Investigation & management of the mature lame animal Flashcards

Question

Tarsal conditions: plantar ligament degeneration - diagnosis & tx

Answer 1

- clinical and radiographic diagnosis with proximal intertarsal subluxation - treat with laterally applied plate and arthrodesis of the calcaneoquartal joint - no further immobilisation required other than a support bandage for a week

Answer 2

- rarely race again - predominantly a right limb injury as in the UK these dogs race anti-clockwise and most force is generated by the RH - combination of subluxations and fractures - medial aspect of the joint collapses with fracture to central bone (several types with its own classification system) - fractures and subluxations occur of the calcaneus and calcaneoquartal joint - specialist injury requiring referrals

Answer 3

- older labs and Dobermans - chronic hindlimb lameness - often bilateral - relatively common - painful swelling to achilles tendon and mineralization on radiographs - characteristic clawing of foot due to lengthening of gastroc but not the SDFT tendon

Answer 4

- resect tendon and place calcaneal tibial screw or transarticular external fixator to support the repair or a pantarsal arthrodesis

Answer 5

- arise from trauma particularly and RTAs - accompanied by varying degrees of soft tissue damage and contamination - manage the soft tissue injuries 1st - temporary external fixator may help in the initial stabilisation of the joint - many of these injuries will require arthrodesis to manage - other than the talocrural and antebrachiocarpal joints all others are low motion joints - loss of low motion joints results in minimal loss of function

Answer 6

- mature GSD - characteristic gait: short stride with a rapid, elastic medial rotation of the paw, internal rotation of the hock, and external rotation of the calcaneus - progressive with no effective tx although some success reported with adipose tissue stem cells and laser tx

Answer 7

- progressive hindlimb lameness - variable severity but can be severe - pain on extension and rotation of hip - diagnosis with MRI or US - rest and NSAIDs or section the muscle at its insertion on the lesser trochanter

Answer 8

- young large breed dogs with minimal trauma - joint effusion with small bone fragment - chronic cases show mineralisation of the torn tendon and a deficit in the femur - tx is by reattaching the fragment or tendonesis to the proximal tibia

Answer 9

- associated with TPLO surgery - tx by tendonesis or securing the ligamentar attachments of the tendon

Answer 10

- either the medial or lateral gastrocnemius - low grade trauma resulting in weight bearing lameness and slightly plantigrade stance - fabellae are displaced - tx is by reattaching the gastrocnemius by direct suturing, screw and spiked washer or suture the gastroc bodies to femur through bone tunnels or suture anchors

Answer 11

- usually lateral - an uncommon condition - most commonly seen in the Shetland sheepdog - intermittent lameness with an audible popping sound and sensation - swelling over the tip of the calcaneus Tx - either suturing the torn retinaculum but recurrence is not uncommon - screwing the SDF to the calcaneus

Answer 12

- can be primary (i.e. originating from the bone) or secondary (i.e. originating from a tumour elsewhere which has mets to bone) - the most common primary tumour is the osteosarcoma accounting for up to 80% of bone tumours - the osteosarcoma has predilection sites: proximal humerus and distal radius and proximal tibia and distal femur -- these tumours fail to cross the joint -- they will have mets to the lungs by time of diagnosis - other tumours types include fibrosarcoma, chondrosarcoma, histolytic tumour and the synovial cell tumour - giant and large breeds with av age of 5-8y are predisposed - the cat suffers from similar tumour types but these are generally less aggressive and less malignant - histolytic sarcoma: arises from the joint

Answer 13

- slow onset of lameness - disuse muscle atrophy - insidious and poorly responsive to analgesia - moderate to marked pain on palpation of the tumour site - may be accompanied by marked muscle atrophy - moderate to marked soft tissue swelling - there may be an acute deterioration when the weakened bone fracture -> pathological fracture - the pathological fracture often occurs with minimal trauma - always consider this when an older dog has fractured a limb with no or little history of trauma

Answer 14

- CS & hx highly suggestive - radiography: may show both a proliferative and destructive pattern, 'sunburst' appearance - remember the joint is usually spared with an osteosarcoma cf arthritis or a synovial cell tumour or histiocytic sarcoma which is centred on the joint - the initial changes of the osteosarcoma occur on the endosteal surface - always do chest rads (3 views are advised - L & R laterals and DV) - CT is more sensitive way to look for chest mets

Answer 15

- often diagnosis can be made on CS and radiographic signs alone - if the diagnosis is unclear or we need to determine whether a lesion is a primary or secondary neoplasm or the O is considered surgical or medical management then it is important to know the precise nature of the tumour - this is achieved with core biopsies obtained with a Jamshidi needle - radiography confirms correct placement of the needle - biopsies should be taken from the centre of the lesion (the periphery may contain reactive bone only) - if considering management recommend CT of chest Jamshidi needles - also designed for bone marrow aspiration - the stylet is removed when entering the bone to harvest a core - vigorous twisting and rocking breaks the core from the bone - the stylet is used to push the core from the free end of the needle and the core is placed in formal saline - several biopsies are taken to increase the diagnostic yield

Answer 16

- it's important that the O is aware that it's unlikely, in the case of most bone tumours, that the tx will be curative - limb amputation offers immediate pain relief - amputation is better tolerated in the hindlimb and in smaller dogs - limb sparing procedures are available with placement of an auto or allograft having excised the tumour - limb amputation can also be followed by the placement of an endoprosthesis - all surgical tx can be followed up by chemo e.g. carboplatin - some O will opt for medical management which is primarily analgesia - bisphosphates are esp useful in this situation (osteoclast inhibitors) - pts also good option

Answer 17

- prognosis for appendicular osteosarcoma in the dog is generally poor with lung mets being the usual outcome and cause of death - average survival times without tx would be less than 1 month - with limb amputation alone the median survival time is 4-5m - with amputation or limb sparing techniques followed by neoadjuvant chemo survival times of 9-10m have been reported - the same tumour in the cat carries a more favourable prognosis. if there is no evidence of mets then no follow up chemo is advised and median survival times range from 24-44m - the prognosis for other tumour types is variable

Answer 18

- nerve root tumours arise from the connective tissue around the nerve, a neurofibroma or sarcoma or the Schwann cells, a schwannoma - they can occur in the brachial and lumbosacral plexuses - on occasions the tumour can extend directly into the spinal cord or mets there

Answer 19

- they're rare tumours of the older dog ~8y/o - rarer in the cat

Answer 20

- chronic and insidious in their nature - painful - marked muscle atrophy usually in 1 limb (a monoparesis) as there is neurogenic as well as disuse atrophy - lameness generally unresponsive to analgesia

Answer 21

- careful palpation of the axilla and rectal exam may detect their presence - MRI is the imaging modality of choice but rads with contrast (myelography) and CT can also be used

Answer 22

- surgical resection but this can be difficult and limb amp is often employed to remove the tumour -- additionally, limb function post-removal is poor - significant neurological deficits can result from the surgery if the limb is spared - the tumour may extend into the spinal canal making full excision, even with a laminectomy, difficult - recurrence is common following incomplete surgical excision - adjuvant chemo can be employed or radiotherapy - prognosis is guarded and recurrence within 1y is likely - is a local dz and rarely spread to other sites

Answer 23

- usually obese - minimal trauma - mineralisation of intra-articular findings may be insignficiant - extra-articular stabilisation but generally improve with rest only -> fibrosis of the joint allows stabilisation and usually function will return in a few months - TTA and TPLO have been performed

Answer 24

- patella fractures in cats - associated with retained deciduous teeth and a variety of other typical fractures - familial tendency occurring in young cats often with little or no hx of trauma - they're unable to fix the stifle (looks like a femoral neuropathy) - associated with fractures in other bones e.g. humerus, tibia and ischium. these occur later in the cats life (~8y) -> warn O that young cat with this is likely to have other fractures in the future - beware of bilateral dz

Answer 25

These rarely heal Limited distraction - conservative management Marked distraction 1. circumferential wire 2. tension band without pin 3. pin and tension band 4. circumferential wire and pin and tension band Augmented with circumpatellar suture of wire or monofilament nylon to the tibial crest Often repair of the soft tissue structures is all you need to do to remain function. Most of these fractures result in functional outcome irrespective of the tx

Answer 26

Fracture/separation of the femoral head physis: Salter Harris type I - usually animals are 6-7m/o - epiphysis remains in acetabulum attached by the trees ligament - often minimally displaced - so always take a 'frog-leg' view on rads - Burmese & British Blues

Answer 27

- stabilisation with 2-3 K-wires or a lag screw, care to avoid penetration of the articular cartilage - 'apple-coring' (irregular loss of the bone of the femoral neck) common 3-6w post-op due to revascularisation of the femoral neck and subsequent bone remodelling, not usually a clinical problem - premature physeal closure and development of OA is common - poor healing reported in the Burmese which might result in a salvage procedure e.g. FHNE or total hip replacement

Answer 28

- chronic lameness - worse in the morning or after rising particularly if been exercising - possible association with colder weather? - swelling to joints - reluctant to mount stairs/jump into cars - previous tick exposure or foreign travel? The cat shows less obvious signs but these include - reluctance to jump onto work surfaces - failure to groom - stiffness on rising - reduced activity levels

Answer 29

- walking stiffly - lameness in 1 or several limbs - joints swollen either as a result of effusion or periarticular fibrosis - pain on manipulation - reduced RoM - muscle atrophy - any systemic signs e.g. pyrexia, general malaise (could indicate polyarthritis)

Answer 30

- CE - manipulation under GA - radiography/CT - joint taps/arthrocentesis - arthroscopy/arthrotomy - US of periarticular structures - CT - MRI Always compare to opposite limb

Answer 31

- underused - aseptic prep of site - can be examined in house - if suspect sepsis send for culture in blood culture medium - always interpret in light of clinical findings

Answer 32

- morbidity low - magnification allows for identification of subtle pathologies - allows therapeutic intervention as well as diagnostic - steep learning curve - increased expense to O but in may joint dz it is considered gold standard e.g. elbow dysplasia

Answer 33

- more invasive and hence increased morbidity but allows direct visualisation - readily available and with limited approaches, e.g. medial arthrotomy to examine menisci, the damage to the synovial structures can be minimised - some procedures are difficult to do athroscopically e.g. meniscus removal - can obtain a synovial biopsy - when 1st performing arthroscopy always be prepped to convert to an open athrotomy

Answer 34

Primary arthritis - rare - hereditary predisposition and no underlying cause is identified Secondary arthritis - very common - developmental conditions e.g. elbow & hip dysplasia, osteochondrosis, patella luxation - degenerative conditions e.g. cruciate dz - inflammatory arthropathies e.g. rheumatoid arthritis, systemic lupus etc - trauma - sepsis - crystal induced (gout), very uncommon in dog and cat Pathophysiology - weight bearing areas of the joint undergo fibrillation (fraying) of the articular cartilage - this results in exposure of the subchondral bone to synovial fluid which then scleroses and produces osteophytes and resulting joint remodelling - all these processes are mediated by an array of synovial, chondrocytic and osteocytic messengers - the resulting synovitis and exposure of subchondral bone results in pain and reduced movement in the joint - the inflammatory process also produces a thickening of the joint capsule which reduces the RoM seen in the joint - investigations for OA are as for all other arthritides, the important feature is determining an underlying cause in secondary arthritis

Answer 35

Analgesia - NSAIDs - opiates - NDMA antagonist - paracetamol - monoclonal antibodes Corticosteroids Disease modifying osteoarthritic drugs (DMOAD) - pentosan polysulphate (Catrophen) - platelet rich plasma - IRAP (Orthokine) - stem cell therapy - hyaluronic acid and polyacrylamide gel Nutraceuticals Environmental modifications Exercise & weight loss Photobiomodulation- laser therapy Extracorporeal shockwave tx TENS Therapeutic US Electromagnetic field therapy Acupuncture Hydro & physiotherapy

Answer 36

- excellent anti-inflammatories and analgesics but are prone to causing GI ulceration and are usually given with food - act on 2 receptors: COX1 & COX2 - COX2 mediate inflammation - COX1 regulate blood flow to the kidneys and gastric mucosa - those which preferentially block COX2 are the latest additions to the group and are less likely to cause GI ulcerations (there is no evidence that antacids protect the stomach from this action) - these drugs should be used with caution in animals under GA: the regulation of renal blood flow is deleteriously affected, particularly in the hypotensive animal, resulting in renal damage and acute failure. only COX2 preferential drugs are licensed for preoperative use

Answer 37

Carprofen - many commercial preparations - selective COX2 inhibitor - licensed for long term use in the dog only Meloxicam - many commercial preparations - tablet and liquid forms - licensed for long term use in the dog and cat and some small animals Cimicoxib - (Cimalgex) - selective COX2 - licensed for long term use in the dog - not licensed in the cat Firocoxib - (Previcox) - selective COX2 - licensed for long term use in the dog - not licensed in the cat Grapipant - (Galliprant) - a piprant, an EP4 receptor antagonist blocking PGE2 (not a COX inhibitor) - licensed for long term use in the dog - not licensed in the cat Ketoprofen - (Ketofen) - not COX2 selective - is licensed for 30d use in the dog - licensed for 5d use in the cat Mavacoxib - (Trocoxil) - selective COX2 inhibitor - licensed for long term use in the dog - not licensed in the cat - is given once, then a single dose 2w later, then monthly Phenylbutazone - non selective compound - licensed for use in the cat but can be used long term in the dog although generally has been superseded by other NSAIDs Robenacoxib - (Onsior) - selective COX2 inhibitor - licensed for long term use in dogs and cats Tolfenamic acid - (Tolfedine) - unknown whether COX2 selective - can be used long term in the dog only if given for 4d with 3d rest Prednisolon and cinchophen - (Prednoleucotropin PLT) - combination of a steroid and non-steriodal - for use in the dog only but is not longer licensed in the UK

Answer 38

- can be used for severe acute flare ups of arthritis - controlled nature means use is limited Tramadol - oral opiate - efficacy and appropriate dosage of this compound has not been determined Buprenorphine - can be administered sublingually and systemic levels have been shown to be similar cf IM injections in the cat

Answer 39

Amantadine - similar in action to ketamine - used primarily in the dog when NSAIDs are failing to provide adequate analgesia - modifies the spinal cord so it becomes less sensitive to the neurones acting on it / firing to it

Answer 40

- useful adjunct to NSAIDs - used only in the dogs - severe and often fatal toxic reaction in cats

Answer 41

- most recent addition to analgesic used to manage OA - nerve growth factor plays a role in the inflammatory process and also increases the sensitivity of the nociceptive neurons Librela - Bednivetmab - dogs - monoclonal antibody directed against nerve growth factor - injection given once monthly - effective and easier for client to manage - each injection is expensive but not necessarily when comparing with long term NSAIDs - few side effects as the antibody is degraded like other proteins by natural processes Solensia - Frunevetmab - cats - monoclonal antibody directed against nerve growth factor - injection given once monthly - effective and easier for client to manage - each injection is expensive but not necessarily when comparing with long term NSAIDs - few side effects as the antibody is degraded like other proteins by natural processes

Answer 42

Examples - prednisolone - methylprednisolone - triamcinolone - dexamethasone - betamethasone Potent anti-inflammatories with resulting analgesia blocking the inflammatory pathway by action on the cell nucleus and reduced synthesis of COX2 among many other actions Can be given systemically, intra-articularly or extra-durably (lumbosarcal dz) Used in the shoulder particularly but should not be given on multiple occasions as this predisposes to cartilage degeneration and soft tissue mineralisation Systemic side effects result from both system and articular use

Answer 43

= Cartophen - a polysulphonates polysaccharide - single injection given weekly over a 4w period - should not be combined with NSAIDs - has potent anti-inflammatory activity but is not analgesic - stimulates mesenchymal stem cells to repair cartilage damage - reduces the inflammatory changes that damage the articular cartilage - improves blood flow to the affected joints - improves the quality and quantity of the synovial fluid - but evidence for its use is not great

Answer 44

- can be prepared in the lab or using kits in the practice - injected intra-articularly - contains many growth factors which are thought to stimulate mesenchymal stem cells and have anti-inflammatory activity - can be used for other soft tissue injuries such as ligament strains as well as in the management of OA - because it is autologous there are few side effects - true efficacy is still in some doubt - said to improve synovial thickness and reduce cartilage fibrillation IRAP (Orthokine) - an autologous conditioned plasma containing increased amounts of cytokines including interleukin 1 receptor antagonist

Answer 45

- most common cell used is adipose tissue derived stem cell - the adipose tissue is harvested (usually from the inguinal region) and stem cells extracted and numbers increased at an external lab, this can take up to 3w - stem cells are then injected into the affected joints - this process may be combined with the use of PRP - it is thought that the mesenchymal stem cells can differentiate into chondrocytes and bring about healing in damaged cartilage - side effects are few due to the autologous nature of the material

Answer 46

Hyaluronic acid - makes up a large component of the synovial fluid - it is strongly hydrophilic and produces a gel like material with water - can be injected into the joint and also given orally Polyacrylamide polygel - non-absorbable material that adheres to the synovial membrane joint capsule - causes the synovial membrane to thicken and become more cellular which offers a protective function to the joint - the synovial fluid increases in volume - beneficial effects are thought to last up to a year

Answer 47

E.g. glucosamine, chondroitin, green lipped mussel, omega 3 fatty acids, turmeric (curcuminoids), collagen, avocado/soybean unsaponifiables, Elk velvet antler, SAMe, vitamin E - market leader is YuMove - there are also diets with increased levels of these compounds such as Hills jd (Mobility) - some evidence for the efficacy of omega 3 fatty acids - evidence of the beneficial effects of other compounds is scant although green lipped mussel and elk velvet antler have shown some promise

Answer 48

- introduce standard and consistent exercise on level surfaces, cheap and can be highly effective - environmental modifications such as ramps and non-slip surfaces in the house, and limit use of stairs - larger baskets for dogs and cats to sleep in - manage underlying pathologies - weight reduction in the overweight pt is possibly the single most important management process with an evidence base - the use of weight reducing diets is usually essential

Answer 49

- type IV is the most recent type using several different light frequencies - evidence for effectiveness is scant but thought to have an anti-inflammatory action and mild analgesic effects and many O report an improvement

Answer 50

- high pressure non-linear high velocity sound waves - shown to have a beneficial effects

Answer 51

= transcutaneous electrical nerve stimulation - no clinical trials have been conducted to look into its efficacy

Answer 52

- low and high frequency US - some trials have shown an improvement but these were very limited

Answer 53

- application of either low, high or pulsed magnetic field - some evidence to suggest this is helpful

Answer 54

- dry needle and electro-acupuncture and implantation where gold wire or beads are placed in the meridians - it is difficult to conduct studies which demonstrate the effectiveness or otherwise of this tx modality

Answer 55

- enlist the help of an ACPAT (association of chartered physiotherapist in animal therapy) qualified physiotherapist - much of the benefits have been extrapolated from man - cats are not good candidates for this tx - the use of non-weight bearing therapies such as swimming and particularly the use of a water treadmill can be very useful - the latter improves muscle mass and the weight bearing can be titrated by the depth of the water in the treadmill - there are various exercises and aids which the physiotherapist uses to improve muscle mass and proprioception which helps the dog manage their disease

Answer 56

Salvage procedures may be required - joint resurfacing -> Arthrex CUE (canine unicompartmental elbow) system, OAT and SOR systems - arthrodesis - arthroplasty - joint replacements (total or partial) - euthanasia

Answer 57

Plantar and palmar to hock and carpus Collaterals - shoulder particular medial glenohumeral - stifle, associated with luxation - elbow, associated with luxation Cruciates - cranial - very occasionally caudal

Answer 58

- ligaments can only tolerate 10% elongation before permanent damage - inflammation of a ligament = desmitis

Answer 59

- palpation (under GA) - assessment of joint stability (eg. after relocating elbow) - US for some ligaments but more useful for tendons such as patella, biceps and gastrocnemius - CT less useful but can see dystrophic mineralisation to supra- and infraspinatus tendons - MRI shoulder and stifle - Arthroscopy: shoulder and stifle

Answer 60

- few collagen fibres broken - swelling - rest, NSAIDs and cold compresses although there is debate in humans whether ice is beneficial

Answer 61

- marked damage to fibres - haematoma - loss of some function - support dressing, NSAIDs, cold compress in acute phase, imbrication? rest for 3-6m - slow to heal imbrication = tightening of the ligament either with cautery or suture, supposed to help stability

Answer 62

- complete rupture or avulsion from insertion/origin - primary repair if possible - support repair: prosthesis or transarticular fixator - arthrodesis for carpal and tarsal hyperextension and resulting subluxation

Answer 63

- joint surface are abnormal in shape and do not articular perfectly

Answer 64

- abnormal joint development

Answer 65

- joint surfaces displaced but maintain some contact

Answer 66

- no contact maintained between joint surfaces, luxation described by the position of the distal articular joint surfaces

Answer 67

Traumatic - common Congenital - rare Acquired/development - frequent - e.g. hip dysplasia

Answer 68

- rare - toy breeds: shoulder - staffies: elbow - the constituents bones and articular surfaces are abnormal in shape - this results in abnormal tensions on the joint and articulation

Answer 69

- 2 types reported - many of these animals show surprisingly little lameness which may be more mechanical rather than originating from pain - prognosis is fair

Answer 70

Conservative - analgesia, weight restriction, physiotherapy Surgical management - difficult due to abnormally shaped articular surfaces - success improved by early intervention - salvage procedures such as arthrodesis, arthroplasty and amputation may be required

Answer 71

- elbow dysplasia - hip dysplasia - often bilateral - develop secondary arthritis

Answer 72

- considerable force required e.g. RTA or being hung from fence - associated with 3rd degree sprains i.e. complete rupture of the restraining ligaments - a traumatic arthritis is an almost inevitable consequence of this injury - surgery is required to manage these luxations (either closed or open reduction) - reduction is the relocation of the joint - closed reduction when no surgery is performed - open when a surgical approach is made and the joint reduced directly

Answer 73

Hip - most common - craniodorsal commonest direction Talocrural - associated with malleolar fractures or collateral ligament rupture - common in RTA shear injuries Elbow - rare - associated with major trauma Carpus - subluxation following a fall

Answer 74

Palpation often requiring GA Radiography - orthogonal views essential - can miss luxations if a single view is taken, esp of the elbow - stressed views may be required to determine site and severity of subluxation - examine for any articular bone fragments which make reduction impossible or unstable

Answer 75

- usually traumatic - developmental

Answer 76

- teres ligament - joint capsule - dorsal acetabular rim - surface tension of joint fluid

Answer 77

Closed reduction - more successful in the dog that the cat - for craniodorsal luxations place towel or rope around limb into groin - pull the limb in a ventrocaudal direction - lift hip over the acetabulum - always take lateral post-op radiograph to confirm reduction - Ehmers sling post-op? Open reduction - rectus femoris or iliofemoral suture - suture placed through tunnel in base of greater trochanter and either origin of rectus femurs muscle, or hole made in ventral aspect of ileum - suture tightened with hip slightly internally rotated - may cause slight internal rotation of paw- resolves when suture fails several weeks later Open reduction - trans-articular pin - more suitable for cats and small dogs - pin size and position important - reasonable function but limited adduction when in place - if hip reduction is incongruent the articular surface can be damaged - 2nd procedure is required to remove the implant (3w) - muscle contraction and peri-articular fibrosis hopefully keep the hip in place post pin removal Open reduction - toggle pin - maintains correct alignment and movement - joint is immediately stable - infection risk due to use of braided material - can be difficult to place particularly in well muscled dogs - 10-15% recurrence rate reported - ideal method

Answer 78

- often occurs after suspension from fence

Answer 79

- elbow outwardly rotated and abducted - a medial luxation - can often palpate the lower part of the trochlear of the humerus on the elbow

Answer 80

- GA - flex elbow and inwardly rotate to engage anconeus in the olecranon fossa/supratrochlear foramen - extend elbow - check collaterals after reduction (Campbell Test) -> collateral ligaments can be ruptured as a consequence of luxation so check them using this test - often damaged - reduction may not be complete - external support for 1w

Answer 81

- devastating injury associated with RTA and falls from height and attempting to free limb when trapped

Answer 82

- multiple ligament injuries including collaterals and cruciates - associated damage to menisci and joint capsule

Answer 83

- requires reduction of the joint and stabilisation (transarticular ESF) - reconstruction of the ligaments or prosthesies with screws and washes - sometimes do surprisingly well - if function remains poor then arthrodesis can be employed

Answer 84

- often occurs as a result of an RTA - occurs with shear injuries to the medial malleolus where there may be considerable loss of skin and soft tissue - associated with fractures to the malleoli or rupture of the collateral ligaments

Answer 85

- GA - malleolar fractures are fixed or ligaments repaired - ligaments need support of it absent then prostheses can be used with nylon anchored too bone screws to mimic the action of the collaterals - if the repair remains unstable a trans-articular fixator can be used

Answer 86

Arthroplasty - excision or replacement of a joint Arthrodesis - surgical fusion of a joint Amputation - removal of limb with or without the placement of an endoprothesis These may result in a mechanical lameness but the pt is pain free The choice depends on many factors including joint affected, surgeons capability and O finances

Answer 87

- grossly dysplastic joints - severe and intractable pain from OA joints - un-reconstructable articular fractures - persistent luxation

Answer 88

Hip - common Shoulder - rare as arthrodesis is very successful in this joint TMJ - occasional

Answer 89

- example indication: Perthe's dz - remember anteversion of canine hip - remove all femoral neck - preserve the lesser trochanter - large dogs, esp if overweight -> unpredictable outcome - rehab important in both small and large pts - lots of pain relief and physio afterwards

Answer 90

- cemented (polymethacrylate) - cement-less (pressfit) - these have a porous metallic surface which encourages new bone ingrowth - hybrid systems: cementless acetabular component (polyurethane), cemented stem (stainless steel or titanium) - micro- and nano- systems were cemented only but now have a press fit acetabular cup

Answer 91

- 20-40kg for standard system but now small dogs and cats can be treated - not overweight - no previous sx? - unresponsive to medical management - compliant O and pt

Answer 92

5-10% - lower end for more experience surgeons Infection - surgical - haematogenous (that can occur at any time) Luxation - esp in first 8w Fracture - stress riser at end of femoral stem Aseptic loosening - implant/cement or bone/cement interface

Answer 93

Total elbow - 2 systems currently available and success rates are increasing Total and partial knee - becoming more available and success rates are improving Patella groove replacement - for intractable patella pain associated with cartilage loss to groove and patella Hock replacement - in development, but not widely available atm

Answer 94

- the surgical fusion of the joint resulting in pain free movement of the limb

Answer 95

- remove all articular cartilage - place cancellous bone graft or equivalent - rigid fixation preferably under compression - fix at a functional angle

Answer 96

- shoulders do well - elbows and stifles more difficult to determine correct limb length -> if too long need to circumduct leg, if too short fail to use

Answer 97

Pan meals all In the carpus - antebrachiocarpal - intercarpal - carpometacarpal In the tarsus - talocrural - intertarsal - tarsometatarsal

Answer 98

- comminuted fracture involving joint - neoplasia - extensive loss of soft tissues - paralysis e.g. brachial plexus avulsion - intractable joint pain when finances won't allow joint replacement

Answer 99

- not overweight - no significant problem with contra-lateral limb - good temperament - committed O

Answer 100

- fore or hind quarter amputation or hemipelvectomy -> these are not appropriate if a prosthesis is anticipated - local nerve blocks applied early in the sx - cut nerves with scalpel - reduce dead space - meticulous homeostasis

Answer 101

- prosthesis retained in bone - avoids pain in the stump tissue and proprioceptive problems that arise in people wearing standard prosthetic - difficult to get soft tissues to form seal around metalwork (reindeer antler model) - O more aware of the availability of these prosthesis and despite the problems that may arise they can offer a good QoL for many pets

Answer 102

- trauma to digit - neoplasia (SCC or melanoma to nail bed)

Answer 103

- digits III and IV are the main weight bearing structures to the foot - do better with amputation of II and V - can amputate through the joint

Answer 104

- the normal animal carries 40% of weight on hindlimbs and 60% of forelimbs - this changes with amputation - weight is transferred to the other limbs after amputation - the remaining fore or hind limb is moved towards the midline to create a triangular arrangement of the legs - there may be no reason to leave a stump unless prosthesis is anticipate

Answer 105

= a means to manage a tumour, provide analgesia and maintain limb function - primarily an oncological sx - resect bone with appropriate margins - cortical allograft used to maintain limb length (or excised tumour bone pasteurise and replace) - arthrodesis if near joint e.g. distal radius - follow up (neoadjuvant) chemo - complications are frequent particularly infection - median survival times are similar between procedures (amputation vs limb sparing)

Answer 106

- improves QoL - a mechanical lameness remains - finances play a large part in the decisions taken by O - outcome depends on pt temperament and O commitment

Investigation & management of the mature lame animal Flashcards

(130 cards)