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MSK2 > Small animal MSK disease 6 > Flashcards

Small animal MSK disease 6 Flashcards

1
Q

Describe grade 3 canine patellar luxation

A

Patella usually luxated, can be replaced into trochlea

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2
Q

Describe grade 4 canine patellar luxation

A

Patella permanently luxated, cannot be replaced into trochlea

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3
Q

Compare the treatment options and prognoses for the different grades of canine patellar luxation

A
  • Grade 1: usually conservative management
  • Grade 2:based on presentation, conservative or surgical
  • Grade 3 and 4: surgical correction
  • Prognosis good for all except grade 4
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4
Q

List the surgical treatment options for canine patellar luxation

A
  • imbrication of soft tissue lateral side of joint
  • Deepening of trochlea (wedge or block recession)
  • Tibial Tuberosity transposition (TTT)
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5
Q

Explain recession sulcoplasty in the treatment of canine patellar luxation

A
  • Block or wedge recession, reduce size then replace to deepen the trochlea
  • Allows quadriceps mechanism to be aligned
  • Fixation of wedge not required, held in place by patella
  • Block may have better stability on extension
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6
Q

List common hock injuries in small animals

A
  • Ligamentous injuries leading to sub-luxations/luxations
  • Shearing injuries
  • Osteochondrosis/OCD
  • Fracture of tibia or tarsal bones
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7
Q

Describe the fractures commonly seen in greyhounds and their treatment

A
  • Acute non-weight bearing lameness of RH due to running in left landed circle
  • Central tarsal bone Fracture (crushed) leads to collapse of hock, leading to fracture of 4th tarsal bone, calcaneous and 5th metatarsal bones
  • Surgical repair of fractures (refer) and partial arthrodesis
  • Will never race again
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8
Q

What should be performed in all cases of HL lameness and why?

A

Rectal exam, in order to identify nerve root tumour which may also cause HL lameness

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9
Q

How may lumbosacral disease present

A
  • HL lameness, may look like hip dysplasia

- Pain on palpation, pain when raise tail head, muscle atrophy

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10
Q

Where are osteosarcomas typically located in the HL?

A

Distal femur, proximal tibia (NB greyhounds get osteosarc in neck of femur)

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11
Q

List the hindlimb disease common in cats

A
  • Hip dysplasia
  • Stifle: cruciate disease, patellar luxation (often related)
  • Hock: shearing injuries and luxations
  • Pad/digital injuries similar to dog
  • Fractures and cat bites common
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12
Q

What is the common signalment for collateral ligament injury of the hock in small animals?

A

RTA, trauma, jumping from height

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13
Q

What is commonly found on physical examination in collateral ligament injury of the hock

A
  • Moderate to severe lameness
  • Swelling
  • Joint instability including extended and flexed
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14
Q

Outline the treatment of collateral ligament injury of the hock

A
  • Wound management where necessary
  • Rigid external coaptation following repair
  • Primary ligament repair
  • Prosthetic reconstruction
  • Transverse screw at origin and insertion of long and short paths of collateral ligament
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15
Q

Describe the signalment for osteochondrosis of the talus in dogs

A
  • Juvenile dogs

- Esp. large and giant breeds

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16
Q

Describe the findings on physical examination in osteochondrosis of the talus in dogs

A
  • Lameness, worse with exercise
  • Joint effusion palpable
  • Decreased ROM in flexion
  • May appear hyperextended
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17
Q

Which radiographic views are used for the diagnosis of osteochodnrosis of the talus in dogs

A
  • Extended plain and craniocaudal, slightly flexed mediolateral, skyline view of tarsus
  • Include lateral, flexed lateral and dorsoplantar views of both tarsi
  • Additionl: imaging of craniocaudal proximal trochlear ridges, dorsolateral-plantomedial oblique
    (DLPMO) view, dorsomedial-plantolateral oblique (DMPLO) view
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18
Q

List the imaging modalities/tests used in the diagnosis of OCD of the talus in dogs

A
  • Radiography
  • CT
  • Arthrogram
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19
Q

Outline the treatment of OCD of the talus in dogs

A
  • Conservative: can fall away naturally, but painful, medical management in older dogs with severe regenerative changes
  • Removal of flap via arthrotomy/arthroscopy
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20
Q

Describe the clinical signs of malleolar fractures in dogs

A
  • Shearing injuries commonly, RTA
  • Acute onset HL lameness
  • Non-weight bearing
  • extensive soft tissue damage and possible bone loss
  • Severe hock instability
  • Pain, swelling
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21
Q

Describe the treatment of malleolar fractures in dogs

A
  • Initial wound management
  • Rigid coaptation following repair (or transarticular ESF) for several weeks
  • Surgical: prosthetic repair of collateral ligaments, ESF until granulation tissue covers defect talocrucral/pantarsal arthrodesis if axial part of trochlear ridge involved
  • Generally good prognosis
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22
Q

What degree of alignment is required for ESF, open-but-do-not-touch and open reduction fracture repairs?

A
  • ESF: >50%
  • Open but do not touch: at least 50% overlap in both planes
  • Open reduction: close to 100%
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23
Q

Which factors should be assessed when evaluating fracture repair?

A
  • Alignment
  • Rotation
  • Implant positioning
  • Apposition of fracture edges
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24
Q

Give examples inappropriate fracture fixation

A
  • Implants too small/large
  • Too large: risk of fracture at stress riser
  • Fail to address forces applied to site
  • Too rigid leading to disuse atrophy (esp. with ESF)
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25
Q

Outline the general discharge instructions that should be given to an owner following fracture repair in dogs and cats

A
  • Garden on lead to 3 weeks
  • Then lead for 8 weeks
  • Cats: restrict to house for 8 weeks
  • Cage if very boisterous, or concerns regarding repair itself
  • Modifications made to house: e.g. carpets, allow easy access onto furniture to prevent jumping
  • Appropriate analgesia
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26
Q

Under what condition may post-operative antibiotics not be required following fracture fixation?

A

If surgery 45mins-1hr long, perioperative may be enough

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27
Q

Outline the instructions that should be given to an owner regarding dressing management following fracture repair in small animals

A
  • Keep dry: polythene and sock when outside
  • Check toes and top of dressing twice daily to ensure toes are warm, no discharge, animal able to feel toe
  • Any smell, bring to surgery
  • If off colour, bring in with dressing on
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28
Q

Outline the potential complications that may occur with external coaptation

A
  • Casts: pressure sores, loss of digits

- Robert-Jones: pressure sores (esp. over accessory carpal bone and calcaneous), avascular necrosis over digits

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29
Q

In what way do IM pins tend to fail?

A
  • Imperfect construction of column of bone leads to collapse

- Fracture may rotate or collapse

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30
Q

In what way do cerclage wires tend to fail?

A

Loosen, fail to maintain reduction of fragments, resulting in instability

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31
Q

In what ways do plates tend to fail?

A
  • Loss of trans cortex with cyclical loading leading to plate breaking
  • Stress protection of bone leading to atrophy of disuse
  • Interface between plate and bone acting as stress riser, common point of failure
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32
Q

In what ways do ESFs tend to fail?

A
  • Pin tract infection
  • Fracture through pin tract
  • Delayed healing/non-union of fracture if too strong
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33
Q

Identify potential iatrogenic IM pin complications

A
  • IM pin to femur can damage sciatic nerve, esp. in cats

- IM pin may enter joint esp. if retrograde placement of tibial IM pin

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34
Q

What does lucency around a pin tract indicate?

A

Movement, premature pin loosening

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35
Q

Explain what is meant by fracture disease

A
  • Disease as a result of fracture treatment and immobilisation
  • Increased risk with external coaptation, avoid esp. in younger animals
  • Includes: joint stiffness, osteoporosis, stress protection, infection, quadriceps contracture
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36
Q

When does quadriceps contracture usually occur?

A

Femoral fractures in young animals

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37
Q

Describe fracture disease commonly associated with distal femoral fracture

A
  • Muscle atrophy
  • Joint stiffness
  • Muscle contracture (quadriceps tie-down - quads adhere to femur) leading to stifle hyperextension
  • Management extremely difficult
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38
Q

Outline how fracture disease can be prevented

A
  • Avoid external coaptation
  • Rigid internal fixation preferable
  • Encourage early use of limb, appropriate anaglesia
  • Early physio and hydrotherapy
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39
Q

Compare acute and chronic osteomyelitis as a result of fracture

A
  • Acute: soft tissues and associated periosteum, easier to manage with antibiotics
  • Chronic: primarily bone infection established around implants
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40
Q

Describe the common presentation for acute osteomyelitis following fracture repair

A
  • ~10 days later

- Not using leg well, some swelling, painful

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41
Q

How long should antibiotics be used for to treat acute osteomyelitis following fracture repair

A

~3 weeks, infection should resolve within a week

42
Q

Describe the radiographic changes that may occur with osteomyelitis following fracture repair

A
  • Proliferative changes to the periosteum
  • Sclerotic margin to infected area
  • Bone lysis, particularly around implants
  • Development of involucrum and sequestrum
  • Soft tissue swelling
43
Q

Outline the management of osteomyelitis following fracture repair

A
  • Stabilise bone and control infection first
  • Remove necrotic bone and sequestrum
  • Appropriate antibiotics, base on swab taken at surgery or from small incision down to bone and swab close to site of infection, not from discharging sinus
  • Stabilise fracture, will heal even with infection if no movement
  • Once fracture healed, remove implants
44
Q

What are the main causes of delayed unions and non-unions of fractures in small animals?

A
  • Instability

- Loss of vascular supply

45
Q

Explain how instability may lead to delayed or non-union of a fracture

A
  • Mild: can have secondary bone healing, takes more time
  • If fracture movement exceeds tolerance of granulation tissue, leads to tearing of blood vessels bridging site, preventing sequential deposition of cartilage and eventually bone
  • Smaller gap = greater strain
46
Q

Explain how a loss of vascular supply to a fracture site may occur

A
  • Original trauma
  • Extensive surgical approach
  • Poor surgical technique
47
Q

What is the normal blood supply to bone?

A
  • Endosteal origin to inner 2/3rds of cortex

- Periosteal origin to outer 1/3rd of cortex

48
Q

Describe the blood supply to a fracture

A
  • Normal blood supply disrupted, initially vascular supply for healing comes from surrounding soft tissues e.g. muscles
49
Q

Outline the management of delayed fracture union

A
  • Patience
  • Realistic expectation to owner
  • Stage down fixator if think is too rigid to encourage bone loading
  • Physiotherapy to encourage weight bearing
50
Q

Outline the management of fracture non-unions

A
  • Atrophic: non-viable, may require amputation
  • Hypertrophic: debride fracture ends, open medullary cavity, compress fracture, apply cancellous bone graft or equivalent
51
Q

Describe the radiographic appearance of atrophic non-union of fracture repair

A

Bone tapers to point, and then tapers out again

52
Q

Describe the radiographic appearance of hypertrophic non-union of fracture repair

A
  • Elephant feet

- Big, splayed, widens at end

53
Q

Where are non-unions of fractures most common?

A
  • Distal radius and femur
  • 2-7yo, between 7-14kg, weight bearing
  • Distal radius common in toy breeds
54
Q

Describe what is meant by malunion

A

Fracture does not heal in correct alignment, commonly seen in strays where fracture has healed naturally in incorrect plane

55
Q

Compare the prognoses of common malunions

A
  • Bend in craniocaudal plane: no concern
  • Bend in mediolateral plane: often ok depending on degree
  • Rotation: poor, esp. in distal femur
56
Q

Outline the management of revision surgery for fractures

A
  • Aggressive management required

- Debride, stabilise, bone graft

57
Q

Briefly outline fracture scoring and how it is used

A
  • Fracture given a score to determine lieklihood of uneventful healing
  • Higher score means more guarded prognosis
  • Performed before fracure repair
58
Q

What factors should be considered for fracture scoring?

A
  • Patient factors: weight, age, boisterousness/ability to manage cage rest, concurrent illnesses
  • Fracture: type, open/closed, associated soft tissue injuries, single/several
  • Owner factors: compliance, finances
  • Surgeon: ability to manage fracture, correct equipment available
59
Q

Outline the initial assessment and management of a trauma patient with orthopaedic injuries

A
  • Assess whole patient for life-threatening injuries
  • ABC
  • Provide analgesia, antibiotic cover (if open wounds) and fluid support
  • Decontaminate and prevent further contamination of open wounds
  • Support grossly unstable fractures
  • Assess for any neurological signs
60
Q

Outline the further investigation of a trauma patient with orthopaedic injuries

A
  • All animals in RTA need thoracic radiograph
  • Drain pneumothorax if present
  • Ultrasound of chest
  • Check integrity of urinary tract
  • FAST ultrasound
  • Monitor patient (frequency depending on severity of injuries)
  • Fractures etc. of low concern
61
Q

Describe a Type 1 open fracture

A
  • Small wound, little contamination, treat as closed fracture
  • may use appropriate antibiotics, open and clean wound
62
Q

Describe a Type 2 open fracture

A

Extensive wound communicating with fracture

63
Q

Describe a Type 3 open fracture

A
  • Very extensive soft tissue damage and fractured bones seen protruding through skin
  • Heavily contaminated
64
Q

Outline the management of open fractures

A
  • Emergencies
  • Sterile water-soluble gel in wound
  • Very wide clip
  • Copious lavage with warm Hartmann’s best (19G needle, squeeze bag, remove debris)
  • Surgical debridement may be needed, maintain as much soft tissue as possible
  • Swab for bacterial culture (but often only shows environmental contaminants, infection usually nosocomial)
  • IV broad spectrum antibiotics
  • Sterile dressing
65
Q

List the Pavletic 6 basic steps in wound management

A
  • Prevent further wound contamination
  • Remove foreign debris and contamination
  • Debride dead and dying tissue
  • Provide adequate wound drainage
  • Provide a viable vascular bed
  • Select appropriate method of closure
66
Q

List the aspects requiring assessment in shearing injuries

A
  • Blood supply
  • Damage to deeper tissues, nerves and ligaments
  • Bones
  • Superficial soft tissues
67
Q

Describe the assessment of blood supply in shearing injuries

A
  • May be difficult to assess viability to tissue remaining on initial investigation
  • In 4-5 days will become more apparent which tissue carries blood supply and is viable
68
Q

Where do shearing injuries most commonly occur and how are these commonly approached in small animals?

A
  • Most common on medial aspect of hock or radiocarpal joint

- May consider as type III open fracture

69
Q

Describe delayed primary closure of soft tissue wounds

A
  • Surgical closure pre-granulation, but 3-5 days after wound occurred
  • Use when unclear as to what will happen to the wound regarding the viable tissue
70
Q

Describe secondary wound closure

A
  • Closure of a wound once granulation tissue is present

- 5-10days post wound formation

71
Q

Describe second intention healing

A
  • Healing by natural processes
  • Granulation, contraction and epithelialisation take place
  • High cost, lots of time (several weeks)
72
Q

What is meant by hypermature granulation tissue?

A
  • Fibrous, thick tissue

- Aka chronic

73
Q

What types of dressing should be used at the debridement stage of wound healing?

A
  • Adherent dressing
  • E.g. wet-to-dry
  • Dry-to-dry
  • Hydrogel
74
Q

What types of dressing should be used at the granulation stage of wound healing?

A
  • Dry, non-adherent
  • Semi-occlusive: absorptive e.g. allevyn (non-adherent, semi-occlusive absorptive, removes some exudate from wound)
  • Occlusive: active rehydration e.g. granuflex
75
Q

Describe the layers of dressings for soft tissue wounds

A
  • Primary/contact layer dependent on wound/stage of healing
  • Secondary layer: absorbent to avoid maceration and provide degree of support
  • tertiary layer: supportive, allows evaporation, protects dressing from further environmental damage
76
Q

Outline the conservative management of pelvic fractures in small animals

A
  • Less invasive, cheaper
  • outcome less predictable (often poorer)
  • Recovery more prolonged
  • Cage rest, analgesia, usually 6-8 weeks
  • Generally few complications
  • Especially good in smaller individuals
77
Q

Outline the surgical management of pelvic fractures in small animals

A
  • Invasive, expensive
  • More rapid and fuller return to function
  • Rapid pain relief, potentially better outcomes
  • No pelvic narrowing and risk of chronic constipation
  • No distortion of pelvis
78
Q

What factors should be considered the indications for surgery on a pelvic fracture?

A
  • Is patient ambulatory?
  • How long fracture has been present
  • Weight bearing axis involvement
  • Acetabulum required?
  • Pelvic canal diameter reduction?
  • Patient intractably painful?
  • Additional fractures eg. limb fractures?
  • Presence of neurological deficits
79
Q

Explain whether surgery is indicated in a cat with sacroiliac luxation with an ischial fracture

A

May only be marginally displaced and so surgical stabilisation would provide little advantage

80
Q

Explain whether surgery is indicated in a cat that has been missing for a week and a half, and returns with pelvic fracture

A

Likely that injury is a week and a half old, fragments will be difficult to move at this point and so surgery is not indicated

81
Q

What forms the weight bearing axis of the hip?

A

Hip, ilial shaft and sacroiliac joint

82
Q

What treatment is indicated with a fracture of the pelvis that does not affect the hip, ilial shaft or sacroiliac joint?

A

Weight bearing axis not affected, so surgery is not required

83
Q

What degree of narrowing of the pelvic canal is an indication for surgical treatment and why?

A
  • > 50% narrowing

- Risk of chronic constipation which would also require further surgery

84
Q

Explain how multiple fractures affect the indication for surgical repair of a pelvic fracture

A

Multiple fractures = less able to cope, esp. if FL as well as hip, surgical repair of pelvic fracture indicated

85
Q

Under what conditions may second intention healing of a sacroiliac subluxation be reasonable?

A

If >60-80% of joint surface is overlapping and animal not in significant pain

86
Q

What does a unilateral sacroiliac luxation indicate?

A

Must be other pelvic injuries present, may be minor but must identify these

87
Q

List the management options for sacroiliac luxations/sacral fracture

A
  • Conservative if >50% of articular surface intact

- Surgical management: large lag screw +/- anti-rotation wire, or trans ilial pin

88
Q

Discuss the use of surgical management for sacroiliac luxations/sacral fracture

A
  • Can be difficult, prone to error
  • Aim to place screw through ilial wing into body of sacrum, easy to miss
  • Too ventral = not enough bone purchase
  • Too dorsal: enter spinal cord causing neurological damage
89
Q

Describe the common pattern of ilial fractures

A
  • Usually long oblique fractures

- Caudal fragment often displaces medially, narrowing the pelvic canal diameter

90
Q

Outline the treatment of ilial fractures

A
  • Well contoured plate placed
  • +/- lag screws
  • Cage rest for week or so, then start to relax if stable for period of time where movement is going to be unlikely/limited
91
Q

Discuss some surgical complications that may occur with ilial fracture repair

A
  • Reduction difficult if chronic injury (>5 days old)

- Iatrogenic damage to sciatic nerve (runs over ilial shaft)

92
Q

Compare the weight bearing aspects of the acetabulum in dogs and cats

A
  • Dogs: dorsocranial aspect

- Cat: mid region

93
Q

List the most common methods of repair for acetabular fractures in small animals

A
  • Referral required
  • Plate fixation (locking plate most commonly)
  • Mid acetabulum: screws, wire, methylmethacrylate composite
  • Complex/cost issues: femoral head and neck excision
94
Q

What are the main risks associated with pubic fractures in small animals?

A

Soft tissue damage and risk for herniation of abdominal contents (as a result of pre-pubic tendon avulsion)

95
Q

Describe capital physeal fractures of the hip

A
  • Slipped epiphysis of hip
  • Salter Harris Type 1
  • Usually 6-7mo
  • Epiphysis remains in acetabulum attached to the teres ligament
  • Often minimally displaced
  • More common in cat than dog
96
Q

What radiographic views are best in order to identify capital physeal fractures in small animals?

A

Frog leg view - standard VD view will close the fracture as a result of extension of the hip

97
Q

Outline the management of capital physeal fractures

A
  • Stabilise with 2-3 K wires or lag screw
98
Q

Describe the common consequences of capital physeal fractures

A
  • Apple coring (neck of femur resorbs over period of time) common 3-6 weeks post-op due to vascularisation of femoral neck and subsequent bone remodelling (not usually a clinical problem)
  • Premature physeal closure and development of DJD is common
  • Poor healing in Burmese cats reported
99
Q

List the different types of jaw fracture/luxation

A
  • Mandibular symphyseal separation
  • Maxillary fractures
  • Temporomandibular luxation
100
Q

What are the most common causes of mandibular symphyseal separation?

A
  • Blow to head from car

- Fall and hits chin on ground

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