musculoskeletal Flashcards
what is an articular fracture
a fracture that involves a joint
salter harris physeal fractures
1 - just physis (most common)
2 - physeal with small amount of metaphyseal inclusion
3 - physeal fracture with small amount of epiphysis
4 - fracture through physis, metaphysis and epiphysis
5 - non-displaced compression of physis on one side
aim of fractures involving growth plates
aim to maintain normal growth of the long bones resulting in normal limb length with no deformities
animals will adapt to a slightly shorter leg
physeal fracture of tibial plateau
if untreated plateau remains at greater angle and puts extra strain on cranial cruciate ligament
fracture of capital physis
young male cat
repair with k wire of femoral head and neck ostectomy/hip replacement may be required
distal femoral physeal fractures
common
diaphysis can lie within the quadriceps
open wound classification
type 1 - small wound <1cm with little contamination, treat as closed
type 2 - extensive wound >1cm communicating with fracture
type 3 - very extensive soft tissue damage and fractured bones protruding through skin
primary bone healing
fracture heals without calus
fracture initially widens as bone resorbs then bone to bone healing occurs
secondary bone healing
formation of fibrous callus first
callus remodels into bone
what is perthe’s disease
avascular necrosis of the femoral head - toy/small under 6 months
lameness/muscle atrophy(gluteals), pain/crepitus on hip extension
mottled femoral head on radiograph
nsaids/ physio conservative rare, surgery - femoral head and neck excision, can do hip replacement
metaphyseal osetopathy
dogs < 6 months, severe pain to metaphysis of all limbs. unable to walk, pyrexic and pitting oedema over metaphyseal
imaging - looks like an extra growth plate with lucency parallel to growth plate, physis can bridge and cause angular limb deformity
hospitalise - analgesia, steroids, prognosis guarded
craniomandibular osteopathy
<6m small breed
palisading new bone on mandible, occipital creast and tympanic bullae
analgesia, coticosteroids, fluids/enteral support
Panosteitis
common <1y, gsd/male. shifting lameness
depresses/pyrexia, pain on diaphysis palpation
loss of trabecular pattern, endosteal and periosteal new bone
rest and analgesia - self limiting
excellent prognosis
rickets
absolute lack of vitamin D - rare, pain/swelling around physeal regions, reluctance to move, wide growth plates with delayed mineralisation
can be caused by secondary hyperparathyroidism from low CA high phosphorus diet(meat)
can have folding fractures/vertebral body collapse
correct diet, analgesia, restrict exercise
pituitary dwarfism
rare congenital condition gsd
physis stays open, puppy coat and no pubertal changes
treat with cortisol, thyroxine, progestogens (SE - pyometra, insulin resistance, mammary hyperplasia)
reduced life expectancy
angular limb defeormities
short ulna most common - distal more prone to trauma and premature growth plate closure
valgus deformity with cranial bowing
short radius - premature closure of distal radius - subluxation of radiohumeral joint
osteochondrosis
very common - failure ossification of articular cartilage, fragmentation of cartilage allows synovial contact with subchondral bone - inflammation
elbow - very common (guarded)
shoulder - rare (good)
stifle - rare (poor)
hock - uncommon (poor)
elbow dysplasia (all elbow ocd)
polygenic inherited disease affected by growth rate diet and exercise
chronic lameness, limb abduction, pain on medial compartment loading, effusion
orthogonal views + flexed lateral can be helpful
common lesions
fragmented medial condyle
osetochondrosis dissecans
ununited anconeal process
incomplete ossification of medial humeral epicondyle
CT and arthroscopy helpful
fragmented coronoid process treatment
conservative - weight control, nsaids, prp, stem cells…..
surgical - options - removal of fragment, off loading medial compartment , partial/total elbow replacement, arthrodesis
guarded prognosis
osteochrondrosis dissecans treatment
surgically managed - medial arthrotomy/arthroscopy, remove fragment, curette deficit
can replace deficit with autograft
prognosis fair
ununited anconeal process treatment
remove fragment, reattach with screw, ulnar osteotomy
in mature animal can treat medically
shoulder osteochondrosis
lab/border collie, 6-8 months
lame rising, worse after exercise, pain on shoulder extension, scapular muscle atrophy
flattening of causal third of glenoid, joint mouse/minearalised cartilage flap sometimes visable
surgical management - remove fragment, debride deficit
analgesia
stifle osteochondrosis
6-12m lab/staffies
chronic lameness, joint pain, joint effusion,
flattened condyle on mediolateral view, deficit either medial or lateral femoral condyles
remove fragment and curette deficit can replace deficit with autograft
prognosis fair/guarded
hock osteochondrosis
6-12m, lab/rottie, lameness after exercise.
ocd on medial trochlea of talus, widened joint space, sclerosis of subchondral bone, secondary arthritic change
remove osteochondral fragment or salvage (pantarsal arthrodesis) - often required
is cruciate disease common
any dog with hind limb lameness has cruciate disease until proven otherwise
is patella subluxation common
common - esp small breeds but also bulldogs, labs and lateral in flat coats
soft tissue shoulder imaging
radiography - mineralisation of infra/supraspinatus tendons
ultrasound of biceps tendon
ct/mri both useful
arthroscopy is gold standard
infraspinatus contracture
rare progressive- working breeds
characteristic limb posture
fibrotic infraspinatus needs to be cut
humeral intracondylar fissure
young-middle age
chronic forelimb lameness, muscle atrophy, elbow swelling, pain on manipulation
multiple views to visualise fissure
ct best - fissure/sclerosis will be visible
treat - rest/non steroidals or transcondylar screw
carpal hyperextension injuries
palmar carpal ligaments and cartilage damaged. swollen with palmargrade stance can occur with destructive arthritis
treated by partial or pancarpal arthrodesis
incomplete ossification of radiocarpal bone
boxers/springers
treat with pancarpal arthrodesis
plantar ligament degeneration
proximal intertarsal subluxation with bilateral changes
plantigrade stance
treated by arthrodesis
gastrocnemius tendinopathy
chronic hindlimb lameness, often bilateral, relatively common
painful achilles swelling, mineralisation on radiograph
resect tendon and place calcaneal screw (not best results) tibial/transarticular external fixator or pantarsal arthrodesis
predilection sites for osteosarcoma
proximal humerous, distal radius, proximal tibia, distal femur
fail to cross the joint
femur head in racing greyhounds
how do bony neoplasias appear on xray
proliferative lesions - radiopaque
destructive lesions - radiolucent
histology of bony neoplasia
jamshidi needles for histology
treatment of bone tumours
limb amputation in smaller breeds
chemotherapy
pain relief
nerve root tumours
marked muscle atrophy of one limb
can occur in brachial/lumbosacral plexuses
treatment for patella fractures
with limited distraction - conservative management
marked distraction - circumfrential wire, tension band, pin/tension band
osteoarthritis
fraying of articular cartilage
exposure of subchondral done to synovial fluid leading to scleroses and osteophyte formation/remodelling
classification of ligament injuries
first - few broken collagen fibre, swelling - rest/NSAIDs
second - marked fibre damage, haematoma, loss of function, support, rest, nsaids
third - complete rupture/avulsion, repair if possible
joint luxations
incongruent - joint surfaces abnormal in shape/do not articulate well
dysplasia - abnormal joint development
subluxation - joint surface displaces but some contact maintained
luxation - no joint contact
can dogs get pododermatitis
yes
what is paronychia
bacterial infection in nail base
what is onychomycosis
fungal infection in multiple nail beds
with facial trauma how should you secure the airway
tracheotomy tube
how can you stabilise mandibular fractures
acrylic bonding of canines
is mandibular symphyseal separation common
yes - fix with wire caudal to canine teeth
