Musculoskeletal System Flashcards
(168 cards)
1
Q
What are the phases of bone healing?
A
- Inflammatory phase
- Repair phase
- Remodelling phase
2
Q
What are some general clinical signs of a fracture?
A
- Loss of function
(lameness) - Swelling
- Change in limb
length, alignment, or orientation- Affected limb is
usually shorter
- Affected limb is
- Abnormal range of
motion (ROM)- Reduced or increased
- Pain
- Crepitus
- Sensation of bone
grating against bone (crunching, grinding feeling)
- Sensation of bone
3
Q
What factors does bone healing require?
A
- Adequate reduction and stability of the fracture site
- Allows for vascularisation of the fracture site (allow capillaries to grow in) and protects the bone cells in the fracture gap
- Absence of complicating factors
- Infection, for example
- Sufficient healing time
4
Q
Describe bone gap healing.
A
- Seconary or indirect healing though callus formation
- Occurs with small gaps between fracture ends
- Occurs with minimal movements
- Lamellar bone forms directly in the fracture gap
- Intracortical remodelling through the fracture gap restores bone
5
Q
What factors are required to describe a bone fracture?
A
- Aetiology
- Bones involved
- Position within bone
- Direction of fracture line(s)
- Number of fracture line(s)
- Relative displacement of fracture fragments
6
Q
Describe an impacted fracture. How is it likely to be managed?
A
- Closed fracture that occurs when pressure is applied to both ends of the bone, causing it to split into two fragments that jam into each other and causes interlocking of cancellous bone
- Often stable and can be managed conservatively
7
Q
What factors determine the frequency of radiographic views taken surrounding bone fracture repair and management?
A
- Baseline views must be taken pre-operatively for fracture fixation planning and immediately post-operative to assess repair
- Frequency of views above baseline is governed by:
- Anticipated rate of healing
- Presence of complicating factors
- Finance
- Intention to remove implants
8
Q
What is immediate first aid advice to give to a pet owner who has a pet with an open fracture?
A
- Prevent contamination by covering open wounds
- Control haemorrhage
9
Q
Describe the steps for treatment of an open fracture wound patient upon arrival to the hospital.
A
- Priority first line treatment upon entry to the hospital:
- Clip fracture area widely
- Lavage copiously with sterile saline or tap water from a shower head
- Debride all devitalilsed tissue
- Start open wound management
- Stabilize fracture and manage soft tissue injuries
- Prevent contamination progressing to infection
- Achieve rapid bone union and restore limb function
10
Q
Describe biological osteosynthesis.
A
- Bone healing philosophy which aims to take full advantage of biological healing potential to maximize rate of fracture healing and create an optimal biological and mechanical environment for fracture repair
- Requires
- Maintenance of limb length and orientation
- Avoidance in creating further surgical trauma
11
Q
What type of fracture support is a splint? In what cases is a splint indicated?
A
- External coaptation
- For short-term use or adjunctive support
- Okay for use in radius and ulna
- Limited used to distal hock
- Should be applied over cast padding and conforming bandage with spoon at the bottom
12
Q
What are casts and when are they indicated for use? What types of casts are available and what are the advantages/disadvantages of each?
A
- Casts are a type of external coaptation which immobilizes a fractured joint above and below the fracture
- Indicated for fractures if expected healing time is within 6 weeks and fractures that are not under axial force as a cast does not counteract axial forces to fractured bone
- Types
- Plaster of Paris cast
- Cheap
- Easy to apply
- Conform well
- Take 8+ hours to dry fully
- Heavy to wear
- Radiodense
- Cannot get wet
- Fibreglass/resin casts
- Light and strong
- Does not soften when wet
- Conforms well
- Sets rapidly
- Radiolucent
- Requires an oscillating saw for removal
- Plaster of Paris cast
13
Q
Give an example of an anatomical moulded splint.
A
- Splint made from thermoplastic materials
- Stronger and lighter than plaster of Paris (POP)
- Material needs to be quite hot before applying
- Can be awkward to use
14
Q
Describe the steps in cast application for a fracture.
A
- Reduce fracture and maintain reduction
- Immobilize joint above fracture
- Immobilize the limb in a normal standing position
- Include the toes and, possibly, pads in the cast
- Cast should be applied with a 50% overlap with up to 6 layers
- Wait until cast is cured before allowing injured animal to walk
- Limb alignment should be assessed radiographically
15
Q
Why do casts often require changing before bone union is complete?
A
- Swelling reduction changes the fitting of the cast on the limb
- Cast damage
16
Q
What are some possible complications with cast use?
A
- Soft tissue complications
- Pressure sores can be caused due to poor cast application technique or loosening
- Ischemia can be caused which may progress to gangrene
- Fracture disease
- Muscle wasting, stiffness, osteoporosis, or tissue adhesion, for example
- Malunion
- Delayed union
- Dressing which is applied too tightly can cause a closed fracture to become an open fracture
17
Q
Describe the application of bone pins for an external fixation system surgery.
A
- Suspend the injured limb from hooks in the ceiling (radius and tibia) or with an intravenous stand (humerus and femur).
- Scrub the liberally clipped area with an antiseptic soap.
- If the fixation is being applied to the radius or tibia, leave the limb suspended during application of the external fixator. If the fixation is being applied to the humerus or femur, release the limb from the suspension after it has been draped.
- Make a small (1-cm) longitudinal skin incision over the proposed pin site.
- Use a hemostat to dissect bluntly through the soft tissue from the skin surface to the bone to create a soft tissue tunnel that allows free gliding motion of surrounding muscles around the fixation pin. The tunnel also prevents the pain and discomfort that can result from impingement of soft tissue against fixation pins. Create the soft tissue tunnel between large muscle bellies rather than through them, and avoid neurovascular structures.
Protect the soft tissue in the walls of the tunnel from trauma using a drill sleeve, or retract and stabilize the tissue with a hemostat. - Predrill the bone using a high revolutions per minute (RPM) speed drill and a twist drill bit 0.1 mm smaller than the core diameter of the fixation pin.
- Place the fixation pin through the drilled hole with a power drill, using low-
RPM speed. - Be sure the pin tip extends beyond the opposite cortex.
18
Q
What are the factors invovled in pin selection for the application of external skeletal fixation.
A
- Patient fracture assessment score
- Bone cortical width
- Pin should be 20-25% cortical width
- Length of bone fragments
19
Q
Describe how external skeletal fixation is compatible with the principles of biological osteosynthesis.
A
- Maintains alignment and lengths of limb
- Minimally disturbs fracture fragments
- Closed or minimally invasive application possible
- All fracture forces can be neutralized
- Encourages early weight bearing
20
Q
What are some complications which may arise with the use of external skeletal fixator pins?
A
- Persistent pin tract drainage
- Best avoided by attention to soft tissue management
- Cannot be avoided at some sites
- Pin loosening
- Promotes pin tract discharge
21
Q
How is the diameter and the length of the intramedullary pin selected for fracture repair?
A
- Diameter
- Should be selected to fill in the medullary canal at narrowest point. Radiographs of contralateral limb useful for assessment (allow 10-15% for magnification of radiograph)
- Length
- Pin should be seated in distal metaphysis and protrude slightly proximally for easy removal after healing
22
Q
What are the methods of insertion of an intramedullary bone pin? Describe them. Which bones can each method be used on?
A
- Retrograde pinning
- Expose the fracture and insert the pin into the medullary canal of the appropriate bone segment. Drive the pin to exit the bone segment. Reduce fracture by driving pin across fracture line
- Can be done on humerus, femur, tibia and ulna
- Normograde pinning
- Inroduce the pin at the appropriate location at one end of the long bone and drive it down the medullary canal to the fracture to reduce the fracture. Continue to drive the pin until it seats in metaphyseal bone.
- Can be used for open or closed fracture
- Can be done on humerus, femur, and ulna
23
Q
Describe the orthopaedic repair interlocking nail.
A
- Intramedullary pin which has been perforated to accept bone screws
- Neutralises all forces very effectively
- Pin resists bending
- Screws lock bone to pin resisting shortening, rotation, and shear force
- Can be technically challenging to use as requires specialized instrumentation or fluoroscopic guidance for use
24
Q
What is a rush pin? How is it used?
A
- Type of intramedullary pin with a hooked end and ‘sledge runner’ tip
- Used in pairs
- Useful for metaphyseal fractures
- Useful especially for distal femur fractures
- May allow physeal growth to continue in skeletally immature animals
25
What is cerclage wire and how is it used?
* Monofilament orthopaedic wire commonly combined with intramedullary pinning
* Can be used with full cerclage or hemicerclage
* Requires wire twister and cutter for use
* Uses
* Provide interfragmentary compression
* Reduces the fracture gap
* Increases interfragmentary friction
* Enhances fracture stability
* Stops undisplaced fissures from opening up or propagating from the fracture site
26
How many twists should there be in an applied circlage wire?
3-4 twists
27
Describe the application of tension band wiring to a bone fracture.
* Reduce fracture and maintain with one or two Kirshner-wires
* Circlage wire is anchored in a transverse bone tunnel and passed around the ends of the pin(s) in a figure-of-eight fashion
* Wire is anchored by twisting bilaterally to ensure even tension
* Ends of the Kirshner wires are bent over and cut short
28
What are some options for bone internal stabilization post-operative care?
* Controlled exercise for rapid return to normal weight bearing and avoidance of muscle-wasting and joint stiffness (especially important following articular fracture repair)
* Physiotherapy
* Passive flexion-extension exercises
* Hydrotherapy
29
Describe what the arrows are pointing out in the the following dorsomedial-planterolateral oblique radiograph of a metatarsal region of a Warmblood gelding:
![]()
There is a large
oval-shaped sequestrum (black arrow)
surrounded by a relatively radiolucent area axially (an involucrum) with
periosteal new bone (white arrows) consistent with osteomyelitis. Note
the variable radiopacity of the overlying soft tissues.
30
What are the radiographic features of osteomyelitis?
* Bone destruction
* Periosteal new bone formation
* Results in an irregular, "fuzzy" appearance to the bone
* Possible soft tissue swelling
* Sequestrum formation
* Surrounded by radiodense and angular bone formation
* Devascularisation of a portion of bone with necrosis and resorption of surrounding bone leaving a 'floating' piece which acts as a reservoir for infection (avascular is not penetrated by antibiotics)
* Involucrum
* Thick sheath of periosteal new bone surrounding a sequestrum
* Delayed healing or non-union
31
What is a radiographic sign of a viable hypertrophic non-union fracture? What can be done to improve the healing?
* Significant callus is indicative that non-unionised bone is attempting to heal
* Treatment of hypertrophic non-union fracture
* Remove loose implants and stabilize fragments
* Acquire fracture culture and sensitivity
* Use of bone graft (does not usually require a bone graft)
32
What creates a non-viable, dystrophic, non-union fracture?
Inadequate blood supply
33
What are the radiographic signs and treatment options of an atrophic, non-viable, non-union bone fracture? In which bones are these commonly found?
* Radiographically shows no evidence of attempt to heal (biological inactivity)
* Bone ends are sclerotic and atrophied
* Medullary cavity may seal over
* Fracture gaps fill will fibrous tissue
* Formation of pseudoarthrosis
* Treatment (aggressive)
* Open approach to be used
* Debride fracture ends to viable bleeding bone
* Tissue samples for culture and sensitivity
* Bone healing has to be stimulated
* Requires rigid stabilization with plate and screws
* Common in distal radius and ulna in toy breed dog
* Final sequel of a non-viable, non-union fracture repair
34
What is quadriceps contracture? How can it be avoided and how may it be treated?
* Quadriceps muscle becomes adherent to fracture site which leads to:
* Progressive decrease in range of stifle joint mobility
* Stifle and hock overextension
* Is avoided by avoiding penetrating muscle masses during external skeletal fixation (ESF) whenever possible
* Treatment
* Surgical release of adhesions
* Muscle/tendon lengthening if necessary to allow normal range of motion (ROM) at stifle joint
* Passive and active physiotherapy are vital following surgical correction
35
What causes bone implant failure?
* Combination of biologic and mechanical factors that lead to implant loosening or breakage over time
* Inappropriate implant size selecton
* Errors in implant placement
* Infection
* Patient comorbidies (obesity, for example)
* Discord in biomechanical environment
* Cyclic loading
* Large cortical defects
* Fracture of plates through unfilled holes
36
What is a bone autograft? Where is it collected from? What are the advantages/disadvantages of using this bone graft?
* Bone graft taken, usually from cancellous bone, in which the donor and recipient is the same individual
* Highly cellular but mechanically weak
* Collection from
* Lateral tuberosity of humerus
* Medial proximal tibia
* Greater trochanter of femur
* Wing of ilium
* Advantages
* No immune response
* Greatest osteogenic effect (high cellularity)
* No risk of cross infection
* Disadvantages
* Extra operating sites must be prepped and accessed
* Large quantities can be difficult to obtain
* Must be kept in moist swab in surgical area until use
37
What is a bone allograft? From where is it usually taken? What are the advantages/disadvantages of its use?
* Donor and recipient are animals of the same species
* Main use is for limb salvage
* Usually taken from cortical bone
* Advantages
* Can be banked
* Convenient
* Unlimited quantity available
* Disadvantages
* Immunogenic
* Slow incorporation into host bone (3-4 years)
* High risk of cross infection
* Surgery requires strict asepsis with implantation of dead bone
38
What is a bone syngenesiograph?
Bone graft in which the donor and recipient are blood relatives
39
What is a bone isograft?
Bone graft in which the donor and the recipient have identical genetic background
40
What is a bone xenograft?
Bone for which the donor and the recipient are from different species
41
Describe the mechanism of action of a bone graft.
* Sources of osteopregenitor cells arise from:
* Within the graft (Osteogenesis)
* The surrounding tissue (Osteoinduction)
* Provides a mechanical support such as a scaffold for bone cell invasion (Osteoconduction)
42
What are the uses of bone grafting?
* Filling defects
* For limb salvage, for example
* To encourage healing
* In a comminuted fracture, non-union, or arthrodesis, for example
43
Describe the radiographic assessment of suspected hip luxation.
* Two orthogonal views should always be taken
* Check for pelvic or avulsion fractures which may stop reduction
* End of femoral head may be resting in the acetabulum (avulsion)
* Assess for the presence of hip displasia which makes closed reduction less likely to succeed
* Check for shallowness of acetabulum which make reduce the stability of the hip after healing
44
Describe the use of the Ehmer sling for closed reduction of coxofemoral luxation. What important factors must be considered for use?
* Prevents weight bearing on repaired limb
* Maintains internal rotation of the femur and enhances hip stability
* Correct application is critical to avoid vascular compromise
* Difficult to maintain on cats
45
When is coxofemoral open reduction indicated?
* Failure of closed reduction
* Re-luxation
* Acetabular fracture
* Significant hip dysplasia (HD) or osteoarthritis (OA) present
* Contralateral limb injury
46
Describe the application of the iliofemoral suture. In which surgery would this procedure be indicated?
* Iliofemoral suture application
* Craniolateral approach
* Bone tunnels prepared in femoral neck and ventral ilium just cranial to the hip
* Suture is tied with hip abducted and stifle joint is internally rotated
* Gives the joint time to heal
* Indicated for coxofemoral capsular repair
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47
Describe the method for performing a dorsal capsulorrhapy. For which conditon is this procedure indicated?
* Indicated for capsular repair for open reduction of coxofermoral luxation
* Method
* Place two screws with flat metal washers or bone anchors in the dorsal rim of the acetabulum. Insert one anchor at the 10 o’clock position and one at the 1 o’clock position (on a left hip).
* Drill a hole through the femoral neck in the trochanteric fossa to accept suture (or place a third screw and washer or anchor in the trochanteric fossa)
* Pass orthopedic suture or heavy non-absorbable suture in a figure-eight pattern between the acetabular anchors and trochanteric fossa.
* Tie the sutures tight enough to maintain reduction but not so tight that they will tear with normal ambulation.
48
Describe the toggle
pin fixation method in terms of orthopaedic repair. What is this surgery used for?
* Used to correct coxofemoral luxation
* Replacement of the ligament of the femoral head (LFH; teres ligament) with a prosthetic ligament
* Steps
* LFH is anchored on the medial aspect of the acetabulum with a toggle pin which passes through acetabulum at origin of LFH and passes into femoral head at insertion of LFH
* Pin passes through a second transverse bone tunnel and exists femur on lateral aspect of femur
49
Describe coxofemoral transarticular pin orthopaedic surgery. What is this surgery used for?
* Used for coxofemoral luxation repair
* Replaces the ligament of the femoral head with a stainless steel (SS) pin
* Steps
* Drill a hole retrograde from the fovea capitis
* Insert intramedullary pin until tip is visible
* Reduce luxation
* Drive pin 4-5mm further though acetabular wall
* Bend pin over and cut off
* Remove pin 4-6 weeks later
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50
Describe the use of the DeVita pin for orthopaedic surgery. What are the possible complications for its use?
* Maintains reduction following craniodorsal luxation
* Intramedullary pin inserted ventral to tuber ischium, dorsal to femoral neck and through the ventral aspect of the ilium
* Possible complications
* Risk of sciatic nerve injury as it passes close to the sciatic nerve
* Reluxation
* Pin migration
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51
What disorder is being indicated in the following radiograph? What is the pathogenesis and treatment of this conditon?
![]()
* Avascular necrosis of the femoral head
* Pathogenesis
* Inherited basis in some breeds such as terriers and other small breeds
* Develops due to inadequate blood supply to the femoral head during development causing avascular necrosis, tranbecular collapse, inadequate cartilage support, and collapse of the femoral head with weight bearing
* Treatment
* Femoral head and neck excision
* Total hip replacement
52
What is an osteotomy?
An osteotomy is a surgical operation whereby a bone is cut to shorten or lengthen it or to change its alignment
53
For which conditions is femoral head and neck excision (ostectomy) indicated? Describe the technique.
* Salvage procedure used to treat avascular necrosis of the femoral head and hip dysplasia
* Allows rapid and predictable return to function
* Technique
* Uses cranio-lateral approach to the hip joint to maintains gluteal integrity
* Femoral head is luxated and stifle is externally rotated to 90 degrees
* The ligament of the femoral head (LFH) must be sectioned to allow adequate visualisation
* Entire femoral head and neck are removed to ensure to avoid leaving any bone spurs
54
What is hip dysplasia? Describe the aetiopathogenesis.
* Disparity between skeletal and muscular growth which leads to the primary lesion of hip laxity which allows hip subluxation
* Aetiopathogenesis
* Affects many breeds (primarily large breeds) and cats (predominantly maine coon cats)
* Development disease of the coxofemoral joint
* Subject to environmental influences
* Inherited predisposition
55
Describe the primary lesion of hip displasia.
* Primary lesion is subluxation
* Forces distribute unevenly over the acetabulum and femoral head and are concentrated over a small area causing fracture, fray, tear, synovitis, degeneration, and pain
56
What is being shown in the following radiograph?
![]()
Severe hip dysplasia with advanced degenerative joint disease ventrodorsal radiograph). Extensive new bone production on femoral necks creates impression of flattening of femoral head (arrow).
57
What is the Norberg angle? What is it used for?
\* The angle made with immaginary line connecting the centers of each femoral head and nother line extending from each femoral head center to its craniodorsal acetabular rim. The angle formed by the intersection of two lines is the Norberg angle.
\* Gives an 'objective' measure of coxofemoral subluxation with 'normal' considered to be \>105 degrees
![]()
58
What are the treatment options for hip dysplasia?
* Conservative
* Clinical signs will improve in many dogs following the period of rapid growth
* Weight loss
* Exercise regulation
* Analgesia
* Surgical
* Triple pelvic osteotomy
* Femoral head and neck excision
* Total hip arthroplasty for older dogs
59
What are Sharpey's fibres?
Sharpey's fibres (bone fibres, or perforating fibres) are a matrix of connective tissue consisting of bundles of strong collagenous fibres connecting periosteum to bone. They are part of the outer fibrous layer of periosteum, entering into the outer circumferential and interstitial lamellae of bone tissue.
60
What is the ortolani test?
Orthopaedic test for subluxation. It provides information about the integrity of the dorsal acetabular rim (DAR).
61
Describe the triple pelvic osteotomy. For which patients is this procedure indicated? What are some potential complications with this procedure?
* Orthopedic procedure which isolates the acetabulum and rotates the pelvic bones to increase the femoral head cover, improve hip joint congruity and slow/halt the development of osteoarthrosis
* Indications
* Hip dysplasia
* Significant patient lamenesss
* Minimal degenerative changes
* Intact dorsal acetabular rim (DAR; can be assessed with ortolani test)
* Young animals of less than 10 months of age
* Complications
* Poor owner/patient compliance
* Implant failure
* Sciatic paralysis
* Narrowed pelvic canal
62
What is total hip arthroplasy (THA)? When is this sugery indicated? What are some potential complications of THA?
* Salvage procedure of the hip joint in which the hip joint is replaced
* Indicated for older patients with hip displasia that are
* Unresponsive to conservative management
* Have no presence of systemic disease
* Have no presence of neuromuscular disease
* Have no other causes of lameness
* Have no source of bacterial infection (teeth and ears have to be clear because of the artificial material inserted in body)
* Complications
* Pulmonary embolism, femoral fracture, luxation, sepsis, aseptic loosening
63
What are osteocytes?
Terminally differentiated osteoblasts that are encased in bone matrix during osteosynthesis
64
What are osteoprogenitor cells?
Cells of various stages which become osteoblasts
65
What is parathyroid hormone? What are its actions?
* Hormone secreted by chief cells in the parathyroid glands in response to low plasma calcium ion concentration
* Increases plasma calcium concentration by
* Mobilizing calcium from bone
* Calcium is released as osteoblasts are diplaced from the bone and replaced by osteoclasts
* Increasing calcium reabsorption and urinary phosphate excretion in the distal tubule of the nephron
* Increasing calcium absorption from the small intestine
66
What is calcitonin? Describe its action(s).
* Hormone secreted by parafollicular cells (C cells) in the thyroid gland during times of hypercalcaemic stress
* Lowers plasma calcium concentration by allowing osteoblasts access to bone surface and decreasing bone resorption
67
How is Vitamin D3 obtained and processed by cats and dogs? What are its actions?
* Hormone obtained from the diet or produced in the skin via effect of UV light. It is metabolized to the active form (calcitriol) in the kidney by 1-α-hydroxylase, catalyzed by parathyroid hormone.
* Active form increases plasma calcium concentration by increasing absoption from the small intestine and bone demineralization
68
What is the condition being shown in the following photo? What is the cause of this condition and describe the common pathogenesis in young and adult animals respectively.
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* Thc condition pictured is rickets characterized by bowing of limb bones and plantigrade/palmigrade stance due to unstable cartilage and ligament laxity
* Caused by
* A dietary deficiency in calcium, phosphorus, and/or vitamin D
* Hereditary defect in body's response to vitamin D
* Pathogenesis
* In young animals
* Hereditary
* Cartilage cells fail to degenerate
* Metaphyseal capillaries cannot penetrate cartilage
* Epiphyseal lines appear thickened and irregular
* In adults
* Dietary
* Osteomalacia apparent due to lack of bone mineralization
69
What are the radiographic findings of rickets?
* Physes are widened and have delayed ossification.
* All physes are affected, but changes tend to be mostsevere in distal radius, ulna, and tibia.
* Metaphyses appear flared and have concave (cupped) margins with pointed edges.
* Epiphyses are normal (unlike most dysplasias).
* Long bone deformities are common.
* Soft tissue swelling is minimal or absent.
70
What are some treatment options for rickets?
* Correct diet (Cacium:Phosphorus ratio should be 2:1)
* Exposure to sunlight
* Supplementation with calcitriol and/or calcium
* Any fractures should be treated conservatively (with cage rest and analgesia, for example) as they are pathological
71
What is a radiographic signs of primary hyperparathyroidism?
Radiolucency around the teeth or poor skeletal mineralization
72
Describe the biochemical profile of an individual with primary hyperparathyroidism.
* Hypercalcaemia- increased ionized calcium (physiologically active form) in the blood
* Increased or normal parathyroid hormone levels
* Low or normal phosphate levels
73
Describe the treatment for primary hyperparathyroidism.
* Parathyroidectomy with subsequent ionized calcium administration because hypocalcaemia generally occurs post-operatively
74
What causes secondary nutritional hyperparathyroidism? Describe the clinical signs.
* Caused by
* All meat or meat-rich diet
* Inablility to absorb calcium
* Clinical signs
* Bone/joint/muscle pain
* Pathological fracture
* Ligament laxity
* Palmigrade/plantigrade stance
75
Describe the treatment for secondary nutritional hyperparathyroidism.
* Correct the diet
* Provide calcium supplementation if needed (initially supplement Calcium to 2:1 Calcium: Phosphorus ratio and then bring to normal ratio of 1.2:1)
* Manage fractures conservatively with anagesics (NSAIDs and opioids) and cage rest as there is poor holding power for implants
* Euthanize if severe neurologic impairment
76
Describe the aetiology of secondary renal hyperparathyroidism.
* Occurs secondarily to chronic renal failure (CRF) where there is a reduction in the glomerular filtration rate (GFR) leading to phosphorus retention, hyperphosphatemia and subsequent hypocalacemia.
* Hypocalacemia triggers parathyroid hormone release which causes bone resorption
* Hyperphosphataemia inhibits vitamin D activation to calcitriol which inhibits intestinal absoption of calcium
77
Desribe the prominent features of the following radiograph of a 6-year-old dog. What condition may this dog be suffering from?
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Lateral skull radiograph of a 6-year-old dog with chronic renal failure and secondary hyperparathyroidism. The teeth appear very opaque because of the reduction in bone mineral. The lamina dura have been
resorbed. This is an example of fibrous osteodystrophy where the cancellous bone of the skull is particularly affected with resorption of alveolar socket bone leading to loose teeth (termed "rubber jaw") and appearance of 'floating teeth' on radiographs.
78
What are some treatment options for secondary renal hyperparathyroidism?
* Unlimited access to water and encouragement to drink to avoid prerenal azotaemia, reduced renal perfusion, and exacerbation of CRF
* Protein/phosphate restriction in diet
* Renal diets
* Oral phosphate binders
* H2 blockers administration to combat uraemic gastritis
* Famotidine, for example
* Erythropoietin administration if anaemia present
* Assessment/treatment of hypertension
* With use of angiotensin-converting-enzyme (ACE) inhibitors, for example
79
Where is hypervitaminosis A commonly seen and what are the biological effects of Vitamin A toxicity?
* Commonly seen in cats that have been fed a diet containing a large proportion of liver for several months
* Vitamin A toxicity
* Promotes the breakdown of musculotendinous insertions in the periosteum during normal muscular activity
* In growing animals causes degeneration and necrosis of chondrocytes and osteoblasts
* In adult animals, it is simulatory to osteoblasts
80
Describe the following radiographic pathology of the elbows and shoulder from the skeleton of a cat. What is the likely cause of this abnormality?
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Radiographs of the elbows and a shoulder from the skeleton of a cat that was euthanized because of ankylosing arthropathy caused by hypervitaminosis A.
81
Describe the following radiograph. What condition is being depicted here?
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Radiograph of the distal radius and ulna of a dog with metaphyseal osteopathy (hypertrophic osteodystrophy). Zone of necrotic, disrupted trabeculae in the metaphysis is found next to growth plate (Subperiosteal haemorrhage).
82
What animals are at risk of metaphyseal ostepathy?
* Young dogs (2-6 months of age)
* Large and giant breeds (rapidly growing)
* Male gender predisposition
83
Describe the treatment and prognosis for metaphyseal osteopathy.
* Treatment is symptomatic for pain (analgesia and anti-inflammatory administration) and supportive for proper bone growth (balanced diet provided)
* Prognosis
* Good to excellent with disease being usually self-limiting with dogs improving in 7-10 days
84
What is panosteitis?
* Self-limiting, episodic disease of the bone marrow of the long bones, characterized by focal areas of endosteal bone proliferation.
* Characterized by degeneration of medullary adipocytes (usually around nutrient foramen in a long bone) associated with
* Vascular proliferation
* Intramebranous ossification
* Vascular congestion and increased intraosseous pressure
* Over time, areas of local bone marrow coalesce and become connected to the endosteum
* Resorption and remodelling of newly formed bone and adipose bone marrow reappears
85
Describe the common signalment for an animal with panosteitis.
* Young age
* Male (predisposed to females 4:1)
* German Shepard Dogs (GSD) most commonly affected
86
What are some clinical signs of panosteitis?
* Acute onset of symptoms
* Lameness
* Shifting leg lameness
* Variable severity
* More frequently found in forelimbs
* Pain on palpation of long bones
* Systemic illness may be preset
87
Describe the features of the following radiograph. What is the likely condition?
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Panosteitis of the proximal femoral diaphysis. Patchy increased medullary opacity is visible with mild periosteal new bone formation present on the cranial femur. Increase in medullary radiopacity with a granular/mottled pattern or a loss of the normal trabecular pattern is common; sometimes referred to as the 'thumbprint' lesion.
88
Describe the treatment and prognosis of panosteitis.
* Treatment is symptomatic (anagelsia and rest) as the condition is self-limiting. Prognosis is good with recovery occuring generally after serveral weeks although the condition can relapse.
89
What is hypertrophic osteopathy and describe the aetiology.
* Bone condition seen in adults characterized by the periosteal reaction of the distal extremities (but it may occur in any bone)
* Aetiology
* Paraneoplastic syndrome characterized by deposition of periosteal new bone
* Most often secondary to pulmonary neoplasia (primary or metastatic)
* Irritation of vagus/intercostal nerves leads to reflex increase in periosteal blood flow causing vascular congestion and deposition of periosteal new bone
90
Describe the condition seen in the following radiograph and accompanying radiographic features.
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Chronic hypertrophic osteodystrophy. An irregular, palisading periosteal productive response surrounds the radial and ulnar metaphyses. The physes are relatively unaffected. Periosteal new bone deposited in palisades 90 degrees to the axis of long bones which begins distally in limbs
91
Describe osteosarcoma in cats.
* Rare
* Malignant
* ~equally likely in axial or appendicular skeleton
* Mean age of disease: 8-10 years
* More common in the hindlimbs than forelimbs
* Lower metastatic rate than dogs
* Surgery is treatment of choice
* Prognosis dependent on resectability
92
Where is a common location for osteosarcoma to occur in dogs?
* Metaphyses of the long bones
* On the cranial limbs on bones away from the elbow joint
* On the caudal limbs towards the bone of the knee (stifle)
93
List the prominent anatomical landmarks of the following figure:
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1, Wing of ilium; 2, ventral iliac spines; 2 ′, coxal tuber; 3, dorsal iliac spines; 3 ′, sacral tuber; 4, greater sciatic notch; 5, ischial spine; 6, pubis; 7, obturator foramen; 8, ischium; 9, ischial tuber; 10, lesser sciatic notch; 11, acetabulum; 12, pelvic symphysis; 13, ischial arch; 14, iliopubic eminence; 15, auricular articular surface; 16, sacrum.
94
List the prominent anatomical landmarks of the following figure:
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1, Wing of ilium; 2, ventral iliac spines; 2 ′, coxal tuber; 3, dorsal iliac spines; 3 ′, sacral tuber; 4, greater sciatic notch; 5, ischial spine; 6, pubis; 7, obturator foramen; 8, ischium; 9, ischial tuber; 10, lesser sciatic notch; 11, acetabulum; 12, pelvic symphysis; 13, ischial arch; 14, iliopubic eminence; 15, auricular articular surface; 16, sacrum.
95
Describe the common biological behaviour of canine appendicular and axial osteosarcoma, respectively.
* Appendicular
* Commonly micrometastasized primarily via haematogenous route towards lungs
* Rarely metastasized towards lymphatics (~5%)
* Axial
* Highly locally invasive
96
What are some common radiographic features of osteosarcoma?
* Lytic, productive, or mixed appearance
* Commonly at the metaphysis
* Does not cross the joint
* Pattern
* Sunburst
* Codman's triangle
* triangular area of new subperiosteal bone that is created when a lesion, often a tumour, raises the periosteum away from the bone
* Osteolysis- moth-eaten appearance
97
What radiographic feature is being shown in the following radiograph? With which bone disorder is this associated?
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Craniocaudal view of a distal radial osteosarcoma. The appearance of the triangular periosteal reaction at the proximomedial aspect of the lesion (arrows) has been termed a Codman’s triangle and accompanies osteosarcoma so often that it has been called pathognomonic. However, this triangle results from periosteal elevation, which can occur secondary to neoplastic, infectious, and traumatic bone lesions.
98
Describe treatment options for osteosarcoma.
* Definitive therapy
* Surgery with chemotherapy
* Amputation or limb sparing
* Carboplastin and doxorubicin drugs used individually or as combination
* Palliative therapy
* Bisphosphonates (prevents loss of bone mass)
* Samarium (radioisotope which targets bone)
* Amputation alone
* Analgesics administration
99
Name the layers of articular cartilage from superficial to deep.
□ Tangential layer
□ Transitional layer
□ Radial layer
□ Calcified cartilage
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100
Describe the components that make up the articular cartilage extracellular matrix.
* Type II Collagen
* Framework upon which collagen is made
* Proteoglycan matrix
* Sugar-protein molecules which bind water to impart low-friction ad cushioning qualities
101
What is synovial fluid and describe its composition.
* Ultrafiltrate of blood with hyaluronan (modulated by type B synoviocytes) added
* Composed of
* Intimal layer
* Type A synoviocytes (macrophages)
* Type B synoviocytes (fibroblasts)
* Sub-intimal layer
* Blood vessels
* Lymphatics
* Connective tissue
102
What are some clinical signs of arthropathies?
* Lameness
* Pain
* Reduction in normal movement
* Effusion
* Instability
* Crepitus
103
Describe the following radiographic schematic:
![]()
Hypertrophic osteopathy. Irregular, well-defined periosteal response involving distal ulna, metacarpal bones, and phalanges (dorsopalmar radiograph). This bone condition is seen in adults and is characterized by the periosteal reaction of the distal extremities.
104
Describe the artrocentesis findings of a degenerative osteoarthritic joint.
* Ineased or decreased synovial fluid volume
* Reduced viscosity
* Increased white blood cell count with predominantly mononuclear cells (lymphocytes)
105
What are treatment/managment options for degenerative osteoarthritis.
* Weight management
* Exercise management
* Physical therapy
* Nutritional supplementation
* Omega-3 Fatty Acids
* Slow-acting, disease-modifying osteoarthritis agents (SADMOAs)
* Pain management
* NSAIDs
* Corticosteroids (as last resort pain management)
* Surgical management
106
What are the surgical management options for degenerative osteoarthritis?
* Corrective osteotomies
* Arthroplasty
* Joint salvage
* Excision arthroplasty
* Joint replacement
* Arthrodesis (artificial induction of joint ossification between two bones by surgery)
* Any joint except hip
107
What is inflammatory, immune mediated osteoarthritis? What is the aetiology and how common is this condition?
* Characterized by an inappropriate immune response in the synovium causing pain and lameness
* Not uncommon
* True aetiology is often unknown (may have a genetic or gender component)
108
Describe the following radiographic schematic:
![]()
Erosive arthritis in a carpus (dorsopalmar radiograph). Subchondral bone erosion, decreased joint space width, and periarticular soft tissue swelling are present.
109
What are common findings in the history of a patient with inflammatory, immune-mediated osteoarthirits?
* Pyrexia
* Stiffness after rest
* Lameness of multiple limbs
* Waxing and waning
* Acute or chronic
110
Describe arthrocentesis of the elbow joint.
* Neutral position
* Palpate lateral epicondyle and olecranon
* Insert needle to parallel to ulna
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111
Describe arthrocentesis of the antebrachiocarpal joint.
* Flex maximally
* Insert needle dorsally and medial to common digital extensor tendon/cephalic vein
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112
Describe the arthrocentesis of the stifle joint
* Use slight flexion
* Palpate tibial tuberosity/patella and place needle between at 45 degree angle
* Collect fluid from lateral parapatella joint pouch
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113
List the common characteristics of synovial fluid collected from a joint with inflammatory, immune-mediated osteoarthritis.
* Increased volume
* Reduced viscosity
* Turbid
* Raised cell count
* Neutrophilic cytology
114
Describe the arthrocentesis findings of a joint affected by bacterial infective arthritis.
* Large volume
* Abnormal apearance
* Increased cell count
* Neutrophilia
* Possible presence of bacteria
115
What are some treatment options for bacterial infective arthritis?
* Antibiotic use
* Broad spectrum used upon diagnosis and then narrow spectrum upon confirmation of culture and sensitivity
* Surgical flush
116
What is ankylosis?
Stiffness of a joint due to abnormal adhesion and rigidity of the bones of the joint.
117
What is arthrodesis?
Artificial induction of joint ossification between two bones
118
What is pathogenesis of rheumatoid arthritis.
* Type 3 hypersensitivity erosive arthritis stimulated by rheumatoid factors (IgM, IgG, Fc)
119
Describe the treatment options for rheumatoid arthritis.
* Immunosuppression
* Arthodesis (artificial induction of joint ossification between two bones by surgery)
120
What is Periosteal Proliferative Polyarthritis?
Feline chronic progressive polyarthritis characterized by aggressive erosion and new bone formation (can be non-erosive as well)
121
What is idiopathic immune-mediated polyarthritis?
Non-erosive immune-mediated arthritis for which no cause can be found.
122
What is systemic lupus erythematosus? How is it treated?
* Non-erosive arthritis characterized by formation of autoantibodies against tissue proteins and DNA result in circulating immune complexes that, when deposited in tissues, induce inflammation and organ damagemulti-organ disease
* Treatment
* Immunosuppression
* Guarded prognosis
123
What is drug-induced polyarthritis? Which drugs are typically involved in pathogenesis?
* Antibody-drug induced vasculitis polyarthritis from long-term or previous therapy
* Most common drug causes:
* Cephalosporins
* Penicillins
* Sulfa drugs
124
What dog breed is most commonly affected by drug-induced polyarthritis?
Doberman
125
What is plasmacytic-lymphocytic synovitis?
Uncommon arthritis of the stifle joint in dogs with cranial-cruciate ligament damage
126
What is osteochondritis dissecans?
In osteochondritis dissecans, normal joint stresses, focal trauma, necrosis, or some other unknown mechanism causes cracks and fissures to develop in the zone of hypertrophied chondrocytes of the epiphyseal cartilage layer and extend toward the articular surface. Propagation of these fissures with ultimate extension into the joint results in the release of cartilaginous breakdown products into the joint fluid with a resultant synovitis, inflammation of subchondral bone and cartilage (osteochondritis), and creation of a flap of cartilage that further dissects away from its underlying subchondral attachments (dissecans).
127
Describe the common signalment and aetiology of fragmented coronoid process.
* Common signalment
* Male
* Large/giant breed
* Advanced age
* Aetiology undetermined
128
Describe the treatment of fragmented coronoid process and the sucess of each method.
* Medical management
* Will not halt progression of disease or osteoarthritis
* Surgical management
* Arthotomy or arthroscopy
* Fragment removal
* Provides short term improvement if any
129
Describe the following condition:
![]()
Fragmented medial coronoid process with degenerative joint disease. Subchondral bone sclerosis is also present adjacent to the ulnar notch (black arrow). Visualization of periosteal new bone on the proximal margin of the anconeal process (white arrow) is facilitated by flexing the elbow joint.
130
What is osteohchondritis dessecans?
* Occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.
131
Describe the disorder depicted in the following schematic:
![]()
Ununited anconeal process of ulna (lateral radiograph). A line of decreased opacity (arrow) is present at the base of the anconeal process.
132
What is developmental elbow luxation/subluxation?
Premature closure of physis due to trauma or chondrodystrophy which results in elbow incongruity
133
What is a varus deformity? What is the opposite of a varus deformity?
In orthopedics, a varus deformity is a term for the inward angulation of the distal segment of a bone or joint. The opposite of varus is called valgus.
134
What are the congenital elbow luxation conditions? Which animals do they commonly affect?
* Type 1: Humeral subluxation
* Common in toy breeds
* Olecranon is rotated lateral to distal humerus
* Marked lateral deviation of the antebrachium
* Treatment
* None required if animal is using limb well
* Type 2: Radial head luxation
* Common in medium and large breeds
* Radius is displaced caudally and laterally
* Often accompanied by minimal or no lameness
135
Describe some elbow salvage procedures.
* Elbow arthrodesis
* Indication
* Severe and intractable elbow joint
* Marked mechanical lameness
* Total elbow replacement
* Indication
* Painful elbow which is unable to be managed medically
136
What is the aetiology and common signalment for shoulder osteochondrosis?
* Aetiology
* Failure of endochondral ossification
* "Flap" formation
* Osteochondritis dissecans
* Caudal humeral head
* Common signalment
* Animals of 4-8 months of age
* Males are more commonly affected than females
137
What are the potential treatment options and prognosis of shoulder osteochondrosis?
* Treatment
* Medical
* Surgical
* Arthroscopy
* Arthroscopy is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision.
* Arthrotomy
* creation of an opening in a joint
* Flap removal/surface abrasion
* Prognosis
* \>90% of surgical cases are sound within 4-8 weeks
* All cases develop mild degeneative joint disease with time
138
Describe the pathology in the following figure:
![]()
Intraarticular gas is present in the shoulder joint of a dog with osteochondrosis. The gas itself is not very conspicuous, but its presence has reduced the opacity of the joint space leading to visualization of the articular cartilage (black arrows) If intraarticular gas were not present, the cartilage would not be visible.
139
Describe the treatment and prognosis for traumatic shouder joint luxation.
* Treatment
* Non-surgical
* Used for animals with no other injuries
* Velpeau sling may be used for medical luxation
* Spica splint may be used for lateral luxation
* Surgical
* Biceps transposition
* Prosthetic glenohumeral ligament
* Arthroscopic repair
* Salvage procedure for recurrent luxation
* Prognosis
* Good but degenerative joint disease develops with time
* Guarded if luxation is recurrent
140
List some shoulder joint support structures.
□ Medial and lateral glenohumeral ligaments
□ Subscapularis tendon
□ Biceps brachii tendon
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141
Describe treatment options for biceps tendon disease.
* Tenotomy
* Surgical cutting of the tendon
* Done after arthroscopy is attempted
* Tenodesis
* Suture of the end of a tendon to a bone
* Screw and washer are used
* Prognosis with this treatment is excellent (in \>90% of partial rupture cases and 50% of tenosynovitis cases)
142
Name the prominent anatomical features:
![]()
Left carpal joint of the dog, palmar view. 1, Ulna; 2, radius; 3, accessory carpal; 4, lateral collateral ligament; 5, distal ligaments of accessory carpal; 6, palmar carpal ligament; 7, flexor retinaculum; 8, medial collateral ligament; the arrow is in the carpal canal.
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143
Describe the prominent anatomical features:
![]()
Muscles of the left forearm of the dog, lateral (A) and medial (B) views. 1, Extensor carpi radialis; 2, common digital extensor; 3, lateral digital extensor; 4, ulnaris lateralis; 5, flexor carpi ulnaris; 6, extensor carpi obliquus; 7, extensor retinaculum; 8, carpal pad; 9, biceps; 10, superficial digital flexor; 11, flexor carpi radialis; 12, pronator teres; 13, radius; 14, deep digital flexor; 15, flexor retinaculum.
144
Describe the treatment options for carpal luxation or subluxation (hyperextension).
* Medical
* Only indicated for "puppy laxity"
* Puppy laxity will spontaneously resolve with exercise
* Surgical
* Pancarpal arthrodesis
* Immobilize all 3 levels of the carpal joint by bone fusion, using internal or external fixation, thereby eliminating painful movement
* Prognosis is excellent in 80% of cases
* Partial carpal arthrodesis
* Prognosis is excellent in 60-80% of cases
145
What are the principles of arthrodesis?
○ Remove all articular cartilage
○ Use cancellous bone graft
○ Provide rigid internal fixation
○ Provide post-operative coaptation
146
Describe the clinical signs of carpal collateral ligament injury.
Normal stance with slight valgus of the front limb because of short collateral ligaments and oblique collateral ligaments.
147
What are some treatment options for carpal collateral ligament injury?
* Abductor pollicis longus (APL; extensor carpi obliquus) transposition
* Prosthetic placement with screws and bone tunnels
148
How can mannitol be used as an adjunct treatement for a skull condition?
Mannitol diuresis can be used to reduce intracranial pressure (ICP)
149
How can phenobarbitone be used as an adjunct treatment for conditions of the skull?
□ Seizure prevention prophylactic
□ Reduces cerebral catabolism
150
How is the course of managment determined for spinal trauma?
* Chosen dependent on neurological status characteristics and radiographic findings
* Ambulatory: strong voluntary movement
* Non-ambulatory: depends on the "stability" (radiographic stability/surgical improvement)
* If there is no deep pain perception, prognosis if often hopeless
151
How are mandibular ramal fractures treated?
* External skeletal fixation
* Multiple pins and Polymethylmethacrylate cement (PMMA)
152
What is craniomandibular osteopathy and aetiology? Describe the treatment for this pathology.
* Involves new bone on mandibular rami
* Genetic basis (common in terrier breeds)
* Common in animals from 3-7 months of age
* Treatment
* Treat pain
* If TMJ ankylosis occurs, prognosis is poor
* If jaw motion is retained, prognosis is fair
153
What is mandibular neuropraxia and its aetiology? Describe a treatment option.
* Paralysis prevents mouth closure
* Occurs with a history of carrying heavy objects
* Treatment
* Tape muzzle (Resolves in under 3 weeks)
154
How is masticatory myositis diagnosed and treated? What is the prognosis?
* Diagnosis
* Serology test using antibodies to test for autoimmunity
* Treatment
* Immunosuppression for up to 6 months
* Prognosis
* Good if caught early
155
Describe management options for pelvic fracture and their indications/contraindications.
* Surgery
* Indications
* Uncontrollable pain
* Pelvic canal compromise
* Other othropaedic injuries
* Sacroiliac luxations
* Acetabular fractures
* Ilial body fractures
* Can provide early return to function
* Is expensive
* Contraindications
* Fractures of the ischium, pubis, and tuber sacrale
* Highly comminuted fractures
* Old (\>7 days) pelvic fractures
* Unless painful and unstable
* Minimally displaced stable fractures
* Conservative management
* Cage rest for 4-6 weeks
* Analgesia
156
Name the prominent anatomical features:
![]()
![]()
Left stifle joint of the dog, cranial view (A-C). The extent of the joint capsule is shown in B. The patella has been removed in C. D shows the crossing of the cruciate ligaments in a medial view. e is a caudal view. 1, Femur; 2, sesamoids in gastrocnemius; 3, patella; 4, extensor groove; 5, tibial tuberosity; 6, fibula; 7, tibia; 8, patellar ligament; 9, tendon of long digital extensor passing through extensor groove; 10, medial meniscus; 11, medial collateral ligament; 12, lateral femoropatellar ligament; 13, lateral collateral ligament; 14, trochlea; 15, caudal cruciate ligament; 16, cranial cruciate ligament; 17, lateral meniscus; 18, stump of 9; 19, popliteus tendon; 20, meniscofemoral ligament
157
What is extracapsular stabilization? For which condition is it indicated?
* Placement of Lateral fabella-tibial suture (LTFS) for cranial cruciate ligament injury stabilization surgery
* Placed using monofilament nylon (or wire) suture. The suture travels: tibial tunnel, under superficial femoral tendon (SFT), around fabella
158
What is the tibial plateau levelling osteotomy (TPLO) and for which condition is it indicated?
* Dynamic stabilization surgical option for cranial cruciate ligament pathology
* Aims to reduce the "tibial plateau angle" from 20-30 degrees to 5-7 degrees
* Plate and screw fixation is used
159
What are the different grades of medial patella luxation?
* Grade 1: Patella is in sulcus and spontaneously returns in sulcus when manually luxated
* Mild reluxation common
* Grade 2: When patella in sulcus, stay in. When patella out of sulcus, stays out
* Grade 3: Patella out of sulcus, can be returned in, but spontaneously luxates out
* Grade 4: Out of sulcus all the time, can't be put in
* Prognosis is guarded
* May require corrective femoral or tibial osteotomy
160
What is stifle osteochondrosis?
Developmental derangement of normal bone growth in the stifle involving the centers of ossification in the epiphysis.
The stifle joint is made up of the femur, patella, and tibia.
161
Describe the prominant anatomical features of the following figure:
![]()
Lateral radiographic views of the canine hock. 1, Tibia and fibula; 2, calcaneus; 2′,sustentaculum tali; 2″, coracoid process; 3, talus; 3′, trochlea of talus; 4, superimposed fourth and central tarsal bones; 4′, plantar tubercle on fourth tarsal bone; 5, distal row of tarsal bones; 6, metatarsal bones.
162
What is proximal intertarsal joint subluxation (PITS)? What is the characteristic posture of an animal suffering from this condition?
* Type of hock ligament injury
* Leads to degenerative changes of plantar ligament or traumatic plantar ligament rupture
* Characteristic posture is curling of toes becaues of destabilization of the proximal intertarsal joint.
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163
Describe the suture pattern for a muscle laceration injury.
Horizontal mattress suture or near-far-far-near sutures
164
Describe the treatment and prognosis of quadriceps contracture.
* Treatment
* Muscle release with Z plasty (technique in orthopaedic and cosmetic surgery in which one or more Z-shaped incisions are made, the diagonals forming one straight line, and the two triangular sections so formed are drawn across the diagonal before being stitched)
* Transarticular fixator
* Prognosis
* Poor and frequently requires amputation as patients fail to improve
165
What is fibrotic myopathy? In which muscle is this common? Describe the clinical signs.
* Muscle contracture (fibrosis of the muscle)
* Aetiology unknown
* Common in the fibrous band of the gracillis muscle
* Clinical signs
* Characteristic gait
* Muscle feels "taught"
* Pain on abduction of limb
166
Describe the following pathology in the hock of the dog:
![]()
Proximal intertarsal joint subluxation (PITS)
167
Name the following prominent anatomical features:
![]()
1- Extensor carpi radialis
2- Common digital extensor
3- Lateral digital extensor
4- Ulnaris lateralis
5- Flexor carpi ulnaris
6- Extensor carpi oblique
7- Extensor retinaculum
168
Describe the following fracture:
![]()
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Complete oblique fracture of the distal diaphysis of the right radius and ulna.
