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Cat & Dog > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

An orthopaedic exam should always be __ & __

A

Consistent & Repeatable

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2
Q

List the scale for lameness in dogs and cats

A

1 - Normal
2 - Mild
3 - Moderate
4 - Severe
5 - Non weight bearing

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3
Q

A head nod to the __ indicates lameness on the forelimb

A

Good side

I.e., the lameness is opposite to the head nod

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4
Q

List the 3 joints in the carpus

A
  1. Antebrachiocarpal
  2. Middle carpal
  3. Carpometacarpal
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5
Q

What is the range of motion of the carpus?

Flexion, extension & valgus

A

Flexion, 150
Extension, 10-20
Valgus, 10-15

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6
Q

Define valgus

A

Stress applied away from the body

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7
Q

Define varus

A

Stress applied towards the body

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8
Q

What is the range of motion of the elbow?

Flexion and extension

A

Flexion, 20
Extension, 150

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9
Q

In which joints is effusion difficult to assess?

A

The elbow, shoulder

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10
Q

What is the range of motion of the shoulder?

Flexion, extension, abduction

A

Flexion, 60
Extension, 160
Abduction, 35

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11
Q

What is the range of motion of the hock?

Flexion and extension

A

Flexion, 20
Extension, 180

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12
Q

What is the range of motion of the stifle?

Flexion, extension and internal rotation

A

Flexion, 40
Extension, 160-170
Internal rotation, 5

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13
Q

Which tests can you perform to test the integrity of the cranial and caudal cruciate ligaments

A

The cranial draw test and tibial compression test

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14
Q

What is the range of motion of the hip?

Flexion, extension, and abduction

A

Flexion, 50
Extension, 160
Abduction, 40

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15
Q

Define arthrocentesis

A

Removal of fluid from a joint

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16
Q

Describe the method for arthrocentesis of the elbow

A

Neutral position, palpate the lateral epicondyle and olecranon, and insert the needle parallel to the ulna

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17
Q

Describe the method for arthrocentesis of the antebrachiocarpal joint

A

Flex maximally, insert needle dorsoventrally medial to the common digital extensor and cephalic vein

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18
Q

Describe the method for arthrocentesis of the stifle joint

A

Slight flexion, palpate the tibial tuberosity and patella, insert the needle at 45 degrees lateral to the parapatella joint pouch

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19
Q

List 5 properties of synovial fluid

A
  1. Clear or pale yellow
  2. Viscous
  3. Small volume
  4. Low cell count
  5. Mononuclear cytology (NO neutrophils)
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20
Q

List 6 clinical signs of a fracture

A
  1. Loss of function
  2. Swelling
  3. Change in limb length, alignment or orientation
  4. Abnormal range of motion
  5. Pain
  6. Crepitus
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21
Q

What causes displacement of the fracture ends after a break?

A

Continued load bearing and muscle contraction

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22
Q

List the 3 requirements for fracture healing

A
  1. Stability & reduction of the fracture site
  2. Absence of infection
  3. Time
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23
Q

List the 4 goals of fracture management

A
  1. Reduce discomfort
  2. Eliminate ongoing trauma
  3. Support healing
  4. Restore function
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24
Q

Describe the steps in callus formation

5 steps

A
  1. Haematoma formation
  2. Granulation tissue
  3. Vascular invasion & fibroblast differentiation
  4. Fibrocartilage formation
  5. Mineralisation
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25
Q

What are 2 general types of bone healing?

A
  1. Healing under limited motion
  2. Primary bone healing
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26
Q

What are the 2 types of primary bone healing?

A
  1. Contact healing
  2. Gap healing
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27
Q

Describe the process of healing under limited motion

A

When there is some movement at the fracture gap, callus formation causes a progressive increase in the stiffness of the fracture site

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28
Q

What is required for healing by primary bone union?

2 things

A

Complete stability and no/small fracture gap

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29
Q

Describe the process of contact healing

What will you see on a radiograph if this form of healing happens?

A

Direct apposition of the fracture ends with NO movement allows remodelling

Reduced radiographic density at the bone ends next to the fracture site

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30
Q

Describe the process of gap healing

A

Small gaps between the fracture ends with SOME movement allows lamellar bone to form between the fracture gap, and intracortical remodelling restores bone integrity

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31
Q

List

Neutralizing forces causing fractures

A
  1. Tension (lengthen)
  2. Compression (shorten)
  3. Bending (tension + compression)
  4. Torsion
  5. Shear (oblique)
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32
Q

Define a pathological fracture

A

A fracture secondary to an underlying pathological process that weakens the structure

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33
Q

List 6 categories in which you can classify/assess a fracture

A
  1. Aetiology
  2. Bones involved
  3. Position within the bone
  4. Direction of fracture lines
  5. Number of fracture lines
  6. Displacement of fracture lines
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34
Q

List 5 classes of fractures based on their position within the bone

A
  1. Diaphyseal (the shaft)
  2. Metaphyseal (end of the shaft)
  3. Physeal (growth plate)
  4. Epiphysis (end of the bone)
  5. Articular (the joint)
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35
Q

What condition will likely develop from an articular fracture

A

Osteoarthritis

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36
Q

What is an incomplete, greenstick, fracture secondary to in mature animals?

A

Skeletal demineralisation (nutritional hyperparathyroidism)

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37
Q

What is a fissure?

A

Cracks coming from the fracture site

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38
Q

List 5 classifications of fractures based on the direction of fracture lines

A
  1. Transverse
  2. Oblique
  3. Segmental
  4. Spiral
  5. Multifragmentary (comminuted)
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39
Q

The displacement of the fracture is always described as the displacement of the __ part

A

Distal

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40
Q

Define avulsion

A

When a bone fragement separates from the rest of the bone becasue of a muscle or ligament attachment

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41
Q

Where do avulsions occur in immature animals?

A

Along the physis

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42
Q

Where do avulsions occur in mature animals?

A

At the muscular or ligament insertions

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43
Q

Define an impacted fracture

A

When fracture ends are driven together

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44
Q

How can you recognize fracture healing clinically?

A
  1. Improved function
  2. Consistent weight bearing
  3. Minimal muscular atrophy
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45
Q

How can you recognize fracture healing radiographically?

A
  1. Briding cells
  2. Loss of fracture lines

Variable signs depending on type of fracture

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46
Q

What are the 3 goals of treating an open fracture?

A
  1. Stabilise and manage soft tissue injuries
  2. Prevent contamination
  3. Achieve rapid bone union and restore function
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47
Q

Which class of drug should you avoid when treating open fractures?

A

Corticosteroids

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48
Q

What are the 3 sections of the fracture patient assessment score?

A
  1. Clinical
  2. Mechanical
  3. Biological
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49
Q

List 3 mechanical factors to consider when scoring a fracture patient

A
  1. Type of fracture
  2. Number of injuries
  3. Size of the animal
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50
Q

List 5 biological factors to consider when scoring a fracture patient

A
  1. Age
  2. Overall health
  3. Soft tissue involvement
  4. Location
  5. Energy of the fracture
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51
Q

What clinical factor should you consider when scoring a fracture patient?

A

Patient and client compliance

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52
Q

List the 4 methods of fracture repair

A
  1. Conservative
  2. External
  3. Internal
  4. Salvage
53
Q

Describe biological osteosynthesis as a method of fracture repair

A

Takes full advantage of biological healing potential to maximise healing, maintains limb length and orientation, and avoids creating further surgical trauma

54
Q

What is the appropriate emergency method of fracture repair for upper limb fractures?

A

Cage rest

55
Q

What is the appropriate emergency method of fracture repair for lower limb fractures?

A

Robert-Jones dressing & cage rest

56
Q

For which type of fractures is conservative management (i.e., cage rest) appropriate?

A

Pelvic fractures & lower limb fractures

57
Q

List 4

Advantages of external coaptation

A
  1. Preserves soft tissue & blood supply (biological)
  2. Quick
  3. Few materials
  4. Generally inexpensive
58
Q

List 5

Disadvantages of external coaptation

A
  1. High maintenance
  2. Can cause soft tissue injury if done wrong
  3. Muscle atrophy & joint stiffness
  4. Osteopenia
  5. Can only be used below elbow & stifle
59
Q

Where are splints best used?

A

The radius and ulna

60
Q

List 2 materials that can be used to form casts

A
  1. Plaster of Paris
  2. Fibreglass/resin
61
Q

List 3 advantages for plaster of paris cast material

A

Cheap, easy to apply and conforms well

62
Q

List 3 advantages for fibreglass/resin cast material

A

Light and strong, conforms well, radiolucent

63
Q

List 3 criteria important for maintaing reduction during cast application

A
  1. Immobilising the joint above the fracture
  2. Immobilising the joint in normal standing position
  3. Including the toe pads
64
Q

If healing time is expected to be longer than __, you should avoid using a cast

A

6 weeks

65
Q

List 4 biological complications of healing with casts

A
  1. Soft tissue injury (pressure sores or ischaemia)
  2. Fracture disease (muscle wasting or osteoporosis)
  3. Malunion
  4. Delayed union
66
Q

Define external skeletal fixation

A

A series of percutaneous pins that pass into or directly through the bone

67
Q

List 3 advantages of ESF

A
  1. Versatile
  2. Easy to apply
  3. Compatible with the principles of biological osteosynthesis
68
Q

How is ESF compatiable with the principles of biological osteosynthesis?

A

It maintains alignment in the limb, minimally disturbs fracture fragments, neutralizes fracture forces and encourages early weight bearing

69
Q

Define a unilateral ESF frame

A

Uses half pins

70
Q

Define a bilateral ESF frame

A

Uses full pins

71
Q

What is a type 1 ESF frame design?

A

Unilateral, uniplanar (straight line running down one side of the bone)

Simplest form

72
Q

What is a type 2 ESF frame design?

A

Bilateral, uniplanar (two sides, one plane)

73
Q

What is a type 3 ESF frame design?

A

Bilateral, biplanar (forms a triangle shape around the bone)

Most complex

74
Q

List the 3 different types of fixation pins

A
  1. Smooth
  2. Negative profile thread
  3. Positive proflie thread
75
Q

When using which type of fixation pin must you pre-drill a pilot hole?

A

Positive profile thread pin

76
Q

How many fixation pins should you place above and below a fracture?

A

3 above and below

77
Q

Why would you hang a limb when preparing for ESF frame placement?

A

It aids in fracture reduction and fatigues the muscles

78
Q

How wide should your pins be compared to the bone for ESF?

A

20-25% of the cortical width (1/4)

79
Q

List 2 complications of using ESF

A

Persistent pin tract drainage (inevitable in some cases) and loosing pins

80
Q

What is an Illizarov ESF?

A

A ring fixator (cESF)

81
Q

Intermedullary pins for fracture alignment resist bending, but what can still happen?

A

Rotation, shear, or axial shortening

82
Q

How can you enhance the stability of an IM pin?

A

Combine with ESF or plate & screws

83
Q

How would you select the diameter and length of an IM pin?

A

You want to fill the medullary canal at the narrowest point and have the pin sitting in the distal metaphysis

84
Q

Define normograde IM pinning

A

Introducing the pin away from the fracture site

85
Q

Define retrograde IM pinning

A

Introduce the pin at the fracture site

86
Q

In which bone can you not use IM pinning?

A

The radius

87
Q

For which bones can you not use retrograde IM pinning?

A

The tibia and radius

88
Q

What is an interlocking nail stabilizer?

A

An IM pin fitted with bone screws

89
Q

How is an interlocking nail better than an IM pin?

A

It neutralizes ALL forces (not just bending), including shortening, rotation and shear

90
Q

What is an orthopaedic wire?

A

A monofilament wire 0.8-1.2mm in diameter

91
Q

When would you use tension band wiring?

A

To repair fractures or osteotomies which are subjective to distractive forces

92
Q

Define the features of a self tapping bone screw

A

They cut their own thread in the bone and have a cutting tip

93
Q

Define the advantage of using a tapped bone screw

A

A thread must first be cut into the bone, but the thread on the bone conforms exactly to the screw proflie, so it maximises its holding power

94
Q

List the steps of bone screw placement

A
  1. Drill pilot hole
  2. Measure depth of hole and add 2mm
  3. Countersink
  4. Tap
  5. Place screw and tigthen
95
Q

Define a lag screw

A

When the screw crosses a fracture line that can be compressed

The screw provides compression

96
Q

Define a position screw

A

When the screw crosses a fracture line that cannot be compressed

97
Q

Which part of the bone do screw threads grip to

A

The far-cortex

So, overdrill in the near cortex to make a gliding hole

98
Q

Define countersinking

A

A technique used to create a platform in the near cortex of bone, for when placing a bone screw

99
Q

Where should you insert a lag screw?

A
  1. In the middle of the fragment
  2. Equidistant from fracture edges
  3. At 90 degrees to the fracture plane
100
Q

What is the main advantage of lag screws?

A

The provide interfragmentary compression

101
Q

When would you use a position screw?

A

When a lag screw fragment collapses or when a fragment is too small to make a gliding hole

102
Q

What are the three ways in which you can apply a bone plate?

A
  1. Compression plate
  2. Neutralisation plate
  3. Buttress plate
103
Q

With a compression plate, which side of the plate provides the compression and which side provides the tension

A

Compression, concave
Tension, convex

104
Q

For which fractures is a compression plate best suited?

A
  1. Transverse fractures
  2. Short oblique fractures
  3. Corrective osteotomies
  4. Articular fractures
105
Q

How would you place a compression plate?

Why would you do it this way?

A

In tension (convex to the bone), to apply compression across the fracture gap

106
Q

When would you use a neutralization plate?

A

To protect a lag screw reconstruction (plate + screws work together, and the bone takes some weight)

Bc it cannot take significant loads without failure

107
Q

When would you use a buttress plate?

A

When a fracture cannot be reconstructed (shattered) and the bone cannot take any weight

108
Q

Define osteomyelitis

A

Inflammation/infection of the bone and associated bone marrow

109
Q
A
110
Q

When do we most commonly see osteomyelitis?

A

As a post surgical infection (70% occur after orthopaedic procedures)

Also after a penetrating injury, as local extension, or spread in blood

111
Q

Why is osteomyelitis so common at sites where metallic implants are placed?

A

Because the glycocalys biofilm on the implant shields bacteria in the site from normal host defences

112
Q

List 3 clinical signs of acute osteomyelitis

A
  1. Localised pain
  2. Swelling
  3. Pyrexia & anorexia

Usually presents 2-3 days post op

113
Q

List 5 clinical signs of chronic osteomyelitis

A
  1. Lameness
  2. Bone pain
  3. Swelling
  4. Discharging sinus tracts (from Sx)
  5. Pyrexia & anorexia
114
Q

What radiographic sign are we looking for to diagnose osteomyelitis?

A

Bone destruction

115
Q

List 5 radiographic signs of osteomyleitis

A
  1. Bone destruction
  2. Periosteal new bone formation
  3. Soft tissue swelling
  4. Sequestrum formation (solo fragment of dead bone away from normal bone)
  5. Delayed or non-union
116
Q

What is most important for a fracture to heal, even with osteomyelitis?

A

It needs to be stable

Fractures will heal in the presence of persistent infection

117
Q

Can you treat osteomyelitis with antibacterials?

A

Yes - culture if possible, and 50-60% of infections involve staph so you can reasonably treat

Treat w prolonged course

118
Q

What is the difference between delayed union and malunion

A

Delayed union isn’t a problem bc the bone will heal eventually (but maybe ask yourself why its so slow), but malunion is when the bone doesn’t heal normally because of inadequate fixation or inaccurate reduction

119
Q

How would you correct a significant deformity from malunion?

A

An osteotomy and realignment

120
Q

Define non-union, and the primary cause

A

When the bone does not heal at all
Usually your fault (poor management, inadequate stability, and excess motion putting high strains on the bone so that it does not progress to mineralisation)

121
Q

Define a viable non-union, and the two types

A

A non-union that will heal following adequate stabilisation
There is hypertrophic and oligotrophic viable non-unions

122
Q

What is the difference between hypertrophic and oligotrophic non-union?

A

In hypertrophic non-union there is a lot of callus formation (it is a highly vascular fracture site), and in oligotrophic there is not a lot

123
Q

What are the 4 types of non-viable non-union?

A
  1. Dystrophic
  2. Necrotic
  3. Defect
  4. Atrophic
124
Q

Define dystrophic non-viable non-union

A

Non-union where blood supply is insufficient

125
Q

Define necrotic non-viable non-union

A

Non-union where there is necrotic tissue in the fracture site

126
Q

Define defect non-viable non-union

A

Non-union where there is a bone defect at the fracture gap

127
Q

Define atrophic non-viable non-union

A

Non-union where there is no evidence that its attempted to heal, and bone ends appear sclerotic and atrophied

128
Q

What are 3 sequale to atrophic non-union?

A
  1. Medullary cavity seals over
  2. Fracture gap fills with fibrous tissue
  3. Pseudoarthrosis formation
129
Q

How would you treat atrophic non-union?

A

Debride fracture ends until you get to viable bleeding bone, open the medullary cavity, and stabilise with plate and screws

Cat & Dog (7 decks)

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