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Ortho Flashcards

1
Q

What are the zones of cartilage

A

Superficial zone (highest cell density)
Transitional
Radiate
(Tidemark)
Calcified cartilage

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2
Q

What are the zones of the physis

A

Resting zone (primarily stem cells)
Proliferative zone (chondrocytes undergoing mitosis)
Hypertrophic zone (Chrondrocytes hypertrophy and undergo apoptosis)
Calcification/mineralization zone (Chrondrocytes secrete matrix to promote calcification, undergo apoptosis)

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3
Q

What are the steps of fracture healing?

A

Inflammation
Intramembranous ossification
Soft callus (chondrogenesis)
Hard callus (osteogenesis, endochondral ossification)
Remodeling

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4
Q

What are the components of elastic plate osteosynthesis and what is the formula for compliance?

A

Increase compliance by:
Longer working length, longer plate, smaller plate (lower ami), lower modulus of elasticity, minimal manipulation, 2-3 screws at each metaphysics, divergent screws, no tapping.

Compliance = L^3/I x E
L = functional working length
I = AMI
E = Young’s modulus of the plate material

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5
Q

Gustily-Anderson Classification (and risk of infection/delayed union)

A

I: <1 cm wound (inside out) 2%/5%
II: >1 cm wound (outside in) 10%/15%
III: open with extensive soft tissue damage 50%/40%
IIIa= adequate soft tissue coverage
IIIb= extensive loss of soft tissue/periosteum
IIIc= arterial injury

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6
Q

What are the locking mechanisms of advanced locking plate system, Fixin, SOP, polyaxial locking plate system?

A

ALPS: proximal threads lock into plate, morse taper
Fixin: Morse taper into the titanium bushings
SOP: proximal threads lock into plate, contact ridge
PAX: head threads cut path into the plate

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7
Q

How to prevent weakness at the bone-pin interface of a ESF

A

Predrill with drill bit 0.1 mm smaller than the core diameter
Saline lavage
Low speed (<300 rpm) drilling
Pins in the center of the bone
Threaded, not smooth, pins
Pins 25-30% of bone diameter

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8
Q

What are the types of nonunions and their causes?

A

Viable:
Hypertrophic: motion
Moderate hypertrophic
Oligotrophic: lack of cellular activity
Nonviable:
Dystrophic: lack of blood flow
Necrotic: infection/dead bone
Defect: critical gap
Atrophic: dead bone removed by host, no healing

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9
Q

What are Paley’s rules of ALD correction?

A

1: If ACA and osteotomy are based on the CORA –> co-linearity achieved
2. If osteotomy is not based on the CORA –> translation
3. If ACA AND osteotomy not based on CORA –> parallelism of axes with undesirable translation

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9
Q

Where can you harvest autogenous cancellous bone?

A

Proximal humerus
Ilial wing
Subtrochanteric femur
Femoral condyle
Proximomedial tibia
Caudoventral mandible
Rib

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10
Q

Scapula fracture classification

A

Type 1: body/spine/acromion
Type 2: neck
Type 3: glenoid

OR

Extra-articular stable
Extra-articular unstable
Intra-articular

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11
Q

Surgical options for medial shoulder instability

A

Biceps/supraspinatus tendon transposition
Medial GHL reconstruction
Imbrication of subscapularis tendon
Radiofrequency induced thermal modification
Excision arthroplasty
Arthrodesis

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12
Q

What is normal supination and pronation on the Campbells test and how is it performed?

A

Elbow and carpus at 90 deg.
Sup= 17-50
Pro= 31-70

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13
Q

What are the types of congenital elbow luxations?

A

Type 1: humeroradial
Type 2: humeroulnar (most common)
Type 3: combination of HR and HU

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14
Q

Treatment options for UAP

A

Excision
Lag screw/pin (PLUS ulnar osteotomy)
Ulnar osteotomy

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15
Q

Treatment options for OCD lesions

A

Palliative
Debride, lavage
Reparative
Curettage
Abrasion arthroplasty
Forage
Microfracture
Spongialization
Restorative
Fragment reattachment
Mosiacplasty
OATS autograft
Allograft
SynAcart

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16
Q

Treatment options for FMCP, which are contraindicated with lateral compartment disease?

A

Conservative/ Alternative tx
Fragment removal + Subtotal Coronoidectomy
BURP
Radius
Radial Osteotomy (CERO)
Ulna
Ulnar Osteotomy (DDUO, DPUO)
PAUL**
PURO**
Humeral
SHO**
ERHO
CUE**
Arthrodesis

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17
Q

What are the types of Monteggia fractures?

A

Type 1: cranial luxation
Type 2: caudal luxation
Type 3: lateral luxation
Type 4: cranial luxation + fracture of proximal radius

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18
Q

What are the types of accessory carpal bone fractures?

A

Type I (67%): distal + cranial (ligament to ulnar carpal bone)
Type IA (palmarolateral)
Type IB (palmaromedial)
Type II (13%): proximal + cranial (ligament to distal R/U)
Type III (3%): distal + palmar (ligament to MC III/IV)
Type IV (12%): proximal + palmar (FCU)
Type V (5%): comminuted

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19
Q

Types of metacarpal fractures that occur in Greyhounds and their treatment

A

Stress/fatigue

Type I = endosteal and cortical bone thickening, lame after race –> 3 months rest
Type II = minimally displaced hairline fractures –> 2 months of coaptation
Type III = complete fractures –> surgical fixation + coap (prognosis = guarded for return to racing)

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20
Q

What are orthopedic conditions associated with racing Greyhounds?

A

Fractures:
Central tarsal bone (right)
Accessory carpal bone fx (right)
Sesamoid fractures (2 and 7) (forelimb?)
Intermedioradialcarpal bone fx (right)
Calcaneal fracture +/- central tarsal bone (right)
3rd tarsal bone fx
Metacarpal fx (Left V or Right II)
Muscle/tendon:
Carpal collateral ligament sprains
SDF luxation
Muscle ruptures (Long head of triceps, gracilis)
Medial biceps tendon luxation
Misc:
Paw pad corns
Greyhound polyarthritis
OSA

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21
Q

What are orthopedic conditions associated with Shetland Sheepdogs?

A

SDF luxation
Plantar instability from proximal intertarsal (sub)luxation
Pes valgus
Congenital elbow lux (type I and II)
Shoulder instability
Congenital glenoid dysplasia

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22
Q

What are orthopedic conditions associated with Dachshunds?

A

Pes varus
Villonodular synovitis
Glenoid Dysplasia/ Shoulder instability
Congenital elbow luxation (Type 1)

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23
Q

What are orthopedic conditions associated with Rottweilers?

A

Sesamoid fractures
CHD
Osteochondrodysplasia
Panosteitis
OSA
Histiocytic Sarcoma
Sublingual SCC
Biceps and Supraspinatus tendinopathy (calcifying)
IOHC
Elbow dysplasia (UAP, FMCP)
(also, diabetes mellitus)

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24
What are orthopedic and neurologic conditions associated with German Shepherd?
CHD GH deficiency Gracilis Rupture Gracilis and Semitendinosis contracture Chondrocalcinosis Elbow dysplasia (FMCP, OCD, Incongruity, UAP, Flexor enthesopathy) IOHC HOD Panosteitis Craniomandibular Osteopathy OSA Medial biceps tendon luxation Congenital elbow luxation (Type 1) Diskospondylitis (Aspergillus) Degenerative Myelopathy FCE T1-T9 IVDE CES Extrarenal nephroblastoma
25
What are orthopedic and neurologic conditions associated with Weimaraners?
HOD SRMA Myelodysplasia (Dysraphism)
26
What are the guidelines for iliosacral screw placement?
1-2 Lag screws, as large as possible, 60% of sacral width Dogs: (sacral wing notch) (100 deg from transverse plane for sacral drilling) Sacrum: 60% from dorsal, 50% from cranial to C cartilage Ilium: 75% caudal length of tuber sacrale, 33% from dorsal Cats: Sacrum: 50% from dorsal, 50% from cranial Ilium: 70% caudal length of tuber sacrale, 50% from dorsal
27
Types of sacral fractures:
Type I = alar Type II = foraminal Type III = transverse Type IV = avulsion Type V = comminuted
28
Closed options for hip luxation
Conservative (walking cats) Closed reduction Ehmer or Hobbles Ischioilial pinning (Davita) ESF Transarticular pinning
29
Open options for craniodorsal hip luxation
Ischioilial pinning Transarticular pinning ESF Capsulorrhaphy +/- deep gluteal tenodesis to ilium Prosthetic capsule Greater trochanter transposition Toggle pin/rod Fascia lata loop Sacrotuberous ligament transposition Extraarticular iliofemoral suture THR TPO FHO
30
Open options for ventral hip luxation
Prosthetic capsule/toggle rod Ventral acetabular lig repair Ventral acetabular lip augmentation (autogenous ilic crest shelf graft, extracap sling, plate) (Trochanter transposition)
31
Classification of Intracapsular, Extracapsular, and Distal Femur fractures
Intracapsular: Epiphyseal Physeal (capital) Subcapital Transcervical Extracapsular: Basilar neck Intertrochanteric Subtrochanteric Distal: Supracondylar Intercondylar Condylar
32
What are extracapsular stabilization methods for CCL rupture?
Lateral fabellotibial suture TightRope SwivelLock Fibular head transposition
33
What are the grades of patellar thickening and what are the risk factors after TPLO?
Grade 0= mild, up to double of baseline Grade 1= 6-11 mm Grade 2= >12 mm Patellar tendinosis= Grade 2 + lameness + pain on palpation + ST swelling Heavier dogs, lower posts TPA, cranial osteotomy +/- partial CCL
34
Types of central bone fractures
Type 1: non displaced dorsal slab Type 2: displaced dorsal salb Type 3: medial slab Type 4: medial + dorsal slab Type 5: comminuted (most common)
35
What are the classifications for ligament injury?
First-degree (minor overstretching, but fibers intact) Second-degree (tearing of some fibers) Can be address with suture imbrication or conservative tx Third-degree (complete tearing or avulsion of the ligament, ligament nonfunctional) Only third-degree and some second-degree injuries resulting in significant joint instability warrant surgical treatment
36
What orthopedic conditions are associated with Bernese Mountain Dogs?
External metatarsal rotation Panosteitis Histiocytic Sarcoma Elbow dysplasia (Incongruity, UAP, FMCP)
37
What orthopedic conditions are associated with Dobermans?
Drug induced IMPA Panosteitis Craniomandibular Osteopathy Bone cysts OSA Synovial myxoma Congenital elbow luxation type I Carpal collateral sprains Carpal laxity syndrome Atraumatic partial CCL tears
38
What are the parts of the pes anserinus?
Sartorius, Gracilis, SemiTENdinosus
39
What are the parts of the common calcaneal tendon?
Paired gastroc tendons Gracilis/SemiTENdinosus/Biceps femorus Superficial digital flexor tendon
40
What are the basic principles of surgical arthrodesis?
Careful planning Removal of all cartilage at all sites to be fused Close apposition of the joint surfaces at a functional standing angle Rigid internal fixation using compression Use of cancellous bone graft Careful preservation of soft tissue
41
What are three buttresses of the maxilla?
Medial nasomaxillary (vertical) Lateral zygomaticomaxillary Caudal pterygomaxillary (vertical)
42
What is the normal cell count for joint fluid, and % of neutrophils?
Normal joint fluid: <2 x 10^9 cells/L, >94% mononuclear cells, <6% neutrophils.
43
What are the stages of muscle strain?
Stage I: myositis and bruising but architecture intact Stage II: myositits and some tearing of the fascial sheath Stage III: tearing of the fascial sheath, muscle fiber disruption, and hematoma formation
44
What are the options for limb-sparing surgery?
Cortical allograft (Traditional) Endoprosthesis (most common) Pasteurized autograft Vascularized ulnar transposition Lateral manus translation Microvascular transfer of the ipsilateral distal ulna Bone transport osteogenesis Irradiated autograft Stereotactic radiosurgery
45
Potential etiologies for OCD
Genetic Joint morphology/limb conformation Rapid growth/overfeeding Calcium/Vitamin d oversupplementation Microtrauma
46
Grading for OC lesions
1. Cartilage surface normal, thicken, minuscule subchondral defect 2. Cartilage surface mottled, more thick, small cleft between cartilage and bone 3. Discoid elevation of cartilage surface, large cleft, underlying sclerotic subchondral bones 4. Typical partially detached cartilage flap or separated flap and joint mice
47
Modified Outerbridge Cartilage Scores
0. Normal 1. Chondromalacia (soft, swollen) 2. Partial thickness fibrillation and fissuring 3. Full thickness fissuring 4. Full thickness cartilage erosion with subchondral bone exposure 5. Subchondral bone eburnation
48
How much strain can cortical, cancellous, fibrocartilage, and granulation tissue handle?
Cortical bone 2% Cancellous 75% Fibrocartilage 10-15% Granulation tissue 100%
49
What are the phases of secondary bone healing?
Inflammation/Hematoma Intramembranous Ossification --> sleeve of early hard callus Chrondrogenesis--> cartilage model in middle Endochondral ossification --> hard callus Remodeling --> woven to lamellar bone
50
How can you decrease locking plate strain?
Span longer length of bone Limit screw hole density to <0.5 Limit distance from bone <2mm Add IM pin
51
How can you increase locking plate stiffness?
Larger plate Additional implants Far-near-near-far 2-3 screws per segment
52
How to increased strength of a ESF
More complex frame Add diagonal bar Add fixation pins IM pin tie-in Smaller diameter rings
53
What is the weakest part of a nonlocking construct? Locking? ESF?
Nonlocking: screw-bone interface Locking: screw-plate interface ESF: pin-bone interface
54
What are the properties of bone grafts?
Osteogenesis: contains bone-forming cells Fresh autogenous cancellous graft Osteoinduction: allows for bone formation where there normally would not be (recruits stem cells and induce differentiation) Demineralized bone matrix, growth factors (BMPs) Osteoconduction: scaffold Allografts Osteopromotion: enhances regenerating bone PRP, biphasic calcium sulfate
55
What are the tests than can help diagnose biceps tendinopathy on physical exam?
Shoulder drawer test Biceps tendon test German biceps tendon test Biceps retraction test
56
Treatment options for UAP
Removal: 50% success Reattachment +PUO: <24weeks, 93% PUO: <7mo,
57
Etiologies of MCD
Incongruity Supraphysiologic loading Instability Medial Humeral Condyle kissing lesions
58
Guidelines for preventing carpal arthrodesis complications
Screws <40% of bone diameter Plate spans >50% of MC III Add IM pins Ensure proper aligment Remove adequate cartilage
59
Ways to prevent premature healing of a ulnar osteotomy
Ostectomy Ostectomy 1.5x diameter of bone Fat graft in between Removal of periosteum
60
What is the Hueter-Volkmann law?
aka Delpech's Law: physeall growth is slowed by compression and accelerated by distraction
61
What is Wolff's law?
Bones will adapt to the degree of mechanical loading,
62
Methods for ilial fracture reduction
Direct fragment manipulation with bone forceps Indirect fragment manipulation (bone forceps on the ischiatic tuberosity (requires it to be intact) Implant lever (plate applied from caudal to cranial, overcontoured) Forceps sliding maneuver
63
What are the primary and secondary stabilizers of the hip?
Primary: (Luxation with loss of 2+) Ligament of the head of the femur Joint capsule Dorsal acetabular rim Secondary: Acetabular labrum (continues ventrally as the transverse acetabular lig) Joint fluid (hydrostatic pressure) Periarticular muscles (gluteals, iliopsoas, quad femoris, gemelli, internal/external obturator)
64
Vancouver Classification for THR femur fractures
AG = greater trochanter AL = lesser trochanter B1 = stable prosthesis B2 + B3 = unstable prosthesis C = distal to the prosthesis
65
What are predisposing factors to quadriceps contracture?
Immature animals Exuberant callus Extended coaptation Muscular trauma Infection Extensive soft tissue manipulation?
66
Types of IMPA
Type I Idiopathic Type 2 Remote Infection Type 3 GI disease Type 4 Neoplasia Drug induced Nonerosive + multisystem disease SLE Breed associated (Shar Pei, Japanese Akita)
67
Types of erosive IMPA
Rheumatoid arthritis Greyhound polyarthritis Periosteal proliferative polyarthritis in cats

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