Flashcards in Orthopedics Deck (27)
What is osteochondrosis? It affects what kind of dogs
Failure of endochondral ossification in Large to giant breed dogs 4-7 months
What is Osteochondritis Dissecans?
Osteochondrosis with significant inflammation
How do we treat Osteochondritis Dissecans? Goals of treatment?
We treat this surgically
Remove cartilage flap and joint mice, or cartilagenous pieces
Stimulate sub-chondreal bone formations and new cartilage formation
What is the theory on how osteochondrosis occurs?
Due to an abnormal conformation there is increased pressure, and so less perfusion. This doesn't allow the cartilage to transform to bone. So cartilage thickens and you get fibrous tissue underneath, and cartilage eventually degrades. (leads to synovitis, lameness etc)
Which meniscus is most commonly damaged?
o Medial meniscus is most commonly damaged
What is pathopneumonic for a coxofemoral luxation?
o Prelvic limb adducted and externally rotated
What type of luxations are most coxofemoral luxations?
• 95% are CRANIODORSAL
What is the Outerbridge Classification?
0 to 5
0 = normal cartilage, 5 = eburnation
Grade 0 = normal cartilage
Grade 1 = cartilage with softening and swelling, mild, superficial fibrillation
Grade 2 = partial thickness defect. Fissures on the surface don’t reach the subchondral bone
Grade 3 = Fissuring to the level of the subchondral bone
Grade 4 = exposed subchondral bone
Grade 5 = Eburnation
What does Synovial Fluid do?
It provides nutrients to the cartilage and lubrication
What do Synoviocytes type 2 produce?
What 3 things do you see on radiographs for animals with osteoarthritis
o See synovial effusion – white density seen within joint
o osteophytes (>2wks)
o Subchondral bone sclerosis
What does gross inspection of synovial fluid tell you? – vol, color, turbidity, cell count, viscosity
Vol = more - problems? DJD? inflammation? sepsis?
Colour/Turbidity = clear to turbid = DJD; turbid = inflammation, turbid/opaque = sepsis Cell count = more cells = inflammation, few = DJD
Viscosity = less? DJD, more = inflammation, thick in sepsis
What 4 things can you do to manage osteoarthritis
1. Diet restriction
2. Exercise restrition
3. Chondroprotective agents
4. +/- alternative drugs?
Name 4 substances given to a dog with osteoarthritis
1. Fish oil (omega 3)
2. Pentosan polysulphate
3. Polysulphated Glycosaminoglycans
4. Glucosamine & chondroitin sulphate
What is the most frequent joint affected by OCD
Shoulder (+++), then elbow(++), hock(+), stifle & sacrum (-)
What are the clinical signs of OCD in the elbow? Treatment?
Holds elbows in, medial condyle of the humerus affected
Surgical osteochondroplasty (guarded to fair prognosis)
Clinical signs of OCD in the stifle
Caudal aspect of the lateral condyle of the femur
Shoulder luxations - common types
80% OF ALL LUXATIONS ARE MEDIAL (18% ARE LATERAL)
When do you use a Velpeau splint?
For a medial shoulder luxation – will push humerus out (lateral joint capsule still intact)
When do you use a Spica splint?
For a lateral shoulder luxation.
When do you use an Ehmer sling?
For a coxo-femoral luxation (cranio-dorsal)
Ehmer sling for 10d (otherwise will reluxate)
When do you use Hobbles?
For a coxo-femoral luxation which is ventral (happened b/c of leg coming OUTWARD – prevent this movement with hobbles)
Should you attept a closed reduction with a congenital shoulder luxation?
*don’t attempt closed reductions in congenital luxations
Bicipital Tenosynovitis - clinical signs
Strain injury of the biceps brachia tendon and is relatively frequent cause of lameness in the medium-to-large breed adult dogs
- Insidious onset (gradual)
- Intermittent lameness worsens with exercise
- Atrophy of shoulder muscles
- Positive “bicipital tendon” test (may not be specific to tendon) → will also be positive on OCD
Shoulder pain may NOT be evident in chronic cases
Bicipital Tenosynovitis - treatment (medical)
- Strict rest for 12wks (up to 7mo)
o Depo-medrol intraarticular - steroid (20-40mg) ONCE → breaks inflammation down
*NOTE steroids are deleterious to cartilage and tendons (can rupture tendon)
Bicipital Tenosynovitis - treatment (surgical)
- Bicipital tenotomy (arthroscopy) - cut the tendon
o Tendon is still attached to joint capsule
o Will then fuse back to joint and return to function
- Bicipital tenodesis (open approach)
o Transect diseased tendon and reattach it to proximal humerus → do this is working animals
o Velpeau sling for 3wks
o Rest for 6wks