Orthopaedics Flashcards
what is included in history for equine lameness workup?
signalment use of horse length of ownership exercise feeding shoeing housing previous conditions limbs affected onset and progression of signs previous treatment
what are aims of equine workups in horses?
determine if lame or sound identify limbs affected score lameness identify source and cause treatment decision
what are the stages of equine lameness workup?
clinical exam body condition assessment of limbs weight bearing posture swellings focused MSK exam gait evaluation flexion tests exam of affected limb nerve blocks imaging
what are parts of the specific MSK exam of equine lameness workup?
inspection
palpation
manipulation
what PPE is needed for working with horses?
hard hat
steel toe cap boots
gloves
overalls
how is horses gait evaluated?
identify abnormalities potential causes degree of lameness affected limb walking and trotting up lunging
describe how to recognise forelimb lameness in horses
assessed when horse walking towards
head non with head up as lame leg hits ground
describe how to recognise hindlimb lameness in horses
assess walking away
hip of lame limb rises and falls with greater range of motion
what is the purpose of grading lameness?
assess improvement or regression
what is lameness locator?
sensors on horse help identify lame limb
what can be observed to help identify lameness in horses?
length of strides
arc and path of foot flight
foot placement
what are uses of flexion tests in horses?
demonstrate and exacerbate mild lameness
localise lameness
describe horse flexion test
limb held flexed for 1 minute
trotted away as soon as limb released
observe for lameness with few lame strides normal
state limitations of horse flexion tests
hard to flex only one joint so lack of specificity
can have false results
inconsistent results
why can lunging help determine lameness?
inside leg lameness worse on circle
hard ground makes worse
what are considerations when lunging horses?
PPE
does horse lunge well
location
what is the purpose of nerve blocking to test for lameness in horses?
identify area of lameness by blocking distal to proximal
describe how nerve blocks are performed in horses
clean with chlorhex and spirit
place blocks medial and lateral
leave for 10 minutes then trop up looking for improvement
what nerve and joint blocks are performed in horses?
nerve- palmer/planter digital, abaxial sesamoid, low point 4
joint- intrasynovial
when is imaging done for equine lameness?
area of lameness already identified to interpret clinical findings
what is seen on radiographs for assessing lameness in horses?
bony changes
what can ultrasounds show regarding equine lameness?
tendon and ligament changes
lesions
peritendinous fluid in tendon sheaths
what is arthroscopy used for in equine lameness investigation?
direct visualisation of joint cavities including articular cartilage, synovial membrane, menisci
how does CT and MRI benefit equine lameness investigation?
cross sectional imaging of complex structures
how is nuclear scintigraphy used for equine lameness investigations?
substance injected IV taken up to bone with higher uptake in areas of high turnover
emits gamma radiation to show areas of injury
what is equine synovial sepsis?
bacterial contamination of synovial structure
what happens if equine synovial sepsis is untreated?
septic arthritis
chronic lameness
describe investigations for equine synovial sepsis
synoviocentesis
analysis of synovial fluid
contrast radiography
what are roles of nurses for arthrocentesis?
prep site
non-sterile assistant
prepare equipment
monitor for lameness for 2 days after
what equipment is needed for arthrocentesis?
needles
syringes
sterile gloves
collection tubes
what is looked at in arthrocentesis samples?
cytology
protein concentration
lactate
culture
define laminitis
inflammation of lamella in hoof
what is the effect of laminitis?
dermal and epidermal separation
rotation or sinking of P3
describe the phases of laminitis
developmental between trigger and clinical signs
acute onset of clinical signs for 72 hours
subacute from 72 hours
chronic structural failure
list clinical signs of laminitis
pottery gait bounding digital pulses leaning on heels recumbency struggling to turn reluctance to pick up feet as usually bilateral
what are causes of laminitis?
PPID EMS excess carbohydrates endotoxemia corticosteroids not fully understood excess weight bearing on one limb due to disease in other limb
what is the likely cause of laminitis due to endocrinopathies?
hyperinsulinemia
insulin toxicity
list risk factors for laminitis?
history of laminitis obesity endocrinopathies season native ponies excess carbs
how is developmental laminitis managed?
intervene before clinical signs if at risk cold therapy to reduce perfusion NSAIDs frog supports deep shavings bed long term management
how is acute laminitis managed?
strict box rest deep shavings bed frog supports NSAIDs treat underlying cause reduce carbs if endocrine related
how is sub acute laminitis managed?
gradually withdraw treatment when improving
strict box rest
how is chronic laminitis managed?
shortening toe over time
remedial shoeing
how can radiography assess laminitis?
measure rotation and sinking
how can you try to prevent laminitis?
control risk factors treat endocrinopathies exercise when possible to increase insulin sensitivity keep ideal BCS reduced carbs restricted grazing
what is box rest for horses?
stabling in confined space no exercise or turnout monitor faecal output check for colic monitor behaviour gradually turnout and introduce exercise
what are GI considerations for box resting?
management changes can cause colic
reduced exercise can cause reduced gut motility
ulcers caused from reduced eating times
what are behavioural considerations for box resting?
stereotypies
stable mates if possible
increased energy
define first aid
emergency care given immediately to injured individual
what is the purpose of first aid?
minimise injury and future disability
keep victim alive
prevent suffering and deterioration
why do you need to assume life threatening injury in trauma patients?
most from RTA
likely have thoracic or abdominal injury
what is the purpose of primary survey for trauma patients?
identify and treat life threatening injury
what is assessed in primary survey?
airway patency breathing rate, effort circulation, MM, CRT, HR, temperature external haemorrhage CNS shock
what are the stages of shock?
compensated
early decompensated
late decompensated
list signs of compensated shock
tachycardia tachypnoea CRT less than 1 second normal mentation normal BP
list signs of early decompensated shock
tachycardia tachypnoea pale MM slow CRT weak pulse poor mentation hypotension peripheral vasoconstriction
list signs of decompensated shock
bradycardia
absent CRT
cheyne stokes breathing
death
when is secondary survey carried out in trauma patients?
after successful resus and stabilisation
what is assessed in secondary survey?
airways CRT pulse BP lungs abdomen spine head pelvis limbs nerves
state signs of orthopaedic injury
recumbency lameness limb wounds, pain, abnormalities abnormal mobility crepitation
list examples of orthopaedic injury
fractures luxation wounds penetrating joints tendons and ligament injury muscle lacerations
define luxation
complete disruption of normal relationship between articular joint surfaces
define subluxation
partial disruption of relationship between articular surfaces
define fracture
disruption in cortical continuity of bone
how are open fractures initially treated?
as lacerations so apply sterile hydrogel to exposed bone
sterile support dressings to restore normal anatomy
cage confinement
antibiotics
analgesia
how are bleeding wounds treated?
sterile contact layer applied
generous padding
absorbent layer
pressure for 30-60 minutes if artery bleed
what is the benefit of reducing fractures?
aid comfort
reduce further tissue injury
how are closed fractured initially treated?
support dress limbs
what are components of support dressings?
soft padding
splinting
conforming layer
protective layer
what is the purpose of bandaging wounds?
prevent self trauma and contamination
support fracture
control swelling
immobilise
where are support dressings mainly used?
distal limbs
support proximal and distal joints around injury
how are upper limb fractures managed?
cage rest before surgical repair
what are the aims of nursing fracture patients?
return patient to normal function
allow bone healing
what are advantages of conservative fracture management?
reduced anaesthesia
no need for surgery
cheaper
what are disadvantages of conservative fracture management?
cost more if doesnt heal and needs surgery immobility causing fracture disease incorrect healing cast sores ischemia
what are principles of conservative fracture management?
surrounding soft tissue provides sufficient stability to keep bones aligned
minimise movement
provide analgesia
what fractures are suitable for conservative fracture management?
some pelvic, scapula and vertebral
minimally displaced fractures
how should owners care for conservatively managed fracture pateints?
good cage size manage boredom assist ambulation non-slip rugs normal requirements regular check ups
how does external coaptation work?
compression transmitted to bones by soft tissues
what happens if pressure is unevenly distributed in external coaptation?
circulatory stasis
what fractures may be suitable for external coaptation?
distal to elbow or stifle
stable fractures
50% overlap of fragments on radiographs
other bones around to support fractured bone
what are examples of external coaptation?
casts
splints
how is external coaptation applied?
double layer stockinette placed with top and bottom overlapping
sofban in 1 or 2 layers
cast material applied under some tension in 3 up 3 down layers
cut cast medial and lateral
tape together cast
fold over sofban and stockinette and tape down
cover whole bandage in cohesive bandage
check toe nails and central pads visible but not protruding
list complications of non-surgical fracture management
ischemia necrosis cast sores incorrect healing fracture disease
what are examples of fracture disease?
joint stiffness muscle atrophy osteoporosis muscle contracture fibrosis
how can fracture disease be avoided?
rapid return to weight bearing
limit un needed immobilisation of joints
consider other treatment options
state some discharge instructions for external coaptation
cast care
informed of complications
what is nursing roles for surgical fracture management?
pre-op analgesia and care surgical prep surgical assistance post op care discharge
how do nurses assist during fracture surgery?
manage instruments
position and prepare patient
define fracture reduction
process of replacing fracture segments in original anatomical position
how is closed reduction done?
traction
counter traction
manipulation
bending
what fractures are suitable for closed fracture reduction?
open
recent
stable
what is meant by toggling?
repairing transverse fractures by bending 180 degrees, engaging ends and straightening limb
list examples of ortho implants
pins wire screws external fixation plates
how are intermedullary pins usually used?
in combination with plates, ESF, wire
what are complications associated with using intermedullary pins?
if too short hard to retrieve
seroma if too long
loosening
migration
how are interlocking nails used?
as medullary pin locked in place with screws
what is the purpose of interlocking nails?
prevent rotation and axial collapse
what is the purpose of bone plates?
restore bone structure to restore weight bearing function and allow healing
how do bone plates work?
compress bone fragments
share load between bone and plates for support
bridging fractures
what are uses of bone screws?
cancellous bone fractures
combined with plates and interlocking nails
list types of bone screws
locking
self tapping
non self tapping
what is the function of bone screws?
secure plate to bone
compress bone fragments
how are articular fractures treated?
open reduction internal fixation compression reduction maintaining joint mobility
what is the different between negative and positive profile pins?
negative has thread cut out but positive has thread around pin
what are components of ESF?
pins interface pins which are rougher to help bind to putty connecting bars putty clamps IM pins
what are benefits to putty connecting ESF?
light
no limit to size or closeness
no pins protruding
what are drawbacks to putty connecting ESF?
may be harder to remove
what are advantages to clamps connecting ESF?
reusable
easier to remove and adjust
what are disadvantages to clamps connecting ESF?
need correct alignment
limit to pin and bar size
how are avulsion fractures treated?
pin and tension band to hold together
what places are avulsion fractures found?
olecranon
greater trochanter
acromion
tibial tuberosity
how do surgical assistants aid ortho surgery?
manage instruments assist retraction manage samples manage bone grafts count swabs
what is post op care for ortho patients?
post op x rays cage rest general care suture removal buster collar physio
what are potential complications post ortho surgery?
premature closure of growth plates
poor fracture healing
lameness
pepper kinks
what is hip dysplasia?
developmental disease so laxity develops in joint capsule resulting in hip subluxation
state aetiology for hip dysplasia
genetics
diet
size of animal
exercies
what is signalment for hip dysplasia?
large breeds
laxity at 6-7 months old
osteoarthritis in adults
list clinical signs of hip dysplasia
short stride stiffness clunking hips lateral swap hopping adducted limb pain on extension muscle atrophy crepitus
how is hip dysplasia diagnosed?
ventrodorsally extended x-rays hip subluxation acetabular remodelling osteophytes ortolani test to test laxity
how can you manage hip dysplasia non-surgically?
OA management NSAIDs rest diet hydrotherapy
how can you surgically manage hip dysplasia?
growth plate fusion
pelvic osteotomy
total hip replacement
femoral head and neck excision
what are causes of avascular necrosis of femoral head?
trauma
ischemia
small breed dispositions
genetics
list clinical signs of avascular necrosis of femoral head
unilateral hindlimb lameness
pain on hip extension and flexion
muscle wastage
how is avascular necrosis of femoral head diagnosed?
imaging showing lucency, collapse, mushrooming
how is avascular necrosis of femoral head treated?
cage rest
femoral head and neck excision
total hip replacement
what is prognosis for avascular necrosis of femoral head?
guarded
usually need salvage surgery
state clinical signs of slipped capital femoral epiphysis
lameness
hip pain
what are radiographic changes seen for slipped capital femoral epiphysis?
radiolucent line at capital physis
separation between femoral head and neck
reabsorption of femoral neck
how is slipped capital femoral epiphysis treated?
femoral head and neck excision
total hip replacement
parallel pin
what are causes of hip luxation?
trauma
hip dysplasia
how is hip luxation diagnosed?
sudden onset lameness stifle out, hock in, leg adducted craniodorsal luxation imaging pain crepitus palpation thumb displacement test
how is hip luxation treated?
analgesia
closed reduction
stabilisation
open reduction
how is hip luxation closed stabilised?
anaesthetise
extend, adduct and externally rotate to lift femoral head over dorsal acetabular rim
abduct and internally rotate to sit femoral head in acetabulum
how can you do open reduction for hip luxation?
toggle
transarticular pin
prosthetic or primary capsular repair
ilio femoral suture
what is prognosis for hip luxation?
good
OA will form
may re dislocate
what is patella luxation?
displacement of patella from groove, usually medial
what are causes of patella luxation?
developmental
hereditary
trauma
how is patella luxation diagnosed?
not flexing and extending stifle
cowboy stance
patella clicking on manipulation
laxity of patella on extension
what is grade 1 patella luxation?
patella normally within groove
returns spontaneously when manually luxated
what is grade 2 patella luxation?
patella normally within groove
can be luxated and remain when released
what is grade 3 patella luxation?
patella normally out of groove
can manipulate back into groove
what is grade 4 patella luxation?
patella normally outside of groove
cant be reduced by manipulation
how can patella luxation be treated?
tibial tuberosity transportation to realign within groove
deepen trochlear groove
release of soft tissue
what is post op care for patella luxation?
analgesia
6 weeks strict rest
gradually increase exercise
what is prognosis for patella luxation?
worse with increased grade
good in small dogs
high risk of complications in large dogs
what is the purpose of cranial cruciate ligament?
limit cranial drawer, hyperextension and internal rotation
what causes cranial CLD?
trauma
degeneration
inflammatory arthopathy
angled tibial plateau by growth abnormality
what is the anatomy of cruciate ligaments?
caudolateral band- tight in extension
craniomedial band- always tight
how is cranial CLD diagnosed?
signalment gait analysis stifle pain crepitus instability effusion cranial drawer test tibial thrust test imaging
how is cranial CLD treated?
conservative
TPLO to flatten tibial plateau
fabello tibial sutures to replace ligament
what is post op care for treating cranial CLD?
NSAIDs for 14 days
opioids for 2 days
physio
what is prognosis for correction of cranial CLD?
doesnt cure slows process of arthritis some risk of complications likely to have OA in later life 50% have meniscal injury
how do you treat meniscal injuries?
arthrotomy at CCLD surgery
debride torn portion
leave unaffected meniscus
