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Year 4 > SA Orthopaedics > Flashcards

SA Orthopaedics Flashcards

1
Q

What should you check if there is a fracture on one side of the pelvis?

A

Check the other side for fractures as the pelvis is usually broken in 2 places

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2
Q

What would happen if you didn’t repair a hip fracture?

A

Osteoarthritis

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3
Q

How can you check whether a pelvic radiograph is straight?

A

Check that the obturator foramen are symmetrical

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4
Q

How do you know if an animal is deep-pain negative or positive?

A

Pinch foot

Animal will pull foot away on reflex, but if it is deep-pain positive it will also look around/yelp/HR will increase

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5
Q

What should you assess when an animal is presented with a possible pelvic fracture?

A

ABC
Control haemorrhage if present
Fluids and shock therapy
Check for other injuries eg diaphragmatic rupture, neurological injury, urinary tract, function of pelvic nerve-perineal reflex
Analgesics-opioids, NSAIDs (not if renal dysfunction)

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6
Q

How may a fractured pelvis affect breeding?

A

May lead to pelvic narrowing

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7
Q

What is neuropraxia?

A

Nerve injury
Has voluntary movement but can’t feel ends of feet
Will recover

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8
Q

Fractures affecting which parts of the pelvis are suitable for conservative management?

A

Those on non-weightbearing axes:
Pubis
Ischium
Wings of ilium

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9
Q

What conservative management would you prescribe to a patient with pelvic fractures?

A

Cage rest for 4-6 weeks
If non-ambulatory: frequent turning and soft bedding
Check bladder qid if not urinating consciously
Analgesia (opioids- full or partial agonists of buprenorphine, NSAIDs if not worried about kidneys)

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10
Q

Surgical treatment is required for which fractures of the pelvis?

A

Sacroiliac separations
Iliac shaft fractures
Acetabular fractures

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11
Q

Femoral head and neck excision is only recommended for dogs up to which weight?

A

15kg

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12
Q

How do cats’ vertebrae differ from dogs?

A

Cats’ are longer and thinner

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13
Q

How do sacroiliac fractures commonly occur?

A

RTA in cats

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14
Q

How will an animal present if it has a sacroiliac separation?

A

Non-ambulatory
+++ pain (esp if nerve root entrapment)
Marked displacement

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15
Q

What treatment is required for sacroiliac separation?

A

Surgery:

  • Lag screw fixation (most commonly used; one long screw in sacral body)
  • Transillial pin
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16
Q

How would you repair an iliac shaft fracture?

A

Most require internal fixation (plating)

Surgical approach involves ‘gluteal roll up’

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17
Q

How would you repair an acetabular fracture?

A 
Internal fixation (plate)
Small dogs/cats: femoral head and neck excision
Surgical approach involves trochanteric osteotomy or gluteal tenotomy
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18
Q

Which nerve runs over the greater trochanter of the femur?

A

Sciatic

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19
Q

What post-operative care would you recommend for pelvic fractures?

A

Cage rest/restricted room rest for 4-8 weeks
Treat as with conservative management-short on-lead walks (5-10 mins) until re-radiograph
See at 3, 7-10 days then 4-8 weeks post-op for repeat radiographs
Analgesia, soft bedding
Physio?

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20
Q

How would you identify a pathological fracture on a radiograph?

A

Thin cortices

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21
Q

What may cause a pathological fracture in puppies and kittens?

A

Nutritional deficiencies

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22
Q

What may cause a pathological fracture in a rottweiler?

A

Osteosarcoma (FLs)

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23
Q

How many carpal bones are there?

A

7

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24
Q

What are the carpal bones supported by?

A

Ligaments

Palmar fibrocartilage

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25
Q

Give some clinical signs of problems with the carpus

A
  • FL lameness (usually non weight-bearing)
  • Abnormal stance: palmigrade
  • Soft tissue swelling
  • Joint effusion
  • Pain/discomfort on manipulation
  • Crepitus on range of motion
  • Instability: lateromedial or craniocaudal
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26
Q

Which dog breeds are more prone to degenerative processes in the carpal ligaments/palmar fibrocartilage?

A
  • Collies

- Shelties

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27
Q

How would you diagnose a carpal/tarsal/metacarpal/metatarsal/phalangeal injury?

A
  • History: acute vs chronic, trauma?
  • Orthopaedic examination
  • Diagnostic tests: radiography (plain vs stress views), CT, MRI (rare), synovial fluid analysis (OA, inflammatory), scintigraphy (to localise lameness)
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28
Q

How does hyperextension of the carpus occur?

A

Usually traumatic

Caused by disruption of palmar ligaments and fibrocartilage

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29
Q

How would a dog present if it had hyperextension of the carpus?

A

Palmigrade stance

Initial swelling of joint which would reduce after a few days, no obvious signs of pain

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30
Q

Which joint is most likely to be affected by hyperextension of the carpus?

A

Carpometacarpal

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31
Q

How would you idenitfy hyperextension of the carpus on a radiograph?

A

Opening in carpal joint space -> ligaments/fibrocartilage has ruptured

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32
Q

How do you treat hyperextension of the carpus?

A
  • Partial carpal arthrodesis (pin/plate fixation)

- Pancarpal arthrodesis (dorsal/palmar plate. external fixator)

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33
Q

Shearing injuries of the carpus are more common on which aspect of the limb?

A

Medial

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34
Q

How many tarsal bones are there?

A

7

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35
Q

Give some clinical signs of problems with the tarsus

A
  • HL lameness (usually non weight-bearing)
  • Abnormal stance: plantigrade
  • Soft tissue swelling
  • Joint effusion
  • Pain/discomfort on manipulation
  • Crepitus on range of motion
  • Instability: lateromedial or craniocaudal
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36
Q

Which tendon inserts on the calcaneus?

A

Common calcanean tendon

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37
Q

Give some specific pathologies that affect the tarsal joint

A
  • Luxations/subluxations
  • Fractures
  • Shearing injuries
  • Hyperextension
  • OCD
  • Luxation of tendon of SDFT
  • Common calcanean tendon pathologies
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38
Q

How can you repair tarsal luxations/subluxations?

A
  • Ligament rupture reconstruction
  • Ligament augmentation with prosthetic ligaments
  • Reattach avulsed ligaments if possible
  • Pantarsal arthrodesis
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39
Q

How would you repair a fracture to the calcaneus?

A

Lateral or plantar plate fixation

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40
Q

How would you repair an avulsion of the common calcanean tendon/proximal fracture of calcaneus?

A

Pins and tension band on calcaneus

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41
Q

How would you repair fractures of the tarsal bones?

A
  • Reduction and stabilisation with pins/lag screws/plates
  • If very small fragments: conservative vs removing fragments
  • Arthrodesis: partial tarsal arthrodesis vs pantarsal arthrodesis
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42
Q

How would you diagnose luxation of the superficial digital flexor tendon?
How does it occur?

A
  • Intermittent lameness
  • Popping sensation on hock (tarsus) ROM
  • Caused by rupture of the medial or lateral retinaculum
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43
Q

How would you treat luxation of the superficial digital flexor tendon?

A
  • Debridement of fibrous tissuse and tendon reduction
  • Suture tendon and ruptured retinaculum
  • Remove/imbricate (overlap) stretched retinaculum
  • Lateral splint support for 2-3 weeks
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44
Q

Which tendons make up the common calcaneal tendon?

A
  • Gastrocnemius
  • Common tendon of biceps femoris, semitendinosus and gracilis
  • SDFT
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45
Q

How could you differentiate between partial and complete rupture/avulsion of the common calcaneal tendon?

A

Partial: plantigrade stance with flexed digits (as SDFT is not affected)
Complete: plantigrade stance with normal/extended digits

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46
Q

How would you diagnose common calcaneal tendon injuries?

A
  • History/orthopaedic exam
  • Radiography: soft tissue swelling, chronic changes, avulsions
  • US
  • CT
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47
Q

How would you treat a common calcaneal tendon injury?

A
  • Debride necrotic edges of tendon
  • Suture tendon individually
  • Make bone tunnels if avulsions of small bone fragments (to place sutures through)
  • Reattach large avulsions: pins and tension bands
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48
Q

How would you manage a common calcaneal tendon injury post-surgery?

A

Immbolisation for 8-10 weeks:

  • Cast/lateral splint (don’t provide much support)
  • Calcaneotibial screw
  • External fixator
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49
Q

Osteochondritis dissecans (OCD) is more common in which kind of dog breeds?

A

Large breeds

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50
Q

Osteochondritis dissecans typically affects which ridges of the talus?

A

Affects both, but medial more often

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51
Q

What is osteochondritis dissecans?

A

Disturbance of endochondral ossification

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52
Q

How would you diagnose osteochondritis dissecans?

A
  • History/ortho exam
  • Radiography
  • CT
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53
Q

How do you treat osteochondritis dissecans?

A
  • Conservative vs surgical (open or arthroscopy)

- Surgical has bette prognosis, but better results if patient <6 months old

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54
Q

What is likely to occur as a result of osteochondritis dissecans?

A

Long-term osteoarthritis

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55
Q

What is the prognosis for osteochondritis dissecans?

A

Poor

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56
Q

How would you treat a fracture/luxation of the central tarsal bone?

A
  • Positional screw into 4th tarsal bone

- Lateral splint support for 4 weeks

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57
Q

Which dog breed is predisposed to tarsal hyperextension?

A

Shetland sheepdog

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58
Q

How would you treat subluxation/luxation of the tarsal bones?

A

Partial tarsal arthrodesis (bone plate or external fixator)

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59
Q

What are the principles of arthrodesis?

A
  • Remove articular cartilage, exposing subchondral bone
  • Maintain proper joint angles
  • Rigid long-standing fixation (most commonly bone plates)
  • Bone grafting
  • Additional stabilisation: splints
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60
Q

What is the proper joint angle of the carpus?

A

10-12 degrees of extension

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61
Q

What is the proper joint angle of the tarsus in dogs and cats?

A

Dogs: 135-145 degrees of extension
Cats: 115-125 degrees of extension

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62
Q

Give some clinical signs of metacarpus/tarsus/phalanges injuries

A
  • FL/HL lameness
  • Soft tissue swelling
  • Joint effusion
  • Pain/discomfort on manipulation
  • Crepitus on ROM
  • Instability: lateromedial or craniocaudal
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63
Q

How would you treat metacarpal/metatarsal fractures?

A

Conservative with external coaptation (casts/bandages)
Surgical with IM pins or dorsal plates if:
->2 bones involved (esp bones II and III)
->50% displaced
-Base of bones are affected or aricular fractures
-Large breeds/working dogs

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64
Q

How would you repair luxations/subluxations of the phalanges?

A
  • Reductions and primary repair of ruptured ligaments (support with external coaptation or external fixator)
  • Toe amputation
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65
Q

Give some indications for imaging the skeletal system

A
  • Acute/chronic lamess
  • Skeletal/joint pain
  • Fracture confirmation/characterisation
  • Swelling centered on bones/joints
  • Monitoring/screening for inherited musculoskeletal disease (eg hip dysplasia)
  • Metabolic bone disease
  • Evaluation of systemic disease
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66
Q

How may geometric distortion occur when taking a radiograph?

A

If structure is towards the edge of the collimated area, or not truly parallel to the film/detector

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67
Q

Give some limitations of radiography

A
  • Oblique projections can create apparent artefactual lesions
  • Poor soft tissue contrast resolution
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68
Q

What is serial radiography?

A

Multiple radiographs taken over a period of time

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69
Q

Why may you want to utilise serial radiography?

A
  • Monitor progression of disease
  • Assess dynamic component of disease
  • Can be useful if diagnosis is uncertain
  • Show diseases radiographically occult (hard to see) in their early stages
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70
Q

How should you describe a radiographic lesion using the Rontgen signs?

A
  1. Number of lesions
  2. Size
  3. Shape (inc margins)
  4. Location
  5. Opacity
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71
Q

What should you consider when you see a lesion on a radiograph?

A
  • Could be an artefact of poor positioning/technique
  • Could be a feature/variant of normal anatomy
  • Could be a composite shadow of superimposed normal structures
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72
Q

What should you assess when looking at bones on a radiograph?

A
  • Alignment, shape, length
  • Periosteal reaction/cortical lysis/defects
  • Endosteal/medullary changes
  • Physes
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73
Q

What should you assess when looking at joints on a radiograph?

A
  • Swelling/effusion
  • Subchondral bone
  • Periarticular changes
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74
Q

Why may you see a focal reduction in size of soft tissues (eg muscles) on a radiograph?

A
  • Chronic lameness
  • Neurogenic (eg nerve damage)
  • Fibrosis/scarring
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75
Q

Why may you see a focal increase in size of soft tissues (eg muscles) on a radiograph?

A
  • Trauma
  • Abscess/seroma
  • Granuloma
  • Neoplasia
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76
Q

Why may you see a diffuse increase in size of soft tissues (eg muscles) on a radiograph?

A
  • Oedema
  • Cellulitis/vasculitis
  • Diffuse neoplasia
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77
Q

What part of the bone is the endosteum?

A

Layer surrounding the medulla

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78
Q

A reduction in opacity means the radiograph is different how?

A

More black

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79
Q

Why may there be a reduction in opacity on a radiograph?

A
  • May be artefactual
  • If generalised: nutritional secondary hyperparathyroidism
  • If focal: neoplasia, occasionally osteomyelitis
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80
Q

What % of mineral loss of a bone is required for it to have reduced opacity on a radiograph?

A

30-60%

Takes a minimum of 7 days to become apparent

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81
Q

What are the 3 descriptions of focal bone lysis?

How aggressive are they?

A

Geographic (less aggressive, area of lysis is fairly well-defined)
Moth-eaten
Permeative (more aggressive, lots of tiny areas of destruction, poorly defined)

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82
Q

Describe a typical aggressive bone lesion as seen on a radiograph

A
  • Long transition zone
  • Active periosteal reaction
  • Cortical integrity is damaged by destruction/expansion
  • Soft tissue swelling/mass
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83
Q

How should skeletal lesions be categorised?

A
  • Monostotic/polyostotic
  • Focal/generalised
  • Symmetrical/assymetrical
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84
Q

What should you assess regarding joints on a radiograph of a lame animal?

A
  • Soft tissue swelling
  • Joint space width
  • Subchondral bone opacity
  • Osteophytes/enthesophytes
  • Periarticular mineralisation
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85
Q

What are enthesophytes?

A

Abnormal bony projections as the attachment of a tendon/ligament

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86
Q

What are osteophytes?

A

Abnormal bony projections in joint spaces

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87
Q

Give some examples of subchondral defects

A
  • Osteochondrosis
  • Aseptic necrosis (femoral head)
  • Septic arthritis
  • Erosive arthritis (carpus/tarsus)
  • Soft tissue neoplasia
  • Trauma (avulsions)
  • Osseous cyst-like lesions
  • Osteoarthritis (only if very severe)
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88
Q

Give some pathologies that may occur on the periarticular bone of a joint

A
  • Osteophytes (joint capsule)/enthesophytes (ligament attachments)
  • Synovial osteochondroma (cats)
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89
Q

What is an osteochondroma?

A

Benign bone tumour

Appears as cartilage-capped bony projections on the surface of bones

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90
Q

How would you identify osteoarthritis on a radiograph?

A
  • Soft tissue swelling/effusion
  • Periarticular new bone at predictable sites (osteophytes) (eg end of patellar, trochlear ridge)
  • Subchondral sclerosis
  • Narrowed joint space (if weight-bearing/very severe)
  • Look for primary disease process
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91
Q

With osteoarthritis, which part of the elbow is the first to get osteophyte formation?

A

Anconeal process

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92
Q

What is the significance of calcified bodies in the joints on radiographs?

A
  • Common

- Normal at predictable sites (sesamoids, accessory centres of ossification)

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93
Q

What are the predilection sites of osteochondrosis?

A
  1. Caudal aspect of humeral head
  2. Media part of humeral condyle
  3. Lateral femoral condyle
  4. Medial trochlear ridge of talus
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94
Q

What are the predilection sites of osteosarcoma?

A
  1. Proximal humerus
  2. Distal radius/ulna
  3. Distal femur
  4. Proximal tibia
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95
Q

US is useful for which joint in particular?

A

Shoulder (soft tissue problems are common and difficult to evaluate with radiographs)

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96
Q

Which key soft tissue structures of the shoulder are useful to evaulate with US?

A
  • Biceps tendon and sheath (craniomedial)

- Supraspinatus and infraspinatus muscles/tendons (lateral/craniolateral)

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97
Q

How is the hip joint kept stable?

A
  • Teres ligament (attaches femoral head to acetabular fossa)
  • Trans-acetabular ligament (ventral aspect of joint)
  • Joint capsule
  • Surrounding muscles
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98
Q

Give some developmental conditions of the hip joint

A
  • Hip dysplasia

- Legg-Perthe’s disease

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99
Q

Give some acquired conditions of the hip joint

A
  • OA
  • Neoplasia
  • Immune-mediated arthropathy
  • VWHOOD (von Willebrand associated heterotopic osteochondrofibrosis of Dobermans)
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100
Q

Give some traumatic conditions of the hip joint

A
  • Acetabular fractures
  • Fractures of femoral head and neck
  • Coxofemoral luxation
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101
Q

How would you characterise hip dysplasia?

A

Laxity and instability of the coxofemoral joint

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102
Q

Which animals are more prone to hip dysplasia?

A
  • Large breed dogs

- Pedigree cats eg Maine Coon, Devon Rex

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103
Q

Which factors control the degree of joint laxity in hip dysplasia?

A

-Genetics, growth rate, nutrition, exercise

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104
Q

Give the aetiopathogenesis of hip dysplasia

A
  • Laxity due to poor soft tissue support of coxofemoral joint -> thickening of joint capsule -> early OA -> femoral head subluxates from acetabulum
  • Erosion of joint margins (eg dorsal acetabular rim)
  • Pain and disuse -> poor muscle development around hip -> further destabilisation
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105
Q

Give the 2 presentations of hip dysplasia

A
  • Young dogs (<1yr old) which suffer pain due to joint laxity and joint inflammation
  • Older dogs with chronic OA of hip secondary to hip dysplasia
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106
Q

Give the clinical signs of hip dysplasia in younger dogs

A
  • Unilateral/bilateral HL lameness
  • ‘Bunny-hopping’
  • Reluctance to exercise
  • Pain upon hip extension/flexion
  • Positive Ortolani test (ie hip luxation)
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107
Q

Give the clinical signs of hip dysplasia in adult dogs

A
  • Stiffness after rest/exercise
  • Exercise intolerance
  • ‘Bunny hopping’
  • Usually bilateral
  • Pain upon joint manipulation and reduced ROM
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108
Q

How do you diagnose hip dysplasia?

A
  • History + clinical signs + radiography

- Radiography can be static (VD, frog-legged or latromedial) or dynamic (not common in UK)

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109
Q

Which radiographic view is required for the BVA Kennel Club Control Scheme for hip dysplasia?

A

VD with the HLs extended such that the femurs are parallel

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110
Q

Give some primary radiographic changes of the hip joint with hip dysplasia

A
  • Wide joint space with medial divergence
  • Centre of femoral head lying on/lateral to dorsal acetabular rim
  • Coxa valga (>150 degree angle of femoral shaft to neck)
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111
Q

Give some secondary radiographic changes of the hip joint with hip dysplasia

A
  • New bone formation around femoral neck within acetabular fossa
  • Remodelling of cranial acetabular rim
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112
Q

What are the treatment options for hip dysplasia?

A
  • Conservative

- Surgical

113
Q

How would you conservatively treat a dog with hip dysplasia?

A
  • NSAIDs
  • Controlled lead exercise
  • Restricted diet
114
Q

What are the surgical treatment options for hip dysplasia?

A
  • Young dogs: triple pelvic osteotomy, juvenile pubic symphysiodesis
  • All dogs: femoral head and neck excision, total hip replacement (if >9 months old)
115
Q

Describe a triple pelvic osteotomy

A
  • Aims to increase cover of the femoral head in hip dysplasia by rotating the acetabulum dorsally
  • 85% success rate
  • Candidate must be skeletally immature and have no secondary radiographic changes
116
Q

Describe juvenile pubic symphysiodesis

A
  • Aims to close the pubic symphysis -> early rotation of acetabular head -> increased cover of femoral head
  • Must be performed before 20 weeks of age
117
Q

Give some indications for performing a total hip replacement

A
  • OA secondary to hip dysplasia
  • Healed femoral head/acetabular fractures
  • Recurrent coxofemoral luxation
  • Candidates must have a recurrent lameness, be non-responsive to conservative treatment, and have no evidence of systemic/spinal/dermatological disease
118
Q

When may femoral head and neck excision be performed?

A

-Hip dysplasia, Legg-Perthe’s disease, infectious arthritis, femoral head and neck fractures not amenable to surgical repair

119
Q

What should you remove when doing a femoral head and neck excision?

A

All of femoral neck and bony spurs

120
Q

What is the success rate like for femoral head and neck excision?

A
  • Moderate to poor in dogs >15-20kg

- Good in small dogs and cats

121
Q

Which muscles should be preserved when doing a femoral head and neck excision?

A

Gluteals, hence use a craniolateral surgical approach

122
Q

There is a specific genetic hip dysplasia predisposition test for which dog breed?

123
Q

How does the Kennel Club Hip Dysplasia Control Scheme work?

A
  • Scoring of radiographic changes in dog over 1 year
  • Each dog is given a score which is compared to the breed average
  • Determines suitability for breeding
124
Q

What is Legg-Calve-Perthe’s disease also known as?

A

Avascular necrosis of femoral head

125
Q

Describe Legg-Calve-Perthe’s disease

A

-Ischaemia of femoral head bone -> deformity of subchondral bone -> flattened femoral head -> joint instability

126
Q

Which dog breeds does Legg-Calve-Perthe’s disease affect?

A
  • Small breeds eg terriers, miniature poodles

- Autosomal recessive gene -> don’t use for breeding

127
Q

What are the clinical signs of Legg-Calve-Perthe’s disease?

A
  • Clinical signs at 5 months old
  • Progressive unilateral HL lameness
  • ‘Bunny-hopping’ or crouching of HLs
  • Pain on hip manipulation
  • May be crepitus and muscle atrophy
128
Q

How will a dog stand if they have a coxofemoral luxation?

A

Affected side: leg will cross over in front of opposite leg

  • Affected leg is carried in slight flexion
  • The greater trochanter is prominent and displaced cranially and the affected leg is shorter
  • Increased distance between the greater trochanter and tuber ischii
129
Q

How do you diagnose Legg-Calve-Perthe’s disease?

A

Radiography-focal bone lysis, ‘apple-core’ appearance

130
Q

How do you treat Legg-Calve-Perthe’s disease?

A

Femoral head and neck excision (excision erthroplasty)

131
Q

Why is post-op rehabilitation recommended after femoral head and neck excision when treating Legg-Calve-Perthe’s disease?
What would you recommend?

A
  • Reduces the decrease in ROM from excess scar tissue formation
  • Once sutures are remived, encourage dog to use the limb increasingly over the first 4-6 weeks (eg on-lead walks, stairs, swimming)
132
Q

Give a rare complication of femoral head and neck excision when treating Legg-Calve-Perthe’s disease

A

Medial patellar luxation (due to relocation of proximal femur)

133
Q

Where is the capital physis?

A

Growth plate on head of femur

134
Q

Capital physeal fractures of the femur occur in which animals?

A

Immature animals (4-7 months) as a result ot trauma

135
Q

Give the presenting signs of a capital physeal fracture of the femur

A
  • Pain on hip manipulation

- Often no crepitus

136
Q

How do you diagnose capital physeal fractures of the femur?

A

Radiography

137
Q

How do you treat capital physeal fractures of the femur?

A

Place 3 diverging Kirschner (K) wires to retabilise the fracture

138
Q

Capital fractures occur most often as a complication of what?

A

Coxofemoral luxation

139
Q

How do you treat a capital fracture?

A
  • Femoral head and neck excision in small dogs and cats
  • Excision of fragments and treatment of luxation
  • Lag screw fixation of fragments with counter sunk screws
140
Q

Where and when do femoral neck fractures occur?

A
  • At the base of the neck at its junction with the metaphysis of the proximal femur
  • Occur in mature dogs and cats following an RTA/fall
141
Q

How do you surgically treat a femoral neck fracture?

A
  • Lag screws and anti-rotational K wire

- Or triangulation with diverging K wires

142
Q

What is the most common direction of a coxofemoral joint luxation?

A

Craniodorsal

143
Q

How do you diagnose a coxofemoral joint luxation?

A

History, clinical signs, radiography (VD and lateral views of pelvis)

144
Q

How do you treat a coxofemoral joint luxation?

A
  • Closed reduction: anaesthetise patient, lateral recumbency, apply traction in a ventrocaudal direction, should feel ‘clunk’ as femoral head engages with acetabulum. Must be done within 48 hours
  • Open reduction: surgery
145
Q

When should closed reduction not be used to treat a coxofemoral joint luxation?

A
  • Hip dysplasia

- Avulsion fracture of femoral head

146
Q

How should you care for an animal after closed reduction of a coxofemoral joint luxation?

A
  • Place animal in an Ehmer sling for 3-10 days

- Strict rest

147
Q

Why may re-luxation occur after closed reduction of a coxofemoral joint luxation?

A
  • Haematoma, bone fragments -> poor seating of acetabulum
  • Inherent instability (eg hip dysplasia)
  • Damage to surrounding musculature
  • Ipsilateral fracture of hemipelvis
148
Q

What should you do if re-lexation occurs after closed reduciton of a coxofemoral joint luxation?

A

-Open reduction and stabilisation (ie surgery)

149
Q

Which surgical techniques can you use for an open reduction and stabilisation of a coxofemoral joint luxation?

A
  • Toggle fixation
  • Iliofemoral suture
  • Transarticular pinning
  • Suture joint capsule
  • Capsulorrhaphy
150
Q

Birefly describe what happens during an open reduction and stabilisation of a coxofemoral joint luxation

A
  • Craniolateral approach to hip
  • Remove haematoma and bone fragments from acetabulum and lavage
  • Replace femoral head with caudal traction of femur
  • Suture joint capsule
  • Keep in place by augmenting joint capsule
151
Q

How can you diagnose stifle conditions?

A
  • History and clinical signs
  • Examination under sedation/anaesthesia
  • Radiography
  • Arthrocentesis
  • Arthroscopy
  • Scintigraphy and CT/MRI
152
Q

Where should you carry out arthrocentesis of the stifle joint and why?

A

-Insert needle proximally to enter the femoropatellar region, to avoid the fat pad being sucked onto the end of the syringe

153
Q

How would synovial fluid appear in cruciate disease?

A
  • Decreased velocity

- May be pale yellow to orange-red

154
Q

Give some developmental conditions of the stifle

A
  • Osteocondrosis
  • Growth disturbances eg Genu valgum (severe valgus, ‘knock knee’
  • Patellar luxation
155
Q

Give some acquired conditions of the stifle

A
  • Cruciate disease
  • OA
  • Immune-mediated arthritis
  • Neoplasia
156
Q

Give some traumatic conditions of the stifle

A
  • Fractures and luxations
  • Ruptured ligaments eg CCL, patellar
  • Avulsions (long digital extensor tendon, gastrocnemius, tibial tuberosity)
157
Q

Where does osteochondrosis of the femur occur?

A

-Lateral or medial femoral condyle (most often medial aspect of lateral condyle)

158
Q

Which kind of dogs does osteochondrosis of the femur affect?

A

Young dogs of medium to larger breeds eg Labrador, Great Dane

159
Q

Give the clinical signs of osteochondrosis

A
  • Lameness from 5 months old
  • Bilateral crouching gait
  • Joint effusion and discomfort upon palpation
160
Q

How would you recognise stifle osteochondrosis on a radiograph?

A

Flattening of femoral condyle with irregualr margins

161
Q

Which radiographic view would you use to diagnose osteochondrosis of the stifle?

A

Cranio-caudal

162
Q

How do you treat osteochondrosis of the stifle?

A
  • NSAIDs and rest for 3-4 weeks

- If no improvement: surgical removal of cartilage flap with curettage of the periphery

163
Q

Which conditions are likely to develop following osteochondrosis of the stifle?

A
  • OA

- Predisposes to cranial cruciate ligament rupture

164
Q

Is medial or lateral patellar luxation more common?

165
Q

Medial patellar luxation is most commonly seen in which dog breeds?

A

Small toy breeds

166
Q

Give some developmental deformities than can predispose to patellar luxation

A

Malalignment of quadricpes complex:

  • Lateral bowing of distal femur
  • Medial bowing of proximal tibia
  • Medial rotation of tibial tuberosity
  • Hypoplasia of medial femoral condyle
167
Q

How may a dog with patellar luxation present?

A

-‘Skipping’ lameness (holds leg semi-flexed for 1-2 steps)

168
Q

What are the 4 grades of patellar luxation?

A

1-Intermittent patellar luxation, reduction immediate (no lameness)
2-Frequent luxation, reduction not always immediate (skipping lameness)
3-Permanent luxation, reduction possible but reluxates (skipping to non-weight-bearing lameness)
4-Permanent luxation but reduction not possible (crouched rear position, unable to extend legs properly)

169
Q

How do you treat patellar luxation?

A
  • Conservative: only if no instability of patella or infrequent lameness. Restricted, controlled exercise, NSAIDs
  • Surgical: if recurrent/persistent clinical signs. Aim to restore normal alignment of quadriceps mechanism eg deepening of trochlear groove
170
Q

What is the most common cause of HL lameness in the dog?

A

Cranial cruciate ligament rupture and disease

171
Q

What are the three basic biomechanical functions of the cranial cruciate ligament?

A
  • To limit cranial drawer movement (translation of the articular surfaces)
  • To limit over extension of the stifle
  • To limit internal rotation of the tibia with respect to the femur
172
Q

What are the 2 components of the cranial cruciate ligament?

A
  • Craniomedial band (taut in flexion and extension)

- Caudolateral band (taut in extension only)

173
Q

Give some causes of cranial cruciate ligament rupture

A
  • Major trauma (uncommon)
  • Degeneration of CCL (weakening due to decreaed collagen remodelling)
  • Rupture in young dogs of large breeds (partial tear -> chronic OA)
  • Rupture associated with inflammatory arthropathies (immune-mediated or infection)
174
Q

How would you diagnose CLL rupture?

A
  • Radiography (may see a joint effusion and signs of OA)
  • Arthrocentesis (increased fluid volume, increased cell count if infected)
  • MRI
  • Cranial drawer and tibial compresion/thrust test
175
Q

How do you treat cranial cruciate ligament rupture?

A
  • Conservative: small dogs <15kg. Rest and restricted exercise for 6-8 weeks with NSAIDs
  • Surgical: 3 techniques:
    • Intracapsular (‘over the top’, fascia graft)
    • Extracapsular (fabello-tibial nylon sutures)
    • Periarticular (eg tibial plateau levelling osteotomy TPLA or tibial tuberosity advancement TTA)
176
Q

What are the clinical signs of cranial cruciate ligament rupture?

A
  • Chronic/acute onset HL lameness
  • Leg carried flexed or ‘toe touching’
  • Stifle effusion (patellar ligament not pencil-like)
  • Medial buttress (thickening of tissues around joint) and OA = chronic
  • Tibial compression test/cranial drawer
177
Q

Dogs with cranial cruciate ligament rupture will have some degree of what?

A

Osteoarthritis

178
Q

Give some possible complications of cranial cruciate ligament disease

A
  • Infection

- Meniscal tears

179
Q

When should you re-examine cranial cruciate ligament repair after surgery?

A

Full recovery wont be evident until 12-16 weeks after surgery

180
Q

How are the menisci anchored to each other?

A

Intermeniscal ligament

181
Q

How are the menisci anchored to the tibia and femur?

A

5 ligaments

182
Q

Whys is the medial meniscus more prone to damage than the lateral?

A

It has an attachment to the medial collateral ligament, making it less mobile

183
Q

When do we see most injuries to the medial meniscus?

A

When there is rupture of the CCL, the medial meniscus becomes trapped and injured by the rotation of the femoral condyles at full extension

184
Q

Give the clinical signs of a meniscal tear

A
  • Suddenly lame several weeks to months after initial CCL surgery
  • Joint may have an effusion and be unstable upon cranial drawer test
185
Q

How do you treat a meniscal tear?

A
  • May respond to conservative management for 4-6 weeks

- Surgical removal if persistent lameness

186
Q

Give some congenital conditions of the elbow joint

A

-Elbow dysplasia
-Ununited medial epicondyle of humerus
-Incomplete ossification of the humeral condyle
(IOHC)

187
Q

Give some degenerative conditions of the elbow joint

A
  • Flexor enthesiopathy

- Osteoarthritis

188
Q

Give some traumatic conditions of the elbow joint

A
  • Condylar fractures
  • Proximal ulna/radius fractures
  • Luxation/collateral ligament rupture
189
Q

What is supination?

A

Outward rolling of the foot during normal motion

190
Q

Give some clinical signs of elbow disease

A
  • Thoracic limb lameness
  • Short stance phase
  • Muscle atrophy
  • Effusion
  • Thickening (chronic)
  • Pain/crepitus on elbow manipulation
191
Q

How do you diagnose elbow disease?

A
  • Radiolography
  • Arthrocentesis
  • CT
  • Arthroscopy
192
Q

Elbow dysplasia affects which kinds of dogs?

A

Medium-large breed dogs eg Labradors, Rottweilers, Bernese Mountain Dogs

193
Q

Give the 4 disease entities of elbow dysplasia

A
  • Fragmentation of the medial coronoid process (FCP)
  • OCD of medial condyle of humerus
  • Ununited anconeal process (UAP)
  • Elbow incongruity (eg short radius)
194
Q 
Give some causes of fragmentation of the medial 
coronoid process (FCP) -> elbow dysplasia
A
  • Genetics
  • Nutrition
  • Biomechanics (sites of greatest load)
  • Gender (males > females)
195
Q 
How would you treat fragmentation of the medial 
coronoid process (FCP) of the ulna?
A

Conservative:
-Lead exercise, analgesics, weight control, physio

Surgical:

  • Arthroscopic removal of fragments
  • Arthrotomy
  • Proximal ulnar osteotomy (PUO)
  • Biceps ulnar release procedure (BURP)
196
Q

Describe the pathogenesis of OCD of the elbow

A
  • Disturbance of the normal orderly process of endochondral ossification
  • Cartilage of increased thickness
  • Necrosis deep within thickened cartilage (? poor nutrition)
  • May progress to cartilage flap
197
Q

How do you treat OCD of the elbow?

A

Surgery: remove cartilage flap, curettage

198
Q

Which dog breeds are more prone to an ununited anconela process of the ulna?

A

Bassets, GSDs, BMD, mastiffs

199
Q

By what age should the anconeal process have ossified and fused to the ulna?

A

5 months old (10-11 in Bassets)

200
Q

How do you treat an uninited anconeal process (ulna)?

A

-Conservative if mild lameness
-Surgical (to promote union of the anconeus and
maintain congruency of the elbow joint): removal of anconeus or proximal ulnar osteotomy (+/-screw fixation)

201
Q

What is elbow incongruity?

A

Either radius or ulna is too short (usually ulna)

202
Q

How do you treat elbow incongruity?

A
  • Osteotomies

- Bone-lengthening procedures

203
Q

What is IOHC?

Which dog breeds does it affect?

A

Incomplete ossification of the humeral condyle (Springers/Cockers/Labradors)

204
Q

Give some clinical signs of incomplete ossification of the humeral condyle

A
  • May be pain
  • Thoracic limb lameness
  • May lead to fracture of the distal humeral condyle
205
Q

How do you treat incomplete ossification of the humeral condyle?

A

Stabilize humeral condyle eg screws

206
Q

Give some diseases of the shoulder

A
  • Congenital luxation and dysplasia
  • Osteochondritis dissecans
  • Muscle, tendon and ligament problems
  • Glenohumeral ligament tears
  • Subscapularis tears
  • Biceps brachii avulsion, rupture and displacement
  • Bicipital tenosynovitis
  • Infraspinatus and supraspinatus contracture
  • Supraspinatus mineralisation
  • Infraspinatus bursa mineralisation
  • Trauma
  • Luxation and fractures
  • Neoplasia
207
Q

How do you diagnose shoulder disease?

A
  • Clinical examination (gait, posture, palpation, manipulation)
  • Radiography
  • Synovial fluid analysis
  • Arthrography
  • Arthroscopy
  • Ultrasonography (biceps tendon)
  • Electromyography
  • (MRI)
208
Q

How would you identify a ruptured biceps brachii?

A

-Hyper-extension of the elbow when the shoulder is in full flexion

209
Q

Which contrast material would you use when doing an arthrography of the shoulder joint?

210
Q

What kind of lesions would arthrography allow you to see on the shoulder joint?

A
  • Biceps lesions

- Capsular tears

211
Q

How would you treat OCD of the shoulder?

A

Surgical: flap removal, curettage to stimulate fibrocartilage formation

212
Q

How would you treat glenohumeral tears of the shoulder joint?

A
  • Conservative: rest, sling
  • Medical: intra-articular corticosteroids
  • Surgical: thermal capsulorrhaphy (capsular shrinkage), prosthetic capsulorrhaphy, subscapularis imbrication, arthroscopic sutures
213
Q

How long should the shoulder be rested for in cases of lameness?

214
Q

Give some nutritional bone diseases

A
  • Nutritional Secondary Hyperparathyroidism
  • Renal Secondary Hyperparathyroidism
  • Hypovitaminosis D (Rickets)
  • Hypervitaminosis A
215
Q

Panosteitis typically affects which dogs?

A

Young large and giant breed dogs (eg GSD)

  • 6-8 months old
  • Mostly males
216
Q

Describe the pathology of panosteitis

A
  • Degeneration of intramedullary adipocytes
  • Stromal cell proliferation
  • Intramembranous ossification (pain, new bone formation, becomes attached to endosteum)
217
Q

Give the clinical signs of panosteitis

A
  • Classically shifting lameness (usually FL)

- Acute onset

218
Q

Which bone condition is known as ‘growing pains’?

A

Panosteitis

219
Q

How would you recognise panosteitis on a radiograph?

A

-Increased medullary radiodensity (new bone formation), thickened cortices, new endosteal bone formation

220
Q

How do you treat panosteitis?

A
  • Self-limiting
  • Exercise control/restriction
  • Analgesics
221
Q

Which dogs are more affected by metaphyseal osteopathy?

A
  • Young rapidly-growing medium and large breed dogs

- 2-6 months old

222
Q

What is metaphyseal osteopathy caused by?

A
  • Unknown
  • Vitamin C deficiency?
  • Distemper virus?
  • Inherited immunodeficiency in Weimaraners
223
Q

Give the clinical signs of metaphyseal osteopathy

A
  • Mild lameness to severe collapse
  • Pyrexia, anorexia, depression
  • Swollen metaphysis
224
Q

How do you confirm metaphyseal osteopathy?

A

Radiographs

225
Q

What would you see on a radiograph of metaphyseal osteopathy?

A
  • Band of increased radiodensity (more white) adjacent to physis
  • Growth plates may be widened
  • Latter stages: calcification proximal to metaphysis
226
Q

How do you treat metaphyseal osteopathy?

A
  • Usually self-limiting
  • Supportive care
  • Analgesics
227
Q

What is craniomandibular osteopathy?

A

A non-inflammatory, non-neoplastic, proliferative bone disease of immature dogs

228
Q

Which breeds are affected by craniomandibular osteopathy?

A

-WHWT (autosomal recessive), Scottish Terrier, Cairn Terrier

229
Q

What are the clinical signs of craniomandibular osteopathy?

A
  • Mandibular swelling/thickening
  • Inability to open mouth/prehend food
  • Salivation
  • Anorexia and weight loss
  • Pain when eating
230
Q

How would you identify craniomandibular osteopathy on a radiograph?

A
  • Palisading bone proliferation on the mandible and tympanic bullae
  • Usually bilateral
231
Q

How do you treat craniomandibular osteopathy?

A
  • Supportive care
  • Analgesics- corticosteroids?
  • Usually self-limiting at 11-13 months
232
Q

Slipped capital femoral epiphysis affects which animals?

A
  • Neutered male, overweight cats <2 years old

- Siamese over-represented

233
Q

Give the clinical signs of slipped capital femoral epiphysis

A
  • Subtle lameness progressing to acute, non-weight bearing lameness
  • Inability to jump
  • Pain and crepitus on hip manipulation
234
Q

What would you see on a radiograph of slipped capital femoral epiphysis?

A
  • Early: mild widening and lateral displacement of the capital femoral growth plate
  • Late: displacement of proximal femoral metaphysis, resorption and sclerosis of femoral neck
235
Q

How do you treat slipped capital femoral epiphysis?

A
  • Femoral head and neck excision

- Total hip replacement

236
Q

Hypertrophic osteopathy occurs secondary to what?

A

Intrathoracic or abdominal neoplasia

237
Q

Hypertrophic osteopathy affects which type of animals?

A
  • Older dogs and cats

- Ave. 9 years old

238
Q

Give the aetiology of hypertrophic osteopathy

A
  • Secondary to neoplasia
  • Increased peripheral blood flow
  • Vacular congestion in periosteum
  • Calcification of periosteum and connective tissue
239
Q

Give the clinical signs of hypertrophic osteopathy

A
  • Lameness can develop over several months (can be non-ambulatory)
  • Single or multiple limbs
  • Firm swelling along bone of distal extremities
  • Pain in early stages
  • ?Hyperthermia, weight loss, depression
240
Q

What radiographic changes would you see with hypertrophic osteopathy?

A
  • Periosteal new bone laid down at right angles to periosteum
  • Increased bone density (more white)
241
Q

How do you treat hypertrophic osteopathy?

A
  • Symptomatic

- Remove primary cause (neoplasia) -> resolution of new bone formation

242
Q

Which cysts can be found in bone?

A
  • Simple unicameral bone cysts (fluid-filled cavity lined by fibrous connective tissue)
  • Aneurysmal bone cysts (osteolytic lesions containing blood sinusoids)
  • Subchondral bone cysts (v. rare)
243
Q

Give some clinical signs of bone cysts

A
  • May be asymptomatic
  • Lameness
  • Painful swelling
  • Acute lameness -> pathological fracture
244
Q

How would you identify a bone cyst on a radiograph?

A
  • Expansile, locally aggressive lucent (black) lesion with little periosteal reaction
  • Typically metaphysis and diaphysis
  • Thinned cortices
245
Q

How would you treat a bone cyst?

A
  • If asymptomatic: no treatment, repeat imaging in 4-6 weeks
  • Surgical drainage, curettage, cancellous bone grafting
  • Radiotherapy
  • Excision
  • Amputation
246
Q

What are muscle contractures?

A

The abnormal shortening of muscle rendering the muscle highly resistant to stretching

247
Q

Infraspinatus muscle contracture typically affects which dogs?

A

Medium sized working/athletic dogs

248
Q

Give the clinical signs of infraspinatus muscle contracture

A
  • Not painful
  • At stance: shoulder abduction, elbow adduction lower limb abduction and external rotation
  • Spinatus muscle atrophy
  • Reduced ROM in flexion
249
Q

How do you treat infraspinatus muscle contracture?

A

Infraspinatus tendinectomy

250
Q

Gracilis/semitendinosus muscle contracture typically affects which dogs?

A
  • GSD

- 3-7 years of age

251
Q

What causes gracilis/semitendinosus muscle contracture?

A
  • Unclear

- Repetitive strain injury/trauma

252
Q

Give the clinical signs of gracilis/semitendinosus muscle contracture

A
  • Non-painful
  • Weight-bearing gait abnormality (Affected limb raised in jerk-like fashion, hyperflexion of tarsus, internal rotation of metatarsus)
  • Firm gracilis/semitendinosus muscle on caudomedial aspect of thigh
253
Q

How do you treat gracilis/semitendinosus muscle contracture?

A

No treatment required

254
Q

Which dogs may be prediposed to quadriceps muscle contracture?

A

Young fast-growing dogs

255
Q

Describe the aetiology of quadriceps muscle contracture

A
  • Secondary to femoral fracture (poor limb use/immobilisation)
  • Fibrotic replacement of muscle fibres
  • Adhesions between muscle and bone
  • Periarticular fibrosis and joint ankylosis
256
Q

Give the clinical signs of quadriceps muscle contracture

A
  • Extension of stifle and tarsus
  • Difficulty ambulating
  • Trauma to dorsal aspect of the pes
  • Pain over femur
257
Q

What is the treatment for quadriceps muscle contracture?

A

Most likely amputation

258
Q

Reversible contracture of the flexor carpi ulnaris muscle affects which dogs?

A

Young dogs, 6-8 weeks old

259
Q

Give the clinical signs of reversible contracture of the flexor carpi ulnaris

A
  • Flexed carpus that cannot be extended

- Tendon of FCU is taught on palpation

260
Q

How do you treat reversible contracture of the flexor carpi ulnaris?

A
  • Resolution usually occurs after 2 – 3 weeks
  • Carpal supports
  • FCU tendinectomy in rare cases
261
Q

What are the 2 types of lining that tendons can have?

A
  • Paratenon

- Sheath

262
Q

Which tendons heal faster: paratenon-lined or sheathed?

A

Paratenon-lined: blood supply derived from paratenon and surrounding soft tissues (eg gastrocnemius, triceps brachii)
Sheathed are slower as they have to rely on intrinsic blood supply (eg flexor tendons)

263
Q

Give the basic principles of tendon repair

A
  1. Expose severed ends
  2. Debride necrotic tissue
  3. Perform anastomoses (three-loop pulley for round tendons, locking-loop for flat tendons)
  4. Immobilise to protect from strain for 3 weeks
264
Q

Define osteopenia

A

Normal bone production but excessive bone resorption

265
Q

Describe the aetiology of nutritional secondary hyperparathyroidism

A
  • Diets high in phosphorus or low in calcium (usually meat based)
  • Hypocalcaemia -> increased PTH (induces progressive skeletal demineralisation)
266
Q

Give the clinical signs of nutritional secondary hyperparathyroidism

A
  • Lameness/ inability to stand
  • Skeletal pain
  • Swollen metaphysis
  • Pathological fracture
267
Q

What changes would you see on a radiograph of nutritional secondary hyperparathyroidism?

A
  • Decreased bone density and thinned cortices
  • Mushroom shaped metaphysis
  • Pathological fracture may be seen
268
Q

How would you treat nutritional secondary hyperparathyroidism?

A
  • Rest
  • Diet correction
  • Oral calcium supplementation
  • NSAID
269
Q

What is Rickets caused by?

A

Vitamin D deficiency

270
Q

Give some clinical signs of Rickets (vit D deficiency)

A
  • Lameness
  • Pathological fracture or bowing of long bones
  • Enlarged costochondral junction and metaphysis
  • Delayed dental eruption, weakness, listlessness, and neurological signs
271
Q

What would you see on a radiograph of Rickets (vitamin D deficiency)?

A
  • Thickening of growth plates
  • Cupping of adjacent metaphysis
  • Osteopenia, thinned cortices
  • Bowed diaphysis
272
Q

How do you treat Rickets (vitamin D deficiency)?

A

Balanced diet

273
Q

Give some clinical signs of renal osteodystrophy

A
  • Pliable mandible/maxilla (rubber jaw)
  • Loose teeth
  • Skeletal pain
  • Pathological fractures
  • Bowing of long bones
274
Q

How do you treat renal osteodystrophy?

A

Reduce phosphate intake/phosphate binder

Calcium or calcitriol supplementation

275
Q

Hypervitaminosis A affects which animals?

A
  • Cats, esp on liver diets

- 2-9 years old

276
Q

Give the clinical signs of hypervitaminosis A

A
  • Malaise, anorexia, lethargy
  • Exopthalmus and scurfy, dull coat
  • Early: neck pain
  • Cervical stiffness
  • Abnormal posture
  • Lameness
277
Q

What would you see on a radiograph of a cat with hypervitaminosis A?

A
  • Ankylosis of cervical and cranial thoracic vertebrae

- May see degenerative joint disease and ankylosis of shoulder and elbow

278
Q

What is the treatment for hypervitaminosis A?

A
  • Feed balanced diet

- Skeletal changes don’t resolve

279
Q

How would you diagnose rupture of the collateral ligaments of the stifle?

A

Abnormal joint movement in medial or lateral direction

Widening of medial or lateral joint space on radiographs

Year 4 (51 decks)

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