Musculoskeletal System (1-14) Flashcards
What 3 topics should be discussed when taking an orthopedic history
- presenting complaint
- general history
- problem history
for forelimb lameness, the head nod goes down on the good or bad side?
good side
A dog with a head nod down on the left side has lameness on which limb?
right forelimb
list the anatomy of the paw
- phalanges
- metacarpal/metatarsal bones
- flexor tendons
what 5 areas of the paw should be examined/palpated during a clinical exam
- digital pad/nail
- central pad
- interdigital webs
- distal and proximal interphalangeal joints
- metacarpal/tarsal phalangeal joint
List the anatomy of the carpus
- antebrachiocarpal joint
- middle carpal joint
- carpometacarpal joint
what 2 areas of the carpus should be palpated/examined during a clinical exam
- styloid processes
- accessory carpal bone
to what degree can a normal carpus be flexed
150
to what degree can a normal carpus be extended
10-20
to what degree can a normal carpus be valgused
10-15
what does applying valgus and varus stress to the carpus check for
collateral ligaments integrity
list the anatomy of the elbow
- medial part of humeral condyle
- anconeus
- collateral ligaments
- annular ligament
what 3 areas of the elbow should be palpated/examined during a clinical exam
- ulna and radius
- medial/lateral epicondyles
- olecranon (and triceps tendon)
to what degree can a normal elbow be extended
150
to what degree can a normal elbow be flexed
20
what degree should the elbow be fixed at in order to rotate the paw to test supination and pronation
90
name the 3 areas of the shoulder that should be examined/palpated during a clinical exam
- deltoid tuberosity
- greater tubercle of the humerus
- acromion of the scapula
to what degree can a normal shoulder be flexed
60
to what degree can a normal shoulder be extensed
160
to what degree can a normal shoulder be abducted
35
list the anatomy of the hock
- tarsal bones
- short and long collateral ligaments
- plantar fibrocartilage
what two areas of the hock should be palpated/examined during a clinical exam
- medial and lateral malleoli
- calcaneous/achilles tendon
to what degree can a normal talocrural (hock) joint be flexed
20
to what degree can a normal talocrural (hock) joint be extended
180
how can you check the long and short collateral ligaments of the hock?
valgus and varus stress in flexion/extension
list the anatomy of the stifle
- complex hinge joint
- collateral ligaments
- cranial and caudal cruciate
- medial and lateral menisci
- joint capsule/muscle
what two areas of the stifle should be palpated/examined during a clinical exam
- tibial tuberosity, fibular head
- patella, fabella
to what degree can a normal stifle be flexed
40
to what degree can a normal stifle be extended
160-170
to what degree can a normal stifle be rotated internally
5
list the anatomy of the hip
- femoral head
- acetabulum
- joint capsule
- Teres ligament
- surrounding muscles
what two areas of the hip should be palpated/examined during a clinical exam
- greater trochanter
- ilial wing, ischium
to what degree can a normal hip be flexed
50
to what degree can a normal hip be extended
160
to what degree can a normal hip be abducted
40
what kind of tube should be used for Arthrocentesis
EDTA tube
list 5 properties of synovial fluid
- clear, colorless or pale yellow
- viscous
- small volume
- low cell count
- mononuclear cytology
what position should the elbow be in for arthrocentesis
neutral position
what position should the antebrachiocarpal joint be in for arthrocentesis
flexed maximally
what position should the stifle be in for arthrocentesis
slight flexion
name 6 clinical signs of fracture
- loss of function (lame)
- swelling
- change in limb length, alignment or orientation
- abnormal ROM
- pain
- crepitus
what 3 things does fracture healing need
- adequate reduction and stability of the fracture site
- absence of complicating factors
- sufficient time
name 4 goals of fracture management
- reduce discomfort
- eliminate ongoing trauma
- support healing
- restore function
what two things does primary bone union require
- complete stability
- no or small fracture gap
name the type of primary bone healing
- direct apposition of the fracture ends with no movement permits direct remodelling
- new cutting cones are initiated in the region of the fracture
- reduced radiographic density at bone ends adjacent to fracture site
contact healing
name the type of primary bone healing
- small gaps between the fracture end
- minimal movement
- lamellar bone forms directly in the fracture gap
- intracortical remodelling throuhg the fracture gap then restores bone integrity
gap healing
name the neutralising force
causes lengthening
tension
name the neutralising force
causes shortening
compression
name the neutralising force
combines tension and compression: tension on convex surface, compression on concave surface - neutral axis results
bending
name the type of fracture
bone fracture secondary to an underlying pathologucal process that weakens the structure (infection, neoplasia, nutritional disease)
-normal loading results in fracture
pathological fracture
name the fracture classification
occurs in the central/middle part of a bone
diaphyseal
name the fracture classification
occurs in the wider part of the bone near the growth plate.
metaphyseal
(occurs in metaphysis)
name the fracture classification
type of bone fracture that affects the growing part of a skeletally immature animal, potential for growth plate damage
-likely articular involvement
epiphyseal fracture
name the fracture classification
when a bone breaks inside or around a joint;
must achieve accurate anatomical reduction and rigid fixation for best results;
‘no compromise’ fractures
articular fractures
name the type of incomplete fracture
skeletally immature animals where bone incompletely mineralized, so less brittle than fully mineralized adult bone;
secondary to skeletal demineralization
Greenstick
name the type of incomplete fracture
crack through a bone without alteration in its alignment and in which the periosteum is not broken;
undisplaced ones are often seen running along the cortex from a major fracture line
fissure
name the type of complete fracture
bone is broken perpendicular to its length in a straight line
transverse
name the type of complete fracture
bone is broken at an angle, straight line that’s angled across the width of your bone
oblique
name the type of complete fracture
bone is broken in at least two places, leaving a piece of bone totally separated by the breaks
segmental
name the type of complete fracture
when bone is broken with twisting motion;
fracture line that wraps around the bone and looks like a corkscrew
spiral
name the type of complete fracture
A fracture with more than one fracture line so that there are one or more intermediate fragments
multifragmentary
this is when a bone fragment is distracted by muscle pull or ligament attachment
(tibial tuberosity, olecranon, elective osteotomy)
avulsion
where does avulsion occur in skeletally immature animals?
along physis
where does avulsion occur in skeletally mature animals
at muscular/ligament insertions
this is when fracture ends are driven together;
often stable and can be managed conservatively
impacted
name the type of fracture
broken bone that causes an open wound or break in the skin;
previously known as a ‘compound’ fracture;
graded 1-3 on the severity of soft tissue injury
open fracture
what is the immediate first aid of open fractures
- cover open wounds
- control hemorrhage
name 3 clinical function signs of fracture healing
- progressive improvement in function
- consistent weight bearing
- minimal muscular atrophy
name 2 radiographic signs of fracture healing
- bridging callus
- loss of fracture lines
what 4 things should be done ASAP to treat an open fracture
- clip widely
- lavage copiously
- debride all dead tissue
- start open wound management
what 3 types of factors play a role in the fracture patient assessment score to identify ‘risky’ patients
- clinical factors
- mechanical factors
- biological factors
the higher the fracture patient assessment score, the (lower or higher?) the risk in fracture healing?
lower
which mechanical aspect of a fracture has a higher risk?
bridge fracture, contact fracture, or compression fracture?
bridge fracture
which mechanical aspect of a fracture has a higher risk?
multiple limb injury OR single limb
multiple limb injury
which mechanical aspect of a fracture has a higher risk?
toy breed, large breed, or giant breed?
giant breed
which biological aspect of a fracture has a higher risk?
juvenile, yong adult, adult, geriatric?
geriatric
which biological aspect of a fracture has a higher risk?
poor health or excellent health?
poor health
which biological aspect of a fracture has a higher risk?
good soft tissue or poor soft tissue?
poor soft tissue
which biological aspect of a fracture has a higher risk?
cortical bone or cancellous bone?
cortical bone
which biological aspect of a fracture has a higher risk?
low enery or high energy?
high energy
name 2 clinical aspects that can make fracture healing more risky
poor client and patient compliance
name one conservative method of fracture repair
cage rest
name two external methods of fracture repair
- Coaptation
- ESF
name 3 coaptation methods of fracture repair
- splint
- cast
- dressing
name 3 External Skeletal Fixation (ESF) methods of fracture repair
- linear
- circular
- hybrid
name 5 internal methods of fracture repair
- internal fixators
- plates and screws
- screws alone
- wires
- pins
name 1 salvage method of fracture repair
amputation
what is the emergency support for lower limb fractures
Robert-Jones Dressing
name 4 advantages of external coaptation for fracture management
- ultimate biological fixation
- quick
- don’t need much inventory
- MIGHT be cheap
name 3 disadvantages of external coaptation for fracture management
- heavy maintenance
- cast associated soft tissue injury
- fracture disease
name the external method of fracture management
short-term/adjunctive support;
OK for radius and ulna;
apply over cast padding and conforming bandage;
spoon part at bottom
splint
name the external method of fracture management
thermoplastic materials;
stronger and lighter than Plaster of Paris;
need to be quite hot before they are moldable;
can be awkward to use
anatomical molded splints
name the external method of fracture management
cheap;
easy to apply;
conform well;
take 8+ h to dry fully;
heavy to wear;
radiodense
Plaster of Paris (cast)
name the external method of fracture management
light and strong;
don’t soften when wet;
conform well;
set rapidly;
radiolucent;
need an oscillating saw for removal
Fiberglass/Resin (cast)
how often should a cast be checked by a vet
weekly
name 5 signs of cast complications to explain to owners to watch for
- rubbing/chewing at cast
- swollen foot pads
- bad smell
- stops weight bearing
- becomes ill
name 4 possible cast complications
- soft tissue complications (pressure sores, ischemia)
- fracture disease (muscle wasting, stiffness, osteoporosis, tissue adhesion)
- malunion
- delayed union
name the external method of fracture management
a series of percutaneous pins that pass into or through the bone and are connected externally by clamps and rods, acrylic bars and epoxy putty
external skeletal fixation (ESF)
name 3 advantages of external skeletal fixation (ESF) for fracture management
- versatile
- easy to apply
- compatible with principles of ‘biological osteosynthesis’
this aims to take full advantage of biological healing potential to maximize rate of fracture healing (maintain limb length and orientation & avoid creating further surgical trauma);
goal is to provide an optimal biological and mechanical environment for fracture repair
biological osteosynthesis
what type of pins does unilateral frame for external skeletal fixation (ESF) use
half pins
what type of pins does bilateral frame for external skeletal fixation (ESF) use?
full pins
which type of external skeletal fixation (ESF)?
unilateral, uniplanar
type 1
which type of external skeletal fixation (ESF)?
bilateral, uniplanar
type 2
which type of external skeletal fixation (ESF)?
bilateral, biplanar
type 3
which type of external skeletal fixation (ESF)?
ring fixator, cESF
Ilizarov
which type of fixation pin for external skeletal fixation (ESF)?
holds fracture together by friction only
smooth pin
which type of fixation pin for external skeletal fixation (ESF)?
good bone purchase;
weak point must be protected
negative profile thread pin
which type of fixation pin for external skeletal fixation (ESF)?
excellent bone purchase;
no weak point;
must pre-drill a pilot hole
positive profile thread pin
what should the width of the pins used for external skeletal fixation (ESF) be?
20-25% of cortical width
how many pins should you aim for per fragment in external skeletal fixation (ESF)?
3 pins per fragment
what can external skeletal fixation (ESF) be used for besides just fracture management?
protection of ligament repairs
name the internal method of fracture repair
holds fragments in alignment;
resists bending but NOT rotation, shear or axial shortening
intramedullary (IM) pins
what should the diameter of IM pins be?
aim to fill the medullary canal at narowest point
name the method of placing an IM pin
- introduce pin away from fracture site
- reduce fracture
- advance pin across fracture
may be able to do this closed
normograde pinning
name the method of placing an IM pin
- introduce pin at fracture site
- push/pull pin through bone to allow fracture reduction
- reduce fracture and drive pin across fracture line
retrograde pinning
what bone can you NOT use intramedullary (IM) pinning in?
radius
name the internal method of fracture repair
an IM pin perforated to accept bone screws;
neutralizes all forces very effectively;
requires specialized instrumentation;
can be technically challenging
interlocking (IL) nail
name the internal method of fracture repair?
used to repair fractures or osteotomies which are subjected to distractive forces (olecranon osteotomy, tibial tuberosity avulsion, malleolar fracture);
figure 8 wire anchored in a transverse bone tunnel and passed around the ends of the pin(s);
anchored by twisting ;
converts distractive forces to compression at the fracture line
tension band wiring
name the type of bone screw
cut their own thread in the bone;
cutting tip
self tapping
name the type of bone screw
thread must be cut in the bone;
thread conforms exactly to screw profile;
maximises metal-bone contact and holding power
tapped
name the 5 steps of bone screw placement
- drill pilot hole
- measure depth of hole (and add 2mm)
- Countersink
- tap
- place screw and tighten
name the type of bone screw
when the screw crosses a fracture line that can be compressed;
provides interfragmentary compression
Lag Screw
name the type of bone screw
when the screw crosses a fracture line that cannot be compressed;
when near fragment is too small to take a gliding hole
position screw
what 3 ways can a bone plate be applied
- compression plate
- neutralisation plate
- buttress plate
name the type of bone plate
bone is anatomically reconstructed and load sharing;
promotes primary bone union;
uses tension band principle
compression plate
name the type of bone plate
applied to protect a lag screw reconstruction; cannot take significant loads without failure;
load sharing between plate and bone
neutralisation plate
name the type of bone plate
fracture cannot be anatomically restructured;
no load sharing between bone and plate;
plate transmits the full force of loading across the fracture gap
buttress plate
this is inflammation/infection of the bone and associated bone marrow
osteomyelitis
what is the most common source of infection causing osteomyelitis?
post-surgery
(open fracture, open reduction of closed fracture)
name 4 sources of infection causing osteomyelitis
- post-surgery
- penetrating injury
- local extension
- haematogenous spread (rare)
what 3 things does the establishment of infection in the bones/bone marrow require?
- sufficient numbers of pathogenic bacteria
- avascular cortical bone
- favorable environment for colonization and multiplication
name 5 clinical signs associated with acute osteomyelitis (ex: following extension of a deep surgical site infection)
- localized pain
- swelling
- pyrexia
- anorexia
- lethargy
name 4 clinical signs associated with chronic osteomyelitis
- lameness
- bone pain
- swelling
- heat
name 5 radiographic signs of osteomyelitis
- bone destruction
- periosteal new bone formation
- soft tissue swelling
- sequestrum formation
- delayed or non-union
this is failure of bone healing and is usually iatrogenic; i.e. YOUR FAULT
non-union
name the type of non-union
usually arise due to inadequate stability of the fracture site or inadequate reduction;
should heal following adequate stabilization
viable non-union
name the type of non-union
highly vascular fracture site;
significant callus;
need to work out what is wrong and put it right (remove loose implants and stabilize fragments);
don’t usually require bone graft
hypertrophic non-union
name 4 types of non-viable non-union
- dystrophic
- necrotic
- defect
- atrophic
name the type of non-union
blood supply inadequate
dystrophic (non-viable non-union)
name the type of non-union
necrotic tissue in fracture site
necrotic (non-viable non-union)
name the type of non-union
bone defect at fracture gap
defect (non-viable non-union)
name the type of non-union
biologically inactive;
no evidence of attempt to heal;
bone ends sclerotic and atrophied;
medullary cavity may seal over;
fracture gap fills with fibrous tissue;
pseudoarthrosis formation
atrophic (non-viable non-union)
what is the treatment for atrophic non-union of a fracture
- aggressive treatment (open approach, debride fracture ends to viable bone, open medullary cavity)
- rigid stabilization
- bone graft
this is when the quadriceps muscle becomes adherent to fracture site;
progressive decrease in range of stifle joint mobility;
stifle and hock overextend
quadriceps contracture
what is the treatment for quadriceps contracture?
- surgical release of adhesions
- muscle/tendon lengthening if necessary
- passive and active physiotherapy
- 90-90 bandage postoperatively
what is the classification of bone graft?
donor and recipient is same individual
autograft