Import Ryan Flashcards
Elbow disease is the main cause of forelimb lameness and secondary osteoarthritis. Is it typically Bilateral or unilateral? From what age does it typically develop?
Bilateral
4m
Principles of treating Harris IV (3) —-
need repair within 48 hours
perfect anatomic reconstruction so no callous
inter fragmentary compression with lag screws
What bone are ESFs contraindicated? —
fractures with large tissue envelop such as humerus (quadriceps) as penetrates the muscle
sequel of fragmented coronoid process (2) —-
osteoarthritis (progressive)
kissing lesion
Salter Harris classification aims to give prognosis and likelihood of premature growth plate closure.
What is the anagram used for remembering 5 types —-
S ingle A bove L over T ransverse V
What is a + sit test and what is the top 2 ddx —-
when dogs sit down it will stick one leg out so not to bend it.
likely cruciate or hock pain (OCD)
If > 3 comminuted fractures then healing aims to keep blood supply. What are the three options
Interlocking nails
Bridging bone plate
External skeletal fixators
Carpus
a) angle of joint
b) landmarks
flexed90 degrees between extensor carpi radials (medial) and common extensor tendon (lateral)
UAP is worse after rest or excercise —-
Exercise
How is Salter Harris 1 treated and what is external landmark? —-
Healed by cross- K wires in young cats and dogs
through long digital extensor fossa then up and across
what is the main complication seen with external coaptation? how often are bandages changed? —
avascular necrosis
change every 2-3 weeks
Shoulder
a) site of OCD
b) breeds
c) CS —-
a) caudal aspect of the humeral head
b) Great Dane and German shepherd
c) unilateral forelimb lameness, scapular atrophy
What is patella alta? —-
high riding patella hence not siting within the trochlear groove
Normal bacteria in septic arhtiritis (3) —-
staph. intermedius
staph. aureus
b-haemolytic strep
Why would we collect joint fluid? —-
joint effusion
suspect tIMGA
lameness, pain and reduced ROM
Describe Juvenile Pubic Symphysiodesis and Triple pelvic osteotomy —-
Thees function to axially rotate the pelvis and lateralise the acetabulum allowing them to have increased dorsal coverage
How to diagnose hip dysplasia radiographically —-
In older dogs then will be OA and DJD
PenHipp score measured the degreeee of lunation as if standing
How does age affect potential to repair?
Younger paitents have a greater biological potential for repair
Are heavy weight repair options load-sharing or non load sharing? —
can be either
Where are changes due to fragmented coronoid process present? —-
medial part of the coronoid process on ulna
For IM pin to work in the femur, the pin must be fully seated into the medial or lateral condyle to avoid the trochlear foramen? —-
Medial
two sequel of pelvic fracture —-
if pelvic canal collapses then risk of constipation or dustocia
(painful)
3 signs of DJD —-
crepitus
Reduced RangeOfMotion
pain
Talocrural landmarks —-
medial to lateral malleolus at dorsomedial aspect of joint
How does late diagnosis (after instability) affect prognosis —-
higher risk of meniscal damage.
abnormal eye position: CN affected —–
III (occulomotor), IV (trocheal), VI (abducens), VIII (vestibulocochlear)
Two main ddx of fracture not healing —-
Infectious
Implant failure
How do we clean wound? How can we overdo this? —-
remove debris, ligate vessels and decried necrotic tissue. The more we decried, the greater the strain on the tendon so don’t overdo
How are acetabular fractures treated? —-
lag screws and tension wire
When do we stop therapy for septic arthritis —-
after repeat arthrocentesis
Give an example of dual bone fixation and how this differs from orthogonal plates —
Like orthogonal plates, two plates are placed e.g.r adits and ulna
The sequential steps to assessing biology of a fracture —
envelope before
envelope after
energy
patient age
Conservative treatment for shoulder OCD —-
if no flap for lameness then cage rest for 6w and anti-inflammatories
Contraindication for femoral fracture. why? —-
casts or ESFs because of the high tissue envelope. ESFs will cause continued trauma
use bone plates, ILNs, medullar pins+cerclage
How to repair humeral condylar fractures —-
lag screws for inter fragmentary compression to prevent callous formation and allow direct healing
What does withdrawal flexor reflex test —–
radial nerve (c6-T2)
Surgical treatment options in a young dog with Hip Dysplasia. What are the age cut-offs for each? —-
Juvenile Pubic Symphysiodesis (<20w)
Triple pelvic osteotomy (<12m)
CS of OA —-
lazy
stiff after getting up then gets better with exercise
lies down alone
exercise intolerance
Salter harris type I —-
Single fracture through the physis.
Most humeral fractures affect the (region).
Majority occur with or without trauma? —-
humeral condylar fractures
atraumatic e.g. spanials
When is IM pin and cerclage wire indicated? What bone cant it be used for? —
IM indicated for long oblique or spiral fractures where length > 2 x width of the bone
Cant be used for radius
Three hindlimb reflexes —–
Patella
Cranial tibial
Withdrawal
Cruciate Disease is diagnosable once there is a palpable instability. True or false? —-
False. Palpable instability (i.e. cranial draw or thrust) is a sign of end stage disease. We can diagnose based on CS of gate and stance and radiographs.
How is SH avulsion treated and why are these material used? —-
K-wire to creat apposition and compress fragments
Tension wire band to resist pull of tendon
How to humeral condylar fractures develop in immature dogs?
What SH classification? —-
before 9 weeks the physis are still open (not ossified) hence break at fusion zones of the condyles.
= SH4
Describe a dynamic compression plate and its two ‘settings’ —
Dyanmic compression plates can be used for neutralisation if screw is placed on bottom of screw hole or for compression when place proximal and distal to the segment and screwed into top hole which pulls the plate together
When is a neutralisation plate used? —
long oblique or spiral fractures
What three forces can IM pins work against? —
Bending
Most common injury of forelimb is the proximal/distal humerus/radius/ulna/carpals?
CS of damage to lateral and medial structures include reduced (2) —-
distal 1/2 humerus (distal 1/3 difficult to treat surgically)
Loss of voluntary movement
Loss of superficial sensation/pain
How long do we immobilise joint and when should we start gradual loading? —-
6- 8 weeks immobilise
from 3 weeks
Conservative Treatment of hip dysplasia —-
WET therapy
Weight reduction
Exercise - moderate and regular
Treatment: NSAIDs
Abnormal facial symmetry: CN affected
- lip and ears droop
- unilateral salication
- absent palpebral reflex
Trigeminal (V) and facial (VI)
OA can develop due to
a) abnormal stress on normal cartilage e.g.
b) normal stress on abnormal cartilage e.g.
a) UAP
b) OCD
What are the CS of problems with fracture healing —-
Non-weight bearing
Painful
Tissue swelling
Describe radiographic signs of Elbow disease —-
sclerosis
osteophytes (e.g. on medial trochlear ridge)
+/- radiolucency
increased joint space, periarticular osteophytes
4 stages of spinal disease —–
loss of
1) general proprioception (good prognosis)
2) motor function (Fair prognosis)
3) superficial pain (Fair prognosis)
4) deep pain (Poor prognosis)
Type 1b ESF —
Multiple frames at 60º angles
What are the three contraindications to external coaptaiton? —
above elbow or stifle
poor healing potential: old or overweight
unstable fractures
Palpebra response
a) CNs
a) III, V and sympathetic
Describe load sharing, the type of fracture it is possible for, and what happens if this doesn’t occur?
Load is shared between the non-comminuted bone fracture and the implant. If the bone takes the load then won’t heal, if implant takes all the load then reconstruction will fail.
What 5 abnormalities might we see with stance? —-
- Tripod stance (one leg out further)
- Forward lean (hindlimb distal to hips joints and elbows tucked) for hindlimb pain
- Close stance of feet
- Stiffeness on standing
- Changing legs often
Name the two forelimb spinal reflexes —–
withdrawal flexor reflex
triceps tendon reflex
Describe a block/wedge trochleoplasty —-
a block is cut out of the trochlear ridge , derided underneath and replaced so there is greater depth to the trochlear groove
Callous formation is needed to rpovide stability to the fracture site and fill in gaps if normal healing is not possible. What are the 5 biological steps to this? —
Clot formation –> granulation tissue –> fibrous callous –> mineralisation –> callous formation
Tibial crest transposition aims to …. —-
medial displace the tibial crest so patella sits within the groove
Three systems we look for when assessing ataxia —–
vestibular
cerebella
proprioceptive
Other shoulder pain CS = crepitus, periarticular cartilage, joint effusion nd reduce range of motion. TRUE or FALSE
FALSE - not typically seen
Carpal hyperextension injuries develops from damage to (ligament) from (case). leading to swollen, lameness, and __________ stance (hyperflexed/extended). How is it diagnoses? —-
falling
flexor retinaculum
hyperextended (palmigrade)
stress rads
Describe the 3 major steps/ aims of physical exam —-
- localise the limb
- localise to area e.g. joint
- radiograph
Legg-calves-Perth
a) pathophysis
immature animals los blood supply to epiphysis from epiphyseal artery causing vascular necrosis and collapse of femoral head = incongruity
What pathophysiological state develops if callous forms? —-
osteoarthritis
What is the first thing we look at for assessment —–
Snesorium (e.g. obutandated) and behaviour (e.g. aggressive
What does the cranial tibial reflex test —–
pernoneal nerve (L6-S1_
What are the two major factors that influence fracture biology?
Blood supply/ tissue envelope
Age of the patient
How to diagnose hip dysplasia clinically (PE)
- CS
- Diagnostics
CS: dogs will typically have bilateral lameness with a waddling walk (shake that booty), abducted elbows and weight shifting.
Diagnosed by the Orlani test which looks at joint laxity hence the degree of lunation when dog is in lateral recumbency and at what angle it returns to normal
What are the two lightweight options? —
IM and cerclage External copatation (casts)
Tibia biology and contraindications? —-
poor tissue envelope and thin area so usually open.
any repair site is good
Describe aim of femoral head excisions arthroplasty? —-
decision of femoral head removes the body contact forming a pseudo joint with scar tissue
Luxation grades I II III IV
At what grade is surgery indicated?
I: able to medial displace the patella, otherwise in normal
II: patella varies in placement. Easily reduced and displaced
III: patella permanently displaced yet can push back in extension
IV: patella permanently displaced yet can’t be reduced
Grade II+ requires surgery
Radiographic signs of OA (2) inc locations of these —-
Epiesiophytes over epicondyles and anneal process
sclerosis over trochlear notch and sub trochlear area of ulna
Repair option for greenstick fracture of radius and tibia?
Non-displaced or partial fractures can be treated with external computation (casts)
How do we treat carpal hypertension injuries which damage the flexor retinaculum. Describe the process.
arthrodesis (joint fusion) by arthroscopically removing cartilage and replacing with cancellous bone graft. Rad in 12 weeks
Name the three differentials for elbow pain —-
Fragmented coronoid process
OCD
Ununited anconeal process
Salter Harris III —-
Across the physis then distally into the articular surface (rare)
What views do we diagnose unnunited anconeal process in a dog? —-
lateral (flexed)
Repair option for oblique fracture (2x bone diameter) or spiral fracture of tibia? how many fragments contraindicates anatomic repair?
A. IM Pins and circle OR bone neutralisation plate
B. If >3 peices
Compare high vs low energy fracture
High energy fracture will cause greater trauma to bone (comminuted and more peices) and soft tissue envelope
Joint disease can be either ____________ or _________________ —-
develpmental or degenerative
Describe Clinical signs associated with cruciate disease (7) —-
- medial buttress
- cranial draw
- sit test
- tripod stance
- muscle atrophy
- tucked elbows (forward press)
- tibial thrust
What is the benefit of anatomic reconstruction? (Exam)
Load sharing
How to treat biceps tendonopathy —-
red and 4 weeks rest
tenotomy
Benefits of a block trochleoplasty —-
greater depth increases resistance to luxation in extended position
Tendons connect muscle to bone. Describe normal healing
a) what happens at 0-3 days inc. collagen type
b) what happens at 1-7 days
c) what is relative strength at 6 weeks (%)
d) What is main collagen type and strength at 1 year
a) clot formation and fibroblasts begin to produce type III collagen
b) angiogenesis and more type III collagen
c) 56%
d) type I and 80%
What happens if we provide too much negative pressure after inserting into the joint, or dont remove negative pressure before removal —-
blood contamination
Diagnostic work up of intermitted lameness which is worse after excercise —-
Localise to limb and joint then
RADIOGRAPH BOTH LIMBS - LATERAL AND CrCa!!
arthroscopy and CT
Traumatic cause of tear at middle of tendon. What diagnostic test can we do? —-
x-ray
What is the tissue envelope? Compare the proximal femur and distal tibia
Tissue envelope is the periosteal blood supply from surrounding muscle required for healing. Minimising trauma to this (non-anatomical recontruction) aids healing. Proximal femur has greater tissue envelope so will heal faster.
what are the two aims of anatomical reconstruction?
Restore biomechanics function
Minimise soft tissue damage (thus delayed healing)
What factors need to be considered for ‘Biomechanic Assessment’ —
Number of limbs affected
Weight and activity levels of dog/ level of confinment
comminuted or not/ anatomically reconstructable/ load sharing
What are the biological consequences of anatomic reconstruction on fracture healing?
2/3 of blood supply to the bone comes from the medullary cavity. This blood supply is compromised when a fracture occurs hence major blood supply is through periosteal arteries in the muscle. Anatomic reconstruction removes this blood supply by stripping away muscle
Describe the pre-drilled holes for screws —
glide hole is larger and aims to compress as screw moves through and into the thread hole
Pathophys of fragmented coronoid process —-
incongruity of joint where there is increased load on ulna (e.g. short radius) which puts greater pressure not he coronoid process
True or False:
Dogs need to be older than 5 months before diagnosing UAP?
F. Need 5m + to look for UAP on radiograph yet if CS are present and contralateral limbs anconeal process is closed…. it is likely UAP
DEscribe patient positioning when checking spinal reflexes —–
lateral and relaxed
List the two surgical options for patella strain —-
tibial crest transposition
block/ wedge resection of trochlear groove
Aim of surgery is to alter biomechanics of the stifle to decrease (a). I has no effect on (b: clinical sign/PE). Post surgery we need to check from damage to (c: details of structure and where it is injured). If damaged, remove.
a) tibial thrust (weight bearing)
b) cranial draw
c) caudal 1/3 of medial meniscus
if we have a heavier patients then how can we adjust which plate we use? —
use a broader plate with more screws (smaller holes
Can circulate wires be used with bridge plating? Why (not)? —
No. Any form of reconstruction damages tissue envelope which can delay healing
HOCK
a) site
b) tolerance of site to OCD
c) duration of treatment
a) medial (or lateral) trochlear ridge
b) very low due to high motion
c) lifelong
Describe the biology of a radial fracture —-
Poor due to poor tissue envelope (poor extra osseous blood supply). Most likely to be comminuted
What two salter harris fractures is small callous ok if diagnosed early so heals in right position —-
I and II
Location of OCS in elbow joint and radiographic signs. —-
trochlear ridge of the medial humeral condyle
- radiolucent lesion & osteophytes on anneal process
- increase joint space, periarticular osteophytes, sclerosis, effusion
Type 1a ESF —
1 pin with a single frame
lag screw not with a plate is called an — lag screw
independent
Describe the initial conservative treatment for a minor tear in the cruciate ligament —-
no conservative! get onto it.
how many plate/lag screws do we need each side? —
4
Define Osteoinduciton —
GF from gram causes pluripotent cells to transform into fibroblasts and osteoblasts to produce new bone
CS of septic arhtirits —-
unilateral single painful limb with hx of sx
acute lameness
How does radiograph look like for osetomylitic fracture? —-
periosteal reaction and lysis around screws (halo rings)
Describe minimally invasive percutaneous ostesysntehesi —
screws are placed proximally and distally though small incisions in the skin
Predisposed breeds, presenting complaint by O —-
small breed dogs intermittent lameness (skipping)
describe the biology of pelvic/ acetabular fractures —-
very good tissue envelope which has good blood supply and keeps everything together (low impact fracture) as they transmit load, minimise comminution and displacement
what NSAIDs do we use for pain relief and control of CS? —-
Rimadyl, Metacam and Gabapentin (NMDA antagonist that decreases synovial fluid
Best approach for humeral condyle is medial, lateral or cranial? —-
medial
Postural defects. Localise the lesion
a) head tilt
b) head or body turn
c) abnormal neck position
d) lordosis
e) abnormal hock angle
f) tremoring or trembling
a) vestibular
b) cerberal
c) brain stem, cervical or vestibular
d) thoracolumbar
e) sciatic
f) cerebellar
Why do we get sclerosis? —-
increased loss of cartilage increases load (wolfes law) or extra epesiophytes
Contraindications for radial fractures? —-
IM pins will get you sued.
best to use plates, ESFs
Bone grafing untilises cancellous bone for COMMINUTED fracture for three processes (3) —
Osteogenesis
Osteoconduction
Osteoinduction
Surgical site infection ([a] disease type) is usually ([b] infectious agent). Why do we do C&S? —-
a) osetomyelitis
b) staphyloccucus
usually multi-drug resistant
What does the withdrawal reflex test —–
Sciatic (L4-s3)
Stifle OCD is uncommon
- common site is
lateral (or medial) condyle of the femur (radiolucent on one side) - careful of not finding because of overlapping condyle
How to treat UAP —-
ulna osteotomy which will push the ulna and anconeal process caudally, thereby eleviating the pressure on the anconeal process.
lag screw are then placed through the anconeal process to provide inter fragmentary compression and allow healing
What are external skeletal fixators and how are they used? —
Transcutaneous pins that are used to provide structure to fracture fragments connected to external frame
Surgical management of OCD - aims —-
- remove flap
- fill in defect (transplant fibrocartiliage
- remove necrotic tissue (current)
= good prognosis
Spinal Segments —– For lesion localisation
C1-C5
C6-T2
T3-L3
L4-S3
What Salter harris trauma leads to OCD of growth plate cartilage? —-
SH V
Menace response
a) CNs
b) response in 11 week puppy with head trauma
a) II, VII (faical)
b) absent - learnt response
How is absolute stability provided to a fracture undergoing primary healing? —
interfragmentary compression via lag screws
Define Patella luxation —-
congenital displacement of the patella from the femoral trochlear groove. Typically medial
What would we look for in history? —-
change in behaviour
exercise intolerance
stiffness on rises
Dog comes in with sudden onset of lameness 21d post-surgery. He has temperature of 39 so we suspect infectious causes. What is our treatment plan? —-
amoxicillin-clav trial (ampicillin)
surgical deep tissue biopsy (not of pus)
Treat for 6 weeks after C&S
Remove implant to prevent biofilm reaction
three requirements for sequestrum formation —
infection
loss of blood supply
strain
IM pins
a) normograde or retrograde placement for tibia? why?
b) pin size in relation to medullary diameter?
c) cut ends short or leave them long?
d) how to measure legnth of bone so it doesnt protrude through joint? —
a) normograde as retrograde (through fracture) damages the menisci
b) 70-80%
c) cut
d) with another rod
Stifle
a) angle of joint and rotation
b) landmarks
a) flexed stifle and externally rotated
b) between patella and tibial tuberosity
What does the patella reflex test —–
femoral nerve (L4-L6)
Rapid onset of clinical sings would suggest which pathological processes? (3) —–
Infection
Trauma
Vacular Damage
Are bacteria always present for septic arhtritis —-
50% of cases
How do we dx OA? —-
CS PE: crepitus, reduced ROM, lameness Rads synotvial fluid analysis arthroscopy
Grading Myelopathy 0: I: II: III: IV: V:
0: normal
I: paraspinal pain present
II: ataxia with proprioceptive deficits
III: paraplegia with voluntary motor function
IV: paraplegia with no motor function
V: paraplegia, absent motor function and loss of deep pain
sequella of UAP treatment —-
pain for 3m
callus at proximal ulna
Repair option for transverse fracture with < 2 pieces?
bone compression plate
Describe the gait of a bilaterally lame dog —-
abnormal stance yet normal gate
The cranial caudal CL runs from (a) –> (b) i.e. in the direction we put our hands in our pockets. —-
medial aspect of lateral femoral condyle
cranial intercondyloid area of tibial plates
What do we use to manipulate tendons to oppose them? What is the maximum gap? And how do we reduce this further? —-
use k-wire and hypodermic needles due to sensory fibres
zero gap
hyper extend or flex the joint to minimise tension on the tendon
Increase TP suggests (2), measured by (how?) —-
inflammation or infectious
refractometer
How can we passively stability a joint to restrain the stifle? —-
lateral fabellar tibial tie
Define Osteoconudction —
provides framework for angiogenesis hence revascularisation
What SH affect articular surfaces? —-
III and IV
Describe Stance (3) —-
narrow based
tucked elbows/abduction
supination (foot faced outwards)
Treatment of septic arhtirits —-
IV AB (C&S) for a 2 days then oral. may need arthroscopic irrigation
How do we localise a lesion (5 steps of a PE to localise a lesion) —-
History and signalment Distance exam Standing exam Recumbency exam Diagnostic imaging
Legg-calves-Perth
a) uni or bilateral
b) fast or slow
c) lytic lesions around epiphysis or nah? —-
a) unilateral
b) slow and insideous
c)
Three predisposing factors to medial patella laxation —-
shallow trochlear groove
femoral varus
tibial values
Dropped elbow may be present in humeral condylar fracture becuase —-
radial nerve runs over it
Radial fracture is usually closed using bone plate + what adjuct treatment? —-
Bone gradt
Vet concludes their is joint effusion in the elbow. What are two ways he/she confirmed this? —-
sclerosis on radiographs
there should be concavity between the olecranon and lateral bursa (e)
How do we repair tendon ensuring the sutures don’t take any of load? name 1 of 2 patterns. —-
flex or extend joint
sutures are place holding only - not load sharing
loop pull or locking lip
Common causes of hip dysplasia —-
Genetic predisposition (programs in place to prevent breeding) Environmental - large breed dogs - rapid growth (e.g. high nutrition) - Obesity - XS excercise (e.g. work dogs)
Repair option for oblique fracture (2x bone diameter) or spiral fracture of radius?
Bone neutralisation plate
What are the 5 factors that affect stability of fracture repair?
- Type of fracture (e.g. comminuted)
- Can it be anatomically repaired (<>3 fractures)?
- Method of fracture repair
- Single or Multiple limb injury
- Patient size and activity level
What is the pathognomonic sign of crucial disease? —-
medial buttress is a firm fibrous swelling on medial side of stifle joint +/- cranial draw
Define bridge plating and what kind of fracture it is used in —
Bridges gap in non-anatomically reconstructable fracture without load-sharing (takes on whole load).
Pathophys of UAP —-
Radius take most of the load (e.g. short ulna) pushing the anconeal physic upwards which prevents closure.
Ligaments connect bone to bone and develop due to shearing injuries, laxation nd join instability. How do we repair?
stent in the joint to mimic action of ligament and prevent strain
What can cause SH I avulsion —-
strain on the tibial apophysis from the patella ligament
Why does multiple leg injury, patient size and activity affect bone healing?
greater load onto fracture site hence complications.
Initial treatment of OA —-
W : weight loss
E : excercise
T : NSAIDs
Two salvage procedures for hip dysplasia? —-
Hip replacement (80% success) Femoral head excision arthroplasty
How long can ESFs stay in —
<12 Weeks
Looseness in flexion and extension (increased cranial draw) suggests which ligament? —-
Cranial Cruciate ligament
What are the three components of the Common calcareous tendon
I.
II.
III (3) —-
I. gastrocnemius
II: superficial digital flexor
III: union of biceps femoris, semi tendinosis and Gracillus
What are the two conditions for direct or primary healing (Heversian remodelling)? —
<1mm gap and <2% strain (absolute stability)
Where do we cut for an excisional head excisions arthroplasty? —-
medial aspect of greater trochanter to
proximal aspect of lesser trochanter (laterally)
Is osteoarthritis an old dog disease? Why does it occur? —-
Nope. Unlike primary disease in humans, OA in animals is usually secondary to a primary disease e.g. hip dysplasia or cruciate disease
Lag screw angle in relation to fracture —
Perpendicular
Does a negative culture rule out septic arthritis? —-
No
To examples of degenerative joint disease —-
secondary osteoarthritis
cruciate disease
Post-surgery management of deep digital flexor tendon laceration and how to check superficial and deep structures were repaired
if repaired then have reduced flexion of carpus and toes.
put in flexion bandage for 3-4 weeks then gradual weight bearing for another 3
Two main “Pros” for ESFs —
Minimally invasive hence protects tissue envelope
No residual implant after healing
What factors need to be considered for ‘Biological Assessment’ (3) —
Age
Soft tissue envelop
Low or High energy comminuted fracture
CS of common calcanea tendon destruction (partial or complete)
hyperflexion of hock and plantigrade stance
curled toes
knuckling
less so if partial and SDFT is intact
When is external copatation indicated? —
Long bones with simple, greenstick (non-comminuted fractures) that heal <3 weeks.
What is a + and - of open reduction for internal fixation?
+ greater stability from mechanical support
- damage to tissue envelope hence delayed healing
Atraumatic cause of tear of common calcaeneal tendon
How to treat?
chronic repetitive stress
can put specialised cast or surgical treatment (may require a tendon prosthetic
Pathophys of Type V fracture and sequelae
Any trauma can result in compression damage to growth plate (e.g. distal Ulna which accounts for 100% of ulna lengening) which is not apparent on DI. This can result in singular lengthening of radius hence bowing of leg and valves.
Radiographs are used to highlight signs of joint disease before joint instability. What might we see? —
epiesiophytes (e.g. distal pole of patella, trochlear ridge and tibial plateau)
joint effusion and displacement of the fat pad
how to treat patella alta? —-
steotomy to lower patella insertion hence lower the patella.
Needs a femoral osteotomy don’t to reduce strain
Function of the cranial cruciate is to (3) —-
- prevent cranial draw of tibial crest
- prevent internal rotation of tibia
- prevent over extension of the stifle
Salter Harris IV —-
Transverse through the articular surface
When is a compression plate indicated? —
transverse fractures
Need to warn O if dog is in traumatic accident to the risk of SHV occurring. How to treat? —-
Distal ulna osteotomy to prevent bowing
Plate rods are commonly used. Describe how they are used, diameter and force(s) they are good against. What fracture are they contraindicated in? —
Normograde entry into medullary cavity (30% of size unlike medullary pins for anatomic reconstruction). Good against bending.
Cant be used in the radius
Ostemyoleitis can lead to other complications such as (4) —-
non/delayed union
implant failure
fracture disease
malunion
Define hip dysplasia —-
Abnormal development of the coxofemoral joint characterized by subluxation to luxation.
Two examples of development joint disease —-
hip or elbow dysplasia
Three “Cons” for ESFs —
Need follow up consultations and x-rays and bandage changes
Temporary as will progressively untighten
Needs removal
What does the triceps tendon reflex test —–
T6-T1 : radial, MSC, axillary, ulnar
How can we reinforce the repair —-
hyper extend or flex joint
circumferential closure of peritendon
if x-ray show halo around screws what is our next step? —-
remove the implant
Surgeon aims to minimise soft tissue damage. What are the four options of repair?
Closed reduction (casts)
Open reduction for internal fixation
Open But Do Not Touch
Minimally Invasive Percutaenous osteosynthesis
6 steps of tendon repair —-
- clean wound
- appose tendon ends
- tendon repair
- reinforce
- immobilise
6, post op
What do we look for in recumbent exam (4) —-
joint movement/ felxibility pain enlargement/ swelling Cranial draw reluctance to move
Prognosis of humeral condylar fracture in adult dog?
What do we look for in CT? —-
likely too reoccur. Because there should be complete ossification. Damage means there is pathology present so we look for signs of sclerosis.
What are the three heavy weigh repair options? —
ESFs
Bone plates
Interlocking nails
PLR
a) CNs
b) response
a) II, III and VI
b) constricts contralateral pupil
Slow onset of CS would suggest which pathological processes? (2) —–
Neoplasia
Degenerative
Joint effusion is apparent when the soft tissue opacity (a: normal structure) extends beyond the boudoirs of the (b: two landmarks)
menisci is normal ST opacity
joint effusion displaces fat pad beyond LD fossa and cranial crest of tibial plates
lateral or medial condylar fractures are more common? —-
Lateral Condyle
Biceps tendinopathy develops due to (2). Test by (3 diagnostics) —-
overuse or intraarticular disease
MRI
arhtorscopy
biceps tendon test looking for pain
Joint fluid
a) normal volume
b) normal viscosity on stretch test
c) color
a)
Describe physical exam of elbow disease —-
Pain crepitus palpable osteophytes effusion at lateral condyle and olecranon decreased ROM
Why are cerclage wires needed with IM pins? —
interfragmentary compression
What predisposing factors increase OCD risk of growth plates? —-
males large breed dogs (4-8 m) genetics overnutrition - rapid growth trauma
How does implant failure due to instability appear on radiograph? —-
lysis around the implant
broken implant
Salter Harris II —-
Most common; across most of the growth plate and up through the metaphysis
Describe hip laxity in a chronic case? —-
No hip laxity because the joint has been stabilised by osteoarthritis
Two surgeries for cruciate disease —-
TPLO
tibial tuberosity advancement
What two views do we use to assess fragmented coronoid process? Describe the diagnostic ability of this. (and ddx)
lateral
craniocaudal
ddx OCD - cant differentiate
Describe when Open But Do Not Touch is employed and what it is? —
+ A bridging plate is placed on both side of fractured bone (no at fracture) for non-anatomically reconstructable fractures.
Radio-graphic signs of OCD (4) of articular cartilage —-
Sclerosis
radilucent defect
mineralised flap
joint mice
What view(s) do we use to assess OCD in elbow —-
craniocaudal
What is OC and how does it develop to OCD (in articular cartilage) —-
Osteochondrosis is the failure of ossification of cartilage. Abnormal thickening means the cartilage can’t absorb nutrients hence begins to necrose. The movement of synovial fluid underneath the necrotising tissue causes further separation and vascular compromise hence breaks away from SCB = OCD
What are the repair options from articular fracture?
Need to prevent callus forming so need primary/ direct healing by anatomic reconstruction with lag screws.
Define Osteogenensis —
Translocation of new bone promotes new bone growth at site
