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CVSOH 4 > Small Animal Musculoskeletal > Flashcards

Small Animal Musculoskeletal Flashcards

1
Q

How can there be overlap of neurological and orthopaedic aetiologies of lameness?

A

Compression of a nerve can lead to lameness

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2
Q

What might you want to establish from the history of a lameness consultation?

A
  • Medication
  • Duration
  • Onset
  • Progression
  • Continuous/intermittent?
  • Effect of exercise/rest
  • Effect of ground surface – corns on footpads can be worse on hard ground and gravel so try to walk on grass
  • Which limb(s)?
  • Occupation – working, racing, can get very specific problems not often seen in others
  • Concurrent problems?
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3
Q

How do cats differ from dogs in lameness cases?

A

Less likely to have lameness when they have arthritis, just sit more and less sociable

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4
Q

What is the effect of a lytic noeplastic lesion in the right proximal femur of a dog?

A

Likely to cause a chronic continuous and progressively worsening lameness. The onset may have been insidious or acute – the latter possibly due to pathological fracture.

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5
Q

What can be assessed from the animal’s stance?

A
  • Symmetry
  • Weight bearing
  • Angular deformity – valgus (laterally) and varus (medially)
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6
Q

What is assessed during gait evaluation?

A
  • Gait at walk, trot, stairs, circles
  • Stride length
  • Head nodding – typically with forelimb lameness
  • Scuffing of nails
  • Ataxia, paraparesis, paraplegia
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7
Q

What is a lameness grade of 0?

A

Sound

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8
Q

What is a lameness grade of 1?

A

Occasionally shifts weight

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9
Q

What is a lameness grade of 2?

A

Mild lameness at slow trot, none whilst walking

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10
Q

What is a lameness grade of 3?

A

Mild lameness whilst walking

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11
Q

What is a lameness grade of 4?

A

Obvious lameness whilst walking, places foot when standing

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12
Q

What is a lameness grade of 5-8?

A

Degrees of severity

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13
Q

What is a lameness grade of 9?

A

Places toe when standing, carries limb when trotting

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14
Q

What is a lameness grade of 10?

A

Unable to weight bear

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15
Q

What do you palpate the standing animal for in an orthopaedic examination?

A

Asymmetry
Swelling
Muscle atrophy
Joint enlargement
Abnormal conformation

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16
Q

What are the joints assessed for in an orthopaedic examination?

A
  • Swelling, joint effusion
  • Pain
  • Instability
  • Range of motion – often painful at extreme ROMs
  • Manipulation – any crepitus
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17
Q

What is a medial buttress?

A

Medial swelling of the stifle

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18
Q

What is assessed in a neurological examination of an orthopaedic examination?

A

Palpate spine – neck and lumbosacral joint

Screening neurological examination – conscious proprioception, spinal reflexes (patella, withdrawal and perineal reflexes)

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19
Q

What is panosteitis?

A

Inflammation of the bone

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20
Q

Name 2 tests to test the integrity of the cranial cruciate ligament.

A

Cranial draw test
Tibial compression/thrust test

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21
Q

How is a cranial draw test performed?

A
  1. Lateral recumbency
  2. Hold femur and tibia and try to move tibia cranially with respect to the femur
  3. Repeat test with stifle at different angles or flexion/extension
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22
Q

How is tibial compression/thrust test performed?

A
  1. Hand over distal femur, first finger on tibial tuberosity, other hand on the foot
  2. Keep stifle still whilst flexing hock
  3. Tibial tuberosity displaces cranially if ligament ruptured
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23
Q

How is patella luxation assessed?

A

Stifle extended – quadriceps muscles relaxed. Try and shift patella medially and laterally

In very small dogs its is difficult to locate the patella – work proximally from the tibial tuberosity

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24
Q

Name the test for hip laxity.

A

Ortolani test

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25
Q

How is the ortolani test performed?

A
  1. Dorsal recumbency
  2. Subluxate hips by pressing towards back
  3. Abduct femurs – click as hip reduces = angle of reduction
  4. Adduct hips – click as hip re-luxated = angle of subluxation
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26
Q

What is the pneumonic for differentials affecting bones?

A

GIFT:

Growth plates
Inflammatory/infectious/immune
Fractures
Tumours

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27
Q

What is the pneumonic for differentials affecting joints?

A

DIM:

Dislocation (congenital and traumatic)
Inflammation (OCD, OA, infectious)
Musculotendinous and ligamentous

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28
Q

What can make orthopaedic radiography challenging?

A

Growth plates in young animals can make fractures in these areas hard to view

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29
Q

How is the infrapatellar fat pad effected by synovial fluid?

A

Infrapatellar fat pad forms triangle with fluid and tendon. When fluid is more, compressed infrapatellar fat pad

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30
Q

What are CT scans useful for in orthopaedics?

A

Identifying minimally displaced fractures

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31
Q

What are MRI scans useful for in orthopaedics?

A
  • Soft tissue architecture
  • Neurology/nerve root tumours
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32
Q

What are ultrasound scans useful for in orthopaedics?

A
  • Soft tissue structures
  • Guide a biopsy
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33
Q

How is a joint effusion at the carpus palpated?

A

Loss of definition of carpal bones cranially

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34
Q

How is a joint effusion at the elbow palpated?

A

Bulge between the olecranon and lateral epicondyle

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35
Q

How is a joint effusion at the shoulder and hip palpated?

A

Effusions not palpable

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36
Q

How is a joint effusion at the hock palpated?

A

Palpable as a bulge cranially and caudally

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37
Q

How is a joint effusion at the stifle palpated?

A

Bulges out either side of patella ligament

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38
Q

How is arthrocentesis performed?

A
  • Release pressure before withdrawing needle from joint as you will contaminate your fluid with blood
  • Make smear and submit EDTA sample
  • Should only have half a needle hub full
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39
Q

Does the fluid obtained through arthrocentesis contain neutrophils?

A

If containing neutrophils, this is abnormal so must determine whether septic or immune mediated

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40
Q

What does 9/10 lameness indicate in the grading scale 0-10?

A

Places tow when standing, carries limb when trotting

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41
Q

When test is the best one for diagnosing cranial cruciate ligament disease in a large standing dog?

A

Tibial thrust test

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42
Q

How can you tell if there is a stifle effusion on a radiography?

A

A reduction in size of the infrapatellar fat pad

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43
Q

What is the normal volume, colour and viscosity of fluid you would expect to obtain from a normal stifle joint in a large dog?

A

0.2ml, clear, viscous

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44
Q

Define chondroprotective.

A

Agents that retard degradation of articular cartilage and promote chondrocyte metabolism in the treatment of osteoarthritis in dogs and cats.

Also called nutraceuticals

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45
Q

What are some examples of chondroprotective agents?

A

They are nutrients, dietary supplements/herbal extracts:

  • Glucosamine
  • Chondroitin
  • Hyaluronic acid
  • Pentosan polysulphate
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46
Q

What is the legislation for neutraceuticals?

A

Not technically drugs, so they can be marketed without proving that they work. Injectables are legislated

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47
Q

What are the possible modes of action of chondroprotective agents?

A
  • Stimulate chondrocytes – to synthesise cartilage matrices
  • Stimulates synoviocytes
  • Increase synovial fluid viscosity
  • Inhibit enzymes indicated in degradation of cartilage matrix
  • Anti-inflammatory activity
  • Anti-oxidants
  • Support collagen formation
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48
Q

How can osteoarthritis be symptomatically treated?

A

NSAIDs
Rest
Weight loss
Physiotherapy
Hydrotherapy
Chondroprotectives

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49
Q

List the veterinary nutraceuticals.

A

Glucosamine
Chrondroitin
Polysulfated glycosaminoglycan
Avocado/soybean unsaponifables
Manganese
Vitamin E
Green lipped mussel extract
Essential fatty acids
Pentosan polysulphate
Hyaluronan
Hyaluronic acid
Circurmin

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50
Q

What is glucosamine?

A

An amino monosaccharide for glycosaminoglycans. Produced commercially by crustacean exoskeleton or less commonly by fermentation of grains.

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51
Q

How is glucosamine a chondroprotective agent?

A

Make extra cellular matrix (ECM) of cartilage

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52
Q

What is chondroitin?

A

Polymer of repeating dissacharide units (galatosamine sulphate and glucuronic acid). Commercially made from poultry, shark or bovine cartilage

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53
Q

How is chondroitin a chondroprotective agent?

A

Predominant component of cartilage

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54
Q

What is the mechanism of action of glucosamine in in vitro studies?

A
  • Glucosamine stimulates glycosaminoglycan, proteoglycan and collagen production
  • Modulating cartilage metabolism improving cartilage integrity and increasing matrix synthesis
  • Synergistic effect when combined with chondroitin
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55
Q

How is the chondroprotective polysulphated glycosaminoglycan given?

A
  • Intra-muscular (or intraarticular) injection for horses and dogs
  • Every 4 days for 28 days or every 5-7 days for 5 weeks
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56
Q

What is a possible risk of the chondroprotective polysulphated glycosaminoglycan given?

A

Toxicity inhibit coagulation as it is chemically similar to heparin

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57
Q

How does hyaluronic acid have a chondroprotective effect?

A

Improves joint fluid viscosity which may improve joint lubrication, reduce inflammatory enzymes and reduce pain

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58
Q

How is hyaluronic acid given?

A

Intra-articular injection

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59
Q

What is the chondroprotective agent pentosan polysulphate?

A

Cartrophen
Weekly injections for 4 weeks IM or SC
Dogs and horses

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60
Q

What is the use of pentosan polysulphate?

A

Relief for thrombi, interstitial cystitis and osteoarthritis

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61
Q

What are the side effects of pentosan polysulphate?

A

Vomiting
Anticoagulant

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62
Q

What are the chondroprotective effects of omega-3 fatty acids?

A

Anti-inflammatory properties in vitro
Reduces cartilage degradation

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63
Q

What are the chondroprotective effects of green lipped mussel?

A

Anti inflammatory - inhibits 5 lipoxygenase pathway

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64
Q

What are the possible adverse effects of chondroprotectives?

A
  • Mild, none or rare
  • Gastrointestinal
  • Anti-coagulant – rare
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65
Q

What is the evidence for pentosan polysulphate use in dogs?

A
  • Improvement in dogs with OA after SC injection
  • Lower levels of proteoglycans in joint fluid after oral PPS no improvement in outcome or radiographs of dogs with CCLD
  • Improved recovery in dogs with CCLD seen by GRF measurements
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66
Q

What is the evidence for pentosan polysulphate use in horses?

A
  • Improved signs of OA in horses
  • Reduced articular cartilage fibrillation in experimental carpal OA
  • IM PPS efficacious when used prophylactically prior to competition
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67
Q

What can you say to clients who are considering chondroprotective treatment for their animals?

A
  • Some scientific evidence but no definitive beneficial effects for animals with OA
  • Side effects minimal and mild if occur
  • Try for 2-3 months
  • If no improvement consider stop usage
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68
Q

What side effects are most commonly seen with chondroprotectives?

A

Vomiting and diarrhoea

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69
Q

Which of the following is an injectable nutraceutical/chondroprotective that can injected intramuscularly in dogs with OA weekly for 4 weeks?

A

Pentosan polysulphate

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70
Q

What are the possible causes of lameness affecting soft tissues?

A

Pads – corns (greyhounds), plasma cell pododermatitis in cats, foreign bodies

Interdigital – foreign bodies, green awns, paronychia

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71
Q

What areas of the foot are assessed in clinical examination of a lame foot?

A

Pads
Interdigital area
Nails
Wounds - think tendons

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72
Q

What are the clinical signs of fractures in the foot and how are these diagnosed?

A

Swelling, pain, instability

Lameness imaging - CT or x-ray

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73
Q

When are foot fractures treated surgically?

A
  • Fragments displaced
  • Base of MC/MT affected
  • Articular surface affected
  • Intramedullary pinning or toggle pinning to avoid arthritis
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74
Q

What are toggle/dowel pins for foot fracture repair?

A

Toggle/dowel pins are put into the bones completely

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75
Q

When are foot fractures not repaired?

A

If its is just one bone, as the others will support

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76
Q

What would you recommend for a fracture of the 1st phalanx, digit II?

A

External coaptation with splint as is quite painful and unstable but is a single phalangeal fracture so not surgery

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77
Q

How are metacarpal and metatarsal/sesamoid fractures treated?

A

Removal

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78
Q

How are metacarpal and metatarsal/sesamoid fractures identified?

A

CT best imaging as they can be easily missed on radiograph due to superimposition of the bones

We also see incidental fragmentation of the sesamoids that are not a cause of lameness – particularly in Rottweilers

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79
Q

What is the pathogenesis of toe dislocations?

A

Rupture of collateral ligaments and joint capsule

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80
Q

What are the treatment options for toe dislocations?

A
  • Closed reduction and conservative
  • Open reduction and collateral ligament prosthesis
  • Closed and ESF
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81
Q

How is collateral ligament rupture causing toe dislocation treated?

A

Conservative management – rest, short nail, bandage

Surgery – if conservative doesn’t work, mini external dixator for example

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82
Q

What is the aetiopathogenesis of corns?

A

Focal areas of hyperkeratinisation from focal pressure of pad seen in dogs with little SC fat

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83
Q

What is the presentation of corns?

A
  • Greyhound, lurcher, whippet
  • Painful pad
  • Local lesions
  • Usually pad III or IV forelimbs but can be any pad
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84
Q

How are corns treated?

A

Superficial digital flexor tenectomy

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85
Q

What is the prognosis for corn treatment?

A

Guarded for recurrence after corn removal, good following tenectomy

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86
Q

How is osteoarthritis characterised?

A

Deterioration of articular cartilage and the formation of new bone at the joint margins

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87
Q

What is the aetiology of small animal osteoarthritis?

A

Primary – wear and tear

Secondary congenital (achondroplasia), developmental (hip dysplasia), acquired (after fractures)

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88
Q

What is the pathogenesis of osteoarthritis?

A
  • Loss of cartilage matrix constituents and chondrocytes
  • Loses water and becomes less resilient causing it to flake and fibrillate
  • Osteophytes – bits of new bone that develop around the margins
  • Synovial membrane thickening and fibrosis and decreased viscosity of joint fluid
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89
Q

What are the clinical signs of osteoarthritis?

A
  • Often paired joints
  • Decreased range of motion/ROM
  • Lameness/stiffness
  • Pain (variable)
  • Joint swelling – fibrosis or effusive
  • Crepitus
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90
Q

How is osteoarthritis diagnosed?

A

Imaging:
- Osteophyte formation – bony protuberances, often cartilage capped that form at the periphery where the joint capsule attached
- Soft tissue swelling
- Joint effusion
- Subchondral sclerosis

Synovial fluid analysis

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91
Q

What are the goals of therapy for osteoarthritis?

A

Alleviate discomfort
Delay progression
Restore affected joints to normal pain free function as soon as possible

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92
Q

What are the treatment considerations for treatment of osteoarthritis?

A

Exercise modulation
Weight loss
Physical therapy and hydrotherapy
Drugs
Surgical Options
Environmental modification

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93
Q

How is exercise modified to manage osteoarthritis?

A

Avoid inactivity
Short and frequent
Gentle controlled exercise
Keep every day the same
Avoid vigorous activity

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94
Q

What are the benefits of exercise for management of osteoarthritis?

A

Strengthen ligaments
Maintain muscle tone
Prevent fibrosis
Lubrication joints
Enhance proteoglycan production

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95
Q

How can physical therapy be used to manage osteoarthritis?

A
  • Massage – stimulates circulation
  • Passive ROM – maintain/improve joint movement
  • Hydrotherapy – improves ROM, muscle strengthen and fitness
  • Acupuncture, homeopathy and chiropractic manipulation – consider in selected individuals
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96
Q

How are chondroprotectives/nutraceuticals used to manage osteoarthritis?

A

Drugs that claim to arrest or moderate the degenerative processes in the cartilage, improve joint fluid and support reparative biosynthesis

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97
Q

What are the surgical options to manage osteoarthritis?

A
  • Instability – CCLR = TPLO, hip dysplasia = TPO/triple pelvic osteotomy, patella luxation = surgery to keep it in the right place
  • Salvage procedures – joint replacement, joint fusion, joint removal
  • Conformation – varus and valgus corrected surgically
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98
Q

What environmental modification can be used to manage osteoarthritis?

A

Soft beds, heated beds, ramps or steps, low litter traps, feed on the floor for cats

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99
Q

What is the aetiology of infectious/septic joint disease?

A

External trauma/bites
Iatrogenic
Secondary to systemic or distant infection
Immunodeficiency syndromes
Secondary to omphalophlebitits
Haematogenous spread

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100
Q

What is the pathogenesis of infectious/septic joint disease?

A
  • Bacteria rapidly proliferate
  • Acute inflammatory response
  • Cytokine release
  • Cartilage damage/loss
  • Erosions
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101
Q

What are the clinical signs of infectious/septic joint disease?

A
  • Sudden onset/chronic
  • Painful
  • Swollen/effusion
  • Severe lameness/non weight bearing
  • Single joints more common than multiple
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102
Q

How is septic/infectious joint disease diagnosed on radiographs?

A
  • Early changes – soft tissue swelling, effusion
  • Late changes – erosions, periosteal reaction
  • Sepsis can affect joints with pre existing OA
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103
Q

How is septic/infectious joint disease diagnosed from arthrocentesis?

A

Visual analysis, cytological analysis, culture and sensitivity

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104
Q

How is septic/infectious joint disease diagnosed from synovial fluid analysis?

A

Viscosity, volume, colour, cell count, cell types

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105
Q

How is septic/infectious joint disease treated?

A
  • Evacuate exudate
  • Lavage
  • Antibiotics based on culture and sensitivity
  • Surgical debridement – implant removal
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106
Q

What is the prognosis of septic/infectious joint disease?

A

Good/fair with acute cases with appropriate therapy

Poor/guarded with chronic cases with cartilage loss

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107
Q

What are the characteristics of erosive immune mediated inflammatory joint disease?

A
  • Neutrophils in joint fluid
  • Bone erosions seen in imaging
  • Rheumatoid arthritis
  • Periosteal perliferative polyarthritis - cats
  • Mycoplasma polyarthritis - greyhounds
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108
Q

What are the characteristics of non-erosive immune mediated inflammatory joint disease?

A
  • Neutrophils in joint fluid
  • No erosions seen on imaging
  • Idiopathic immune mediated polyarthritis
  • Systemic lupus erythematous
  • Polyarthritis/polymyositis
  • Polyarthritis/meningitis
  • Vaccination reactions - calicivirus
  • Drug reactions - potentiated sulphonamides in Dobermans and Weinmaraners
  • Breed related - Sharp pei fever (renal mayloidosis, hocks, pyrexia
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109
Q

What are the characteristics of rheumatoid arthritis?

A
  • Erosive joint disease
  • Small breeds
  • Joint collapse
  • Crepitus and instability
  • Pain variable
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110
Q

What are type I, II, III and IV idiopathic immune mediated polyarthritis?

A

Type I = uncomplicated

Type II = remote infection eg pyometra

Type III = GIT disease, immune complex deposition

Type IV = neoplasia

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111
Q

What are the clinical signs of idiopathic immune mediated polyarthritis?

A

Lameness, distal small joints, joint effusions, pain, lethargy, pyrexia, migratory problem

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112
Q

How is idiopathic immune mediated polyarthritis diagnosed?

A

Imaging for soft tissue swelling

Lab investigations with haematology, ANA/RF, arthrocentesis (6 joints), +++PMNs

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113
Q

How is immune mediated polyarthritis treated?

A

Treat underlying cause, such as pyometra. Immunosuppressive drugs:

  • Prednisolone
  • Azathioprine
  • Cyclophosphamide
  • Gradually tapering dose
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114
Q

Name the tumour types that invade joints?

A

Synovial sarcoma
Fibrosarcoma
Myxosarcoma
Haemangiosarcoma
Malignant fibrous histiocytoma

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115
Q

What is the aetiopathogenesis of tumours that invade joints?

A

Malignant (vs benign)
Secondary invaders from articular margin or joint capsule

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116
Q

How are tumours that invade joints investigated and diagnosed?

A
  • Radiographs for where tumour crosses joints, erosions/slow growing
  • Histology and immunohistochemistry
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117
Q

How are tumours that invade joints treated?

A

Amputation, may metastasise locally and/or distally

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118
Q

What is the pathogenesis of osteochondrosis?

A

Osteochondrosis occurs as a failure of endochondral ossification or abnormal differentiation of cartilage into bone which results in a thickened area of cartilage

Osteochondritis dissecans (OCD) – flap of cartilage separates from the bone

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119
Q

What is the signalment of osteochondrosis in small animals?

A

4-8 months old in large and giant dog breeds

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120
Q

What are the clinical signs of osteochrondrosis?

A
  • Lameness insidious onset, chronic
  • Deteriorates after rest or excessive exercise
  • Bilateral
  • Physical examination findings – joint has reduced ROM, pain on manipulation and effusions
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121
Q

How is osteochondrosis diagnosed from radiography?

A
  • Thickened cartilage – subchondral defects
  • Mineralised flaps
  • Joint mice
  • Osteophyte formation
  • Early changes may be subtle – repeat radiographs in 6 weeks if strong index of suspicion
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122
Q

How is osteochondrosis treated conservatively?

A

Rest
NSAIDs
Diet

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123
Q

How is osteochondrosis treated surgically?

A
  • Arthrotomy/arthroscopy for cartilage flap removal
  • Forage
  • Chondrectomy
  • Polysulphated glycosaminoglycans or hyaluronic acid
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124
Q

What is the post operative management for osteochondrosis surgery?

A

Exercise restriction 4-6 weeks

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125
Q

What are the possible complications of osteochondrosis surgery?

A

Seroma
Failure to remove all cartilage flap

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126
Q

When is prognosis of osteochondrosis better and worse?

A

Better – bigger/looser joints (shoulder and stifle), smaller lesions, recent problem

Worse – tight joints (hock and elbow), large lesions and chronic problem with pre-existing OA

All dogs will develop OA irrespective of treatment

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127
Q

What are the sites of osteochondrosis?

A

Shoulder = caudomedial humeral head (OCD)

Elbow = medial humeral condyle (OCD), ununited anconeal process of the ulna, fragmented coronoid process of the ulna

Carpus = retained cartilaginous cores of the ulna

Stifle = lateral (medial) condyle of the femur

Hock = medial (lateral) talar ridge of the talus

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128
Q

What are the clinical signs of fractures?

A
  • Lameness – usually, but not always, severe
  • Pain on palpation/manipulation
  • Swelling
  • If unstable = deformity, abnormal mobility and crepitus
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129
Q

How are patients triaged and assessed for thoracic trauma in orthopaedic cases/

A
  • Airway, Breathing, Circulation
  • Deal with life threatening injuries
  • After a traumatic fracture thoracic imaging should be done for all cases where you don’t know the cause and assessed for pulmonary contusions, pneumothorax, fractured ribs and other thoracic problems
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130
Q

What are the signalments of fractures?

A
  • Age – young fracture (GP) > luxation (more common when older)
  • Sex – male cats more likely to roam so more common in males, not may RTAs in dogs
  • Breed – springer spaniels with humeral stress fractures
  • Size – small breeds distal radial and ulnar fractures
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131
Q

What is the aetiology of fractures?

A
  • Usually direct trauma – RTA
  • Indirect fracture – landing injury with a fracture higher up leg
  • High energy – high damage (comminuted) and soft tissue damage
  • Fracture after minor trauma – consider pathological
  • Stress fracture
  • Concurrent disease/medication – osteopenia
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132
Q

How are fractures classified by cause?

A

Extrinsic – direct or indirect trauma

Intrinsic – muscular, pathological, stress (increased bony density around the fracture

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133
Q

How are fractures classified by communication with the environment?

A

Closed
Open

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134
Q

How are fractures classified by extent of bony damage?

A

Incomplete – greenstick (1 cortex still intact), fissure (crack), depressed (fragment in a cavity)

Complete

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135
Q

How are fractures classified by number and position of fragments?

A

Simple - 2 pieces

Comminutes - more than 2 pieces

Segmental - segment is completely separate and displaced

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136
Q

How are fractures classified by the direction of fracture lines?

A

Fracture configuration is a function of the forces acting on the bone:

  • Compression force – oblique fracture
  • Tension/avulsion – transverse fracture
  • Torque – spiral fracture
  • Bending (tension and compression) – butterfly
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137
Q

How are fractures classified on location?

A
  • Diaphyseal – proximal, midshaft or distal
  • Metaphyseal
  • Epiphyseal
  • Condylar
  • Articular
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138
Q

How are fractures classified by stability?

A

Stable – contact between the 2 bones ends, load sharing between bones

Unstable – lots of fragments, un-reconstructable

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139
Q

How are fractures classified based on complexity and involvement of other soft tissues?

A

Muscle damage
Nerve damage
Blood vessel damage

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140
Q

What other way can fractures be classified?

A

Age of fracture

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141
Q

How is emergency fracture management done?

A
  • A,B,C
  • IV catheter, fluids – treating shock and dehydration
  • Analgesia
  • Open fracture management – early wound management. Sedate, clip, clean, cover to prevent infection
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142
Q

What is the order of priority for repair once a patient is stable for GA?

A
  • Skull and spinal fractures (within 24 hours, neuro status dependant)
  • Open fractures (6 hours – wound management)
  • Articular fractures and dislocations (1-2d)
  • Long bone fractures (1-5d)
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143
Q

How are pelvic fractures temporarily managed?

A

Cage rest and analgesia

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144
Q

How are femur fractures temporarily managed?

A

Cage rest and analgesia

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145
Q

How are humeral fractures temporarily managed?

A

Cage rest and analgesia or spica splint

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146
Q

How are radius and ulna fractures temporarily managed?

A

Splinted bandage and analgesia

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147
Q

How are tibial fractures temporarily managed?

A

Support bandage, splinted bandage or analgesia

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148
Q

How are hock, carpus and foot fractures temporarily managed?

A

Support bandage, splint or analgesia

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149
Q

What are the aims of fracture management?

A

To create an optimal environment for fracture healing and return the patient to normal function as soon as possible

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150
Q

What are fracture diseases?

A

Occur during bone healing as a result of immobilisation of the limb

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151
Q

Name 4 fracture diseases.

A

Joint stiffness
Muscle atrophy
Osteoporosis
Muscle contracture and fibrosis

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152
Q

What does fracture healing require?

A

Adequate bone reconstruction
Stability
Vascularity
Balance between these must be achieved

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153
Q

What are the fracture healing/fixation options?

A

Conservative management – cage rest

External coaptation – splints, casts, bandages

Surgical management:
- External skeletal fixation with/without IM pin
- Internal fixation – pins, screws, bone plates, interlocking nails

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154
Q

How is conservative management of fracture healing done?

A

Surrounding soft tissue (muscle, periosteum, adjacent bones) provides sufficient stability to keep bones aligned whilst healing.

Minimise movement whilst healing

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155
Q

How is movement minimised during fracture healing?

A
  • Restrict exercise (cage rest)
  • Provide pain relief (NSAIDs)
  • Duration age dependant (2-4w)
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156
Q

Which cases can he healed with conservative management?

A
  • Flat bones/axial skeleton - pelvic fractures, mandibular fracture, spinal fractures, scapula fractures
  • Minimally displaced
  • Cancellous bone
  • Non load bearing bones
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157
Q

What is external coaptation and when it is used?

A
  • Splint, cast, bandage
  • Fractures below elbow/stifle
  • Young animals
  • Minimal displacement
  • Stable fractures
  • Cast or customised splint best
  • Off the shelf splint and bandage –for temporary use
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158
Q

what are the suitable fractures for external coaptation?

A
  • Lower limb
  • Simple stable fractures
  • Transverse/interdigitating
  • Radius with intact ulnar
  • Tibia with intact fibula
  • Fractures with overlap >50%
  • Good healing potential – young
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159
Q

What are the advantages of non-surgical management?

A
  • Reduce/avoid anaesthesia
  • Avoid need for open surgery
  • No disruption blood supply
  • Cheaper materials
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160
Q

What are the disadvantages of non-surgical management?

A
  • Fracture disease
  • Insufficient stability leading to a delayed or non-union
  • Cast sores
  • Malunion
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161
Q

What are the aims of surgical management of fractures?

A

Place implants (isolation or in combination) between fracture fragments to hold them securely while fracture heals

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162
Q

What must implants withstand in surgical fracture management?

A

Implants must withstand forces that are trying to separate fracture fragments and disrupt healing

The most deleterious forces that implants need to resist are rotation and tension

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163
Q

What is fracture seduction? How is this done in open and closed fractures?

A

The process of replacing the fracture segments in their original anatomical position

  • Closed – recent, stable, lower limb
  • Open – most fractures, instruments, toggling
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164
Q

What do cancellous bone grafts do in fracture management?

A

Stimulates bone healing:

Stimulate bony union in fracture repair
Arthrodesis
Delayed/non-union fractures

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165
Q

What are the sites of harvest for cancellous bone grafts?

A

Proximal lateral humerus, iliac crest in cats

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166
Q

What is the definition of a comminuted fracture?

A

A fracture with more than 2 fracture fragments

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167
Q

What is the best way to manage a radius and ulna fracture prior to definitive treatment?

A

Analgesia and splinted bandage

Ehmer sling = luxated hip. Velpeau sling = non-weight bearing front leg sling would probably move the fracture fragments and cause more pain.

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168
Q

Which of the following fractures is most suitable for cast repair (external coaptation) in a 6 month old cat?

A

Simple transverse radius fracture with an intact ulna

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169
Q

What are the possible orthopaedic implants?

A

Pins
Orthopaedic wire
Screws
Bone plates
External skeletal fixators

Use either in isolation or combination for fracture stabilisation

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170
Q

How are bone pins used? What are the complications?

A
  • Stainless steel sharp tipped pins
  • Uses intramedullary (IM), transosseous, and pin and tension band wire
  • Intramedullary pinning complications
  • Once loosen, they will always migrate out
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171
Q

What are interlocking nails used for?

A
  • Stainless steel pin used as intramedullary pin
  • Locked in place using screws
  • Prevents rotation and axial collapse
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172
Q

What are pain and tension band wires?

A
  • 1 or 2 K wires pins – through fragment into bone
  • Orthopaedic wire in a figure of eight – through hole in bone and around pins
  • Uses – avulsion fractures
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173
Q

What is orthopaedic wire and when is it used?

A

Malleable stainless steel wire

  • Wire is placed to completely encircle bone (cerclage) or partially encircle bone (hemi-cerclage)
  • Tension band wire (TBW)
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174
Q

What are the types of bone screws used?

A

Cortical, cancellous, locking, self tapping or non self tapping

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175
Q

When are bone screws used?

A
  • With a plate or interlocking nail
  • In isolation for fractures of cancellous bone
  • Secure a plate to a bone to support a fracture during healing
  • To compress fragments together in lag fashion to enable rapid primary (direct) bone healing without callus
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176
Q

When should bone screws not be used?

A

Never use in isolation for diaphyseal fractures – slower healing and greater forces through bone

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177
Q

What is the purpose of bone plates?

A

Restore bone structure to restore weight bearing function and enable healing

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178
Q

What are the uses of external skeletal fixation?

A
  • Comminuted fractures
  • Open fractures
  • Across joints
  • Get discharge
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179
Q

What are the types of external skeletal fixation implants?

A

Threaded transosseous pins
Clamps
Bars
Acrylic

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180
Q

Which diaphyseal fractures can be managed with casts?

A

Transverse

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181
Q

Which diaphyseal fractures can be managed with pin and cerclage wires?

A

Spiral/oblique in young animals

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182
Q

Which diaphyseal fractures can be managed with plate and screws (interlocking nail or ESF)?

A

Spiral/oblique
Transverse
Comminuted

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183
Q

Which diaphyseal fractures can be managed with plate, screws and IM pins?

A

Comminuted

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184
Q

What can be ruled out when it comes to fracture repair decisions?

A

No cast for upper limb fractures

No IM pin for radius

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185
Q

When is cerclage wire used?

A

Cerclage wire needs an oblique fracture about 2x the width of the bone so it doesn’t override and go too much the other way. If you can’t place at least 2 wires, do not do.

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186
Q

What are the principles of repair for articular fractures?

A

Rigid internal fixation – once reduced, needs to be compressed to get direct bone healing. If not will get clot, fibrous tissue and callus

Compression of gap (lag screw)

Early mobilisation – any joint immobilised for more than 4 weeks is going to get joint diseases

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187
Q

What is an avulsion fracture?

A

An injury to the bone in a location where a tendon or ligament attaches to the bone. When an avulsion fracture occurs, the tendon or ligament pulls off a piece of bone

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188
Q

What are the common locations for avulsion fractures?

A

Olecranon
Greater trochanter
Medial malleolus
Acromium of scapula
Os calcaneus
Tibial tuberosity

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189
Q

What is used for avulsion fractures?

A

Tension band wire for avulsion fractures – active distracting forces are counteracted and converted into compression forces.

Can also use tension band plate

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190
Q

What are the characteristics of physis and physeal fractures?

A
  • Physis 3-5 times weaker than ligament attachment to bone
  • Types of growth plates – pressure, traction
  • Cats that are neutered will have growth plates that stay open for longer, while not actively growing, is still open
  • Worse prognosis with higher number in Salter and Harris classification
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191
Q

What are the surgical principles for physeal fractures?

A
  • Articular fracture – priority over physeal aspect
  • Consider external coaptation if minimal displacement and non articular
  • Perpendicular to growth plate
  • Implants should damage < 10% surface area of physis
  • Avoid compressing physis
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192
Q

What is the aetiology of premature growth plate closure?

A

Trauma – fracture

Hereditary – achondroplasia in basset hounds

Diseases – osteochondrosis/retained cartilage cores, metaphyseal osteopathy

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193
Q

What can premature closure of growth plates lead to?

A

Can lead to closure of growth plates and subsequent angular limb deformity/shortening

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194
Q

What is the pathogenesis of premature growth plate closure?

A

Injury to germinal cells/blood supply of physis

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195
Q

What should you warn owners of with premature closure of growth plates?

A

Any fracture close to/through GP, any injury, trauma or lameness in puppy/kitten

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196
Q

What are the clinical signs of premature growth plate closure?

A
  • Angular limb deformity
  • Lameness – check joints for pain
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197
Q

What are the consideration of premature growth plate closure?

A

GP closes about 7m
Worse is paired bone (radius and ulna)
Partial closure possible

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198
Q

How is premature closure of growth plates diagnosed?

A

Image with whole limb – with carpal valgus, elbow might also be affected

Image both limbs to compare

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199
Q

When is premature closure of growth plates treated conservatively and surgically?

A

Conservative – mild problem, no pain

Surgical – if painful and lame/young

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200
Q

What are the surgical principles of premature growth plate closure treatment?

A
  • Restore joint congruency
  • Restore paw to a functional position
  • Correct rotational deformity
  • Correct angular deformity
  • Restore limb length
  • Osteotomy = cut bone
  • Ostectomy = remove piece of bone
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201
Q

Which is the most commonly affected growth plate of premature closure?

A

Distal ulna physis

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202
Q

Why do cats not have many distal ulna deformities?

A

Have flat distal ulna, unlike dogs that have conical shape

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203
Q

What is concurrent with trauma in the aetiology of distal ulna physis premature closure?

A

Distal radial fractures
Hereditary
Disease
Chondrodystrophic breeds
Idiopathic
Retained cartilage core

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204
Q

What are the clinical signs of distal ulna physis premature closure?

A
  • Deformity = radius curvus
  • Lame – elbow subluxation?
  • Carpal valgus
  • External rotation of the foot (supination)
  • Cranial and medial bowing of radius
  • Subluxation of humeroulnar joint and radiocarpal bone
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205
Q

How is the – premature closure distal ulna growth plate 4 month deerhound, with carpal valgus and a normal elbow treated?

A

Ulna osteotomy/ostectomy and physeal stapling medial radius

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206
Q

How is the premature closure distal ulna growth plate in a 5m Corgi, with mild carpal valgus, elbow subluxation and pain treated?

A

Cut ulna to come into a more natural place, ulna osteotomy/ostectomy

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207
Q

How is the premature closure distal ulna growth plate in a 12m Lab, with left carpal valgus and a normal elbow treated?

A

Radius and ulna osteotomy/ostectomy

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208
Q

What is an alternative to stabilising the leg post surgery fixing premature growth plate closure?

A

Circular frame

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209
Q

How is leg lengthening done in small animals with angular deformities?

A

Leg lengthening – distraction osteogenesis. Dog with short limb segment. Osteotomy and distract leads to 1mm/day induces new bone and lengthens bones.

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210
Q

What is the most likely cause of premature closure of the distal ulna growth plate in a Dachshund?

A

Hereditary

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211
Q

In dogs, which growth plate is most commonly implicated in angular limb deformity cases?

A

Distal ulna

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212
Q

When can carpal valgus be normal?

A

Mild carpal valgus with outward pronation may be normal. As foal grows, chest widens and elbow pronation by 4 months and virtually straight by 8-10 months

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213
Q

What is digital hyperextension and how is it managed?

A
  • Common in newborn foals
  • Self correcting in a few weeks
  • May require heel protection
  • Moderate exercise on soft surface
  • Swimming increases muscle tone
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214
Q

What are angular limb deformities?

A

Deviation to limb in sagittal plane viewed from the frontal. Either laterally/valgus or medially/varus

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215
Q

What are flexural limb deformities?

A

Deviations in the frontal plane when viewed from lateral aspect

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216
Q

How is carpal valgus characterised?

A

Fetlock varus
Carpal varus
Tarsal valgus

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217
Q

What is congenital epiphyseal wedging of angular limb deformities?

A

Wider side has more chondrocytes so grows more bone

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218
Q

What is congenital incomplete ossification of cuboidal bones of angular limb deformities?

A

More in tarsi than carpi for hypoplasia. Subsequent carpal bone collapse or subluxation

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219
Q

What is congenital periarticular/collateral ligament laxity of angular limb deformities?

A
  • Can manually correct this
  • Take stressed and neutral radiographs
  • Mare has hormones that relax her ligaments for foaling but these can also affect the foal
220
Q

What is the pathophysiology of acquired angular limb deformities?

A
  • Asymmetrical growth at distal physis in the bone proximal to the joint
  • Associated with physitis - exercise, dry hard ground causes trauma, affected medial side closes earlier, affected medial side closes earlier
  • Nutritional in heavier foals - all bear weight more on inside of limb and when heavier this slows growth medially even more than usual
221
Q

What are the aetiologies of congenital angular limb deformities?

A
  • Severe disturbance to dam during pregnancy - metabolic, endotoxic (colic)
  • Placentitis
  • Prematurity
  • Dysmaturity
  • Twins
  • Foetal position in utero
222
Q

What are the aetiologies of acquired angular limb deformities?

A
  • Excessive growth rates
  • Physeal injury/inflammation
  • Contralateral limb overload
  • Infection
  • Conformation
223
Q

What management is used in angular limb deformities?

A
  • Trim if mild
  • Shoes if marked
  • Medial extensions for valgus
  • Lateral extensions for varus
  • Move centre of weight bearing axis under limb
  • Apply increased forces over the side with rapid growth slowing it down
224
Q

How is cuboidal bone hypoplasia supported with splinting?

A
  • Support limb whilst ossification occurs
  • Confinement
225
Q

How is ligamentous laxity supported with splinting?

A

Support limb whilst the natural loss of elasticity over the first month of life

Movement restriction

226
Q

What are the indications for surgery for angular limb deformities?

A
  • Fail to respond to conservative measure
  • Severe
  • Presented late
227
Q

When is surgery for angular limb deformities contraindicated?

A
  • Those not centred at physis
  • Timed before closure of physis
228
Q

When must surgery be done by with angular limb deformities?

A

2m = fetlock
4m = hock
6m = carpus

229
Q

What is the surgical treatment of choice for angular limb deformities?

A

Transphyseal lag screw - physical prevention of growth rate in overactive side. Single screw so easy to place and remove.

Can also do transphyseal bridging - same principle but more hardware. 2 screws, figure of 8 wire. Increased incision length, longer surgery, increased risk of infection

Can also do periosteal strip - removing periosteum thought to stimulate growth

230
Q

What is the presentation of flexural deformity?

A

1 or more joints persistently flexed when standing square at rest

231
Q

How is congenital flexural deformity managed?

A
  • 3g oxytetracycline dissolved in saline and slow IV, repeat in a few weeks - direct action on myofibroblasts
  • Firm surface
    Physiotherapy - passive ROM stretches
  • Improve foot balance
232
Q

What is the conservative management for a foal with acquired flexural deformity?

A
  • Limit diet to reduce growth rate
  • Analgesia (muscle contraction = pain response)
  • Moderate exercise on firm ground
  • Shoeing
  • Physiotherapy - passive ROM stretches
233
Q

What is the surgical management for a foal with acquired flexural deformity?

A

DIP = inferior check ligament desmotomy

MCP = inferior check ligament desmotomy and/or superior check ligament desmotomy

Complication - risk of distal joint luxation

234
Q

What management is used for adults with flexural deformities?

A
  • Improve foot balance
  • Physiotherapy - passive ROM stretches
  • Controlled exercise on a firm surface
  • Desmotomy?
  • Manage primary problem
235
Q

What are the 3 As for evaluation of fracture healing immediately post op?

A

Alignment – leg straight

Apposition – fracture surfaces apposed

Apparatus – implant position, loosening, breakage

236
Q

What is the 4th A in the evaluation for fracture healing?

A

Activity 6 weeks later – callus, fracture healing. Is there any abnormal amount of activity, instability or bony change suggestive of infection

237
Q

Why might bandages be used post operatively for fractures?

A

Reduce swelling and increase comfort short term. Try to avoid long term if we want to surgery as the aim is to avoid putting anything outside

238
Q

How is exercise restricted post operatively for fractures?

A

House/cage, 4-6w (maybe less for younger or more for older)

239
Q

What are the adjunctive therapies used for post operative care of fractures?

A

Physiotherapy, hydrotherapy

240
Q

What analgesia is used for post operative care of fractures?

A

Opioids, NSAIDs

241
Q

How are fractures checked and managed once healed post operatively?

A

Recheck(s) – x-ray every 3-6w

Once healed – gradual return to normal exercise. For dogs you can increase the duration of lead walks but can be harder in cats

242
Q

What is the prognosis of fractures post operatively?

A

Guarded for articular (will get OA), good for diaphysis

243
Q

What are the possible complications of fractures post operatively?

A

Infection
Delayed or non union
Malunion
Refracture
Implant complications – breakage, loosening

244
Q

Describe the classification for open fractures?

A

Grade I – small puncture wound (1cm) larger skin wound caused by external trauma. Severe bruising equates to a grade I open fracture as skin barrier effect is lost

Grade II – wound (>1cm) larger skin wound caused by external trauma

Grade III – extensive loss of skin and bone often severe fractures

245
Q

Why are open fractures an emergency?

A

Tissue devitalisation, ischaemia, foreign material all promote a contaminated wound becoming infected

246
Q

Outline how open fractures are managed.

A
  1. Institute haemostasis
  2. Cover wound with sterile dressing
  3. Wear sterile apparel
  4. Apply water soluble gel to wound
  5. Clip hair
  6. Flush wound - saline (water), large volume
  7. Take bacterial swab
  8. Apply sterile dressing and bandage/splint
  9. Dressing – non adherent, wet to dry swabs for further debridement
  10. If fracture below, splint prior to more definitive treatment
247
Q

What is the golden period of open fracture management?

A
  • Operate within 6-8 hours
  • Perform adequate debridement and lavage
  • Open fracture can be treated as a closed fracture – with internal fixation
  • When bacteria not had enough time to proliferate
248
Q

Why are open fractures debrided?

A
  • Remove dead fat and muscle (and skin)
  • Preserve tendon, ligament, nerves, blood vessels, bone
  • Serial debridement over several days to limit infection
249
Q

How are grade I open fractures stabilised?

A

Internal fixation methods. Always warn over that implants may need to be remove and may get infection a year later

250
Q

How are grade II and III open fractures stabilised?

A

ESF – bigger likelihood of bigger wound and greater risk of infection so implants have a greater risk of becoming infection

251
Q

Define osteomyelitis.

A

Any inflammatory condition of the bone, bone marrow or periosteum

252
Q

What are the aetiologies of osteomyelitis?

A
  • Iatrogenic following surgery
  • Haematogenous – endogenous
  • Extension from local lesion
  • External source (bite wound)
  • Open fracture
  • Nosocomial – infection acquired during hospitalisation if good aspect if technique is not maintained
253
Q

What is sequestrum in osteomyelitis?

A

A necrotic bone fragment. Radiographically appears as a dense area of bone with sharp well defined edges

254
Q

What is involucrum in osteomyelitis?

A

The body attempts to wall off the sequestrum by an avascular wall of fibrous tissue and sclerotic bone the involucrum.

255
Q

What are the acute clinical signs of osteomyelitis?

A

Pain
Swelling
Pyrexia
Lameness
Abscess
No bony changes radiographically, just soft tissue swelling

256
Q

What are the chronic clinical signs of osteomyelitis?

A
  • Less severe clinical signs – lameness, pain, discharging sinuses
  • Radiographic changes evident
257
Q

What are the radiographic changes that occur from osteomyelitis?

A
  • Soft tissue swelling
  • Periosteal new bone
  • Lucencies
  • Disuse osteopenia – painful and infection so limb not used as much and bone is resorbed
  • Sequestra and involucrum
  • Loose implants
258
Q

How is acute osteomyelitis treated?

A
  • Antibiotics - culture and sensitivity, treat for 6 weeks, repeat culture 3-5d after end of course
  • Assess and address fracture stability
  • Debridement
  • Drainage
259
Q

How is chronic osteomyelitis treated?

A
  • Identify cause and remove – sequestrum, implants
  • Lavage
  • Repair soft tissue prior to removal or implants or leave to close by secondary intention
  • Bacterial culture
  • Assess fracture stability
260
Q

What are glycocalyx?

A
  • Implants may be covered by a gelatinous mucinous carbohydrate layer where bacteria can lie dormant and protected from antibiotics.
  • All implants may need removal for the infection to resolve
261
Q

Distinguish delayed union and non-union.

A

Delayed union – a fracture that has not healed in the time normally expected for that type of fracture to heal

Non union – fracture healing has stopped and union will not occur without surgical intervention

262
Q

Use the acronym BIG RIB to explain the aetiopathogenesis of delayed/non-uniform union.

A
  • Loss of Blood supply at the time of fracture or at surgery
  • Inadequate immobilisation
  • General factors – old, on steroids, hypothyroid/concurrent diseases
  • Inadequate Reduction of fracture
  • Infection
  • Loss of Bone
263
Q

What are the clinical signs of delayed/non-uniform union?

A
  • Motion at fracture site
  • Pseudoarthrosis (false joint formation at fracture site)
  • Progressive deformity
  • Disuse of limb from pain and not using leg, causing muscle atrophy and joint stiffness
264
Q

How is delayed/non-uniform union diagnosed?

A
  • Radiolucent gap – callus is not very effective and is not reaching across fracture gap
  • Feathery appearance and moderate/no callus
  • Sealed medullary canal
  • Rounded fracture end
265
Q

How is delayed/non-uniform union treated?

A
  • Ensure no major nerve damage or fracture disease
  • Provide rigid fixation to stabilise
  • Stimulate osteogenesis/healing, such as with bone grafting
  • Treat infection
266
Q

Which bones are prone to non-union? What is done?

A

Radial and ulna fractures are prone to non-union if not done appropriately as leg in cast, there is too much movement at the fracture site so could lead to disturbance of the blood supply and lead to non-union

Pins can bend due to fracture site movement in these cases. Treat by taking out and putting plate and screws across this fracture

267
Q

What is malunion?

A
  • A fracture that has healed or is healing in an abnormal position
  • Caused by improper immobilisation or reduction
268
Q

When and how is malunion treated?

A

If malunion causes lameness problems may need to treat by osteotomising the bone and correcting malignment

269
Q

What is the gelatinous mucinous carbohydrate layer called that covers implants and where bacteria can lie dormant and protected from antibiotics?

A

Glycocalyx

270
Q

List the urgent/emergency steps that should be taken when presented with a cat with an open tibial fracture (cat is otherwise stable and sedated for injury management).

A
  1. Haemostasis
  2. Cover wound with a sterile dressing whilst preparing for lavage
  3. Sterile gloves
  4. Water soluble gel or saline soaked swabs to the wound
  5. Clip away hair, working from the wound outwards if possible
  6. Flush wound with copious amounts of sterile saline to remove debris and dilute bacteria
  7. Take a deep bacterial swab for culture
  8. Apply a sterile dressing and bandage/splint
271
Q

What 4 things should you assess on 6 week post-operative radiographs after a fracture repair?

A

Apposition, alignment, apparatus, activity

272
Q

How are the 3 aspects of the scapula treated if fractured?

A

Body, blade, spine – can treat conservatively if minimal displacement, consider repair if widely displaced

Glenoid – articular fractures so repair recommended

Supraglenoid tuberosity – biceps tendon origin, repair as avulsion fracture or remove fragment

273
Q

What are the inflammatory conditions of the shoulder?

A

OCD, OA, sepsis

274
Q

What are the musculotendinous and ligamentous conditions of the shoulder?

A

Infraspinatus contracture
Bicipital tenosynovitis
Medial displacement of the biceps brachii tendon

275
Q

What is the pathogenesis of shoulder luxation?

A
  • Congenital – never articulates so joint does not develop properly
  • Acquired – traumatic, rupture of collateral ligaments
276
Q

What are the clinical signs of shoulder luxations?

A
  • Lame with shortened stride
  • Congenital – lameness may be mild/missed
  • Palpable abnormal anatomy
  • Reduced ROM and pain/crepitus around shoulder
277
Q

Why might the glenoid be flat and round?

A

Hasn’t been articulated with so been luxated for a while

278
Q

How are congenital and acquired shoulder luxations treated?

A

Congenital – none, trans-articular pin, excision, arthrodesis

Acquired:
- Closed reduction – spica splint (lateral luxation), velpeausling (medial luxation)
- Open reduction, and prosthetic sutures or tendon transposition

279
Q

What is the aetiology of shoulder osteochondrosis?

A

Herediatry
Nutritional

280
Q

What is the pathogenesis of shoulder osteochondrosis?

A
  • Fissuring and detachment of flap of cartilage
  • Caudomedial humeral head
281
Q

What are the clinical signs of shoulder osteochondrosis?

A
  • Gradual onset, chronic lameness
  • Shoulder muscle atrophy
  • Pain on shoulder extension (flexion)
282
Q

How is radiography used to visualise shoulder osteochondrosis?

A
  • Mediolateral views of both extended shoulders
  • Supinated or pronated views if lesion medial or lateral
  • Subchondral defect with flattening of the caudal humeral head
  • Mineralised cartilage flap or joint mouse
  • DJD
  • Arthrography may be useful
283
Q

What are the treatment options for shoulder osteochondrosis?

A

Conservative – for small (<1cm) or non-clinical lesions. Rest for 4 weeks and NSAIDs

Surgical – arthroscopy, arthrotomy, chondrectomy and debridement

Post operative – rest and NSAIDs for 4 weeks

284
Q

What are the possible complications of shoulder osteochondrosis surgical treatment?

A

Failure to remove whole flap
Seroma formation

285
Q

What is the aetiology and pathogenesis of bicipital tenosynovitis?

A

Aetiology – trauma during exercise or direct

Pathogenesis – range of pathology from inflammation to partial to complete rupture

286
Q

What are the clinical signs of bicipital tenosynovitis?

A
  • Acute or insidious onset forelimb lameness
  • Pain on direct palpation of tendon
  • Thickening and pain over tendon origin
287
Q

How is bicipital tenosynovitis diagnosed from imaging?

A
  • Loss of clear tendon outline
  • Changes in tendon structure
  • Complete rupture of tendon
288
Q

How is bicipital tenosynovitis treated?

A
  • 6-8 w rest and NSAIDS
  • Intra articular steroids
  • Severe pain/tear
  • Tenotomy and tenodesis
289
Q

How is a partial biceps tendon rupture treated?

A

Tenotomy and tenodesis

290
Q

How is a complete biceps tendon tear identified?

A
  • Pathognomic test for complete biceps brachii tendon rupture
  • Can flex shoulder while elbow extended
291
Q

Which breed is susceptible to medial displacement of the biceps tendon?

A

Greyhounds and lurchers

292
Q

What is the pathogenesis of medial displacement of the biceps tendon?

A
  • Tendon displaces out of groove medially, after racing/running
  • Secondary to bicipital tenosynovitis, rupture transverse humeral ligament
293
Q

How is medial displacement of the biceps tendon treated?

A

Replace transhumeral ligament. Smooth staple or screws and suture/mesh to replace transhumeral ligament

294
Q

What is the pathogenesis of infraspinatus tendon contracture?

A

Trauma > inflammation > fibrosis and contracture

295
Q

What are the clinical signs of infraspinatus tendon contracture?

A
  • Characteristic stance/gait – circumducting gait
  • Manipulation – not possible to extend shoulder
296
Q

What is the treatment and prognosis for infraspinatus tendon contracture?

A

Treatment – sever/excision tendon

Prognosis – good for complete recovery

297
Q

What are the locations of humeral fractures?

A
  • Humeral head – physeal/articular
  • Greater tubercle fracture – avulsion
  • Humeral diaphysis – diaphyseal
  • Supracondylar – diaphyseal
  • Condylar fractures – articular/physeal
298
Q

What are the characteristics of humeral physeal fractures?

A
  • Proximal humeral physis
  • Interdigitating fracture, stable, repair with 2 pins
  • Cats more likely mid diaphysis and dogs more likely condyle
299
Q

How appropriate is cast/external coaptation for humeral diaphyseal fractures?

A

Not appropriate for fractures of the upper limb

300
Q

How appropriate is IM pin fixation for humeral diaphyseal fractures?

A

Can be used in combination with plate and screws, ESF or cerclage wires

301
Q

How appropriate is an interlocking nail for humeral diaphyseal fractures?

A

Can be used but as bone narrows distally only suitable for mid and proximal diaphyseal fractures

302
Q

How appropriate is plate and screws for humeral diaphyseal fractures?

A

Often the best choice, surgical approach, anatomy and shape of bone make fixation of this bone challenging

303
Q

How appropriate is ESF for humeral diaphyseal fractures?

A

Avoid in upper limb bone if internal fixation is a better option. But can be used particularly for comminuted fractures and in cats. Transarticular frames can be used for severe supracondylar fractures.

304
Q

How is a humeral diaphyseal fracture best treated and why?

A

Lag screw, IM pin and neutralisation plate

Reconstructing the bone so there is load sharing between the bone and the plate

305
Q

What is the aetiology of humeral condylar fractures?

A
  • Often minimal indirect trauma – drop, fall
  • Fissure/stress fracture (HIF) – Springer spaniel
306
Q

What is the pathogenesis of humeral condylar fractures?

A

Indirect/shear fracture – force through foot, radius, shear off condyle. 3 types seen:

  • Lateral aspect of condyle (70%)
  • Both condyles (25%)
  • Medial aspect of the condyle (5%)
307
Q

What are the clinical signs of humeral condylar fractures?

A
  • Sudden onset forelimb lameness
  • Pain, crepitus elbow manipulation
  • Lateral epicondyle palpably more proximal than medial (lateral condylar fracture
  • Palpably unstable and swollen (Y)
  • Elbow effusion
  • Prodromal lameness (HIF)
308
Q

How are articular humeral condylar fractures treated?

A
  • ORIF/open reduction and internal fixation
  • Compression
  • Perfect reduction
  • Maintain joint mobility
309
Q

How are bicondylar/Y/T humeral condylar fractures treated?

A
  • Early ORIF/open reduction and internal fixation – double plates and screws
  • Very challenging cases
310
Q

What is the post-operative management for humeral condylar fractures?

A
  • Bandage to reduce swelling increase comfort
  • Strict exercise restriction
  • Cage rest 4-6 weeks
  • Elbow physiotherapy
  • Follow up x-rays 4-6 weeks
311
Q

What are the complications of humeral condylar fracture repair?

A

Implant failure, infection, OA

312
Q

What is the prognosis of humeral condylar fracture repair?

A

Early surgery and complication free healing prognosis good. All dogs will develop OA

313
Q

What are humeral intracondylar fissures?

A

Incomplete ossification of humeral condyle - present with lameness and a fissure. Acute fracture = prodromal lameness

Best detected on CT

314
Q

How are humeral intracondylar fissures treated?

A

Place prophylactic screw to prevent fracture

315
Q

Which of the following breeds is prone to developing shoulder osteochondrosis dissecans?

A

Border collie

316
Q

What aspect of the humeral condyle is most commonly affected fractures? Usually seen in young small breed puppies that jump from owners arms, such as French bulldogs.

A

Lateral

317
Q

Which scapula fractures would definitely benefit from surgical repair?

A

Glenoid

318
Q

What are ligaments and their functions?

A

Short bands of tough fibrous tissue that

  • Bind the bones of the body together
  • Hold structures in place (eg transverse humeral ligament holds biceps tendon in place)
319
Q

What are ligaments made up of?

A

Made of dense regularly orientated connective tissue made of fibres of collagen, fibroblasts, ground substance (glycan proteoglycans/GAGs and proteoglycans, gel substance to give nutrients to the joint, forms space between fibres and cells)

320
Q

Define sprain and strain.

A

Ligament injuries are sprains

Tendon injuries are strains

321
Q

What is a type 1 sprain? How are these managed?

A

Minimal tearing with some haemorrhaging. Rest or bandage for 2 weeks

322
Q

What is a type 2 sprain? How are these managed?

A

Partial tearing and stretching of fibres with haemorrhage. Surgical repair, suture or protect with a prosthetic, external coaptation post op

323
Q

What is a type 3 sprain? How are these managed?

A

Complete rupture of avulsion of attachment. Surgical repair and/or prosthetic replacement. ESF or external coaptation post op. Arthrodesis – palmar or plantar carpal/tarsal ligament rupture

324
Q

What do sprains require for healing due to healing being slow?

A

So they need protection – 3 weeks of rigid support, followed by 3 weeks flexible support:

  • May need to replace or splint ligament with a prosthetic as primary repair often not possible
  • Arthrodesis sometimes indicated – palmar carpal ligament rupture or plantar tarsal ligament rupture
325
Q

What are the presenting signs of collateral ligament injuries?

A
  • Lameness
  • Obvious instability
  • Pain on manipulation
  • Luxation (dislocation)
  • May be open injury
326
Q

How are collateral ligament injuries diagnosed?

A
  • Palpation
  • Survey radiographs
  • Stressed radiographs – varus or valgus stressed to test collateral ligament integrity
327
Q

How are type 1 collateral ligament injuries treated?

A

Conservative management with bandage
Rest
NSAIDs

328
Q

How are type 2 and 3 collateral ligament injuries treated?

A
  • Collateral ligament – repair/replacement
  • Anchor points at origin and insertion – anchor using screws and washers, anchor using suture anchors, suture replaces ligament
  • Avulsion fracture – repair with pin and TBW
329
Q

What are the post-operative managements for collateral ligament injuries?

A

ESF, external coaptation

330
Q

What are suture anchors and how can they be used for collateral ligament injuries?

A

Suture anchors can be put into the bone and place suture through little holes, used at origin and insertion of the ligament to protect the ligament and replace the function of the ligament.

331
Q

Distinguish valgus and varus.

A
  • Valgus means the distal part deviates laterally
  • Varus means the distal part deviates medially
332
Q

What causes valgus and varus?

A

Bone deformity
Ligament laxity injury

333
Q

Distinguish valgus and varus stress.

A

Varus stress – tests lateral collateral ligament

Valgus stress – tests medial collateral ligament

334
Q

What are open ligament injuries from degloving or shear injuries?

A

Open wounds with loss or damage to collateral ligaments

335
Q

How are ligament injuries from degloving or shear injuries treated?

A
  • Open wound management – flush, debride, analgesia
  • Provide stabilisation (bandage/splint/ESF)
  • Collateral Instability may not need specific treatment – fibrosis may be sufficient to restore stability but may need to consider fusion of the lower motion joints of the carpus/arthrodese (salvage procedure for very severe)
  • Severe injury – amputate
336
Q

What is the pathogenesis and signalment of plantar/palmar ligament rupture?

A

Rupture of ligament causes loss of function/luxation/subluxation

Shetland sheepdog/collie types predisposed

337
Q

What are the clinical signs of plantar/palmar ligament rupture?

A

Plantigrade/palmigrade stance
Lameness

338
Q

How is palmar/plantar ligament rupture diagnosed?

A

Palpation
Stressed radiographs

339
Q

How is palmar/plantar ligament rupture treated?

A
  • Ligaments short
  • Tension high – repair failure likely
  • Joint low motion
  • Arthrodesis-partial or pan
340
Q

What is the prognosis of plantar/palmar ligament rupture?

A

Arthrodesis has a better outcome for treatment as is a low motion joint as there is often lots of ligaments affected

341
Q

Distinguish luxation and dislocation.

A

Luxation is a complete dislocation of a joint, a subluxation can be defined as a partial dislocation of a joint.

Dislocation – displacement of a part

342
Q

Distinguish congenital and acquired luxations.

A

Congenital - dogs usually seen at young age with abnormal gait and conformation. Reported in the shoulder and elbow

Acquired – usually occur after major trauma such as RTAs or falls. Significant soft tissue damage has to occur to allow dislocation. There will be ligament ruptures (collaterals) and possibly muscle or tendon ruptures as well. Can affect any joint. Can be open or closed

343
Q

Define salvage procedure?

A

An operation that allows continuance of function of an animal without preservation of normal anatomy

344
Q

What are some examples of salvage procedures?

A
  • Arthrodesis
  • Amputation
  • Excision arthroplasty – for bone on bone contacts that are painful, if dysplastic, degenerative or painful, cut off some bone and forms a false joint, such as femoral head and neck excision
  • Prosthetic surgery (total hip replacements)
345
Q

Why arthrodese/fuse a joint?

A

Relieve pain, restore function

346
Q

Which joints might benefit from arthrodesis?

A
  • Chronic unrelenting joint pain
  • Untreatable articular fractures
  • Chronic joint luxations
  • Partial neurological injuries
  • Unreconstructable
  • Ligament injuries – palmar carpal ligament rupture
347
Q

Why and how might you arthrodese intertarsal joints?

A

To treat plantar tarsal ligament rupture

Fuse and stabilise with plate and screws, but maintaining the high motion tibiotarsal joint

348
Q

What are the surgical principles of arthrodesis?

A
  • Debride – debridement/remove cartilage
  • Angle – stabilisation at an appropriate angle for the joint, avoid angulation/rotation.
  • Graft – placement of cancellous bone graft to speed up healing
  • Immobilise
349
Q

Which joints can be arthrodesed with good prognoses?

A
  • Distal joints – carpus and to a lesser degree the tarsus are arthrodesed without significant effect on the gait of the animal.
  • Shoulder arthrodesis ROM lost by arthrodesis is gained by an increase in motion in the muscles holding the scapula to the trunk (synsarcosis) so can often maintain stride length
350
Q

Which joints can be arthrodesed with poor prognoses?

A
  • Elbow and stifle will results in a significant alteration in gait with circumduction of the limb to compensate for the ‘long lever arm’ and inability to now flex these major joints
  • Arthrodesis of the hip is contraindicated
351
Q

What are the indications of amputation?

A
  • Neoplasia
  • Severe pain
  • Dysfunction beyond repair
  • Osteomyelitis that is not responding to treatment
  • Neurological injury – plexus avulsion
  • Fracture/wound/injury that cannot be treated (for financial reasons)
352
Q

What is done before amputation surgery?

A

Examine whole animal especially other joints to ensure suitable for amputating one leg

353
Q

What are the possible amputation level of thoracic limbs?

A

Disarticulate shoulder
Proximal humerus
Remove whole limb plus scapula

354
Q

What are the possible amputation level of pelvic limbs?

A

Disarticulate hip
Proximal femur - marked muscle atrophy and bony prominences, hemipelvectomy

355
Q

What is the anatomy of tendons?

A

In area of direction change/friction, there are tendon sheath, bursas or a bony enlargement

356
Q

What are the characteristics of tendons that influence healing and repair?

A
  • Avascular – poor blood supply = long healing time
  • Orientation of fibres – parallel to direction of strain
  • Scar/adhesion formation – are weak points and may interfere with function
  • Muscle contraction-complicates reapposition particularly if chronic injury
357
Q

What tendon suture patterns are used?

A

Compensate for the longitudinal orientation of the collagen fibres by having horizontal components to maintain apposition, without pulling out:

  • 3 loop pulley - such as for gastrocnemius rupture
  • Locking loop for small flat tendons like DDFTs
  • Bunnell’s suture for larger flat tendons
358
Q

What are the surgical principles of tendon repair?

A
  • Early surgery to minimise contracture problems
  • Incision may need extending to find contracted tendon ends
359
Q

What are the post-operative tendon surgery management options?

A
  • Rigid support post operatively to protect from loading with external coaptation or TESF/transarticular external skeletal fixator for 4-6 weeks
  • Placing a calcaneotibial screw to keep the hock extended after gastrocnemius tendon repair
  • Or bandaging the foot in a flexed position after digital flexor tendon severance
360
Q

What is the gait abnormality from biceps brachii disruption?

A

Increased ROM of shoulder with elbow extended

361
Q

What is the gait abnormality from calcaneal/gastrocnemius disruption?

A

Dropped hock and claw foot

362
Q

What is the gait abnormality from quadriceps tendon disruption?

A

Dropped stifle, unable to keep extended

363
Q

What is the gait abnormality from digital flexor tendon disruption?

A

Knocked up toes/flat toes

364
Q

What is the gait abnormality from triceps brachii disruption?

A

Dropped elbow - unable to keep extended

365
Q

What is the gait abnormality from popliteus disruption?

A

Lameness, other changes subtle

366
Q

What is the gait abnormality from long digital extensor tendon disruption?

A

Lameness, other changes subtle

367
Q

What is the aetiopathogenesis of avulsion or rupture of musculotendinous structures?

A

Usually results from an abnormal or spastic contraction of a muscle against a fixed joint

368
Q

What are the clinical signs of digital flexor tendon lacerations?

A

Dropped or knocked up toe

369
Q

How are digital flexor tendon lacerations treated?

A

Repair with suture pattern and leave untreated if old injury

370
Q

What is the post operative management after digital flexor tendon repair?

A

Support with foot flexed to prevent weight bearing

371
Q

What is the aetiopathogenesis of achilles tendon rupture?

A

Incoordinate contraction > rupture at weak point musculotendinous junction

372
Q

What are the clinical signs of achilles tendon rupture?

A

Loss of function
Rupture gastrocnemius then unable to extend hock

373
Q

How is achilles tendon rupture treated?

A
  • Repair – tendinous sutures/mattress sutures
  • External coaptation/support while healing
374
Q

What are the clinical signs of gracilis rupture?

A

Lameness
Swelling, haemorrhage
Palpable tear
Loss of function

375
Q

How is gracilis rupture treated?

A
  • Repair muscle – mattress sutures
  • Conservative – if not returning to racing
376
Q

What are the clinical signs of gastrocnemius avulsion?

A

Lameness and plantigrade stance
Claw foot

377
Q

How is gastrocnemius avulsion treated?

A

Reattach tendon to bone
Pin and tension band wire

378
Q

What is the aetiology and pathogenesis of musculotendinous contracture?

A
  • Trauma – repetitive/single
  • Parasites – Neospora cysts within muscle

> Fibrosis of muscle secondary to ischaemia/inflammation

379
Q

What are the clinical signs of musculotendinous contracture?

A
  • Reduction in ROM of joint
  • Abnormal gait/posture
  • Firm/fibrous muscle on palpation
380
Q

How is musculotendinous contracture treated?

A
  • Resect fibrosed muscle
  • Cut tendon/tenectomy
  • Release contracted muscle and lengthen it
381
Q

What are the breed dispositions for musculotendinous contractures?

A

Infraspinatus = working breeds, like spaniels and weimaraners

Gracilis = active dogs, like German shepherds

Quradriceps = post femoral fracture in young cats and dogs

DFT = post antebrachial trauma/swelling in older cats

382
Q

What is the aetiopathogenesis of musculotendinous displacement?

A
  • Trauma and rupture of the retinaculum (retaining tissue)
  • Tendonitis and inflammation of the tendon
  • Conformational abnormalities
383
Q

How is musculotendinous displacement treated?

A

Aim restore tendon to normal place. Deepen groove, suture surrounding soft tissues, smooth staple, mesh to retain tendon in groove

384
Q

What are the breed dispositions to tendon displacements?

A

Biceps brachii = Greyhounds, lurchers

SDFT = shetland sheepdogs, others

Quadriceps tendon/patellar luxation = small breeds, cats, any

Long digital extensor tendon = any, very rare

385
Q

Rupture of which muscle in the dog and cat can result in a dropped elbow?

A

Triceps brachii

386
Q

You are presented with a Shetland sheepdog with lameness and swelling around the point of the hock. What tendon can displace in this area and this breed and be a cause of lameness?

A

SDFT

387
Q

Contracture of which muscle is a recognised cause of lameness in a German shepherd dog?

A

Gracilis

388
Q

Injury to a ligament resulting in partial tearing and stretching of ligament fibres with internal and peri-ligamentous haemorrhage is classified as what type and grade of injury?

A

Type 2 sprain

389
Q

Which joint is least likely to be arthrodesed due to the resulting poor outcome?

A

Hip

390
Q

How well do pelvic fracture heal with conservative treatment?

A

Usually heal but with malunions

391
Q

What are the indications for surgical repair of pelvic fractures?

A
  • Fractures of weight bearing axis
  • Articular fractures (acetabular)
  • Narrowing of the pelvic canal
392
Q

What is the aetiopathogenesis of ilial pelvic fractures?

A
  • Traumatic fracture of the ilium
  • Fragment displaces medially and cranially
  • Narrows pelvic canal
  • Weight bearing axis
393
Q

How are ilial pelvic fractures treated surgically?

A

Surgery preferable if significant narrowing/cat lame and painful. Can also get sciatic nerve entrapment

Surgical stabilisation – widened pelvic canal post op and increased comfort

394
Q

What are the complications of treating ilial pelvic fractures conservatively?

A

Malunion
Narrowed pelvis
Constipation

395
Q

What is the post-operative management used for ilial pelvic fractures?

A

Analgesia, cage rest and monitor urination/defecation

396
Q

What is the most common pelvic injury, particularly in cats?

A

Sacroiliac luxations

397
Q

When do you decide to treat and what treatment is used for sacroiliac luxations?

A

Displacement, pain

Treatment – usually single lag screw fixation

398
Q

When is surgery used to treat acetabular fractures?

A

Reducible displaced fractures

399
Q

When are acetabular fractures conservatively managed?

A
  • Caudal 1/3rd (non-weightbearing)
  • Non-displaced, skeletally immature
  • Extensive comminution
400
Q

Name the salvage procedure used for acetabular fractures.

A

Femoral head and neck excision

401
Q

What is the aetiology of hip dysplasia?

A
  • Developmental disease
  • Born with normal hips
  • Laxity develops in joint capsule which allows hip to subluxate
402
Q

What are the clinical signs of hip dysplasia?

A

Short stride, stiffness, clunking of hips
Lateral sway
Bunny hopping
Adducted hindlimbs
Muscle atrophy
Pain on hip extension
Crepitus
Clunking

403
Q

How can hip dysplasia be diagnosed with the Ortolani test?

A

Dog in soral/lateral recumbency. Test of hip laxity. Negative is normal or dislocated hip

404
Q

How can hip dysplasia be diagnosed with the Bardens test?

A

Dog in lateral recumbency, finger on greater trochanter pushing in and out up and down of the socket if loose

405
Q

How can hip dysplasia diagnosed with imaging?

A

Ventrodorsal extended x-rays – draw circle around acetabulum and draw a line to connect the pelvis and more than half the femoral head should be medial to this line/in the socket

Hip subluxation, acetabular remodelling, osteophytes (early stages is Morgan’s sign)

406
Q

How is hip dysplasia managed non-surgically?

A

NSAIDs, rest, hydrotherapy, diet – dog gets better but radiographs get worse so base on how the dog is doing and not imaging

407
Q

How is hip dysplasia in young dogs with mild laxity before osteoarthritis surgically managed?

A
  • Growth plate fusion – eg juvenile pubic symphysiodesis (JPS), before 4 onths of age
  • Osteotomies – double or triple pelvic osteotomy (DPO or TPO)
408
Q

How is severe hip dysplasia or hip dysplasia with osteoarthritis surgically managed with salvage surgery?

A
  • Total joint replacement – cemented or uncemented
  • Ostectomies – femoral head and neck excision (FHNE)
409
Q

Outline how hip dysplasia is treated surgically with juvenile pubic symphysiodesis.

A
  • Iatrogenic closure of the pubic symphysis
  • Electrocautery to create thermal necrosis and GP closure
  • Causes acetabular ventroversion – increase femoral head coverage
  • Must be done during early growth phase (less than 17 weeks of age)
  • Difficulty acquiring good candidates
  • Controversial
  • Neuter animals at the same time – don’t want people to breed this animal who has bad hips but has had this procedure
410
Q

When is hip dysplasia surgically treated with triple or double pelvic osteotomy?

A
  • 6-7mths of age, no DJD, mild laxity
  • Good clunk on ortolani test
  • Indications – hip dysplasia, dislocation, dysplastic hip?
411
Q

When is hip dysplasia surgically treated with femoral head and neck excision?

A
  • Salvage procedure
  • Try non surgical management first
  • Indication – severe cases/marked
412
Q

What is the outcome of femoral head and neck excision to treat hip dysplasia?

A

Pseudoarthrosis - encourage exercise after surgery

413
Q

What are the indications of total hip replacement to treat hip dysplasia?

A
  • Coxofemoral arthritis
  • Hip dysplasia
  • Chronic dislocation
  • Fractured femoral head
  • Ischaemic necrosis
  • Slipped capital femoral epiphysis – cats
414
Q

What are coxofemoral luxations?

A

Craniodorsal direction, can also go ventral (painful) or caudodorsal

415
Q

What are the clinical signs of hip luxations?

A
  • May be weight bearing
  • Gait – stifle out, hock in and leg adducted
  • Compare leg length – affected leg seems shorter
416
Q

How hip luxations treated with closed reduction?

A
  • Animal anaesthetised
  • Extend leg and internally rotate hip
  • Assistant needed to hold on to dog or may be pulled off table
  • Confirm reduction with two orthogonal films
  • Ehmersling or cage rest post reduction
  • Causes of failure
  • Should be difficult to do as if it is easy it will come out again easily when awake
417
Q

How hip luxations treated with open reduction?

A
  • Primary capsular repair
  • Prosthetic capsular repair
  • Transarticular pin
  • Ilio femoral suture
  • Toggle
418
Q

What is the aetiopathogenesis of avascular necrosis of the femoral head?

A
  • Trauma, ischaemia, small breed predisposition
  • Affected animals should not be bred from as the disease has an inherited basis consistent with an autosomal recessive gene
419
Q

What are the clinical signs of avascular necrosis of the femoral head?

A
  • Unilateral hind limb lameness
  • Pain on hip extension and flexion
  • Muscle wastage
420
Q

How is avascular necrosis of the femoral head diagnosed on imaging?

A

Lucent areas initially, collapse and mushrooming

421
Q

How is avascular necrosis of the femoral head treated?

A

Conservative – cage rest

Surgery – femoral head and neck excision, total hip replacement

422
Q

What does slipped capital femoral epiphyseal cause?

A

Automatic fracture of the capital femoral physis

Aetiopathogenesis - neutering delays growth plate closure

423
Q

What is the signalment of slipped capital femoral epiphyseal?

A

Neutered large breed male cats - neutering stops the growth plate closing and makes it weak and so fractures, but is questioned why that happens with only this joint

424
Q

How is slipped capital femoral epiphyseal treated?

A

Pin (early and undisplaced?), later salvage surgery FHNE or THR

425
Q

What are the clinical signs of gracilis m. rupture?

A
  • Swelling, haemorrhage
  • Palpable tear
  • Loss of function
  • Greyhounds/lurchers
426
Q

What are the clinical signs of gracilis m. contracture?

A
  • Characteristic gait – can’t get wide stride and so flicks around the leg at the stifle and hock
  • Initially painful
427
Q

How is gracilis m. contracture treated?

A
  • Temporary alleviate by cutting tendon
  • Condition will recur
428
Q

What are the possible fractures of the femur?

A
  • Capital physeal and slipped capital femoral epiphysis (SCFE)
  • Neck fractures
  • Diaphyseal
  • Condylar
  • Intracondylar – articular
429
Q

What are proximal capital physeal separation/fracture?

A

Salter-Harris type 1 common

430
Q

How are proximal capital physeal separation/fracture treated?

A
  • Small pins or K wires frequently used
  • Treatment – FHNE, THR
431
Q

How appropriate is external coaptation for femoral diaphyseal fractures?

A

Not appropriate for femoral fractures

432
Q

How appropriate are IM pins for femoral diaphyseal fractures?

A

Combined with cerclage wires for a long oblique fracture in immature animal or with a bone plate, or an ESF (cats). The IM pin should be inserted in a normograde manner (from top of bone not from fracture) to avoid any damage to the sciatic nerve if it loosens and migrates

433
Q

How appropriate are interlocking nails for femoral diaphyseal fractures?

A

Good for mid diaphyseal comminuted fractures

434
Q

How appropriate are plate and screws for femoral diaphyseal fractures?

A

Place on lateral aspect of the bone, often combined with an IM pin for comminuted fractures. Most common repair option

435
Q

How appropriate is ESF for femoral diaphyseal fractures?

A

Avoid if possible as large muscle mass for pins to go through which will cause morbidity – esp. in dogs. With severely comminuted fractures particularly in cats may be an appropriate option

436
Q

What are the aims of femoral fracture repair?

A
  • Preserve blood supply
  • Do not disturb fragments
  • Spatial alignment
437
Q

What are the stabilisation options for femoral fractures?

A
  • ESF
  • Buttress plate
  • Pin plate – pin aids alignment and increases resistance to bending
  • Interlocking nail - mid diaphyseal comminuted or transverse fractures
438
Q

What are the characteristics of distal physeal femoral fractures?

A
  • The younger the animal at the time of the injury the more significant the deformity
  • Warn owner of the likelihood of premature growth plate closure
  • Supracondylar fractures
  • Cats – cross pin
439
Q

What is the pathogenesis of premature tibial growth plate closure?

A

Premature closure proximal physes often affects the caudal aspect, often secondary to a fracture, you get physis and plateau that come away together so can get premature fusion of the caudal proximal physis. With continued growth at the cranial aspect of the proximal tibia leads to an abnormal tibia plateau angle and may predispose to cranial cruciate ligament rupture so may need to do an osteotomy to correct

440
Q

What is the clinical presentation of tarsal valgus in Shelties or tarsal varus in Dachshunds?

A

Bilateral angular limb deformity
Usually immature/young adult

441
Q

How is tarsal varus/valgus treated?

A
  • Osteotomy and then ESF or plate while it heals
  • Physeal staple in immature dog in hopes it corrects itself
442
Q

What is the aetiology of tibial tuberosity avulsion fractures?

A

Fall or jump, intrinsic force/muscle contraction

443
Q

How are tibial tuberosity avulsion fractures diagnosed?

A

Radiography, both sides to compare, particularly in young dogs as they can be minimally displaced

444
Q

How are tibial tuberosity avulsion fractures treated?

A

Pins and tension band wires

445
Q

How suitable is external coaptation for tibial diaphyseal fractures?

A

Can be suitable for simple, stable fractures in young animals, particularly if they have an intact fibula

446
Q

How suitable is IM pinning for tibial diaphyseal fractures?

A

Normograde, limit by size of distal bone. Care with length distally (hock joint) and proximally (stifle). Combine with another implant eg ESF, plate

447
Q

How suitable are interlocking nails for tibial diaphyseal fractures?

A

Can be used for proximal/mid fractures, size limited by distal bone IM canal

448
Q

How suitable are plate and screws/plate and pins for tibial diaphyseal fractures?

A

Common repair option, plate applied to medial tibia. Limited by size of the tibia

449
Q

How suitable ESF for tibial diaphyseal fractures?

A

Useful for simple fractures in young dogs and cats and for open/comminuted fractures

450
Q

How might a 4 week old animal be treated for a tibial diaphyseal fracture?

A

Very young so healed with conservative management with cage rest

451
Q

Describe distal tibial diaphyseal fracture management.

A
  • Cats – distal tibia slow to heal
  • Double plate
  • Cranial and medial tibia
  • Maximise screw number in small distal fragment
452
Q

What is the clinical presentation of distal tibial growth plate fractures?

A

Dogs and cats <9 months
Salter Harris Type I/II

453
Q

How are distal tibial growth plate fractures treated?

A
  • Physeal fracture principles
  • ORIF if displaced
  • External coaptation if minimal displacement
  • Use small X pins

Post-operative – external coaptation

454
Q

What is the pathogenesis of hock dislocation?

A

Collateral ligament ruptures and/or avulsion fractures of medial malleoli/distal fibular. Can be open or closed

455
Q

How are closed hock dislocations of the hock treated?

A

Open tarsal luxation management – pout intrasite water soluble jelly in the wound, clip hair, slush with saline/Hartmann’s, initial debridement, wet to dry dressing for more superficial debridement and then place bandages until we can do definitive treatment

456
Q

How are open hock dislocations of the hock treated?

A

Reduction and TESF

Put intrasite water soluble jelly in the wound, clip hair, slush with saline/Hartmann’s, initial debridement, wet to dry dressing for more superficial debridement and then place bandages until we can do definitive treatment

457
Q

How are hock dislocations treated?

A
  • Palpation (collateral ligaments)
  • Observation – open wounds
  • Imaging – CT can be used for more advanced imaging but diagnosis can be made from radiography
458
Q

What does TESF provide for open tarsal luxations?

A

Temporary immobilisation while ligaments and wounds heal

459
Q

How are closed tarsal luxations treated?

A

Suture prosthesis to replace collateral ligaments then external coaptation

460
Q

What is the pathogenesis of tarsal osteochondrosis?

A

Lesion (ODC flaps) medial or later to the talar ridge

461
Q

What are the clinical signs of tarsal osteochondrosis?

A
  • Tarsal swelling
  • Upright hock
  • Lameness
  • Reduced ROM hock
462
Q

How is tarsal osteochrondrosis diagnosed from imaging?

A

Craniocaudal view – most useful. Look for increased gap

Lesion – medial (or lateral) talar ridge. Flattening of the caudal aspect of the medial talar ridge

463
Q

How is tarsal osteochondrosis treated?

A

Conservative – restricted exercise/NSAIDs

Surgical – debridement for larger lesions that are more painful

464
Q

What is the prognosis of tarsal osteochondrosis?

A

Develop OA, may need salvage surgery later on for this which would be a pan tarsal arthrodesis

465
Q

What causes proximal intertarsal joint subluxation?

A

Rupture of Plantar tarsal ligaments and fibrocartilage

466
Q

What are the clinical signs of proximal intertarsal joint subluxation? How is this diagnosed?

A

Lameness
Plantigrade stance
Can be bilateral changes

Diagnosed with stressed radiographs

467
Q

H

A
468
Q

What is the presentation of lateral displacement of SDFT?

A

Palpably displacing tendon
Lameness/altered gait

469
Q

How is lateral displacement of SDFT treated?

A

Surgical repair of torn retinaculum

470
Q

What is the aetiopathogenesis of gastrocnemius rupture?

A
  • Trauma or degeneration
  • Partial or complete
  • Elongation of tendon in partial rupture
  • ‘Claw foot’ as SDFT travels longer distance
471
Q

What are the clinical signs of gastrocnemius rupture?

A

Lameness
Thickened tendon
Dobermanns
Dropped hock
Claw foot, plantigrade

472
Q

How is gastrocnemius partial rupture treated?

A

Extend hock (eg calcaneotibial screw) for 6w to take tension off tendon whilst healing

473
Q

How is gastrocnemius complete rupture treated?

A

Tenectomy and suture

474
Q

How is gastrocnemius avulsion rupture treated?

A

Dependant on size of avulsed fragment. Want to repair this, either by fusing the tendon back onto the calcaneus or pan tarsal arthrodesis as last resort

  • Small – excise fragment and treat as tendon rupture
  • Large – treat as avulsion fracture – pins and TBW
  • Pantarsal arthrodesis – salvage surgery
475
Q

A claw foot posture is seen in dogs when weight bearing on their hind limbs and it is associated with various pathological conditions. In which of the 5 listed conditions would you not expect to see a claw foot posture – mid body rupture of the gastrocnemius, fracture of the calcaneus, plantar tarsal ligament rupture, partial rupture of the gastrocnemius (with stretching), or superficial digital flexor tendon rupture?

A

Superficial digital flexor tendon rupture

476
Q

In what age and breed would you most likely see a tibial tuberosity avulsion fracture?

A

Staffordshire bull terrier 4 months old

477
Q

What part of the hock is most commonly affected by osteochondrosis?

A

Medial talar ridge

478
Q

What are the clinical signs of craniomandibular osteopathy?

A

Enlarged mandibles
Dull
Drooling
Pain on attempting to open mouth

479
Q

How is craniomandibular osteopathy diagnosed?

A

Imaging shows proliferative new bone on mandibles/TMJ

480
Q

How is craniomandibular osteopathy treated?

A

NSAIDs
Steroids suggesting there is an immune mediated component
Liquefied food

481
Q

What is the prognosis of craniomandibular osteopathy?

A
  • Good as self limiting, bone may regress
  • Can interfere with prehension/respiration
482
Q

What is the aetiology of mandibular fractures?

A

Trauma
RTA
Dog fight
Fall
Dental disease

483
Q

What are the clinical signs of mandibular fractures?

A

Malocclusion
Swelling
Oral haemorrhage

484
Q

How are mandibular fractures diagnosed?

A
  • CT is bets as X-ray gets superimposition of the 2 hemimandibles
  • Careful oral examination
485
Q
A
486
Q
A
487
Q
A
488
Q
A
489
Q
A
490
Q
A
491
Q
A
492
Q
A
493
Q
A
494
Q
A
495
Q

How are mandibular fractures treated?

A
  • ESF – try to line the teeth up and ESF with pins through the bone
  • Transarticular ESF
  • BEARD suture
  • Bone plates and screws
  • Interfragmentary wire
  • Interdental wire
  • Interdental acrylic – acrylic placed over the canine teeth so it holds teeth together, lines up the jaw properly and allows things to heal
  • Partial mandibulectomy – severe fractures
496
Q

What are the treatment principles of treating mandibular fractures?

A
  • Perfect occlusion
  • Place ET tube via pharyngostomyincision
  • Preserve dentition (even if broken)
  • Provide route for nutrition
  • If use plate – accurate contouring needed
  • Avoid placing an IM pin in mandible
  • Avoid damaging NV structures with implants
  • Suture repair the gum – aids stability
497
Q

When is ESF to treat mandibular fractures indicated?

A

Open and rostral fractures

498
Q

Describe ESF to treat mandibular fractures.

A
  • Allows oral feeding
  • Transarticular frames for complicated fracture
  • Acrylic bars/epoxy putty useful to go around jaw
499
Q

What is the MAMA BEARD technique of treated mandibular fractures?

A

Mandibular and maxillary bignathic encircling and reduction device

Indicated for caudal mandibular fractures/immature fractures

500
Q
A
501
Q
A
502
Q

Outline how a MAMA BEARD is placed.

A
  • Place a piece of monofilament nylon (40lb) between skin and bone over maxilla and under chin
  • Care during recovery that cat does not regurgitate – risk of aspiration, have scissors handy to cut suture if necessary for the first 24 hours
  • Maintains bone alignment during early healing
  • Secure with metal tube crimp
  • Leave in place for 2-3 weeks
  • Advantages – non-invasive technique (not pins, just a suture)
503
Q

What is the post-operative management for MAMA BEARD placement?

A
  • Soft/liquid food
  • Oral hygiene
  • Radiographs 3-4 weeks and palpable assessment of stability
503
Q

What are the possible complications of MAMA BEARD placement?

A

Infection
Malunion
Non-union

504
Q

What are the repair methods for symphyseal separations?

A
  • Encircling piece of malleable orthopaedic wire – cerclage wire to keep 2 halves of the hemimandibles together
  • Use large gauge wire and apply tightly
  • Good success rate and most commonly performed repair
  • Lag screw or pin
505
Q

How can symphyseal separations be treated with cerclage wire?

A
  1. Symphyseal separation
  2. Make a stab incision on the ventral aspect of the chin
  3. Hypodermic needle placed between the skin and bone
  4. Wire is placed and goes back up through the hypodermic needle
  5. 2 ends of wire twisted around itself on the outside of the skin and twist until 3 twists remaining
  6. Wire inside the mouth is cut after 4 weeks when you have nice occlusion
506
Q

What is the effect of bisphosphates?

A

Reduce bone resorption by inhibit osteoclasts (cells in the bone that resorb bone)

507
Q

What are bisphosphates used for?

A
  • Bone tumours – can treat bone pain (dogs that aren’t good candidates for amputation?) and inhibit development of bone metastases
  • Hypercalcaemia – to reduce calcium levels
  • Immune mediated haemolytic anaemia (IMHA)
  • Malignant histiocytosis
508
Q

Distinguish non-amino bisphosphates and amino bisphosphates.

A

Non-amino bisphosphonate – disrupt metabolism of osteoclast leading to apoptosis (death) of osteoclast

Amino bisphosphate – newer, better antiresorptive properties, disrupts intracellular signalling leading to apoptosis of osteoclast. Higher potencies

509
Q

What are the actions of bisphosphates?

A
  • Inhibit osteoclasts
  • Inhibit neoplastic cell proliferation
  • Induce apoptosis (cell death)
  • Inhibit angiogenesis
  • Inhibit matrix metalloproteinases, affect cytokines and growth factors
  • Immunomodulatory
  • Deplete phagocytic cells
510
Q

Why can bisphosphates be used for bone tumours?

A
  • Decrease bone resorption
  • Decrease tumour pain
  • Decrease metastasis
511
Q

What is the effect of bisphophates on malignant histiocytosis?

A
  • Limited clinical use
  • Combining bisphosphonates with chemotherapeutic agents shows promise, such as chlorinate and vincristine, or alendronate and doxorubicin
512
Q

Why are bisphosphates be used for immune mediated haemolytic anaemia?

A
  • Liposome encapsulated clodronate may have a role in treating immune mediated cytopaenias
  • Interferes with macrophages – stops erythrocyte death
  • So gains time for slower onset immunosuppressive drugs to start working
513
Q

How are bisphosphates administered?

A

Orally - may result in poor absorption and have to be given daily or every other day

IV - rapidly cleared from plasma, every 3-4 weeks

514
Q

What are the possible side effects of bisphosphates?

A
  • Oesophagitis, gastritis
  • Delayed bone healing – ‘frozen bone’
  • Nephrotoxicity
  • Allergic reactions
515
Q

What are the clinical signs of osteosarcomas?

A
  • Lame – may be acute onset where it grows to be painful or slowly growing a size where it becomes prone to fracturing
  • History
  • Swelling and pain on palpation
  • Pathological fractures
516
Q

What are the possible appendicular osteosarcoma sites?

A

Distal radius
Proximal humerus
Proximal tibia
Distal femur

517
Q

What is the effect of different osteosarcoma treatment options on distant metastases?

A
  • Medical/symptomatic - limited pain relief
  • Bisphosphates - delays metastases and analgesic
  • Radiation - no effect on metastases but analgesic. MST = 4-6m
  • Amputation - none but analgesic. MST = 4-5m
  • Amputation and chemotherapy - delays. MST = 8-12m
  • Limb sparing and chemo - delays. MST = 8-10m
518
Q

Why is euthanasia a reasonable action for osteosarcoma?

A

By the time it is apparent in the bone it may have already metastasised elsewhere. Painful and poor prognosis

519
Q

What is the aetiology of nutritional secondary hyperparathyroidism?

A
  • Diet high in Phosphorous/low in Calcium (all meat diet)
  • Horses – exclusive grain diet
520
Q

What is the pathogenesis of nutritional secondary hyperparathyroidism?

A
  • If calcium in blood is low stimulates release of parathormone to return Ca levels to normal
  • Calcium reabsorbed from bone
  • Osteopenia/osteoporosis – pathological fractures
  • Normal bone still produced and normal growth
521
Q

What are the clinical signs of nutritional secondary hyperparathyroidism?

A
  • Puppies and kittens after weaning
  • Lameness, pathological fractures, lax ligaments neurological deficits, growth and teeth deformity

Horses – enlargement of mandible/loose teeth

522
Q

How is nutritional secondary hyperparathyroidism diagnosed?

A

Imaging – cortices thin, little differentiation between cortex and medulla ‘ghost’ like bones. Normal growth plates

Bloods – low/normal calcium and phosphorous, high parathormone

523
Q

How is nutritional secondary hyperparathyroidism treated?

A
  • Balanced diet, NSAIDs, Cage rest
  • If possible avoid ORIF, most fractures will heal – but malunions likely
524
Q

What is the aetiology of panoestitis?

A

Viral, excess nutrition, hereditary

525
Q

What is the pathogenesis of panoestitis?

A

Degeneration of Intramedullary (IM) adipocytes, intramedullary ossification of adipocytes so you get inflammatory and then bone deposition

526
Q

What are the clinical signs of panoestitis?

A
  • Migrating and painful lameness, non weight bearing, shifting
  • Dull, anorexia, pyrexia, painful bones on palpation
527
Q

How is panoestitis diagnosed?

A
  • Radiography/CT
  • Patchy increased density of medulla of bone
  • Distal humerus
  • Proximal ulna
  • ‘Thumbprints’
  • Near nutrient foramen
528
Q

What is the aetiology of hypertrophic osteodystrophy?

A

Infection, hereditary, nutrition

529
Q

What are the clinical signs of hypertrophic osteodystrophy?

A
  • Inappetance, reluctance to stand, lameness
  • Swollen painful and hot metaphyseal areas of lower limb bones. Bilateral change
  • Pyrexia
530
Q

How is hypertrophic osteodystrophy diagnosed?

A
  • Soft tissue swelling
  • Periosteal new bone formation
531
Q

How is hypertrophic osteodystrophy treated?

A
  • Balanced diet/no supplements
  • Analgesia – NSAIDs/opiates/rest
  • Antibiotics/steroids if pyretic in case there is a bacterial infection
532
Q

What is the aetiopathogenesis of hypertrophic osteopathy?

A

Secondary manifestation of thoracic (abdominal) disease

533
Q

What are the clinical signs of hypertrophic osteopathy?

A

Firm, warm, non oedematous swelling – all limbs
Lame
Stiff
Dyspnoea
Cough

534
Q

How is hypertrophic osteopathy identified from radiography?

A
  • Soft tissue swelling in early stages
  • Periosteal new bone on MT/MC later on
  • Long bones affected in severe cases
  • Thoracic or abdominal mass
535
Q

How is rickets diagnosed?

A

Imaging - widened cup shaped growth plates due to accumulation of unmineralized osteoid

536
Q

How is rickets treated?

A

Correct diet, expose to sunlight

537
Q

What is physitis?

A

Enlargement of the physeal region of long bones in growing horses

538
Q

What are the clinical signs of physitis?

A
  • Variable lameness/stiffness
  • Widening of the bone at the level of the physis
  • Especially distal radius, tibia and metacarpus/metatarsus
  • May be seen with other developmental orthopaedic diseases e.g. angular limb deformities, osteochondrosis, flexural deformities and wobbler syndrome
539
Q

How is physitis identified on radiography?

A

Flaring of the metaphysis and epiphysis adjacent to the physis. Irregularity of the physis and surrounding sclerosis

540
Q

How is physitis treated?

A

Reduction of energy content of ration to slow growth, ensure correct mineral balance in ration, rest, NSAIDs

541
Q

What bone disease in young dogs can cause bilaterally symmetrical painful swelling of the bones adjacent to the joints of the distal limbs, particularly the forelimbs? Affected dogs are often very sore, recumbent and may be pyrexic.

A

Metaphyseal osteopathy

542
Q

Hypertrophic pulmonary osteoarthroscopy (Maries or hypertrophic osteopathy) is most often seen secondary to what condition?

A

Pulmonary neoplasia

543
Q

Panosteitis is an inflammatory bone disease seen in the diaphysis in young dogs which is self resolving. How do you make a definitive diagnosis of panosteitis?

A

Patchy or mottled radiodensity in the medulla on radiography

544
Q

What cells do bisphosphates act on and what action do they have on that cell?

A

They disrupt metabolism of osteoclasts leading to apoptosis of the cells

CVSOH 4 (32 decks)

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