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157 Cards in this Set
- Front
- Back
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Describe the mechanism of fracture repair
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Periosteum forms soft callus then periosteal cells differentiate into osteoblasts and lay down hard callus
If oxygen supply is insufficient periosteal cells differentiate into chondrocytes and lay down cartilage which then undergoes endochondral ossification |
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What are the therapeutic benefits of intra-articular corticosteroids in DJD?
(3 things) |
- inhibit prostglandin synthesis
- inhibit cytokine synthesis - inhibit enzyme action (MMPs + aggrecanase) |
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What is the drawback of intra-articular corticosteroids in DJD?
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Inhibit cartilage metabolism and healing (controversial evidence)
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What are the risks of intra-articular corticosteroids in DJD?
(2 things) |
Increased risk of joint infections
Increased risk of laminitis |
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What is the rationale behind use of polysulphated glycosaminoglycans in DJD?
(3 things) |
- inhibit MMPs
- promote hyaluronan production - stimulate matrix synthesis |
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Pentosan polysulphate is a glycosaminoglycan. What is its specific effect (in addition to those of all GAGs?)
(3 things) |
- inhibits clotting
- mobilises thrombi, lipids + cholesterol - increases plasma lipase (all GAGs: - inhibit MMPs - promote hyaluronan production - stimulate matrix synthesis) |
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What is the function of endogenous sodium hyaluronate?
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Major structural component of articular cartilage matrix and synovium
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What therapeutic benefits is exogenous sodium hyaluronate thought to have in DJD?
(4 things) |
- lubrication
- anti-inflammatory - supplement endogenous hyaluronan - stimulate endogenous hyaluronan synthesis |
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What are glucosamine and chondroitin sulphate?
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Matrix glycosaminoglycans.
Neutraceuticals used in the management of DJD (Best evidence of all) |
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How can the bioavailability of chondroitin sulphate be improved?
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Administer concurrently with glucosamine (this also improves glucosamine bioavailability)
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What is methylsulphonylmethane (MSM)?
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A neutraceutical used in DJD.
Thought to be a sulphur source for collagen and matrix metabolism - no convincing efficacy data Some analgesic effect proven in humans |
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What is harpagophytum procumbens?
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Devil's claw - a neutraceutical used in traditional African medicine for joint disease.
No scientific evidence in horses |
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How is IL-1 receptor antagonist protein used in management of DJD?
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Intra-articular administration in cases refractory to corticosteroids.
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What is tiludronate, and how is it administered?
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Non-nitrogenous bisphosphonate used in management of DJD.
Give as IV CRI |
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Name 2 benefits and 1 risk of tiludronate use in DJD management
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Benefits:
- anti inflammatory - inhibits bone resorption (causes osteoclast apoptosis) Risk: - may cause colic |
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What is a type 1 Salter-Harris fracture?
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Straight across the physis
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What is a type 2 Salter-Harris fracture?
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Above the physis (i.e. diaphysis)
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What is a type 3 Salter-Harris fracture?
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Below the physis (i.e. epiphysis)
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What is a type 4 Salter-Harris fracture?
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Crosses through the physis
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What is a type 5 Salter-Harris fracture?
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The physis is crushed (injury only becomes apparent days or weeks later due to loss of bone growth)
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What is a type 6 Salter-Harris fracture?
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Bridge formation on peripheral physis
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What type of fracture goes straight across the physis?
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Salter-Harris type 1
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How is a diaphyseal fracture classified?
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Salter-Harris type 2
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How is an epiphyseal fracture classified?
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Salter-Harris type 3
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What type of fracture crosses through the physis?
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Salter-Harris type 4
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How is a fracture that crushes the physis classified?
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Salter-Harris type 5
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What 6 pieces of information are required to classify a fracture?
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- bone and site (proximal/distal/middle)
- incomplete/complete - simple/comminuted - closed/open - articular/non-articular - soft tissue disruption |
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What 3 parameters are used to quanitfy laminitic changes in the equine foot?
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- founder distance (sinking)
- solar thickness - rotation angle of P3 |
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What is bone spavin? Name 2 physical examination findings you would expect in a horse with this disease.
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Osteoarthritis of the hock joint
Improves with exercise Worsens with flexion test |
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What is the rationale behind corrective shoeing in bone spavin?
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Raise heel and roll toe (reduce hock movement with each stride)
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What is bog spavin? What does it indicate?
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Chronic synovitis of tibiotarsal joint.
May be idiopathic or related to sprain or bony degeneration (more likely if unilateral) |
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What is osteochondrosis dissecans? How is it treated?
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Focal disturbance in endochondral ossification.
Surgical removal of cartilage fragment, curette subchondral bone to stimulate fibrocartilage formation, NSAIDs and GAGs |
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What is a type 1 distal phalanx fracture?
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wing, non-articular
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What is a type 2 distal phalanx fracture?
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wing, articular
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What is a type 3 distal phalanx fracture?
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sagittal (2 fracture lines seen: dorsal and palmar aspect of P3)
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What is a type 4 distal phalanx fracture?
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extensor process (point of insertion of common digital extensor tendon)
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What is a type 5 distal phalanx fracture?
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comminuted
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What is a type 6 distal phalanx fracture? What causes this type of fracture?
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solar margin - may be due to laminitis, concussion or penetrating wounds.
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How is a non-articular fracture of the wing of P3 classified?
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Type 1 distal phalanx fracture
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How is an articular fracture of the wing of P3 classified?
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Type 2 distal phalanx fracture
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How is a sagittal fracture of P3 classified?
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Type 3 distal phalanx fracture
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How is an avulsion fracture of the site of insertion of the common digital extensor tendon classified?
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NB site of insertion = extensor process of P3
Type 4 distal phalanx fracture |
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How is a comminuted fracture of P3 classified?
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Type 5 distal phalanx fracture
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How is a fracture of the solar margin classified?
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Type 6 distal phalanx fracture
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At what incidence level should you interfere with dairy cow lameness?
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16 cases/100 cows/year
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What claw is most commonly affected in cow lameness?
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Hind limb outside claw - more variable loading and more growth
(front limb inside claw) |
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What is the target value for cow comfort index?
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less than 15%
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How many cows should cubicles accommodate?
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110% of the number of cows in the herd
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What is pododermatitis circumscripta?
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sole ulcer (two-thirds of the way from toe to heel) in cattle. Painful.
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What causes sole ulcers in cattle?
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Caudal rotation of P3 due to laminitis or toe overgrowth
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How are bovine sole ulcers treated?
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trim foot and apply block to sound claw
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What possible complications are there with bovine sole ulcers?
(3 things) |
- infection of the corium
- infection of the navicular bursa - flexor tendon degeneration |
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What is interdigital necrobacillsis?
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Foul of the foot in cattle. Causes lameness and necrosis/swelling of tissues above the hoof
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How is bovine interdigital necrobacillsis (foul of the foot) treated?
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Systemic antibiotics.
Peracute form requires aggressive local and parenteral treatment, but prognosis is still poor |
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What causes bovine interdigital necrobacillsis (foul of the foot)?
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Fusobacterium necrophorum/Dichelobacter nodosus, plus trauma and constant wetting
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Heel erosion/slurry heel affects all 4 feet of a cow and does not cause lameness. How is it treated?
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Gently pare horn to remove fissures without cutting corium
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What is digital dermatitis (cattle)?
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Highly infectious, painful, foul-smelling lesion between the bulbs of the heel. Lesions may become proliferative and develop into 'hairy warts'
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How is bovine digital dermatitis treated?
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topical antiobiotic (unresponsive to systemic)
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How is bovine digital dermatitis prevented?
(2 things) |
- hose heels in parlour
- regular antibiotic footbaths |
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What causes bovine digital dermatitis?
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Dichelobacter nodosus
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What is interdigital dermatitis (cattle)?
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Mild inflammation, rarely recognised in UK
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What disease causes muscular tremors, endocarditis, septicaemia and death in piglets aged 7-14 days?
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Streptococcal joint ill.
Respond to penicillin |
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What causes polyarthritis, polyserositis, meningitis, and death in weaners?
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Haemophilus parasuis (Glasser's disease)
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What presentation is associated with acute erysipelas in pigs?
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septicaemia, pyrexia, diamond-shaped skin lesions, endocarditis, sudden death
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What causes bovine interdigital necrobacillsis (foul of the foot)?
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Fusobacterium necrophorum/Dichelobacter nodosus, plus trauma and constant wetting
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Heel erosion/slurry heel affects all 4 feet of a cow and does not cause lameness. How is it treated?
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Gently pare horn to remove fissures without cutting corium
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What is digital dermatitis (cattle)?
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Highly infectious, painful, foul-smelling lesion between the bulbs of the heel. Lesions may become proliferative and develop into 'hairy warts'
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How is bovine digital dermatitis treated?
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topical antiobiotic (unresponsive to systemic)
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How is bovine digital dermatitis prevented?
(2 things) |
- hose heels in parlour
- regular antibiotic footbaths |
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What causes bovine digital dermatitis?
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Dichelobacter nodosus
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What is interdigital dermatitis (cattle)?
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Mild inflammation, rarely recognised in UK
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What disease causes muscular tremors, endocarditis, septicaemia and death in piglets aged 7-14 days?
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Streptococcal joint ill.
Respond to penicillin |
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What causes polyarthritis, polyserositis, meningitis, and death in weaners?
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Haemophilus parasuis (Glasser's disease)
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What presentation is associated with acute erysipelas in pigs?
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septicaemia, pyrexia, diamond-shaped skin lesions, endocarditis, sudden death
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What presentation is associated with chronic erysipelas infection?
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diamond-shaped skin lesions and proliferative arthritis in limbs and spine
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What disease would you suspect if a group of recently purchased breeding sows present with soft, swollen joints and shifting lameness?
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Mycoplasma hyosynoviae
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How is Mycoplasma hyosynoviae treated?
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Treat all affected and in-contact pigs with Tiamulin
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What causes acute-onset lameness, wide-legged stance and swaying, short strides in growers?
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Osteochondrosis (arthritis and epiphyseolysis)
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What is ovine interdigital dermatitis (scald/strip)?
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Whitish necrotic material and interdigital erosion.
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What causes ovine interdigital dermatitis?
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Fusobacterium necrophorum
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What causes interdigital abscess formation (sheep)?
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Ovine interdigital dermatitis (Fusobacterium necrophorum) superinfection with Arcanobacter pyogenes
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What causes footrot in sheep?
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Ovine interdigital necrosis (Fusobacterium necrophorum) superinfection with Dichelobacter nodosus and constant wetting
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How can footrot be prevented?
(4 things) |
- Quarantine new stock until climatic conditions have been suitable for transmission for 2-3 weeks
- footbath: 10% zinc sulphate or 4% formalin - vaccinate: 2 doses 4 weeks apart gives 12 weeks protection - genetically select for resistance |
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What climatic conditions are suitable for footrot transmission?
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temperatures over 10*C, damp
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What heritable degenerative diseases causes weakness, swelling and elongation of the common calcaneal tendon?
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Gastrocnemius enthesiopathy (commonly affects dobermanns)
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How are avulsion fractures repaired?
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Pin and tension band technique
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What suture is appropriate for repair of tendons?
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Monofilament nylon and propylene or PDS
Locking loop or 3-loop pulley pattern |
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How long does it take tendons to regain strength after repair?
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50% in 6 weeks, 80% in 1 year
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When does permanent ligament deformation occur?
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Stretch over 10%
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How is ligament deformation demonstrated?
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Stressed radiographs
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What is the difference between sprains and strains?
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Sprains are ligament damage, strains are muscle or tendon damage
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How are sprains graded?
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First, second or third degree (third being total rupture)
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What does 'second degree sprain' describe?
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A ligament that is intact but unlikely to regain normal function without treatment. Stressed radiographs are normal.
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What breeds do not suffer from cranial cruciate disease?
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Sighthounds
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What is a modified DeAngelis suture?
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Surgical treatment of cranial cruciate ligament disease: extracapsular suture from femoral condyle to tibial tuberosity
Slow recovery, stifle instability returns within weeks |
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What is a TPLO?
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Tibial Plateau Levelling Osteotomy - surgical treatment of cranial cruciate disease.
Tibial plateau is rotated to reduce the angle and fixed with a plate and screws. Quick recovery, permanent resolution of tibial thrust, aggressive and expensive |
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What is a TTA?
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Tibial Tuberosity Advancement - surgical treatment of cranial cruciate disease.
Fewer complications than TPLO |
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What does CWO-TPLO stand for?
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Cranial Wedge Osteotomy - Tibial Plateau Levelling Osteotomy
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What causes core lesions in equine tendons?
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Overstrain
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What presenting signs are seen with tendon overstrain injuries?
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Lameness, joint overextension, swelling and pain after intense exercise (may be delayed).
Pain/lameness does not correlate with severity of the lesion |
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What would you suspect if a case presented with a straight hock, overextended metatarsophalangeal joint and acute or insidious lameness which is worse with the affected leg on the outside of the circle?
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Proximal suspensory desmitis
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What complications are frequently associated with proximal suspensory desmitis?
(2 things) |
- Periligamentar fibrosis
- Distal splint bone fracture |
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Where are the most common sites for deep digital flexor tendinopathies?
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Within the digital sheath or navicular bursa, on the lateral border (especially in the forelimb)
Tend to be severe and persistent |
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What syndrome is associated with distension of the digital sheath and mild/moderate lameness partially responsive to rest and digital sheath analgesia?
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Annular ligament syndrome
The annular ligament is >2mm thick on ultrasound |
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What is the manica flexoria?
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A loop of the superficial digital flexor tendon
Prone to tears in the hindlimb |
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What are the principles of tendon injury rehabilitation in horses?
(3 things) |
Aim to minimise fibrosis and maintain stretchiness:
- prevent inflammation - early and progressive mobilisation - ultrasound monitoring |
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What cross-sectional area increase is appropriate in tendon injury?
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No more than 10% every 2-3 months
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How is distal interphalangeal joint flexural deformity classified?
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Type 1 = hoof wall less than vertical
Type 2 = hoof wall past vertical |
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What causes distal interphalangeal joint flexural deformity?
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Associated with pain. Onset around 6 months
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What are nail bind and nail pricks?
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Outcomes of poor farriery.
Nail bind - nail impinging on laminae Nail pricks - nail pentrating laminae |
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What causes keratomas?
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Persistent laminar infection (via white line)
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How are keratomas treated?
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Surgical debridement and hoof wall stabilisation. Never resolve spontaneously.
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What are osseous cyst-like lesions?
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Look like keratomas but occur on the midline or point of insertion of the navicular collateral ligament.
Drill and bone graft |
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What angle is required to radiograph the equine distal phalanx?
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60 degrees
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How do you recognise pedal osteitis on X-rays?
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Not perfectly round like a keratoma, occurs on the crina (tip) of the pedal bone
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What causes pedal osteitis?
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Repetitive concussion and resultant chronic laminar inflammation
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Distal interphalangeal joint sprain would cause what findings on clinical examination?
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Lameness, palpable effusion, positive to hoof testers and flexion tests
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What treatment is appropriate for distal interphalangeal joint sprain?
(4 things) |
- corrective farriery
- NSAIDs - corticosteroids and hylauronan - GAGs |
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What are the 2 proposed mechanisms of navicular syndrome?
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- impaired blood supply
- abnormally high force between DDFT and navicular bone causing remodelling |
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What clinical findings suggest navicular syndrome?
(5 things) |
- Positive response to palmar digital nerve block
- Positive reponse to navicular bursal analgesia - Positive to toe elevation test (opposite of flexion test) - Negative to hoof testers - Usually no radiographic changes at stage of diagnosis |
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Name 3 complications of navicular syndrome
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- enlargement of DIP synovial fossae
- suspensory ligament desmitis - fibrillations (tears) of the DDFT |
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Name 2 salvage procedures for navicular syndrome
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- neurectomy
- suspensory ligament desmotomy |
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Name 3 ways of assessing hoof balance
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- Dynamic (watch horse in motion - does hoof land squarely?)
- Geometric (use a T bar) - Natural (4-point assessment of similarity to feral horses' feet) |
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Name 5 ways to assess hoof health
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- Medial wall should be more vertical than lateral wall
- Both walls should be the same height - Both hooves should be the same size (a smaller one has been used less) - Hoof angle should be 45-60 degrees (front wall of hoof) - Solar surface should be concave |
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What are the 3 principle targets of surgical management of hip dysplasia? Give examples of techniques that achieve each aim.
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- Reduce subluxation (triple pelvic osteotomy/pubic fusion/femoral corrective osteotomy)
- Reduce pain (joint capsule denervation/femoral head resection) - Restore function (total hip replacement) |
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Why are all-meat diets bad?
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Cause nutritional secondary hyperparathyroidism:
loss of muscle tone, paralysis, hyperaesthesia + pathological fractures (expecially of pelvis and vertebrae) |
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What is osteitis?
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Septic or aseptic cortical inflammation WITHOUT marrow involvement
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What is osteomyelitis?
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Infection of cortical bone AND medullary cavity
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What instrument is used to biopsy bone lesions?
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Jamshidi needle or Michelle trephine
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What treatment options are there for osteosarcoma? What survival time is associated with each?
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- Radiotherapy and NSAIDs/bisphosphonates - palliative only
- Amputation - 4 months - Amutation and chemotherapy - 12-14 months |
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What is indirect union?
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Bone healing by callus formation. Stronger than direct union.
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What is contact union?
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A type of direct union (bone healing without callus formation). Secondary Haversian osteomes grow from one bone fragment into the other.
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What is gap union?
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A type of direct union (bone healing without callus formation). Secondary Haversian osteomes grow from each fragment into the gap between fragments
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What is malunion?
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Bone healing at an abnormal angle
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What is non-union? What do you do about it?
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Fracture fails to repair: cut away fibrous tissue on bone ends and place bone graft to release cytokines to promote healing
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What are the principles of fracture fixation using bone plates?
(3 things) |
Use the largest plate possible.
Screws should be bi-cortical At least 3 screws each side of fracture |
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How does a compression plate work?
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Compresses fracture ends. Bone takes most load, plate only takes load in the direction of forces the bone is not stable to.
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When is a neutralisation plate used?
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When a fracture has been reconstructed with an implant. The load is shared roughly evenly between the plate and bone
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What plate can be used to encourage bone growth across a gap?
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Buttress/bridging/lengthening plate. The plate takes 100% of the load.
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What are the principles of use of external skeletal fixators?
(3 things) |
- 2-4 pins per bone fragment
- Maximum pin size should be 30% of bone diameter - Pins should be bi-cortical (NB half pins are bi-cortical but do not protrude out the other side of the limb) |
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What are the 2 types of bone screws used in fracture fixation?
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Positional screws (hold bone in place)
Lag screws (compress fracture ends - should be placed at 90 degrees to the fracture line) |
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If you find neutrophils on arthrocentesis what do you have?
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Inflammatory joint disease
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If you find macrophages on arthrocentesis what do you have?
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Non-inflammatory (degenerative) joint disease
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What clinical findings would lead you to diagnose rheumatoid (erosive) arthritis?
(6 things) |
- symmetrical joint swelling
- multiple joints affected within the past 3 months - monocytosis of synovial fluid - destructive lesions seen radiographically - anti-IgG antibodies - subcutaneous nodules |
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What is diagnostic of SLE?
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Anti-nuclear antibodies
Alos haemolytic anaemia and thrombocytopaenia |
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What are the 4 divisions of the equine stance phase?
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- 1st impact: large acceleration, low force (soft tissue bruising)
- 2nd impact: low acceleration, large force (natural braking action) - support (force up to 2.5x body weight per limb - increased with speed. Excess fetlock flexion) - breakover/propulsion |
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What effect do wedge shoes have (raised heels)?
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Move point of zero moment and alter force distribution in limb.
DDFT and navicular bone are unloaded Articular contact area of DIP joint is shifted dorsally which may cause pain or alter vascularisation |
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What are the mechanical properties of hoof horn?
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Arranged in tubules that are strong to compression but weak to bending
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What type of hypersensitivity reaction is immune-mediate arthritis?
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Type III (IgG mediated)
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What is pannus?
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Proliferative granulation tissue that invades articular cartilage and erodes sub-chondral bone in erosive immune-mediated arthritis
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What are the 4 types of immune-mediated joint disease?
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Type 1: uncomplicated idiopathic
Type 2: associated with remote infection Type 3: associated with GI disease Type 4: associate with remote neoplasia Types 1 and 2 are generally more severe than types 3 and 4 |
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How is exertional rhabdomyolysis diagnosed?
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An increase of CK over 100% from resting seen after 20 minutes trot/canter work
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Name 4 ways exertional rhabdomyolysis may be acquired
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- eccentric muscular contraction
- metabolic exhaustion - oxidative injury of myocytes - electrolyte imbalance (supportive evidence weak) |
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What is the pathomechanism of recurrent exertional rhabdomyolysis of thoroughbreds?
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Hypersensitivity to substances that cause calcium release from the sarcoplasmic reticulum
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What treatment is appropriate for recurrent exertional rhabdomyolysis of thoroughbreds?
(3 things) |
- Dantrolene (oral calcium channel blocker)
- Regular exercise/turn-out - High fat, low carbohydrate diet |
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What is polysaccharide storage myopathy?
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Skeletal muscle glycogen synthase mutation affecting many breeds. May cause muscle atrophy and weakness in draught horses
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What is appropriate management of polysaccharide storage myopathy?
(2 things) |
High fat, low-carbohydrate diet
Regular exercise of gradually increasing intensity |
