ortho Flashcards
how common in osteoarthritis?
what causes it (dogs/cats)?
20% of dogs, 60% of cats
dogs- intiating trauma, laxity
cats- primary or idiopathic
factors causing OA
obesity, genetics, gender
OA pathogenesis
cartilage- decreased stiffness-> increased proliferation-> loss of tissue when chondrocytes can’t keep up
leads to osteophyte formation, inflammation, fibrosis
hx and C/S of OA (dogs and cats)
dogs: reluctant to exercise, lameness, inability to jump up, influenced by weather, worsens.
C/S- bunny hopping, muscle atrophy, joint swelling, pain
cats:more hidden, cant jump
C/S- cannot do performance tests (jumping), responds to discomfort
radiographic features of OA
osteophytes, effusion
**NWB images-> cannot assess cartilage
MRI- ligaments, menisci, tendons
CT- good for bony changes
arthroscopy- **evaluates cartilage
OA management
weight loss, controlled exercise
NSAIDs, solensia for cats
omega3s
sx- joint debridement, replacement
OCD definition and stages
disorder of endochondral ossification
latens- early
manifesta- subclinical rads, clinically present
dessicans- flaps
happens in fast growing breeds, poor limb conformation
common sites for OCD in dogs
humeral head, medial humeral condyle, femoral condyles
trochlear ridges of talus
pathogenesis of OCD
avascular necrosis of developing cartilage
OCD presentation, C/S
young lg breed dogs, lameness, exercise intolerance, often bilateral
OCD dx
survey rads-> defect in subchondral bone, flaps
arthroscopy
OCD tx
non surgical: sm lesions, dogs w OA where flap removal is not helpful
NSAIDs, exercise restriction, dietary supplements, weight control
shoulder OCD in young dogs-> exercise
surgical:arthroscopy-> flap removal, palliative (curettage, microfx) or restorative (transplant, autograft, resurfacing)
OCD prognosis
stifle- guarded to fair
shoulder- excellent w sx
medial humeral condyle- good if sx before OA
talus- guarded to poor, conservative tx
avascular necrosis of femoral head signalment, C/S, dx, tx
acute HL lameness, sm breeds
noninflammatory necrosis 4-11m
dx- apple core on rads
tx- femoral head/neck excision, THR
slipped capital femoral epiphysis signalment, C/S, dx, tx
young cats (male, overweight), not traumatic
lameness, cant jump, pain
often bilateral
dx- frogleg rads
tx- FHNE, maybe THR
hypertrophic osteodystrophy signalment, C/S, dx, tx
young fast growing dogs, lg breed males.
fever, anorexia, pain, cant walk, swelling on distal radius/ulna, tibia
dx- double physis line on rads
tx- symptomatic
hypertrophic osteopathy
periosteal rxn of distal limbs
associated w primary and metastatic neoplasia
progressive lameness, firm swelling
panosteitis dx, tx
self limiting inflammatory disease in BM, 5-12 dogs
dx- patchy opacity on rads
tx- rest, pain meds
multiple cartilagenous exostosis signalment, dx, tx
young growing dogs, before skeleton matures (danes, bernards, hounds)
cats- feLV associated, after skeleton matures
dx- rads (thin cortex bony masses)
histo definitive
tx- rest, NSAIDs
sx- single.lg mass compressing spinal cord
dysostoses dx, tx
ectrodactyly (split hand)- dominant in cats
polydacytyl- dominant in dogs/cats
preaxial/medial polydactyl (extra thumb)- recessive in dogs
dx- rads, MRI for axial
tx- medical: rehab, splinting, NSAIDs
sx- palliative (amputation),
reconstructive- realignment/arthrodesis
swimmers syndrome
1-3wks old, sm breeds, devon rex.
dx- PE (cant paddle), lateral splaying
tx- rehab, splinting, correct sternum w sx if needed
prognosis good if caught early, guarded of chronic
puppy carpal laxity
6-16wks, lg breeds
dx- ortho exam, palmarograde stance w normal rads
tx- exercise, splint 2wks if cannot be extended
sx if severe-> tenotomy, arthrodesis
retained cartilage cores
lg breed, 5m
torsion angulation deformity, retarded growth of distal ulna
dx- rads, radiolucent cartilage cores
tx- monitor for angular deformity
distal ulnar ostectomy, radial osteotomy
CCL insufficiency C/S, dx, tx
degenerative condition
loss of muscle mass, fails sit test, medial buttress, effusion, pain, +ve drawer/thrust
dx- rads r/o other causes
tx- weight loss, exercise modification, NSAIDs
CCLR sx
extracapsular- lateral fabellotibial suture, tightrope, fibular head transposition (create fibrosis)-> dogs <15kg
osteotomies, osteotomies-> dynamic stability (TPLO, TTA, CCW)
patellar luxation C/S
sit test failure, skipping gait, effusion, drawer positive in flexion (medial)
developmental- medial in sm breeds, lateral in lg breeds
can be traumatic
factors creating malignment of extensors
- coxa vara
- distal femoral varus
- shallow trochlear groove
- hypoplastic medial femoral condyle
- medial torsion of tibial tuberosity
- proximal tibial valgus
- internal torsion of foot
patellar luxation grades
grade I: stays in, can be luxated but goes back
grade II: stays in, can be luxated and put back
grade III: stays out, can reduce but in goes back out
grade IV: stays out, cannot reduce
patellar luxation tx
soft tissue procedures- release contracted tissues, desmotomy, quad release
groove reconstruction- sulcoplasty, chondroplasty, wedge resection, block recession
limb alignment- fabello tibial anti-rotational suture, tibial tuberosity transposition, distal femoral osteotomy (vaurs >15 degrees)
hip dysplasia causes
genetic susceptibility, environment-> hip laxity (excessive joint fluid, low pelvic muscle, hormones, nutritional excess, increased BW)
pathophysiology of hip dysplasia
forces crossing the joint increase, and are put on less contact area (instead of being spread evenly across the acetabulum)-> cartilage damage, joint inflammation, OA
progression of hip dysplasia w time
normal at birth-> earliest changes at 30d-> rad signs at 7wks-> pain and disability (OA) w age
**palpable/rad changes appear before degeneration
signalment C/S for hip dysplasia
lg breeds, not sight hounds
juvenile 5-12m: sudden onset lameness, bunny hopping, difficulty rising, laxity
chronic: pain from DJD, stiff pelvic limbs, exercise intolerance
PE for hip dysplasia
localize to hip joint, r/o CCLR, back pain, neoplasia, ortolani test
hip rads
OFA- extended hip rads, results variable in young animals
pennhip (neutral position)- needs GA/certification, rated from 0-1 (tx >0.7)
hip dysplasia tx
medical- palliative, pain meds, nutritional, modified exercise
surgical: prophylactic- no OA-> prevent
juvenile pubic symphysiodesis 12-20wks, palpable laxity
pelvic osteotomy 10m-1y
salvage- >1y w OA-> eliminate pain
FHO, THR (restores function)
hip luxation causes
usually trauma, hip dysplasia
most hip luxations are
craniodorsal, ventral less common
hip luxation C/S
craniodorsal- pain, lameness, external rotation, adduction, shortened limb
ventral- pain, lameness, internal rotation, longer limb
hip luxation dx, tx
rads (Vd and lateral)-> check for fx, hip dysplasia
tx- reduction within 3d
closed for CD-> elmer sling ventral-> hobbles
open reduction for fx, or if chronic: capsulorrhaphy, prosthetic capsule, FHNE/FHO, THR-> OA
which hip luxation has better prognosis w closed reduction?
ventral
factors in elbow dysplasia
medial compartment disease
ununited anconeal process
OCD
incongruity
ununited anconeal process (UAP), dx
lg breed, males, 5-12m, bilateral
caused by incongruity, genetics, etc (unclear)
dx- PE, rads-> gradual onset NWB, effusion, pain on palpation and extension
UAP tx
early intervention (prevent DJD)
anconeal process removal, reattachment
ulnar osteotomy, ostectomy
medial compartment disease
fragmented medial coronoid incongruity, signalment
young lg breeds (goldens, labs, GSD) 6-18m presentation. biphasic <3y >7y
medial coronoid disease?
complex polygenic trait-> delay in endochondral ossification-> incongruence, instability
lesions on medial humeral condyle from MCD
kissing lesion from FCP, graded w MOS scale
1- swelling, dull
2- partial thickness
3- down to subchondral bone
4- full thickness cartilage erosion
5- bone eburnation
elbow dysplasia C/S
lameness, pain on manipulation, bilateral-> lameness hard to see
elbows abducted, paw externally rotated
effusion, fibrosis (enlarged joint)
decreased ROM if chronic
elbow dysplasia dx
rads- good for osteophytes, lacks Se for medial coronoid disease
CT- gold standard for medial coronoid, evaluation of subchondral bone, cannot see cartilage
arthroscopy- needs GA, can see joint surfaces, minimally invasive tx
elbow dysplasia tx
arthrotomy, arthroscopy
fragment removal, subtotal coronoid osteotomy
biceps ulnar release procedure
ulnar osteotomy/ostectomy
humeral osteotomy-> sliding, external rotational
NSAIDS, weight loss, exercise/rehab, injections, radiation
factors to consider with elbow dysplasia tx
severity of OA
patient age
expected activity level
best prognosis for elbow dysplasia is in:
early surgical tx in young dogs, mild OA
postop rehab
