Foot and miscellaneous orthopaedic conditions

Question 1

What are main conditions of the foot?

Answer 1

• Fractures (Mc/Mt/Phalanges)
• Luxations of joints
• Pad injuries - e.g. Corn
• FBs
• Nail injuries
• (Sesamoid disease)

Question 2

What is a corn? Tx?

Answer 2

• Paw pad keratoma =
  -focal area of hyperkeratosis, (excess keratin + thickening)
• Tx = topical ointment, hulling (digging out corn), complete excision - But will recur =
  Superficial digital flexor tendonectomy

Question 3

What should be done with fractures of the foot? What are complications?

Answer 3

• Single = external coaptation
• Multiple = dowel pinning / SPIDER external fixation
• Complications = Extensive soft tissue injuries - check viability

Question 4

When would you do a toe amputation?

Answer 4

• Single digit
• Severe luxation / fracture / neoplasia
• Can cut through joint

Question 5

What are paraneoplastic bone disease?

Answer 5

• Marie’s disease = Hypertrophic osteopathy

Question 6

What are developmental bone disease?

Answer 6

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

Question 7

What are nutritional bone disease?

Answer 7

• Nutritional Secondary Hyperparathyroidism
• Renal Secondary Hyperparathyroidism
• Hypovitaminosis D (Rickets)

Question 8

What is seen with panoseitis? Dx? Tx?

Answer 8

• Classically shifting lameness
• Varies in severity from mild to non-weight bearing
• Acute onset, no trauma
• Forelimb:hindlimb ratio 4:1
• Dx = Hx, CS + Radiography
• Tx = Self limiting, exercise restriction + analgesia

Question 9

What is seen with metaphyseal osteopathy? Dx?

Answer 9

• Young large breed dogs (2-6m/o)
• Mild lameness to severe collapse
• Pyrexia, anorexia + depression
• Dx = History, CS, Radiographs

Question 10

What is seen on radiography of Metaphyseal osteopathy? Tx?

Answer 10

• Distal radius + ulna = radiolucent lines in metaphysis
• Widened growth plates
• Tx = self-limiting, supportive = analgesia

Question 11

What is seen with craniomandibular osteopathy?

Answer 11

• WHWT - 4-10m/o
• Mandibular swelling / thickening
• Inability to open mouth / prehend food
• Salivation, pain when eating
• Anorexia, weight loss

Question 12

What is Dx of craniomandibular osteopathy? What is seen on radiography? Tx?

Answer 12

• Dx = Hx, CS, Radiography
• Radiograph = bilateral changes, palisading proliferation on mandible + tympanic bullae
• Tx = Supportive, analgesia (can be self-limiting)
• NOT SURGERY

Question 13

What is seen with hypertrophic osteopathy?

Answer 13

• Older dogs/cats (around 9y/o)
• Lameness, single/multiple limbs
• Firm swelling along bones of distal extremities
• Pain in early stages
• Hyperthermia, weight loss + depression

Question 14

How is hypertrophic osteopathy Dx / Tx?

Answer 14

• Dx = Hx + CS + Radiographs (thoracic + limb)
• Radiograph = increased bone density, periosteal new bone formation
• Tx = Symptomatic + remove primary cause

Question 15

What causes nutritional secondary hyperparathyroidism? CS?

Answer 15

• Causes = Diets high in phosphorus or low in calcium
  -Usually meat based diets
  -Ideal Ca:P ratio 2:1 (dogs) and 1:1 (cats)
  -Hypocalcaemia = increased PTH
  -Induces progressive skeletal demineralisation
• CS = Lameness/ inability to stand
  -Skeletal pain
  -Swollen metaphysis
  -Pathological fracture

Question 16

How is nutritional secondary hyperparathyroidism diagnosed / treated?

Answer 16

• Dx = Hx, CS + Radiography
• Radiograph = decreased bone density, mushroom shaped metaphysis, pathological fractures
• Tx = rest, diet correction, oral supplements, NSAIDs

Question 17

What causes renal osteodystrophy?

Answer 17

• Impaired phosphate excretion = hyperphosphataemia = hypocalcaemia = increased PTH = bone demineralisation = rubber jaw
• Impaired vit D production = depressed enteric calcium absorption = impaired osteoid mineralisation = rickets / osteomalacia

Question 18

CS of renal osteodystrophy? Tx?

Answer 18

• CS = Pliable mandible/maxilla (rubber jaw)
  -Loose teeth
  -Skeletal pain
  -Pathological fractures
  -Bowing of long bones
• Tx = Reduce phosphate intake / phosphate binder
  -Calcium / calcitriol supplement

Question 19

What are the different degrees of ligament injuries?

Answer 19

• First degree (sprains) = minimal tearing, rapid healing
• Second degree = partial rupture associated with haemorrhage + oedema
• Third degree = complete rupture of ligament / avulsion from bony attachment

Question 20

How would you treat different degrees of ligament injuries?

Answer 20

• First degree = 1 week restricted exercise + NSAIDs
• Second degree = Support/bandage for 3-4 weeks
  -exercise controlled for up to 3 months
• Third degree = surgical repair

Question 21

How would you treat tendon injuries?

Answer 21

• In acute phase = reduce inflammation = cold compress + immobilisation
• Surgical Tx for rupture / severed / avulsed tendons
• Immobilisation for 4-6wks
• Gradual increase in exercise over 2 months
• Platelet rich plasma

Question 22

What is seen with reversible contracture of the flexor carpi ulnaris muscle?

Answer 22

• Young dogs (6-8wks)
• Flexed carpus that cannot be extended
• Tendon of FCU is taut on palpation

Question 23

Tx of contracture of flexor carpi ulnaris?

Answer 23

• Resolution occurs after 2-3 wks
• Carpal supports
• FCU tendinectomy = RARE