Orthopaedics: Foot and Miscellaneous

Question 1

What are the main conditions that can affect the foot?

Answer 1

• Fractures
• Luxations of joints
• Pad injuries- corn
• Foreign bodies
• Nail injuries

Sesamoid disease

Question 2

What is a corn?

Answer 2

Focal area of hyperkeratosis
* excess keratin, thickening of pad

Keratin is a structural fibrous protein

Question 3

How is a corn treated?

Answer 3

Historically:
* Hulling/excision (primary cause not addressed- recur)

Regression:
* Silicone gel implants
* Revision surgery on distal amputations

If the pad is unloaded then the corn will grow out

Superficial digital flexor tendonectomy
* removal of 1cm + of tendon

Question 4

How are fractures of metatarsals/metacarpals treated?
What are the potential complications?

Answer 4

Single
* External coaptation

Multiple
* III IV need internal fixation
* Dowel pinning
* Spider

Complications
* Extensive soft tissue injuries- check viability
* Synostosis between bones

Question 5

What are indications for toe amputation?

What is the technique?

Answer 5

Severe luxations/fracture/neoplasia

Y-shaped incision to preserve the pad- can cut through joint

Question 6

What is the scientific name for marie’s disease?

What kind of disease is it?

Answer 6

Hypertrophic Oesteopathy

Paraneoplastic bone disease

Question 7

What nutritional bone diseases can develop in small animals?

Answer 7

• Nutritional secondary hyperparathyroidism
• Renal secondary hyperparathyroidisim
• Hypovitaminosis D

Question 8

1. What is panostitis?
2. What are the clinical signs?
3. What bones are more commonly affected?

Answer 8

1. Painful inflammation of the periosteum
2. Classically shifting lameness, acute onset, morelikely forelimb
3. Ulna > radius > Humerus

Question 9

How is panostitis diagnosed?
How is it treated?

Answer 9

Diagnosis- signalment, history, clinical signs and radiographs (young large breed dogs)

Treatment
* Self limiting
* Excercise control/restriction
* Analgesics

Lack of definition between cortex and medulla (thumbprint opacities)

Question 10

1. What is the usualt signalment of metaphyseal osteopathy?
2. What is the aetiology?
3. What are the clinical signs?
4. How is it diagnosed?
5. How is it treated?

Answer 10

1. Young, rapid growing breeds- 2-6mo
2. Unknown
3. Mild lameness to severe collapse- swelling
4. Signalment, history, CS, radiography
5. Self-limiting- supportive care, analgesics

Radiolucent line and increased radiodensity in metaphysis parallel to physis

Question 10

1. What is the usualt signalment of metaphyseal osteopathy?
2. What is the aetiology?
3. What are the clinical signs?
4. How is it diagnosed?
5. How is it treated?

Answer 10

1. Young, rapid growing breeds- 2-6mo
2. Unknown
3. Mild lameness to severe collapse
4. Signalment, history, CS, radiography
5. Self-limiting- supportive care, analgesics

Possible anglular limb deformities

Radiolucent line and increased radiodensity in metaphysis parallel to physis

Question 11

1. What is craniomandibular osteopathy?
2. What is the signalment?
3. What are the CS?
4. How is it diagnosed?

Answer 11

1. Non-inflammatory, non-neoplastic proliferative bone disease
2. 4-10mo, WHWT, scottish terrier, cairn terrier
3. Mandibular swelling/thickening, inability to open mouth, salivation, anorexia, pain on eating
4. Signlament, history, CS, radiography

Question 12

Whar radiographic changes can be seen with craniomandibular osteopathy?

How is it treated?

Answer 12

• Changes usually bilateral
• Palisading proliferation on the mandible and tympanic bullae
• Temporal, frontal and maxillary bones
• Occasionally affects long bones

Treatment
* Supportive care
* Analgesics

Prognosis
* Self limiting at 11-13 months
* Euthanasia may be requested

Question 13

What is the aetiology of marie’s disease?
What are the clinical signs?

Answer 13

Aetiology
* Paraneoplastic- secondary to intrathoracic or abdominal neoplasia
* Neural- ?

Clinical signs
* Lameness can develop over several months
* Single or multiple limbs
* FIrm swelling along bone of distal extremities
* Pain in early stages

Question 14

How is maries disease diagnosed or treated?

Answer 14

Diagnosis
* History and clinical signs
* Thoracic radiographs and abdominal ultrasound
* Radiographic changes- periosteal new bone formation, increased bone density

Treatment
* Symtomatic
* Remove primary cause- resolution of new bone formation

Question 15

What causes nutritional secondary hyperparathyroidism?

Answer 15

• Diets high in phosphorous or low in calcium
• Usually meat based diets
• Ideally 1.2: Ca:P 1:1 in cats
• Hypocalcaemia- increased PTH

Question 16

What are the clinical signs of Secondary hyperPTH?

How is it diagnosed?
How is it treated?

Answer 16

CS:
* Lameness
* Skeletal pain
* Swollen metaphysis
* Pathological fracture

Diagnosis- history and radiographs
* Decreased bone density/thinned cortices
* Mushroom shaped metaphysis

Treatment
Rest, diet correction, oral calcium supplementation, NSAID

Thin cortices with fractures

Question 17

Why does CKD cause increased PTH?

Why does impaired vit D cause increased PTH?

Answer 17

Impaired phosphate excretion
* Hyperphosphataemia- causes hypocalcaemia

Impaired vit D production causes depressed enteric calcium absorption- rickets

Question 18

What are the clinical signs of CKD osteopenia?

How is it treated?

Answer 18

CS
* Pliable mandible
* Loose teeth
* Skeletal pain
* Pathological fractures
* Bowing of bones

Treatment
* Reduce phosphate intake/phosphate binder
* Calcium or calitrol supplementation

Question 19

What is 1st, 2nd and 3rd degree ligament injuries?

Answer 19

1st- minimal tearing, rapid healing
2nd- partial rupture associated with haemorrhage and oedema
3rd- complete rupture- avulsion

Sprain is ligament, Strain is tendon

Question 20

How are different degree ligament injuries treated?

Answer 20

1st degree
* Healing is rapid- transient lameness
* 1 week rest- restricted excercise and NSAIDs

2nd degree
* Weight bearing- support for 3-4 weeks
* Excercise controlled for upto 3 months

3rd degree
* Not weight bearing, joint alterations
* Surgical repair, reattachment or replacement

Question 21

How are stains of tendons treated?

Answer 21

• In acute phase need to reduce inflammation- alternate cold warm compresses
• Surgical treatment for ruptures or displacement- monofilament nylon sutures
• Immobilisation for 4-6 weeks post op
• Gradual increase in excercise over the following 2 months

Question 22

How are tendons surgically treated?

What post-operative care is needed?

Answer 22

• Early repair better
• Monofilament nylon sutures used to attach ends

Imombilisation necessary for 4-6 weeks
* Splint for DFT/extensor tendons
* Transarticular external skeletal fixator
* Hock/ankle held in extension with bone screw for common calcanean tendon

Question 23

What extra support is needed after surgical repair of which tendon injuries?

Answer 23

• Splint for digital flexor/extensor tendons
• Transarticular external skeletal fixator
• Hock/ankle held in extension with bone screw for calcanean tendon

Question 24

What does this image show?

Answer 24

Reversible contracture of the flexor carpi ulnaris muscle

Question 25

What is the signalment, clinical signs and treatment of reversible contraction of the flexor carpi ulnaris?

Answer 25

Signalment
* young dogs 6-8 weeks

Clinical signs
* flexed carpus that cannot be extended
* Tendon of FCU is taut

Treatment
* Resolution usually after 2-3 weeks
* Carpal supports
* FCU tendinecromy in rare cases