Juvenile Bone Disease, Pt. 2 Flashcards
What is the most common cause of an ununited anconeal process? When does it normally become ossified?
delay or cessation in normal physeal development
5 months of age
What signalment is most commonly associated with an ununited anconeal process?
- large or chondrodystrophic breeds
- M > F
- 30% bilateral disease
How does breed affect etiology of ununited anconeal processes?
BASSET HOUNDS - elbow incongruity
GSDs - osteochondrosis
What are the most common signs of an ununited anconeal process? How is it diagnosed?
intermittent lameness, joint effusion, and pain on extension in patients that are 4 months to 3 y/o at presentation
flexed lateral radiograph
What treatment is used for ununited anconeal process? What is prognosis like?
surgical removal of the anconeal process
guarded to good, depending on degenerative changes at the time of surgery
Ununited anconeal process removal:
Other than removal, how can an ununited anconeal process be treated? When is this performed over removal? What risk is associated?
stabilization
- large bone fragment to permit lag screw fixation
- minimal degenerative changes at the time of surgery
implant failure
What is a fragmented coronoid process? What signalment is most commonly associated?
disruption of the coronoid process prior to ossification
- 3 months to 7 y/o
- M > F
- 30% bilateral
What 3 signs are associated with fragmented coronoid processes? How is it diagnosed?
- intermittent lameness
- pain on deep palpation of the coronoid process
- joint effusion
two view radiographs or CT
What are the 2 options for fragmented coronoid processes? What is prognosis like?
- open arthrotomy - osteotomy, tendon transection, tendon spreading
- arthroscopy
guarded to good depending on the degenerative changes at the time of surgery
Fragmented coronoid process, open arthrotomy:
What is osteochondrosis of the medial humeral condyle?
progressive degenerative joint disease - cartilage of the growing elbow joint fails to develop normally and becomes abnormally thickened and damaged
- 3-6 m/o, large or giant breeds
- 50% bilateral
What are 3 signs of osteochondrosis of the medial humeral condyle? When do radiographic changes manifest?
- insidious onset lameness
- joint effusion
- secondary degenerative changes, commonly occuring with other forms of osteochondrosis (FCP, UAP)
6-8 months
What are the 2 options for treating osteochondrosis of the medial humeral condyle?
- arthroscopic - minimally invasive, technically demanding, high equipment cost
- open arthrotomy - invasive, low cost, high success
What are the 2 major limitations of surgical treatment of osteochondrosis of the medial humeral condyle?
- surgical removal of all joint mice and curettage of the cartilage defect is difficult
- difficult to inspect all joint compartments from one approach
What 2 treatments are recommended post-op for osteochondrosis of the medial humeral condyle?
- glucosamine/chondroitin sulfate
- physical therapy
What signalment is associated with congenital elbow luxation? What causes it?
5-6 weeks old toy and small breeds
abnormal boney development causes secondary laxity in the ligamentous support structures of the joint —> ligamentous hypoplasia = radial/ulnar luxation
Why is prognosis for congenital elbow luxation so poor?
surgical reduction is often impossible —> arthrodesis usually necessary
What is the most common etiology of premature closure of the distal ulna physis? What is a sign of this on radiographs?
- trauma**
- hypertrophic osteodystrophy = excessive callus formation restrict physis
physis/fracture lines not visible
What are 3 reasons that the antebrachium so susceptible to premature closure of physes?
- growth distribution
- physeal anatomic differences
- interdependency of the radius and ulna
What is the growth distribution of the radius and ulna?
RADIUS - 60% of length from distal physis
ULNA - 85% of length from distal physis
Why does a majority of growth in length arise from the distal physis of the ulna? What disadvantage does this have?
conical shape of distal physis and increased diameter provide increased surface area for germinal cells
conical shape is unique to the dog and results in an increased susceptibility to Salter-Harris Type V (crush) physeal injuries
Salter-Harris physeal fractures:
Physis
Metaphysis + physis
Epiphysis + physis
(BOTH) metaphysis + epiphysos + physis
Compression of physis
How does the Salter-Harris fracture type contribute to prognosis?
Type I = slip fracture due to lateral traumatic forces applied to the distal radius —> good prognosis
Type V = compression/crush fracture due to lateral forces applied to the distal ulna —> poor prognosis
What 2 bones must grow in synchrony for normal development?
radius and ulna
What are 5 signs of premature compression of the distal ulnar physis?
- cranial bow
- carpal valgum
- decreased length
- supination
- proximal subluxation of the humeral condyle
Premature compression of the distal ulnar physis, cranial bow:
Premature compression of the distal ulnar physis, carpal valgum:
displacement of part of a limb lateral from the midline
Premature compression of the distal ulnar physis, supination:
rotation lateral to midline
(+ decreased length)
What treatments for premature compression of the distal ulnar physis are recommended for growing and mature dogs?
< 8 months = multiple ulna ostectomies, distraction osteogenesis, physeal stapling, periosteal stripping
> 8 months = dome, stair step, or wedge radial osteotomy, ulna osteotomy/ostectomy
What is the purpose of a proximal ulna ostectomy?
constraining effect on the radius allowing continued limb growth and releasing pressure upon the joint surfaces
(< 8 m/o growing dogs)
What is the purpose of a distraction osteogenesis?
breaking the bone and applying/segmentally adjusting an external fixation device around the limb, usually a ring fixator, allows the bone segments to gradually move apart from one another = lengthening!
(< 8 m/o)
Which form of surgical treatment of premature closure of the ulnar physis is rarely performed?
periosteal stripping —> undocumented results
(< 8 m/o)
What is the purpose of physeal stapling?
temporarily slow or stop growth on medial side of distal radial growth plate following ulnar transection, thereby correcting angular growth deformity
(< 8 m/o)
What is the purpose of a dome radial osteotomy?
semicircular osteotomy based upon an arc drawn from the radius about a central point, allowing for large amounts of compression and inherent stability between radius and ulna
(> 8 m/o)
What is a stair-step radial osteotomy?
re-establishing the length of the bone and the elbow congruence by creating step that can extend the bone
(> 8 m/o)
What is a wedge radial osteotomy?
removing a bone wedge from the radius to shorten it to the ulna’s length, resulting in a shortened limb, but a correction to the angular limb deformity of the antebrachium
(> 8 m/o)
What 3 things does premature closure of the distal radial physis result in?
- shortened radius
- distal subluxation of the humeral condyle
- increased radial-humeral joint space
(usually assymetric and results in deformations similar to PCDUP, but not as common)
What are the options for treating premature closure of the distal radial physis in growing and mature dogs?
< 8 months = resection of closed portion, distraction osteogenesis
> 8 months = dome radial, stair step, or wedge osteotomy, ulna ostectomy
What causes a retained cartilaginous core? What signalment is associated?
disruption in endochondral ossification, possibly sue to rapid growth exceeding vascular capabilities
> 4 m/o giant breeds, commonly bilaterally
What are 3 diagnostic signs of retained cartilaginous cores?
- triangular lucency in distal ulnar metaphysis
- cranial bowing. ofthe distal radius
- pain on deep palpation
How are retained cartilaginous cores treated?
- NSAIDs and rest
- curettage
- corrective osteotomy
What are 3 possible causes of carpal hyperextension? What is diagnostic?
- puppies raised in confined environments
- trauma —> usually just needs gradula exercise on surfaces with good traction
- underlying collagen disorder —> poor prognosis with surgical intervention
plantigrade stance
What is hip dysplasia? What dogs are commonly more often clinical?
abnormal laxity in one or both coxofemoral joints, translating into degenerative joint disease, including malformation of the acetabulum
large breed dogs
What are 5 signs of hip dysplasia?
- stiffness
- pain on extension
- reluctance to exercise
- sway in gait
- bunny hops stairs
What is the difference between what in seen in early vs. late diagnosis of hip dysplasia?
EARLY = palpable subluxation, radiographic subluxation, remodeling, and sclerosis
LATE = palpable crepitus, radiographic subluxation, severe remodeling and osteophytosis
What 2 early treatments (no DJD) are recommended for hip dysplasia?
- triple pelvic osteotomy
- subtrochanteric osteotomy
What 3 late treatments (DJD present) are recommended fo rhip dysplasia?
- conservative - NSAIDs, chondroprotectants
- femoral head and neck ostectomy
- total hip replacement
What is Legg-Calve-Perthes? What signalment is associated?
aseptic necrosis of the femoral head and neck, most common in small and toy breeds 4-11 m/o
(unilateral)
When is conservative vs. surgical treatment recommended for Legg-Calve-Perthes?
CONSERVATIVE = no fracture present
SURGERY = usually necessary, femoral head and neck ostectomy
What patellar luxation is most common in toy breeds? Large breeds? What kind of condition is it?
medial
lateral, possibly due to hip disease
progressive —> boney derangement, DJD, secondary ligamentous injury
What is the characteristic sign of patellar luxation? What else is seen?
non-painful hopping gait
palpable subluxation or luxation
What are 4 grades of patellar luxation?
- found in reduction, but can be luxated with stifle in extension
- found in reduction, but can be luxation with stifle extension and flexion
- found in luxation, but can be reduced and associated with boney derangement
- found in luxation, cannot be reduced, associated with severe boney derangement
When is conservative treatment of patellar luxation recommended? What is done?
GRADES 1 and 2 ONLY —> must be non-clinical
NSAIDs and 2-4 weeks of rest, monitor for progression
When is surgical treatment recommended for patellar luxations? What is done?
clinical grades 1-3
- release + imbrication
- sulcoplasty
- wedge recession
- tibial crest transposition
What is recommended post-op for patella luxations?
- controlled exercise
- chondroprotective agents
- NSAIDs
What are 3 signs of osteochondrosis of the lateral femoral condyle? What is not seen?
- palpable effusion
- radiographic evaluation shows subchondral defects, joint mice, and sclerosis
- inflammatory joint aspirates
joint instability
What treatments are recommended for osteochondrosis of the lateral femoral condyle?
- curettage + removal of joint mice
- chondroprotectives
- NSAIDs
(good prognosis)
What portion of the talus is most affected by osteochondrosis? What signalment is associated?
medial
M > F, 7-10 m/o
What are 2 signs of osteochondrosis of the talus?
- palpable effusion
- subchondral defect, joint mice, sclerosis
What treatments are recommended for osteochondrosis of the talus?
- curettage + removal of joint mice
- chondroprotectives
- NSAIDs
(fair prognosis)
What causes hyperextension of the tarsus? What signalment is associated?
conformational abnormality or secondary to hip dysplasia
Akitas and Rottweilers < 1y/o - usually bilateral
What are 2 signs of tarsal hyperextension?
- palpable tarsal thickening without evidence of effusion
- soft tissue swelling with mild DJD
How is tarsal hyperextension treated? What must be ruled out first?
no definitive treatment - NSAIDs and chondroprotectives as needed
OD
What is hypertrophic osteodystrophy? What is most commonly affected?
abnormal proliferation of bone in giant breeds 3-4 months of age —> only. indogs with an open physis
metaphyseal region, usually lasting 5-10 days with recurrence every 1-6 weeks - usually bilateral!
What are 5 signs of hypertrophic osteodystrophy?
mild to severe
- lameness
- pain on deep palpation
- anorexia
- fever/depression
- swollen/painful extremities
What is characteristic of hypertrophic osteodystrophy on radiographs?
lucency proximal to the physeal line = pseudophysis
What treatment is recommended for hypertrophic osteodystrophy?
usually self-limiting, residual boney remodeling expected
- NSAIDs and supportive care
- vit C (controversial)
What is panosteitis? What signalment is most commonly affected?
inflammatory disease of the medullary canal with cyclic recurrence every 4-6 weeks
< 1 y/o large breeds (GSD) —> resolved by 2 years of age
What are the 5 most common clinical signs seen with panosteitis?
- fever
- shifting leg lameness
- pain on palpation
- depression
- anorexia
What is seen on radiographs in cases of panosteitis? What treatment is recommended?
patchy medullary densities
rest and NSAIDs —> good prognosis
What is multiple cartilaginous exostosis? What is a probable cause?
ectopic bone proliferation seen in dogs during the growth phase, commonly in multiple sites
displacement of a fragment of physeal germinal tissue, resulting in continued bone proliferation until cessation of the growth phase
When is multiple cartilaginous exostosis seen?
- incidental finding
- bone proliferation can cause impingement of vital structures, causing clinical signs —> requires surgical decompression
What is craniomandibular osteopathy?
abnormal bone proliferation of the mandible, bulla, and occiput most commonly seen in Scottish Terriers and WHWT 3-7 months old
What clinical signs are associated with craniomandibular osteopathy?
- pain
- inability to open mouth
- palpable, firm swelling
- fever, anorexia
What treatment is recommended for craniomandibular osteopathy?
usually self-limiting
- NSAIDs, steroids in severe cases
- pharyngostomy tube if cannot open mouth
