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Vet607 - Veterinary Radiology > Orthopeadics and Spinal Disease > Flashcards

Orthopeadics and Spinal Disease Flashcards

1
Q

When working out what fixation to use we thing about biology and biomechanic’s explain

A
  • Biology
    • Age
    • Soft tissue envelope
    • enegy of fracture
  • Biomechanics
    • Single/multiple limbs
    • non/Comminuted, re/constructable, load sharing?
    • Bone stock
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2
Q

What are the 5 factors that affect the stability of a fracture you repair?

A

Stability of a repaired fracture depends on 5 key things :-

  1. The type of fracture
  2. Whether the fracture can be anatomically reconstructed
  3. The method of fracture repair
  4. Whether it is a single or multiple limb injury
  5. The patient size and level of activity
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3
Q

Of the 3 types of elbow disease which can you diagnose from radiographs?

A
  • UAP
  • OCD
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4
Q

What are the 3 functions of the Cranial Cruciate Ligament CrCL?

A
  • Prevent cranial displacement of the tibia
  • Limit internal tibial rotation
  • Prevent stifle hyperextension
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5
Q

If you have a fracture involving an articular surface, what kind of bone healing are you requiring and why? How is this acheived?

A
  • Fractures involving Articular surface require anatomic reconstruction and interfragmentart compression to achieve Direct bone healing and to avoid callus formaion within the joint.
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6
Q

What is Hip Dysplasia?

A
  • Abnormal development of the coxofemoral joint
  • characterised by subluxation in young animals
  • which leads to degerative joint disease in older animals
  • HD is the most common Heritable orthopaedic problem in dogs
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7
Q

What are the Forelimb Spinal Reflexes, Nerve they test and spinal location?

A
  • Extensor carpi radialis reflex
    • Radial Nerve
    • C7-T1
  • Triceps tendon reflex
    • Radial Nerve
    • C6-T1
  • Withdrawal-Flexor reflex
    • Musculocutaneous, axillary, Median, Ulnar, Radial Nerves
    • C6-T1
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8
Q

If a bone callus formes within a joint what would be some side effects of this?

A
  • Callus formation within a joint causes osteoarthritis and consequest poor function.
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9
Q

What are the causes of acute onset of spinal disease in dogs?

A
  • Hansen type I IVDD(Intervertebral Disc DIsease)
    • Acute prolapse of disk
  • FibroCartilaginous Embolism (FCE)
  • Trauma
  • Granulocytic Meningo Encephalomyelitis
  • Discospondylitis (Infection of the disks)
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10
Q

What are the 5 biomechanical factors that dictate the degree of stability acheived in a fracture fixation?

A
  • The type of fracture
  • Whether the fracture can be anatomically reconstructed
  • The method of fracture repair
  • whether it is a single of multiple limb injury
  • The patient size and level of activity during the healing period
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11
Q

What are teh 3 types of elbow disease in dogs?

A
  • Elbow Diseases
    • Fragmented Coronoid Process FCP
    • Osteochondritis dissecans
    • Ununited anconeal process UAP
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12
Q

This dog has a firm fibrous swelling on the medial side of the stifle joint. What is this and that iw it pathognomonic for?

A
  • Medial Buttress
  • Medial Buttress will be present even before cruciate rupture
  • Therefor
    • Medial Buttress = Cruciate disease
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13
Q

Neuro Exam Dog

Eyeball Position and Movement is testing what CN’s?

A
  • CN III, VI, VIII
  • Strabismus (Eye position)
    • Ventrolateral (oculomotor nerve CNIII)
    • Medial (Aducens Nerve CNVI)
    • Ventral with Elevated head (Vestibular Disease)
  • Nystagmus
    • Physiologic vs Positional
    • CNVIII
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14
Q

This dog stands in a tripod stance and then patella has been tested it does not luxate. What can you see and what do you diagnose here?

A
  • Effusion and osteophytes in the absence of patella luxation = cruciate disease
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15
Q

What tests do we use to test for cruciate instability?

A
  • Cranial drawer
  • Cranial tibial thrust
    • Stimulates weight bearing
    • a functional test
  • Stance tells you more than gait
    • Look for tripod if unilateral
    • forward press is bilateral
    • Positive sit test (not pathognomic but means you need to rule out CCL)
  • Look for Medial Buttress
    • Pathognomonic for cruciate disease
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16
Q

What are the components of a full neurologic exam on a dog?

A
  • In the Consult Room
    • Sensorium and Behaviour
  • Walk Outside
    • Posture
    • Gait
  • Examination (from head to tail)
    • Cranial Nerves
    • Postural Reactions
    • Muscle tone and mass
    • Spinal Reflexes
    • Sensation
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17
Q

What are teh 2 cruciate ligaments?

A
  • Cranial Cruciate Ligament CrCL
  • Caudal Cruciate ligament CaCL (Rare)
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18
Q

If you have elbow disease what would you expect to see during orthopeadic exam?

A
  • :Pain on elbow extension (supination with elbow at 90degrees)
  • +/- Joint effusion
  • Decreased range of motion/crepitus/periarticular fibrosis once secondary OA is present
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19
Q

What are the causes of Chronic Spinal disease in dogs? (DDx)

A
  • Hansen Type II IVDD
  • Degenerative Myelopathy
  • Neoplasia
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20
Q

How do you diagnose Osteochondrosis?

A
  • History/Signalment
    • Larger breed dogs 4-8months old (can be older)
    • Progressive intermittent lameness worsened by exercise
  • Physical Exam
    • Painon manipulation of affected joint (rarely crepitus)
    • Mild - moderate muscle atrophy
  • Further diagnostics
    • Radiography (both limbs)
    • Arthroscopy
    • Exploratory arthrotomy
    • CT/MRI
    • Contrast rads
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21
Q

What treatment for OCD?

Where can dogs get OCD?

A
  • Debride the necrotic cartilage down to healthy bleeding subchondral bone
  • Healing bone replaces necrotic cartilage
  • Articular cartilage is replaced by fibrocartilage
  • OCD
    • Shoulder
    • Elbow
    • Stifle
    • Hock
    • Sacral
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22
Q

Biologic factors that effect fracture healing

A
  • Age
  • Blood supply/soft tissue envelope
    • Prior to fracture
    • after the fracture (high or low energy)
    • after the fracture repair
  • Fracture gap
  • Location of fracture/type of bone
  • infection
  • concurrent injuries
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23
Q

What are some options for repairing anatomically reconstructable long bone fractures (2 or 3pieces)?

A
  • Casts (external coaptation)
    • Best suited for minimally dispaced greenstick fractures of the radius or tibia in immature dogs
  • Intramedullary pin and cerclage wire
    • Only suitable for the repair of simple fast healing 2 peice long oblique or spiral fractures of the femur or tibia (or rarely the humerous)
    • Minimium lenght of the obliquity to use cerclage wire > 2 x the bone diameter
  • Bone plate applied as a neutralisation plate
    • This is suitable for the repair of 2 or 3 piece long oblique or spiral fractures of any of the long bones
  • Bone plate applied as a compression plate
    • This is suitable for the repair of 2 piece transverse fractures of any of the long bones
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24
Q

When a dog stands with the forelimbs base narrow and supinated (feet turned outwards) what does this indicate?

A

Elbow Disease

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25
Q

If a dog has diseased hock’s what will be apparent?

A

Joint enlargement due to Effusion and fibrosis

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26
Q

If a dog has any of these where is the Lesion?

  • Abnormal mentation
  • Nystagmus
  • Strabismus
  • Dilated or Constricted pupils
  • Poor-absent PLR
  • Gait deficits
  • Contralateral or ipsilateral posture reactions
A

Midbrain Lesion

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27
Q

What is the most common cause of neurological problems in dogs?

A

Invertebral disc disease

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28
Q

If a dog has any of these where is the Lesion?

  • Ipsilateral motor and sensory deficits
  • Vestibular dysfunction
  • Deficits of CN V-XII
  • Abnormal mentation
  • Cerebellar ataxia (hypermetria)
  • Intention tremors
  • Menace deficits with normal vision
A

Hindbrain Lesion

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29
Q

What are teh Cranial Nerve tests we do when doign a neuro exam on a dog?

A
  • PLR
  • Menace responce
  • Palpebral fissure, thrid eyelid
  • Eyeball movemnet & position
  • Facial symmetry and sensation
  • Tongue, Larynx and Pharynx
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30
Q

Whilst doing a Dog Neuro Exam what are we accessing when we are doing

Sensorium and Behaviour

A
  • Level of Mental State
    • Depression
    • Obtunded
    • Stupor
    • Coma
  • Quality of mental state
    • Aggression
    • Hyperactivity
    • Hysteria
    • propulsive movements
    • Loss of continence
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31
Q

Whats a common site for SalterHarris 1 injury

How do you fix them?

A

Distal femur

K wires (same with SH2)

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32
Q

When would we test for Superficial and Deep Pain?

A

When there is no voluntary motor function

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33
Q

When trying to localise Neuro Lesions what are the SPinal segments we need to know?

A
  • C1-C5
  • C6-T2
  • T3-L3
  • L4-S3
34
Q

What is the Ortolani test?

A
  • Used for testing HD
  • Objective test for subluxation of femoral head
  • Best under GA
  • Lateral or dorsal recumbency
  • Clunk felt as the subluxated femoral head reduces
  • not realiable at 6-10 weeks
  • Reliable >16-18 weeks but a high incidence of false negatives
  • A POSITIVE Ortolani test = Hip Dysplasia
35
Q

WHat xrays do you take to diagnose Cruciate Disease?

A
  • Always both legs
  • Lateral
    • Most useful
    • Effusion and osteophyte
  • Craniocaudal
  • Treatment = Surgery
36
Q

What are some complications with fracture repair?

A
  • Delayed union/non-union
  • malunion
  • Osteomyelitis
  • Implant failure
  • Fracture disease
  • Implant associated neoplasia
37
Q

What is Osteochondrosis?

A
  • Disease that affects the normal endochondral ossification of the growth plates
    • Epiphyseal (Articular)Metaphyseal
    • Apophyseal
  • Ossification that occurs in and replaces cartliage
  • Cartilage continues to grow without being transformed into bone
    • Cartilage becomes abnormally thick synovial fluid supplys cartilage as no blood supply)
      • OCD = when the dead cartilage lifts off and is painful
38
Q

What age does animals gain the menace responce?

A

LEarned responce not present until abotu 10-12weeks of age

39
Q

What are the 3 principals of articular repair?

A
  1. Ideally repair withing <48hrs
  2. Perfect anatomical reduction
  3. Interfragmentary compression
40
Q

Radiographic signs of IVDD?

A
  • Narrowing of disc space
  • Opacity in foramen
  • Chronic
    • Sclerosis of end plates
    • Ventral spondylosis

DO NOT use corticosterois int he management of acute spinal cord trauma

41
Q

What are the “Other” spinal reflexes that are not Fore or hindlimb?

A
  • Cutaneous trunci
    • Nociceptors in dermatomes
    • Intact afferent and efferent arms as well as ascending L4-C8
  • Peroneal
    • Pudendal nerves, S1-S3
    • Caudal Nerves
42
Q

What are the options for repairing non-anatomically reconstructable long bone fractures >3 pieces?

A
  • This is called a bridging fixation
    • Bone Plates
    • External Skeletal fixators (ESF’s)
    • Interlocking nails (ILNs)
43
Q

Where in the Elbow does OCD affect?

A
  • Medial humeral condyle
  • Radiographic Veiws
    • Lateral
    • Flexed lateral
    • CranioCaudal
  • Definitive diagnosis = radiolucent concativy on trochlea ridge of medial humeral condyle
    • Secondary OA
      • Earliest sign - Osteophyte on anconeal process
      • Later - articular and periarticular ostephytes, subchondral bone sclerosis, joint space narrowing, joint effusion
  • Treatment
    • Surgical (prefer arthroscopic)
      • Same as OCD in any joint
    • COnservative treatment is an essential and lifelong part of elbow disease
44
Q

How do you diagnose Osteoarthritis?

A
  • Clinical signs
  • Orthopaedic exam
  • Treatment trial ??
  • Radiography
  • SYnovial fluid analysis
  • arthrotomy/arthroscopy
  • synovial membrane biopsy
45
Q

What are the letters and arrow indicating?

A
  • R = Radius
  • MCP = Medial part of the coronoid process of the ulna
  • Yellow Arrow = Fractured Coronoid process
46
Q

What are the Hindlimb Spinal Reflexes, Nerve they test and spinal location?

A
  • Patella Reflex
    • Femoral Nerve
    • L4-L6
  • Cranial Tibial Reflex
    • Peroneal Nerve
    • L6-S1
  • Withdrawal- Flexor Reflex
    • Sciatic Nerve
    • L4-S3
47
Q

Explain Load Sharing with respect to anatomical reconstruction

A
  • Stable anatomic reconstruction of fractured long bones allows the animal to weight-bear on the repaired bone and share all of the biomechanical loads between the reconstructed bone column and the method of fracture repair. This is an ideal biomechanical situation and called load-sharing.
  • Fracture repairs where load-sharing is acheived are more stable and provided that the surgeon has not caused excessive iatrogenic damage to the muscles attachments to the fractured bone, are less likely to result in failure of the method of fracture repair before bone healin is completed.
  • Effective load sharing can only be acheived when there is 3 or less fracture peices
48
Q

What type of stance would a dog with HD have?

A
  • Severity dependent
  • Weight shifted forward (Forward press)
  • Waddling pelvic limb gait - overuse of spine
  • Poorly developed hindlimb musculature
  • Pain on extension and abduction of the hips
  • Under GA palpable increased laxity of hip joint
    • Ortolani test
    • Hip lift (Bardens test)
49
Q

What are teh surgical options for a luxating patella?

A
  • Lateral reinforcement techniques
  • Tibial crest transposition
  • Trochleoplasty
    • Wedge recession
    • Block recession
  • Medial desmotomy
  • Corrective osteotomy
  • Transposition of the origin of the rectus femoris
50
Q

What can you see at the red and yellow arrows?

A
  • Red = Osteophyte
  • Yellow = Sclerosis
51
Q

What are some suitable methods of bridging fixation?

A
  • Bone Plates
  • External Skeletal Fiaxtors (ESF’s)
  • Interlocking Nails (ILNs)
52
Q

Which grade Medial Patella Luxations need to be repaired?

A

Grade 2,3,4

53
Q

How do you localise the exact site of lameness in a dog?

after you ahve observed the gait, stance and sit test

A
  • Joint enlargement - not palpable in shoulder and hip
    • effusion
    • periarticular fibrosis
  • Reduced range of motiuon
  • Instability
  • Pain
54
Q

What are the 4 primary physiological forces that may act on a fracture repair?

A
  • Axial compression
  • Bending
  • Torsion (Rotation)
  • Axial Tension
55
Q

Cruciate disease Surgical Treatment

Aims

Types?

A
  • Aims
    • Stabilise the stifle joint
    • Diagnose and treat any meniscal injury present
  • Types
    • Passive joint stabilisation
      • aims to physiclly restraint eh stifle joint
      • Extracapsular stabilisation with synthetic material
      • Intracapsular replacement of the ligament
    • Tibial Osteotomy surgery
      • Active joint stabilisation by changing the biomechanis of the stifle joint
      • No physical restraint of the joint
56
Q

What are the grading system using the Modified Frankel Score ?

A
  • Grade 0
    • Normal Dog
  • Grade 1
    • Paraspinal pain only
  • Grade 2
    • Ataxia, Proprioceptive deficits
  • Grade 3
    • Paraplegia, with voluntary motor function
  • Grade 4
    • Paraplegia, absent voluntary motor function, deep pain intact
  • Grade 5
    • Paraplegia, absent voluntary motor function, absent deep pain
57
Q

Where in the shoulder is OCD found and in what breeds commonly

How do you Diagnose?

A
  • Caudal aspect of humeral head
    • Primary weight bearing site
  • Common Breeds
    • Great dane
    • GSD
    • Newfoundland
    • Bernese Mountain Dog
  • ​Diagnose
    • Lateral radiographs of both shoulders
      • Flattened radiolucent defect in caudal humeral head
      • May see joint mice
  • Surgery is indicated if lameness develops
58
Q

List the cranial nerves

A
59
Q

Whilst doing a Dog Neuro Exam what are we accessing when we are doing

Posture
Gait

A
  • Posture
    • Standing and Walking
      • Head tilt –> vestibular
      • Head or body turn–> Cerebral
      • Neck Postion –> brainstem (tilted), Vestibular, cervical spine (Flexed)
      • Hock ANgle —> Sciatic Nerve
      • Trembling/tremor –> Cerebellum
      • Tail postion
      • Rigidity
  • Gait
    • Strenght
    • Ataxia
    • Paresis : Weakness
      • brain has reduced capacity
    • Plegia: Paralysis
      • brain cannon initiate
60
Q

Where is FCP seen?

A
  • Medial part of the coronoid process ont he Ulna
  • Results in progressive OA
  • Often causes a kissing lesion on the adjecent medial humeral condyle
  • On exam
    • Reduced Range of Motion
    • Palpable elbow effusion and osteophytes
    • Pain on elbow extension
61
Q

What are the three wayscancellous bone grafting helps with bone healing?

A
  • Osteogenesis
    • Vaible translocated bone cells produce newbone
  • Osteoinduction
    • growthfactors induce surrounding pluripotent cells to transform fibroblases and osteoblases to produce bone
  • Osteoconduction
    • Encourages revascularisation
62
Q

When looking at Rads for assessment of HD what are we looking at

What is the best type of rad for diagnosing HD?

A
  • that 50% or more of the femoral head is inside the acetabulum with legs extended
  • PennHip - Need a licence to take these
    • Good predictator of future OA
    • Simulates position of the hip when the dog is standing
    • Documents an Ortolani test
63
Q

A dog is running flat out at the park and suddenly the dog yelps and then their back legs collapse (Paretic/paralysed) behind them. Other than the initial yelp there is no pain, (and this may be unilateral)

What has happened and where?

A

Likely to be FibroCartilaginous Embolism FCE

  • Acute vascular imparment of the spinal cord, embolism in the vessles supplying the spinal cord of medium to large dogs
  • Usually lumbar intumentence, LMN. They have an absent withdrawal reflex although they may have deep pain

REMEMBER FCE is non painful

64
Q

If a dog has any of these where is the Lesion?

  • Blindness
  • Depression
  • Seizures
  • Contralateral loss of postural reactions
  • Contralateral sensory deficits
A

Forebrain

65
Q

What is IVDD Hansen type I

A
  • Acute Onset para/tetra paresis/paralysis
  • Degeneration of the nucleus pulposus (Middle jelly)
    • dehydtarion
    • Chondroid metaplasia
    • mineralisation
  • Occurs in chondrodystrophoid dogs
    • Peak age 3-7years

Remember Large volume High energy - Grade 0 to grade 5 lameness in seconds = Surgery

Low VOlume high energy paralysed, these surgery is of no benifit, cage rest

Hansen type I usually happens T11/12-L3/4 (85%) C2/3-C6/7 (15%)

66
Q

What Cranial nerves does the PLR test

A
  • CNII
  • CNIII
  • CNVII
67
Q

What are the 4 grades of Patella luxation?

A
  • Grade 1
    • Patella in place but can be temporarily luxated
  • Grade 2
    • Patella varies and is easily luxated and reduced
  • Grade 3
    • Patellla luxated but can be temporarily reduced
  • Grade 4
    • Patella permanently luxated and cannot be reduced
68
Q

Treatment/Management of HD?

Consertative?

Surgical

A
  • Consertative Management
    • Weight control
    • Exercise - regular and moderate
    • Treatment
      • NSAIDS - Rimadyl, Metacam, Zubrin
      • Use of DMOADs -
        • Cartrophen (contraindicated with NSAIDS)
        • Cosequin
  • ​Surgical
    • When young dogs want to minimise future DJD (Prevenative)
    • When conserative management is unsuccessful (Salvage)
      *
69
Q

**Where do you feel for effusion in the elbow of a dog?

A

Between the olecranon and the lateral epicondyle of the humerus. The lateral pouch should be concave.

70
Q

Whne doing a Neuro Exam on a dog what are the Postral Reacionts we are testing?

A
  • Hopping
  • Paw Placement
  • Tactile Placing
  • Hemiwalking
  • Wheelbarrowing
  • Extensor postral thrust

These reactios assess both motor and proprioceptive systems

  • Weakness (LMN disease)
  • Pain (Orthopaedic disease)
  • Proprioceptive pathway lesion
71
Q

What are the 5 key biomechanical factors that affect the stability of a fracture after is it repaired repair

A
  1. Type of fracture
  2. Can it be reconstructed
  3. Method of fracture repair
  4. Single or multiple limb injury
  5. Patient size and level of activity
72
Q

When doing a neuro exam on a dog

What CN are involved in Palpebral Fissue and eyelid symmetry

A
  • Tests cranial nerves III, V and sympathetic nerves
  • Ptosis
    • CNIII dysfunction
  • Horners SYndrome
    • Sympathetic dysfunction
    • Enophthalmos, ptosis, miosis, elevation third eyelid
73
Q

How do you treat UAP?

A

Ulna osteotomy and lag screw repair

74
Q

What are the Preventative Surgical options for HD?

A
  • Preventative - Contraindicated if DJD exists
    • Juvenile pubic symphysiodesis (JPS) <20weeks
      • Excellent - needs early detection of HD
      • Surgery most successful if done <20weeks (<16weeks best)
    • Tripple (or double) Pelvic osteotomy (TPO) 5-12 months
      • Axially rotates and lateralises the acetabulum resulting in increased dorsal coverage of the femoral head (Better fit)
  • Salvage (only if WET therapy fails)
    • Total Hip Replacement (THR)
    • Femoral head Excision arthroplasty - Smaller dogs <15kg
75
Q

How do we diagnose HD in a dog?

A
  • Signalment/History
  • Observation
  • Orthopaedic exam
  • Ortolani test
    • Hip joint laxity = hip dysplasia
  • Rads
76
Q

Are these UMN or LMN?

Bladder Easy to express?

Hard and Firm?

A
  • Bladder
    • Easy to Express
      • LMN
    • Hard to Express
      • UMN
77
Q

What is involved in a lameness exam?

A
  • History and signalment
  • Observe gait, stance and sit
  • Standing exam for symmetry
    • Muscle wasting
    • Joint Enlargement
  • Detailed recumbent exam
    • Pain
    • Range of Motion
    • Instability
    • Joint enlargement
  • Further imaging
78
Q

Which direction is more common out of the patella luxations?

A
  • Medial patella luxation most common
  • Toy and small breeds most common
79
Q

What is Osteoarthritis (OA)?

A

Osteoarthritis is a complex of biomechanical and biochemical alterations in

  • articular cartilage
  • subchondral bone
  • joint soft tissues

Which leads to

  • Impaired joint junction
  • inflammaion (arthritis)
  • pain
  • lameness

Can be Primary (aging changes (doesnt happen in dogs) or secondary (most coommon) caused by disease eg HD, OCD, Cruciate Disease

80
Q

Whats the difference between Hansen type I and Hansen type II spinal disease?

A
  • Hansen type I
    • Acute
    • The Gel )Neculas Pulposis) squirts out dorsally
  • Hansen type II
    • Chronic
    • Bulging of Annulus Fibrosis (Outer)

Vet607 - Veterinary Radiology (3 decks)

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