (Kittens and puppies are fed a non-balanced diet e.g. purely meat
    Ideal ratio of calcium:phosphorus is altered)
  • Usually meat based diets
  • Ideal Ca:P ratio 1.2:1 (dogs) and 1:1 (cats)
  • Hypocalcaemia -> increased PTH
  • Induces progressive skeletal demineralisation
45
Q

Describe the clinical signs of nutritional secondary hyperparathyroidism

A

Lameness/ inability to stand
Skeletal pain
Swollen metaphysis
Pathological fracture

46
Q

Describe the radiographic signs of nutritional secondary hyperparathyroidism

A

Decreased bone density/thinned cortices
Mushroom shaped metaphysis
Pathological fractures may be seen

47
Q

How is nutritional secondary hyperparathyroidism treated?

A

Rest
Diet correction
Oral calcium supplementation
NSAID

48
Q

What is renal osteodystrophy?

A

Osteopenia secondary to chronic kidney disease

49
Q

What are the main causes of renal osteodystrophy

A

Impaired phosphate excretion
Impaired vitamin D production

50
Q

Describe how impaired phosphate excretion leads to renal osteodystrophy

A

Hyperphosphataemia -> hypocalcaemia
Increased PTH secretion
Bone demineralisation

51
Q

Describe how impaired vitamin D production leads to renal osteodystrophy

A

Depressed enteric calcium absorption
Impaired osteoid mineralisation
Rickets-osteomalacia

52
Q

List the orthopaedic clinical signs of renal osteodystrophy

A

Pliable mandible/maxilla (rubber jaw)
Loose teeth
Skeletal pain
Pathological fractures
Bowing of long bones

53
Q

How is renal osteodystrophy treated?

A

Reduce phosphate intake/phosphate binder
Calcium or calcitriol supplementation

54
Q

Ligament injuries are known as?

A

Sprains

55
Q

Tendon injuries are known as?

A

Strains

56
Q

Describe the 1st, 2nd and 3rd degree ligament injuries

A

First degree = Minimal tearing, rapid healing
Second degree = Partial rupture associated with haemorrhage and oedema
Third degree = Complete rupture of ligament or avulsion from bony attachments

57
Q

Describe the 1st, 2nd and 3rd degree tendon injuries

A

First degree:
- Healing is rapid- transient lameness
- 1 week restricted exercise and NSAIDS
Second degree:
- Weight-bearing –Support bandage/splint for 3-4 weeks
- Exercise controlled for up to 3 months
Third degree:
- Not weight-bearing, joint alterations
- Surgical repair, reattachment or replacement of ligament usually necessary e.g. ACL/CCL

58
Q

Describe general treatment of tendon injuries

A
  • In acute phase need to reduce inflammation-alternate cold warm compresses, and immobilisation to prevent further stress
  • Surgical treatment for ruptured, severed, displaced, avulsed tendons (in dog)
  • Immobilisation for 4-6 weeks post-operatively
  • Gradual increase in exercise over the following 2 months
59
Q

Describe surgical treatments of tendon injuries

A

Early repair better
Make sure wound clean
Monofilament nylon sutures used to attach ends
Immobilisation necessary for 4-6 weeks

60
Q

Muscle contractures are seen where anatomically?

A

Reversible contracture of the flexor carpi ulnaris muscle

61
Q

Describe the signalment of reversible contracture of the flexor carpi ulnaris muscle

A

Young dogs 6 – 8 weeks of age
- Skeleton and muscles grow at different rates leading to a flexural deformity

62
Q

Describe the clinical signs of reversible contracture of the flexor carpi ulnaris muscle

A

Flexed carpus that cannot be extended
Tendon of FCU is taut on palpation

63
Q

Describe the treatment of reversible contracture of the flexor carpi ulnaris muscle

A

Resolution usually occurs after 2 – 3 weeks
Carpal supports
FCU tendinectomy in rare cases

Y4 SA - Orthopaedics (7 decks)

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