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MSK2 > Small animal MSK disease 7 > Flashcards

Small animal MSK disease 7 Flashcards

1
Q

With repair of a mandibular symphyseal fracture, what is the main criteria for determination of whether acute or reasonable repair has been achieved in small animals?

A

Whether or not the animal can close its mouth

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2
Q

Outline the method for repair of a mandibular symphyseal fracture in small animals?

A

Cerclage wire around jaw, just caudal to canines

Can place large needle to brace wire behind teeth

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3
Q

What are the main causes of maxillary fractures in small animals?

A
  • Falling from a height

- RTA

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4
Q

List the methods used for fixation of maxillary fractures

A
  • Interdental wiring
  • Acrylic bonding of canines
  • Plates (rare)
  • External skeletal fixation
  • BEARD (bi-gnathic encircling and retaining device)
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5
Q

Outline the use of interdental wiring for the fixation of maxillary fractures

A
  • Wire between teeth to align maxillary fracture
  • Apposes 2 sides of hard palate well
  • Usually placed below gingiva and soft tissues of hard palate
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6
Q

Outline the use of acrylic bonding of canines for the fixation of maxillary fractures

A
  • Acrylic resin on teeth, leaving mouth open 1cm, ensuring jaw aligned
  • Anaesthetic required for removal
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7
Q

Outline the use of a BEARD maxillary fracture fixation

A
  • Suture around mandible and maxilla, aligns teeth
  • Prevents opening of mouth
  • Mainly used in cats
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8
Q

Describe the clinical signs of a temporomandibular luxation

A
  • Similar to maxillary fracture in presentation

- Inability to close mouth

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9
Q

What direction will the jaw deviate in a temporomandibular luxation in small animals?

A

Away from the site of the luxation

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10
Q

Outline the treatment of a temporomandibular luxation

A
  • Place wooden dowel into angle of jaw as caudal as possible
  • Apply dorsal pressure to rostral mandible
  • Normally reduction is easily achieved with this
  • Feed soft foods for several days
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11
Q

In which cat breeds is patellar luxation more common?

A

Pure breeds, e.g. Abysinnian, Devon Rex

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12
Q

Outline the clinical signs of patellar luxation in cats

A
  • Unwillingness to jump
  • Awkward gait
  • Lax patella on palpation is not indicative unless showing clinical problem
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13
Q

Which cats are predisposed to cranial cruciate ligament rupture?

A

Obese cats, but rarely occur in isolation, mainly associated with trauma

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14
Q

What are the treatment options for cranial cruciate ligament rupture in the cat?

A
  • Conservative treatment (preferred)

- Or using extra-capsular suture

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15
Q

Outline the treatment for total disruption of the stifle in small animals

A
  • Surgery: extra-capsular suture + prosthetic collateral lig (+/- meniscectomy) or trans-articular skeletal fixator to maintain joint reduction
  • Remove damaged menisci
  • Stabilisation
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16
Q

Outline the management of a patellar fracture in cats

A
  • Conservative or surgical
  • Conservative preferred if not too distracted
  • If surgical, use cerclage wires to capture and bring closer
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17
Q

Discuss the presentation of patellar fracture in young cats

A
  • Often have retained deciduous canines (Knees and teeth syndrome)
  • Also commonly fractures to other bones incl. tibia and calcaneous
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18
Q

Give examples of salvage procedures for MSK diseases in small animals

A
  • Arthroplasty
  • Arthrodesis
  • Amputations (+/- prosthetics)
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19
Q

Give examples of indications for salvage procedures in small animals

A
  • Severe osteoarthritis (arthroplasty, total hip replacement)
  • Severe fractures
  • Financial concerns
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20
Q

What is arthroplasty?

A

Surgical reconstruction of a joint

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21
Q

What are the types of arthroplasty available?

A
  • Excision or replacement

- Partial or total

22
Q

List the indications for arthroplasty in small animals

A
  • Dysplasia leading to unmanageable juvenile pain
  • Persistent luxation
  • Non-reconstructable articular fracture
  • Painful intractable degenerative joint disease
23
Q

Discuss the outcome of excisional arthroplasty

A
  • Pseudoarthrosis
  • Pain free
  • Instability of joint leading to abnormal movement
  • Reduced ROM and regional muscle atrophy
  • Mechanical lameness
  • Outcome variable esp. in bigger dog
24
Q

Where is excisional arthroplasty most commonly performed?

A
  • Hip

- Occasionally in TMJ

25
Q

Discuss the outcome of replacement arthroplasty

A
  • Normal joint function

- But lifelong potential morbidity

26
Q

Why does mechanical lameness occur with exciscional arthroplasty of the hip?

A
  • Limb shorter

- When weight bears, femur will rise up due to lack of dorsal acetabular aspect

27
Q

Describe the position of the cut for a femoral head and neck excision

A
  • Insertion of the iliopsoas and the gluteals i.e. maintain greater and lesser trochanter
  • Remove more of caudal neck (make cut perpendicular to neck)
28
Q

Discuss the factors influencing the outcome of a femoral head and neck excision

A
  • Larger = poorer outcome
  • Temperament/fitness: fitter active individuals to better
  • Age: younger to better
  • More chronic = more muscular atrophy = poorer outcome
  • Bilateral/concurrent: more difficult to manage, poorer outcome
  • Owner compliance wth physiotherapy
29
Q

In which species can arthroplasty, amputation or arthrodesis be performed?

A
  • Arthroplasty: cats and dogs
  • Arthrodesis: all small animal species depending on joint
  • Amputation: dogs and cats (limbs, digits, tail), and small caged pets (limbs and tail)
30
Q

In which joints can a replacement arthroplasty be performed in cats and dogs?

A
  • Canine: hip, elbow, stifle

- Cat: hip only

31
Q

List the indications for total hip replacement

A
  • Any size dog/cat
  • Esp. for active/working animals
  • Ideally 10-40kg dog
  • Intractable pain assocaited with hip dysplasia
  • Perthes disease
  • Compliant owner
  • No previous hip surgery
  • Good temperament
32
Q

Identify the different types of total hip replacement implants

A
  • Cemented (polymethylmethacrylate PMMA)
  • Cementless (bone ingrowth)
  • Hybrid systems
33
Q

List the possible complications of total hip replacements

A
  • Infection (surgical or haematogenous)
  • Dislocation (esp. first 8 weeks)
  • Aseptic necrosis of cemented systems as a result of technical error or cement failure, or accumulation of wear
34
Q

Outline the management of total hip replacement complications

A
  • Reassess
  • Likely to need conversion to femoral head and neck excision
  • If dislocation, can replace, but will likely re-luxate
35
Q

Discuss the use of total elbow replacements in small animals

A
  • Rare
  • High complication rate 20%
  • Commonly a bilateral disease
  • Little can be done if fails, poor candidate for amputation
36
Q

In which joints can arthrodesis be carried out?

A
  • Carpal
  • Talocrural
  • Shoulder
  • Stifle and elbow are poor candidates
37
Q

Give an example of an indication for arthrodesis of the carpus

A

Hyperextension injury leading to rupture of palmar cartilage or palmar ligaments

38
Q

Outline the principles of arthrodesis

A
  • Absolute stability, ideally through compression
  • remove cartilage from contact areas
  • Contour opposing joint surfaces
  • Cancellous bone graft
  • Fuse at functional angle
  • Provide temporary external support
39
Q

Explain why a pancarpal athrodesis is better than a partial one

A
  • Pancarpal means equal pressure on joints

- Partial will put more pressure on some joints

40
Q

What are the possible complications of stifle or elbow arthrodesis?

A
  • Leg left too long: scuffs nails on ground, must circumduct limb to move
  • Too short: never puts foot on ground
41
Q

List the indications for amputation in small animals

A
  • Limb not salvageable (e.g. result of trauma, esp. if involving joints)
  • Intractable pain
  • Neoplasia (malignant, locally invasive)
  • Failure of first line treatment
  • Paralysis e.g. brachial plexus avulsion
  • Financial reasons
42
Q

List key factors to think about when considering amputation

A
  • Presence of bilateral problem/other orthopaedic disease
  • Body condition/weight
  • Age
  • Owner
  • Temperament
43
Q

Outline the general principles of limb amputation in small animals

A
  • Cut bone short and leave excess skin and soft tissue to cover
  • Peri-neural local anaesthesia, sharp incision through nerves
  • Careful haemostasis
  • Meticulous surgical closure to eliminate dead space
  • Local analgesia/nerve block post-operatively
44
Q

Identify the sites for amputation in the forelimb of small animals

A
  • Forequarter amp: removal of scapula as well as limb
  • Mid humerus
  • Proximal third of humerus
45
Q

Identify the sites for amputation in the hindlimb of small animals

A
  • Proximal third of femur
  • Disarticulation at hip
  • Hemipelvectomy
46
Q

Outline the key principles of digit amputation in small animals

A
  • Major weight bearing on digits 3 and 4

- Careful dressing post-op required

47
Q

Compare hindlimb and forelimb amputation

A

Cope better with HL as there is more even weight distribution

48
Q

Compare the outcome for amputation and limb sparing procedures for the treatment of neoplasia

A
  • Similar median survival rates if adjuvant chemotherapy given
  • Some dogs may not cope with amputation e.g. large dog with FL amputation
49
Q

Identify limb sparing procedures that may be used for neoplasia

A
  • Resection of bone with appropriate margins
  • Cortical allograft to maintain limb length
  • Arthrodesis if near joint
  • Chemotherapy
50
Q

Identify the drugs commonly used in the treatment of osteoarthritis in dogs

A
  • NSAIDs e.g. meloxicam, carprofen, galliprant/grapiprant

- Neutraceuticals e.g. chondroitin sulphate, glucosamine, EFAs

MSK2 (29 decks)

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