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457 Cards in this Set
- Front
- Back
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What 4 fracture treatments can be used to help quickly recover the function of broken limbs?
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external coaptation- casts/bandages
pins/wires external fixation plates and screws |
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What is the main purpose of external coaptation?
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reduction
alignment anatomic position of proximal/distal joints |
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What are 3 methods of external coaptation?
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bandages
Splints Casts |
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Why is surgical stainless better to use to treat fractures?
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It has a lower amount of carbon, making it less magnetic and less prone to rust.
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What type of pins and wires are generally used for fracture treatment?
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Intramedullary pins (steinmann- Rush)
2.0/5.0 mm Wires (kirschner or K-wires) 0.8/ 2.0 mm |
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WHen pins are used for fracture treatment, what are they counteracting?
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bending
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WHen pins are used for fracture treatment, what are they not counteracting?
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tension & rotation
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What are some indications that pins & wires may be required for fracture treatment?
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simple shaft fractures
as cross pins as stack pins stabilization small fragments combined |
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Why is using one pin to treat a fracture not recommended?
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It will compromise the stabilization of the fracture site and cause the bone to rotate more during the healing process.
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How is a pin placed using a normograde technique?
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Pin is placed through medullary cavity from proximal end of fracture site.
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How is a pin placed using a retrograde technique?
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Through the fracture site and out the proximal end and site needs to be open.
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How much of the medullary cavity should be filled when using pins for fracture treatment?
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70%
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How do thicker pins effect blood supply of fracture site?
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impair
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What parts of the bone should be included when placing an intramedullary pin?
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2 epiphysis and 1 cortex
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What should intramedullary pins be combined with when treating a fracture?
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cerclage wire or external fixators
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What size of dog should intramedullary pins be used to treat a fracture?
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small and medium sized animals
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Should loose pins be replaced and does pin migration occur?
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yes
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Should implants at a fracture site be removed?
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Only if they cause problems.
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What should be avoided when using a steinmann pinning technique?
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It should not involve the joint.
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Using the Steinmann pinning technique, how much of the pin should you leave exposed for removal?
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1.5 cm
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When you are placing a pin using the the Steinmann pinning technique in the femur, what nerve should you look out for?
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sciatic nerve
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What 3 types of orthopedic wires are used for fracture treatment?
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cerclage wire
Hemicerclage Tension band |
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What type of orthopedic wire can be place completely around the bone?
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Cerclage
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What type of orthopedic wire can go through the bone after pre-drilled holes are placed?
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hemicerclage wire
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What happens to the fracture site when orthopedic wire is placed to tight around the bone and soft tissue?
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reduces circulation and damages periostium. If soft tissue is included it will prolong the healing time.
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How much orthopedic wire should be used when applying to fracture site?
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It should be twice the diameter of the bone
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Can orthopedic wire be used alone when treating a fracture site?
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no
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Describe the technique used when placing orthopedic wire on a fracture site?
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Make 2 or 3 twists w/ hand-grab knot then pull & twist to make it tight.
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How will a non-symmetrical loop using cerclage wire effect a fracture site?
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It won't tie tight w/o displacing fracture sight.
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What type of fractures are cerclage wires recommended for and what type are not?
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Use them only for long oblique fractures, do not use them on transverse or short fractures.
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How is a hemicerclage wire placed?
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Through center of bone using a transfixation like ligature.
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Where would you place a tension band wire?
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It could be placed around the olecrannon, tibial crest or patella.
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How is a tension band wire applied?
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two wires/pins- bend the tips of the wire around the pins and form a figure 8, this will create compression and help the healing process.
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Where are external fixatiors placed?
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Below elbow and stifle
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WHat type of fracture uses external fixation?
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mandibular
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What is the preferred pin diameter for external fixation treatment?
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20% diameter of bone
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Describe the Ilzarov method.
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It is an external fixation method
Forms tubular structure around the bone, used in complicated/ severe cases |
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What are lag screws?
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Also called compression screws are used to apply compression between fragments. They are partially or fully threaded.
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What is a position screw?
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They are screws used to hold bone fragments in anatomical position and prevent them from collapsing into the marrow cavity.
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What are plate screws?
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Screws used to anchor a bone plate to bone.
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How does one apply a position screw?
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drill a full threaded hole
Measure & tap Make sure fragment's position is maintained |
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How does one apply a plate screw?
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diameter = plate size
proper length or next length end holes first retightened |
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When might tubular plates be used?
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When soft tissue coverage is limited
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Why are reconstruction plates used for fracture treatment?
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The notches on the plate allow contouring of the plate to the bone's shape.
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What are the 4 main functions of using bone plates for fracture treatment?
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axial compression
neutralization or protection of diaphyseal neutralization metaphyseal bridging/biological plating |
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Classify these long bone fractures.
22B 31C 11A |
radius/ulna/shaft/bufferfly
femur/proximal/complex humerus/proximal/single |
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WHat type of loading is required for bones to frx?
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axial
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what different forces act on long bones?
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compression
tension shearing bending rotation |
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How are closed long bone fractures classified?
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Bone- femur
Place- distal Fragments- single |
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What is a type I open long bone fracture?
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wound < 1 cm - clean
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What is a Type II open long bone fracture?
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wound > 1 cm with moderate soft tissue trauma
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What is a Type IIIa open long bone fracture?
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severe soft tissue trauma- wound coverage possible
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What is a Type IIIb open long bone fracture?
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tissue loss- bone exposed- periosteal stripping
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What is a Type IIIc open long bone fracture?
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blood supply impaired- arterial repair necessary
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What is the difference between soft tissue healing vs. fracture healing?
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Scar stage is difference it will leave a scar behind in soft tissue where as bone absorbs scaring during fracture healing.
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What are the 4 aims of fracture repair?
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anatomical reduction
stable fixation blood supply preservation early mobilization |
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What are the 3 patterns of healing?
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adequate blood supply
spontaneous healing at the fracture site mechanical stability causing Osteosynthesis |
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How are unstable fractures classified?
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unresticted movement and restricted movement causing callus formation
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What does the Theory of Interfragmentary Strain mean?
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It states that tissue s form at the site of a fracture.
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What type of cells respond to local deformation within the gap during bone healing?
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mesenchymal
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What do these percentages mean when it comes to bone healing?
100% 10% 2-10% 2% |
100%- non-union
10%- fibrous granulation tissue within fracture site 2-10%- cartilage formation 2%- direct bone formation (primary fracture healing) |
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What are the 3 phases of indirect secondary healing of an unstable fracture?
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Phase I: Inflammation
Phase II: Repair Phase III: Remodeling |
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How long does the inflammatory process of secondary healing last?
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3-4 days
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what is the end result of Phase I secondary healing?
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extraosseus blood supply
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What are some of the events that occur during Phase 1 of the secondary healing process?
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Hemorrhage
bone ischemia Necrosis Hematoma formation |
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When is an extraosseus blood supply not necessary during Phase I bone healing?
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when prominent vasculature is present.
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During Phase I bone healing, how is medullary and extraosseous blood supply effected?
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Medullary is increased
Extraosseous decreases |
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How long does it take for a hematoma to be reabsorbed during Phase I bone healing?
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1 week
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Describe the repair process of secondary healing?
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Hematoma
granulation tissue chondroblasts/osteoblasts Osteogenesis |
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What is an external callus?
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fibrous in nature @ periosteum
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What is a soft callus?
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Its fibrocartilage that forms 3 weeks after a facture and occurs @ the level of endosteum
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What is a hard callus?
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Mineralization that proceeds from ends to center of gap.
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What is mitochondria and what is its function in Phase II bone healing?
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They are calcium- containing granules (hypoxic environment) and release Ca Phosphate that forms apatite micro crystals.
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What is endochondrial bone formation?
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bone formed on a cartilaginous precursor and part of the process of bone union.
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What is intramembranous bone formation?
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direct differentation of mesenchymal stem cells into osteoblasts so bone forms without a cartilagnous precursor.
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what is Wolff's law?
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It corrects angular deformities
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What is the purpose of Phase III bone healing?
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The repair phase causes a slow morphological adaptation for optimal function and strength.
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What is the end process of bone healing called?
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bone union
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How does spontaneous healing effect an unstable fracture?
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It will cause malalignment
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What are the benefits of allowing a fracture to heal with restricted movement?
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osteogenic intensity
Increased bone density radiographic union biomechanical strength |
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How does rigid stabilization effect the healing of an unstable fracture?
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It establishes excellent alignment
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Stable fractures go through what type of healing process?
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Primary healing- direct osteonal proliferation
Contact healing Gap Healing |
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What type of implants are the best to use for stable fracture?
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Rigid, non-gliding implants- plates & screws.
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What some characteristics of contact healing of stable fractures?
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Interfragmentary gap < 0.01 mm/strain < 2%
New bone forms in the axial direction along the long axis of bone Cutting cones appear at the fragments end- osteoblasts |
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How long does it take for a gap to fill during the gap healing process of a stable fracture?
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2 weeks = gap is usually filled - fragments united
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What some characteristics of gap healing of stable fractures?
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Interfragmentary gap up to 1 mm / strain < 2%
Gap fills with intramembranous bone (perpendicular to long axis) 2 weeks gap fills 3-8 weeks Haversian remodeling starts Osteon proliferates longitudinally |
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What are some features of cancellous bone grafting?
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One of the better ways to stimulate bone healing
Scaffold for osteoprogenitor cells Viable osteoprogenitor cells Bioactive bone-inducing factors No immune reactions No transmitted diseases |
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Name some osteoconductive materials that can stimulate fracture healing.
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Scaffold for bone deposition
Bone products, bioceramics, polymers |
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Can bone heal in the presense of infection? How about soft tissue?
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yes
no |
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How does soft tissue trauma effect bone healing?
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Limits the access to fracture sites
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Why is it recommended to avoid rigid fixation during biological osteosynthesis?
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vascular injury will be minimized avoiding periosteal distruption
periosteal stripping is limited |
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What is a preferred method of repairing fractured femurs?
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Intramedullary pins
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What is the aim of biological osteosynthesis?
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Getting the best anatomical reduction and the most rigid fixation possible
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Why do articular fractures need 100% compression?
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Otherwise DJD may occur for proximal & distal fractures.
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How do DCP (Butress) plates promote osteogenesis?
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They have oval holes and the plate has a slope, so that when screws are placed the plate moves and pulls the fracture together. The plate also causes stress protection.
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What is delayed union fracture repair?
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When the fracture site heals slow.
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What is non-union fracture repair?
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When the fracture site does not heal at all.
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What is malunion fracture repair?
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When the fracture site heals wrong.
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What are some causes of delayed union fracture repair?
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Impaired blood supply
movement- unstable frx Initial mgmt wrong orthopedic technique implant failure- surgeon error Inadequate post-op care |
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What is the history and clinical signs of delayed union bone healing?
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use of limb?
Pain Movement at site muscle atrophy |
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WHat might you see radiographically with delayed union bone healing?
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sequential x-ray control (4-6wks)
Limited bone resorption mineralized callus- bridging frx open medullary cavity Evidence of fracture line |
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How do you treat delayed union bone healing?
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confine, wait & observe
reoperation- no rush! cancellous/cortical bone graft biomaterials |
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What are 3 examples of viable nonunion bone healing?
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hypertrophic- elephant foot (fibrous)
slightly hypertrophic- horse foot oligotrophic- bone atrophy w/ no callus |
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What are 4 examples of non viable nonunion bone healing?
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dystrophic- callus at one end
necrotic- necrotic fragments defect- bone loss atrophic- resorption |
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WHat needs to occur for 2 bone fragments to begin the healing process?
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There needs to be at least 25% contact between bone fragments
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What is the main cause of non union bone healing?
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Untreated delayed union caused by surgeon error
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What are some cause of non union bone healing?
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impaired blood supply
movement initial management wrong orthopedic technique implant failure inadequate post-op care Interposition soft tissue comminuted fractures open fractures metabolic disease |
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What is the history and clinical signs of non union bone healing?
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lameness
muscle atrophy movement at fracture site chronic pain |
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What might you seen radiographically with nonunion bone healing?
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no biological signs of osteogenesis seen.
persistent gap Sclerotic ends closed medullary cavity sequestra |
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What are some treatment option for nonunion bone healing?
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surgical approach
debridement implant removal osteotomy sclerotic ends open medullary cavity to increase blood supply lavage bone graft- cancellous rigid fixation |
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What is malunion bone healing?
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fracture healed w/o anatomical alignment
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What is the major cause of malunion bone healing?
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improper treatment
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What would be the history and clinical signs of malunion bone healing?
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gait abnormalities
regional deformation lameness |
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What would be seen radiographically with malunion bonehealing?
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angular deformity
shortening rotational deformity |
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What is the treatment for malunion bone healing?
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conservative tx. if it doesn't impair gate
corrective osteotomy if it impairs gate. |
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What are 2 major contributors to osteomyelitis?
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Instability & Ischemia
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WHat is the best way to avoid posttraumatic osteomyelitis?
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prevention
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Most cases of posttraumatic osteomyelitis in practise are caused by what?
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bacteria and are usually chronic
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How is posttraumatic osteomyelitis presented?
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Ischemia
penetrating lesions foreign bodies Instability bone necrosis soft tissue trauma |
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What might cause an infection due to osteomyelitis?
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contamination & inadequate blood supply
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What are acute clinical signs of osteomyelitis?
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lameness
fever depression anorexia local pain swelling |
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What are the chronic clinical signs of osteomyelitis?
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only local signs
fistulous tracts |
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What lab findings would be found with osteomyelitis?
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leukocytosis
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What are the radiographic signs of osteomyelitis?
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periosteal proliferation
bone resorption areas of increased density sequestra bone lysis loose implants culture and antibiogram |
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What radiographic sign can easily dx osteomyelitis?
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sequestra
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What are the treatment goals for osteomyelitis?
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culture & sensitivity
improvement of fracture site AB therapy- gentimycin |
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What is the preferred AB therapy for osteomyelitis?
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gentamicin- impregnated methylmethacrylate beads "string of pearls."
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What treatments can improve a fracture site affected by osteomyelitis?
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aggressive debridement
elimination of "biofilm" implant removal remove foreign material lavage open drainage muscle flaps rigid fixation |
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How long should AB therapy last for the Tx. of osteomyelitis?
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Therapy should last more than 6 weeks.
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How should AB therapy be managed with osteomyelitis?
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Choose drug according to culture/sensitivity
use IV infusion local drug delivery system - bone heals w/ infection - be cautious w/ prognosis string of pearls |
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What is the average age of 55% of dogs and cats with growth plate fractures?
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under 1 year
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What % of growth plate fractures occur at the epiphyseal?
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20-25%
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What are the most Salter Type fractures in young dogs?
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Types I & II
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WHat is clinically important about growth plate fractures?
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They often occur at the distal end of the radius/ulna.
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Why do angular limb deformities occur after a physis fracture?
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Bone stops growing on one side due to frx. other bone (radius/ulna) continues to grow and bends.
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Why is it important to make a fast diagnosis for growth plate fractures?
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bone calluses form fast
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How should one manage growth plate fracture?
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Immobilize
accurate anatomical reconstruction bone soft/friable prevent further fragment injury of articular surface avoid cartilage damage select proper ortho method |
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Why is stability so important when managing a growth plate fracture?
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Can cause early joint motion which prevents excessive callus formation which allows growth plate to continuously grow.
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Which orthopedic device provides anti-rotation for repair of a growth plate fracture?
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Lag screws
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How does Salter I fracture effect the growth plate?
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It separates the growth plate horizonitally along the metaphysis of the bone and there is a risk of premature growth plate closure (rare)
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How are lag screws applied in a growth plate fracture?
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A hole is drilled in the proximal bone which allows the screw to pass easily then bits are placed in the distal portion of the bone allowing compression.
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A SH II (in a dog over 6 months) is likely to cause what kind of defect upon healing?
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Angular limb deformity due to metaphyseal callus
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Which growth plate fracture is an emergency and requires immediate attention?
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SH III in animals over 6 months of age can cause grave arthritis, fracture occurs through the epiphysis.
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If SH III frx is not perfectly reduced, what could occur in the future?
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Arthritis
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Which SH frx. type is very unstable and requires immediate reduction?
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SH IV, over 9 months of age, through metaphysis, physis and epiphysis
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How quickly must sx. be performed to correct a SH V fracture?
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Does not require surgery, premature closure is highly probable and can occur at any age during growth period.
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Can angular deformities occur with SH V fractures?
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yes, if asimetry occurs
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Why are articular fractures in adults difficult to deal with?
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fracture reduction must be exact
need special instruments articular cartilage has low healing potential Cartilage nourishment movement and weight bearing are needed |
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How can cartilage damage be fixed?
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with connective tissue
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Joint osteosynthesis should not be attempted unless, what?
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You have precise knowledge of the joint anatomy.
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What is the common problem with repairing the distal femur using a atraumatic surgical technique?
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cranial lateral incision is necessary which could the LDF tendon to be accidentally cut.
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Anatomically, when should osteosynthesis not be undertaken?
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WHEN THE FRACTURE CAN'T BE ANATOMICALLY REDUCED. Arthrodesis (fusion of joint) should be performed to get rid of pain
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What are the benefits of stable osteosynthesis of articulate fractures in adults?
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It will prevent periosteal callus formation
direct osteonal proliferation healing can be achieved by using non-gliding implants (plates w/ rigid fixation. |
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Which type of ortho plate is used under compression?
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DCP dynamic compression plate
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What is the benefit to early mobilization in fracture healing?
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Prolonged immobilization leads to joint stiffness
Exercise stimulates cartilage healing due to weight bearing on fracture Pain prevents early mobilization Bandaging may be necessary to stabilize joint |
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What is the prognosis for an articular fracture in an adult?
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unfavorable
long term arthrosis likely to develop depends on jopint that is fractured and surgeon's expertise Damage to cartilage |
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What are the common causes of pelvic fractures?
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traumatic (rarely pathologic)
car accident fights gunshot |
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A pelvic fracture is typically a closed fracture, what other injuries should you be aware of?
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urinary tract injury
intestinal perforation nerve damage vascular injury |
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What nerves are susceptible to damage due to pelvic fractures?
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pudendal, sciatic and obturator
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Due to the box shape appearance of the pelvis, what should you assume when you see one fracture?
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That there is at least one more.
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What history and CS will be seen with a pelvic fracture?
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recumbency
pain (prominent sign) assymetry hematoma neuro deficits (sciatic nerve) anuria (bladder perforation) blood in feces (rectal perferation) |
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What dx tests can help diagnose a pelvic fracture?
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xrays
U/S |
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what are the treatment goals for pelvic fracture repair?
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Prevention of further injuries (soft tissue damage)
Stabilization of pelvis Restoration of pelvic canal diameter (dystocia) Restitution of limb function |
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What are the two approaches to treating a pelvic fracture?
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conservative
surgical |
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When would you treat a pelvic fracture conservatively?
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When there is very little displacement
No risk of narrowing Intact acetabulum No sharply pointed fragments |
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What are the conditions needed for treating a pelvic fracture conservatively?
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confinement (4-6 weeks)
soft floor restricted exercise (4-6 weeks) Diet Urination/defecation Analgesia positional changes |
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When is surgical treatment of a pelvic fracture necessary?
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decreased diameter
articular fractures triple unilateral fractures SI luxation/fracture Ilial fracture long bone contralateral fracture |
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When surgical repairing a pelvic fracture what area is repaired first?
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pelvis is repaired first then femur
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Should surgery take place soon after the injury or later and why?
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Immediately never wait more than 10 days. It causes more harm and increases the risk of iatrogenic injury.
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How should the sacroiliac joint be surgical repaired?
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using the dorsal approach & lag screws
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How should a fractured ilium be surgically repaired?
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lateral approach
plate lag screws external fixator |
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Surgical repair of an acetabular fracture by plating should be attempted when?
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Only if perfect reduction can be achieved.
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What is an alternative approach to acetabular repair?
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pins, wires and bone cement
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What surgical approach do you take if only the pubis is fractured?
|
no surgery. the pubis stabilizes itself when you fix the ilium
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What are some of the common pathologies of the coxofemoral joint?
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luxation
acetabular fractures capital/subcapital fractures dysplasia leg-calve-perthes |
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What is the pathomnomic sign for hip luxation?
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Luxated limb would be shorter and no RADS would be needed. Trochanter displacement can also be tested.
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In which direction is hip luxation most common?
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90% cranial dorsal
10% caudal ventral |
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What is the typical history of a dog with hip luxation?
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Previous trauma
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What signs do you look for on physical examination that could lead to hip luxation?
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pain on manipulation
crepitation limb shortening test of trochanter displacement |
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Differental dx for hip luxation include what?
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Any condition that causes hip pain
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When can a hip luxation be reduced by a closed technique?
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If the case arrives early, within a week.
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When would a hip luxation be reduced using the open technique and why?
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A week or more after it occurred because a clot has formed in the acetabulum and turns into fibrin, filling the joint making it immobile.
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How would you get enough force to reduce a luxated hip by closed technique?
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Use a towel or sheet tied around the joint and yourself
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I am right
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Tengo razon
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How is the closed reduction technique performed when treating a hip luxation?
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Externally rotate head of femur upwards then inwards while pulling to get over the acetabulum then rotate inward and you will hear a pop.
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What is a transarticular pin procedure?
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Its used to repair luxated hips, its an older technique.
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What is a basilar fracture?
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Its a fracture of the head and neck of the femur
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What is the most common part of the hip that is fractured in adult animals?
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neck of the femur
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What ortho device would you use to surgically repair a transcervical fracture of the femoral neck?
|
K-wires
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How is a hip avulsion and capital fracture corrected?
|
surgically by slipping the hip back into place and placing 2 k-wires at angles into femoral head.
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What are the 2 most common proximal femur fractures in young animals?
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Avulsion
Capital fracture |
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What is a hip avulsion?
|
Its a proximal femur fracture at the tip of the femoral head, must be surgically corrected.
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What is a capital fracture of the femur?
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Its a proximal femur fracture of the entire femoral head.
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|
|
What is important to remember when repairing any proximal femur fracture?
|
You must achieve perfect anatomical alignment or valgus/vargus will occur.
|
|
|
What is Legg-Calve Perthes disease?
|
Non-Inflammatory Aseptic Necrosis of the femoral head in young animals. Femoral head crumbles and collapses.
|
|
|
What are the clinical signs of Legg-Calve Perthes disease?
|
lameness
pain hyperextension internal rotation, abduction of the hip joint Shortening of the affected leg. |
|
|
What is the best method of diagnosing Legg-Calve Perthes disease?
|
rads
|
|
|
What is the best treatment for Legg-Calve Perthes disease?
|
Femoral head and neck excision
|
|
|
What type of disease is hip dysplasia?
|
multifactorial, hereditary disease
|
|
|
What factors influence the development of HD
|
large, fast growing breeds
soft tissue laxity femoral and acetabular conformation joint incongruence/subluxation |
|
|
How does soft tissue laxity effect HD?
|
It causes loss of shape/conformation of femur and acetabulum leading to joint incongruence/subluxation
|
|
|
What in the history would help ID an HD case?
|
exercise intolerance
difficulty to sit and stand legs to the side when sitting and acts painful in cold weather |
|
|
What will you see clinically in a case of HD?
|
shortened stride
lameness pain on manipulation weight shifting positive Ortolani sign (pop) |
|
|
What radiographic signs of HD can be seen?
|
50% subluxation
osteophyte formation flattening of acetabulum remodeling of femoral neck |
|
|
What is the Penn Hip Method?
|
amount of subluxation divided by radius > 0.75 indicates looser hips and greater risk
|
|
|
What is the Norberg's angle?
|
Its the angle that passes b/w two hips of acetabulum > 105 degrees = HD
< 105 degrees = normal |
|
|
What are some DD for Hip Dysplasia?
|
Osteochondrosis
Hip luxation DJD Ruptured CCL Arthritis Neoplasia Neurological deficits |
|
|
What conservative approaches can you take to treating HD?
|
weight reduction
exercise NSAIDS chondroprotection |
|
|
What are 4 initial considerations to consider with Hip Dysplasia?
|
CS
Degenerative changes Joint laxity Owner's intentions |
|
|
What are the surgical approaches that can be used for HD?
|
Pectinectomy
Capsule denervation Triple Pelvic Osteotomy (TPO) Double Pelvic Osteotomy (DPO) Excision arthroplasty (FHO) Juvenile simphysiodesis Total Hip replacement (THR) |
|
|
What surgical approach to HD is a pectinectomy?
|
Pectineus muscle is cut at insertion, then a capsular denervation is performed on the cranial gluteal nerve, rami and dorsalis sciatic nerve
|
|
|
In a TPO, what bones does the surgeon cut and reallign?
|
Ischium
Pubis Ilium |
|
|
What is the goal of a TPO?
|
Rotate the acetabulum to cover the femoral head to prevent luxation.
|
|
|
What is another name for the excision arthroplasty procedure?
|
Femoral Head Ostectomy (FHO)
|
|
|
What important to remember when performing an excision arthroplasty procedure?
|
That the femur must be resected with a portion of the neck to avoid leaving a ridge. If the ridge is left on the femur, it will not interact properly with the acetabulum and cause pain.
|
|
|
What is a juvenile symphysiodesis?
|
Its the surgical destruction of the symphaseal growth plate to force the pelvis to grow outwards over the femoral heads. It must be done b/f 25 months of age
|
|
|
What is a capsular denervication procedure?
|
It is a procedure used to treat HD/arthrosis to suppress pain and promote painless walking by dissecting the cranial gluteal n. and rami dorsalis Sciatic n.
|
|
|
What conditions can affect the articular tissues of the stife?
|
Distal femur fractures
proximal epiphyseal fx. of the tibia avulsion of the tibal crest cranial/caudal cruciate/menisci rupture osteochondritis/osteochondrosis |
|
|
What is another term for a metaphyseal fracture of the distal femur?
|
supracondylar
|
|
|
What is another term for an epiphyseal fracture of the distal femur?
|
condylar
|
|
|
What anatomical factors contribute to a femur fracture?
|
Metaphysis & epiphysis have no connection while growing, making the shape of the femur susceptible to fracture.
|
|
|
What type of fixation is needed for a distal femur fracture located near the joint?
|
Rigid
|
|
|
What type of flexible pin is used for a supracondylar fracture?
|
Rush pin
|
|
|
What type of pins do you use to repair a proximal epiphyseal fracture of the tibia?
|
Cross pins
|
|
|
How do you repair an avulsion fracture of the tibial crest?
|
wire & figure of 8
|
|
|
In what age of dogs do avulsions of the tibial crest occur?
|
young dogs
|
|
|
What is another term for physeal fractures of the distal femur?
|
Salter-Harris fractures I through V.
|
|
|
What is the best way to repair Salter Harris fractures of the distal femur?
|
Use only gliding implants
|
|
|
What steps should be taken for the treatment of a SH fracture after germinal cells and blood vessels are present?
|
early tx.
light implants avoid screws and plates avoid threaded pins |
|
|
What is the cause of a patella fracture?
|
Direct trauma
|
|
|
What findings will be seen during a PE of a dog with a patellar fracture?
|
non weight bearing lameness
pain on palpation of stifle depression in the straight patellar ligament |
|
|
What is the preferred orthopedic treatment for a fractured patella?
|
tension band, lag screws
|
|
|
What would you see radiographically with a fracture of the patella?
|
Evidence of 2 fractured fragments.
|
|
|
What are the causes of a medial patellar luxation?
|
Mal-alignment of quadriceps
Bone deformations |
|
|
In which breeds does medial patellar luxation occur more often?
|
small and toy breeds
|
|
|
What are the clinical signs of a patellar luxation?
|
Various degrees of lameness and leg extends backwards.
|
|
|
What treatment option should you try in a toy breed with a medial patellar luxation
|
conservative tx. option to avoid surgery.
|
|
|
What diagnostic technique would you use to confirm a medial patellar luxation?
|
radiography
|
|
|
What surgical approaches are available for patellar luxation?
|
imbrication
trochleoplasty tibial crest transposition antirotational technique |
|
|
What is the goal of imbrication?
|
To bring the capsule together
|
|
|
What 2 approaches are there for trochleoplasty and what is the goal of this procedure?
|
Wedge and block
To deepen the groove. |
|
|
What is the best tool to use for doing a wedge trocheoplasty procedure?
|
osciliating swa
|
|
|
Where is the best location to place a antirrotational suture?
|
Behind the feballar ligament, strongest place for a suture.
|
|
|
What are the types of meniscal lesions (tears)?
|
longitudinal
bucket handle transverse fold |
|
|
which type of meniscal lesions heal the best and usually don't require surgery?
|
longitudinal
buckle handle (most common) |
|
|
What are the causes of meniscal lesions?
|
usually a consequence of CCL rupture
ligament injuries meniscocapsular rupture severe trauma |
|
|
What are the clinical signs of a meniscal lesion?
|
severe pain
lameness sometimes a click inflammation joint effusion |
|
|
What would you see by analyzing the joint fluid of a potential meniscal lesion?
|
If it were positive you would see signs of inflammation and an increase in WBC.
|
|
|
What are the causes of a ruptured cranial cruciate ligament?
|
Aging = degeneration
female + fat + fifties usually bilateral partial or total rupture Joint instability |
|
|
what might you see in the history that could indicate a ruptured cranial CL?
|
Intermittent lameness
|
|
|
What are some of the CS related to a ruptured cranial CL?
|
Pain on manipulation
joint effusion muscle atrophy when chronic crepitation joint instability |
|
|
What classic sign can be seen on PE of a cranial cruciate rupture?
|
Drawer sign
|
|
|
What are 4 diagnostic tools that can be used to diagnose a ruptured cranial CL?
|
Radiography
MRI Arthroscopy Arthrocentesis- synovial fluid |
|
|
How does one do a intracapsular sx procedure to repair a ruptured cranial CL?
|
Open the joint and replace ligamnet of stifle joint.
|
|
|
What is a crimping device and what is it used for?
|
Used to repair ruptured cranial CL. It is alteration of biomechanical properties of nylon
Puts tension on needle and is less traumatic than TPLO. |
|
|
When might you choose to treat a cr. CL rupture conservatively?
|
Only if the animal is less than 10kg.
|
|
|
What surgical approaches are available for repairing a cranial cruciate ligament?
|
intracapsular
extracapsular tibial tuberosity advancement TPLO |
|
|
what is the surgical landmark when using stabilization sutures to repair a ruptured cr. CL?
|
Febellar ligament located behind chondyles of the femur. Use non-absorbable, 1 degree nylon.
|
|
|
What is a tight rope repair?
|
Procedure done to repair ruptured cr. cruciate ligament.
imitates cr. cruciate ligament traumatic procedure to joint |
|
|
What is a tibial tuberosity Advancement?
|
Provides tension to the joint, relieves patellar ligament tension and is described as an osteotomy of the tibial crest.
Hyperextends patellar ligament & prevents movement of femoral chondyles. |
|
|
What is a TPLO?
|
Its a tibial plateau leveling osteotomy.
Must be certified to perform. Measures angle of tibial plateau, osteotomy of tibial crest, rotate cut tibia down to measured angle, changes slope of joint, prevents chondyles displacing cranially. |
|
|
What are the causes of a ruptured caudal CL
|
Cranial to caudal trauma of the stifle
general trauma |
|
|
WHat might be a DD for a caudal ruptured CL?
|
cranial CL rupture
multiple lig. injury |
|
|
How is a caudal cruciate ligament tx. surgically?
|
Conservative or surgically
Sx.- stabilization by suture or popiteal tendon entrapment (stabilize joint) |
|
|
What is osteochondritis dissecans?
|
Area where deep endochondral ossification stops, leading to the detachment of a flap of articular cartilage (joint mouse)
|
|
|
OCD is what type of condition?
|
Hereditary
|
|
|
What is the signalment of a dog w/ OCD?
|
young, large to giant breed, male
|
|
|
Where do many OCD lesions occur?
|
Medial surface of the lateral femoral condyle
|
|
|
Does OCD occur more in males or females?
|
more males-lateral condyle
|
|
|
What would you see in the history that could help you diagnose OCD?
|
hind limb lameness
worsens with exercise acute or chronic lameness |
|
|
What are some of the CS that go with OCD?
|
lameness
pain on joint manipulation joint effusion when chronic muscle atrophy when chronic |
|
|
After removal of the joint mouse, the surgeon forages the bone, meaning what?
|
Uses a steinman pin to poke holes into the subchondral bone to stimulate growth
|
|
|
What conditions affect the scapulohumeral joint of large breed dogs?
|
OCH of the humeral head
biceps tenosynovitis Infraspinatus muscle contracture Brachial plexus tumor |
|
|
What is the etiopathogenesis of OCD?
|
Disturbance of endochondral ossification
Inherited predisposition Nutritonal |
|
|
What is the etiopathogenesis of OCD when it originates from the disturbance of endochondral ossification?
|
Failure of symmetrical maturation of physeal and articualr cartilage.
Results in injury-prone thickened areas of articular cartilage. |
|
|
What effect can nutrition have on OCD?
|
Feeding too many calories to increase rate of growth & mature body size is associated w/ severe OCD in genetically predisposed breeds.
|
|
|
What type of signal ment is seen w/ OCD?
|
Large breed dogs
Males vs. females = 3:1 Age: 4-8 months (cartilage injury) 2-3 years (secondary osteoarthritis) |
|
|
A dog w/ OCD can show lameness after rest. What might be seen with exercise?
|
Lameness in the early phase after exercise
Improve with exercise in later phase. |
|
|
What are the PE findings for scapulohumeral joint OCD?
|
shortened swing at walk
muscle atrophy (deltoid, supraspinitis, infraspinitis) pain on hyperextension |
|
|
What are the radiographic findings of OCD of the scapulohumeral joint?
|
Flattening of subchondral bone of caudal central humeral head: 4-6 months
Defect in Head: 6-7 months Calcification of cartilagenous flap: 7-8 months Detached cartilagenous flap (joint mouse) |
|
|
What is the Tx. for early OCD w/ minimal pain or lameness?
|
Rest
Reduced caloric intake |
|
|
What is the surgical tx. for later stage OCD w/ persistent lameness or joint mouse?
|
Surgical removal of flap and lavage of joint.
Curettage or frometage of subchondral bone to stimulate formation of fibrocartilage. |
|
|
What are the surgical approaches for OCD?
|
Craniolateral
Caudolateral Osteotomy of acromion |
|
|
What is the prognosis for OCD?
|
pet dog- fair to good
working dog- guarded to fair. |
|
|
What is the etiology of biceps Tenosynovitis?
|
Strain injury of tendon of origin
-Grade 3 injury w/ tendon fiber disruption -Acute to chronic inflammation |
|
|
What is the anatomical cause of biceps tenosynovitis?
|
Synovial tissue surrounds proximal tendon
Transverse humeral ligament compresses tendon when inflamed and swollen. |
|
|
What is major cause of biceps tenosynovitis?
|
transverse ligament compresses and becomes painful.
|
|
|
What type of dogs does biceps tenosynovitis affect and what might you see in the history?
|
Middle aged, medium and large breed dogs
Weight-bearing lameness |
|
|
What are some typical PE findings for biceps tenosynovitis?
|
Pain on deep palpation over intertubercular groove w/ flexion & extension of shoulder joint
|
|
|
What are some DD for Biceps Tenosynovitis?
|
Fracture of supraglenoid tubercle
DJD of shoulder Neoplasia |
|
|
What are the radiographic findings for biceps tenosynovitis?
|
Acute cases- no Rad changes
Chronic cases- osteophytes in intertubercular groove (skyline0 Calcification of tendon |
|
|
What is the Tx. for biceps tenosynovitis in acute cases?
|
Strict confinement for 4-6 weeks
NSAIDS |
|
|
What is the Tx. for biceps tenosynovitis in prolonged lameness cases w/ no DI changes?
|
Intraarticular corticosteroid injection
Confinement, 2-3 weeks |
|
|
What is the Tx. for biceps tenosynovitis in chronic cases and cases w/ DI changes?
|
Tenodesis of bicipital
|
|
|
How is tenodesis of the bicipital tendon performed?
|
The tendon is cut to relieve tension then sutured to the supra-spinous muscle, then anchored with washer and screws.
|
|
|
What would postoperative care for biceps tenosynovitis involve?
|
Velpeau sling for 2-3 weeks
Confinement for 6 weeks, followed by gradual return to full exercise |
|
|
What is the prognosis for medical tx. of biceps Tenosynovitis?
|
good to poor. poor only b/c of lack of confinement.
|
|
|
What is the prognosis for surgical tx. of biceps Tenosynovitis?
|
good to excellent
Start conservative 2 to 9 months required to regain full function |
|
|
What is the etiopathogenesis of Infraspinatus Muscle Contracture?
|
Primary muscle disorder of hunting and working dogs
Acute traumatic disruption of muscle fibers Muscle atrophy and fibrosis |
|
|
What would you see in the history to help Dx IMC?
|
Acute lameness for 10-14 days
Chronic lameness beginning 2 weeks after Acute stops. Non-weight bearing lameness |
|
|
What would you find during a PE to help clue in to IMC?
|
Scapulohumeral jt. can't be internally rotated
Limited range of motion. Usually no pain on manipulation of the joint |
|
|
What is the suggested treatment for IMC and what is the prognosis?
|
Partial tenectomy of infraspinatus tendon or removal of tendon from joint capsule
Excellent prognosis but takes time to heal. |
|
|
What condition effects dogs of any size?
|
scapulohumeral joint luxation
Originates traumatically (common) Congenitally |
|
|
What is the etiology for a scapulohumeral joint luxation?
|
congenital or traumatic
|
|
|
What is the nomenclature for a scapulohumeral joint luxation?
|
Named for direction in which humeral joint deviates
Medial & lateral are common Cranial & caudal are rare |
|
|
what are the support structures of scapulohumeral joint?
|
joint capsule
glenohumeral ligaments and surrounding tendons |
|
|
What would be the common signalment and history for a scapulohumeral joint luxation?
|
Any age or breed of dog, rare in cats
History of trauma or evidence of injury Acute onset |
|
|
What would be seen during a PE to suspect a traumatic scapulohumeral joint luxation?
|
Non-weight bearing lameness
Pain and crepitus w/ movement of shoulder |
|
|
What would be seen during a PE to suspect a traumatic lateral scapulohumeral joint luxation?
|
Foot is internally rotated, greater tubercle lateral to normal position
|
|
|
What would be seen during a PE to suspect a traumatic medial scapulohumeral joint luxation?
|
Foot is internally rotated, greater tubercle medial to normal position
|
|
|
What is the preferred treatment for a traumatic scapulohumeral joint luxation?
|
Closed reduction should be attempted first, using general anesthesia, it should be a recent injury & no associated fractures (scapula or humerus)
|
|
|
What is the preferred treatment for a traumatic scapulohumeral joint luxation, if the joint is stable?
|
Apply Spica splint (lateral luxation) or Velpeau sling (medial luxation) for 10-14 days
|
|
|
What is the preferred treatment for a traumatic scapulohumeral joint luxation that is unstable after a closed reduction or if luxation is chronic?
|
Open reduction followed by capsulorraphy
tendon transposition- (aims to keep both articular components in place) |
|
|
What is the signalment and what would you see in the history of a congenital scapulohumeral joint luxation?
|
small & miniature breeds (poodles & Shetland sheepdogs)
Chronic lameness beginning at early age, w/o history of trauma. |
|
|
What are some characteristics of a congenital scapulohumeral joint luxation?
|
Luxation is medial, often bilateral
Congenital or developmental laxity of capsule & ligaments Deformation or hypoplasia of glenoid cavity |
|
|
What would you possibly see during a PE of a possible congenital scapulohumeral joint luxation case?
|
Lameness may be intermittent
Joint easily luxated and reduced No pain on manipulation |
|
|
What does the conservative treatment of a congenital scapulohumeral joint luxation consist of?
|
For patients w/ mild intermittent pain and minimal degenerative joint disease
Exercise restriction Weight reduction NSAID agents |
|
|
What are the surgical treatments that can be used to repair a congenital scapulohumeral joint luxation?
|
Capsulorraphy
Tendon transposition Salvage procedures for severe joint dysplasia or DJD. |
|
|
What are the disease components for elbow dysplasia?
|
Inherited polygenic disease
Environmental factors Mainly in large breed dogs |
|
|
What some of the specific conditions associated with elbow dysplasia?
|
Fragmented medial coronoid process
Ununited anconeal process Fragmented medial coronoid OC of the medial humeral condyle Ununited medial epicondyle of humerus Joint incongruence |
|
|
What are some specific conditions that could lead to joint incongruence?
|
Irregular humero-ulnar joint space
Radio-Ulnar stepping (out of place) Irregular humero- radial joint space |
|
|
What is the recommended treatment for joint incongruence?
|
Osteotomies to arthrodesis
radial osteotomy (proximal radius) |
|
|
What % of FMCP cases occur in males?
|
75%
|
|
|
What is signalment of FMCP?
|
Medium to large breeds occuring in 4-7 months of age (7-8 months on RADS)
|
|
|
What is the most common manifestation of elbow dysplasia?
|
Fragmented Medial Coronoid Process (FMCP)
|
|
|
What would be the radiographic findings for an FMCP case?
|
Rare to see the fragment loose
Abnormal medial coronoid process Elbow joint incongruity Recognize secondary arthritis |
|
|
What radiographic view is preferred for the DX of FMCP and why?
|
Oblique views because they are the only view that shows the coronoid process loose in the joint.
|
|
|
What secondary osteoarthritis condition can be found on Rads to help DX FMCP?
|
osteophytes on
anoceal process proximal radius medical epicondyle medial coronoid process Sclerosis of trochlear notch of ulna |
|
|
What is the recommended TX. for FMCP?
|
Conservative and surgical
|
|
|
How would you treat FMCP conservatively?
|
Control inflammation & pain but can result in further joint damage
|
|
|
How would you treat FMCP surgically?
|
Excision of the Coronoid process
Standard arthrotomy- Arthroscopic removal |
|
|
What is the signalment of animals with a ununited anconeal process?
|
Males affected twice as often than females
5-12 months of age Large breeds- Labs/GSD Normal Anconeal process fuses at 5 m. May be bilateral 25-30% |
|
|
What are the radiographic findings for an ununited anconeal process?
|
Osteophytes may be seen
Radiolucent line separating the ancoeal process from the olecrannon after 20 weeks Sclerotic ends, secondary osteoarthritis Flexed lateral view |
|
|
What is the suggestion treatment for an ununited anconeal process?
|
Surgical excison
Distraction Ulnar Osteotomy (DUO) Re-attachment of the process- screw is passed from olecrannon to anconeal process Re-attachment + DUO |
|
|
What is the signalment for elbow OCD?
|
Males effected more than females
5-10 months Large breeds, retrievers Part of the elbow dysplasia complex Often bilateral |
|
|
What is the second most common manifestation of elbow dysplasia?
|
Osteochondrosis Dissecans (OCD)
|
|
|
What are the radiographic findings for OCD of the Elbow?
|
Subchondral defect in medial condyle
Subchondral sclerosis Rarely see mineralized flap Craniolateral-caudomedial oblique Secondary osteoarthritis |
|
|
What is the suggested treatment for elbow OCD?
|
Conservative- control of pain & inflammation can be useful in older dogs
Surgical- flap removal and foraging |
|
|
What are 5 developmental bone abnormalities?
|
Hypertrophic osteopathy
Hypertrophic osteodystrophy Craniomandibular osteopathy Panosteitis Growth Plate Abnormalities |
|
|
What is Hypertrophic osteopathy?
|
Mild to severe periostitis involving long bones and distal limbs
|
|
|
What is the pathophysiology of Hypertrophic osteopathy?
|
Increased peripheral blood flow associated with pulmonary & other diseases.
Can effect all limbs. Paraneoplastic syndrome |
|
|
What is the signalment for Hypertrophic osteopathy?
|
No breed or size preference- older dogs
|
|
|
What is the history for Hypertrophic osteopathy?
|
reluctance to move
swollen limbs distally |
|
|
What would you see during a PE to suspect Hypertrophic osteopathy?
|
pain on palpation
warm and swollen Inflammation doesn't cross the joint- no joint involvement |
|
|
What would be some radiographic findings for Hypertrophic osteopathy?
|
Disseminated periosteal proliferation
From distal to proximal Normal joints Thoracic disease Abnormal x-rays and U/S |
|
|
What are two DD for Hypertrophic osteopathy?
|
Panosteitis
Bone neoplasia |
|
|
What is the preferred treatment for Hypertrophic osteopathy?
|
Treat the primary disease
Control pain & inflammation |
|
|
What is Hypertrophic osteodystrophy?
|
Its an alteration of the metaphysis of long bones
|
|
|
What is the pathophysiology of Hypertrophic osteodystrophy?
|
Not known
Vit. C deficiency excessice Ca+ supplementation severe infections Alterations of the metaphyseal blood supply |
|
|
What is the signlament of dogs effected with Hypertrophic osteodystrophy?
|
large breeds, young animals
2-7 months |
|
|
What would you see in the history for dogs effected with Hypertrophic osteodystrophy?
|
Lameness of acute onset
Animals refuse to walk Stop eating |
|
|
What would you see during a PE in dogs effected with Hypertrophic osteodystrophy?
|
Mild/severe lameness in all 4 legs.
Some patients can't stand Metaphysis warm, swollen Pain & fever |
|
|
What would be some radiographic findings in dogs effected with Hypertrophic osteodystrophy?
|
radiolucent metaphyseal edge
widening of the metaphysis periosteal reaction |
|
|
What could be some DD for dogs effected with Hypertrophic osteodystrophy?
|
Aseptic arthritis
Epiphysitis Panostelitis |
|
|
What are some recommended treatments for dogs effected with Hypertrophic osteodystrophy?
|
Medical management
analgesics- NSAIDS Steroids |
|
|
What is Craniomandibular osteopathy defined as?
|
Lion Jaw- proliferative condition of young dogs affected the manidble, bullae and occiptial bones
|
|
|
What is the pathophysiology of Craniomandibular osteopathy
|
Unknown
Mostly effects Terriers (West Highland) Possibly Genetic 5-8 months of age osteoblasts/osteoclastic activity Neutrophilic, lymphocyte, plasma cell inflitration |
|
|
What is the signalment for dogs with Craniomandibular osteopathy
|
West Highland Terriers
Males = Females 5-8 months of age |
|
|
What is typically found in the history of dogs with Craniomandibular osteopathy?
|
Refuse to eat
Refuse to open their mouths Drooling Pain on oral movements |
|
|
What is typically found during a PE of dogs with Craniomandibular osteopathy?
|
Severe pain on manipulation
Intermittent fever Enlargement of the bullae and mandible (bilateral) |
|
|
WHat are some radiographic findings that could been seen w/ Craniomandibular osteopathy?
|
Irregular bone proliferation
Tympanic bullae, occipital, manidible |
|
|
What could be some DD for dogs effected with Craniomandibular Osteopathy?
|
Osteomyielitis
|
|
|
What are some suggested treatments for dogs effected with Craniomandibular Osteopathy?
|
Medical management
Pain management until the patient reaches maturity |
|
|
What is the prognosis for dogs effected with Craniomandibular Osteopathy?
|
Guarded to grave in relation to the ability to feed
|
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What is Panosteitis?
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It is a condition affecting the bones of young dogs causing shifting lameness
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WHat is the pathophysiology for Panosteitis?
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High energy/high protein diet leading to intraosseous edema and increased intramedullary pressure and endosteal bone formation
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What is the common signalment of dogs suffering from Panosteitis?
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70-80% large breed males
Affects dogs 8-16 months of age |
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What is found in the history of dogs suffering from Panosteitis?
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Chronic shifting lameness
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What might be found during a PE that might suspect Panosteitis?
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Pain when long bones are firmly compressed
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What radiological findings can be seen with Panosteitis?
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Early x-rays are negative
Widening of nutrient foramen Ground glass appearance Marked trabecular patterns Endosteal bone formation Mottled aspect |
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What DI tool makes Panosteitis more revealing?
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scintigraphy
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What are some DD for Panosteitis?
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In the absense of radiological evidence, all orthopedic conditions known to occur in each leg must be ruled out/
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What is are the treatments for Panosteitis?
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Condition is self-limiting
NSAIDS Limited exercise |
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WHat is the prognosis for Panosteitis?
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Long term prognosis is good but could reoccur.
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What are considered growth plate abnormalities?
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They usually affect the front legs and can cause damage to the proximal radial, distal ulnar and distal radial physis in growing dogs.
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What is important to know about premature closure of the distal ulnar?
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Frequently seen
Causes angular deformation This physis contributes 80% of ulnar length. Bow & Arrow |
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What are the problems that need to be addressed with the premature closure of the distal ulnar?
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valgus deviation (staple to correct)
cranial bowing external rotation subluxation of radio carpal joint |
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What is the surgical treatment for the premature closure of the distal ulnar?
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Ulnar release (ulnar osteotomy)
Corrective osteotomies- oblique or wedge Humeroulnar subluxation |
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What are the different forms of premature radial physeal closure?
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Distal physis = commonly asymetrical (lateral or medial)
Proximal physis = elbow incongruence |
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How can one diagnose a premature radial physeal closure?
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Deformity of the radius
Elbow joint ingruence Radiocarpal incongruence |
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What are the surgical treatment options for a premature radial physeal closure?
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Dynamic radial osteotomy
Mitchel's staple Angular radial osteotomy |
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What is osteoarthrosis?
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Non-inflammatory joint disease with bone involvement
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What are the different classifications for arthropaties?
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Inflammatory- infectious & non infectious
Non-inflammatory- DJD |
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What might you see in the history of arthropathies?
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Acute or chronic lameness
All breeds, ages and sizes Pain in one or more joints |
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What might you look for during a PE in dogs with arthropathies?
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Articular pain on examination
Inflammation, enlargement, effusion Reduced motion range Instability and crepitation |
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What radiological findings would be seen in dogs with arthropathies?
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Periosteal reaction
Erosive lesions Joint distension Epiphysis deformation |
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What is the benefit of using a CT scan on potential arthropathies cases?
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Better than x-rays for hard joint components.
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What is the benefit of using an MRI on potential arthropathies cases?
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Better than x-rays for soft joint components.
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What should a DD list for arthropathies include?
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All conditions involving one or more joints, whether inflammatory or non-inflammatory.
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What is the primary goal for general treatment of arthropathies?
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Pain control and Limb function
Medical therapy Physiotherapy Exercise control Weight control Surgical Mgmt. |
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What are the options for medical therapy of Arthropathies?
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NSAIDS
Glycoaminoglycans Hyaluronic acid Steroids Antibiotics |
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What are the goals of physiotherapy for arthopathies?
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Directed primarily to maintain the range of joint motion using passive exercise, walking and swimming.
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What 4 postoperative mgmt options for arthopathies?
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Joint stabilization
Joint immobilization Weight bearing Body weight control |
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What are LMN?
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Cell bodies in the spinal cord gray matter, axons via the ventral nerves and a peripheral nerve, ends in a muscle.
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What are UMN?
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Cell bodies in the brain, axons form descending pathways of the spinal cord ending in inter-neurons that synapse w/ LMNs.
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What are the divisions of the spinal cord?
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Cervical- C1 to C5
Cervical Intumescens- C6 to T2 Thoracolumbar- T3 to L3 Lumbar Intumescens- L4 yo Cd 5 |
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How does one localize spinal cord lesions of Lower Motor Neurons?
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C6-T2: cell bodies of Thoracic Limbs
L4- S1: cell bodies to Pelvic Limbs S1- S3: innervation to anal and urethral sphincters |
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What are possible signs of Upper Motor Neuron damage?
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Increase in excitation of LMNs
Reduction/loss of voluntary motor activity Increased/exaggerated spinal reflexes Abnormal spinal reflexes Disuse muscle atrophy |
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What are signs of C1 to C5 lesions
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Respiratory paralysis (c5 to c7)
Ataxia/paresis/paralysis of 4 limbs Hemiparesis/Paraparesis Decreased/absent propioception Spasm and pain of neck muscles Horner's Syndrome Schiff- Sherrington sign syndrome No fecal incontinence Urinary incontinence common |
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What are signs of C6 - T2 Intumescens Lesions?
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Superficial/Deep pain normal or moderately decreased
Sometimes Hyperesthesia Horner's syndrome present Voluntary defecation may be abolished Urinary Incontinence present or not |
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What is the most commonest segment for spinal cord lesions
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T3 to L3
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What are some common signs of T3-L3 Lesions in the Thoracic limb and Pelvic limb?
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Thoracic limb = normal gait propioception and reflexes
Pelvic limbs = paresis, ataxia or paralysis, no propioception, exaggerated reflexes, atrophy |
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WHat type of pain response would occur with lesions from T3-L3?
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Pain = normal in FL - decreased in HL
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What are some common signs of T3-L3 Lesions?
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Panniculus reflex is reduced or absent
Schiff-Sherrington in severe acute lesions. Voluntary defication may be abolished Urinary incontinence may or may not be present. |
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What are signs of L4- Cd5 Lesions in the thoracic limbs and Hind limbs?
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Thoracic Limbs- no neurologic deficits
Hind Limbs- From ataxia to paresis/paralysis Reflexes decreased to absent Decreased muscle tone and atrophy Propioception decreased or absent |
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How do L4-Cd5 lesions effect the bladder/
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It causes bladder dysfunction
Paralysis of anal sphincter and tail. |
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Describe what cauda equina lesions are?
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It refers to the compression of the nerve roots and spinal nerves of the last segments of the spinal cord.
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What are some clinical signs of Cauda Equina Lesions?
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They are similar to those present when nerves of the segment L6 to Cd5 are injured.
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What are some signs of Atlantoaxial Instability?
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Subluxation/luxation of the atlantoaxial joint, dens malformation or fracture and/or lesion of ligaments in small & large breeds of dogs (rare in cats)
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What would you find in the history of a Atlantoaxial Instability case?
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progressive ataxia
tetraparesis neck pain |
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What would you find during a neurological exam of a Atlantoaxial Instability case?
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UMN signs to all four limbs
Neck Pain |
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What DI techniques would be used to diagnose Atlantoaxial Instability?
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Plain x-rays (lateral) w/o anesthesia
Plain x-rays (flexed lateral) (laxity/sublaxation) CT & MRI |
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WHat radiographic finding would be seen using plain x-rays (flexed lateral) (laxity/sublaxation) ?
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Increased intervertebral space (dorsally)
Increased gap lamina Atlas & spine Axis Absense, malformation, fracture of DENS. |
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What is recommended for the surgical treatment of Atlantoaxial Instability?
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Ventral approach- Stabilization
Dorsal Approach- Decompression and Stabilization |
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What is included in the ventral approach for surgical treatment of Atlantoaxial instability?
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STABILIZATION
Removal of the dens and reduction of sub-luxation Cross-pin stabilization |
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What is included in the dorsal approach for surgical treatment of Atlantoaxial instability?
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DECROMPRESSION & STABILIZATION
Hemilaminectomy Wire loop (dorsal spine axis/arch of atlas) Kishigami Tension Band |
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What is the prognosis for Atlantoaxial instability?
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Ventral stabilization: good
Dorsal stabilization: wire rupture! guarded Medical treatment- poor- recurrence |
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What the common name of cervical spondylomyeopathy or cervical Vertebral Instability?
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Wobbler Syndrome
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What is Wobbler Syndrome?
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Its a syndrome the affects the caudal cervical vertebrae of large breed dogs that leads to spinal cord compression w/ variable neurological signs
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How is wobbler syndrome presented?
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Intervertebral Disk Degeneration (Hansen Type II) C5-C7
Vertebral tipping C5-C7 Congenital Osseus malformation C3-C7 Thickening of Lig. Flavum C4-C7 Hourglass type compression C2-C7 |
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WHat are some of the clinical signs for Wobbler Syndrome?
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Depends on the dynamics of the lesion.
UMN signs & ataxia in rear limbs Stiff gait & ataxia in fore limbs (severe cases) |
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What is a Wobbler syndrome Static lesion defined as?
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Degree of compression does not change when the head and neck are moved.
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What is a Wobbler syndrome Dynamic lesion defined as?
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Degree of compression becomes more severe when head and neck are moved.
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How is Wobbler syndrome diagnosed?
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History and CS
Neurological exam DI- stress myelogram, MRI and CT Scan |
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Why is a stress myelogram used to diagnose Wobbler Syndrome?
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Necessary to determine if lesion is static or dynamic
It includes the neck in ventral flexion and in linear traction |
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What are 3 differential diagnosis for Wobbler Syndrome
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degenerative-DJD, disk DZ
Trauma- luxation, subluxation fx. Neoplasia- tumors of the spinal cord, nerve roots or surrounding structures. |
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How is cervical decompression treated?
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Conservative or surgically
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What is the suggested treatment for Wobbler Syndrome?
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Strict confinement for 3-4 weeks
Gradual return to normal activity Anti-inflammatory medication Neck Brace Use harness instead of collar |
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How would you conservatively treat, Wobbler syndrome?
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Used for dogs w/ pain, mild weakness and motor deficits.
Must monitior patient for deterioration Improvement usually temporary |
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What are the objectives of surgical treatment for Wobbler syndrome?
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Relief of spinal cord compression
Cervical spinal stabilization (if needed) Reversal of neurological deficits. |
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What are the different surgical treatments available for Wobbler Syndrome?
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Ventral slot decompression
Ventral stabilization Ventral traction-stabilization Fenestration Dorsal laminectomy |
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What surgical tool is used for ventral cervical stabilization in the treatment of Wobbler Syndrome?
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Cervical Locking pLate
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How are Gelpi retractors used to treat Wobbler syndrome?
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Used for ventral slot decompression, they stretch vertebral bodies to release compression. You cut a rectangle from 2 vertebral bodies to relieve compression.
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What are some potential complications w/ surgical treatment of wobbler syndrome?
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Can cause deterioration of neurological status
Rupture or migration of implants Rupture or displacement of cement Vertebral instability |
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What is inter-vertebral disk disease?
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acute or chronic spinal cord compression due to a degenerative process of one or more inter-vertebral disks
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What is Hansen Type 1 Intervertebral Disk disease?
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Chondroid disk degeneration
Extrusion of nuclear material in the canal. Granular or calcified nucleus pulposus Annulus can rupture causing spinal cord compression |
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Where does pain originate from with Hansen Type 1 disk disease?
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diskogenic
Myelogenic Radicular |
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Where does diskogenic pain originate from?
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derangement of Intervertebral disk
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Where does myeloogenic pain originate from?
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Compression of the spinal cord
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Where does radicular pain originate from?
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compression of the nerve root
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Which cervical disks are effected with hansen Type I disk disease?
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C2-C3
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How does Hansen Type I disk disease effect cervical discs and ligaments of the spine?
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It causes pain w/o neurological signs b/c of the spinal canal being relatively larger than the spinal cord, compared to lumbar spine
Ligaments along the ventral surface of the canal, limit extrusion into the spinal cord |
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Where do 65% of ruptured disks occur?
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T11-T12 and T13-L1
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What is the recommended treatment for Thoracolumbar Disk disease of patients w/o deep pain?
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If no deep pain < 12-24 hours, surgery immediately.
If no deep pain > 12-24 hours, surgery |
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What are some characteristics of Hansen Type II disk disease?
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Fibronoid metaplasia
Annulus fibrosus hypertrophies & protrudes into ventral spinal canal but doesn't rupture No extrusion of nuclear material |
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WHat is the signalment for dogs w/ Hansen Type II disk disease?
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Non-chondrodystrophic breeds
Often Large breeds Middle-aged or old dogs No sex predilection |
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Where are lesions commonly found with Hansen Type II disk disease?
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C5-C6 or C6-C7
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What are some common characteristics of Hansen Type II disk disease in Lumbar disks?
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Middle aged or old large breed dogs
Most common at L7-S1 |
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What are the CS of Hansen Type II disk disease of Lumbar disks?
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Back pain, sciatic nerve deficits, muscle atrophy, incontinence
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What are the treatment options of Hansen Type II disk disease for Lumbar disks?
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Conservative
Surgical Cervical: ventral slot decompresion Lumbrosacral: dorsal laminectomy pediculectomy |
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What is cauda equina syndrome?
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Complex of neurological signs caused by compression of the terminal nerve roots in the lumbosacral spinal canal
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What is the signalment for acquired Cauda Equina Syndrome?
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Large breed dogs, German Shepherds
Middle-aged No sex predilection |
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What would you see in the history for acquired Cauda Equina Syndrome?
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Chronic lameness, back pain
Urinary & fecal incontinence Abnormal tail carriage or movement Muscle atrophy Self-mutilation of tail or hind feet |
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What would you see during a neurological exam if you suspect acquired Cauda Equina Syndrome?
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Highly variable
Lumbosacral hyperpathia Loss of proprioception, weakness, hind limb muscle atrophy Normal or exaggerated patellar reflexes Urinary or fecal incontinence |
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What is the recommended medical management for acquired cauda equina syndrome?
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In mild cases only
Strict confinement 4-6 weeks NSAID therapy |
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What is the recommended surgical treatment for acquired cauda equina syndrome?
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Dorsal laminectomy +/- fascetectomy & excision of interarcuate ligaments.
Retract nerve roots to remove disk Remove fibrous tissue surrounding nerve roots Stabilize, if instability is diagnosed |
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What is the prognosis for acquired cauda equina syndrome?
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Mild cases manage medically- good
Surgically treated patients w/o incontinence- good Chronic cases w/ incontinence- guarded to poor |
