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3. cat & dog 2 > Misc orthopedic conditions > Flashcards

Misc orthopedic conditions Flashcards

1
Q

CARPAL LAXITY OR DEVELOPMENTAL HYPEREXTENSION
- clinical signs
> 2 forms
- age, breeds
- cause

A

2 forms:
* Hyperextension
> Carpal plantigrade stance
* Hyperflexion
> tightness of the flexor muscles
<><>
* No pain or swelling
* Normal radiographs
<><>
6-12 weeks of age
* Dobermans, German Shepherd Dogs and Great Danes, others…
<><>
Cause?
* Imbalance between growth and muscles
tendons/ligaments strength or length
* Nutritional imbalances (high proteins?)
* Genetic

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2
Q

CARPAL LAXITY OR DEVELOPMENTAL HYPEREXTENSION
- Tx, prognosis

A

Treatment
* Moderate activity on tractable surface
* Good plane of nutrition: Avoid OVER nutrition
* Rehabilitation
* NO supportive bandage or splint: unless absolutely necessary
<><>
Prognosis
* Generally very good
* Spontaneous resolution in 2-4 weeks for mild to moderate cases

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3
Q

CARPAL / TARSAL HYPEREXTENSION INJURY
- causes
- what happens
- concurrent issues

A

Causes
* TRAUMA (jump or fall from a height, HBC)
* Degenerative (especially Shelties and Collies)
<><>
* Rupture of the palmar carpal/tarsal ligaments and palmar fibrocartilage
<><>
± Concomitant injuries
* Metacarpal fractures (especially II and V)
* Collateral ligament rupture

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4
Q

CARPAL / TARSAL HYPEREXTENSION INJURY
- clinical signs

A
  • Carpal/Tarsal hyperextension
  • Severe pain if acute
  • Moderate weight bearing pain if chronic or degenerative
  • Unilateral or bilateral
    <><>
  • Carpal / Tarsal swelling and periarticular thickening
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5
Q

CARPAL / TARSAL HYPEREXTENSION INJURY
- Dx

A

Palpation
* Hyperextension
* Valgus-varus deformity
* Excessive rotation
<><>
Radiographs
* Rule-out/diagnose fractures
* Stress radiographs must be performed
> Determine level of joint and ligaments involved

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6
Q

CARPAL / TARSAL HYPEREXTENSION INJURY
- Tx options, efficacy?

A

Conservative management (splint)
* Ineffective
* Ruptured palmar fibrocartilage does not return to sufficient strength to prevent recurrence
* Recurrence very common
<><>
Surgical treatment
* Pancarpal or Pantarsal arthrodesis
* ± Partial Carpal or Tarsal arthrodesis
> ONLY if main joint intact! (radio-carpal or talo-crural)
* Very good prognosis

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7
Q

Pan- or Partial Carpal Arthrodesis
- what do we do?
- prognosis?

A
  • Remove all articular cartilage
  • Cancellous bone graft in joint spaces
  • Strong bone plate
  • Splinting until radiographic of arthrodesis (6-12 weeks)
    <><>
    Prognosis
  • Good to very good
  • Once healed…
  • High complication rate (mostly due to bandages)
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8
Q

panosteitis
- pathophysiology
- etiology?
- who is affected?

A
  • Unknown: Necrosis and inflammation of fatty bone marrow
  • Genetics? Young, Large breed dogs (especially German Shepherd Dogs)
    <><>
    Other ?
  • Vascular abnormality?
  • Viral infection?
  • Hormonal?
  • not bacterial, parasitic, or allergic
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9
Q

panosteitis clinical signs
- age
- sex
- size, breed
- presentation
- physical exam

A
  • 5-18 months
  • Male>female 4:1
  • Large breed dogs
  • Acute onset of lameness (without trauma)
    > Forelimbs usually affected first
    > Pelvic limb can also be affected
    <><>
  • Shifting lameness for 14-21 days
  • Severe pain on palpation of diaphyseal bone
  • ± Pyrexia, anorexia and lethargy
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10
Q

panosteitis Dx

A
  • RADIOGRAPHS
  • Increased radiodensities in the medullary canal starting at the nutrient foramen and then becoming multifocal and coalescing
    > Loss of definition between medullary canal and cortex
    > Endosteal roughening with coarse trabecular pattern
  • Radiographic signs persist longer than clinical signs
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11
Q

panosteitis Tx, prognosis?

A

Supportive
* Rest
* ± NSAIDs
<><>
Prognosis
* 10-15 days episode(s)
* Self-limiting by 12-20 months
* Very good to excellent

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12
Q

Metaphyseal Osteopathy
- pathophysiology / causes?
- who is affected?

A
  • Disturbance of the metaphyseal blood supply leading to failure in ossification of the growth plate
  • Unknown
  • Genetics?
    > Large to giant breed dogs
    > Especially Weimaraner, Setters, Great Danes
    > 3-6 months of age
    <><><><>
  • Modified-live virus vaccination?
    > Has been observed after vaccination
  • Infection (distemper)?
    > Viral DNA has been isolated
    > Does not mean it caused it…
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13
Q

Metaphyseal Osteopathy
- clinical signs

A
  • Acute swelling of distal extremities
    > Distal metaphyseal region
    > Warm
    > Very Painful
  • Bilateral ± all four limbs
  • Lameness variable (mild to recumbent)
    <><>
  • Pyrexia ± anorexia and depression
  • ± Upper respiratory tract infection and diarrhea
    > Week preceding lameness
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14
Q

Metaphyseal Osteopathy
- Dx

A
  • RADIOGRAPHS
  • Radiolucent line adjacent to physis (pathognomonic)
    > “Double growth plate”
  • Metaphyseal flaring
  • ± Premature physeal closure
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15
Q

Metaphyseal Osteopathy
- treatment and prognosis?

A

Supportive
* NSAIDs
* Corticosteroids > NSAIDs and morphinics for peracute cases
* Intravenous fluids, enteral nutrition and well- padded bedding
<><>
Prognosis
* Good to excellent in majority of cases
* Guarded for severely affected dogs with peracute presentation

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16
Q

HYPERTROPHIC OSTEOPATHY (HO)
- pathophysiology

A
  • Peripheral vasodilation of the distal extremities which stimulates connective tissue and periosteal proliferation
  • Cause of peripheral vasodilation unknown

> Neural stimulation (vagal nerve)
Intrathoracic disease (most often)
=> Metastatic neoplasia most common (> 90%)
=> Primary neoplasia (lungs and chest wall)
=> Lung abscess and pneumonia
=> Esophageal granuloma
=> Heartworm disease

17
Q

HYPERTROPHIC OSTEOPATHY (HO)
- clinical signs

A
  • Acute onset of lameness
  • Reluctance to move
  • Bilaterally symmetrical involvement of all 4 limbs
  • Painful swelling of the extremities
  • ± Pyrexia
18
Q

HYPERTROPHIC OSTEOPATHY (HO)
- Dx

A

DIAGNOSIS - LIMB and thoracic RADIOGRAPHS

19
Q

HYPERTROPHIC OSTEOPATHY (HO)
- treatment
- prognosis

A

Curative-intent treatment
* Removal of primary cause (metastatectomy)
<><>
Palliative treatment for tumours
* Chemotherapy
* Palliative radiation
* NSAIDs
* Bisphosphonates…
<><>
Prognosis poor
* lesions regress but die from primary disease

20
Q

PREMATURE PHYSEAL CLOSURE
- pathophysiology
- most commonly affected anatomic location

A
  • Radius-ulna is a paired bone system
  • Growth of a paired bone system is synchronous but proximal and distal physes of each bone contribute different proportions to bone growth
  • Distal ulna is most commonly affected
    > Only growth plate responsible for length of the
    ulna below the joint
    > Conical shape of the distal physis?
21
Q

DISTAL ULNAR PHYSEAL CLOSURE
> what happens? what is the problem?

A
  • Ulna restricts growth of the radius
    > Bowstring effect?
  • Carpal abnormalities
    > Bowing of radius
    > Valgus deformity carpus
    > External rotation
  • Elbow abnormalities
    > Humeroulnar subluxation
    > ± Ununited anconeal process
22
Q

PREMATURE PHYSEAL CLOSURE
- treatment options for immature dog
> aims
> timing
> techniques

A

Aims
* Prevent further bone deformation
* Prevent joint subluxation
* MAY correct mild deformities
> Bone must “grow out” of the deformity
> ONLY immature with growth potential
<><>
Must be done quickly!
* Before severe deformity
* Before elbow subluxation
<><>
Surgical techniques
* Segmental distal ulnar ostectomy

23
Q

PREMATURE PHYSEAL CLOSURE
- treatment for a mature dog
> aims
> techniques

A

Aims
* Correct bone deformities
* Facilitate ambulation
* Improve cosmetic appearance
* Minimize progressive carpal and elbow osteoarthritis
<><>
Surgical techniques
* Definitive corrective radial osteotomy (ies)

24
Q

COLLATERAL LIGAMENT INJURY (SPRAIN)
- gradings and treatments

A

Grade I
- Lesion: Fibre rupture with minimal instability
- Treatment: Conservative
<><>
Grade II
- Lesion: Partial ligament rupture with severe fibre stretching
- Treatment: Surgical or Conservative +Splinting
<><>
Grade III
- Lesion: Complete ligament rupture
- Treatment: Surgical + Splinting

25
Q

COLLATERAL LIGAMENT INJURY (SPRAIN)
- pathophysiology

A
  • Trauma (especially jumps, fall, HBC)
  • Medial collateral ligaments more commonly injured than lateral
  • May be associated with fractures !
  • Must rule out possible concurrent hyperextension
26
Q

COLLATERAL LIGAMENT INJURY (SPRAIN)
- clinical signs
- Dx

A
  • Clinical signs
    > Non-weight bearing lameness
    > Joint swelling
  • Collateral ligament assessment
    > Valgus and varus forces applied while the carpus is in extension and flexion
  • Palmar ligament assessment
  • Radiographs
    > Dorsopalmar and lateromedial ± oblique projections > Stress projections
27
Q

PROSTHETIC COLLATERAL LIGAMENT
- what do we do?
- post op management
- prognosis

A
  • Ligament is replaced using heavy suture between bone screws or anchors
  • Primary repair may be attempted in addition but not often possible
    <><>
    Postoperative management
  • Immobilization in a splint / Cast for 4-6 weeks
    > Must be partially loaded at 4 weeks to orient collagen fibers
  • Activity restricted to leashed walks for 12 weeks
    <><>
    Prognosis
  • Good if no other significant injuries
  • Decreased range of motion and osteoarthritis
  • Prognosis depends on intended use of animal
28
Q

SHEARING INJURIES
- pathophysiology, type of injuries seen

A
  • Degloving injury caused by low velocity shearing forces
  • Skin disruption mechanical and physiological with crushing and avulsion injuries
  • Heavily contaminated with open joints and fractures
  • Concurrent injury common
29
Q

shearing injuries treatment
- how do we manage
- long term?

A

Temporary Stabilization
> Splints or external fixators
<><>
* Analgesia
<><>
Wound management
* Daily or twice daily initially (7-10 days…)
> Debride
> Lavage
> Bandage
(2nd intention healing)
<><>
Excellent wound care and bandage care is ESSENTIAL
<><><><><>
Additional Surgeries
* Further debridement
* Permanent stabilization
* Skin grafting
> Accelerates the wound care
<><>
* On average, 1.8 surgeries are required…
* Requires a strong commitment from owner and Vet
> Time, $$$

30
Q

shearing injury prognosis
* Bone or joint exposure or joint instability
* No bone or joint exposure or joint instability
- other options?

A

Bone or joint exposure or joint instability
* > 75% good to excellent outcome
* Mean healing time 7 weeks
<><>
No bone or joint exposure or joint instability
* > 90% good to excellent outcome
* Mean healing time 3
<><>
* Decision to amputate versus treat is often financial

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