Orthopaedics (SA) Flashcards
Where are two common sites of avulsion fracture?
Tibial Tuberosity
Lateral Malleolus
what are the 3 main methods for fixing a fracture?
Plate and Screw
ESF
Pins and Wires
What are the two major categories of plate for fixing a fracture?
Dynamic Compression Plate
Locking Plate
In which type of bone are locking plates particularly useful?
Poor Quality Bone - Juvenile or Oseteopenic
What is a disadvantage of a locking system?
Lag screws cannot be placed
What do lag screws produce?
Interfragmental compression
Name 3 advantages of a IM pin
Resists Bending
In Neutral axis of bone
Can use with other fixation devices
Name 3 disadvantages of an IM pin
Cant resist rotation/shear
Interferes with medullary blood supply
difficult in chondrodystrophic breeds
What type(s) of fracture can be fixed with an IM pin ALONE?
Mid diahpyseal transverse fracture
What type(s) of fracture can be fixed with an IM pin alongside a plate?
comminuted fracture
Medium-long oblique simple fracture
When is cerclage wire used?
with IM pin in long oblique fracture
What type of fracture are pin and tension band wires used for?
Avulsion fracture
How do pin and tension band wires fix a fracture?
Provide compression to avulsion fragment
What is a grade 1 open fracture?
bone end pierced skin and retracted
What is a grade 2 open fracture?
Fracture end exposed
What is a grade 3 open fracture?
major ST loss and trauma
What is a Salter-Harris type 1 fracture?
passes through entire growth plate. No bone involved.
What is a Salter-Harris type 2 fracture?
passes along GP and through metaphysis
What is a Salter-Harris type 3 fracture?
passes along GP and through epiphysis
What is a Salter-Harris type 4 fracture?
passes through GP, Metaphysis and epiphysis
What is a Salter-Harris type 5 fracture?
Crushing injury compressing GP - no displacement
What is a Salter-Harris type 6 fracture?
Injury to perichondral structures
Where does a healing fracture obtain its blood supply?
Periosteal Vessels
Surrounding Tissues
What are the 6 stages of # healing?
- Haematoma
- Granulation
- Connective Tissue
- Fibrocartilage
- Callus formation
- Callus remodelling
In which type of fracture healing does callus formation NOT occur?
Direct Healing
Name 6 Fracture healing + factors.
Young Healthy Closed # Single Injury Closed Reduction Low Energy
Name 6 Fracture healing - factors.
Old Systemic/local Dz High Energy Open Articular Implants present
What type of fracture may benefit from external coaptation?
simple, stable and closed
Which patients are suitable for external coaptation
small dogs
some cats
Where should a fracture be to be suitable for external coaptation?
Long Bone Diaphysis
How reducible should a # be to be considered for external coaptation?
> 50% bone contact in 2 planes
Name 6 indications for ESF.
Long bone Highly comminuted Open/infected Corrective osteotomy Immobilising a joint Adjunct to other fixation
Name 5 advantages to eSF
Minimal invasion Allows access to open wound Maintains limb length Minimal complication rate Inexpensive
Which two checks may be conducted to assess CrCL integrity?
Cranial Drawer
Tibial Compression Test
Which Rx views are used to assess the stifle?
CrCd
ML
What is the most common cause of HL lameness in the dog?
CrCL disease
What is the most common cause of CrCL disease in the dog?
Degeneration (+/- minor trauma)
What may cause CrCL Dz in predisposed breeds?
Inc collagen metabolism
Sloping angle of tibial plateau
IM disease
How may the affected leg be positioned in a standing dog with CrCL Dz?
Toe Touching
What may be noted on Cx of a dog with CrCL Dz? (2)
Stifle Effusion
Medial Buttress
What are 3 Rx signs of CrCL disease?
Osteophyte Formation
Effusion (Compression of IP fat pad)
Cr Translation of Tibia
Which dogs with CrCL Dz may be managed conservatively?
<15kg
What does conservative management of CrCL Dz involve?
Restrict rest 6-8w
Analgesia
Name 3 surgical techniques used in a patient with CrCL Dz.
TPLO
TTA
Lateral Suture
Which ligament is most commonly affected in meniscal tears?
Medial Meniscus
How long should conservative management be undertaken for meniscal injury?
4-6w
How should a meniscal injury non-responsive to conservative management be treated?
Surgical Removal
Which type of patellar luxation is most common?
Medial
What is developmental patellar lunation caused by?
Malalignment of the quadriceps complex
What is grade 1 patellar luxation?
Intermittent, immediate reduction
What is grade 2 patellar luxation?
frequent, self-reduction
What is grade 3 patellar luxation?
Permanent - can be replaced
What is grade 4 patellar luxation?
Permanent non-reducible
When should surgical Tx be undertaken for patellar luxation?
Recurrent Cx
What are the 3 different surgeries which may be performed for patellar luxation?
TTT
Trochlear Groove Deepening
Medial Retinaculum Release/Reinforcement
Where are OCD lesions found?
- Caudal aspect humeral head
- Medial part humeral condyle
- Lateral femoral condyle
- Medial trochlear ridge talus
3 Cx of OCD are…
Lame from 5m
Bilateral Crouching Gait
Join Effusion and discomfort
How is collateral ligament rupture diagnosed?
Abnormal joint movement in M or L direction
Stressed Rx vs CL limb - widened joint space
How is Collateral ligament rupture treated?
Parapatellar surgery - repair ligament and re-attach
Which dogs commonly suffer form multiple ligament injury?
Working dog
how are multiple ligament injuries fixed?
Trans-articular external skeletal fixation
Name the most common SECONDARY disease of the stifle.
Osteoarthritis
Which animals are most susceptible to hip dysplasia?
Large Breed Dog
Devon Rex Cat
What causes the pain associated with hip dysplasia?
Femoral head hitting dorsal acetabular rim
Describe the aetiopathogenesis of hip dysplasia.
poor ST cover > Laxity/instability of CF joint > OA
Which are the two groups of dogs that commonly present with hip dysplasia?
Immature <12m
Adult dog with OA 2e to Hip Dysplasia
How do young dogs with hip dysplasia present? (4)
HL lame (uni/bilateral)
Bunny-hopping gait
Reluctant to exercise
+ ortolani test
How do adult dogs with hip dysplasia present? (4)
Stiff after exercise/rest
“bunny hop”
bilateral lameness
reduced ROM + pain
Which Rx views should be taken to check for hip dysplasia?
VD extended
LM view
What are the 1e changes seen on Rx of Hip Dysplasia? (3)
wide joint space
medial divergence
Centre of FH lateral to dorsal acetabular edge
What are the 2e changes seen on Rx of Hip Dysplasia? (3)
Bone formation on femoral neck (morgan line)
Remodelling of FH/N
Remodelling of acetabular rim
What is the success rate for conservative management of Hip Dysplasia?
75-80%
Which surgical Tx may be appropriate for a young dog with Hip Dysplasia?
TPO
Juvenile Pubic Symphisiodesis
Which surgical Tx may be appropriate for any dog with Hip Dysplasia?
FHNE
Total Hip Replacement (>9m)
What is the principle behind JPS for Hip Dysplasia?
Electrocautery causes arrest of chondrocytes
Shorter Pubic bones
VL rotation of acetabulum = better congruity
Over what age does a JPS no longer work?
> 22w
Which rare disease can be treated with a FHNE?
Legg-Calve-Perthes
Which dogs are most suitable for FHNE?
Small dogs <15kg
Which is the most appropriate surgical Tx for Hip Dysplasia in MOST dogs?
Total Hip Replacement
What is a common CI for Total Hip Replacement?
Chronic systemic illness
Which breeds are predisposed to LCP disease?
WHWT and Manchester Terrier
What is LCP Dz?
Ischaemia of the femoral head > deformity/collapse
How does LCP Dz present?
<5m
Unilateral lameness
pain on hip manipulartion
Which Rx should be taken to diagnose LCP?
Frog Leg
Vd Extended
ML
What is the best Tx approach for LCP?
Surgical (FHNE or Total Hip Replacement)
Which age of animal most commonly suffers capital physical #s?
4-7mo, 2e to trauma
Pain on manipulation
How are capital physeal #s treated?
3 diverging/parallel K wires
Craniolateral or dorsal approach!
Which animals are commonly affected by CF luxation?
Small
Following RTA
<12m
Which direction of CF luxation is most common?
Craniodorsal
How is the leg carried in a case of CF luxation?
Flexion
Stifle Out, Hock in
Which anatomical landmark is more prominent in the affected leg during CF luxation?
Greater Trochanter
Which Rx views are important to diagnose CF luxation?
VD
Lateral
Common Ddx for CF Lux?
Hip Dysplasia
Capital Physeal #
How should CF lux be initially Tx?
CLOSED reduction - followed by Ehmer sling & rest 7-10d
What are 2 common CIs of closed reduction for CF luxation?
Hip Dysplasia
Avulsion # of femoral head
How long after CF luxation can closed reduction be performed?
48h
How should a CF lux patient be prepared for closed reduction?
GA
TIE to table
How long should a dog be cage rested for post closed reduction of CF lux?
7-10d
Which approach is taken in open reduction of hip luxation?
Craniolateral
What is the first step of CF lux surgery?
Remove haematoma and bone fragments + lavage
Name 3 surgical options for open reduction of CF lux?
Toggle Fixation
Transarticular Pinning
Iliofemoral Suture
What is the most appropriate Tx for a single MT #?
External Coaptation
What is the most appropriate Tx for multiple MT #s?
Internal fixation
Two complications of MT # are…
- ST injury
2. Synostosis
Which breed commonly sufffers from interphalangeal luxation?
Greyhounds
Name the 3 Tx options for interphalangeal luxation.
Reduce & wire collateral ligaments
Small ESF
Amputation
Name 3 indications for toe amputation
Neoplasia
Severe #
Severe IP luxation
Where are OCD lesions commonly found?
Medial/Lateral Trochlear Ridge
How do OCD lesions appear on Rx?
Flattened Trochlear Ridge
What si the best Tx for OCD?
Surgery
What is the most common type of # to the central tarsal bone?
Dorsal Slab
What is the best Tx for central tarsal bone #?
Lag screw
What is the underlying cause of talocrural instability?
Damage to medial/lateral collateral ligaments OR malleolar #
In Talocrural instability, what are the first-line and second-line Tx?
Surgery
If fails - Pantarsal arthrodresis