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Advanced Clinical Nursing Theory > Hip, Elbow and Cruciate Disease > Flashcards

Hip, Elbow and Cruciate Disease Flashcards

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1
Q

what is hip dysplasia characterised by?

A

laxity of the hip joint

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2
Q

how is hip dysplasia acquired?

A

inherited

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3
Q

in what breeds is hip dysplasia common?

A

can be seen in all but most common in large and giant breeds

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4
Q

when does laxity become apparent in puppies?

A

born normal
apparent around 4-5 months

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5
Q

what is commonly linked to hip laxity?

A

hip dysplasia

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6
Q

at what age may animals present with hip dysplasia?

A

either:
4-12 months
as an adult

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7
Q

what do animals present with if coming to practice for hip dysplasia at 4-12 months?

A

laxity

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8
Q

what do animals present with if coming to practice for hip dysplasia as an adult?

A

arthritis secondary to hip dysplasia

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9
Q

what is often described in patient history of patients with hip dysplasia?

A

HL stiffness
reluctant to get up or jump
bilateral issues
bunny hopping

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10
Q

what is seen on gait analysis of patients with hip dysplasia?

A

short stride
weight over FL
lateral sway - back taking strain of stride
bunny hopping
hind feet close together
hips adducted

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11
Q

what will be detected on the orthopedic exam of a patient with hip dysplasia?

A

muscle atrophy
pain on hip extension but not necessarily flexion
crepitus on ROM
clunking heard or felt on manipulation

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12
Q

what muscle usually atrophies in patients with hip dysplasia?

A

quads

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13
Q

what radiographic views are needed to diagnose hip dysplasia?

A

ventrodorsal extended
VD frog leg
lateral pelvis
(orthogonal views)

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14
Q

what is VD frog leg most useful for?

A

surgical planning rather than diagnosis of hip dysplasia

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15
Q

what palpation techniques are involved in diagnosis of hip laxity?

A

ortolani test
bardens hip lift test

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16
Q

what is indicated by a positive ortolani test?

A

hip laxity

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17
Q

what is a downside of the ortolani test?

A

would be a negative test in animals with full luxation of the hip

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18
Q

what is involved in the bardens hip lift test?

A

measure how much hip moves out of the acetabulum when lifted by the femur

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19
Q

when is the bardens hip lift test performed?

A

under GA only

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20
Q

what are the treatment options for hip dysplasia?

A

non-surgical / conservative
myotomies
growth plate fusion
osteotomies
THR
FHNE

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21
Q

what is the myotomy that can be performed to treat hip dysplasia?

A

pectineal myotomy

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22
Q

what growth plate fusion can be performed to treat hip dysplasia?

A

juvenile pubic symphysiodesis

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23
Q

what osteotomies can be performed to treat hip dysplasia?

A

triple pelvic osteotomy
intertrochanteric

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24
Q

where is juvenile pubic symphysiodesis most commonly performed?

A

young animals and even then often not suitable

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25
Q

what are the most common methods of treatment for hip dysplasia?

A

conservative / non-surgical
THR
FHNE

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26
Q

what is involved in conservative treatment of hip dysplasia?

A

exercise restriction - no vigorous off lead exercise
hydrotherapy
controlling food intake
use of NSAIDs and other medication

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27
Q

what is the purpose of exercise restriction in conservative treatment of hip dysplasia?

A

maintain muscle mass and reduce hip joint inflammation

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28
Q

what is the purpose of food restriction in conservative treatment of hip dysplasia?

A

restriction of weight
slowing growth but ensuring correct nutrition

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29
Q

how is lifestyle altered for patients receiving conservative management of hip dysplasia?

A

weight loss
exercise restriction
hydrotherapy

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30
Q

why is hydrotherapy so good for hip dysplasia patients?

A

exercise that causes low stress for hips

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31
Q

how effective is conservative management for hip dysplasia?

A

76% minimal or no lameness when assessed 4.5 years since diagnosis
actually works well

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32
Q

what are the 4 main areas of surgical management of hip dysplasia?

A

growth plate fusion
osteotomies
THR
ostectomies

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33
Q

what is involved in juvenile pubic symphysiodesis?

A

iatrogenic closure of the pubic symphasis using electrocautery to cause thermal necrosis

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34
Q

in what patients is juvenile pubic symphysiodesis performed?

A

young (4-5 month patients)

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35
Q

what is the aim of juvenile pubic symphysiodesis?

A

stop growth of pubic bone
creation of acetabular ventroversion so increasing dorsal cover of femoral head

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36
Q

when must juvenile pubic symphysiodesis be performed?

A

during early growth phase

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37
Q

what are the main issues with juvenile pubic symphysiodesis?

A

neutering needed due to hip dysplasia
diagnosis needed early which is often not possible

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38
Q

what patients are good candidates for triple/double pelvic osteotomy?

A

young - 6 to 7 months
no DJD present only laxity
good clunk on ortolani test
small angles of reduction and subluxation

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39
Q

what condition would mean an patient was not a good candidate for triple/double pelvic osteotomy?

A

DJD present

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40
Q

what angle of reduction makes a patient suitable for triple/double pelvic osteotomy?

A

25-35 degrees

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41
Q

what angle of subluxation makes a patient suitable for triple/double pelvic osteotomy?

A

5-10 degrees

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42
Q

what is the purpose of triple/double pelvic osteotomy?

A

increase dorsal cover of femoral head

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43
Q

what is involved in triple/double pelvic osteotomy?

A

cutting ileum, ischium and pubis
bones then rotated to increase dorsal cover of femoral head

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44
Q

what are the main complications associated with triple/double pelvic osteotomy?

A

usually implant related
screw pull out
screw breakage

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45
Q

what is the success rate of triple/double pelvic osteotomy?

A

90%

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46
Q

does triple/double pelvic osteotomy prevent arthritis?

A

not totally, some patients may still need THR

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47
Q

do implant issues with triple/double pelvic osteotomy need correction?

A

not usually

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48
Q

what is the aim of FHNE?

A

salvage procedure for advanced OA
relieving patient of pain of femoral head hitting acetabulum

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49
Q

what happens during healing once the femoral head and neck are removed?

A

pseudoarthrosis formed

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50
Q

what is a pseudoarthrosis?

A

area filled with bone and fibrous tissue

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51
Q

why is it crucial that all the femoral head and neck are removed during FHNE?

A

if neck remains it may still contact acetabulum and cause pain

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52
Q

what is the aim of denervation of the acetabulum?

A

removal of pain sensation in OA

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53
Q

is denervation common?

A

no

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54
Q

what are the aims of THR?

A

pain relief
return to high level function

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55
Q

what are the indications for THR?

A

end stage hip arthritis
hip dysplasia
fracture

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56
Q

what is involved in THR?

A

removal of acetabulum and femoral head and neck
implants placed to replace these

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57
Q

what are the types of hip implant available?

A

cemented
uncemented / BFX / biological fixation

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58
Q

what is the difference between cemented and uncemented hip implants?

A

cemented implants are held in with bone cement (no way!!)
non-cemented are hammered in and then rely on bony ingrowth to secure them in place

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59
Q

how are THR implant sizes chosen?

A

imaging measured with acetabular and femoral templates before surgery
selection available in theatre

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60
Q

what is a key concern in THR surgery?

A

infection risk and so strict asepis

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61
Q

what is the result of SSI in THR?

A

surgical failure
implant removal
FHNE

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62
Q

what are the steps involved in THR?

A

Femoral head excision
ream acetabulum
ream femur
cement or impact acetabulum
cement or impact femur
place femoral head
reduce hip
bacterial swab taken
suture joint capsule
routine closure

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63
Q

what is involved in reaming the acetabulum and the femur?

A

hollowing out femur
removal of acetabular cartilage

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64
Q

what is the aim of reaming the acetabulum and the femur?

A

tight fit for implant

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65
Q

how is the size of femoral head chosen?

A

size of acetabulum
patient
needs to be as tight as possible

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66
Q

why is the joint capsule sutured closed?

A

reduces risk of luxation in post op period

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67
Q

when are radiographs taken following THR?

A

immediately post op
6 weeks post op

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68
Q

what is being checked for during post op THR xrays?

A

positioning of femoral stem and acetabulum (particularly)
cement fill
presence of any fissures

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69
Q

what is being checked for during 6 week post op THR xrays?

A

no dislocation
positioning of femoral stem and acetabulum
any periosteal reaction
cement or bone interferance

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70
Q

what is periosteal reaction?

A

reaction to reaming seen in cemented implants and young dogs

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71
Q

what is the complication rate for THR?

A

5-15%

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72
Q

what are the main complications associated with THR?

A

fracture
loosening
dislocation
infection
subsidence
cement granuloma
neurological damage

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73
Q

when can fracture occur during THR?

A

reaming
stem placement
older dogs post op

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74
Q

what is the most common THR complication?

A

dislocation

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75
Q

what is subsidence?

A

BFX implants used to subside into bone before they were bolted in place

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76
Q

what decides what type of THR implant is used?

A

surgeon
patient
femur

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77
Q

can cemented and uncemented implants be mixed?

A

yes - often do cemented stem and BFX acetabulum

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78
Q

what are the common complications seen with uncemented THR?

A

subsidence
dislocation
femur fracture

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79
Q

how long should patients be rested for following THR?

A

strict 6 weeks

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80
Q

what is involved in the care of patients post THR?

A

keep quiet - possible sedation
cage rest
lead walks in sling for toiletting
care with surfaces to prevent slipping
no jumping

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81
Q

what can be used in THR patients to reduce ventral dislocation risk?

A

hobbles

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82
Q

what discharge advice would you give to owners regarding exercise post THR?

A

restricted
cage rest
avoid slippery floors
no playing or jumping
all to reduce dislocation risk

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83
Q

what is indicated by periosteal reaction on xray post THR?

A

infection

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84
Q

what indicates loosening of THR implants on Xray?

A

increased lucency between bone and cement

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85
Q

what is the purpose of the 6 week radiographs following THR?

A

check for complications
assess if slow return to normal exercise can start

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86
Q

how long may it take for a patient to return to normal exercise following THR?

A

up to 6 months post op

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87
Q

what is the most common cause of forelimb lameness in dogs?

A

elbow dysplasia

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88
Q

what is elbow dysplasia also known as?

A

developmental elbow disease

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89
Q

what are the main issues seen with developmental elbow disease?

A

uninited anconeal process of ulna
OCD of medial humeral condyle
fragmented medial coronoid process of ulna
asynchronous growth of radius and ulna leading to joint incongruity

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90
Q

can issues seen with developmental elbow disease be seen individually or together?

A

can occur together

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91
Q

what breed is commonly affected by developmental elbow disease?

A

large breeds e.g. labs, rottweillers, retrievers

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92
Q

at what age do dogs present with developmental elbow disease?

A

6 months
may be older

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93
Q

when dogs present with developmental elbow disease once they are older what secondary issue to they commonly have?

A

arthritis secondary to DED

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94
Q

what sex is commonly affected by DED?

A

males and females both affected
males slightly overrepresented

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95
Q

why may male dogs be slightly overrepresented with DED?

A

faster growth
heavier

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96
Q

what is often seen on patient history with DED?

A

low grade, mild lameness
bilateral
stiffness on rising

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97
Q

what would be seen on physical exam of a patient with DED?

A

elbow effusion
decreased ROM
pain on extremes of elbow flexion and extension

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98
Q

how is elbow effusion often seen?

A

bulge between lateral epicondyle and olecranon

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99
Q

what diagnostic tool is used in DED?

A

imaging - xray or CT

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100
Q

what xray views are required to assess the patient for DED?

A

orthogonal
flexed mediolateral
craniocaudal
(neutral mediolateral)

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101
Q

what are you looking for on xray to indicate DED?

A

evidance of degenerative joint disease as a result of DED

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102
Q

what signs on xray will indicate DJD and so DED?

A

osteophytes on dorsal anconeal process and radial head
sclerosis of ulna notch
flattened or blurred FCP
increased humeroradial joint space

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103
Q

what is a neutral lateral view of the elbow most useful for?

A

looking at incongruity

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104
Q

what is the purpose of a fully flexed mediolateral view of the elbow?

A

see anconeal process and osteophytes
remove superimposed humerus

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105
Q

what is seen on the craniocaudal view of the elbow?

A

OCD on medial humeral condyle

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106
Q

what are two additional xray views that can be used to assess the elbow?

A

craniolateral-caudomedial oblique
distomedial-proximolateral oblique

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107
Q

what is the purpose of craniolateral-caudomedial oblique elbow views?

A

see fragmentation of coronoid

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108
Q

what is the positioning for craniolateral-caudomedial oblique elbow?

A

slight rotation of limb with olecranon moved laterally

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109
Q

what is the purpose of distomedial-proximolateral oblique elbow views?

A

view of coronoid process

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110
Q

what is the best elbow imaging modality?

A

CT
no superimposition

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111
Q

in what breeds is ununited anconeal process commonly seen?

A

GSD

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112
Q

when should the anconeal process fuse?

A

4-5 months

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113
Q

what may lead to ununited anconeal process?

A

short ulna
development issues

114
Q

what is the consequence of an ununited anconeal process?

A

elbow stability is compromised
inflammation
lameness
OA caused

115
Q

what imaging is needed to diagnose ununited anconeal process?

A

fully flexed mediolateral xray
CT

116
Q

what does treatment of ununited anconeal process depend on?

A

age of patient
degree of displacement

117
Q

what are the treatment options for ununited anconeal process?

A

conservative
removal of anconeal process
proximal dynamic ulna osteotomy (PDUO)
lag screw fixation

118
Q

when would the removal of anconeal process in the treatment of ununited anconeal process be performed?

A

very arthritic older dog

119
Q

what is the aim of proximal dynamic ulna osteotomy (PDUO) in treatment of ununited anconeal process?

A

allows lengthening of the ulna as the radius grows removing shear stress on the anconeal process and allowing it to fuse with the ulna

120
Q

what is the aim of lag screw fixation of the anconeus in treatment of ununited anconeal process?

A

reattachment of anconeus to ulna

121
Q

what is elbow incongruity often caused by?

A

short radius relative to the length of the ulna

122
Q

what is the result of elbow incongruity?

A

cartilage wear and fragmentation of the medial coronoid process

123
Q

how is elbow incongruity treated?

A

ulna ostectomy +/- pin

124
Q

what is involved in an ulna ostectomy?

A

segment of ulna is removed and ulna may or may not be supported through placement of a pin

125
Q

what is the benefit of not pinning the ulna for elbow incongruity?

A

allows ulna to find ‘best fit’ location when healing
issues associated with pin placement and migration

126
Q

what is the benefit of pinning the ulna during ulna ostectomy?

A

reduction of pain
prevention of excessive movement of proximal ulna

127
Q

whereabouts in the elbow is osteochondrosis (OCD) most commonly seen?

A

medial humeral condyle

128
Q

what breeds is osteochondrosis common in?

A

medium sized e.g. labrador

129
Q

what will be seen in the history of a patient with OCD?

A

forelimb lameness
some improvement seen with NSAIDs
effusion

130
Q

when do animals commonly present with OCD?

A

6 months old or younger

131
Q

what is OCD?

A

thickened, partially detached flap of cartilage on the medial humeral condyle overlaying subchondral bone defect

132
Q

what xray views are needed to diagnose OCD?

A

craniocaudal and flexed mediolateral

133
Q

what may be seen on craniocaudal view of a patient with OCD if lesion is large enough?

A

flattening of medial humeral condyle

134
Q

how can OCD be treated?

A

conservative management
surgery

135
Q

what is involved in conservative treatment of OCD?

A

restricted exercise for 4-6 weeks
NSAIDs

136
Q

what does treatment method of OCD depend on?

A

severity and size of lesion
if conservative treatment has been effective

137
Q

what should be done for a patient with OCD if they have not improved on conservative management?

A

surgery considered

138
Q

what are the surgical treatment options for OCD?

A

arthrotomy and debridement
arthroscopy and debridement

139
Q

when is surgery a first line treatment for OCD?

A

large lesion
very lame
large effusion

140
Q

what is the commonest elbow pathology diagnosed in dogs with elbow dysplasia?

A

fragmented coronoid process

141
Q

where is the most common area of fragmentation seen in FCP?

A

craniolateral aspect of medial coronoid process

142
Q

what are the causes of FCP?

A

hereditary
short radius
shallow ulna notch

143
Q

what age do patients present with FCP?

A

6-10 months

144
Q

what dogs is FCP most commonly seen in?

A

medium to large breed

145
Q

is FCP often bilateral?

A

yes

146
Q

what may be seen alongside FCP?

A

other concurrent elbow disease
e.g. incongruity, ununited anconeal process, fissures

147
Q

how is FCP diagnosed?

A

xray
CT

148
Q

what is the best method of diagnosis of FCP?

A

CT

149
Q

what can be seen on xray of dogs with FCP?

A

secondary osteophyte formation and OA

150
Q

what is the treatment for FCP?

A

arthroscopic debridement if young
medical management of arthritis if already well established

151
Q

what do all dogs with elbow dysplasia develop?

A

osteoarthritis

152
Q

what influences treatment of OA?

A

severity of disease
clinical signs

153
Q

what is usually tried to treat OA before surgery?

A

medical management

154
Q

what is involved in medical management of OA?

A

NSAIDs
weight loss
hydrotherapy
physiotherapy

155
Q

why may arthroscopy be used in OA treatment?

A

evaluation of cartilage to assess damage
removal of loose or damage cartilage

156
Q

what are the main surgical treatments for OA?

A

arthroscopy and abrasion arthroplasty or microfracture
long bone osteotomy
elbow replacement
arthrodesis

157
Q

what is involved in abrasion arthroplasty?

A

cartilage and subchondral bone is removed using a burr until diffuse bleeding is seen over the lesion site
joint is the lavaged to remove bone debris

158
Q

what is involved in microfracture for OA treatment?

A

necrotic cartilage removed
angled micropick is used to make holes in subchondral bone surface
joint is the lavaged

159
Q

what is the aim of abrasion arthroplasty or microfracture?

A

encourage cartilage replenishment through neovascularisation and stem cell release

160
Q

what is formed in a joint when mesenchymal stem cells are released?

A

hyaline and fibrocartilage

161
Q

where in the elbow joint are most issues seen with elbow dysplasia?

A

medial aspect

162
Q

what is the aim of long bone osteotomy to treat OA?

A

decrease medial compartment load

163
Q

in long bone osteotomy for OA is a plate used?

A

depends on surgeon

164
Q

how does long bone osteotomy decrease medial compartment load?

A

shifts weighbearing from medial to lateral to allow medial cartilage to heal

165
Q

what is the purpose of a proximal abducting ulna osteotomy (PAUL) plate?

A

plate is positoned to shift ulna across to the lateral compartment and alter weightbearing

166
Q

what scale is used to grade cartilage damage?

A

Outerbridge

167
Q

when is elbow replacement surgery indicated

A

advanced arthritis
extreme cartilage loss

168
Q

what are the main risks associated with elbow replacement?

A

complications are common
may need additional surgery
end result may still be arthrodesis or amputation

169
Q

when is arthrodesis indicated?

A

last resort on end stage painful joint
final salvage procedure

170
Q

what lameness level must be seen in patients undergoing arthrodesis?

A

unilateral as if bilateral arthrodesis could make contralateral limb worse

171
Q

what is the benefit of elbow arthrodesis?

A

pain relief

172
Q

what is the disadvantage of elbow arthrodesis?

A

gait abnormality

173
Q

when is arthroscopy indicated?

A

Exploration of joints for diagnosis through observation, biopsy and culture
Removal of loose bodies
Topical treatment of OA – microfracture and abrasion arthroplasty
Joint debridement and lavage
Arthroscopic assisted joint stabilization or fracture repair

174
Q

what are the advantages of arthroscopy compared to arthrotomy?

A

Decreased morbidity
More rapid recovery than arthrotomy
Decreased complications
Improved outcomes
Decreased surgery, anaesthesia and hospitalization times

175
Q

what are the disadvantages of arthroscopy compared to arthrotomy?

A

High level of skill required
Long learning curve
High cost of equipment
Increased cost to client

176
Q

what equipment is needed for arthroscopy?

A

arthroscope
camera
monitor
light source
cannula
irrigation
egress systems
hand instruments
power tools
electrocautery
other standard surgical kit

177
Q

what diameter arthroscopes are commonly used for elbow arthroscopy?

A

1.9
2.4
2.7

178
Q

what is the lens angle used in arthroscopy?

A

30 degrees

179
Q

why is a 30 degree lens angle used for arthroscopy?

A

better view of field than 0 degrees

180
Q

what working length of arthroscope is available?

A

short - 8.5cm
long - 13cm

181
Q

what light source is commonly used for arthroscopy?

A

xenon

182
Q

why are xenon bulbs often used for arthroscopy?

A

better quality picture

183
Q

what does choice of arthroscope working length depend on?

A

joint depth

184
Q

what is the downside of xenon bulbs for arthroscope light source?

A

can blow without warning so need a spare

185
Q

what are the functions of arthroscope cannulas?

A

maintain arthroscope portal
protect arthroscope
ingress of fluid

186
Q

why is irrigation needed for arthroscopy?

A

joint needs continual flushing with saline to keep it inflated and blood free. The fluid enters the joint through the cannula

187
Q

what are egress systems used for in arthroscopy?

A

source for removal of the fluid – a needle or the instrument cannula can be used. Fluid siphoned away or allowed to go onto floor and suctioned.

188
Q

what is the purpose of instrument cannulas for arthroscopy?

A

have a rubber seal that allows insertion of instruments without allowing egress of fluid

189
Q

how should a patient be clipped for arthroscopy?

A

circumferential around elbow
enough to allow for open approach if arthrotomy needed
often bilateral

190
Q

how should the patient be positioned in theatre for arthroscopy?

A

dorsal if bilateral
lateral otherwise
joints distracted over sandbag or edge of table
hanging leg for prep

191
Q

how should the limb be held to faciliatate elbow arthroscopy?

A

abducted
pronated

192
Q

what drapes may be needed in arthroscopy?

A

waterproof to prevent patient becoming saturated

193
Q

where should the monitor be positioned in relation to the surgeon?

A

in line with scope and surgeon

194
Q

what is the purpose of the instrument portal during arthroscopy?

A

instruments can be passed into joint through cannula
portal is secure so instruments can be changed

195
Q

what cutting instruments are available for arthroscopy?

A

hooks
knives
forceps

196
Q

what needs to be cut beofre cartilage fragments can be removed?

A

attachment to annular ligament

197
Q

what is the role of fragment manipulators during arthroscopy?

A

movement of fragment before removal

198
Q

what are common equipment types for fragment removal during arthroscopy?

A

alligator forceps
artery forceps
shaver motorised handpiece

199
Q

describe the process of arthroscopy

A

Set everything up – camera, light source, arthroscope, ingress and egress, blunt probe and cannula.
Check camera working, white Aspirate joint fluid with needle and syringe – to ensure in the joint – (egress portal)
Inject saline through the needle to inflate the joint
Place second needle at the location where the arthroscopy cannula will enter the joint
Enlarge the hole with a scalpel
Place the cannula and blunt obturator into the joint
Remove the obturator and place the arthroscope
Connect egress tube / remove syringe and ensure egress needle functioning.
Turn on fluids, to ensure the arthroscope is correctly positioned in the joint
Inspect the joint – moving the light cable to rotate the end of the arthroscope
Make an instrument portal – insert a needle
Enlarge the hole with a No 11 scalpel blade
Place a blunt switching stick through the hole
Place instrument cannulas
Use a variety of instruments in the instrument cannulas to debride / treat the joint
Flush joint through at the end by switching the ingress fluid line to the egress line (so bigger hole for fluid to exit through.
Remove all equipment and place skin sutures through small incisions.

200
Q

what is the cranial cruciate ligament formed from?

A

2 bands of tissue

201
Q

what are the 2 bands called found within the cranial cruciate ligament?

A

craniomedial
caudolateral

202
Q

what explains partial cruciate ligament tears?

A

2 bands that make up cranial cruciate ligament

203
Q

what is the role of the cranial cruciate ligament?

A

resists stifle extension
resists internal rotation
prevents tibia moving cranially

204
Q

what breeds are commonly affected by cranial cruciate disease?

A

any breed

205
Q

what age group are commonly affected by cranial cruciate disease?

A

over 6 months
middle aged most common

206
Q

when is cranial cruciate ligament rupture seen in small dogs?

A

avulsion fracture

207
Q

what sex are commonly affected by cranial cruciate disease?

A

female

208
Q

what body condition score are commonly affected by cranial cruciate disease?

A

overweight

209
Q

what is the most common cause of cranial cruciate disease?

A

degenerative cause

210
Q

what are the causes of cranial cruciate ligament disease?

A

trauma
inflammation

211
Q

is traumatic cranial cruciate ligament rupture common?

A

no

212
Q

what are the main tests for cranial cruciate disease?

A

cranial draw
tibial thrust

213
Q

what may affect cranial draw test?

A

over extension of the stifle due to restriction by collateral ligaments

214
Q

what is mimicked by the tibial thrust test?

A

standing

215
Q

what radiographic views are needed to diagnose cranial cruciate disease?

A

orthogonal on both limbs
mediolateral stifle
caudocranial

216
Q

what is seen on xray which indicates cranial cruciate disease?

A

Joint effusion most commonly seen
decreased size of infrapatella fat pad due to compression by effusion
Periarticular osteophytes near fabella, top and bottom of patella

217
Q

what effect can joint effusion caused by cranial cruciate disease have on the joint space?

A

decreased size of infrapatella fat pad

218
Q

what are the main treatment options for cranial cruciate disease?

A

conservative
surgical

219
Q

what are the main surgical treatment options for cranial cruciate disease?

A

intra articular replacement of ligament
extra articular replication of ligament function
combination
alteration of joint angles

220
Q

what is the aim of altering the joint angle in cranial cruciate disease treatment?

A

remove need for cranial cruciate ligamnet

221
Q

what animals are candidates for conservative treatment for cranial cruciate disease?

A

dogs and cats <15kg

222
Q

what is involved in conservative management of cranial cruciate disease?

A

strict rest for 6 weeks
surgery if no improvement

223
Q

what does conservative treatment of cranial cruciate disease rely on?

A

fibrosis

224
Q

what is involved in the Modified DeAngelis suture / lateral suture?

A

arthrotomy
confirm diagnosis
debride ligament
check meniscus
place suture
secure suture with crimps
repair fascia lata

225
Q

where is Modified DeAngelis suture / lateral suture placed?

A

around femorofabella ligament and through bone tunnel in the tibial tuberosity

226
Q

what suture is used for Modified DeAngelis suture / lateral suture?

A

monofilament leader line

227
Q

how is the suture secured during Modified DeAngelis suture / lateral suture?

A

metal crimps

228
Q

what suture is used to repair the fascia lata during Modified DeAngelis suture / lateral suture surgery?

A

modified mayo mattress

229
Q

what is the purpose of crimping the suture in place during Modified DeAngelis suture / lateral suture?

A

holds suture in place
progresive increase in tension

230
Q

how are crimp clamps placed during Modified DeAngelis suture / lateral suture surgery?

A

progressive increase of tension
cranial draw checked
crimp tube crimped in 3 places

231
Q

what are the complications associated with Modified DeAngelis suture / lateral suture?

A

suture failure
instability
infection
meniscal tear
anchor pull out

232
Q

what are the main ways suture may fail during Modified DeAngelis suture / lateral suture?

A

breakage
stretching
pull through crimp

233
Q

what is the most common method of cranial cruciate ligament rupture management?

A

tibial plateau leveling

234
Q

is the gastrocnemius attached to the tibia?

A

no

235
Q

what direction does the tibial plateau slope?

A

caudally

236
Q

what will happen to the tibia if not restrained by cranial cruciate ligament?

A

tibia will slide forwards and joint may subluxate

237
Q

what are stifle forces?

A

compression forces caused by weight and muscular propulsion

238
Q

what is the only passive restraint to tibia slippage in the stifle joint?

A

cranial cruciate ligament

239
Q

what is cranial tibial thrust?

A

force created by compression between the femur and tibia

240
Q

what is cranial tibial thrust proportional to?

A

slope of tibial plateau

241
Q

what is measured in order to calculate tibial slope?

A

tibial slope
weightbearing axis
tibial plateau angle

242
Q

where is the tibial slope measured?

A

between the cranial and caudal points of the tibial plateau

243
Q

where is the weightbearing axis measured?

A

middle of tibia diaphysis up to highest point of tibia

244
Q

what is the tibial plateau angle?

A

perpendicular line with weightbearing axis

245
Q

what is the averae tibial plateau angle?

A

24 degrees

246
Q

what does a higher tibial plauteau angle indicate?

A

steeper slope and increased tibial thrust force

247
Q

what is the aim of TPLO?

A

altering slope of tibial plateau to prevent cranial tibial thrust during weight bearing

248
Q

what approach is used during TPLO surgery?

A

medial parapatellar

249
Q

how is diagnosis of cranial cruciate rupture confirmed?

A

arthrotomy or arthroscopy to assess ligament before TPLO

250
Q

what may be done during the arthrotomy/arthroscopy before TPLO?

A

debride ligament
removal of torn meniscus if necessary

251
Q

how should the patient be positioned for TPLO?

A

dorsal
hanging leg for prep

252
Q

what should be checked during prep?

A

patient skin to reduce SSI risk

253
Q

what is the difference between stifle distractors and gelpis?

A

SD have tips which cross over

254
Q

what is the purpose of a meniscal probe?

A

check for meniscal tears

255
Q

what saw blades are often used for TPLO?

A

oscillating
varying sizes

256
Q

what is the purpose of a TPLO jig?

A

pins tibia
allows rotation of cut portion of tibia and prevents leg hanging or moving

257
Q

how is a TPLO cut performed?

A

cut made
lines made on cut portion and rest of tibia to mark amount of pre calculated rotation required
tibia then cur through fully

258
Q

what are pins used for during TPLO?

A

aid rotation of bone to match up pre made marks

259
Q

how is the TPLO stabilised once the cut has been made?

A

plate is applied - contoured to the bone and a variety of screws used (locking and non-locking)

260
Q

how are screws placed?

A

hole drilled appropriate to plate size
depth measured
appropriate length screw placed (either need hole to be tapped or use self tapping screws)

261
Q

what is the aim of quick coupling drill connection?

A

easy change of drill bit

262
Q

what should the tibial plateau angle be reduced to following TPLO?

A

6/7 degrees
not 0

263
Q

why should the tibial plateau angle not be reduced to 0?

A

pressure then placed on caudal cruciate ligament

264
Q

what happens to the step created by tibial plateau rotation during healing?

A

remodels

265
Q

what is being assessed on post op TPLO xrays?

A

screw placement
post op angle
small gap between tibia and rotated portion

266
Q

what are the possible complications associated with TPLO?

A

fibula fracture
peroneal nerve damage
popliteal artery trauma
tibial tuberosity avulsion fracture
patella ligament desmitis
pivot shift
osteomyelitis

267
Q

what is pivot shift?

A

odd gait seen in TPLO post op complications

268
Q

what is the complication rate of TPLO like?

A

low - around 10%

269
Q

what are the other possible tibial levelling procedures?

A

triple tibial osteotomy
tibial tuberosity advancement
cranial closing wedge

270
Q

what patietns is the cranial closing wedge used in?

A

those with small bones (e.g. little dogs)

271
Q

what is the aim of tibial tuberosity advancement?

A

patella ligament is brought 90 degrees to tibial plateau to limit tibial thrust

272
Q

what are the main menisci?

A

medial and lateral

273
Q

what other ligament does the medial meniscus have attachment to?

A

medial collateral ligament

274
Q

which meniscus is more commonly torn?

A

medial

275
Q

how commonly is cranial cruciate ligament rupture associated with meniscal tear?

A

50% of cases

276
Q

how can meniscal injuries be identified?

A

arthroscopy or arthrotomy
may be audible or palpable click

277
Q

what is the treatment for meniscal tear?

A

removal of ruptured portion during arthroscopy/arthrotomy

278
Q

what can occur after cruciate ligament surgery?

A

late meniscal tears - probably started at cruciate ligament rupture

279
Q

what equipment is useful for assessing the integrity of the meniscus?

A

meniscal probe

280
Q

what is involved in post operative care of cruciate disease patients?

A

strict rest / confinement for 6 weeks
radiographs to monitor healing at 6 weeks
gradual reintroduction of exercise over the following 6 weeks
physio and hydro useful

281
Q

when is there poorer prognosis for outcome of cranial cruciate rupture?

A

older dogs
those with meniscal tears

282
Q

what is the impact of reduced quality of outcome for dogs with meniscal tears?

A

dogs with cranial cruciate ligament rupture should be treated as soon as possible to reduce likelihood of tear

Advanced Clinical Nursing Theory (36 decks)

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