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CVNT2 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

what are the non-surgical management methods for fracture fixation?

A

external coaptation

conservative

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2
Q

what are the surgical management methods for fracture fixation?

A

pin and wire
external skeletal fixation
plate and screw

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3
Q

what are the principles of fracture fixation?

A

return the patient to normal function as soon as possible

create circumstances which allow bone healing to be optimal

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4
Q

what are the potential advantages of non-surgical management?

A

reduce/avoid anaesthesia

avoid need for open surgical approach

cheaper materials

cheaper overall? (may end in surgery anyway)

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5
Q

what are the potential disadvantages of non-surgical management?

A

fracture disease
insufficient stability, leading to delayed/non-union
malunion
cast sores, ischaemia

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6
Q

what are the principles of conservative fracture management?

A

surrounding soft tissue provides sufficient stability to keep bones aligned whilst healing

minimise movement whilst healing - restrict exercise, prevent weight-bearing

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7
Q

which fractures are suitable for conservative management?

A

selected fractures of pelvis, scapula or vertebra

stable, minimally displaced fractures

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8
Q

how long do fractures typically take to heal with conservative management?

A

4-6 weeks

possibly less in younger animals

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9
Q

what can be used to prevent weight bearing on scapular fractures?

A

carpal flexion bandage

velpeau sling

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10
Q

what information needs to be given to owners of animals undergoing conservative fracture management?

A 
cage size and contents
prevention of boredom
nursing care 
decubitus ulcer prevention 
provide non-slip rugs and ramps
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11
Q

what is external coaptation?

A

compressive forces transmitted to bones by means of interposed soft tissues

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12
Q

which joints must be immobilised in external coaptation?

A

immobilise joint above and below fracture

this principle extends to all joints distal to the fracture to avoid foot swelling

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13
Q

which fractures are suitable for coaptation?

A

fractures distal to elbow or stifle

stable fractures

50% overlap of fracture fragments on orthogonal radiographs

fracture of one bone of a 2 bone segment (e.g. radius and ulna)

2 or fewer metatarsal/metacarpal fractures

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14
Q

what is the first layer of a cast?

A

‘stockinette’
double layer, long enough for overlap top and bottom
hold taut so doesn’t ruck up

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15
Q

what is the second layer of cast?

A 
primary layer - soffban 
water-repellant, conformable bandage 
1-2 50% overlap layers 
not too much padding over bony prominences 
allow excess top and bottom for overlap
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16
Q

what is the third layer of cast?

A

cast material - fibreglass impregnated polyurethane

lightweight, comfortable, waterproof, radiolucent, fast setting

wear gloves!

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17
Q

how do you apply the cast material?

A

immerse in water and squeeze 6 times
apply under a little tension
average of 6 layers (3 up and downs) - more at bends
avoid wrinkles

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18
Q

what should you do once the cast material has set? why?

A

bivalve using a cast saw while dog still sedated/under GA

for ease of removal if problems or if another vet does not have a cast saw

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19
Q

what should you do with the cast once it has been bivalved?

A

secure it firmly using strips of non-stretchy tape (zinc oxide tape)

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20
Q

how do you protect against sharp ends of cast?

A

fold over sofban and stockinette - apply extra padding as necessary to avoid sharp edges

reinforce foot area with extra tape (wears through)

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21
Q

what is the final layer of cast?

A

outer protective layer - vetrap (cohesive bandage)

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22
Q

what final check should be done once the cast is in place?

A

make sure toenails and central pads are visible but not protruding

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23
Q

why is the complication rate of external coaptation high?

A

inappropriate case selection
owner compliance
difficulties in management

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24
Q

what is the most common complication of external coapation?

A

soft tissue injury - ischaemic injury

mild dermatitis to avascular necrosis

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25
Q

what structural complications can arise from external coaptation?

A

may heal with rotation, angulation and/or shortening

may be functional or non-functional depending on degree/severity

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26
Q

how does fracture disease occur?

A

occurs during the time necessary for the bone to heal and is a result of fracture management

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27
Q

what can result from fracture disease?

A

joint stiffness
muscle atrophy
osteoporosis
muscle contracture and fibrosis

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28
Q

how can fracture disease be avoided?

A

aim for a rapid return to weight-bearing

avoid unnecessary immobilisation of joints by external coaptation

consider other options that cause less fracture disease e.g. ESF or internal fixation

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29
Q

what is the nurses role in surgical fracture repair?

A

analgesia provision and patient care prior to surgery
aseptic surgical prep
equipment gathering and setup for theatre
trolley assistant for surgery
post-operative care of the patient
discharging patient to owner

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30
Q

what trolley setup can make fracture surgery easier?

A

tidy instruments with handles all in same direction
separate tray for sharps
needles separate
commonly used instruments in separate tray

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31
Q

what type of drape is used in fracture surgery?

A

adhesive drape (opsite/loban)

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32
Q

is the foot clipped for fracture surgery?

A

only if directly involved in surgery - must always be covered regardless

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33
Q

what is fracture reduction?

A

the process of replacing the fracture segments in their original anatomical position

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34
Q

which injuries are suitable for closed fracture reduction?

A

recent/stable fractures

lower limb fractures - less soft tissue, easier to reduce and palpate

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35
Q

which methods are used for closed fracture reduction?

A

traction and counter-traction
manipulation
bending

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36
Q

what is the main barrier in open fracture reduction?

A

overcoming muscle contraction

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37
Q

h

A
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38
Q

how can we overcome muscle contraction during open fracture reduction?

A

levers (Hohmann retractors)
bone holders
muscle relaxants

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39
Q

why aren’t muscle relaxants always used to overcome muscle contraction?

A

often don’t respond well as the tissue is inflamed

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40
Q

what is toggling?

A

bending the fracture 180° to engage the ends, then straightening the limb in order to position the bone straight for stabilisation

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41
Q

which fractures are suitable for toggling?

A

transverse fractures

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42
Q

what types of implants are used in fracture repair?

A 
pins 
wire 
screws 
external skeletal fixation 
plate and screws
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43
Q

can intramedullary pins be used alone?

A

rarely - do not prevent rotation at the fracture site

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44
Q

what are intramedullary pins often combined with?

A

plate or ESF

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45
Q

when are intramedullary pins used alone?

A

metacarpal/metatarsal repair - splinted by other bones

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46
Q

what are the complications with using intramedullary pins?

A

length - too long/short and won’t stabilise fracture effectively + difficult to retrieve
too long will result in seroma formation

loosening and migration

fracture non-union

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47
Q

what is an interlocking nail? why is it used?

A

stainless steel pin used as intramedullary pin - locked in place using screws/bolts
prevents rotation and axial collapse

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48
Q

what materials are bone plates/screws made out of?

A

stainless steel or titanium alloy

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49
Q

what is the function of bone plates?

A

compression of bone fragments

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50
Q

what is the effect of bone compression?

A

friction - increases stability
primary bone healing
load-sharing between bone and implants

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51
Q

what is bridging fixation?

A

plate is used to shore up/support fragments in unreconstructable fractures
uses a larger plate

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52
Q

what are the different uses for bone screws?

A

combination with a plate or interlocking nail

used in isolation for fractures of cancellous bone (never for diaphyseal)

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53
Q

why aren’t bone screws ever used in isolation for diaphyseal fractures?

A

slower healing and greater forces through bone

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54
Q

what different types of bone screws are there?

A

locking screws
self tapping
non-self tapping

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55
Q

what are the functions of a bone screw?

A

secure a plate to a bone to support a fracture during healing

to compress fragments together in lag fashion to enable rapid healing without a callus

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56
Q

where is it important to avoid callus formation?

A

in fractures close to a joint

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57
Q

how should you treat an articular fracture?

A

open reduction and internal fixation
compression
perfect reduction
maintenance of joint mobility

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58
Q

when are smooth bone pins used?

A

rarely as don’t hold bone well

sometimes used if very small pin required

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59
Q

what types of threaded pins are there?

A

negative (Ellis) or positive (Imex) profile

end threaded (positive or negative)

centrally threaded (positive only)

interface pins (roughened to help stick to putty)

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60
Q

when is putty used?

A

to replace bars and clamps

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61
Q

what is the advantage of using stainless steel/carbon connecting bars?

A

reusable

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62
Q

what are the disadvantages of using stainless steel/carbon connecting bars?

A

heavy (carbon light)

all clamps need to be in a straight line

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63
Q

what are the advantages of using acrylic/putty?

A

light
no limit to pin size/closeness
no protruding pin ends which might irritate

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64
Q

what is the disadvantage of using acrylic/putty?

A

removal is more difficult

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65
Q

what are clamps used for?

A

connecting pins to bars

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66
Q

what are the advantages of using clamps?

A

reusable if not deformed

makes adjustments and pin removal easier

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67
Q

what are the disadvantages of using clamps?

A

limit to pin and bar size

need to be constructed correctly

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68
Q

what is a tied-in IM pin?

A

the IM pin is left long and connected to the ESF via a separate connecting bar or by bending the bar

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69
Q

what is the advantage of using a tied in IM pin?

A

IM pin can’t migrate/loosen - increases stability of the whole structure

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70
Q

which bones are prone to avulsion fractures?

A 
olecranon 
greater trochanter 
medial malleolus 
acromion of scapula 
os calcaneus 
tibial tuberosity
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71
Q

what is the tension band wire principle?

A

active distracting forces are counteracted and converted into compressive forces

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72
Q

what is the role of the surgical assistant during fracture repair surgery?

A

managing the surgical table and passing instruments correctly

assisting with surgical retraction and haemostasis

ensuring that diagnostic samples are not lost and transferred appropriately to sample pots

keeping bone graft safe and reminding the surgeon to use it

keeping count of surgical swabs

running a continuous suture and cutting sutures

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73
Q

how should you pass instruments to the surgeon?

A

in a decisive manner

tip of instrument visible and handles placed in surgeons waiting hand in proper position for use

don’t reach behind a member of the sterile team

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74
Q

what should be carried out post-op?

A

post-op x-rays

discussion of physio

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75
Q

what information should be given to the owners post-op?

A

cage rest information

timeframe of when weight-bearing should occur

suture removal information

buster collar info

prognosis

warn about possibility of premature closure of growth plate in young animals

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76
Q

what complications might occur post-op?

A

fracture instability
loosening
breakage
delayed or non-union

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77
Q

what should owners be looking out for post-op?

A 
lameness
change in limb use 
change in shape 
swelling 
discharge
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78
Q

what is the purpose of orthopaedic first aid?

A

to minimise injury and future disability

to keep the patient alive in serious cases

79
Q

what are the 3 aims of orthopaedic first aid?

A

preserve life
prevent suffering
prevent deterioration

80
Q

what is triage of the trauma patient?

A

a methodical initial assessment to rapidly identify the major life threatening injuries

81
Q

what do we check in triage of the trauma patient?

A 
airway 
breathing
circulation 
external haemorrhage 
CNS function
82
Q

what possible oral/skull reasons could there be for a patient having difficulty breathing following trauma

A

head trauma/fractures (skull, maxillary)
blood clots
ruptured trachea

83
Q

how do you assess the airway during the primary survey/what are we checking for?

A 
check mouth for obstruction (blood clot, foreign body) 
nostril blockages 
tongue swollen/lacerated 
hard palate split 
swelling around larynx
84
Q

how do we check breathing during the primary survey?

A

breathing rate/effort/adequacy

85
Q

what might have occurred if a cat has blood around nose, excess saliva, and inability to close the mouth

A

fractured jaw

86
Q

how can we check circulation during the primary survey?

A 
mm colour 
CRT 
heart/pulse rates, pulse quality 
rectal temperature 
peripheral pulses and temperature
87
Q

what are the symptoms of mild shock?

A

mild tachycardia and tachypnoea
darker pink mm
CRT <1 second
normal mentation and BP

88
Q

what are the signs of early decompensated shock?

A 
tachycardia and tachypnoea 
pale mm
slow CRT 
weak pulse 
poor mentation 
hypotension
89
Q

what what point of shock should we give the patient fluids?

A

early decompensated

90
Q

what are the signs of late decompensated shock?

A 
bradycardia 
absent CRT 
severe hypotension 
cheyne stokes breathing 
death
91
Q

when should we assume RTA patients have severe injury?

A

until proven otherwise

92
Q

how should we transport recumbent RTA patients?

A

on an improvised stretcher

93
Q

what is a secondary survey?

A

thorough check of body systems if primary survey ok/patient stabilised

94
Q

what does A CRASH PLAN stand for?

A

A - airway - nose/larynx/neck/thoracic inlet

C- cardiovascular (CRT, pulse, BP) 
R - respiratory (chest wall, lungs) 
A - abdomen (diaphragm, inguinal, flank, paracostal) 
S - spine 
H - head (eyes/ears/mouth/teeth/tongue)

P - pelvis (rectum, perineum, scrotum, vulva)
L - limbs
A - arteries and veins
N - nerves (cranial and peripheral)

95
Q

when is the secondary survey performed?

A

only after successful resuscitation and stabilisation of life-threatening injuries is the history taken and the thorough physical examination performed

96
Q

what are the main signs of orthopaedic injury?

A

recumbency/severe lameness

limb wounds with pain/swelling

deformity

abnormal mobility/instability of limb

crepitation (due to bone-bone contact)

97
Q

what is a luxation?

A

dislocation

complete disruption of normal relationship between articular surfaces of a joint

98
Q

what are the major types of orthopaedic injury?

A

fractures
luxations
subluxations
wounds penetrating joints

tendon lacerations/avulsions
ligament strains
muscle lacerations
(all soft tissue injuries)

99
Q

what is a fracture?

A

a disruption in the cortical continuity of a bone - can be complete or incomplete

100
Q

what is an incomplete fracture?

A

not across full bone, only one cortex affected

seen in young animals due to flexibility of bone

101
Q

what is sub-luxation?

A

partial disruption of relationship between articular surfaces of a joint

102
Q

why is water soluble jelly used in management of open contaminated wounds?

A

to protect wound and prevent hair falling in while clipping

103
Q

which order should be used in management of open contaminated wounds?

A 
give analgesia and antibiotics therapy ASAP 
apply water soluble jelly 
clip 
flush 
debride 
bandage
104
Q

what equipment is required for management of open contaminated wounds?

A 
water soluble jelly 
clippers 
fluids for flush 
scalpel to debride necrotic tissue 
bandage for stabilisation
105
Q

what is involved in first aid for open fractures/luxations?

A

treat as for laceration
apply sterile hydrogel to exposed articular cartilage and/or bone
support dress the injured limb, attempting to restore normal anatomy

106
Q

should patients undergoing orthopaedic first aid be cage confined?

A

yes - unless only minor injuries

confinement will help prevent further injury through restricting movement

107
Q

can we attempt to reduce luxations/fractures in the conscious patient?

A

no - too painful

108
Q

can we attempt to stabilise proximal limb injuries in the conscious patient?

A

no - only below stifle/elbow

not possible with external coaptation, must be internal repair

109
Q

why is it not possible to stabilise proximal limb injuries with external coaptation?

A

muscle will stabilise these joints

difficult to support joints above and below

110
Q

what are orthogonal radiograph views?

A

views at 90° to each other

111
Q

what else can be done while the patient is under GA for radiography?

A

wound care
splint/bandage application
reduction of luxation/fracture (if simple transverse fracture)

112
Q

when might it be possible to support dress a limb in reduction/near reduction?

A

some distal injuries with torn ligaments and tissues resulting in marked laxity

113
Q

how can you dress unstable fractures to support them?

A

use soft padding, then splinting material

then conform and outer protective layer

114
Q

what splinting materials are available?

A

fibreglass resin - activated by water (5 min to harden)

orthoboard - plasticised cardboard, mould in hot water

thermoplastic - heat in water/use heat gun

plaster of paris - activated by water (long time to set)

115
Q

what are the 4 layers of bandaging?

A

dressing - wet to dry/cotton wool (melolin/absorban)
sofban (water repellent)/swabs
conforming layer
vet wrap

116
Q

what are the functions of a bandage?

A

protection
support for fracture/luxation/pre and post-surgery
pressure (haemostasis/swelling control)
immobilisation

117
Q

where are support dressings useful in first aid?

A

stabilisation of distal limb only - support joint proximal and distal to injury

118
Q

what are some of the different shapes of splint?

A

green gutter
tongue depressor
custom made splint using cast material

119
Q

what does a robert jones bandage achieve?

A

immobilisation of fracture/luxation
control swelling and oedema
comfort

120
Q

how do we provide first aid for bleeding?

A

treat as for laceration
apply a sterile contact layer, then generous padding using an absorbent layer (cotton robert jones)
apply pressure 30 mins-1hour for arterial bleed

121
Q

what is hip dysplasia?

A

a developmental disease where laxity develops in the joint capsule, which allows hips to subluxate

122
Q

what is the aetiology of hip dysplasia?

A

combo of genetics, size (larger breeds), diet, exercise

123
Q

what is the common signalment associated with hip dysplasia?

A

mainly affects large/giant breed dogs (can affect small breeds and cats)

124
Q

how does hip dysplasia manifest in young dogs (4-12 months)?

A

laxity

125
Q

how does hip dysplasia manifest in adult dogs?

A

osteoarthritis

126
Q

what can be seen with gait analysis of an animal with hip dysplasia?

A

short strides, stiffness, clunking of hips

lateral swaying

bunny hopping

adducted hindlimbs

127
Q

what can be seen on orthopaedic examination of an animal with hip dysplasia?

A

pain on hip extension
clunking
hindlimb muscle atrophy
crepitus

128
Q

what can be seen on an x-ray of an animal with hip dysplasia?

A

hip subluxation
acetabular remodelling
osteophytes

129
Q

what x-ray position should be used for suspected hip dysplasia?

A

ventrodorsal extended - very important for hips to be straight

130
Q

which test can be used to confirm hip dysplasia?

A

ortolani test (test of hip laxity) - dog in dorsal/lateral recumbency and stifles rotated outwards

will be negative if normal or just dislocated hip

131
Q

what are the non-surgical treatment options for hip dysplasia?

A

osteoarthritis management - NSAIDs, rest, hydrotherapy, diet

132
Q

what are the surgical treatment options for hip dysplasia?

A

juvenile pubic symphysiodesis (young dogs)
triple/double pelvic osteotomy (young dogs)

total hip replacement
femoral head and neck excision

133
Q

what is avascular necrosis of the femoral head?

A

lack of blood supply to the femoral head, causes tissue death

134
Q

what is the aetiopathogenesis of avascular necrosis of the femoral head?

A

trauma
ischaemia
small breed disposition
inherited basis with an autosomal inherited gene

135
Q

what are the clinical signs of avascular necrosis of the femoral head?

A

unilateral hindlimb lameness
pain on hip extension and flexion
muscle wastage

136
Q

what will be seen on a radiograph of a dog with avascular necrosis of the femoral head?

A

lucent areas initially

collapse and mushrooming of the femoral head as disease progresses

137
Q

how can avascular necrosis of the femoral head be treated?

A

surgery - femoral head and neck excision; total hip replacement

conservative - cage rest

138
Q

what is the prognosis for avascular necrosis of the femoral head?

A

guarded - usually requires salvage surgery

139
Q

what is slipped capital femoral epiphysis?

A

damaged growth plate resulting in separation of the femoral head from the femoral neck

140
Q

what are the clinical signs of slipped capital femoral epiphysis?

A

lameness and hip pain

atraumatic - often not acute onset of lameness

141
Q

which animals are more likely to be affected by slipped capital femoral epiphysis?

A

young, male, neutered cats (<2 years), overweight/large breed

142
Q

why does castration influence development of slipped capital femoral epiphysis?

A

castration delays growth plate fusion

143
Q

what radiographic changes are seen with slipped capital femoral epiphysis?

A

radiolucent line at capital physis

separation/movement between femoral head and femoral neck

resorbtion of femoral neck

144
Q

what is the treatment for slipped capital femoral epiphysis?

A

salvage surgery -
femoral head and neck excision
total hip replacement
parallel pin

145
Q

what is the prognosis for slipped capital femoral epiphysis allowed to head spontaneously?

A

guarded for healing - usually do not heal and surgery is required

146
Q

what is the pathogenesis of hip luxation?

A

usually traumatic (RTA, fall)

147
Q

what is the aetiology of hip luxation?

A

can be seen spontaneously in dogs with hip dysplasia

148
Q

how is the gait altered in dogs with hip luxation?

A

sudden onset lameness
stifle out, hock in and leg adducted
dislocated leg appears shorter

149
Q

which direction does hip luxation usually occur in?

A

craniodorsally

150
Q

what are the clinical signs of hip luxation?

A

variable lameness/pain/crepitus

palpation of landmarks (greater trochanter in line with iliac crest/tuber ischii)

‘shorter’ limb length

thumb displacement test

151
Q

how do you carry out the thumb displacement test for hip luxation?

A

place thumb between tuber ischii and greater trochanter - with dislocation, thumb will stay in notch with manipulation

152
Q

why are radiographs/CT scans essential for diagnosis of hip luxation?

A

physical examination and clinical signs can be complicated by the presence of fractures of the pelvis and proximal femur

153
Q

which factors affect the method of treatment for hip luxation?

A

presence of pre-existing disease (hip dysplasia)
duration of luxation
concurrent orthopaedic injuries

154
Q

what are the management options for hip luxation?

A

closed reduction +/- stabilisation
open reduction
salvage surgery

155
Q

what is closed reduction of hip luxation?

A

manual manipulation of the femoral head back into the acetabulum

156
Q

when should closed reduction of hip luxation never be attempted?

A

if:
acetabular/femoral head fractures

chronic luxations/hip dysplasia

other injuries e.g. pelvic fractures preventing reduction

evaluation of the cartilage is needed

157
Q

what is the technique for closed reduction of hip luxation?

A

–Animal anaesthetised
–Assistant needed to hold on to dog or may be pulled off table
–Extend, adduct and externally rotate limb to lift femoral head over dorsal acetabular rim
–Then abduct and internally rotate to sit femoral head into the acetabulum
–Confirm reduction with two orthogonal xrays
–Ehmer sling or cage rest post reduction

158
Q

what are the methods involved in open reduction of hip luxation?

A 
iliofemoral suture (common)
toggle 
transarticular pin 
prosthetic capsular repair 
primary capsular repair
159
Q

what is the prognosis for hip luxation?

A

good in 75% of cases
OA will form eventually
recurrent dislocation possible

160
Q

what is patella luxation?

A

displacement of the patella from its groove in the distal femur

161
Q

which way does the patella usually luxate?

A

medially

162
Q

is patella luxation usually unilateral or bilateral?

A

bilateral

163
Q

which animals are more likely to develop patella luxation?

A

common in small breed dogs
lateral luxation in large breed dogs
can occur in cats

164
Q

what is the aetiology of patella luxation?

A

most cases are developmental and appear when young - possibly hereditary

occasionally atraumatic

165
Q

how is the gait altered with patella luxation?

A

may avoid flexing or extending the stifle

appears to walk in ‘cowboy’ stance with stifles flexed and a wide based stance

166
Q

what is usually found with clinical examination of patella luxation?

A

stifle discomfort
patella clicks on manipulation of stifle
stifle in extension - look for patella laxity

167
Q

what is a grade I patella luxation?

A

Patella normally within the groove

Returns spontaneously when luxated manually

168
Q

what is a grade II patella luxation?

A

Patella normally within the groove

Can be luxated and will remain so when released

169
Q

what is grade III patella luxation?

A

Patella normally outside the groove

Can be manipulated back into the groove

170
Q

what is grade IV patella luxation?

A

Patella normally outside the groove

Cannot be reduced by manipulation

171
Q

what is the most common grade of patella luxation?

A

grade II

172
Q

how is patella luxation treated?

A

tibial tuberosity transposition - realigns the tibial tuberosity and the quadriceps line of pull with the groove

173
Q

what is involved in post-op care for patella luxation?

A

consider support dressing

multimodal analgesia

strict rest initially, gradual increase in exercise after 6 weeks

174
Q

what is the prognosis for patella luxation?

A

deteriorates with increasing grade of luxation
90-95% success in small dogs
significantly higher risk of failure in larger dogs (>20kg)

175
Q

what is the most common cause of hindlimb lameness in dogs?

A

cranial cruciate ligament disease (CCLD)

176
Q

what are the functions of the cranial cruciate ligament?

A

limit cranial drawer
limit hyperextension
limit internal rotation

177
Q

what are the causes of cranial cruciate ligament disease?

A

degeneration of the ligament (common)
inflammatory arthropathy
growth abnormality (tibial plateau angle)
major trauma (uncommon)

178
Q

which dogs are most likely to develop cranial cruciate ligament disease?

A

young (6m-3y)

large breeds

179
Q

what percentage of cranial cruciate ligament disease occurs bilaterally?

A

30-50%

180
Q

what are the 2 bands of the cranial cruciate ligament?

A

caudolateral - only tight in extension

craniomedial - always tight

181
Q

which band of the cranial cruciate ligament is more susceptible to partial tears?

A

craniomedial band

182
Q

how is cranial cruciate ligament disease diagnosed?

A

gait analysis

physical examination - stifle pain, effusion, crepitus, medial buttress, instability

183
Q

what are the 2 tests used to assess instability in cranial cruciate ligament disease?

A

cranial drawer test

tibial thrust

184
Q

what are the drawbacks of the cranial drawer test?

A

can be painful

can be resisted in the conscious animal

185
Q

what is the tibial thrust test?

A

applying pressure at the level of the hock in order to test for tibial movement against the femur

186
Q

how is cranial cruciate ligament disease diagnosed?

A

straightforward cases - signalment, instability tests, painful stifle, effusion

187
Q

how are problem cases of cranial cruciate ligament disease diagnosed?

A

if not DJD on radiograph or effusion
possibly partial rupture but other arthropathies are possible
consider arthrocentesis

188
Q

how is cranial cruciate ligament disease treated?

A

conservative treatment

surgical - intra/extra-articular replacements (fabello-tibial sutures)
OR corrective osteotomy (TPLO)

189
Q

what are the post-op considerations for cranial cruciate ligament disease?

A

opioids for 24-48 hours, NSAIDs for 10-14 days

physiotherapy is important and beneficial to recovery

must make owners aware that surgery is not a cure, only slows progression of arthritis - joint will never be normal again

190
Q

what is the prognosis for cranial cruciate ligament disease?

A

complication and success rates similar between techniques
most effective is osteotomy procedures
‘over the top’ is least effective
full recovery can take several months

191
Q

how often does cranial cruciate ligament disease also result in meniscal tearing?

A

50%

192
Q

how are meniscal tears treated?

A

must perform arthrotomy during surgery - debride torn portion and leave unaffected meniscus

193
Q

which meniscus usually tears with cranial cruciate ligament disease?

A

usually medial meniscus

CVNT2 (47 decks)

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