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Year 4 Small Animal Studies > Orthopaedics: Common Conditions of the Hip > Flashcards

Orthopaedics: Common Conditions of the Hip Flashcards

1
Q

What is the name of the hip joint?

A

Coxofemoral joint

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2
Q
  1. What developmental conditions may affect the coxofemoral joint?
  2. What traumatic conditions may affect the hip joint?
A
  1. Developmental
    * Hip dysplasia
    * Legg-perthes disease
  2. Traumatic
    * Fractures- hip and pelvis
    * Luxation/dislocation
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3
Q

What acquired conditions of the hip can develop?

A
  • Hip OA
  • Neoplasia
  • Immune mediated arthropathy
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4
Q

What is the aetiopathogenesis of hip dysplasia?

A
  • Laxity and instability of hip joint
  • Large breed dogs/Devon rex cat
  • Genotype and then BW, nutrition, growth rate
  • Laxity due to poor soft tissue cover
  • OA change as a response
  • Pain as femoral head hits dorsal effective acetabular rim
  • Clinical signs ‘subside’ 12-18mo
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5
Q

What are the two commonly presented groups with hip dysplasia?

A
  • Immature dogs < 12 months
  • Adult dogs with OA secondary to HD
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6
Q

What are the clinical signs of hip dysplasia in imature dogs?

A
  • Less than 1 yo
  • Unilateral/bilateral HL lameness
  • ‘Bunny-hopping’
  • Reluctance to excercise
  • Pain upon hip extension/flexion
  • Positice ortolani test
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7
Q

What are the clinical signs of hip dysplasia in adult dogs?

A
  • Mature dogs
  • Stiffness after rest/excercise
  • Bunny hopping
  • Usually bilateral
  • Pain upon joint manipulation and reduced ROM
  • Differentiate from bilateral stifle, hock and lumbosacral disease
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8
Q

How is hip dyplasia diagnosed?

A
  • History and CS
  • Radiographic signs: Static
    VD extended/frog-legged
    Lateromedial view
    Special views
  • Dynamic-distraction index 0-1
  • 1- joint out, 0 in
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9
Q
  1. What early (primary) changes occur in hip dysplasia?
  2. What secondary changes occur?
A
  1. Primary
    * Important to note for double/triple pelvic osteotomy
    * Wide joint space with medial divergence
    * Centre of femoral head lateral to dorsal acetabular edge

2) Secondary
* New bone formation
* Remodelling of femoral head/neck
* Remodelling of cranial effective acetabular rim

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10
Q

What conservative treatment can be given for HD treatment?

A
  • NSAIDs
  • Weight control
  • Excercise/environment modification
  • Nutritional managment- nutraceuticals
  • Adjunct medications
  • Adjunct therapies
  • Education
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11
Q

What surgical treatment can be given to young dogs and all dogs?

A

Young dogs
* Double/triple pelvic osteotomy
* Juvenile pubic symphisiodesis

All dogs
* Femoral head and neck excision
* > 9mo, total hip replacement

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12
Q

What are the pros and cons of juvenile pubic symphisiodesis?

A
  • Risk over 20 weeks of age
  • Not often done
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13
Q

What are the pros and cons of femoral head and neck excision?

A
  • Salvage procedure
  • Used to treat legg-perthes unreducible
  • Craniolateral approach
  • Removal all neck and bony spurs
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14
Q

What are the pros and cons of total hip replacement?

A
  • Treatment of choice in dogs
  • Contraindications- chronic systemic illness
  • Maintained on analgesics
  • Spenny
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15
Q
  1. What breeds are pedisposed to Legg-Calve-Perthes disease?
  2. What is the pathogenesis?
  3. What is the usual history and clinical signs?
  4. How is it diagnosed?
  5. How is it treated?
A
  1. Small breeds such as WHWT
  2. Ishaemia of femoral head bone leads to deformity and collapse
  3. Immature dogs, unilateral lameness
  4. Hx and CS, pain/crepitus upon hip manipulation, radiography-frog-leg and VD extended
  5. Surgical > Conservative- Femoral head and neck excision, total hip replacement
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16
Q

Where are femoral head and neck fractures more common?

A
  • Capital and capital physeal
  • Femoral neck
  • Greater trochanter
17
Q
  1. What age more commonly fracture their capital physeal?
  2. What is it secondary to?
  3. How is it diagnosed?
  4. How is it treated?
A
  1. Immature animals (4-7mo)
  2. Secondary to trauma
  3. HX, CS (pain upon manipulation), radiography
  4. Three diverging/parallel K or arthrodesis wires, craniolateral or dorsal approach to hip
18
Q

What is assessed with suspected pelvic fracture?

A
  • Assess urinary tract
  • Neurological exam- sciatic with ilial fracture- assess CPS
  • Assess function of pelvic nerve-anal/perineal reflex
  • Palpate and feel for crepitus, assess for asymmetry
  • May be shearing injuries
19
Q

How should a pelvis be radiographically assessed for fractures?

A
  • There is always two fractures- like a box
20
Q

What are the treatment options for pelvic fractures?
What are the general considerations?

A

Conservative or Surgical
* 75% conservative would work
* Area of pelvis affected
* Small animals do better
* Surgery is needed within 5 days
* Use of animal
* Finance

21
Q

When is conservative managment of pelvic fractures suitable?

A

Non weight bearing axes
* Pubis
* Ischium
* Wing of ilium

22
Q

What does conservative managment of pelvic fractures entail?

A
  • Cage rest/small room rest for 4-6 weeks
  • If non-ambulatory- frequent turning and soft bedding
  • Check bladder qid if not urintating consciously
  • Analgesia- opioids- full or partial agonists, NSAIDs
23
Q

When is surgical treatment of pelvic fractures indicated?

A
  • Acetabulum- controversial
  • Ipsilateral fractures of ilium, pubis, ischium
  • Iliac shaft
  • Sacroiliac joint
  • Fractures causing marked stenosis of pelvic canal
  • Pain
  • Neurological defecits
24
Q
  1. When are sacroiliac separations commonly seen?
  2. How can they present?
  3. When do they need surgical treatment?
  4. What are the methods of treatment?
A
  1. Commonly seen post RTAs
  2. If nerve root entrapment- pain++
  3. Painful, non-ambulatory, marked displacement, other contralateral fractures
  4. Lag screw fixation, transilial pin
25
Q

How are iliac shaft and acetabular fractures repaired surgically?

A
  • Most require internal fixation
  • Other techniques- lag screws, K or arthrodesis wires
26
Q

What post-operative care is required for pelvic fractures?

A
  • Cage rest for 4-8 weeks
  • Treat as conservative- short on-lead walks 5-10 mins
  • See at 3, 7-10d and 4-8 weeks post-op for repeat radiographs
  • Analgesia/soft bedding
  • Passive physiotherapy/hydrotherapy

Year 4 Small Animal Studies (97 decks)

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