Ortho

Question 1

What are the purposes of vet orthopedics?

Answer 1

to improve comfort and function, improve QOL

Question 2

What’s the most innervated spot on the bone?

Answer 2

periosteum is highly innervated and so is subchondral bone (underneath cartilage)

Question 3

What are the landmarks of the cranial drawer test?

Answer 3

have a thumb on the caudal aspect of femoral condyles with index on the patella. Other hand’s thumb is on the head of the fibula with the index on the tibial crest

Question 4

If a positive cranial drawer test is found, what does this mean?

Answer 4

It means there is rupture of the cranial cruciate ligament

Question 5

How do you perform the tibial thrust test?

Answer 5

Hold the stifle in a slightly flexed position, index finger of one hand over the tibial crest, other hand flexes and extends the hock.

Question 6

You get a positive tibial thrust test, what does this mean?

Answer 6

cranial cruciate ligament is ruptured

Question 7

What does a negative cranial drawer but positive tibial thrust test indicate?

Answer 7

dynamic instability, but static stability

Question 8

Explain when the medial and lateral collagen bundles of the CCL are taught or relaxed

Answer 8

Medial bundle is taught in both flexion and extension (if it is I ntact, there is no drawer in flexion or extension); the lateral bundle is only taught in extension but not in flexion (you can have a partial rupture in which only one bundle tears)

Question 9

Which bundle is typically torn first?

Answer 9

medial bundle > lateral

Question 10

What happens if you lose the medial bundle first but still have the lateral?

Answer 10

You will lose the flexion stability and get a positive drawer in flexion

Question 11

T/F: you can just test cranial drawer or tibial thrust in extension

Answer 11

False: always test in extension and flexion –> flexion will help to elucidate early tears

Question 12

What’s the weight limit max of extracapsular techniques?

Answer 12

Dogs < 15 kg

Question 13

What kind of stability does extracapsular techniques provide?

Answer 13

dynamic and static stability

Question 14

What kind of stability does osteotomies or ostectomies provide?

Answer 14

dynamic stability by eliminating shearing forces and so thurst.

Question 15

What sizes of dogs are good for osteotomies?

Answer 15

all sizes

Question 16

Give examples of osteotomies

Answer 16

TPLO, TTA, CCW, CBLO

Question 17

T/F: you normally get a lot of osteochondrosis with patellar luxation

Answer 17

False: you don’t

Question 18

What procedures can we do for a patellar luxation?

Answer 18

Desmototomy (soft tissue surgery - only used as sole treatment in young pups, but often with other treatments), groove reconstruction procedures (depends trochlear groove), limb alignment procedures, distal femoral osteotomy

Question 19

What are the only two groove reconstruction surgeries you can do in mature animals?

Answer 19

wedge or block recession. Wedge = take a triangle out of bone then put it aside then take out another triangle of same size and put the old block back in; Block = cutting on either side of highest point of trochlea, remove block, chisel down sides then put block back in

Question 20

What is a sequela of hip dysplasia?

Answer 20

Osteoarthritis

Question 21

Why do dogs with hip dysplasia get joint laxity?

Answer 21

Excessive joint fluid, low pelvic muscle mass giving it stability, hormones, nutritional excess (calcium and vitamin D), IM injected polysulfated glycosaminoglycans (6 weeks to 8 months) < building blocks of cartilage can help improve hip laxity at a young age, increased body weight

Question 22

What’s the earliest you can diagnose dyasplastic hip changes?

Answer 22

by 30 days, 4 weeks of age

Question 23

What comes first on radiographs? Degenerative changes or osteoarthritis?

Answer 23

Before you see osteoarthritis, you will see degenerative changes on xrays

Question 24

What is our job as a GP with detecting hip d ysplasia?

Answer 24

We need to detect it early, give a good diet recommendation. If you recognize it early, the more options of fixing are available.

Question 25

Which dogs do not get hip dysplasia?

Answer 25

sight hounds (greyhounds, borzoi)

Question 26

Why is there a honeymoon phase with hip dysplasia with less pain ?

Answer 26

This is the perarticular fibrosis phase which improves hip joint laxity

Question 27

What are the two hip radiographs you can take for hip dysplasia and which one requires certification?

Answer 27

OFA is the extended hip view, false negative possible; PennHIP must have animal sedated/anesthetized, you need certification and requires 3 views (VD hip extended, compression view, distraction view)

Question 28

What’s the compressed and distracted view?

Answer 28

Compressed is like a frog stance, you try put push those acetabulums into the joints as much as possible, the distracted view is that you try to push out the acetabulums as much as possible

Question 29

All patients with hip dysplasia need _____ management

Answer 29

medical

Question 30

What are the two surgeries you can do as prophylactic surgery on young dogs?

Answer 30

Juvenile pubic symphysiodesis (JPS) and pelvic osteotomy (double or triple)

Question 31

What’s the age limit for a JPS?

Answer 31

12-20 weeks, palpable laxity

Question 32

Pelvic osteotomy age limit?

Answer 32

younger than 10 months to 1 year

Question 33

What do you briefly do in a JPS?

Answer 33

You do electrosurgery and use thermeal heat to kill the pubic symphysis growth. It fuses that part of the pelvis while the rest of the plvis grows and it grows to have better coverage of the acetabulum

Question 34

How do you do a pelvic osteotomy?

Answer 34

Cut pelvis into 2-3 pieces and manually rotate it to get better acetabular coverage. Double osteotomy = don’t cut ischium and end up with slightly wider pelvic opening vs a triple < super invasive

Question 35

What are some salvage procedures for hip dysplasia = for patients > 1 yo with OA

Answer 35

to eliminate pain from secondary OA, we do femoral head and neck excision (FHO) or total hip arthroplasty (hip replacement)

Question 36

What’s the most common cause of hip luxation?

Answer 36

Traumatic

Question 37

Most hip luxations luxate in which direction?

Answer 37

cranio-dorsal

Question 38

How do you distinguish craniodorsal luxation and ventral luxation?

Answer 38

Craniodorsal luxation: legs aren’t equally as long, one is shorter; pops up overtop and sits on dorsal edge < non weightbearing. Ventral luxation: legs are gonna look longer rather than shorter, have internal rotation and abduction and is where the joint pops out and sits within the forament at bottom of pelvis

Question 39

What’s the treatment for hip luxation?

Answer 39

you need to reduce it ASAP (closed or open within 3 days)

Question 40

Ventral or craniodorsal has a better outcome with closed reduction?

Answer 40

Ventral

Question 41

What’s the role of the anconeal process?

Answer 41

Engages with humerus and is to stabilize joint in mediolateral motion in extension

Question 42

What’s typical signalement of ununited anconeal process (UAP)?

Answer 42

Large, giant breed dog, male > female, 5-12 months old and up to a third of these cases are bilateral (older = bilateral), weight bearing lameness worse after exercise

Question 43

What kind of radiographs should you take for a UAP?

Answer 43

Neutral lateral, flexed lateral of both elbows

Question 44

Why is flexed lateral the most important view for UAP?

Answer 44

It opens up the anconeal process

Question 45

What’s the posture in terms of elbows and paws designed to unload medial joint compartment seen with medial coronoid disease?

Answer 45

Elbows are abducted, paws are turned outwards (externally rotated)

Question 46

What’s the gold standard for medial coronoid disease diagnosis and why?

Answer 46

CT: allows quantification of incongruity, evaluation of subchondral bone (vs arthroscopy is just evaluating cartilage), but we can’t image the cartilage this way

Question 47

Difference between osteotomy and osteoctomy?

Answer 47

Osteotomy = remove part of bone, osteoctomy = remove entire bone

Question 48

What’s the alternative, more conservative management of elbow dysplasia?

Answer 48

NSAID, weight management, exercise modification, formal rehab, injections of steroids, stem cells, etc. radiation

Question 49

What are the 4 nonsurgical management techniques for elbow dysplasia, specifically osteochondrosis dissicans?

Answer 49

small lesions in dogs younger than 6.5 months, mild clinical signs or joint mice; dogs with advanced secondary OA where clinical value of flap removal is limited; NSAIDs, exercise changes, rehab, dietary changes, weight control; Complete surgical removal of the flap

Question 50

What are surgical management methods of osteochondrosis dissicans?

Answer 50

Arthrotomy or arthroscopy; flap excision and joint mouse retrieval; palliative techniques (curettage, abration arthroplasty, forage, microfracture); restorative techniques (fragment reattachment, osteochondral transplants)

Question 51

Most common sites of OCD lesions?

Answer 51

Stifle (least common location), shoulder (males > females), medial humeral condyle, talus

Question 52

Rank the prognosis of the OCD lesion sites (stifle, talus, medial humeral condyle, shoulder)

Answer 52

Best to worst: Shoulder > stifle + medial humeral condyle > talus