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CVNT 2 > Orthopaedics > Flashcards

Orthopaedics Flashcards

1
Q

benefits of non surgical management of fractures

A
  • avoid anaesthesia
  • avoid open surgery risks
  • cheaper?
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2
Q

disadvantages of non surgical management of fractures

A
  • fracture disease
  • insufficient stability can cause delayed, mal or non-union
  • cast sores, ischaemia
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3
Q

suitable fractures for conservative management

A
  • pelvis
  • scapula
  • vertebrae
  • stable minimally displaced fractures
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4
Q

conservative management of fractures

A
  • restricted activity
  • confinement
  • 4-6 weeks
  • prevent weight bearing (carpal flexion bandage, velpeau sling)
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5
Q

external coaptation for fractures

A
  • compressive forces transmitted to bones by means of interposed soft tissues
  • cast, splint, bandage
  • pressure must be evenly distributed throughout the cast to avoid circulatory stasis
  • immobilise joint above and below the fracture
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6
Q

suitable fractures for external coaptation

A
  • fractures distal to elbow or stifle
  • stable fractures
  • 50% overlap of fracture fragments
  • one bone fracture in 2 bone segment
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7
Q

cast application steps

A
  1. stockinette, double layer
  2. sofban, overlap 50% each layer
    - don’t put too much over bony prominences
  3. fibreglass impregnated polyurethane
    - wear gloves, immerse in water
    - some tension, 6 layers (up 3, down 3), more at bends, avoid wrinkles
  4. cut cast using cast saw
  5. secure cast back together with non-stretch tape
  6. check for any sharp edges, fold over excess sofban and stocking
  7. check toe nails and pads not protruding (toes will splay if swollen)
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8
Q

complications of external coaptation

A
  • ischaemic injury
  • mild dermatitis to avascular necrosis
  • owner compliance
  • due to bad care and inappropriate case selection
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9
Q

fracture disease

A
  • occurs during the time necessary for the bone to heal, a result of fracture management
  • joint stiffness, osteoporosis, atrophy
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10
Q

how to avoid fracture disease

A
  • aim for rapid return to weight bearing
  • avoid unnecessary immobilisation of joints by external coaptation
  • consider other options that cause less fracture disease
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11
Q

fracture reduction definition

A

replacing the fracture segments in their original anatomical position

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12
Q

fractures that can be reduced closed

A
  • recent, stable fractures
  • lower limb- easier to reduce and palpate due to less soft tissue
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13
Q

toggling reduction definition

A
  • transverse fractures
  • bend fracture 180 degrees and engage ends
  • straighten limb, attach bone plate
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14
Q

intramedullary pins as internal skeletal fixation

A
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15
Q

broad choices for fracture fixation

A
  • conservative
  • external coaptation
  • external skeletal fixation
  • internal skeletal fixation (pins, plates)
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16
Q

intramedullary pins as internal skeletal fixation option

A
  • rarely used alone, combined with plate or external skeletal fixation (ESF)
  • not effective in preventing rotation
  • kirschner wires, steinmann pins
  • used alone in metacarpal/tarsal fractures
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17
Q

complications with intramedullary pins

A
  • too long or short
  • difficultly in retrieval
  • loosening and migration
  • seroma (irritation)
  • fracture non-union
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18
Q

interlocking nail as internal skeletal fixation option

A
  • intramedullary pin with holes, locked in place with screws preventing rotation
  • needs jig (shows where holes are on outside of bone)
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19
Q

bone plates and screws as internal skeletal fixation option

A
  • restore bone structure to restore weight bearing function
    functions:
  • compress bone fragments
  • neutralise fracture forces
  • bridge the fracture
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20
Q

screw lag fashion

A
  • compresses fragments together to enable rapid healing without callus
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21
Q

threaded pins

A
  • negative profile (ellis)
  • positive profile (imex)
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22
Q

connecting bars in external skeletal fixation

A
  • stainless steel/carbon
    • reusable, rounded ends, steel heavy
  • acrylic/putty
    • light, no limit to pin size or closeness, no protruding pin ends to irritate
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23
Q

clamps for external skeletal coaptation

A
  • for connecting pins to bars
  • limit to pin and bar size
  • reusable
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24
Q

pin and tension band

A
  • for avulsion fractures
  • olecranon, greater trochanter etc
  • active distracting forces are counteracted and converted to compressive forces
25
Q

hip dysplasia aetiology

A
  • developmental disease
  • laxity develops in joint capsule which allows hip to subluxate
  • genetic, large breeds, diet, exercise
  • 6-7 months old or adults with arthritis
26
Q

clinical signs of hip dysplasia

A
  • short stride, stiffness, clunking of hips
  • lateral sway, bunny hop, adducted hindlimbs
  • pain on hip extension
  • muscle atrophy
  • crepitus
27
Q

diagnosis of hip dysplasia

A
  • ventrodorsal extended x-rays
    • will see hip subluxation, osteophytes, acetabular remodelling
  • ortolani test- test of hip laxity
28
Q

treatments of hip dysplasia

A
  • non surgical: manage as arthritis case
  • surgical:
    • growth plate fusion (young only)
    • osteotomies (young only)
    • total hip replacement
    • femoral head + neck excision
29
Q

non surgical treatment of hip dysplasia

A
  • NSAIDs, rest, hydrotherapy, diet (to prevent growing too quickly)
  • body adapts over time (minimal lameness but radiographs are worse)
30
Q

avascular necrosis of femoral head aetiopathogenesis

A
  • same as ischaemic necrosis, legg calve perthes
  • caused by trauma, ischaemia, small breed predisposition
31
Q

clinical signs of avascular necrosis of femoral head

A
  • small breeds from 5 months old
  • unilateral hindlimb lameness
  • pain on hip extension/flexion
  • muscle wastage
32
Q

diagnosis of avascular necrosis of femoral head

A

imaging
- initially lucent areas which progress to collapse and mushrooming of femoral head

33
Q

treatment of avascular necrosis of femoral head

A

surgical:
- femoral head and neck excision
- total hip replacement
conservative:
- cage rest
guarded prognosis (usually salvage surgery)

34
Q

slipped capital femoral epiphysis

A
  • mainly in young male neutered cats
  • capital physis of femoral head separates from femoral neck
35
Q

clinical signs of slipped capital femoral epiphysis

A
  • recent onset hindlimb lameness
  • pain of hip extension
  • young, male, overweight and castrated cats
36
Q

diagnosis of slipped capital femoral epiphysis

A
  • radiolucent line at capital physis
  • separation/movement between femoral head and neck
  • resorption of femoral neck
37
Q

treatment of slipped capital femoral epiphysis

A

salvage surgery:
- femoral head and neck excision
- total hip replacement
- parallel pin
prognosis- doesn’t usually heal

38
Q

hip luxation aetiology

A
  • trauma
  • spontaneous in dogs with hip dysplasia
39
Q

diagnosis of hip luxation

A
  • gait= stifle out, hock in, leg adducted
  • leg length
  • radiography (orthogonal)
  • CT essential
40
Q

clinical signs of hip luxation

A
  • variable lameness
  • variable pain and crepitus
  • palpation of landmarks (greater trochanter, iliac crest, ischial tuberosity form straight line)
  • limb length
  • thumb displacement test (between tuber ischium and greater trochanter)
    • thumb stays in notch if dislocated
41
Q

treatment of hip luxation

A

dependent on:
- concurrent disease (hip dysplasia, fracture)
- duration of luxation
management:
- closed reduction +/- stabilisation (sling, ESF)
- open reduction
- salvage options (FHNE, THR)

42
Q

treatment of hip luxation

A

dependent on:
- concurrent disease (hip dysplasia, fracture)
- duration of luxation
management:
- closed reduction +/- stabilisation (sling, ESF)
- open reduction
- salvage options (FHNE, THR)

43
Q

closed reduction of hip luxation contraindications

A
  • acetabular or femoral head fractures
  • chronic luxations
  • hip dysplasia
44
Q

technique of closed reduction of hip luxation

A
  • extend, externally rotate limb to lift femoral head over dorsal acetabular rim
  • abduct and internally rotate limb to sit femoral head in acetabulum
  • confirm reduction with radiographs
  • cage rest or ehmer sling post reduction
45
Q

surgical/open reduction of hip luxation

A
  • toggle to replace round ligament
  • transarticular pin
  • prosthetic capsular repair
  • ilio femoral suture
    good prognosis in 75% cases
  • can cause arthritis
  • recurrent dislocation possible
46
Q

patella luxation

A
  • common in small breed dogs (medial luxation
  • can occur in large breed dogs (lateral luxation)
  • can occur in cats
47
Q

patella luxation aetiology and pathophysiology

A
  • most cases are developmental (not born with luxation)
  • possibly hereditary
  • occasionally traumatic
48
Q

clinical signs of patella luxation

A
  • characteristic gait= avoid flexing/extending stifle
    • cowboy stance in bilateral cases
  • clinical exam= stifle discomfort, patella click on manipulation
49
Q

patella luxation grading

A
  1. patella normally within groove, returns spontaneously when luxated manually
  2. patella in groove, remains luxated when manually luxated
  3. patella outside groove, can be manipulated back into groove
  4. patella outside groove, cannot be reduced by manipulation
50
Q

patella luxation treatment

A
  • deepening trochlear groove
  • tibial tuberosity transposition
  • soft tissue release, imbrication
51
Q

patella luxation post op care and prognosis

A
  • consider support dressing if grade 4
  • gradual increase in exercise after 6 weeks strict rest
    prognosis- deteriorates with increasing grade of luxation, bigger dogs more at risk for complications
52
Q

cranial cruciate ligament disease

A
  • most common cause of hindlimb lameness in dog
    functions of cranial cruciate ligament:
  • limit cranial draw, hyperextension, internal rotation
  • can also have meniscal injury in 50% cases
53
Q

cranial cruciate ligament disease aetiology

A
  • trauma (hyperextension)- uncommon
  • degeneration- common
    • breed predisposition
  • young, large breed dogs
  • inflammatory arthropathy
54
Q

diagnosis of cranial cruciate ligament disease

A
  • gait analysis
  • stifle pain, effusion, crepitus, medial buttress
  • cranial drawer test
  • tibial thrust test
  • radiographs (increased joint fluid)
55
Q

cranial draw test for CCL disease diagnosis

A
  • leg should be moderately flexed
  • hold femur still and try move tibia cranially
  • movement indicates cranial cruciate ligament rupture
  • best to do under sedation as can be painful
56
Q

tibial thrust test for CCL disease diagnosis

A
  • hand over stifle with finger over tibial tuberosity
  • mimic weight bearing by flexing hock
  • tibia will move forward and move finger if CCL ruptured
57
Q

treatment for cranial cruciate ligament disease

A
  • conservative
    surgical
  • intra/extra articular replacements (sutures mimicking ligament)
  • corrective osteotomy (TPLO)
58
Q

CCL disease post op care and prognosis

A
  • opioids for 24-48hrs, NSAIDs for 10-14 days
  • slows progression of arthritis, not heal
  • physiotherapy important for recovery
    prognosis
  • TPLO is most effective but higher infection rate

CVNT 2 (33 decks)

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