Ortho 2 Flashcards
3 components of initial diagnostics (before imaging) for ortho issue
PE, gait analysis, ortho exam
lab is BCS 8/9, lame worsening with exercise, loss of muscle mass in left thigh, medial buttress + effusion + pain + crepitation of left stifle. positive cranial drawer and positive tibial thrust, meniscal click. top ddx?
cranial cruciate disease, complete CCLR
compare and contrast partial vs complete CCLR
complete tear: acute initial NWB lameness that worsens with exercise, obvious instability on testing, progressive OA within weeks, medial buttress forms over time, and positive cranial drawer and tibial thrust.
partial tear: acute, intermittent, PWB, worse when rising from rest and may resolve with rest but often recurs with activity, often not lame during exercise, subtle instability, resents testing of CCL, and positive cranial drawer in flexion but negative in extension, positive tibial thrust
both have joint effusion
what additional diagnostics (after PE, ortho exam, gait analysis) do you perform when you suspect CCLR?
radiographs to confirm dx, rule out other causes of lameness, and surgical planning
serum chemistry
describe “conservative” medical mgmt for cranial cruciate disease
weight loss!!, exercise modifications, pain mgmt, and structure modifying treatment and nutraceuticals
all dogs should get medical mgmt even if they don’t get sx
what is the gold standard treatment for cranial cruciate insufficiency
surgical mgmt that includes evaluation and tx of meniscus
either extracapsular techniques or osteotomies/ostectomies (latter provides best long term outcomes)
which provides best long-term outcomes for cranial cruciate insufficiency, extracapsular techniques or osteotomies/ostectomies?
osteotomies/ostectomies
describe key features of extracapsular techniques for CCLR, including what treatment depends on and size of dog it is used for
provides dynamic and static stability by stimulating CCL from outside the joint
process: lateral fabellotibial suture, tightrope, orthostay, fibular head transposition
depends on development of PERIARTICULAR FIBROSIS
NOT good for larger dogs
describe key features of osteotomies./ostectomies for CCLR, including what treatment depends on and size of dog it is used for
provide dynamic stability by eliminating shearing techniques and thus thrust
TPLO, TTA, CCW, CBLO
suitable for virtually ALL SIZES of dogs and is the best choice for large dogs and (likely) many smaller breeds
4 y/o MC small mixed breed with chronic lameness of left pelvic limb, worsening over last 3 weeks, fails sit test and skipping gait. loss of muscle mass in left thigh, no buttress, milk effusion of left stifle, medial patellar luxation, and cranial tibial drawer in flexion but not extension. top ddx?
medial patellar luxation (partial CCLR is possibly present also)
etiology: which breeds get developmental medial patellar luxations?
toy, mini, and large breed dogs and cats
etiology: which breeds get developmental lateral patellar luxations?
toy and mini dogs
etiology: which breeds get developmental lateral patellar luxations (genu valgum)
large and giant breed dogs
etiology: which breeds get traumatic medial or lateral patellar luxations?
any dog or cat
what is the basic problem of a patellar luxation
“fundamental misalignment of the extensor mechanism” of stifle
explain basic pathogenesis of patellar luxation
explained: twist and torsion of tibia outwards flares out the distal femur (bc force is slightly medial, rather than a straight line down the leg). muscles, patella, and patellar ligament are misaligned, causing bony abnormalities to accommodate that misalignment due to patella being out of place
name the abnormalities associated with patellar luxation
coxa vara, distal femoral varus, shallow trochlear groove with poorly developed medial ridge, hypoplastic medial femoral condyle, medial torsion of tib tub, proximal tub valves, internal torsion of foot
describe 4 grades of patellar luxation
grade 1: patella is in trochlear ridge (slightly misaligned), spontaneously reduces in when you luxate it out
2: in, you can luxate out and it stays out
3, out, can be reduced in
4: out and cannot be reduced in bc there is no trochlear ridge
“in in, in out, out in, out out”
do you need to treat CCLR in face of patellar luxation
yes, it is uncomfortable. nnec to do sx though
you have a positive cranial drawer test in flexion but not extension. what does this mean?
you have a partial CCLR
you have a positive cranial drawer test and positive tibial thrust test. what does this mean
complete CCLR
________ is a common sequelae to patellar luxation
CCLR
radiographic evidence of CCLR is _____ but radiographic evidence of OA is _______
high; limited
treatment for patellar luxation depends on what combination of signs?
instability in both directions, presence of crepitus, degree of tin tub rotation, limb torsion of angulation, location o reduced patella (Alta, too high, or Baja too low), inability to extent limb to norma, standing angle, presence or absence of drawer movement
what kind of patellar luxation procedure is RARELY used alone, and its purpose is to release contracted tissues on side of luxation while tightening loos tissue on opposite side?
soft tissue procedures
what 2 types of trochlear groove reconstruction procedures are used in young animals for patellar luxation?
sulcoplasty and chondroplasty
what 2 types of trochlear groove reconstruction procedures are used in mature animals for patellar luxation?
wedge recession trochleoplasty and block recession trocheoplasty
what are the two basic types of procedures involving bone are used for patellar luxation
(trochlear) groove reconstruction procedures and limb alignment procedures
what are 3 types of limb alignment procedures used for patellar luxation
fabellotibial antirational procedure, tib tub transposition, and distal femoral osteotomy
