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
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?
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
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.
5
Q
What can be assessed from the animal’s stance?
A
- Symmetry
- Weight bearing
- Angular deformity – valgus (laterally) and varus (medially)
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
7
Q
What is a lameness grade of 0?
A
Sound
8
Q
What is a lameness grade of 1?
A
Occasionally shifts weight
9
Q
What is a lameness grade of 2?
A
Mild lameness at slow trot, none whilst walking
10
Q
What is a lameness grade of 3?
A
Mild lameness whilst walking
11
Q
What is a lameness grade of 4?
A
Obvious lameness whilst walking, places foot when standing
12
Q
What is a lameness grade of 5-8?
A
Degrees of severity
13
Q
What is a lameness grade of 9?
A
Places toe when standing, carries limb when trotting
14
Q
What is a lameness grade of 10?
A
Unable to weight bear
15
Q
What do you palpate the standing animal for in an orthopaedic examination?
A
Asymmetry
Swelling
Muscle atrophy
Joint enlargement
Abnormal conformation
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
17
Q
What is a medial buttress?
A
Medial swelling of the stifle
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)
19
Q
What is panosteitis?
A
Inflammation of the bone
20
Q
Name 2 tests to test the integrity of the cranial cruciate ligament.
A
Cranial draw test
Tibial compression/thrust test
21
Q
How is a cranial draw test performed?
A
- Lateral recumbency
- Hold femur and tibia and try to move tibia cranially with respect to the femur
- Repeat test with stifle at different angles or flexion/extension
22
Q
How is tibial compression/thrust test performed?
A
- Hand over distal femur, first finger on tibial tuberosity, other hand on the foot
- Keep stifle still whilst flexing hock
- Tibial tuberosity displaces cranially if ligament ruptured
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
24
Q
Name the test for hip laxity.
A
Ortolani test
25
How is the ortolani test performed?
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
26
What is the pneumonic for differentials affecting bones?
GIFT:
Growth plates
Inflammatory/infectious/immune
Fractures
Tumours
27
What is the pneumonic for differentials affecting joints?
DIM:
Dislocation (congenital and traumatic)
Inflammation (OCD, OA, infectious)
Musculotendinous and ligamentous
28
What can make orthopaedic radiography challenging?
Growth plates in young animals can make fractures in these areas hard to view
29
How is the infrapatellar fat pad effected by synovial fluid?
Infrapatellar fat pad forms triangle with fluid and tendon. When fluid is more, compressed infrapatellar fat pad
30
What are CT scans useful for in orthopaedics?
Identifying minimally displaced fractures
31
What are MRI scans useful for in orthopaedics?
- Soft tissue architecture
- Neurology/nerve root tumours
32
What are ultrasound scans useful for in orthopaedics?
- Soft tissue structures
- Guide a biopsy
33
How is a joint effusion at the carpus palpated?
Loss of definition of carpal bones cranially
34
How is a joint effusion at the elbow palpated?
Bulge between the olecranon and lateral epicondyle
35
How is a joint effusion at the shoulder and hip palpated?
Effusions not palpable
36
How is a joint effusion at the hock palpated?
Palpable as a bulge cranially and caudally
37
How is a joint effusion at the stifle palpated?
Bulges out either side of patella ligament
38
How is arthrocentesis performed?
- 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
39
Does the fluid obtained through arthrocentesis contain neutrophils?
If containing neutrophils, this is abnormal so must determine whether septic or immune mediated
40
What does 9/10 lameness indicate in the grading scale 0-10?
Places tow when standing, carries limb when trotting
41
When test is the best one for diagnosing cranial cruciate ligament disease in a large standing dog?
Tibial thrust test
42
How can you tell if there is a stifle effusion on a radiography?
A reduction in size of the infrapatellar fat pad
43
What is the normal volume, colour and viscosity of fluid you would expect to obtain from a normal stifle joint in a large dog?
0.2ml, clear, viscous
44
Define chondroprotective.
Agents that retard degradation of articular cartilage and promote chondrocyte metabolism in the treatment of osteoarthritis in dogs and cats.
Also called nutraceuticals
45
What are some examples of chondroprotective agents?
They are nutrients, dietary supplements/herbal extracts:
- Glucosamine
- Chondroitin
- Hyaluronic acid
- Pentosan polysulphate
46
What is the legislation for neutraceuticals?
Not technically drugs, so they can be marketed without proving that they work. Injectables are legislated
47
What are the possible modes of action of chondroprotective agents?
- 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
48
How can osteoarthritis be symptomatically treated?
NSAIDs
Rest
Weight loss
Physiotherapy
Hydrotherapy
Chondroprotectives
49
List the veterinary nutraceuticals.
Glucosamine
Chrondroitin
Polysulfated glycosaminoglycan
Avocado/soybean unsaponifables
Manganese
Vitamin E
Green lipped mussel extract
Essential fatty acids
Pentosan polysulphate
Hyaluronan
Hyaluronic acid
Circurmin
50
What is glucosamine?
An amino monosaccharide for glycosaminoglycans. Produced commercially by crustacean exoskeleton or less commonly by fermentation of grains.
51
How is glucosamine a chondroprotective agent?
Make extra cellular matrix (ECM) of cartilage
52
What is chondroitin?
Polymer of repeating dissacharide units (galatosamine sulphate and glucuronic acid). Commercially made from poultry, shark or bovine cartilage
53
How is chondroitin a chondroprotective agent?
Predominant component of cartilage
54
What is the mechanism of action of glucosamine in in vitro studies?
- Glucosamine stimulates glycosaminoglycan, proteoglycan and collagen production
- Modulating cartilage metabolism improving cartilage integrity and increasing matrix synthesis
- Synergistic effect when combined with chondroitin
55
How is the chondroprotective polysulphated glycosaminoglycan given?
- Intra-muscular (or intraarticular) injection for horses and dogs
- Every 4 days for 28 days or every 5-7 days for 5 weeks
56
What is a possible risk of the chondroprotective polysulphated glycosaminoglycan given?
Toxicity inhibit coagulation as it is chemically similar to heparin
57
How does hyaluronic acid have a chondroprotective effect?
Improves joint fluid viscosity which may improve joint lubrication, reduce inflammatory enzymes and reduce pain
58
How is hyaluronic acid given?
Intra-articular injection
59
What is the chondroprotective agent pentosan polysulphate?
Cartrophen
Weekly injections for 4 weeks IM or SC
Dogs and horses
60
What is the use of pentosan polysulphate?
Relief for thrombi, interstitial cystitis and osteoarthritis
61
What are the side effects of pentosan polysulphate?
Vomiting
Anticoagulant
62
What are the chondroprotective effects of omega-3 fatty acids?
Anti-inflammatory properties in vitro
Reduces cartilage degradation
63
What are the chondroprotective effects of green lipped mussel?
Anti inflammatory - inhibits 5 lipoxygenase pathway
64
What are the possible adverse effects of chondroprotectives?
- Mild, none or rare
- Gastrointestinal
- Anti-coagulant – rare
65
What is the evidence for pentosan polysulphate use in dogs?
- 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
66
What is the evidence for pentosan polysulphate use in horses?
- Improved signs of OA in horses
- Reduced articular cartilage fibrillation in experimental carpal OA
- IM PPS efficacious when used prophylactically prior to competition
67
What can you say to clients who are considering chondroprotective treatment for their animals?
- 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
68
What side effects are most commonly seen with chondroprotectives?
Vomiting and diarrhoea
69
Which of the following is an injectable nutraceutical/chondroprotective that can injected intramuscularly in dogs with OA weekly for 4 weeks?
Pentosan polysulphate
70
What are the possible causes of lameness affecting soft tissues?
Pads – corns (greyhounds), plasma cell pododermatitis in cats, foreign bodies
Interdigital – foreign bodies, green awns, paronychia
71
What areas of the foot are assessed in clinical examination of a lame foot?
Pads
Interdigital area
Nails
Wounds - think tendons
72
What are the clinical signs of fractures in the foot and how are these diagnosed?
Swelling, pain, instability
Lameness imaging - CT or x-ray
73
When are foot fractures treated surgically?
- Fragments displaced
- Base of MC/MT affected
- Articular surface affected
- Intramedullary pinning or toggle pinning to avoid arthritis
74
What are toggle/dowel pins for foot fracture repair?
Toggle/dowel pins are put into the bones completely
75
When are foot fractures not repaired?
If its is just one bone, as the others will support
76
What would you recommend for a fracture of the 1st phalanx, digit II?
External coaptation with splint as is quite painful and unstable but is a single phalangeal fracture so not surgery
77
How are metacarpal and metatarsal/sesamoid fractures treated?
Removal
78
How are metacarpal and metatarsal/sesamoid fractures identified?
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
79
What is the pathogenesis of toe dislocations?
Rupture of collateral ligaments and joint capsule
80
What are the treatment options for toe dislocations?
- Closed reduction and conservative
- Open reduction and collateral ligament prosthesis
- Closed and ESF
81
How is collateral ligament rupture causing toe dislocation treated?
Conservative management – rest, short nail, bandage
Surgery – if conservative doesn’t work, mini external dixator for example
82
What is the aetiopathogenesis of corns?
Focal areas of hyperkeratinisation from focal pressure of pad seen in dogs with little SC fat
83
What is the presentation of corns?
- Greyhound, lurcher, whippet
- Painful pad
- Local lesions
- Usually pad III or IV forelimbs but can be any pad
84
How are corns treated?
Superficial digital flexor tenectomy
85
What is the prognosis for corn treatment?
Guarded for recurrence after corn removal, good following tenectomy
86
How is osteoarthritis characterised?
Deterioration of articular cartilage and the formation of new bone at the joint margins
87
What is the aetiology of small animal osteoarthritis?
Primary – wear and tear
Secondary congenital (achondroplasia), developmental (hip dysplasia), acquired (after fractures)
88
What is the pathogenesis of osteoarthritis?
- 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
89
What are the clinical signs of osteoarthritis?
- Often paired joints
- Decreased range of motion/ROM
- Lameness/stiffness
- Pain (variable)
- Joint swelling – fibrosis or effusive
- Crepitus
90
How is osteoarthritis diagnosed?
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
91
What are the goals of therapy for osteoarthritis?
Alleviate discomfort
Delay progression
Restore affected joints to normal pain free function as soon as possible
92
What are the treatment considerations for treatment of osteoarthritis?
Exercise modulation
Weight loss
Physical therapy and hydrotherapy
Drugs
Surgical Options
Environmental modification
93
How is exercise modified to manage osteoarthritis?
Avoid inactivity
Short and frequent
Gentle controlled exercise
Keep every day the same
Avoid vigorous activity
94
What are the benefits of exercise for management of osteoarthritis?
Strengthen ligaments
Maintain muscle tone
Prevent fibrosis
Lubrication joints
Enhance proteoglycan production
95
How can physical therapy be used to manage osteoarthritis?
- 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
96
How are chondroprotectives/nutraceuticals used to manage osteoarthritis?
Drugs that claim to arrest or moderate the degenerative processes in the cartilage, improve joint fluid and support reparative biosynthesis
97
What are the surgical options to manage osteoarthritis?
- 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
98
What environmental modification can be used to manage osteoarthritis?
Soft beds, heated beds, ramps or steps, low litter traps, feed on the floor for cats
99
What is the aetiology of infectious/septic joint disease?
External trauma/bites
Iatrogenic
Secondary to systemic or distant infection
Immunodeficiency syndromes
Secondary to omphalophlebitits
Haematogenous spread
100
What is the pathogenesis of infectious/septic joint disease?
- Bacteria rapidly proliferate
- Acute inflammatory response
- Cytokine release
- Cartilage damage/loss
- Erosions
101
What are the clinical signs of infectious/septic joint disease?
- Sudden onset/chronic
- Painful
- Swollen/effusion
- Severe lameness/non weight bearing
- Single joints more common than multiple
102
How is septic/infectious joint disease diagnosed on radiographs?
- Early changes – soft tissue swelling, effusion
- Late changes – erosions, periosteal reaction
- Sepsis can affect joints with pre existing OA
103
How is septic/infectious joint disease diagnosed from arthrocentesis?
Visual analysis, cytological analysis, culture and sensitivity
104
How is septic/infectious joint disease diagnosed from synovial fluid analysis?
Viscosity, volume, colour, cell count, cell types
105
How is septic/infectious joint disease treated?
- Evacuate exudate
- Lavage
- Antibiotics based on culture and sensitivity
- Surgical debridement – implant removal
106
What is the prognosis of septic/infectious joint disease?
Good/fair with acute cases with appropriate therapy
Poor/guarded with chronic cases with cartilage loss
107
What are the characteristics of erosive immune mediated inflammatory joint disease?
- Neutrophils in joint fluid
- Bone erosions seen in imaging
- Rheumatoid arthritis
- Periosteal perliferative polyarthritis - cats
- Mycoplasma polyarthritis - greyhounds
108
What are the characteristics of non-erosive immune mediated inflammatory joint disease?
- 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
109
What are the characteristics of rheumatoid arthritis?
- Erosive joint disease
- Small breeds
- Joint collapse
- Crepitus and instability
- Pain variable
110
What are type I, II, III and IV idiopathic immune mediated polyarthritis?
Type I = uncomplicated
Type II = remote infection eg pyometra
Type III = GIT disease, immune complex deposition
Type IV = neoplasia
111
What are the clinical signs of idiopathic immune mediated polyarthritis?
Lameness, distal small joints, joint effusions, pain, lethargy, pyrexia, migratory problem
112
How is idiopathic immune mediated polyarthritis diagnosed?
Imaging for soft tissue swelling
Lab investigations with haematology, ANA/RF, arthrocentesis (6 joints), +++PMNs
113
How is immune mediated polyarthritis treated?
Treat underlying cause, such as pyometra. Immunosuppressive drugs:
- Prednisolone
- Azathioprine
- Cyclophosphamide
- Gradually tapering dose
114
Name the tumour types that invade joints?
Synovial sarcoma
Fibrosarcoma
Myxosarcoma
Haemangiosarcoma
Malignant fibrous histiocytoma
115
What is the aetiopathogenesis of tumours that invade joints?
Malignant (vs benign)
Secondary invaders from articular margin or joint capsule
116
How are tumours that invade joints investigated and diagnosed?
- Radiographs for where tumour crosses joints, erosions/slow growing
- Histology and immunohistochemistry
117
How are tumours that invade joints treated?
Amputation, may metastasise locally and/or distally
118
What is the pathogenesis of osteochondrosis?
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
119
What is the signalment of osteochondrosis in small animals?
4-8 months old in large and giant dog breeds
120
What are the clinical signs of osteochrondrosis?
- Lameness insidious onset, chronic
- Deteriorates after rest or excessive exercise
- Bilateral
- Physical examination findings – joint has reduced ROM, pain on manipulation and effusions
121
How is osteochondrosis diagnosed from radiography?
- 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
122
How is osteochondrosis treated conservatively?
Rest
NSAIDs
Diet
123
How is osteochondrosis treated surgically?
- Arthrotomy/arthroscopy for cartilage flap removal
- Forage
- Chondrectomy
- Polysulphated glycosaminoglycans or hyaluronic acid
124
What is the post operative management for osteochondrosis surgery?
Exercise restriction 4-6 weeks
125
What are the possible complications of osteochondrosis surgery?
Seroma
Failure to remove all cartilage flap
126
When is prognosis of osteochondrosis better and worse?
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
127
What are the sites of osteochondrosis?
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
128
What are the clinical signs of fractures?
- Lameness – usually, but not always, severe
- Pain on palpation/manipulation
- Swelling
- If unstable = deformity, abnormal mobility and crepitus
129
How are patients triaged and assessed for thoracic trauma in orthopaedic cases/
- 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
130
What are the signalments of fractures?
- 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
131
What is the aetiology of fractures?
- 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
132
How are fractures classified by cause?
Extrinsic – direct or indirect trauma
Intrinsic – muscular, pathological, stress (increased bony density around the fracture
133
How are fractures classified by communication with the environment?
Closed
Open
134
How are fractures classified by extent of bony damage?
Incomplete – greenstick (1 cortex still intact), fissure (crack), depressed (fragment in a cavity)
Complete
135
How are fractures classified by number and position of fragments?
Simple - 2 pieces
Comminutes - more than 2 pieces
Segmental - segment is completely separate and displaced
136
How are fractures classified by the direction of fracture lines?
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
137
How are fractures classified on location?
- Diaphyseal – proximal, midshaft or distal
- Metaphyseal
- Epiphyseal
- Condylar
- Articular
138
How are fractures classified by stability?
Stable – contact between the 2 bones ends, load sharing between bones
Unstable – lots of fragments, un-reconstructable
139
How are fractures classified based on complexity and involvement of other soft tissues?
Muscle damage
Nerve damage
Blood vessel damage
140
What other way can fractures be classified?
Age of fracture
141
How is emergency fracture management done?
- A,B,C
- IV catheter, fluids – treating shock and dehydration
- Analgesia
- Open fracture management – early wound management. Sedate, clip, clean, cover to prevent infection
142
What is the order of priority for repair once a patient is stable for GA?
- 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)
143
How are pelvic fractures temporarily managed?
Cage rest and analgesia
144
How are femur fractures temporarily managed?
Cage rest and analgesia
145
How are humeral fractures temporarily managed?
Cage rest and analgesia or spica splint
146
How are radius and ulna fractures temporarily managed?
Splinted bandage and analgesia
147
How are tibial fractures temporarily managed?
Support bandage, splinted bandage or analgesia
148
How are hock, carpus and foot fractures temporarily managed?
Support bandage, splint or analgesia
149
What are the aims of fracture management?
To create an optimal environment for fracture healing and return the patient to normal function as soon as possible
150
What are fracture diseases?
Occur during bone healing as a result of immobilisation of the limb
151
Name 4 fracture diseases.
Joint stiffness
Muscle atrophy
Osteoporosis
Muscle contracture and fibrosis
152
What does fracture healing require?
Adequate bone reconstruction
Stability
Vascularity
Balance between these must be achieved
153
What are the fracture healing/fixation options?
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
154
How is conservative management of fracture healing done?
Surrounding soft tissue (muscle, periosteum, adjacent bones) provides sufficient stability to keep bones aligned whilst healing.
Minimise movement whilst healing
155
How is movement minimised during fracture healing?
- Restrict exercise (cage rest)
- Provide pain relief (NSAIDs)
- Duration age dependant (2-4w)
156
Which cases can he healed with conservative management?
- Flat bones/axial skeleton - pelvic fractures, mandibular fracture, spinal fractures, scapula fractures
- Minimally displaced
- Cancellous bone
- Non load bearing bones
157
What is external coaptation and when it is used?
- 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
158
what are the suitable fractures for external coaptation?
- Lower limb
- Simple stable fractures
- Transverse/interdigitating
- Radius with intact ulnar
- Tibia with intact fibula
- Fractures with overlap >50%
- Good healing potential – young
159
What are the advantages of non-surgical management?
- Reduce/avoid anaesthesia
- Avoid need for open surgery
- No disruption blood supply
- Cheaper materials
160
What are the disadvantages of non-surgical management?
- Fracture disease
- Insufficient stability leading to a delayed or non-union
- Cast sores
- Malunion
161
What are the aims of surgical management of fractures?
Place implants (isolation or in combination) between fracture fragments to hold them securely while fracture heals
162
What must implants withstand in surgical fracture management?
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
163
What is fracture seduction? How is this done in open and closed fractures?
The process of replacing the fracture segments in their original anatomical position
- Closed – recent, stable, lower limb
- Open – most fractures, instruments, toggling
164
What do cancellous bone grafts do in fracture management?
Stimulates bone healing:
Stimulate bony union in fracture repair
Arthrodesis
Delayed/non-union fractures
165
What are the sites of harvest for cancellous bone grafts?
Proximal lateral humerus, iliac crest in cats
166
What is the definition of a comminuted fracture?
A fracture with more than 2 fracture fragments
167
What is the best way to manage a radius and ulna fracture prior to definitive treatment?
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.
168
Which of the following fractures is most suitable for cast repair (external coaptation) in a 6 month old cat?
Simple transverse radius fracture with an intact ulna
169
What are the possible orthopaedic implants?
Pins
Orthopaedic wire
Screws
Bone plates
External skeletal fixators
Use either in isolation or combination for fracture stabilisation
170
How are bone pins used? What are the complications?
- 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
171
What are interlocking nails used for?
- Stainless steel pin used as intramedullary pin
- Locked in place using screws
- Prevents rotation and axial collapse
172
What are pain and tension band wires?
- 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
173
What is orthopaedic wire and when is it used?
Malleable stainless steel wire
- Wire is placed to completely encircle bone (cerclage) or partially encircle bone (hemi-cerclage)
- Tension band wire (TBW)
174
What are the types of bone screws used?
Cortical, cancellous, locking, self tapping or non self tapping
175
When are bone screws used?
- 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
176
When should bone screws not be used?
Never use in isolation for diaphyseal fractures – slower healing and greater forces through bone
177
What is the purpose of bone plates?
Restore bone structure to restore weight bearing function and enable healing
178
What are the uses of external skeletal fixation?
- Comminuted fractures
- Open fractures
- Across joints
- Get discharge
179
What are the types of external skeletal fixation implants?
Threaded transosseous pins
Clamps
Bars
Acrylic
180
Which diaphyseal fractures can be managed with casts?
Transverse
181
Which diaphyseal fractures can be managed with pin and cerclage wires?
Spiral/oblique in young animals
182
Which diaphyseal fractures can be managed with plate and screws (interlocking nail or ESF)?
Spiral/oblique
Transverse
Comminuted
183
Which diaphyseal fractures can be managed with plate, screws and IM pins?
Comminuted
184
What can be ruled out when it comes to fracture repair decisions?
No cast for upper limb fractures
No IM pin for radius
185
When is cerclage wire used?
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.
186
What are the principles of repair for articular fractures?
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
187
What is an avulsion fracture?
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
188
What are the common locations for avulsion fractures?
Olecranon
Greater trochanter
Medial malleolus
Acromium of scapula
Os calcaneus
Tibial tuberosity
189
What is used for avulsion fractures?
Tension band wire for avulsion fractures – active distracting forces are counteracted and converted into compression forces.
Can also use tension band plate
190
What are the characteristics of physis and physeal fractures?
- 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
191
What are the surgical principles for physeal fractures?
- 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
192
What is the aetiology of premature growth plate closure?
Trauma – fracture
Hereditary – achondroplasia in basset hounds
Diseases – osteochondrosis/retained cartilage cores, metaphyseal osteopathy
193
What can premature closure of growth plates lead to?
Can lead to closure of growth plates and subsequent angular limb deformity/shortening
194
What is the pathogenesis of premature growth plate closure?
Injury to germinal cells/blood supply of physis
195
What should you warn owners of with premature closure of growth plates?
Any fracture close to/through GP, any injury, trauma or lameness in puppy/kitten
196
What are the clinical signs of premature growth plate closure?
- Angular limb deformity
- Lameness – check joints for pain
197
What are the consideration of premature growth plate closure?
GP closes about 7m
Worse is paired bone (radius and ulna)
Partial closure possible
198
How is premature closure of growth plates diagnosed?
Image with whole limb – with carpal valgus, elbow might also be affected
Image both limbs to compare
199
When is premature closure of growth plates treated conservatively and surgically?
Conservative – mild problem, no pain
Surgical – if painful and lame/young
200
What are the surgical principles of premature growth plate closure treatment?
- 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
201
Which is the most commonly affected growth plate of premature closure?
Distal ulna physis
202
Why do cats not have many distal ulna deformities?
Have flat distal ulna, unlike dogs that have conical shape
203
What is concurrent with trauma in the aetiology of distal ulna physis premature closure?
Distal radial fractures
Hereditary
Disease
Chondrodystrophic breeds
Idiopathic
Retained cartilage core
204
What are the clinical signs of distal ulna physis premature closure?
- 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
205
How is the – premature closure distal ulna growth plate 4 month deerhound, with carpal valgus and a normal elbow treated?
Ulna osteotomy/ostectomy and physeal stapling medial radius
206
How is the premature closure distal ulna growth plate in a 5m Corgi, with mild carpal valgus, elbow subluxation and pain treated?
Cut ulna to come into a more natural place, ulna osteotomy/ostectomy
207
How is the premature closure distal ulna growth plate in a 12m Lab, with left carpal valgus and a normal elbow treated?
Radius and ulna osteotomy/ostectomy
208
What is an alternative to stabilising the leg post surgery fixing premature growth plate closure?
Circular frame
209
How is leg lengthening done in small animals with angular deformities?
Leg lengthening – distraction osteogenesis. Dog with short limb segment. Osteotomy and distract leads to 1mm/day induces new bone and lengthens bones.
210
What is the most likely cause of premature closure of the distal ulna growth plate in a Dachshund?
Hereditary
211
In dogs, which growth plate is most commonly implicated in angular limb deformity cases?
Distal ulna
212
When can carpal valgus be normal?
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
213
What is digital hyperextension and how is it managed?
- Common in newborn foals
- Self correcting in a few weeks
- May require heel protection
- Moderate exercise on soft surface
- Swimming increases muscle tone
214
What are angular limb deformities?
Deviation to limb in sagittal plane viewed from the frontal. Either laterally/valgus or medially/varus
215
What are flexural limb deformities?
Deviations in the frontal plane when viewed from lateral aspect
216
How is carpal valgus characterised?
Fetlock varus
Carpal varus
Tarsal valgus
217
What is congenital epiphyseal wedging of angular limb deformities?
Wider side has more chondrocytes so grows more bone
218
What is congenital incomplete ossification of cuboidal bones of angular limb deformities?
More in tarsi than carpi for hypoplasia. Subsequent carpal bone collapse or subluxation
219
What is congenital periarticular/collateral ligament laxity of angular limb deformities?
- 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
What is the pathophysiology of acquired angular limb deformities?
- 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
What are the aetiologies of congenital angular limb deformities?
- Severe disturbance to dam during pregnancy - metabolic, endotoxic (colic)
- Placentitis
- Prematurity
- Dysmaturity
- Twins
- Foetal position in utero
222
What are the aetiologies of acquired angular limb deformities?
- Excessive growth rates
- Physeal injury/inflammation
- Contralateral limb overload
- Infection
- Conformation
223
What management is used in angular limb deformities?
- 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
How is cuboidal bone hypoplasia supported with splinting?
- Support limb whilst ossification occurs
- Confinement
225
How is ligamentous laxity supported with splinting?
Support limb whilst the natural loss of elasticity over the first month of life
Movement restriction
226
What are the indications for surgery for angular limb deformities?
- Fail to respond to conservative measure
- Severe
- Presented late
227
When is surgery for angular limb deformities contraindicated?
- Those not centred at physis
- Timed before closure of physis
228
When must surgery be done by with angular limb deformities?
2m = fetlock
4m = hock
6m = carpus
229
What is the surgical treatment of choice for angular limb deformities?
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
What is the presentation of flexural deformity?
1 or more joints persistently flexed when standing square at rest
231
How is congenital flexural deformity managed?
- 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
What is the conservative management for a foal with acquired flexural deformity?
- Limit diet to reduce growth rate
- Analgesia (muscle contraction = pain response)
- Moderate exercise on firm ground
- Shoeing
- Physiotherapy - passive ROM stretches
233
What is the surgical management for a foal with acquired flexural deformity?
DIP = inferior check ligament desmotomy
MCP = inferior check ligament desmotomy and/or superior check ligament desmotomy
Complication - risk of distal joint luxation
234
What management is used for adults with flexural deformities?
- Improve foot balance
- Physiotherapy - passive ROM stretches
- Controlled exercise on a firm surface
- Desmotomy?
- Manage primary problem
235
What are the 3 As for evaluation of fracture healing immediately post op?
Alignment – leg straight
Apposition – fracture surfaces apposed
Apparatus – implant position, loosening, breakage
236
What is the 4th A in the evaluation for fracture healing?
Activity 6 weeks later – callus, fracture healing. Is there any abnormal amount of activity, instability or bony change suggestive of infection
237
Why might bandages be used post operatively for fractures?
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
How is exercise restricted post operatively for fractures?
House/cage, 4-6w (maybe less for younger or more for older)
239
What are the adjunctive therapies used for post operative care of fractures?
Physiotherapy, hydrotherapy
240
What analgesia is used for post operative care of fractures?
Opioids, NSAIDs
241
How are fractures checked and managed once healed post operatively?
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
What is the prognosis of fractures post operatively?
Guarded for articular (will get OA), good for diaphysis
243
What are the possible complications of fractures post operatively?
Infection
Delayed or non union
Malunion
Refracture
Implant complications – breakage, loosening
244
Describe the classification for open fractures?
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
Why are open fractures an emergency?
Tissue devitalisation, ischaemia, foreign material all promote a contaminated wound becoming infected
246
Outline how open fractures are managed.
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
What is the golden period of open fracture management?
- 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
Why are open fractures debrided?
- Remove dead fat and muscle (and skin)
- Preserve tendon, ligament, nerves, blood vessels, bone
- Serial debridement over several days to limit infection
249
How are grade I open fractures stabilised?
Internal fixation methods. Always warn over that implants may need to be remove and may get infection a year later
250
How are grade II and III open fractures stabilised?
ESF – bigger likelihood of bigger wound and greater risk of infection so implants have a greater risk of becoming infection
251
Define osteomyelitis.
Any inflammatory condition of the bone, bone marrow or periosteum
252
What are the aetiologies of osteomyelitis?
- 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
What is sequestrum in osteomyelitis?
A necrotic bone fragment. Radiographically appears as a dense area of bone with sharp well defined edges
254
What is involucrum in osteomyelitis?
The body attempts to wall off the sequestrum by an avascular wall of fibrous tissue and sclerotic bone the involucrum.
255
What are the acute clinical signs of osteomyelitis?
Pain
Swelling
Pyrexia
Lameness
Abscess
No bony changes radiographically, just soft tissue swelling
256
What are the chronic clinical signs of osteomyelitis?
- Less severe clinical signs – lameness, pain, discharging sinuses
- Radiographic changes evident
257
What are the radiographic changes that occur from osteomyelitis?
- 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
How is acute osteomyelitis treated?
- Antibiotics - culture and sensitivity, treat for 6 weeks, repeat culture 3-5d after end of course
- Assess and address fracture stability
- Debridement
- Drainage
259
How is chronic osteomyelitis treated?
- 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
What are glycocalyx?
- 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
Distinguish delayed union and non-union.
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
Use the acronym BIG RIB to explain the aetiopathogenesis of delayed/non-uniform union.
- 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
What are the clinical signs of delayed/non-uniform union?
- 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
How is delayed/non-uniform union diagnosed?
- 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
How is delayed/non-uniform union treated?
- Ensure no major nerve damage or fracture disease
- Provide rigid fixation to stabilise
- Stimulate osteogenesis/healing, such as with bone grafting
- Treat infection
266
Which bones are prone to non-union? What is done?
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
What is malunion?
- A fracture that has healed or is healing in an abnormal position
- Caused by improper immobilisation or reduction
268
When and how is malunion treated?
If malunion causes lameness problems may need to treat by osteotomising the bone and correcting malignment
269
What is the gelatinous mucinous carbohydrate layer called that covers implants and where bacteria can lie dormant and protected from antibiotics?
Glycocalyx
270
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).
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
What 4 things should you assess on 6 week post-operative radiographs after a fracture repair?
Apposition, alignment, apparatus, activity
272
How are the 3 aspects of the scapula treated if fractured?
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
What are the inflammatory conditions of the shoulder?
OCD, OA, sepsis
274
What are the musculotendinous and ligamentous conditions of the shoulder?
Infraspinatus contracture
Bicipital tenosynovitis
Medial displacement of the biceps brachii tendon
275
What is the pathogenesis of shoulder luxation?
- Congenital – never articulates so joint does not develop properly
- Acquired – traumatic, rupture of collateral ligaments
276
What are the clinical signs of shoulder luxations?
- Lame with shortened stride
- Congenital – lameness may be mild/missed
- Palpable abnormal anatomy
- Reduced ROM and pain/crepitus around shoulder
277
Why might the glenoid be flat and round?
Hasn’t been articulated with so been luxated for a while
278
How are congenital and acquired shoulder luxations treated?
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
What is the aetiology of shoulder osteochondrosis?
Herediatry
Nutritional
280
What is the pathogenesis of shoulder osteochondrosis?
- Fissuring and detachment of flap of cartilage
- Caudomedial humeral head
281
What are the clinical signs of shoulder osteochondrosis?
- Gradual onset, chronic lameness
- Shoulder muscle atrophy
- Pain on shoulder extension (flexion)
282
How is radiography used to visualise shoulder osteochondrosis?
- 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
What are the treatment options for shoulder osteochondrosis?
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
What are the possible complications of shoulder osteochondrosis surgical treatment?
Failure to remove whole flap
Seroma formation
285
What is the aetiology and pathogenesis of bicipital tenosynovitis?
Aetiology – trauma during exercise or direct
Pathogenesis – range of pathology from inflammation to partial to complete rupture
286
What are the clinical signs of bicipital tenosynovitis?
- Acute or insidious onset forelimb lameness
- Pain on direct palpation of tendon
- Thickening and pain over tendon origin
287
How is bicipital tenosynovitis diagnosed from imaging?
- Loss of clear tendon outline
- Changes in tendon structure
- Complete rupture of tendon
288
How is bicipital tenosynovitis treated?
- 6-8 w rest and NSAIDS
- Intra articular steroids
- Severe pain/tear
- Tenotomy and tenodesis
289
How is a partial biceps tendon rupture treated?
Tenotomy and tenodesis
290
How is a complete biceps tendon tear identified?
- Pathognomic test for complete biceps brachii tendon rupture
- Can flex shoulder while elbow extended
291
Which breed is susceptible to medial displacement of the biceps tendon?
Greyhounds and lurchers
292
What is the pathogenesis of medial displacement of the biceps tendon?
- Tendon displaces out of groove medially, after racing/running
- Secondary to bicipital tenosynovitis, rupture transverse humeral ligament
293
How is medial displacement of the biceps tendon treated?
Replace transhumeral ligament. Smooth staple or screws and suture/mesh to replace transhumeral ligament
294
What is the pathogenesis of infraspinatus tendon contracture?
Trauma > inflammation > fibrosis and contracture
295
What are the clinical signs of infraspinatus tendon contracture?
- Characteristic stance/gait – circumducting gait
- Manipulation – not possible to extend shoulder
296
What is the treatment and prognosis for infraspinatus tendon contracture?
Treatment – sever/excision tendon
Prognosis – good for complete recovery
297
What are the locations of humeral fractures?
- Humeral head – physeal/articular
- Greater tubercle fracture – avulsion
- Humeral diaphysis – diaphyseal
- Supracondylar – diaphyseal
- Condylar fractures – articular/physeal
298
What are the characteristics of humeral physeal fractures?
- Proximal humeral physis
- Interdigitating fracture, stable, repair with 2 pins
- Cats more likely mid diaphysis and dogs more likely condyle
299
How appropriate is cast/external coaptation for humeral diaphyseal fractures?
Not appropriate for fractures of the upper limb
300
How appropriate is IM pin fixation for humeral diaphyseal fractures?
Can be used in combination with plate and screws, ESF or cerclage wires
301
How appropriate is an interlocking nail for humeral diaphyseal fractures?
Can be used but as bone narrows distally only suitable for mid and proximal diaphyseal fractures
302
How appropriate is plate and screws for humeral diaphyseal fractures?
Often the best choice, surgical approach, anatomy and shape of bone make fixation of this bone challenging
303
How appropriate is ESF for humeral diaphyseal fractures?
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
How is a humeral diaphyseal fracture best treated and why?
Lag screw, IM pin and neutralisation plate
Reconstructing the bone so there is load sharing between the bone and the plate
305
What is the aetiology of humeral condylar fractures?
- Often minimal indirect trauma – drop, fall
- Fissure/stress fracture (HIF) – Springer spaniel
306
What is the pathogenesis of humeral condylar fractures?
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
What are the clinical signs of humeral condylar fractures?
- 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
How are articular humeral condylar fractures treated?
- ORIF/open reduction and internal fixation
- Compression
- Perfect reduction
- Maintain joint mobility
309
How are bicondylar/Y/T humeral condylar fractures treated?
- Early ORIF/open reduction and internal fixation – double plates and screws
- Very challenging cases
310
What is the post-operative management for humeral condylar fractures?
- Bandage to reduce swelling increase comfort
- Strict exercise restriction
- Cage rest 4-6 weeks
- Elbow physiotherapy
- Follow up x-rays 4-6 weeks
311
What are the complications of humeral condylar fracture repair?
Implant failure, infection, OA
312
What is the prognosis of humeral condylar fracture repair?
Early surgery and complication free healing prognosis good. All dogs will develop OA
313
What are humeral intracondylar fissures?
Incomplete ossification of humeral condyle - present with lameness and a fissure. Acute fracture = prodromal lameness
Best detected on CT
314
How are humeral intracondylar fissures treated?
Place prophylactic screw to prevent fracture
315
Which of the following breeds is prone to developing shoulder osteochondrosis dissecans?
Border collie
316
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.
Lateral
317
Which scapula fractures would definitely benefit from surgical repair?
Glenoid
318
What are ligaments and their functions?
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
What are ligaments made up of?
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
Define sprain and strain.
Ligament injuries are sprains
Tendon injuries are strains
321
What is a type 1 sprain? How are these managed?
Minimal tearing with some haemorrhaging. Rest or bandage for 2 weeks
322
What is a type 2 sprain? How are these managed?
Partial tearing and stretching of fibres with haemorrhage. Surgical repair, suture or protect with a prosthetic, external coaptation post op
323
What is a type 3 sprain? How are these managed?
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
What do sprains require for healing due to healing being slow?
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
What are the presenting signs of collateral ligament injuries?
- Lameness
- Obvious instability
- Pain on manipulation
- Luxation (dislocation)
- May be open injury
326
How are collateral ligament injuries diagnosed?
- Palpation
- Survey radiographs
- Stressed radiographs – varus or valgus stressed to test collateral ligament integrity
327
How are type 1 collateral ligament injuries treated?
Conservative management with bandage
Rest
NSAIDs
328
How are type 2 and 3 collateral ligament injuries treated?
- 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
What are the post-operative managements for collateral ligament injuries?
ESF, external coaptation
330
What are suture anchors and how can they be used for collateral ligament injuries?
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
Distinguish valgus and varus.
- Valgus means the distal part deviates laterally
- Varus means the distal part deviates medially
332
What causes valgus and varus?
Bone deformity
Ligament laxity injury
333
Distinguish valgus and varus stress.
Varus stress – tests lateral collateral ligament
Valgus stress – tests medial collateral ligament
334
What are open ligament injuries from degloving or shear injuries?
Open wounds with loss or damage to collateral ligaments
335
How are ligament injuries from degloving or shear injuries treated?
- 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
What is the pathogenesis and signalment of plantar/palmar ligament rupture?
Rupture of ligament causes loss of function/luxation/subluxation
Shetland sheepdog/collie types predisposed
337
What are the clinical signs of plantar/palmar ligament rupture?
Plantigrade/palmigrade stance
Lameness
338
How is palmar/plantar ligament rupture diagnosed?
Palpation
Stressed radiographs
339
How is palmar/plantar ligament rupture treated?
- Ligaments short
- Tension high – repair failure likely
- Joint low motion
- Arthrodesis-partial or pan
340
What is the prognosis of plantar/palmar ligament rupture?
Arthrodesis has a better outcome for treatment as is a low motion joint as there is often lots of ligaments affected
341
Distinguish luxation and dislocation.
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
Distinguish congenital and acquired luxations.
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
Define salvage procedure?
An operation that allows continuance of function of an animal without preservation of normal anatomy
344
What are some examples of salvage procedures?
- 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
Why arthrodese/fuse a joint?
Relieve pain, restore function
346
Which joints might benefit from arthrodesis?
- Chronic unrelenting joint pain
- Untreatable articular fractures
- Chronic joint luxations
- Partial neurological injuries
- Unreconstructable
- Ligament injuries – palmar carpal ligament rupture
347
Why and how might you arthrodese intertarsal joints?
To treat plantar tarsal ligament rupture
Fuse and stabilise with plate and screws, but maintaining the high motion tibiotarsal joint
348
What are the surgical principles of arthrodesis?
- 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
Which joints can be arthrodesed with good prognoses?
- 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
Which joints can be arthrodesed with poor prognoses?
- 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
What are the indications of amputation?
- 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
What is done before amputation surgery?
Examine whole animal especially other joints to ensure suitable for amputating one leg
353
What are the possible amputation level of thoracic limbs?
Disarticulate shoulder
Proximal humerus
Remove whole limb plus scapula
354
What are the possible amputation level of pelvic limbs?
Disarticulate hip
Proximal femur - marked muscle atrophy and bony prominences, hemipelvectomy
355
What is the anatomy of tendons?
In area of direction change/friction, there are tendon sheath, bursas or a bony enlargement
356
What are the characteristics of tendons that influence healing and repair?
- 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
What tendon suture patterns are used?
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
What are the surgical principles of tendon repair?
- Early surgery to minimise contracture problems
- Incision may need extending to find contracted tendon ends
359
What are the post-operative tendon surgery management options?
- 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
What is the gait abnormality from biceps brachii disruption?
Increased ROM of shoulder with elbow extended
361
What is the gait abnormality from calcaneal/gastrocnemius disruption?
Dropped hock and claw foot
362
What is the gait abnormality from quadriceps tendon disruption?
Dropped stifle, unable to keep extended
363
What is the gait abnormality from digital flexor tendon disruption?
Knocked up toes/flat toes
364
What is the gait abnormality from triceps brachii disruption?
Dropped elbow - unable to keep extended
365
What is the gait abnormality from popliteus disruption?
Lameness, other changes subtle
366
What is the gait abnormality from long digital extensor tendon disruption?
Lameness, other changes subtle
367
What is the aetiopathogenesis of avulsion or rupture of musculotendinous structures?
Usually results from an abnormal or spastic contraction of a muscle against a fixed joint
368
What are the clinical signs of digital flexor tendon lacerations?
Dropped or knocked up toe
369
How are digital flexor tendon lacerations treated?
Repair with suture pattern and leave untreated if old injury
370
What is the post operative management after digital flexor tendon repair?
Support with foot flexed to prevent weight bearing
371
What is the aetiopathogenesis of achilles tendon rupture?
Incoordinate contraction > rupture at weak point musculotendinous junction
372
What are the clinical signs of achilles tendon rupture?
Loss of function
Rupture gastrocnemius then unable to extend hock
373
How is achilles tendon rupture treated?
- Repair – tendinous sutures/mattress sutures
- External coaptation/support while healing
374
What are the clinical signs of gracilis rupture?
Lameness
Swelling, haemorrhage
Palpable tear
Loss of function
375
How is gracilis rupture treated?
- Repair muscle – mattress sutures
- Conservative – if not returning to racing
376
What are the clinical signs of gastrocnemius avulsion?
Lameness and plantigrade stance
Claw foot
377
How is gastrocnemius avulsion treated?
Reattach tendon to bone
Pin and tension band wire
378
What is the aetiology and pathogenesis of musculotendinous contracture?
- Trauma – repetitive/single
- Parasites – Neospora cysts within muscle
> Fibrosis of muscle secondary to ischaemia/inflammation
379
What are the clinical signs of musculotendinous contracture?
- Reduction in ROM of joint
- Abnormal gait/posture
- Firm/fibrous muscle on palpation
380
How is musculotendinous contracture treated?
- Resect fibrosed muscle
- Cut tendon/tenectomy
- Release contracted muscle and lengthen it
381
What are the breed dispositions for musculotendinous contractures?
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
What is the aetiopathogenesis of musculotendinous displacement?
- Trauma and rupture of the retinaculum (retaining tissue)
- Tendonitis and inflammation of the tendon
- Conformational abnormalities
383
How is musculotendinous displacement treated?
Aim restore tendon to normal place. Deepen groove, suture surrounding soft tissues, smooth staple, mesh to retain tendon in groove
384
What are the breed dispositions to tendon displacements?
Biceps brachii = Greyhounds, lurchers
SDFT = shetland sheepdogs, others
Quadriceps tendon/patellar luxation = small breeds, cats, any
Long digital extensor tendon = any, very rare
385
Rupture of which muscle in the dog and cat can result in a dropped elbow?
Triceps brachii
386
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?
SDFT
387
Contracture of which muscle is a recognised cause of lameness in a German shepherd dog?
Gracilis
388
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?
Type 2 sprain
389
Which joint is least likely to be arthrodesed due to the resulting poor outcome?
Hip
390
How well do pelvic fracture heal with conservative treatment?
Usually heal but with malunions
391
What are the indications for surgical repair of pelvic fractures?
- Fractures of weight bearing axis
- Articular fractures (acetabular)
- Narrowing of the pelvic canal
392
What is the aetiopathogenesis of ilial pelvic fractures?
- Traumatic fracture of the ilium
- Fragment displaces medially and cranially
- Narrows pelvic canal
- Weight bearing axis
393
How are ilial pelvic fractures treated surgically?
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
What are the complications of treating ilial pelvic fractures conservatively?
Malunion
Narrowed pelvis
Constipation
395
What is the post-operative management used for ilial pelvic fractures?
Analgesia, cage rest and monitor urination/defecation
396
What is the most common pelvic injury, particularly in cats?
Sacroiliac luxations
397
When do you decide to treat and what treatment is used for sacroiliac luxations?
Displacement, pain
Treatment – usually single lag screw fixation
398
When is surgery used to treat acetabular fractures?
Reducible displaced fractures
399
When are acetabular fractures conservatively managed?
- Caudal 1/3rd (non-weightbearing)
- Non-displaced, skeletally immature
- Extensive comminution
400
Name the salvage procedure used for acetabular fractures.
Femoral head and neck excision
401
What is the aetiology of hip dysplasia?
- Developmental disease
- Born with normal hips
- Laxity develops in joint capsule which allows hip to subluxate
402
What are the clinical signs of hip dysplasia?
Short stride, stiffness, clunking of hips
Lateral sway
Bunny hopping
Adducted hindlimbs
Muscle atrophy
Pain on hip extension
Crepitus
Clunking
403
How can hip dysplasia be diagnosed with the Ortolani test?
Dog in soral/lateral recumbency. Test of hip laxity. Negative is normal or dislocated hip
404
How can hip dysplasia be diagnosed with the Bardens test?
Dog in lateral recumbency, finger on greater trochanter pushing in and out up and down of the socket if loose
405
How can hip dysplasia diagnosed with imaging?
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
How is hip dysplasia managed non-surgically?
NSAIDs, rest, hydrotherapy, diet – dog gets better but radiographs get worse so base on how the dog is doing and not imaging
407
How is hip dysplasia in young dogs with mild laxity before osteoarthritis surgically managed?
- Growth plate fusion – eg juvenile pubic symphysiodesis (JPS), before 4 onths of age
- Osteotomies – double or triple pelvic osteotomy (DPO or TPO)
408
How is severe hip dysplasia or hip dysplasia with osteoarthritis surgically managed with salvage surgery?
- Total joint replacement – cemented or uncemented
- Ostectomies – femoral head and neck excision (FHNE)
409
Outline how hip dysplasia is treated surgically with juvenile pubic symphysiodesis.
- 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
When is hip dysplasia surgically treated with triple or double pelvic osteotomy?
- 6-7mths of age, no DJD, mild laxity
- Good clunk on ortolani test
- Indications – hip dysplasia, dislocation, dysplastic hip?
411
When is hip dysplasia surgically treated with femoral head and neck excision?
- Salvage procedure
- Try non surgical management first
- Indication – severe cases/marked
412
What is the outcome of femoral head and neck excision to treat hip dysplasia?
Pseudoarthrosis - encourage exercise after surgery
413
What are the indications of total hip replacement to treat hip dysplasia?
- Coxofemoral arthritis
- Hip dysplasia
- Chronic dislocation
- Fractured femoral head
- Ischaemic necrosis
- Slipped capital femoral epiphysis – cats
414
What are coxofemoral luxations?
Craniodorsal direction, can also go ventral (painful) or caudodorsal
415
What are the clinical signs of hip luxations?
- May be weight bearing
- Gait – stifle out, hock in and leg adducted
- Compare leg length – affected leg seems shorter
416
How hip luxations treated with closed reduction?
- 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
How hip luxations treated with open reduction?
- Primary capsular repair
- Prosthetic capsular repair
- Transarticular pin
- Ilio femoral suture
- Toggle
418
What is the aetiopathogenesis of avascular necrosis of the femoral head?
- 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
What are the clinical signs of avascular necrosis of the femoral head?
- Unilateral hind limb lameness
- Pain on hip extension and flexion
- Muscle wastage
420
How is avascular necrosis of the femoral head diagnosed on imaging?
Lucent areas initially, collapse and mushrooming
421
How is avascular necrosis of the femoral head treated?
Conservative – cage rest
Surgery – femoral head and neck excision, total hip replacement
422
What does slipped capital femoral epiphyseal cause?
Automatic fracture of the capital femoral physis
Aetiopathogenesis - neutering delays growth plate closure
423
What is the signalment of slipped capital femoral epiphyseal?
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
How is slipped capital femoral epiphyseal treated?
Pin (early and undisplaced?), later salvage surgery FHNE or THR
425
What are the clinical signs of gracilis m. rupture?
- Swelling, haemorrhage
- Palpable tear
- Loss of function
- Greyhounds/lurchers
426
What are the clinical signs of gracilis m. contracture?
- Characteristic gait – can’t get wide stride and so flicks around the leg at the stifle and hock
- Initially painful
427
How is gracilis m. contracture treated?
- Temporary alleviate by cutting tendon
- Condition will recur
428
What are the possible fractures of the femur?
- Capital physeal and slipped capital femoral epiphysis (SCFE)
- Neck fractures
- Diaphyseal
- Condylar
- Intracondylar – articular
429
What are proximal capital physeal separation/fracture?
Salter-Harris type 1 common
430
How are proximal capital physeal separation/fracture treated?
- Small pins or K wires frequently used
- Treatment – FHNE, THR
431
How appropriate is external coaptation for femoral diaphyseal fractures?
Not appropriate for femoral fractures
432
How appropriate are IM pins for femoral diaphyseal fractures?
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
How appropriate are interlocking nails for femoral diaphyseal fractures?
Good for mid diaphyseal comminuted fractures
434
How appropriate are plate and screws for femoral diaphyseal fractures?
Place on lateral aspect of the bone, often combined with an IM pin for comminuted fractures. Most common repair option
435
How appropriate is ESF for femoral diaphyseal fractures?
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
What are the aims of femoral fracture repair?
- Preserve blood supply
- Do not disturb fragments
- Spatial alignment
437
What are the stabilisation options for femoral fractures?
- ESF
- Buttress plate
- Pin plate – pin aids alignment and increases resistance to bending
- Interlocking nail - mid diaphyseal comminuted or transverse fractures
438
What are the characteristics of distal physeal femoral fractures?
- 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
What is the pathogenesis of premature tibial growth plate closure?
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
What is the clinical presentation of tarsal valgus in Shelties or tarsal varus in Dachshunds?
Bilateral angular limb deformity
Usually immature/young adult
441
How is tarsal varus/valgus treated?
- Osteotomy and then ESF or plate while it heals
- Physeal staple in immature dog in hopes it corrects itself
442
What is the aetiology of tibial tuberosity avulsion fractures?
Fall or jump, intrinsic force/muscle contraction
443
How are tibial tuberosity avulsion fractures diagnosed?
Radiography, both sides to compare, particularly in young dogs as they can be minimally displaced
444
How are tibial tuberosity avulsion fractures treated?
Pins and tension band wires
445
How suitable is external coaptation for tibial diaphyseal fractures?
Can be suitable for simple, stable fractures in young animals, particularly if they have an intact fibula
446
How suitable is IM pinning for tibial diaphyseal fractures?
Normograde, limit by size of distal bone. Care with length distally (hock joint) and proximally (stifle). Combine with another implant eg ESF, plate
447
How suitable are interlocking nails for tibial diaphyseal fractures?
Can be used for proximal/mid fractures, size limited by distal bone IM canal
448
How suitable are plate and screws/plate and pins for tibial diaphyseal fractures?
Common repair option, plate applied to medial tibia. Limited by size of the tibia
449
How suitable ESF for tibial diaphyseal fractures?
Useful for simple fractures in young dogs and cats and for open/comminuted fractures
450
How might a 4 week old animal be treated for a tibial diaphyseal fracture?
Very young so healed with conservative management with cage rest
451
Describe distal tibial diaphyseal fracture management.
- Cats – distal tibia slow to heal
- Double plate
- Cranial and medial tibia
- Maximise screw number in small distal fragment
452
What is the clinical presentation of distal tibial growth plate fractures?
Dogs and cats <9 months
Salter Harris Type I/II
453
How are distal tibial growth plate fractures treated?
- Physeal fracture principles
- ORIF if displaced
- External coaptation if minimal displacement
- Use small X pins
Post-operative – external coaptation
454
What is the pathogenesis of hock dislocation?
Collateral ligament ruptures and/or avulsion fractures of medial malleoli/distal fibular. Can be open or closed
455
How are closed hock dislocations of the hock treated?
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
How are open hock dislocations of the hock treated?
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
How are hock dislocations treated?
- Palpation (collateral ligaments)
- Observation – open wounds
- Imaging – CT can be used for more advanced imaging but diagnosis can be made from radiography
458
What does TESF provide for open tarsal luxations?
Temporary immobilisation while ligaments and wounds heal
459
How are closed tarsal luxations treated?
Suture prosthesis to replace collateral ligaments then external coaptation
460
What is the pathogenesis of tarsal osteochondrosis?
Lesion (ODC flaps) medial or later to the talar ridge
461
What are the clinical signs of tarsal osteochondrosis?
- Tarsal swelling
- Upright hock
- Lameness
- Reduced ROM hock
462
How is tarsal osteochrondrosis diagnosed from imaging?
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
How is tarsal osteochondrosis treated?
Conservative – restricted exercise/NSAIDs
Surgical – debridement for larger lesions that are more painful
464
What is the prognosis of tarsal osteochondrosis?
Develop OA, may need salvage surgery later on for this which would be a pan tarsal arthrodesis
465
What causes proximal intertarsal joint subluxation?
Rupture of Plantar tarsal ligaments and fibrocartilage
466
What are the clinical signs of proximal intertarsal joint subluxation? How is this diagnosed?
Lameness
Plantigrade stance
Can be bilateral changes
Diagnosed with stressed radiographs
467
H
468
What is the presentation of lateral displacement of SDFT?
Palpably displacing tendon
Lameness/altered gait
469
How is lateral displacement of SDFT treated?
Surgical repair of torn retinaculum
470
What is the aetiopathogenesis of gastrocnemius rupture?
- Trauma or degeneration
- Partial or complete
- Elongation of tendon in partial rupture
- ‘Claw foot’ as SDFT travels longer distance
471
What are the clinical signs of gastrocnemius rupture?
Lameness
Thickened tendon
Dobermanns
Dropped hock
Claw foot, plantigrade
472
How is gastrocnemius partial rupture treated?
Extend hock (eg calcaneotibial screw) for 6w to take tension off tendon whilst healing
473
How is gastrocnemius complete rupture treated?
Tenectomy and suture
474
How is gastrocnemius avulsion rupture treated?
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
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?
Superficial digital flexor tendon rupture
476
In what age and breed would you most likely see a tibial tuberosity avulsion fracture?
Staffordshire bull terrier 4 months old
477
What part of the hock is most commonly affected by osteochondrosis?
Medial talar ridge
478
What are the clinical signs of craniomandibular osteopathy?
Enlarged mandibles
Dull
Drooling
Pain on attempting to open mouth
479
How is craniomandibular osteopathy diagnosed?
Imaging shows proliferative new bone on mandibles/TMJ
480
How is craniomandibular osteopathy treated?
NSAIDs
Steroids suggesting there is an immune mediated component
Liquefied food
481
What is the prognosis of craniomandibular osteopathy?
- Good as self limiting, bone may regress
- Can interfere with prehension/respiration
482
What is the aetiology of mandibular fractures?
Trauma
RTA
Dog fight
Fall
Dental disease
483
What are the clinical signs of mandibular fractures?
Malocclusion
Swelling
Oral haemorrhage
484
How are mandibular fractures diagnosed?
- CT is bets as X-ray gets superimposition of the 2 hemimandibles
- Careful oral examination
485
How are mandibular fractures treated?
- 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
486
What are the treatment principles of treating mandibular fractures?
- 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
487
When is ESF to treat mandibular fractures indicated?
Open and rostral fractures
488
Describe ESF to treat mandibular fractures.
- Allows oral feeding
- Transarticular frames for complicated fracture
- Acrylic bars/epoxy putty useful to go around jaw
489
What is the MAMA BEARD technique of treated mandibular fractures?
Mandibular and maxillary bignathic encircling and reduction device
Indicated for caudal mandibular fractures/immature fractures
490
491
492
Outline how a MAMA BEARD is placed.
- 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)
493
What is the post-operative management for MAMA BEARD placement?
- Soft/liquid food
- Oral hygiene
- Radiographs 3-4 weeks and palpable assessment of stability
493
What are the possible complications of MAMA BEARD placement?
Infection
Malunion
Non-union
494
What are the repair methods for symphyseal separations?
- 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
495
How can symphyseal separations be treated with cerclage wire?
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
496
What is the effect of bisphosphates?
Reduce bone resorption by inhibit osteoclasts (cells in the bone that resorb bone)
497
What are bisphosphates used for?
- 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
498
Distinguish non-amino bisphosphates and amino bisphosphates.
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
499
What are the actions of bisphosphates?
- Inhibit osteoclasts
- Inhibit neoplastic cell proliferation
- Induce apoptosis (cell death)
- Inhibit angiogenesis
- Inhibit matrix metalloproteinases, affect cytokines and growth factors
- Immunomodulatory
- Deplete phagocytic cells
500
Why can bisphosphates be used for bone tumours?
- Decrease bone resorption
- Decrease tumour pain
- Decrease metastasis
501
What is the effect of bisphophates on malignant histiocytosis?
- Limited clinical use
- Combining bisphosphonates with chemotherapeutic agents shows promise, such as chlorinate and vincristine, or alendronate and doxorubicin
502
Why are bisphosphates be used for immune mediated haemolytic anaemia?
- 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
503
How are bisphosphates administered?
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
504
What are the possible side effects of bisphosphates?
- Oesophagitis, gastritis
- Delayed bone healing – ‘frozen bone’
- Nephrotoxicity
- Allergic reactions
505
What are the clinical signs of osteosarcomas?
- 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
506
What are the possible appendicular osteosarcoma sites?
Distal radius
Proximal humerus
Proximal tibia
Distal femur
507
What is the effect of different osteosarcoma treatment options on distant metastases?
- 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
508
Why is euthanasia a reasonable action for osteosarcoma?
By the time it is apparent in the bone it may have already metastasised elsewhere. Painful and poor prognosis
509
What is the aetiology of nutritional secondary hyperparathyroidism?
- Diet high in Phosphorous/low in Calcium (all meat diet)
- Horses – exclusive grain diet
510
What is the pathogenesis of nutritional secondary hyperparathyroidism?
- 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
511
What are the clinical signs of nutritional secondary hyperparathyroidism?
- Puppies and kittens after weaning
- Lameness, pathological fractures, lax ligaments neurological deficits, growth and teeth deformity
Horses – enlargement of mandible/loose teeth
512
How is nutritional secondary hyperparathyroidism diagnosed?
Imaging – cortices thin, little differentiation between cortex and medulla ‘ghost’ like bones. Normal growth plates
Bloods – low/normal calcium and phosphorous, high parathormone
513
How is nutritional secondary hyperparathyroidism treated?
- Balanced diet, NSAIDs, Cage rest
- If possible avoid ORIF, most fractures will heal – but malunions likely
514
What is the aetiology of panoestitis?
Viral, excess nutrition, hereditary
515
What is the pathogenesis of panoestitis?
Degeneration of Intramedullary (IM) adipocytes, intramedullary ossification of adipocytes so you get inflammatory and then bone deposition
516
What are the clinical signs of panoestitis?
- Migrating and painful lameness, non weight bearing, shifting
- Dull, anorexia, pyrexia, painful bones on palpation
517
How is panoestitis diagnosed?
- Radiography/CT
- Patchy increased density of medulla of bone
- Distal humerus
- Proximal ulna
- ‘Thumbprints’
- Near nutrient foramen
518
What is the aetiology of hypertrophic osteodystrophy?
Infection, hereditary, nutrition
519
What are the clinical signs of hypertrophic osteodystrophy?
- Inappetance, reluctance to stand, lameness
- Swollen painful and hot metaphyseal areas of lower limb bones. Bilateral change
- Pyrexia
520
How is hypertrophic osteodystrophy diagnosed?
- Soft tissue swelling
- Periosteal new bone formation
521
How is hypertrophic osteodystrophy treated?
- Balanced diet/no supplements
- Analgesia – NSAIDs/opiates/rest
- Antibiotics/steroids if pyretic in case there is a bacterial infection
522
What is the aetiopathogenesis of hypertrophic osteopathy?
Secondary manifestation of thoracic (abdominal) disease
523
What are the clinical signs of hypertrophic osteopathy?
Firm, warm, non oedematous swelling – all limbs
Lame
Stiff
Dyspnoea
Cough
524
How is hypertrophic osteopathy identified from radiography?
- Soft tissue swelling in early stages
- Periosteal new bone on MT/MC later on
- Long bones affected in severe cases
- Thoracic or abdominal mass
525
How is rickets diagnosed?
Imaging - widened cup shaped growth plates due to accumulation of unmineralized osteoid
526
How is rickets treated?
Correct diet, expose to sunlight
527
What is physitis?
Enlargement of the physeal region of long bones in growing horses
528
What are the clinical signs of physitis?
- 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
529
How is physitis identified on radiography?
Flaring of the metaphysis and epiphysis adjacent to the physis. Irregularity of the physis and surrounding sclerosis
530
How is physitis treated?
Reduction of energy content of ration to slow growth, ensure correct mineral balance in ration, rest, NSAIDs
531
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.
Metaphyseal osteopathy
532
Hypertrophic pulmonary osteoarthroscopy (Maries or hypertrophic osteopathy) is most often seen secondary to what condition?
Pulmonary neoplasia
533
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?
Patchy or mottled radiodensity in the medulla on radiography
534
What cells do bisphosphates act on and what action do they have on that cell?
They disrupt metabolism of osteoclasts leading to apoptosis of the cells
535
What is the pathogenesis of stifle luxation?
Rupture of multiple ligaments - such as cranial and caudal cruciate and collaterals
536
What are the clinical signs of stifle luxation?
Severe non weight bearing lameness and stifle instability and crepitus
537
How is stifle luxation treated?
- They need surgery
- Sequential repair/prosthetic replacement of individual ligaments
538
What is the post operative care needed for stifle luxations?
- Stifle support for 3-6 weeks
- Transarticular pin in cats and small dogs
- TESF
539
What are the complications of stifle luxation surgery?
- Implants/coaptation related
- Reluxation/OA
540
What is the prognosis of stifle luxations?
Joint remains stiff with a reduced range of motion and lameness
541
Which condyle is usually affected by stifle osteochondrosis?
Usually lateral condylar lesion
542
How is stifle osteochondrosis treated?
- Surgical treatment – debridement
- Osteochondral autograft
543
What is one of the most common causes of stifle lameness in dogs (less common in cats?)
Tear or rupture of the cranial cruciate ligament
544
What is the aetiology of cranial cruciate ligament rupture?
Degenerative – commonest. Ligaments degenerate from an early age
Traumatic – occur after fall, may be other ligaments damaged
Inflammation – polyarthritis
545
What is the pathogenesis of cranial cruciate ligament rupture?
- Hyperextension or increased internal rotation can cause cranial cruciate ligament rupture (CCLR)
- Ligament can be ruptured completely or partially
- The term cranial cruciate ligament disease (CCLD) is often used as pathology varies.
- Meniscal cartilage damage concurrent or subsequent
- Usually medial meniscus
546
What are the clinical signs of cranial cruciate ligament rupture?
- Often minimal trauma
- Acute or insidious onset
- Improve initially but remain lame
- Mild pelvic limb lameness
- Variable severity
- Circumduct limb – minimise stifle flexion
547
How is cranial cruciate ligament rupture diagnosed?
- Compare/symmetry
- Quadriceps muscle atrophy
- Swelling medial aspect of joint
- Joint effusion
- Bilateral?
- Hyperextension of stifle painful
- Cranial draw test
- Tibial compression/thrust test
548
How is cranial cruciate ligament rupture diagnosed from imaging?
- Joint effusion
- Compression of infrapatellar fatpad
- Periarticular osteophytosis
- Subluxation of stifle rare unless steep tibial plateau angle
549
How is cranial cruciate ligament rupture treated with arthrotomy/arthroscopy?
Inspect cruciate ligament and meniscus followed by:
- Intra articular replacement of ligament e.g. Fascia latagraft
- Extra articular replicate function of ligament e.g. Lateral suture
- Alteration of joint angles – tibial plateau levelling osteotomy, tibial tuberosity advancement, cranial closing wedge
Strict rest 6 weeks, rely on fibrosis, if no improvement then surgery
550
How is cranial cruciate ligament rupture treated using extra articular surgical repair?
- Suture placed around the femorofabella ligament and through a bone tunnel in the tibial tuberosity
- Replicates function of CCL
- Aims to eliminate cranial draw
- Fewer major complications
- Instability may persist
551
What are the forces through the stifle that must be considered when it comes to treatment of cranial cruciate ligament rupture?
- Gastrocnemius – fixed length
- Tibial plateau slopes caudally
- Tibia slides forwards unless restrained by the CCL
- Cranial cruciate ligament is the only passive restraint to ‘slippage’
- Weight bearing – compression force between the femur and the tibia
- Force is proportional to the slope of the tibial plateau (steeper = more force)
552
Why do we want to reduce the force across the stifle in cranial cruciate ligament rupture and how?
By flattening the tibia from 24+ to 4-6 degrees, forces go through down the joint instead of translating. This alters the patellar tendon angle to be more perpendicular
553
What is the average tibial plateau angle?
24 degrees
554
Why is the medial meniscus more commonly torn?
Medial meniscus has an attachment to the medial collateral ligament
555
How is meniscal tear treated?
Partial meniscectomy then post-op:
- Confinement/strict rest 6w
- Radiograph to monitor healing
- Physiotherapy/swimming useful
556
What is the aetiopathogenesis of quadriceps rupture?
- Post femoral fracture
- Muscle damage
- Complications with repair
- Compartment syndrome
557
What are the clinical signs of quadriceps contracture?
- Hyperextended stifle, firm fibrous muscle
- Reduced stifle flexion and circumducted gait
558
How is quadriceps contracture treated?
Resect muscle, physiotherapy
559
What is the pathogenesis of patella luxation?
Abnormal conformation/soft tissue damage – abnormal quadriceps m. alignment allows patella to displace out of the trochlear groove
Lameness – instability, OA, cartilage, inability to keep stifle extended
560
Distinguish the gait analysis and conformation of medial and lateral patella luxation?
Medial luxation – genu vara (bowlegged = walk with hyperflexion)
Lateral luxation – genu valga (knock kneed = walk with hyperextension)
561
What is a grade 1 patella luxation?
Can be luxated but will return to the groove once released
562
What is grade 2 patella luxation?
Patella can be luxated and will stay luxated until leg moved
563
What is grade 3 patella luxation?
Patella luxated most of the time but can move back into the groove
564
What is grade 4 patella luxation?
Patella permanently luxated, cannot return to the groove
565
When is patella luxation conservatively managed?
Mature dogs with low grade luxation (I or II) and only intermittent problems. Dogs with no or minimal clinical signs
566
When is patella luxation surgically managed?
Immature dogs with clinically significant patella luxation. Adult dogs with debilitating luxations
567
Name the surgical techniques for patella luxations.
- Deepen the groove – block/wedge recession
- Realign quadriceps – tibial tuberosity transposition
- Soft tissues – joint capsule/retinaculum release and overlap
- Corrective femoral osteotomy – severe abnormalities
568
How is a trochlear wedge or block recession used to treat patella luxation?
- Both deepen groove and preserve hyaline cartilage
- With block get deeper proximal groove
- Patella groove replacement and prosthetic ridges
569
How is a tibial tuberosity transposition used to treat patella luxation?
- To realign quadriceps
- Cut tibial tuberosity
- Leave periosteum attached distally
- Move laterally
- Reattach with 2 K wires
- Or detach completely and secure with 2 K wires and figure of 8 TBW
570
What is the post-operative care needed for patella luxation surgery?
Exercise restriction 3-6 weeks
Crate/house
Gradual return to normal exercise/physiotherapy/hydrotherapy
571
What are the complications of patella luxation surgery?
- Under correction and reluxation
- Over correction and luxates the other direction
- Implant breakage/loosening
- Tibial tuberosity fracture
- Infection/seroma/osteoarthritis
572
What is the main aim of the tibial osteotomies that are performed to treat dogs with cranial cruciate ligament ruptures?
To eliminate tibial thrust
573
You diagnose grade II patella luxation in a 4 month cavalier king Charles spaniel with 5/10 lameness. Wat action do you recommend to the owner?
Surgery should be performed fairly soon
574
You diagnose stifle osteochondrosis in a 8 month old German Shepherd dog/ Where about in the stifle are you most likely to find the OCD lesion?
Lateral femoral condyle
575
What are the aims of the different patella luxation surgeries?
- Deepen groove (block or wedge recession)
- Realign quadriceps mechanism by moving (transposing) tibial tuberosity (TTT)
- Realign patella in groove by loosening soft tissues on medial side
- Realign patella in groove by tightening soft tissues on lateral side (imbrication)
576
What is often secondary to cruciate rupture?
Meniscal tear
577
What changes do you most commonly see on radiographs in dogs with cranial cruciate ligament rupture?
Joint effusion, osteophytes
578
What is the pathogenesis of elbow luxation?
Usually lateral and proximal luxation. Collateral ligament ruptures
579
How is elbow luxation treated?
- Attempt closed reduction
- Bandage/spica splint – maximum 2 weeks
- Surgical stabilisation if unstable/unreducible
579
What are the clinical signs of elbow luxation?
- Non weight bearing, adducted elbow, abducted and pronated foot
- ROM reduced, elbow swollen and painful
580
What are monteggia fractures?
Fracture of the ulna and associated elbow luxation/radial head luxation
581
How are monteggia fractures treated?
Stabilise both the ulna fracture and the radial head luxation by surgery to restore function. Replace annular ligament if ruptured
Complication – reluxation
582
What are the features of elbow dysplasia in dogs?
- Fragmented medial coronoid (FCP) process of ulna
- Ununited anconeal process (UAP) of ulna
- OCD of medial humeral condyle
- Asynchronous growth of radius and ulna leading to joint incongruity
- Can occur in combinations
583
What is the aetiopathogenesis of elbow dysplasia in dogs?
- Disparity in growth between the ulna and radius
- Increased humeroradial gap
- Increased force on medial coronoid process
- Fragmented medial coronoid process
- Ulna notch too small
- Kissing lesions
- May be concurrent OCD lesions
584
What is seen on physical examination of a dog with elbow dysplasia?
- Variable lameness, often mild, may be bilateral
- Elbow effusion in severe cases
- Decreased ROM especially flexion
- Pain elicited on extremes of flexion and extension
- Rare to be unilateral
585
How is elbow dysplasia in dogs diagnosed from radiography?
- DJD
- Dorsal anconeal process and radial head
- Sclerosis of ulna notch
- Flattened or blurred FCP
- Increased humeroradial joint space
- The fragmented coronoid can be difficult to see so important to be able to identify secondary DJD
586
What may be seen on mediolateral radiographs for elbow disease?
- Osteophytes on dorsal anconeal process
- Sclerosis and whiteness in ulnar notch
587
What is the conservative treatment for elbow dysplasia in dogs?
- Restricted exercise
- NSAIDs 4-6 weeks
- Chondroprotective
588
What is the surgical treatment for elbow dysplasia in dogs?
- Debridement of fragments by Arthrotomy or Arthroscopy
- Ulna osteotomy (incongruity)
589
What are some complications of surgical treatment of elbow dysplasia in dogs?
Seroma formation
Arthritis inevitable in all dogs
590
What is united anconeal process?
Asynchronous growth between radius and ulna
591
How is united anconeal process treated?
Ulna osteotomy with/without screw and removal of anconeal process (OA)
592
How is medial humeral condyle osteochondrosis diagnosed?
Flattening/concavity of medial humeral condyle
593
What is the aetiology of triceps tendon rupture?
Acute flexion of the muscle or direct blow/wound/dog bite
594
What are the clinical signs of triceps tendon rupture?
- Inability to extend elbow
- Dropped elbow
- Palpable defect in tendon
595
How is triceps tendon rupture treated?
Surgical reconstruction and protect repair
596
How is an olecranon avulsion fractures treated?
Pin and tension band wire
597
How suitable is external coaptation for antebrachial fracture repair?
Can be suitable for simple stable well apposed fractures in young animals
598
How suitable are IM pins and interlocking nails for antebrachial fracture repair?
Not suitable for radius as no possible to place them without damaging articular surface. IM pins can be used in the ulna
599
How suitable are plate and screw repairs on the cranial/medial aspects of the radius for antebrachial fracture repair?
Best option for most fractures particularly simple transverse fractures. In large dogs and cats advisable to stabilise both radius and ulna
600
How suitable is ESF for antebrachial fracture repair?
For comminuted/open fractures – but pin placement can be challenging in the oval radius and aftercare and complication rate often higher than for plate and screw fixation
601
What are the treatment options for distal radial fractures in toy breeds?
Prone to atrophic non union if treated with external coaptation
Plate and screw fixation – optimal treatment
602
Why are there complications with distal radial fracture repair?
- Excessive movement in cast
- Poor blood supply
603
What may be the end result of distal ulna growth plate fracture with radial physeal fracture?
Carpal valgus
604
What is the pathogenesis of palmar carpal ligament rupture?
Rupture of palmar ligaments results in subluxation of carpal bones and carpal hyperextension
605
How is palmar carpal ligament rupture treated?
Carpal arthrodesis
Pancarpal
Partial carpal arthrodesis
606
What is the aetiopathogenesis of carpal laxity in puppies?
- Laxity in digital flexor tendons
- Lack of exercise/poor diet/growth discrepancy? Idiopathic/after external coaptation
607
What are the clinical signs of carpal laxity in puppies?
From 6 weeks, palmigrade stance. Breed predisposition GSDs
608
How is carpal laxity in puppies treated?
None, alter exercise regime
609
What is the aetiopathogenesis of carpal hyperflexion in puppies?
- Due to tight flexor carpi ulnaris(FCU) tendon
- Diet, exercise, discrepancy in growth between tendon and bone
610
What are the clinical signs of carpal hyperflexion in puppies?
Breeds – dobermann, Great Dane, terriers
6-12 weeks, hyperflexed carpus
611
How is carpal hyperflexion in puppies treated?
- Conservative – diet, exercise
- Surgery – persistent cases cut FCU
612
In what direction does the elbow dislocate after trauma in dogs and cats?
Lateral
613
Which growth plate is most commonly damaged/stops growing in the forelimb of the dog?
Distal ulna
614
Carpal hyperflexion is seen in immature puppies – usually as a result of an imbalance between bone and tendon growth and its resulting buckling of the carpus. It is usually self-limiting if the owner reduces food and exercise, what tendon causes the carpal hyperflexion?
Flexor carpi ulnaris
615
What is the commonest form of elbow dysplasia in the dog?
Fragmented coronoid process of the ulna
616
What is a monteggia lesion?
Fracture of the ulna with a dislocation of the radius
