Radiographic Evaluation, Complications and Neoplasia Flashcards
Why do we take post-op RADs?
To see if repair is acceptable or if changes need to be made
What 3 things are we checking on re-check RADs?
Is bone healing?
Are implants stable?
Any other concerning changes?
What are the 4 A’s of systematic assessment?
Apposition
Alignment
Apparatus
Activity
What is meant by Apposition?
Are fragments well apposed?
What is meant by Alignment?
Are joints above and below fracture aligned properly?
What is meant by Apparatus?
Is the fixator/implants appropriately placed and are they loosening or failing?
What is meant by Activity?
Is there evidence of:
- Bone healing
- Infection
- Osteopenia
- Malunion
What is the average healing time for a fx?
6-8 weeks
What are 5 things that affect bone healing?
Configuration/severity Soft tissue damage Stability Presence of infection Patient factors
What is delayed union?
Healing is prolonged, but callus is visibe
What is malunion?
Failure to reestablish normal form and function
What are the two types of nonunion?
Viable
Nonviable
What is viable nonunion?
Active fx with cartilage and fibrous tissue between fx ends
What is a nonviable nonunion?
Fracture ends are sclerotic with rounded bone edges and visible fracture gap
What are 4 types of “fracture disease”?
Joint stiffness
Musclecontracture/scarring
Disuse osteoporosis
Ligamentous laxity
What is quadriceps contracture?
Often irreversible replacement of muscle fibers by fibrous tissue, severe decrease in limb mobility
What 4 things can share quadriceps contracture as a complication?
Distal femoral fractures
Young patients
Prolonged immobilization
Extensive muscle/ST trauma
What are 4 clinical signs of quadriceps contracture?
Tight band at level of quad
Extension of tarsus and stifle with major decrease in ROM
Muscle atrophy
Difficulty ambulating on limb
What are 3 ways to prevent quadriceps contracture?
Use stable, rigid fixation to promote early limb use
Passive range of motion
NSAIDs
NOTE: Prevention is IMPERATIVE, treatment rarely successful
What is the prognosis for quadriceps contracture?
Poor for full fxn
Guarded for partial fxn
What is disuse osteoporosis?
Decrease in stress application to the bone = increased osteoclast activity… Wolff’s Law
When do we see muscle atrophy?
Secondary to disuse or immobilization
Is muscle atrophy permanent or reversible?
Reversible, can take a long time though
What is ligamentous laxity?
Loose ligaments and joint instability associated with muscle atrophy
How can ligamentous laxity be fixed?
Should resolve with improved muscle tone
What is cartilage atrophy?
Atrophy of cartilage after prolonged immobilization of a joint
What is digital flexor contracture?
Associated with improper casting/splinting of the elbow/antebrachial fx
How do you prevent digital flexor contracture?
Lumb must be in weight-bearing position
What is a fracture associated sarcoma associated with?
Severe inflammation
What are 3 causes of severe inflammation that might result in a fracture associated sarcoma?
Comminuted fx
History of complications
Implant corrosion
What are 4 types of primary bone neoplasia?
Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Hemangiosarcoma
What are 2 types of metastatic bone neoplasia?
Multiple myeloma
Lymphoma
What are the 2 common types of digital tumor in a dog?
SCC
Melanoma
What are the 5 common types of digital tumor in a cat?
SCC FSA AdCa OSA HSA
What constitutes 85% of canine skeletal tumors?
Osteosarcoma
Who is predisposed to OSA?
Large and giant breed dogs 18-24 months of age or ~7years (Bimodal age distribution)
What is the most common site for OSA
Appendicular skeleton, with predilection for metaphyseal region of long bones
NOTE: Away from the elbow, towards the knee
What does the hx look like with OSA?
Chronic, progressive lameness (pathologic fx may result in acute and severe worsening of lameness)
May respond to pain management (pathologic fx may present response)
What will exam findings be with OSA?
Pain +/- swelling on palpation of affected area
Disuse muscle atrophy
What are 4 major radiographic changes you’ll see with osteosarcoma?
Cortical lysis
Periosteal reaction
Mineralization of soft tissue
Lack of distinct border
What is the gold standard for diagnosing OSA?
NOTE: Be sure to take multiple samples from center of the mass
What is often present in most patients at time of initial diagnosis?
Micromets (seen in lung, other bones and LNs)
What 3 things should staging of OSA include?
3 view RADs or CT (CT is better)
Aspiration of any enlarged LNs
CBC/Chem/UA (Increased ALKP = poorer prognosis)
What 3 things does palliative OSA treatment include?
Pain mangement
Bisphosphenates (inhibit osteoclasts)
Radiation (helps with pain management)
Does amputation help mean survival time with OSA?
Not really, 3-4 months
How much does amputation and chemo help OSA survival times?
MST increases to ~9-12 months
What is a limb sparing surgery?
Local removal of OSA with wide margins, then bone replaced (allograft, autograft, prosthesis, regenerated bone)
What lesion has the best outcome for limb sparing surgery?
Distal radial lesion
