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Small animal surgery > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

When would you use a neutralization vs. compression plate?

A

Neutralization: reducible, midshaft, comminuted fracture
Compression: transverse fractures, lag screws with oblique fractures can work too

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2
Q

What forces does the bone plate neutralize?

A

Axial, rotational, torsion, bending

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3
Q

What is the most common cause of nonunion?

A

Motion

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4
Q

What forces does a cast neutralize?

A

Bending and a little rotational (not axial loading)

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5
Q

What forces does an IM pin neutralize?

A

Only bending

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6
Q

What forces does a cerclage wire neutralize?

A

torsion (these are rarely used on their own)

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7
Q

What forces does a plate neutralize?

A

Bending (attached to bone), axial loading, Torsion

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8
Q

What forces does External Fixators neutralize?

A

Bending, axial loading, torsion

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9
Q

Interlocking nail forces neutralize?

A

Implant that is fixed to the bone: bending, axial compression, torsion

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10
Q

What are the objectives of fracture fixation?

A
  • We want them early weight bearing

- Osseous union (healing) and return to normal function

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11
Q

Things we can control with fracture assessment:

A

reduction
immobilization
excessive operative trauma
asepsis

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12
Q

What is an example of a high fracture score assessment?

A

9 week old puppy with a long oblique tibial fracture and the fibula is intact.

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13
Q

Every orthopedic patient requires:

A

a complete PE, orthopedic exam, and neurological assessment

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14
Q

What is the primary survey for trauma patients?

A 
A - airway
B - breathing
C - circulation
D - disability (BAR,neuro?)
E - examination - whole patient
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15
Q

What do we mean by secondary survey for trauma patients?

A

How is the patient responding to stabilization?

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16
Q

Factors that can influence # of bacteria that cause infection:

A

Virulence of organism
Condition of the wound
Presence of implants
Host defenses

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17
Q

For fractures above the elbow and stifle what type of external coaptation can you use? (Lateral shoulder luxations also)

A

Spica splint

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18
Q

For fractures below the elbow and stifle are best coapted with…

A

Robert Jones, splint or cast

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19
Q

What type of coaptation can you do for craniodorsal hip luxation?

A

Ehmer sling - keeps femoral head in the acetabulum

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20
Q

For medial shoulder luxations what kind of sling do we use?

A

Velpeau

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21
Q

Key is with stabilization of long bone fractures with coaptation?

A

Stabilize the joint above and below the injury

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22
Q

Order of fracture description

A 
Open vs. Closed
Salter-Harris Classification
Orientation (e.g. comminuted)
Location within the bone
Bone
Displacement
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23
Q

Grade 1 - 3 open fractures?

A

level of soft tissue trauma

  1. inside bone poke out then covered
  2. bone exposed
  3. high velocity, severe bone fragmentation exposed bone
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24
Q

What are the Salter-Harris fractures?

A
  1. Separation along the physis
  2. Through the metaphysis and then through the physis
  3. Diaphysis fracture then through physis
  4. both diaphysis and metaphysis straight up
  5. Compression of physis (can’t see on rads well) = later on limb deformity
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25
Q

How is prognosis with salter-harris fractures?

A

Higher the number, the worse the prognosis

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26
Q

What bone can you never really put an IM pin in?

A

the Radius

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27
Q

What are the for As

A

For follow up assessment
Alignment - The joint above and below lining up?
Apposition - fracture segments lining up (50%)
Apparatus - type (appropriate), neutralizing forces?
Activity - Do we see healing

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28
Q

What is considered internal fixation of a fracture?

A

IM pin
Interlocking nail
Cerclage wires
Bone screws and plates

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29
Q

What are the goals for healing?

A

Adequate reduction
Rigid fixation
early active motion
early weight bearing

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30
Q

What are the principles of atraumatic surgical technique with internal fixation?

A

Preserve function
Maintain blood supply
Decrease incidence of infection
Minimize invasion of soft tissue

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31
Q

Implant characteristics?

A 
Biocompatible
Resist corrosion
same alloy (plate and screws)
316L stainless steel
Never reuse (set # of cycles)
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32
Q

What can you place an IM pin in?

A 
Humerus
Femur
Tibia
Ulna
Metacarpals and metatarsals
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33
Q

What are the pros and cons of an IM pin?

A

Pro: resist bending
Cons: poor axial loading, rotational, lack fixation
So IM pins should be used supplementary to something like cerclage, exf, or plate

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34
Q

What is the main force with avulsion fractures?

A

Tension

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35
Q

What is the best fixation for avulsion fractures?

A

Tension bands, good for:
Greater trochanter
Olecranon
Tibial tuberosity

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36
Q

Concepts for applying bone plates

A

Select the appropriate plate size
Select a plate that spans the bone length for diaphyseal fractures (70% of bone)
Accurately contour the plate
Place a minimum of three screws or secure six cortices above and below the fracture.
Use a longer and stronger plate as a bridging plate or augment with IM pin

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37
Q

Types of bone healing

A

Direct (primary)
Indirect (secondary) -
Intramembranous

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38
Q

Factors that affect healing

A 
Biological factors
-Age
-Fracture location 
- Cellular response
- Circulation
- Concurrent soft tissue
Mechanical factors
-Stability of bone segments and fragments after fixation
 Clinical factors
-Aseptic technique
-Activity of patient
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39
Q

What is the normal blood supply of a long bone

A

Nutrient artery
Proximal and distal metaphyseal arteries
Periosteal arteries

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40
Q

Normal blood flow of long bone vs fracture?

A

Normal: Centrifugal - from medullary cavity out to periosteum
Fracture: Centripetal from surrounding soft tissue in

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41
Q

What happens do the blood supply during a fracture?

A
  1. medullary supply is disrupted
  2. Metaphyseal vessels enhanced
  3. extraosseous vasculature
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42
Q

Which reduction (open vs. closed) provides the least amount of disruption to the fracture blood supply?

A

Closed

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43
Q

What is the most important thing to give a fracture to allow it to heal?

A

Stability

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44
Q

what is “biological treatment” method to fracture healing?

A

Preservation of blood supply

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45
Q

What two fixations are highly biologic?

A

Cast or External fixation

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46
Q

What is strain?

A

Motion

The change in the width of the gap over the total width of the gap

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47
Q

What is strain?

A

Motion

The change in the width of the gap over the total width of the gap

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48
Q

If you have strain on a fracture sight at what stage will the healing stop?

A

Fibrous tissue, fibrous callus but no bone formation

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49
Q

How much strain can bone formation tolerate?

A

<2% strain

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50
Q

How close does the fracture gap need to be in order for direct bone healing to occur?

A

150 microns! basically in contact

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51
Q

Where would direct bone healing be favorable?

A

Articular fractures or fractures close to a joint (you don’t want callus formation there)

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52
Q

How can you help speed up healing in a low biological scoring fracture (old dog)

A

Add a bone graft to the fracture site (cancellous autograft)

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53
Q

Where are sources for autogenous cancellous bone?

A

Proximal Humerus
Proximal tibia
Ilium

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54
Q

What are some important properties of bone grafts?

A

Osteogenesis and Osteoinduction

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55
Q

Rate of union in terms of clinical union

A

<3mo Exf: 2 - 3 wks plate:4wks
3 - 6 mo Exf: 4-6 wks Plate:2-3mo
6-12 mo exf:5-8 wk plat 3-5 mo
>1 yr exf : 7 - 12 wks plate: 5mo - 1 yr

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56
Q

Delayed union

A

Slower healing than it should (at 8 weeks not much healing..)

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57
Q

Reasons for delayed union?

A 
Systemic status of the patient
Nature of trauma
High energy fracture (open)
Poor fixation (too rigid, lg gap etc)
Drugs
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58
Q

Non union

A

Repair process is not happening

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59
Q

Reasons for non union

A

poor vascularity
hypertrophic non union (so unstable, it can’t heal)
Atrophic nonunion - biologically inactive

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60
Q

What is the main goal with mandibular/maxillary fractures?

A

If the teeth line up

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61
Q

Tape muzzles work for what?

A

minimally displaced
caudal fractures
comminuted fractures

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62
Q

Dental bonding is used for what?

A

works like an external fixator, more stability than the muzzle. work for same fractures as muzzle

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63
Q

Do mandibular or maxillary fractures more often need fixation?

A

Mandibular (esp. symphysial fractures)

biggest thing is avoiding the teeth

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64
Q

Scapular fractures 50 - 70% of them have concurrent injury

A

usually its high impact injury - and its over the thorax so look for rib fractures also

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65
Q

When do you need to surgically fixate a fracture of the scapula?

A

If it is intraarticular, unstable neck fractures

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66
Q

How many fractures do you typically see with a pelvic fracture?

A

Usually fractures in 3 places since it is a box like structure. (esp. older animals)

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67
Q

Which pelvic fractures require stabilization?

A

Articular fractures (FHO may work too)
Contralateral injuries (more rigid repair for wt.)
If there is uncontrollable pain (usually a sacral fracture)
Wt. bearing bones (ilium, acetabulum, sacroiliac joint)
If it is narrowing the pelvic inlet (esp. breeding animals)

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68
Q

What should you always warn owners about with pelvic fractures?

A

Damage to the urinary system (nerves, etc)

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69
Q

What fractures distal to the tibia/radius should you refer?

A

Carpal/tarsal fractures

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70
Q

When can you do coaptation with?

A

Non-displaced maxillary fractures
Mandibular symphysial fractures
Transverse fractures below the stifle/elbow (young)
Minimally displaced pelvic/scapular fractures
Most metacarpal/metatarsal fractures (unless lg dog)

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71
Q

What type of humus/femur fractures should you refer?

A

Diaphyseal and supracondylar fractures
articular fractures
physeal fractures

72
Q

What is a malunion?

A

Healed fracture that has poor anatomical bone alignment

73
Q

Will a non-articular fracture of a long bone lead to OA?

A

NOPE! only time a long bone fracture MAY lead to OA is if they have a malunion (incorrect loading of the joint)

74
Q

What are some radiographic evidence of osteomyelitis?

A

Periosteal reaction
Sequestrum (rare)
Osteolysis (far progressed)

75
Q

If you have to treat osteomyelitis, how do you select your abx?

A

Based on culture (at site, not tract)

Abx for 4 - 6 weeks

76
Q

When do you take out an implant if you have an infection?

A

If implant is stable, leave until the fracture is healed if unstable, remove and replace (or add External fixator)

77
Q

Why do you want to place a pin in a femur normograde vs retrograde?

A

To avoid impinging the sciatic nerve

78
Q

If you are asked to assess a fracture 4 weeks post - op, what do you assess?

A

Activity
Apparatus
Alignment (again cuz still can change)
Apposition (again)

79
Q

What type of healing would you expect with a compression plate on fracture?

A

Direct (at least minimal callus formation)

80
Q

Which joints are more commonly clinically affected by OA?

A

Elbow, Carpus, Hock

81
Q

How much percent of body weigh is distributed to front limbs?

A

60%

82
Q

What are the clinical causes of OA?

A 
Hip Dysplasia
Elbow Dysplasia
OCD
Patella Luxation
Trauma
Mechanical instability
secondary chronic intraarticular degeneration (Tenosynovitis, CCL)
83
Q

What is an example of first level imaging for OA?

A

Orthogonal bilateral radiographs

84
Q

What is diagnosis of OA based off of?

A

History, Clinical signs and radiographic findings (Not response to treatment)

85
Q

What are the multimodal management strategies for OA?

A
  • Weight reduction
  • Exercise modification (PT/Rehab)
  • NSAIDs/DMOAs
86
Q

What is the general weight loss strategy for OA?

A

Reduce dietary intake by 1/3-1/2 per day

Weigh regularly/monitor with BCS (target 4/9)

87
Q

When are glucocorticoids indicated as a treatment for OA?

A

END STAGE ONLY, shone to make OA worse

88
Q

True or False: NSAIDs used in multimodal therapy are used as part of a daily dosing regimen for OA.

A

FALSE, if used long term only to be used PRN (as needed)

89
Q

What is a drug you can give to inactivate metalloproteinases?

A

Tetracyclines

90
Q

For patients with OA that have sx and those that don’t they should both get what other tx?

A

individualized multimodal approach for tx of clinical signs of OA

91
Q

Differentials for thoracic limb lameness due to dysplasia

A

OCD
UAP
MCPD
Medial compartment disease

92
Q

Why is the incidence of hip dysplasia and elbow dysplasia less than reality with OFA reports?

A

Owners don’t have to submit the radiographs if they don’t want to.

93
Q

What is the pathogenesis of Medial Coronoid Process Disease?

A

Overloading of the medial side of the coronoid (sometimes its a fracture, or erosion, etc)

94
Q

What is the pathogenesis of ununited anconeal process (UAP)

A

Asynchronous growth of the proximal ulna and radius -> radius grows faster than ulna -> Sheering forces on humeral condyle -> salter harris type 1 like fracture of the anconeal process

95
Q

Pathogenesis of Medial compartment disease?

A

Incongruency and overloading of medial compartment of articular surfaces -> cartilage erosion, can be concurrent to MCPD

96
Q

5-8 mo of age, slight lameness, worse after exercise, prominent after resting, discomfort marked on flexion/extension of elbow

A

OCD and MCPD, MCD

97
Q

Where will the lesions be on radiographs with elbow OCD?

A

Weight bearing side of the medial condyle (cranial caudal view)
and osteophytes off the epicondylar ridge and one off the radial head

98
Q

Where will you see an osteophyte in ANY elbow joint disease?

A

off the medial coronoid process

99
Q

With any elbow joint disease what type of diagnostics should you do?

A

BILATERAL RADIOGRAPHS

100
Q

What is a unique radiographic finding for MCPD?

A

Kissing lesion (on the non-weight bearing surface of the medal condyle)

101
Q

What elbow diseases can you rule in/out with plain radiographs?

A

OCD

UAP

102
Q

Diagnosis of UAP

A

Large breed dogs with separate centers of ossification of the anconeal process

103
Q

Clinical signs with UAP

A

7-8 mo old, moderate lameness, circumduction of forelimb! externally rotated paw.

104
Q

When should the physis of the anconeal process close?

A

5 - 5.5 mo

105
Q

For the elbow dysplasia, how is the prognosis for lame free function is..

A

Erosion dependent

106
Q

Small dogs and cats with patellar luxation get OA True or False?

A

FALSE

107
Q

What are the medial patellar luxation grades?

A

1 - in, in (in and you can move it out but put it back in)
2 - in, out
3- out, in
4 - out, out

108
Q

What do neonates and older puppies usually have what grade(s) of patellar luxation?

A

3-4

109
Q

What grades do young to mature dogs get?

A

2-3

110
Q

Older dogs?

A

1-2

111
Q

Any age but subclinical

A

1-3

112
Q

What is the lameness due to with patellar luxation?

A

Mechanical function rather than pain

113
Q

High calcium puppy diets do what to the joints?

A

Can set them up for OCD

114
Q

Which joint is most commonly associated with OCD?

A

The shoulder joint (humeral head)

115
Q

If the dog comes in with a single limb lameness but you find out it is OCD, what should you check?

A

Its a bilateral disease so check the other limb

116
Q

If you have a young dog with stifle pain on flexion and extension, the joint is effusive and thickened. What are your differentials?

A

OCD (young puppies)
CCL (usually middle aged)
Trauma/injury

117
Q

If you see a young dog with hind limb lameness with hyperextension of the tarsal joint, with palpation you notice marked effusion of the medial side of the joint, what is your top differential?

A

Tarsal OCD (would be lateral in Rottweilers)

118
Q

Which radiographic view gives you the best view of shoulder OCD?

A

Bilateral lateral radiographs

119
Q

Where is the OCD lesion for stifle usually?

A

The lateral side of the medial femoral condyle or the lateral femoral condyle and osteophytes

120
Q

Which OCD lesion usually involves a large fragment of bone as well?

A

The tarsal/hock OCD lesions

121
Q

What is the only OCD lesion where early conservative management may improve the clinical signs?

A

Shoulder joint (if there is no mineralization present and they are < 6 months old)

122
Q

Is OCD considered a heritable disease in dogs?

A

YES

123
Q

How is the hind limb held when they have a craniodorsal luxation of the femoral head? caudoventral luxation?

A

CD: Stifle is externally rotated, limb is adducted
CV: Stifle is internally rotated and limb is abducted

124
Q

What is critical to determine the orientation of the luxation and potential fractures of the Coxofemoral joint?

A

Orthogonal views

125
Q

How soon after hip is luxated do you have to do a closed reduction?

A

3 days (less than 7)

126
Q

What are the open reduction techniques for Coxofemoral luxations?

A 
Capsulorraphy
Toggle Pin
Transarticular pinning
Prosthetic capsule
Transpostision of the greater trochanter
(all are trying to restablish the ligementum of teres)
127
Q

What is the exception to the rule of closed reduction before open in Coxofemoral joint luxation?

A

Hip dysplasia (their hip joints/ligaments are already lax) open reduction works best for these guys

128
Q

True or False, A cause common of hind limb (hip joint) lameness in dogs is typically OA

A

False, dogs with hip dysplasia often have SEVERE OA but can get around just fine

129
Q

What is the common breed and direction of displacement of shoulder luxations?

A

(75%) medial - small breeds

- potentially congenital (look at the patella’s too)

130
Q

Clinical signs of a medial shoulder luxations?

A

forelimb is abducted and externally rotated, joint swelling, greater tubercle is medially displaced, pain and instability of joint.

131
Q

Which way does the shoulder joint need to be displaced in order to use a Velpeau sling?

A

Medially

132
Q

How long do you keep them in the sling?

A

2 weeks

133
Q

What do you do for close reduction if the shoulder is luxated laterally?

A

Spica (2 weeks)

134
Q

What keeps the shoulder joint stable normally?

A 
Active stabilizer-
-subscapularis tendon (medial side)
Passive stabilizers-
medial glenohumeral ligaments
labrum
135
Q

What is the common luxation of the elbow?

A

Lateral luxation

136
Q

What is the treatment?

A

Closed reduction - modified Robert jones - or spica

Open reduction - collateral ligaments (do if not reducing)

137
Q

Traumatic luxation of stifle

A

uncommon
rupture of collateral ligaments, CCLs
non weight bearing

138
Q

Treatment?

A

Surgery, small and large dogs, External fixator with a trans-articular joint

139
Q

Carpal sprains

A

common, hyperextension

splint primary and secondary sprains.

140
Q

How do you treat tarsal sprains?

A

same as carpal sprains

141
Q

Congenital elbow luxation in dogs will have

A

limited range of motion and progressive osteoarthritis

142
Q

True or False: the reduction of traumatic Coxofemoral luxations should be delayed as long as possible to preserve as much hyaline cartilage of the joint as possible

A

False

143
Q

Collateral ligament injuries are common on what part of the body?

A

Carpus and tarsus

144
Q

What instability do you see if you see Varus?

A

Lateral collateral ligament

145
Q

Valgus?

A

Medial collateral ligament

146
Q

What is treatment for collateral ligament injury?

A

Conservative (ice 3 days, then heat, NSAIDs, splint 4 wks)
Primary repair - suturing CL
Secondary repair - prosthetic (suture)

147
Q

Which joints should you try closed reduction first?

A

Hip, Shoulder, Elbow

148
Q

Which joints should you NOT try closed reductions first?

A

Stifle, carpus, tarsus

149
Q

What is the use of CCLs besides mechanical use?

A

Loss of proprioception (loss of stabilization of the joint)

150
Q

Pathogenesis of CCL Rupture

A

Early spaying and neutering (<6mo)

Progressive - immune-mediated (Degeneration)

151
Q

What three breeds of dogs are over-represented with CCL disease?

A

Lab
Rottweiler
Newfinland

152
Q

Newfies usually present… why?

A

bilateral CCL, genetic identified

153
Q

True or False, the risk of CCL rupture on the contralateral hind limb after a single CCL rupture increases esp with excessive weight

A

FALSE, not correlated with studies

154
Q

What are the radiographic findings of CCL

A

Effusion (caudally)
Osteophytes
medial buttress (stifle instability)

155
Q

When can you do conservative treatment with CCLs?

A

< 15 Kg, or clinically normal

156
Q

What about cats with CCL?

A

Weight management

157
Q

When should you do rehab for CCLs?

A

With conservative treatment AND post op!

158
Q

Which is better TPLO or TTA?

A

TPLO

159
Q

What is required for a TPLO to function?

A

intact caudal cruciate ligament to function

160
Q

What is hoop stress?

A

Loss of edges of the meniscus and results in joint instability

161
Q

Pathogenesis of meniscal tear?

A

Constant sheering on the medial meniscus

162
Q

If you have a click on stifle palpation what is likely?

A

meniscal tear

163
Q

Treatment for meniscal tears?

A

Take it out (aren’t lame from it)

164
Q

Strains

A

junciontal (myotendinous jct, tenosseous)

165
Q

PE findings with myo/tendonopathies

A

heat, swelling, pain, fibrous tissue, loss of continuity, alteration in function

166
Q

Strains are not graded like sprains

A

based off of severity of damage

167
Q

Medical

A

chronic

168
Q

surgical

A

acute

169
Q

Medical treatment for acute strains

A 
ice (24 - 72 hr)
heat (>72 hr)
NSAIDs
Methocarbamol
Hydrotherapy (later in healing)
acupuncture
170
Q

Supraspinatus myopathy/tendon mineralization - muscles/tendons involved?

A

Supraspinatus, Biceps

171
Q

PE and diagnostics

A

PE: no pain on palpation, discomfort on biceps palpation
Dx: radiographs, ultrasound!! (best)

172
Q

How do you treat non-mineralized

A

medical, NSAIDs, PRP rest 6 weeks +/- rehab

173
Q

Tx for mineralized?

A

NO PRP (platelet rich protein), go in arthroscopically partial tenectomy, restrict activity 6 weeks, rehab

174
Q

When do you see shifting limb lameness?

A

Bilateral disease (e.g. tenosynovitis of biceps tendon)

panosteotis

175
Q

Radiographically what do you see with biceps tenosynovitis

A

osteophytes on intertubertcular groove

Small animal surgery (1 decks)

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