Ortho ALD & Forelimb Flashcards
(234 cards)
1
Q
What are indications for BURP?
A
- treat cartilage malacia or limited fissures along radial incisure of MCP
- juvenile with clinical signs of bilateral elbow disease BUT minimal changes on arthroscopy
- adjuvant treatment to fragment excision in dogs with no radioulnar incongruity & mild cartilage disease
2
Q
What is the disadvantage of static ulnar osteotomy/ostectomy?
A
more involved measurements, doesn’t change with growth of the limb
3
Q
Where is the location to perform bi-oblique dynamic PUO?
A
junction of proximal and middle 1/3 of radius with angle 55 degrees caudal to cranial and 48 degrees lateral to medial
4
Q
What has been found for PAUL biomechanically?
A
it does unload medial joint, but doesn’t transfer load to lateral compartment
5
Q
What is the prognosis for dynamic osteotomies?
A
good - some have slower progression of OA, less pain & improved force plate analysis
6
Q
Treatment for T/Y fracture of scapula?
A
fix articular surface 1st with saw cranial to caudal, then the rest can be fixed with any wire vs. plate
7
Q
Treatment for medial/lateral labrum fracture glenoid?
A
larger dogs - 1or 2 lateral to medial lag screws
8
Q
Outcome for scapular articular fracture repair?
A
most have residual lameness
9
Q
Salvage for scapular articular fracture?
A
glenoid excision - good results
10
Q
Treatment for scapular luxation?
Prognosis?
A
20/22g wire around 5th, 6th, 7th rib & holes drilled ream caudodorsal border of scapula
11
Q
Treatment for scapular luxation?
Prognosis?
A
20/22g wire around 5th, 6th, 7th rib & holes drilled ream caudodorsal border of scapula
Px: excellent (if isolated injury)
12
Q
Is ununited accessory ossification center of caudal glenoid usually bilateral or unilateral?
treatment?
A
bilateral
scope removal/debridement – resolves lameness
13
Q
Medial and lateral humeral condyle appear when?
Fuse when?
Fuse to metaphysis when?
A
- medial: 14-22d
- lateral: 21-43d
- fuse to each other at 3mo
- fuse to metaphysis around 5.5-6mo
14
Q
What % of humeral condylar fractures are lateral vs. medial vs. T-Y?
A
- lateral: 34-67% of HC fractures
- medial: 37% of all humeral fractures
- T-Y: 26-35% of HC fractures
15
Q
What breeds are predisposed to humeral condylar fractures?
A
French Bulldogs - greatest
Yorkies
Cocker Spaniels (springer?)
16
Q
What % of humeral condylar fractures are lateral vs. medial vs. T-Y?
A
- lateral: 34-67% of HC fractures
- medial: 37% of all humeral fractures
- T-Y: 26-35% of HC fractures
17
Q
What breeds are predisposed to humeral condylar fractures?
A
French Bulldogs - greatest
Yorkies
Cocker Spaniels (springer?)
18
Q
What % of all non-traumatic lameness to elbow in dogs is congenital luxation?
A
15-20%
19
Q
What % of humeral condylar fractures are lateral vs. medial vs. T-Y?
A
- lateral: 34-67% of HC fractures
- medial: 37% of all humeral fractures
- T-Y: 26-35% of HC fractures
19
Q
What breeds are predisposed to humeral condylar fractures?
A
French Bulldogs - greatest
Yorkies
Cocker Spaniels (springer?)
20
Q
What are the 3 types of congenital elbow luxation?
A
- I: humeroradial (radius head –> lateral)
- II: humeroulnar (lateral rotation/subluxation or luxation of ulna)
- III: humeroulnar and humeroradial (often associated with generalized joint laxity)
21
Q
What type of congenital elbow luxation most common?
A
II
22
Q
Greater tubercle formed at ___ months
epiphysis fuses with metaphysis at ___ months (dogs vs cats)
A
- 4 months
- 7.5-12 months DOG
- 19-26 months CAT
23
Q
What is the humeral head - greater trochanter fusion angle?
A
102 degrees
24
What are the most common Salter Harris fractures in the proximal humerus?
I / II
25
Generally for humeral fractures...what is the prognosis for T-Y fractures?
- 41% excellent
- 52% good
- 10% fair
- but Tobias says guarded
- depends on severity of complications
26
List different treatment options for OCD of humeral condyle?
- remove flap, abrasion arthroplasty = worse outcome than FCP
OATS
- allografts (cadavers)
- autogenous (femoral trochlea)
- synthetic osteochondral transplant (thermoplastic polycarbonate urethane plug with titanium base -- good to excellent Px)
27
Describe the Modified Outerbridge scores for MCP
MOS1 = chondromalacia (soft, swollen, lucent, dull)
MOS2 = fibrillation (partial thickness defects)
MOS3 = deep fibrillation to subchondral bone (still has poor flocculent cartilage)
MOS4 = full thickness erosion
MOS5 = eburnation (burnished appearance)
28
What are 3 configurations for repairing acromion fracture?
- two wires (D-->V) with figure of 8 tension band
- inter fragmentary wire only (2)
- single inter fragmentary wire cross proximal then tie
29
What are the standard approaches to scapular neck fractures?
lateral or craniolateral with osteotomy of acromion process or tenotomy of acromial head of deltoideus
(+/- osteotomy of greater tubercle or tenotomy of infraspinatus or teres minor)
30
What is the alternative approach described for scapular neck fractures?
muscle separation between supra/infraspinatus & deltoideus
31
For Type I congenital elbow luxation
- breeds / age?
- treatment options?
- prognosis?
- 2-5months of age
- Large breeds (Afghan, Golden Retriever, Bull Mastiff, Boxer, Collie)
- Smaller breeds (Pekignese, Doxie, Shih Tzu)
32
For Type I congenital elbow luxation
- treatment options?
33
For Type I congenital elbow luxation
- breeds / age?
- 2-5months of age
- Large breeds (Afghan, Golden Retriever, Bull Mastiff, Boxer, Collie)
- Smaller breeds (Pekignese, Doxie, Shih Tzu)
34
For Type I congenital elbow luxation
- treatment options?
- Medical management: rest, PT, controlled exercise, joint supplements
Surgery
1. Open reduction (recon LCL + joint capsule) +/- surgical synostosis (temporary transarticular pin or interosseous screw)
2. Radial head ostectomy
3. Arthrodesis
4. Amputation
35
For Type I congenital elbow luxation
- prognosis?
combination of shorter radius & temporary transarticular pin = functional improvement
36
What are the differences in angling IM pins for humeral fractures in dogs vs. cats?
- Dog: toward/inserted into trochlea (medial) of humeral condyle
- Cat: into central area of distal part of diaphysis just proximal to olecranon fossa
37
What % of the humerus should the IM be?
36-45% width and 80% of humeral length
38
How do you position blade for subtotal coronoidectomy?
What is the advantage of this procedure?
- start caudal to MCL & aim slightly caudal to most caudal extend of coronoid fragment/fissure
- direct distocaudally to limit proximal-distal length
- can do parallel directions to remove in "slices"
- advantage: improve joint incongruence if positive radioulnar incongruence localized to apex
39
Is scintigraphy sensitive or specific for diagnosis of IOHC?
Not specific - can see bilateral increased uptake in young dogs
40
What is the average fracture rate of conservatively managed cases of IOHC?
~30-45%
one study if partial radiolucent line was 43% and complete 8%
41
Which direction of drilling a transcondylar lag screw had a higher rate of penetrating the joint?
medial to lateral
42
When can you actually diagnose UAP on rads?
not until 20 weeks of age
43
What is the prognosis for anconeal process removal?
>90% of owners satisfied
good to excellent (1994)
44
What situation may be amenable to anconeal process reattachment?
- ulnar osteotomy (UO) alone: success if <7mo & attached AP/non-displaced = good
- AP reattach + UO -- fusion rate 93% (good to excellent)
- problem is you have to catch it early
45
What is sensitivity/specificity for detecting MCP disease with nociceptive blockade?
sensitivity = 87%
specificity = 87%
46
With MCP, where do you commonly see osteophytes on rads?
- proximal anconeal process
- cranial radial head
- cranial edge MCP
- caudal lateral supracondylar crest
- medial contour humeral trochlea
- medial contour MCP
47
What % of MCP disease show trochlear notch sclerosis?
40-86.7%
48
What other rad sign is suggestive of MCP disease?
blunting/blurring of cranial edge MCP
sens = 80%
spec = 100%
49
What breed has highest predisposition to OC/OCD & MCP?
Labs, Rotties, GSD, BMD, Golden Retriever
50
For medial compartment disease, what & is bilateral?
25-80%
51
What % of Bernese Mountain Dogs with MCP disease have radioulnar incongruence?
60%
52
For the external rotational humeral osteotomy (ERHO), how much do you rotate?
How much pressure is decreased in medial compartment?
- rotate by 15 degrees
- 50% reduced pressure
53
What are the components made of with the CUE procedure?
- polyethylene plug -- MCP
- cobalt chromium prosthesis -- humerus "figure eight"
- ulnar -- porous titanium socket & polyethylene bearing surface
54
What are prognosis of traumatic elbow luxation with closed or open reduction?
- closed = early studies ~89% success (good to excellent) but reported as low as 47%
- open = good, provided not too much OA long term
- Sajilk JSAP 2016 - 20/37 needed open approach
55
What is the major complication of closed elbow reduction?
re-luxation
56
What breeds are predisposed / overrepresented to get medial humeral condylar fracture?
chondrodystrophic
57
List 3 approaches to T-Y fracture of humeral condyle
1. osteotomy of olecranon tuberosity
2. tenotomy of triceps brachii (avoid in immature patients)
3. combo medial and lateral approaches
58
For bilateral approach to T-Y humeral condylar fractures, where is the plate placed?
medial plate - caudal or caudomedially
lateral - caudal
59
Is contrast arthography more or less sensitive than US to diagnose biceps brachii tendinopathy?
MORE!
60
List medial vs. surgical treatment options for biceps tendinopathy
Medical
- triamcinolone/HA injection
- NSAID + rest
- ESWT (shockwave)
- PRP
- stem cells
- transcutaneous electrical nerve stimulation
- therapeutic US
- PT
Surgical
- tenodesis
- tenotomy
61
What breeds reported for medial displacement of tendon of origin of biceps brachii?
Tx & Px?
- Greyhounds, Afghan, GSD, Border Collie
- primary reconstruction of THR - or augment with screws & PDS or staples & polypropylene mesh
- excellent prognosis
62
What breeds predisposed to supraspinatus tendinopathy?
success of treatment?
- Rottweilers, Labradors
- variable, surgery vs. medial management debated
63
Describe classifications of scapular fractures
I. body + spine
II. neck
III. glenoid (including SGT)
64
What has been recommended for plate application on scapular body with regards to proximal and distal spine?
plate caudal to spine on proximal 1/2
plate cranial to spine on distal 1/2
65
What is prognosis for partial scapulectomy?
removal of 60% -- excellent recovery
66
For treatment of humeral condylar fractures, what are 2 approaches for lag screw?
1. normograde with fracture reduced
2. retrograde (glide hold) -- you can see lateral exit clearly, but medial could be severely affected
67
For lateral humeral condylar fracture repair, screw should be parallel to ____?
Outcomes?
parallel to lateral part of humeral condyle to decrease shear force
good outcomes
68
List treatment options for proximal humerus fracture with humeral head and greater tubercle together
- young dogs: 2 pins GT into humeral neck
- mature dogs: 2 K-wires and tension band or lag screws
69
List treatment options for proximal humerus fracture when humeral head and greater tubercle separate
- repair both with pins or K wires
- HH: wire cranial to caudal with pins inserted distal to GT directed proximally/caudally
- GT: wire and tension band
70
List treatment options for proximal humerus fracture with fracture of lesser tubercle
2 K wires or small screw in lag fashion
71
For IM pin placement in humerus, which insertion technique is NOT often recommended? Why?
Distal retrograde --> damage to periarticular ST & articular cartilage, & ulnar nerve entrapment
72
What are disadvantages of humerus for ILN?
- tapering bone
- often only 1 space available distally
- thickness of cortex proximally doesn't enhance screw holding power
73
With intact ligaments, you can rotate the paw ___ degrees in supination and ____ degrees pronation?
- supination = 17-50 degrees
- pronation = 31-70 degrees
74
Peak contact pressure shifts to MCP apex in (pronation/supination?) and away in (pronation/supination?)
- increased with PRONATION
- decreases with SUPINATION
75
What anatomic structures do you look out for when approaching the elbow via olecranon osteotomy?
- ulnar nerve
- collateral ulnar artery
76
The distal growth plate of humerus contributes to what & length?
20%
77
What age does the distal humerus GP close?
5-8 months
78
What are treatment options for bi-apical antebrachial ALD?
- plates (following a type of osteotomy)
- Hinged ESF
- *remember, ulnar osteotomized at each CORA
79
Prognosis for ALD of antebrachii?
depends on the study...
- studies on ESF show severity of OA & other functional impairments as prognostic indicators
- worse with bi-apical
80
For the CUR, what is the reported outcome?
- full function = 48%
- acceptable = 44%
- unacceptable = 9%
81
What is overall prognosis for surgery to treat end-stage MCP disease?
- favorable regardless of technique
- up to 90% good to excellent
82
Which procedures for elbow dysplasia have least complications?
DPUO <<< PAUL < CUE < SHO
83
List 6 treatment options for treatment of medial shoulder instability
1. transposition of origin of biceps or tendon of supraspinatus
2. augmentation of exciting MCL -- synthetic suture, screws/washer, bone tunnels, or suture anchors
3. imbrication of tendon of subscapularis
4. radio frequency induced thermal modification
5. excisional arthroplasty
6. arthrodesis
84
List treatment options for supracondylar fracture
- Pin/cross
- unilateral plating
- bilateral plating
- screw and anti-rotation wire
- transcondylar pin + anti-rotation pin
- transcondylar screw + anti-rotation screw or pin
85
For the humerus, which side (proximal vs. distal) of the bone has tension?
- proximal = craniolateral
- distal = caudomedial
86
For distal supracondylar fracture, what is the benefit of placing plate on caudomedial aspect? Caudal aspect?
- Caudomedial = helps angle screws in cranial direction avoiding olecranon fossa & max screw length/purchase
- Caudal = can place additional place craniomedial for fracture of small distal fragment
87
What % of developmental elbow disease is FCP? OC? Incongruity?
- FCP = >96%
- OC = 2.7-25.4%
- RUI = 6-50.3%
88
What breed is prone to radioulnar incongruity? What % get it with development elbow disease?
Bernese Mountain Dog
50%
89
What breed commonly gets OC?
Golden Retriever
seen in 25.4% of GR with development elbow disease
90
What % of dogs have bilateral elbow disease?
35%
usually giant breeds
91
What are 3 tests to perform for biceps tendinopathy?
1. Biceps tendon test - flex shoulder, press on inter tubercular groove
2. Drawer test - flex shoulder, grasp humerus, stabilize scapula, push cranial with humerus
3. Biceps retraction test - grasp tendon insertion near cranial elbow and pull caudal while standing
92
What are treatment options described for IOHC?
Prognosis?
Complication rate?
- transcondylar cortical screw
- transcondylar lag screw (shaft screw)
- transcondylar cancellous screw
- transcondylar cannulated screw
- transcondylar fenestrated tubular screw
93
What is prognosis and complicate rate for IOHC treatment
94
What are treatment options described for IOHC?
- transcondylar cortical screw
- transcondylar lag screw (shaft screw)
- transcondylar cancellous screw
- transcondylar cannulated screw
- transcondylar fenestrated tubular screw
95
What is prognosis and complicate rate for IOHC treatment
- more guarded than traumatic d/t concern for failure or non-union
- 23% reported implant failure/loss of reduction
- fair to guarded prognosis
96
List all reported areas of shoulder to get OCD
- caudocentral / caudomedial humeral head
- glenoid cavity
- medial to greater tubercle
- adjacent to inter tubercular groove
- glenoid adjacent
- adjacent to supraglenoid tubercle
97
What is normal flexion and extension of the shoulder in dog vs. cat?
Dog
- flexion = 57 degrees
- extension = 165 degrees
Cat
- flexion = 32 degrees
- extension = 164 degrees
98
What are passive vs. active mechanisms of stability in the shoulder?
Passive
- limited joint volume
- concavity compression
- glenohumeral ligaments
- joint capsule
- labrum
- origin of biceps brachii
Active
- infra/supraspinatus
- subscapularis
- teres minor
- biceps brachii
99
What path does radial nerve take after crossing the elbow?
craniolateral to joint, deep branch running under cranioproximal border of extensor carpi radialis
100
What is Campbell's test?
carpus/elbow flexed 90 degrees then supinate/pronate to induce luxation
101
What is the signalment, treatment, and prognosis for glenoid dysplasia?
- 3-10 months of age
- toy/mini-poodle, Chihuahua, Pom, other small dogs
- Tx = arthrodesis, excision of glenoid
- Px = "acceptable"
102
What is prognosis for multiple epiphyseal dysplasia?
poor - painful, usually euthanized
103
What breed is seen with focal humeral head dysplasia?
Boerboel
104
What is chondrocalcinosis? Breeds seen with this?
- aka pseudo gout - hydroxyapatite in articular cartilage
- Greyhounds - humeral head (bilateral)
- GSD - femoral head
105
What are the safe corridors for humerus (ESF)?
NONE
- can do I / I-II hybrid, but not ideal
106
For 2nd pin after transcondylar pin with ESF, what degree from lateral bar adds strength?
60-90 degrees
107
Describe ideal insertion & exit points for transcondylar pin/screw in the dog vs. cat
- Dog: aim pin craniodistal to lateral epicondyle to exit medial at similar point halfway between epicondyle and articular surface
- Cat: aim from spot just cranial to epicondyle exiting medial side just caudodistal to medial epicondyle
108
How does lateral shoulder luxation differ in PE than medial?
holds distal limb in adduction
109
For lateral should luxation, what bandage do you do?
Spica or neutral sling (NOT Velpeau)
110
For traumatic shoulder luxation, what are some additional treatment options besides glenohumeral ligament reconstruction?
- woven poly-L-lactide device augmentation
- modified Campbell prosthetic suture (through transverse holes in humeral head & scapular neck)
- temporary transarticular bridging (plate/screws)
111
List techniques to repair elbow luxations
1. collateral ligament primary repair +/- with synthetic suture/autogenous tissue (e.g. fascia)
2. avulsion humeral attachment - bone tunnels + suture OR anchor w/ screws + washers OR bone anchors
3. avulsion distal attachments - sutures to annular OR screw in lag fashion OR tension band
4. Ligament replacement - synthetic suture; "humeral transcondylar tunnel & bi-axial suture repair"
112
What are different mechanisms for medial shoulder instability in large vs small breed dogs? For small breed, which breeds most common?
- Large: overuse, repetitive microtrauma
- Small: congenital ST laxity progresses to subluxation
- TOY BREEDS
113
What is "normal" abduction angle vs. clinically affected for medial shoulder instability?
- normal = 30 degrees
- clinical = 50 degrees
114
List surgical techniques for medial compartment disease (15)
1. FCP removal + subtotal coronoidectomy
2. biceps ulnar release procedure (BURP)
3. osteotomy of radius (CERO)
4. dynamic distal ulnar ostectomy
5. segmental ulnar ostectomy
6. BODPUO
7. proximal abducting ulnar osteotomy (PAUL)
8. proximal ulnar rotational osteotomy
9. static ulnar osteotomy
10. sliding humeral osteotomy (SHO) or open wedge
11. external rotational humeral osteotomy (ERHO)
12. canine unicompartmental elbow (CUE)
13. Total elbow
14. arthrodesis
15. amputation
115
For CORA, which side is opening vs. closing CORA?
- opening = convex
- closing = concave
116
What does it mean to have partially compensated CORA? non-compensated?
Partially compensated
- CORAs with planes in opposite directions
- joints are parallel but translated
Non-compensated
- planes of 2 deformities in the same direction
- magnification of angulation
117
What breeds are seen with infra/supraspinatus muscle contracture? Treatment?
- medium to large
- Brittany Spaniels, Labs, Pointers
- Tx = tenotomy +/- excise a portion followed by PT
118
What is treatment for chondrometaplasia?
- debridement, NSAID, PT
- severe cases - arthrodesis / excision arthroplasty
119
You can do flexible ESF or PT for post-op luxation repair on elbows. What are benefits of early mobility?
- decrease adhesions between periarticular structures
- increase synthesis of GAGs + hyaluronate
- encourage more orderly collagen deposition and normal cross linkage
- improved joint nutrition
- improved clearance of joint hematoma
120
When should a flexible ESF be removed post elbow luxation repair?
3-4 weeks
121
For flexor enthesopathy, primarily affects ___% of cases?
Breeds? Treatment?
- 15-35%
- young labrador, GSD, English Setter
- Primary: medical management, IA steroids, tenotomy or partial excision of flexor tendon, resect osseous bodies
- good prognosis
- Concomitant: treat only intraarticular lesions
- prognosis less favorable
122
What are the functions of the 3 smaller synovial joints making the ginglymus (hinge joint)?
- humeroulnar: restrict joint to sagittal plane
- humeroradial: most weight bearing forces
- radioulnar: allows pronation, supination
123
What are the flexors/extensors of the elbow? Innervation?
Extensors
- triceps, anconeus, tensor fascia antebrachii
- radial nerve
Flexors
- biceps, brachialis
- musculocutaneous nerve
124
Where of the biceps brachii & brachialis muscles insert?
- Biceps: weak band on radial tuberosity, strong band on ulnar tuberosity
- Brachialis: ulnar tuberosity
125
What is ratio of muscles that give shoulder movement?
- 2/3 from shoulder joint
- 1/3 scapulothoracic synsarcosis
126
When does the glenoid physis fuse? Proximal humerus?
- Glenoid = 6 months
- Prox humerus = 1 year
127
What makes up "rotator cuff"?
- coracobrachialis + subscapularis medially
- supra/infraspinatus + teres minor laterally
128
What is unique about the medial glenohumeral ligament?
- Medially is Y-shaped
- Cranial leg is intra-articular
129
Fractures of humerus account for ___% of fracture in dogs and ___% in cats
8-10% in DOGS
5-13% in CATS
130
What is different between dog/cat humeri?
Cat
- no supratrochlear foramen
- has supracondylar foramen (median nerve and branch of brachial artery pass through)
Dog
- no supracondylar foramen
- membrane over supratrochlear foramen
131
Which breeds are predisposed to IOHC?
- SPANIELS
- Labs
- English pointer
- GSD
- Rottweiler
- Yorki
- German Wachtel
- Tibetan Mastiff
132
For IOHC, is unilateral or bilateral more common? Other elbow lesions are seen in ___%
- bilateral most common
- 23-25% have other lesions
133
What is the mean value of mLDHA?
134
What is the mean value of mLDHA?
86.9 degrees
135
What makes the distal humeral JOL?
caudodistal point on medial humeral epicondyle to center of best-fit circle superimposed over lateral humeral condyle
136
What are the mean value mCdPHA and mCrDHA?
- mCdPHA = 43 degrees
- mCrDHA = 71.9 degrees
137
List 2 approaches to humeral diaphysis. Disadvantages?
- craniolateral -- radial nerve in distal portion, must retract
- medial -- have to dissect /cut pectoral proximally; avoid median/ulnar nerves
138
What are possible indications of external coaptation for humerus?
- minimally displaced proximal physis
- greenstick fracture in young puppy/kitten
139
What usually causes proximal metaphyseal fracture of humerus?
- osteoporosis (OSA, young animal with hyperPTH)
- iatrogenic (e.g. grafting)
140
What are 2 salvage procedures for shoulder disease? Prognosis?
1. excision arthroplasty - only known in small dogs for good to excellent outcome
2. arthrodesis - good to excellent generally
141
For shoulder arthrodesis, what angle do you strive for?
105-110 degrees without varus/valgus
otherwise, >105-110 can lead to more lameness post-op
142
When making a craniolateral approach to the shoulder, which artery/vein do you watch out for and ligate?
omobrachial vein
143
What is the incidence of scapular fractures?
0.5-2.4% of all fractures
144
What inserts on the acromion?
acromion head of deltoideus muscle
145
What is the trajectory of supra scapular nerve?
emerges cranially from scapular notch and wraps distal to scapular spine (deep to acromion)
146
Where is the axillary nerve located?
emerges caudal border of subscapularis & crosses caudal scapulohumeral joint
147
What are the primary 2 differences of carpus/digits in the cat?
148
What are the primary 2 differences of carpus/digits in the cat?
- absence of straight medial collateral ligament
- cat claw retractable (as has the smaller dorsal elastic ligament attachment to dorsal P2 base & medial ungual crest and longer DEL from head of P2 to dorsal ungual crest)
149
Why can't dogs retract their claws
lack of dorsal elastic ligament attachment to head of middle phalanx, shape of head of middle phalanx different from the cat
150
Treatment for articular avulsion of P1 or P2
- small screws in lag fashion
- K-wire & tension band
151
When bandaging a forelimb, which breed should you limit time in bandage? Why?
Toy breeds - osteopenia
152
What are treatments options for digit joint issues?
- conservative: NSAID, rest, w/ or w/o splint
- ligament replacement
- transarticular ESF with small K-wires
- arthrodesis
- plate or tension band technique
153
When accessing proximal radial fractures (e.g. near head), what structure should you look for? Where is it located?
Radial nerve -- located deep/beneath supinator muscle!!
154
What surgical options are there for comminuted radial head/neck fractures?
155
What surgical options are there for comminuted radial head/neck fractures?
- circular ESF
- circular ESF hybrid
- +/- have ESF attached to ulna proximally ("radius floats")
- may need bone plate to keep ulna stabilized
156
Which approach to radius gives most direct access to bone?
medial - also resists cranial/caudal bending
157
Which side of radius is tension surface?
cranial
158
What type of ESF can by used for the radius?
I, IB, I-II, Hybrid, II, circular
159
Why is Ib such a great ESF option for the radius?
- 2 corridors with small ST/bone interference for placing transfixation pins
- placed craniomedial / craniolateral to have larger bone surface area
160
What is the benefit of double-block with circular/hybrid ESF?
allows each major segment to be engaged with separate ring block to assist with distraction & reduction before the two are locked together
161
What are techniques to use hybrid/circular ESF and avoid interference with elbow?
"strength" or "horseshoe" used at proximal aspect
162
Treatment options for distal radial fractures
- ESF (circular with olive tip wires)
- K-wire & tension band (articular)
- screw in lag fashion (articular)
- pancarpal arthrodesis (articular, irreparable)
163
Complications of toy breed dog with radial fracture repair
- skin irritation
- cold conduction
- synostosis
- angulation
- osteopenia
- plate failure
- screw loosening
- infection
164
With fracture of the proximal ulna, what is the advantage of retrograde pin placement?
165
With fracture of the proximal ulna, what is the advantage of retrograde pin placement?
decrease risk of directing into trochlear notch
166
When using wire tension band and pin for olecranon fracture repair, does the diameter of the pin or wire matter more?
wire
Neat, Vet Surgery 2006
167
What are treatment options for Monteggia Type I fracture?
closed reduction of radial head and normograde IM pin in ulna (+/- plate via open reduction if needed) & rigid coaptation
168
For Montaggia fractures, how do you treat a more distal fracture with radioulnar luxation?
suture repair of annular ligament
169
Surgical repair for styloid process fracture?
Single IM pin and tension band
170
With corrective ulnar ostectomy to treat radial shortening, what age is recommended and why?
skeletally mature -- less risk of gap healing quickly
171
For radial shortening corrective ulnar ostectomy, why do some suggest proximal to interosseous ligament?
to avoid varus deformity
172
Distal ulnar physeal injury is ___% of all physis injuries. Why?
63%
conical shape - can't shear
173
For antebrachial deformity, torsion in >___ degrees leads to radiographic miscalculation >___ degrees in frontal plane
>15 degrees
>5 degrees
174
For uniapical deformities in the radius, CORA is most often where?
on or just proximal to distal physis or physeal scar
175
What is Hueter-Volkmann law ('Delpech's law')?
What breeds have this normally?
- physeal growth slowed by excessive compression & accelerated by distraction (forms partially compensated bi-apical deformities)
- Chondrodystrophic breeds (80% bi-apical)
176
List surgical techniques to treat ulnar shortening (9)
1. ulnar ostectomy
2. dynamic (distal to coronoid) ulnar ostectomy (semi-controlled)
3. controlled ulnar ostectomy (IM pin in young patient)
4. Oblique osteotomy in mature patient
5. distal ostectomy (+/-removal of distal physis
6. ulnar osteotomy (mature patient)
7. sagittal sliding osteotomy
8. stapling of distal physis of radius
9. ulnar styloid transposition with aggressive ostectomy of distal ulna
177
Which side of the carpus most often affected by shearing injury?
medial
178
With flexor tendon lacerations, which is most often affected with carpus?
deep digital flexor
179
What are 2 surgery options described for flexor tendon lacerations?
- primary repair with flexion bandage
- DDF tendonectomy (cat)
180
What are alternative treatment options / adjuvant therapy for flexor tendon lacerations?
- modified HA & lubricin in tendon reconstruction
- PRP
181
What breeds are over-represented with sesamoid diseases?
Which bones are most affected?
- Rottweilers and Greyhounds
- II / VII
182
What are treatment options for sesamoid disease?
conservative = better than surgery in literature
183
Which of carpal joints more commonly luxated per Nakladal 2013? per Piermatti/Flo 2006?
Nakladal - 47% carpometacarpal
Piermatti/Flo - 50% middle carpal
184
List different total elbow replacement systems
- Chancrin (linked)
- Lewis
- Cook (hybrid)
- Conzemius (Iowa State)
- TATE (Acker/Van Der Meullen)
- BANC (hemiarthroplasty by Wendelburg/Tepic?)
185
What are the components of the BANC system made of?
- humeral part -- UHMW polyethylene conical disc with titanium cylinder
- polyethylene insert articulates into titanium hemicircular ulnar piece
186
For the IOWA STATE total elbow, what is the surgical approach, bone prep, implantation, primary fixation, secondary fixation?
- lateral CL desmotomy for elbow luxation
- humerus -- condylar wedge ostectomy
- RU -- semicircular ostectomies
- sequential
- bone cement = primary
- bone ingrowth = secondary
187
For the TATE total elbow, what is the surgical approach, bone prep, implantation, primary fixation, secondary fixation?
- medial epicondyle osteotomy (NO elbow luxation
- Humerus - R - U simultaneous articular resurfacing, limited bone resection
- simultaneous
- press-fit = primary
- bone ingrowth (both components) = secondary
188
For the BANC total elbow, what is the surgical approach, bone prep, implantation, primary fixation, secondary fixation?
- medial epicondyle osteotomy (needs subluxation)
- H-U simultaneous articular resurfacing preserves lateral compartment
- sequential
- bone screws = primary
- bone ingrowth (both components) = secondary
189
Which digits most often affected with metacarpophalangeal OA?
IV / V >> II / III
190
What breeds predisposed to carpal laxity syndrome?
Dobermans, Sharpeis
191
What breed affected by paw pad corns? Recurrence rate?
Greyhounds
> or = to 50%
192
Treatment for R/U collateral ligament tears?
primary repair with synthetic suture augmentation recommended
193
What % of thoracic limb weight is born by the radius?
51%
194
Where is the interosseous ligament compared to interosseous membrane?
membrane proximal and distal
195
What are the muscles that originate between radius and ulna at level of mid-diaphysis?
- pronator quadratus
- DDF
- abductor pollicus longus
196
What % of the distal radius/ulna physis contributes to long growth?
radius - 30-50%
ulna - 100%
197
What may need to be done with intra-articular fracture (comminuted) of ulna before applying a plate?
need inter fragmentary compression via positional screws or screws in lag fashion
198
What is a Montaggia fracture? Describe fracture types
Fracture of proximal ulna and subluxation or luxation of radial head
I. (most often) cranial luxation of radial head, cranioproximal angulation of ulna fracture
II. caudal luxation of radial head & caudal angulation of ulna fracture
III. lateral luxation of radius
IV. fracture of proximal part of R/U diaphysis with cranial luxation of radial head
199
What are methods to treat metacarpal fractures?
- IM K-wire normaograde starting proximal
- Dowel pin technique
- plate 1.2-2mm
200
What are methods to treat metacarpal fractures?
- IM K-wire normaograde starting proximal
- Dowel pin technique
- plate 1.2-2mm
- ESF + small pins & epoxy putty / tie-in (spider)
201
Digit masses - about what % are malignant?
~60-75%
202
Digit masses - what is the most common neoplasia? %?
Where does it arise?
Prognosis?
- SCC
- 24-38% (depending on study)
- subungual epithelium
- poor prognosis (higher met rate than other parts of the body)
- one study = 72d
- another study 76% 1 year survival with amputation; 43% 2 year survival
203
What average age of radial/ulna physeal closures?
222-250 days
204
What is the mean procurvatum of the radius?
26 degrees
205
For radial shortening, what are the types of treatment?
1. radius elongation
- transverse osteotomy & pins in humeral condyle & proximal radius metaphysis
- Stader apparatus (linear ESF threaded bar)
- acute distraction with osteotomy (transverse or sagittal sliding osteotomy)
2. ulnar ostectomy
206
What makes distal radial joint orientation line in frontal plane?
lateral most aspect of articular surface & medial aspect of articular surface (IGNORE styloid process)
207
What is the equation for procurvatum in the radius?
(90 degree - aCdPRA) + (90 degree - aCdDRA) + intersection of anatomic axis
208
What is the mean procurvatum of the radius?
27 degrees
209
What are sex/breed predilection for intermedioradial carpal bone fracture?
- male > female
- Boxer, English Springer, Setters, Pointers
210
Treatment options and aftercare for intermedioradial carpal bone fracture?
- lag screw & headless self-compressing screw or K-wire
- coapt for 6 weeks with rest
211
What is most common fracture configuration of intermedioradial carpal bone?
dorsal slab fracture
212
List types of surgery for treatment of ALD in R/U
- bone plate
- circular ESF
- linear ESF
- hybrid ESF
- use of opening wedge, closing wedge, dome, or cylindrical
213
What is the disadvantage of dome or cylindrical cut for R/U ESF?
less bone apposition than closing wedge & potential for under correction
214
What are surgery treatment options for congenital elbow luxation?
- conservative
- open reduction & fixation (R/U screw/pin?)
- radial head ostectomy
- elbow arthrodesis
- amputation
- closed reduction - circular ESF (Olive/stopper wire)
215
What are treatment options for proximal/distal radial physeal fracture?
Possible risks?
in juveniles, both K-wire cross pinning open or closed reduced via fluoro
premature closure of GP, pin migration, possible radial shortening & angular deformation, OA, loss of motion
216
When do you remove implants following fracture stabilization of proximal/distal radial physeal fracture?
4-6 weeks
217
What % of humeral condylar fractures are lateral vs. medial vs. T-Y?
- lateral: 34-67% of HC fractures
- medial: 37% of all humeral fractures
- T-Y: 26-35% of HC fractures
218
What breeds are predisposed to humeral condylar fractures?
French Bulldogs - greatest
Yorkies
Cocker Spaniels (springer?)
218
Greater tubercle formed at ___ months
epiphysis fuses with metaphysis at ___ months (dogs vs cats)
- 4 months
- 7.5-12 months DOG
- 19-26 months CAT
219
What is the humeral head - greater trochanter fusion angle?
102 degrees
220
Which approach is recommended for accessory carpal bone fracture?
palmarolateral
221
Which type of accessory carpal bone is non-surgical?
V
222
What should be preserved with repair of accessory carpal bone fracture?
paired accessory metacarpal ligaments & accessory ulnar carpal ligaments
223
What are the Iowa State total elbow components?
- cement/porous --> cobalt chrome humeral stem, UHMW polyethylene RU part (humeral stem not side specific)
224
What are the TATE total elbow components made of?
- cementless cobalt chrome humeral part
- UHMW polyethylene RU part (with CoChrome backing)
- 3rd generation = titanium humeral component with titanium nitride coating humerus hydroxyapatite coating metal-bone surfaces
225
What are Paley's 3 rules of osteotomy? End result of each?
1. Osteotomy & ACA w/ CORA -- co-linearity of axes achieved
2. Osteotomy at different level but ACA & CORA same -- co-linearity axes with translation
3. Osteotomy & ACA together but different than CORA -- parallel axes with undesirable translation
226
What does it mean to have a CORA called bi-planar?
actually uniplanar oblique to orthogonal directions
227
for graphical method of plane determination, what does the vector direction go?
plane of deformity that is 180 degrees opposite bone angulation (e.g. valgus goes medial)
228
What is the angulation correction axis?
hinge point on which rotation 2 segments of bone (choice of surgeon)
229
For Type II congenital elbow luxation, which breeds are predisposed?
How might they stand (if bilateral)?
- male > female
- Small breeds: Yorki, Boston, Mini Poodle, Min Pin, etc.
- cross thoracic limbs & walk on elbows/antebrachium
230
What are treatment options for Type II congenital elbow luxation?
Prognosis?
closed reduction & immobilization
- pin or modified ESF
- successful if <4 months old
open reduction & immobilization
- medial imbrication
- transpose olecranon medial/distal
- ulnar osteotomy & R/U synostosis
- trochlea/trochlear notch reconstruction
- ESF or transarticular pin
Fair to good prognosis for both
231
Describe the path of the radial nerve
originates proximomedial to humerus and passes caudally deep to lateral triceps, courses cranially/distal with brachialis
232
What % humeral fractures occur proximal, diaphyseal, supracondylar, and condylar in the dog and cat?
Dog
- proximal = 5%
- diaphyseal = 39%
- supracondylar = 15%
- condylar = 40%
Cat
- proximal = 2%
- diaphyseal = 75%
- supracondylar = 18%
- condylar = 5%
