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737C - Ortho sx > Exam 3: Lecture 19 - Osteochondrosis Osteochondritis Dessicans > Flashcards

Exam 3: Lecture 19 - Osteochondrosis Osteochondritis Dessicans Flashcards

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1
Q

Define Endochondral Ossification

A

A process where growth cartilage in epiphyses and growth plates is gradually turned into bone through a sequence of matrix mineralization, chondrocyte death, vascularization, and ossification

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2
Q

Define Osteochondrosis

A

failure in the normal process of endochondral ossification
- manifests as delayed in ossification of endochondral cartilage

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3
Q

Osteochondrosis commonly occurs in which areas of the body
- Also which breed of dogs are predisposed

A
  • shoulder
  • elbow
  • stifles
  • hock
  • Large and Giant breed dogs
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4
Q

What does this image show?

A

Osteochondrosis

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5
Q

________ is clinical manifestation of Osteochondrosis
- involvement of metaphyseal (primary) physis results in growth abnormalities (angular deformity, slipped physis)
- involvement of epiphyseal (secondary) physis results in chondro-osseous flaps
(Osteochondritis Dissecans)

A

Osteochondritis

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6
Q

What is the primary physeal closure

A

Metaphysis

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7
Q

What is the secondary physeal closure

A

Epiphyseal

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8
Q

Involvement of eipiphyseal (secondary) physis results in chondro-osseous flaps known as?

A

Osteochondritis dissecans

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9
Q

What are the arrows pointing at in this specimen with Osteochondrosis

A

Focal area of delayed ossification

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10
Q

How do you diagnose Osteochonditis dissecans (OCD)

A
  • radiographic appearance of osteochondrosis
  • Must be ACCOMPANIEDBY CLINICAL SIGNS referable to joint involved = OCD
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11
Q

What does this image show

A

Osteochondrosis

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12
Q

What does this image show

A

Osteochondrosis vs Osteochondritis dissecans

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13
Q

What is the main reasons (pathogenesis) of Osteochondrosis

A

Failure of endochrondral ossification

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14
Q

What is the result when there is failure of endochondral ossification

A
  • Thickning of articular epiphyseal cartilage
  • inadequate diffusion of nutrient from synovial fluid
  • necrosis at deep portion of thickened cartilage
  • susceptible to trauma - can lead to flap formation and detachment
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15
Q

The most common clinical manifestation of Osteochondrosis is?

A

Osteochondritis Dissecans

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16
Q

What happens with Osteochondritis Dissecans?

A
  • focal area of delayed ossification
  • normal joint stressed induce trauma creating cracks + fissuring
  • can lead to eventual detachement of a cartilage flap
  • Results in synovitis, inflammation and lameness
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17
Q

What is the etiology of Osteochondrosis

A

unknown: Considered multifactoral

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18
Q

Some think Osteochondrosis may have a genetic componet. Where a strong predisposition in breeds strongly suggest a _____ etiology componet
- Breed predisposition in digs have been demonstrated for al forms of Osteochondrosis
(reported herability for these condition ranges 10-45%)

A

Heritable

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19
Q

Describe the etiology of trauma in Osteochondrosis

A
  • Locations of biomechanical stress seem predisposed by repeat microtrauma
  • microtrauma could just be a contriburting factor to flap formation
  • Caudal humeral head
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20
Q

With Osteochondrosis where is cartilage normally thicker and more vulnerable to microtrauma

A

Caudal humeral head or caudal glenoid of scapula

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21
Q

How can nutrition play a role in Osteochondrosis

A
  • increases growth rate could predispose development of Osteochondrosis lesions
  • increasing muscle mass and body weight
    = biomechanical overload of joint surfaces that are stil structurally weak
  • No definitive evidence
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22
Q

Diets high in calcium and/or high in vitamin D3 may be associated with _______. This is shown in Great Danes, but not in other breeds (may not be the case in all breeds)

A

Osteochondrosis

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23
Q

How does rapid growth play a role in Osteochondrosis

A
  • Increases incidence of skeletal disease, including Osteochondrosis
  • large and giant breed dogs with rapid rate of skeletal growth predisposed
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24
Q

How can overfeeding play a role in Osteochondrosis

A

Elevated levels of:
= growth hormone
= IGF-1
= T3
= T4
= Insulin

  • stimulates chrondrocytes differentation, proliferation and growth plate growth
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25
Which dogs are predisposed to Osteochondrosis
large and giant breed dogs
26
How can you diagnose Osteochondrosis
- Signalment - hitory - PE - Radiology (routine radiology, historically constrast arthrography and presently CT and MRI machine
27
What is the signalment of animals with Osteochondrosis in the shoulder
- males more commenly affected than females - 4-8 months of age = some may present as older patients = typically bilateral **always radiograph both joints**
28
What is the normal history of animals with Osteochondrosis in the shoulder
- unilateral forelimb lameness - gradual onset of lameness - may improve with rest and worsen after erercise - lameness occasionally associated with trauma
29
How would animals with Osteochondrosis of the shoulder present during a PE
- palpate shoulder and move through range of motion - typically painful with extreme extension
30
How would the radiographs look in animals with Osteochondrosis of the shoulder
- primarily: an irregularity in the normal subchondral bone contour on caudal aspect of humeral head - Also: calcified linear object indicating a falp (subchondral bone sclerosis)
31
What does this image show?
Osteochondrosis of the shoulder
32
In animals with Osteochondrosis of the shoulder how would you treat those that are - less than 6.5 months of age - small lesions on radiograph with no free fragments - no lameness or clinical pain on palpation
medical treatment
33
In animals with Osteochondrosis of the shoulder how would you treat those with - pain + lameness on presentation (typically indicates OCD vs OC) - greater than 8 months of age - joint mouse present - large lesions
Surgical treatment
34
Describe surgical management of Osteochondritis dissecans
- surgical removal of loose osteo-chondral flap via arthrotomy or arthroscopically - debridment (curettage) of exposed subchondral bed
35
What does this image show?
Osteo-chondral flap
36
What is the usual signalment of osteochondrosis of the elbow
males are more commonly affected than females, around 5-7 months of age, and typically bilateral
37
T/F: we should always radiograph both joints when we suspect osteochondrosis of the elbow
true!!
38
what is the usual history for osteochondrosis of the elbow
forelimb lameness that worsen after exercise and is usually acute or chronic
39
what do we see on PE with osteochondrosis of the elbow
1. palpate elbow and move through ROM 2. typically painful on extension and lateral rotation of forelimb 3. affected forelimb may be externally rotated
40
what can be seen on rads of the elbow with osteochondrosis
irregularity in the normal subchondral bone contour on medial aspect of the humeral condyle
41
what is being pointed to in this radigraph
irregularity in normal subchondral bone contour on medial aspect (osteochondrosis)
42
when can we medically manage osteochondrosis of the elbow
1. less than 6.5 months of age 2. small radiographic lesions 3. no free fragments 4. no clinical pain or lameness
43
when should we surgically treat osteochondrosis of elbow
1. lameness and pain on presentation (typically indicates OCD vs OC) 2. greater than 8 months of age 3. free fragments (joint mouse) 4. large lesions
44
what is this arthroscopic view of the elbow showing
OCD of the elbow
45
what is the usual signalment of osteochondrosis of the stifle
large breed dogs, males more commonly affected than females, 5-7 months of age, typically bilateral
46
what does the history usually look like for osteochondrosis of the stifle
rear limb lameness, gradual onset of lameness, stiffness after rest or sleep, gets worse after exercise
47
what do we see on PE with osteochondrosis of the stifle
1. pain on palpation 2. stifle effusion and crepitus 3. slight cranial drawer in immature animals with normal stop
48
what do we see on rads with osteochondrosis of the stifle
flattening and irregularity in the normal subchondral bone contour on medial aspect of lateral femoral condyle
49
when can we medically manage osteochondrosis of the stifle
if the patient is less than 6.5 months old, small radiographic lesions, no free fragments, and no clinical pain or lameness
50
when should we do surgical treatment for osteochondrosis of the stifle
1. pain and lameness on presentation 2. greater than 8 months old 3. free fragments 4. large lesions
51
what is an OATS procedure
Osteochondral Autograft Transfer System
52
what is the signalment of a pet with osteochondrosis of the tarsus
large breed dogs, especially rotties!! males more commonly affected compared to females, 5-7 months of age and typically bilateral
53
what kind of history do patients usually have with osteochondrosis of the tarsus
rear limb lameness, may have hyperextended hocks, stiff stilted gait
54
what can we see on PE for osteochondrosis of tarsus
1. pain on palpation 2. tarsal effusion and crepitus 3. may be UNABLE to flex hocks
55
This is the medial trochlear ridge of the talus. What condition is it showing?
Tarsal OCD
56
when can we do medical management of osteochondrosis of stifle
1. less than 6.5 months old 2. small radiographic lesions 3. no free fragments 4. no clinical pain or lameness
57
when should we do surgical treatment for osteochondrosis of tarsus
1. pain and lameness on presentation 2. greater than 8 months of age 3. joint mouse present 4. large lesions
58
What does medical managemet of osteochondrosis consist of?
4-6 weeks of cage rest, NSAID and DMOA treatment, and diet modification
59
what does diet modification consist of for medical management for osteochondrosis
limit calories and eliminate supplementations (calcium and Vit D)
60
what does surgical management of osteochondrosis consist of
1. flap removal 2. debride cartilage to bleeding subchondral bone 3. induce fibrocartilage formation
61
how can we induce fibrocartilage formation
1. abrasion arthroplasty with motorized abrader 2. curette 3. forage 4. micropic
62
what does OCD prognosis depend on in general
varies depending upon joint involved and relative size of the defect
63
What is OCD prognosis of the shoulder if it is in the causal aspect of the humeral head
generally good to excellent prognosis
64
What is OCD prognosis of the elbow if the medial humeral condyle is affected
prognosis varies with other conditions present like FMCP of ulna..... then prognosis is fair to good
65
What is OCD prognosis of the stifle
Lateral > medial femoral condyle is guarded to fair
66
What is OCD prognosis of the tarsus if medial trochlear ridge of the talus bone is affected
fair to poor due to relatively large size of defect
67
what does post op care consist of for OCD
1. modified robert jones bandage overnight 2. pain meds 3. restricted activity for 4 weeks 4. rehab after suture removal
68
what pain medications can be used for post op care of OCD
1. intra-articular bupivacaine intraoperatively can be used 2. opioids 3. NSAIDS

737C - Ortho sx (23 decks)

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