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Y4 SA - Orthopaedics > Foot and miscellaneous orthopaedic conditions > Flashcards

Foot and miscellaneous orthopaedic conditions Flashcards

(63 cards)

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1
Q

Describe the anatomy of the foot

A

Pes/Manus
5 metacarpal/tarsal bones
1st is always medial – not always present (dew claw)
P1, P2 and P3
Sesamoids
Tarsometatarsal joint
Metacarpal phalangeal joint
Proximal phalangeal joint
Extensor tendons on the dorsal aspect

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2
Q

List the main conditions affecting the foot

A
  • Fractures (MTs/MCs/Phalanges)
  • Luxations of joints
  • Pad injuries e.g. corn
  • FBs
  • Nail injuries
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3
Q

What is a corn?

A

Paw pad keratoma
- focal area of hyperkeratosis

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4
Q

Describe the features of a corn

A

Excess keratin
Thickening of hard pad
Lameness
Commonly seen in greyhounds

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5
Q

What is keratin?

A

Structural fibrous protein
Skin, horns, nails, scales etc

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6
Q

Describe some treatments for corns

A
  • Digging out corn -> Incomplete removal - Temporary relief, recurrence common
  • Silicone gel implants
  • Distal amputations
  • Superficial digital flexor tendonectomy
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7
Q

Describe a Superficial digital flexor tendonectomy procedure for corns

A
  • Originally performed when adjacent digit had FT or missing
  • Began as a tenotomy: Incidences of corn recurrence
  • Developed into SDF tendonectomy = removal of 1cm + of tendon
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8
Q

Describe treatment of single fractures of the MCs/MTs

A

External coaptation

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9
Q

Describe treatment of multiple fractures of the MCs/MTs

A

Need internal fixation (plates/wires)

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10
Q

Which bones in the foot are weightbearing?

A

3rd and 4th metacarpal/tarsal bones

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11
Q

What are some complications of fractures of the metacarpals/tarsals?

A

Extensive soft tissue injuries-check viability!
Synostosis between bones-painful!

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12
Q

What type of toe amputation is well tolerated?

A

Single digit

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13
Q

When is toe amputation indicated?

A

Severe luxations/fracture /neoplasia (STAGE)

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14
Q

What type of incision in a toe amputation preserves that pad?

A

‘Y’ shape

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15
Q

List some developmental bone diseases

A
  • Panosteitis
  • Metaphyseal Osteopathy
  • Craniomandibular Osteopathy
  • Legg-Calve-Perthes Disease
  • Slipped Capital Femoral epiphysis
  • Bone Cysts
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16
Q

List some paraneoplastic bone diseases

A

Hypertrophic Osteopathy (Marie’s disease)

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17
Q

List some nutritional bone diseases

A
  • Nutritional Secondary Hyperparathyroidism
  • Renal Secondary Hyperparathyroidism
  • Hypovitaminosis D (Rickets)
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18
Q

Describe the clinical signs of panosteitis

A
  • Self-limiting disease seen in young large breed dogs
  • Classically shifting lameness
  • Varies in severity from mild to non-weight bearing
  • Acute onset, no trauma
  • Forelimb:hindlimb ratio 4:1
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19
Q

Which bones are most commonly affected by panosteitis?

A

Ulna 42%
Radius 25%
Humerus 14%
Femur 11%
Tibia 8%

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20
Q

How is panosteitis diagnosed?

A

Signalment, history and clinical signs
Radiography

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21
Q

How does panosteitis appear on radiography?

A

Lack of definition between the cortex and medulla
‘thumb print’ radiopacities in the long bones
0 – 10 days: may appear normal
10 – 70 days: subtle, poorly marginated increased radiodensity in medullary cavity with some corticomedullary blurring and periosteal and endosteal new bone formation and thickened cortices
70 – 90 days: remodeling of medullary canal. Medullary canal regains normal appearance

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22
Q

How is panosteitis treated?

A

Self-limiting
Exercise control/restriction
Analgesics

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23
Q

Describe the signalment of metaphyseal osteopathy

A

Young rapidly growing medium and large breed dogs
Puppies may present between 2 and 6 months old

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24
Q

Describe the aetiology of metaphyseal osteopathy

A

Unknown
? Vitamin C deficiency
?Distemper Virus
Inherited immunodeficiency in Weimaraners

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25
Describe the clinical signs of metaphyseal osteopathy
Vary from mild lameness to severe collapse Pyrexia, anorexia and depression
26
How is metaphyseal osteopathy diagnosed?
Signalment, history, clinical signs Radiography
27
Describe the radiographic appearance of metaphyseal osteopathy
Common in distal radius and ulna Radiolucent line and increased radiodensity in metaphysis parallel to physis Epiphysis and growth plates may appear slightly widened
28
How is metaphyseal osteopathy treated?
Most cases are self-limiting Supportive care Analgesics
29
What is craniomandibular osteopathy?
Non-inflammatory, non-neoplastic proliferative bone disease-immature dogs
30
Describe the signalment of craniomandibular osteopathy
Usually present between 4 – 10 months of age Most common in WHWT, Scottish Terrier and Cairn Terrier
31
Describe the aetiology of craniomandibular osteopathy
Autosomal recessive in WHWT
32
Describe the clinical signs of craniomandibular osteopathy
Mandibular swelling/thickening Inability to open mouth/prehend food Salivation Anorexia and weight loss Pain when eating
33
How is craniomandibular osteopathy diagnosed?
Signalment History Clinical findings Radiography
34
How does craniomandibular osteopathy appear on radiography?
- Changes usually bilateral - Palisading proliferation on the mandible and tympanic bullae - Temporal, frontal and maxillary bones can be affected - Occasionally affects long bones
35
Describe the treatment of craniomandibular osteopathy
Supportive care Analgesics - ?corticosteroids Surgery not successful
36
What is the medical condition termed 'Maries disease'?
Hypertrophic osteopathy
37
Describe the signalment of Hypertrophic osteopathy
Older dogs and cats Mean age 9 years (6 month – 15 years))
38
Describe the aetiology of Hypertrophic osteopathy
- Paraneoplastic: secondary to intrathoracic or abdominal neoplasia - Increased peripheral blood flow - Vascular congestion in periosteum - Calcification of periosteum and connective tissue - New bone formation on the distal limbs starting from the toes - Neural mediated: ?vagus, ?intercostal, other afferents
39
Describe the clinical signs of Hypertrophic osteopathy
Lameness can develop over several months Can be non-ambulatory Single or multiple limbs Firm swelling along bone of distal extremities Pain in early stages ?hyperthermia, weight loss, depression
40
How is Hypertrophic osteopathy diagnosed?
History and clinical signs Thoracic radiographs and abdominal ultrasound Radiography
41
Describe the radiographic changes seen in Hypertrophic osteopathy
Periosteal new bone formation – 90 degrees Increased bone density
42
How is Hypertrophic osteopathy treated?
Symptomatic Remove primary cause -> resolution of new bone formation
43
Normal bone production but excessive bone resorption lead to?
Osteopenia
44
Describe the aetiology of nutritional secondary hyperparathyroidism
- Diets high in phosphorus or low in calcium (Kittens and puppies are fed a non-balanced diet e.g. purely meat Ideal ratio of calcium:phosphorus is altered) - Usually meat based diets - Ideal Ca:P ratio 1.2:1 (dogs) and 1:1 (cats) - Hypocalcaemia -> increased PTH - Induces progressive skeletal demineralisation
45
Describe the clinical signs of nutritional secondary hyperparathyroidism
Lameness/ inability to stand Skeletal pain Swollen metaphysis Pathological fracture
46
Describe the radiographic signs of nutritional secondary hyperparathyroidism
Decreased bone density/thinned cortices Mushroom shaped metaphysis Pathological fractures may be seen
47
How is nutritional secondary hyperparathyroidism treated?
Rest Diet correction Oral calcium supplementation NSAID
48
What is renal osteodystrophy?
Osteopenia secondary to chronic kidney disease
49
What are the main causes of renal osteodystrophy
Impaired phosphate excretion Impaired vitamin D production
50
Describe how impaired phosphate excretion leads to renal osteodystrophy
Hyperphosphataemia -> hypocalcaemia Increased PTH secretion Bone demineralisation
51
Describe how impaired vitamin D production leads to renal osteodystrophy
Depressed enteric calcium absorption Impaired osteoid mineralisation Rickets-osteomalacia
52
List the orthopaedic clinical signs of renal osteodystrophy
Pliable mandible/maxilla (rubber jaw) Loose teeth Skeletal pain Pathological fractures Bowing of long bones
53
How is renal osteodystrophy treated?
Reduce phosphate intake/phosphate binder Calcium or calcitriol supplementation
54
Ligament injuries are known as?
Sprains
55
Tendon injuries are known as?
Strains
56
Describe the 1st, 2nd and 3rd degree ligament injuries
First degree = Minimal tearing, rapid healing Second degree = Partial rupture associated with haemorrhage and oedema Third degree = Complete rupture of ligament or avulsion from bony attachments
57
Describe the 1st, 2nd and 3rd degree tendon injuries
First degree: - Healing is rapid- transient lameness - 1 week restricted exercise and NSAIDS Second degree: - Weight-bearing –Support bandage/splint for 3-4 weeks - Exercise controlled for up to 3 months Third degree: - Not weight-bearing, joint alterations - Surgical repair, reattachment or replacement of ligament usually necessary e.g. ACL/CCL
58
Describe general treatment of tendon injuries
- In acute phase need to reduce inflammation-alternate cold warm compresses, and immobilisation to prevent further stress - Surgical treatment for ruptured, severed, displaced, avulsed tendons (in dog) - Immobilisation for 4-6 weeks post-operatively - Gradual increase in exercise over the following 2 months
59
Describe surgical treatments of tendon injuries
Early repair better Make sure wound clean Monofilament nylon sutures used to attach ends Immobilisation necessary for 4-6 weeks
60
Muscle contractures are seen where anatomically?
Reversible contracture of the flexor carpi ulnaris muscle
61
Describe the signalment of reversible contracture of the flexor carpi ulnaris muscle
Young dogs 6 – 8 weeks of age - Skeleton and muscles grow at different rates leading to a flexural deformity
62
Describe the clinical signs of reversible contracture of the flexor carpi ulnaris muscle
Flexed carpus that cannot be extended Tendon of FCU is taut on palpation
63
Describe the treatment of reversible contracture of the flexor carpi ulnaris muscle
Resolution usually occurs after 2 – 3 weeks Carpal supports FCU tendinectomy in rare cases

Y4 SA - Orthopaedics (7 decks)

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