Orthopaedics Flashcards
what causes rickets?
vitamin C deficiency
is the first metacarpal/tarsal medial or lateral?
medial (count outwards)
what is the first metacarpal/tarsal also known as?
dew claw
does distal limb lameness tend to appear worse on a smooth surface or gravel surface?
gravel
what are the main conditions seen in the foot?
fractures
joint luxations
pad injury - corns…
foreign bodies
nail injuries
what breed gets sesamoid disease of the foot?
Rottweilers
what is a footpad corn?
focal area of hyperkeratosis causing a thickened/harder pad
how are footpad corns treated?
cutting the superficial flexor tendon (tendonectomy) so dog doesn’t walk on it and corn grows out
what breeds are footpad corns most commonly seen in?
greyhounds
how are single fractures of the metacarpal/tarsal bones fixed?
external coaptation
how are multiple fractures of the metacarpal/tarsal bones fixed?
internal fixation
what shaped is used for toe amputation?
Y shaped to allow preservation of the footpad
what are the clinical signs of panosteitis?
shifting lameness (mild to non-weight bearing)
acute onset
usually forelimb
what dogs is panosteitis most commonly seen in?
young large breed dogs with no abnormalities on clinical exam
how is panosteitis treated?
self-limiting - exercise control and analgesia
what dogs is metaphysical osteopathy seen in?
young large breeds
what is the cause of metaphysical osteopathy?
idiopathic
what are the clinical signs of metaphyseal osteopathy?
mild to severe lameness
pyrexia, anorexia, depression
what are the radiographic signs of metaphyseal osteopathy?
radiolucent line in metaphysis parallel to physis
slightly widened epiphysis and growth plate
how is metaphyseal osteopathy treated?
self-limiting - supportive and analgesia
what breed does craniomandibular osteopathy occur in?
west highland white terriers
what are the clinical signs of craniomandibular osteopathy?
mandibular swelling/thickening
inability to open mouth (anorexia)
salivation
pain when eating
what are the radiographic signs of craniomandibular osteopathy?
bilateral palisading proliferation of mandible and tympanic bullae
how is craniomandibular osteopathy treated?
self-limiting - supportive and analgesia
what is hypertrophic osteopathy?
paraneoplastic syndrome causing palisading new bone formation on distal limbs
what are the clinical signs of hypertrophic osteopathy?
slowly developing lameness
firm swelling along distal extremities
painful
what is the aetiology of nutritional secondary hyperparathyroidism?
puppies/kittens fed high phosphorous or low calcium diets of purely meat leading to hypocalcaemia and increased parathyroid hormone inducing skeletal demineralisation
what are the clinical signs of nutritional secondary hyperparathyroidism?
lameness
skeletal pain
swollen metaphysis
pathological fractures
what are the radiographic signs of nutritional secondary hyperparathyroidism?
decreased bone density and thinned cortex
mushroom shaped metaphysis
how is nutritional secondary hyperparathyroidism treated?
rest
diet correction
oral calcium
NSAIDs
what occurs with renal osteodystrophy?
impaired phosphate excretion leads to hyperphosphataemia causing a hypocalcaemia leading to increased parathyroid hormone secretion and bone demineralisation
what are the clinics signs of renal osteodystrophy?
rubber jaw
loose teeth
skeletal pain
pathological fractures
how is renal osteodystrophy treated?
reduce phosphate intake
phosphate binder
calcium supplementation
what are the possible fracture forces?
bending
axial compression
torsion
high energy/comminuted
what side does the implant need to go onto a fracture?
tension side (node compression side)
what is the only type of fracture bandaging alone should be used for?
transverse
what are avulsion fractures?
pull of muscle/ligament tears away the cartilage link to bone in young dogs
what is the only way to fix avulsion fractures?
surgery
what are the three main categories of implants?
plates/screws
external skeletal fixators
pins/wires
what are the two types of plates?
dynamic compression paltes
locking plates
what is a transverse fracture?
a fracture up to 30 degrees
how fast would a fracture be expected to heal in a young dog (under 6 months old)?
4 weeks
what are the advantages of locking plates?
good in young dogs and poor quality bone
less contouring
improved vascularity
what is the appearance of a cortical screw?
small threads
what is the appearance of a cancelous screw?
large thread (better in soft bones)
how can screws be placed?
positional
lag
what is positional screw placement?
both pieces of bone have the screw thread in so it simply holds it in place
what is the function of a lag screw?
gives compression
what are the two types of pins?
negative thread
positive thread (wider than the shaft)
what is a negative thread pin?
the thread is cut into the shaft of the bone
do connecting bars of an external fixator need regular tightening?
no (should need to be tightened)
how are external frames described?
number of planes its in
how many times it goes through the skin
what are the advantages of IM pins?
good resistance to bending forces
inexpensive
can be used with other fixations devices
what are the distadvanatges of IM pins?
poor resistance to rotation and sheer
interferes with medullary blood supply
difficult to place in chondrodystrophic dogs
why are IM pins generally better used in cats?
they have straighter legs than dogs
what are cerclage wires used for?
long oblique fractures
what are the four As of fracture repair assessment?
apparatus (implants)
alignment (joint alignment)
apposition (fracture compression)
activity
what is the most common cause of hip luxation?
trauma
what are the two directions a hip can luxate?
craniodorsal
caudoventral
what is the most common direction of hip luxation?
craniodorsal
why is craniodorsal the most common hip luxation?
weight bearing on foot
pull from gluteal muscle
what are the two causes of craniodorsal hip luxation?
trauma
hip dysplasia
what cause caudoventral hip luxation?
animal does the splits
what are the clinical signs of craniodorsal hip luxation?
internal rotation of limb
non-weight bearing
greater trochanter higher than normal
what are the three boney landmarks associated with the hip region?
greater trochanter
ischiadic tuberosity
ileal wing
what is the technique for non-surgical reduction of craniodorsal hip luxation?
GA/sedation plus epidural
lateral recumbency (affected limb uppermost)
towel/rope around inguinal region (stability)
externally rotate limb to release femoral head
traction caudodistally
internally rotate when femoral head is distal to dorsal acetabular rim
what should be done one hip luxations have been non-surgically reduced?
xray and bandage (before moving patient)
what type of bandage is used for craniodorsal luxations?
ehmer sling (keep limb inwardly rotated)
what are the signs of mandibular physical separation?
mandibular canine misaligned
excess movement
what are the possible treatment options for mandibular physical separation?
muzzle
wire - metal and PDS (surgery)
how are mandibular physical separation fixed with wire?
place widest gauge needle through just caudal to mandible and pass wire through it, repeat on the other side and then tighten wire outside mouth
what animals will naturally correct carpal extension?
very young dogs who have had a bandaged fracture and have tendon laxity due to this
can carpal hyperextension be treated by bandaging?
no
what can cause a carpal hypertension?
high rise falls
degeneration (border collie…)
collateral ligament rupture
inflammation (NAD seen on radiograph)
what factors drive how carpal/tarsal hyperextension is managed?
degree of lameness
dysfunction
exercise tolerance
load bearing angle of the carpus (take care with skin ulceration)
what is the treatment for traumatic carpal hyperextensions?
surgery
what radiographic views need to be taken for carpal hyperextension?
mediolateral
dorsopalmar
stressed views of these
what is almost always the treatment option for tarsal instability?
surgery
what size dog is gastrocnemius enthesopathy seen in?
large breeds
what is gastrocnemius enthesopathy?
marked thickening of the gastrocnemius (achilles) tendon causing a partial/complete plantigrade stance (crabbed toes)
what is always the treatment option for gastrocnemius enthesopathy?
surgery (bandaging won’t work)
where does the achilles (gastrocnemius) tendon insert?
calcaneus
why does gastrocnemius enthesopathy cause toes to curl?
as the calcaneus/hock drops the superficial digital flexor tendon has to travel further
what does the management of digit luxation depend on?
whether is is stable or unstable
which joint luxates
how are stable digit luxations treated?
surgical stabilisation
digit amputation
if securing stable P2/P3 luxations with a split, what should be done?
cut nail short
ungunal crest ostectomy
(nail acts as a lever to luxate the joint again)
what are the weight bearing digits?
3 and 4
how many digits can be removed from the foot?
1
when is it best to do the dynamic assessment of an animal?
after getting a clinical history
what are the ways of subjective gait analysis?
visual analogue scale
numerical rating systems
descriptive systems
what are the features of a thoracic limb lameness on dynamic assessment?
head position - shifts weight caudally, head rise when lame leg on floor
short stance distance on lame leg
fast swing on non-lame leg
what is the position of the head on dynamic assessment of the thoracic limbs?
head rise when lame limb is down (throw weight off of limb)
what are the features of a pelvic limb lameness on dynamic assessment?
head position - shifts weight cranially, hip rise when lame leg on floor, head drop when lame leg on floor
short stance phase on lame leg
fast swing phase on non-lame leg
what is the position of the head/hip on dynamic assessment of the pelvic limbs?
hip rise when lame leg on floor
head drop when lame leg on floor
(throw weight cranially)
why is the dynamic assessment done before the physical examination?
so you can determine which limb is lame and leave the examination until last (painful)
what needs to be assessed on physical examination of the lame limb?
soft tissue - muscle mass/symmetry, joints, tendons
long bones
joints - motion, thickening, crepitus
what are the four considerations for managing the lame patent non-surgically?
exercise modification
physiotherapy
analgesia
weight management
what is standard analgesia for lame dogs?
NSAIDs and paracetamol (possibly gabapentin)
