Radiographic Evaluation, Complications and Neoplasia

Question 1

Why do we take post-op RADs?

Answer 1

To see if repair is acceptable or if changes need to be made

Question 2

What 3 things are we checking on re-check RADs?

Answer 2

Is bone healing?
Are implants stable?
Any other concerning changes?

Question 3

What are the 4 A’s of systematic assessment?

Answer 3

Apposition
Alignment
Apparatus
Activity

Question 4

What is meant by Apposition?

Answer 4

Are fragments well apposed?

Question 5

What is meant by Alignment?

Answer 5

Are joints above and below fracture aligned properly?

Question 6

What is meant by Apparatus?

Answer 6

Is the fixator/implants appropriately placed and are they loosening or failing?

Question 7

What is meant by Activity?

Answer 7

Is there evidence of:

• Bone healing
• Infection
• Osteopenia
• Malunion

Question 8

What is the average healing time for a fx?

Answer 8

6-8 weeks

Question 9

What are 5 things that affect bone healing?

Answer 9

Configuration/severity
Soft tissue damage
Stability
Presence of infection
Patient factors

Question 10

What is delayed union?

Answer 10

Healing is prolonged, but callus is visibe

Question 11

What is malunion?

Answer 11

Failure to reestablish normal form and function

Question 12

What are the two types of nonunion?

Answer 12

Viable

Nonviable

Question 13

What is viable nonunion?

Answer 13

Active fx with cartilage and fibrous tissue between fx ends

Question 14

What is a nonviable nonunion?

Answer 14

Fracture ends are sclerotic with rounded bone edges and visible fracture gap

Question 15

What are 4 types of “fracture disease”?

Answer 15

Joint stiffness
Musclecontracture/scarring
Disuse osteoporosis
Ligamentous laxity

Question 16

What is quadriceps contracture?

Answer 16

Often irreversible replacement of muscle fibers by fibrous tissue, severe decrease in limb mobility

Question 17

What 4 things can share quadriceps contracture as a complication?

Answer 17

Distal femoral fractures
Young patients
Prolonged immobilization
Extensive muscle/ST trauma

Question 18

What are 4 clinical signs of quadriceps contracture?

Answer 18

Tight band at level of quad
Extension of tarsus and stifle with major decrease in ROM
Muscle atrophy
Difficulty ambulating on limb

Question 19

What are 3 ways to prevent quadriceps contracture?

Answer 19

Use stable, rigid fixation to promote early limb use
Passive range of motion
NSAIDs

NOTE: Prevention is IMPERATIVE, treatment rarely successful

Question 20

What is the prognosis for quadriceps contracture?

Answer 20

Poor for full fxn

Guarded for partial fxn

Question 21

What is disuse osteoporosis?

Answer 21

Decrease in stress application to the bone = increased osteoclast activity… Wolff’s Law

Question 22

When do we see muscle atrophy?

Answer 22

Secondary to disuse or immobilization

Question 23

Is muscle atrophy permanent or reversible?

Answer 23

Reversible, can take a long time though

Question 24

What is ligamentous laxity?

Answer 24

Loose ligaments and joint instability associated with muscle atrophy

Question 25

How can ligamentous laxity be fixed?

Answer 25

Should resolve with improved muscle tone

Question 26

What is cartilage atrophy?

Answer 26

Atrophy of cartilage after prolonged immobilization of a joint

Question 27

What is digital flexor contracture?

Answer 27

Associated with improper casting/splinting of the elbow/antebrachial fx

Question 28

How do you prevent digital flexor contracture?

Answer 28

Lumb must be in weight-bearing position

Question 29

What is a fracture associated sarcoma associated with?

Answer 29

Severe inflammation

Question 30

What are 3 causes of severe inflammation that might result in a fracture associated sarcoma?

Answer 30

Comminuted fx History of complications Implant corrosion

Question 31

What are 4 types of primary bone neoplasia?

Answer 31

Osteosarcoma Chondrosarcoma Fibrosarcoma Hemangiosarcoma

Question 32

What are 2 types of metastatic bone neoplasia?

Answer 32

Multiple myeloma | Lymphoma

Question 33

What are the 2 common types of digital tumor in a dog?

Answer 33

SCC | Melanoma

Question 34

What are the 5 common types of digital tumor in a cat?

Answer 34

``` SCC FSA AdCa OSA HSA ```

Question 35

What constitutes 85% of canine skeletal tumors?

Answer 35

Osteosarcoma

Question 36

Who is predisposed to OSA?

Answer 36

Large and giant breed dogs 18-24 months of age or ~7years (Bimodal age distribution)

Question 37

What is the most common site for OSA

Answer 37

Appendicular skeleton, with predilection for metaphyseal region of long bones NOTE: Away from the elbow, towards the knee

Question 38

What does the hx look like with OSA?

Answer 38

Chronic, progressive lameness (pathologic fx may result in acute and severe worsening of lameness) May respond to pain management (pathologic fx may present response)

Question 39

What will exam findings be with OSA?

Answer 39

Pain +/- swelling on palpation of affected area | Disuse muscle atrophy

Question 40

What are 4 major radiographic changes you'll see with osteosarcoma?

Answer 40

Cortical lysis Periosteal reaction Mineralization of soft tissue Lack of distinct border

Question 41

What is the gold standard for diagnosing OSA?

Answer 41

NOTE: Be sure to take multiple samples from center of the mass

Question 42

What is often present in most patients at time of initial diagnosis?

Answer 42

Micromets (seen in lung, other bones and LNs)

Question 43

What 3 things should staging of OSA include?

Answer 43

3 view RADs or CT (CT is better) Aspiration of any enlarged LNs CBC/Chem/UA (Increased ALKP = poorer prognosis)

Question 44

What 3 things does palliative OSA treatment include?

Answer 44

Pain mangement Bisphosphenates (inhibit osteoclasts) Radiation (helps with pain management)

Question 45

Does amputation help mean survival time with OSA?

Answer 45

Not really, 3-4 months

Question 46

How much does amputation and chemo help OSA survival times?

Answer 46

MST increases to ~9-12 months

Question 47

What is a limb sparing surgery?

Answer 47

Local removal of OSA with wide margins, then bone replaced (allograft, autograft, prosthesis, regenerated bone)

Question 48

What lesion has the best outcome for limb sparing surgery?

Answer 48

Distal radial lesion