Flashcards in SA Orthopaedics Deck (279)
What should you check if there is a fracture on one side of the pelvis?
Check the other side for fractures as the pelvis is usually broken in 2 places
What would happen if you didn't repair a hip fracture?
How can you check whether a pelvic radiograph is straight?
Check that the obturator foramen are symmetrical
How do you know if an animal is deep-pain negative or positive?
Animal will pull foot away on reflex, but if it is deep-pain positive it will also look around/yelp/HR will increase
What should you assess when an animal is presented with a possible pelvic fracture?
Control haemorrhage if present
Fluids and shock therapy
Check for other injuries eg diaphragmatic rupture, neurological injury, urinary tract, function of pelvic nerve-perineal reflex
Analgesics-opioids, NSAIDs (not if renal dysfunction)
How may a fractured pelvis affect breeding?
May lead to pelvic narrowing
What is neuropraxia?
Has voluntary movement but can't feel ends of feet
Fractures affecting which parts of the pelvis are suitable for conservative management?
Those on non-weightbearing axes:
Wings of ilium
What conservative management would you prescribe to a patient with pelvic fractures?
Cage rest for 4-6 weeks
If non-ambulatory: frequent turning and soft bedding
Check bladder qid if not urinating consciously
Analgesia (opioids- full or partial agonists of buprenorphine, NSAIDs if not worried about kidneys)
Surgical treatment is required for which fractures of the pelvis?
Iliac shaft fractures
Femoral head and neck excision is only recommended for dogs up to which weight?
How do cats' vertebrae differ from dogs?
Cats' are longer and thinner
How do sacroiliac fractures commonly occur?
RTA in cats
How will an animal present if it has a sacroiliac separation?
+++ pain (esp if nerve root entrapment)
What treatment is required for sacroiliac separation?
-Lag screw fixation (most commonly used; one long screw in sacral body)
How would you repair an iliac shaft fracture?
Most require internal fixation (plating)
Surgical approach involves 'gluteal roll up'
How would you repair an acetabular fracture?
Internal fixation (plate)
Small dogs/cats: femoral head and neck excision
Surgical approach involves trochanteric osteotomy or gluteal tenotomy
Which nerve runs over the greater trochanter of the femur?
What post-operative care would you recommend for pelvic fractures?
Cage rest/restricted room rest for 4-8 weeks
Treat as with conservative management-short on-lead walks (5-10 mins) until re-radiograph
See at 3, 7-10 days then 4-8 weeks post-op for repeat radiographs
Analgesia, soft bedding
How would you identify a pathological fracture on a radiograph?
What may cause a pathological fracture in puppies and kittens?
What may cause a pathological fracture in a rottweiler?
How many carpal bones are there?
What are the carpal bones supported by?
Give some clinical signs of problems with the carpus
-FL lameness (usually non weight-bearing)
-Abnormal stance: palmigrade
-Soft tissue swelling
-Pain/discomfort on manipulation
-Crepitus on range of motion
-Instability: lateromedial or craniocaudal
Which dog breeds are more prone to degenerative processes in the carpal ligaments/palmar fibrocartilage?
How would you diagnose a carpal/tarsal/metacarpal/metatarsal/phalangeal injury?
-History: acute vs chronic, trauma?
-Diagnostic tests: radiography (plain vs stress views), CT, MRI (rare), synovial fluid analysis (OA, inflammatory), scintigraphy (to localise lameness)
How does hyperextension of the carpus occur?
Caused by disruption of palmar ligaments and fibrocartilage
How would a dog present if it had hyperextension of the carpus?
Initial swelling of joint which would reduce after a few days, no obvious signs of pain
Which joint is most likely to be affected by hyperextension of the carpus?
How would you idenitfy hyperextension of the carpus on a radiograph?
Opening in carpal joint space -> ligaments/fibrocartilage has ruptured
How do you treat hyperextension of the carpus?
-Partial carpal arthrodesis (pin/plate fixation)
-Pancarpal arthrodesis (dorsal/palmar plate. external fixator)
Shearing injuries of the carpus are more common on which aspect of the limb?
How many tarsal bones are there?
Give some clinical signs of problems with the tarsus
-HL lameness (usually non weight-bearing)
-Abnormal stance: plantigrade
-Soft tissue swelling
-Pain/discomfort on manipulation
-Crepitus on range of motion
-Instability: lateromedial or craniocaudal
Which tendon inserts on the calcaneus?
Common calcanean tendon
Give some specific pathologies that affect the tarsal joint
-Luxation of tendon of SDFT
-Common calcanean tendon pathologies
How can you repair tarsal luxations/subluxations?
-Ligament rupture reconstruction
-Ligament augmentation with prosthetic ligaments
-Reattach avulsed ligaments if possible
How would you repair a fracture to the calcaneus?
Lateral or plantar plate fixation
How would you repair an avulsion of the common calcanean tendon/proximal fracture of calcaneus?
Pins and tension band on calcaneus
How would you repair fractures of the tarsal bones?
-Reduction and stabilisation with pins/lag screws/plates
-If very small fragments: conservative vs removing fragments
-Arthrodesis: partial tarsal arthrodesis vs pantarsal arthrodesis
How would you diagnose luxation of the superficial digital flexor tendon?
How does it occur?
-Popping sensation on hock (tarsus) ROM
-Caused by rupture of the medial or lateral retinaculum
How would you treat luxation of the superficial digital flexor tendon?
-Debridement of fibrous tissuse and tendon reduction
-Suture tendon and ruptured retinaculum
-Remove/imbricate (overlap) stretched retinaculum
-Lateral splint support for 2-3 weeks
Which tendons make up the common calcaneal tendon?
-Common tendon of biceps femoris, semitendinosus and gracilis
How could you differentiate between partial and complete rupture/avulsion of the common calcaneal tendon?
Partial: plantigrade stance with flexed digits (as SDFT is not affected)
Complete: plantigrade stance with normal/extended digits
How would you diagnose common calcaneal tendon injuries?
-Radiography: soft tissue swelling, chronic changes, avulsions
How would you treat a common calcaneal tendon injury?
-Debride necrotic edges of tendon
-Suture tendon individually
-Make bone tunnels if avulsions of small bone fragments (to place sutures through)
-Reattach large avulsions: pins and tension bands
How would you manage a common calcaneal tendon injury post-surgery?
Immbolisation for 8-10 weeks:
-Cast/lateral splint (don't provide much support)
Osteochondritis dissecans (OCD) is more common in which kind of dog breeds?
Osteochondritis dissecans typically affects which ridges of the talus?
Affects both, but medial more often
What is osteochondritis dissecans?
Disturbance of endochondral ossification
How would you diagnose osteochondritis dissecans?
How do you treat osteochondritis dissecans?
-Conservative vs surgical (open or arthroscopy)
-Surgical has bette prognosis, but better results if patient <6 months old
What is likely to occur as a result of osteochondritis dissecans?
What is the prognosis for osteochondritis dissecans?
How would you treat a fracture/luxation of the central tarsal bone?
-Positional screw into 4th tarsal bone
-Lateral splint support for 4 weeks
Which dog breed is predisposed to tarsal hyperextension?
How would you treat subluxation/luxation of the tarsal bones?
Partial tarsal arthrodesis (bone plate or external fixator)
What are the principles of arthrodesis?
-Remove articular cartilage, exposing subchondral bone
-Maintain proper joint angles
-Rigid long-standing fixation (most commonly bone plates)
-Additional stabilisation: splints
What is the proper joint angle of the carpus?
10-12 degrees of extension
What is the proper joint angle of the tarsus in dogs and cats?
Dogs: 135-145 degrees of extension
Cats: 115-125 degrees of extension
Give some clinical signs of metacarpus/tarsus/phalanges injuries
-Soft tissue swelling
-Pain/discomfort on manipulation
-Crepitus on ROM
-Instability: lateromedial or craniocaudal
How would you treat metacarpal/metatarsal fractures?
Conservative with external coaptation (casts/bandages)
Surgical with IM pins or dorsal plates if:
->2 bones involved (esp bones II and III)
-Base of bones are affected or aricular fractures
-Large breeds/working dogs
How would you repair luxations/subluxations of the phalanges?
-Reductions and primary repair of ruptured ligaments (support with external coaptation or external fixator)
Give some indications for imaging the skeletal system
-Swelling centered on bones/joints
-Monitoring/screening for inherited musculoskeletal disease (eg hip dysplasia)
-Metabolic bone disease
-Evaluation of systemic disease
How may geometric distortion occur when taking a radiograph?
If structure is towards the edge of the collimated area, or not truly parallel to the film/detector
Give some limitations of radiography
-Oblique projections can create apparent artefactual lesions
-Poor soft tissue contrast resolution
What is serial radiography?
Multiple radiographs taken over a period of time
Why may you want to utilise serial radiography?
-Monitor progression of disease
-Assess dynamic component of disease
-Can be useful if diagnosis is uncertain
-Show diseases radiographically occult (hard to see) in their early stages
How should you describe a radiographic lesion using the Rontgen signs?
1. Number of lesions
3. Shape (inc margins)
What should you consider when you see a lesion on a radiograph?
-Could be an artefact of poor positioning/technique
-Could be a feature/variant of normal anatomy
-Could be a composite shadow of superimposed normal structures
What should you assess when looking at bones on a radiograph?
-Alignment, shape, length
-Periosteal reaction/cortical lysis/defects
What should you assess when looking at joints on a radiograph?
Why may you see a focal reduction in size of soft tissues (eg muscles) on a radiograph?
-Neurogenic (eg nerve damage)
Why may you see a focal increase in size of soft tissues (eg muscles) on a radiograph?
Why may you see a diffuse increase in size of soft tissues (eg muscles) on a radiograph?
What part of the bone is the endosteum?
Layer surrounding the medulla
A reduction in opacity means the radiograph is different how?
Why may there be a reduction in opacity on a radiograph?
-May be artefactual
-If generalised: nutritional secondary hyperparathyroidism
-If focal: neoplasia, occasionally osteomyelitis
What % of mineral loss of a bone is required for it to have reduced opacity on a radiograph?
(Takes a minimum of 7 days to become apparent)
What are the 3 descriptions of focal bone lysis?
How aggressive are they?
Geographic (less aggressive, area of lysis is fairly well-defined)
Permeative (more aggressive, lots of tiny areas of destruction, poorly defined)
Describe a typical aggressive bone lesion as seen on a radiograph
-Long transition zone
-Active periosteal reaction
-Cortical integrity is damaged by destruction/expansion
-Soft tissue swelling/mass
How should skeletal lesions be categorised?
What should you assess regarding joints on a radiograph of a lame animal?
-Soft tissue swelling
-Joint space width
-Subchondral bone opacity
What are enthesophytes?
Abnormal bony projections as the attachment of a tendon/ligament
What are osteophytes?
Abnormal bony projections in joint spaces
Give some examples of subchondral defects
-Aseptic necrosis (femoral head)
-Erosive arthritis (carpus/tarsus)
-Soft tissue neoplasia
-Osseous cyst-like lesions
-Osteoarthritis (only if very severe)
Give some pathologies that may occur on the periarticular bone of a joint
-Osteophytes (joint capsule)/enthesophytes (ligament attachments)
-Synovial osteochondroma (cats)
What is an osteochondroma?
Benign bone tumour
Appears as cartilage-capped bony projections on the surface of bones
How would you identify osteoarthritis on a radiograph?
-Soft tissue swelling/effusion
-Periarticular new bone at predictable sites (osteophytes) (eg end of patellar, trochlear ridge)
-Narrowed joint space (if weight-bearing/very severe)
-Look for primary disease process
With osteoarthritis, which part of the elbow is the first to get osteophyte formation?
What is the significance of calcified bodies in the joints on radiographs?
-Normal at predictable sites (sesamoids, accessory centres of ossification)
What are the predilection sites of osteochondrosis?
1. Caudal aspect of humeral head
2. Media part of humeral condyle
3. Lateral femoral condyle
4. Medial trochlear ridge of talus
What are the predilection sites of osteosarcoma?
1. Proximal humerus
2. Distal radius/ulna
3. Distal femur
4. Proximal tibia
US is useful for which joint in particular?
Shoulder (soft tissue problems are common and difficult to evaluate with radiographs)
Which key soft tissue structures of the shoulder are useful to evaulate with US?
-Biceps tendon and sheath (craniomedial)
-Supraspinatus and infraspinatus muscles/tendons (lateral/craniolateral)
How is the hip joint kept stable?
-Teres ligament (attaches femoral head to acetabular fossa)
-Trans-acetabular ligament (ventral aspect of joint)
Give some developmental conditions of the hip joint
Give some acquired conditions of the hip joint
-VWHOOD (von Willebrand associated heterotopic osteochondrofibrosis of Dobermans)
Give some traumatic conditions of the hip joint
-Fractures of femoral head and neck
How would you characterise hip dysplasia?
Laxity and instability of the coxofemoral joint
Which animals are more prone to hip dysplasia?
-Large breed dogs
-Pedigree cats eg Maine Coon, Devon Rex
Which factors control the degree of joint laxity in hip dysplasia?
-Genetics, growth rate, nutrition, exercise
Give the aetiopathogenesis of hip dysplasia
-Laxity due to poor soft tissue support of coxofemoral joint -> thickening of joint capsule -> early OA -> femoral head subluxates from acetabulum
-Erosion of joint margins (eg dorsal acetabular rim)
-Pain and disuse -> poor muscle development around hip -> further destabilisation
Give the 2 presentations of hip dysplasia
-Young dogs (<1yr old) which suffer pain due to joint laxity and joint inflammation
-Older dogs with chronic OA of hip secondary to hip dysplasia
Give the clinical signs of hip dysplasia in younger dogs
-Unilateral/bilateral HL lameness
-Reluctance to exercise
-Pain upon hip extension/flexion
-Positive Ortolani test (ie hip luxation)
Give the clinical signs of hip dysplasia in adult dogs
-Stiffness after rest/exercise
-Pain upon joint manipulation and reduced ROM
How do you diagnose hip dysplasia?
-History + clinical signs + radiography
-Radiography can be static (VD, frog-legged or latromedial) or dynamic (not common in UK)
Which radiographic view is required for the BVA Kennel Club Control Scheme for hip dysplasia?
VD with the HLs extended such that the femurs are parallel
Give some primary radiographic changes of the hip joint with hip dysplasia
-Wide joint space with medial divergence
-Centre of femoral head lying on/lateral to dorsal acetabular rim
-Coxa valga (>150 degree angle of femoral shaft to neck)
Give some secondary radiographic changes of the hip joint with hip dysplasia
-New bone formation around femoral neck within acetabular fossa
-Remodelling of cranial acetabular rim
What are the treatment options for hip dysplasia?
How would you conservatively treat a dog with hip dysplasia?
-Controlled lead exercise
What are the surgical treatment options for hip dysplasia?
-Young dogs: triple pelvic osteotomy, juvenile pubic symphysiodesis
-All dogs: femoral head and neck excision, total hip replacement (if >9 months old)
Describe a triple pelvic osteotomy
-Aims to increase cover of the femoral head in hip dysplasia by rotating the acetabulum dorsally
-85% success rate
-Candidate must be skeletally immature and have no secondary radiographic changes
Describe juvenile pubic symphysiodesis
-Aims to close the pubic symphysis -> early rotation of acetabular head -> increased cover of femoral head
-Must be performed before 20 weeks of age
Give some indications for performing a total hip replacement
-OA secondary to hip dysplasia
-Healed femoral head/acetabular fractures
-Recurrent coxofemoral luxation
-Candidates must have a recurrent lameness, be non-responsive to conservative treatment, and have no evidence of systemic/spinal/dermatological disease
When may femoral head and neck excision be performed?
-Hip dysplasia, Legg-Perthe's disease, infectious arthritis, femoral head and neck fractures not amenable to surgical repair
What should you remove when doing a femoral head and neck excision?
All of femoral neck and bony spurs
What is the success rate like for femoral head and neck excision?
-Moderate to poor in dogs >15-20kg
-Good in small dogs and cats
Which muscles should be preserved when doing a femoral head and neck excision?
Gluteals, hence use a craniolateral surgical approach
There is a specific genetic hip dysplasia predisposition test for which dog breed?
How does the Kennel Club Hip Dysplasia Control Scheme work?
-Scoring of radiographic changes in dog over 1 year
-Each dog is given a score which is compared to the breed average
-Determines suitability for breeding
What is Legg-Calve-Perthe's disease also known as?
Avascular necrosis of femoral head
Describe Legg-Calve-Perthe's disease
-Ischaemia of femoral head bone -> deformity of subchondral bone -> flattened femoral head -> joint instability
Which dog breeds does Legg-Calve-Perthe's disease affect?
-Small breeds eg terriers, miniature poodles
-Autosomal recessive gene -> don't use for breeding
What are the clinical signs of Legg-Calve-Perthe's disease?
-Clinical signs at 5 months old
-Progressive unilateral HL lameness
-'Bunny-hopping' or crouching of HLs
-Pain on hip manipulation
-May be crepitus and muscle atrophy
How will a dog stand if they have a coxofemoral luxation?
Affected side: leg will cross over in front of opposite leg
-Affected leg is carried in slight flexion
-The greater trochanter is prominent and displaced cranially and the affected leg is shorter
-Increased distance between the greater trochanter and tuber ischii
How do you diagnose Legg-Calve-Perthe's disease?
Radiography-focal bone lysis, 'apple-core' appearance
How do you treat Legg-Calve-Perthe's disease?
Femoral head and neck excision (excision erthroplasty)
Why is post-op rehabilitation recommended after femoral head and neck excision when treating Legg-Calve-Perthe's disease?
What would you recommend?
-Reduces the decrease in ROM from excess scar tissue formation
-Once sutures are remived, encourage dog to use the limb increasingly over the first 4-6 weeks (eg on-lead walks, stairs, swimming)
Give a rare complication of femoral head and neck excision when treating Legg-Calve-Perthe's disease
Medial patellar luxation (due to relocation of proximal femur)
Where is the capital physis?
Growth plate on head of femur
Capital physeal fractures of the femur occur in which animals?
Immature animals (4-7 months) as a result ot trauma
Give the presenting signs of a capital physeal fracture of the femur
-Pain on hip manipulation
-Often no crepitus
How do you diagnose capital physeal fractures of the femur?
How do you treat capital physeal fractures of the femur?
Place 3 diverging Kirschner (K) wires to retabilise the fracture
Capital fractures occur most often as a complication of what?
How do you treat a capital fracture?
-Femoral head and neck excision in small dogs and cats
-Excision of fragments and treatment of luxation
-Lag screw fixation of fragments with counter sunk screws
Where and when do femoral neck fractures occur?
-At the base of the neck at its junction with the metaphysis of the proximal femur
-Occur in mature dogs and cats following an RTA/fall
How do you surgically treat a femoral neck fracture?
-Lag screws and anti-rotational K wire
-Or triangulation with diverging K wires
What is the most common direction of a coxofemoral joint luxation?
How do you diagnose a coxofemoral joint luxation?
History, clinical signs, radiography (VD and lateral views of pelvis)
How do you treat a coxofemoral joint luxation?
-Closed reduction: anaesthetise patient, lateral recumbency, apply traction in a ventrocaudal direction, should feel 'clunk' as femoral head engages with acetabulum. Must be done within 48 hours
-Open reduction: surgery
When should closed reduction not be used to treat a coxofemoral joint luxation?
-Avulsion fracture of femoral head
How should you care for an animal after closed reduction of a coxofemoral joint luxation?
-Place animal in an Ehmer sling for 3-10 days
Why may re-luxation occur after closed reduction of a coxofemoral joint luxation?
-Haematoma, bone fragments -> poor seating of acetabulum
-Inherent instability (eg hip dysplasia)
-Damage to surrounding musculature
-Ipsilateral fracture of hemipelvis
What should you do if re-lexation occurs after closed reduciton of a coxofemoral joint luxation?
-Open reduction and stabilisation (ie surgery)
Which surgical techniques can you use for an open reduction and stabilisation of a coxofemoral joint luxation?
-Suture joint capsule
Birefly describe what happens during an open reduction and stabilisation of a coxofemoral joint luxation
-Craniolateral approach to hip
-Remove haematoma and bone fragments from acetabulum and lavage
-Replace femoral head with caudal traction of femur
-Suture joint capsule
-Keep in place by augmenting joint capsule
How can you diagnose stifle conditions?
-History and clinical signs
-Examination under sedation/anaesthesia
-Scintigraphy and CT/MRI
Where should you carry out arthrocentesis of the stifle joint and why?
-Insert needle proximally to enter the femoropatellar region, to avoid the fat pad being sucked onto the end of the syringe
How would synovial fluid appear in cruciate disease?
-May be pale yellow to orange-red
Give some developmental conditions of the stifle
-Growth disturbances eg Genu valgum (severe valgus, 'knock knee'
Give some acquired conditions of the stifle
Give some traumatic conditions of the stifle
-Fractures and luxations
-Ruptured ligaments eg CCL, patellar
-Avulsions (long digital extensor tendon, gastrocnemius, tibial tuberosity)
Where does osteochondrosis of the femur occur?
-Lateral or medial femoral condyle (most often medial aspect of lateral condyle)
Which kind of dogs does osteochondrosis of the femur affect?
Young dogs of medium to larger breeds eg Labrador, Great Dane
Give the clinical signs of osteochondrosis
-Lameness from 5 months old
-Bilateral crouching gait
-Joint effusion and discomfort upon palpation
How would you recognise stifle osteochondrosis on a radiograph?
Flattening of femoral condyle with irregualr margins
Which radiographic view would you use to diagnose osteochondrosis of the stifle?
How do you treat osteochondrosis of the stifle?
-NSAIDs and rest for 3-4 weeks
-If no improvement: surgical removal of cartilage flap with curettage of the periphery
Which conditions are likely to develop following osteochondrosis of the stifle?
-Predisposes to cranial cruciate ligament rupture
Is medial or lateral patellar luxation more common?
Medial patellar luxation is most commonly seen in which dog breeds?
Small toy breeds
Give some developmental deformities than can predispose to patellar luxation
Malalignment of quadricpes complex:
-Lateral bowing of distal femur
-Medial bowing of proximal tibia
-Medial rotation of tibial tuberosity
-Hypoplasia of medial femoral condyle
How may a dog with patellar luxation present?
-'Skipping' lameness (holds leg semi-flexed for 1-2 steps)
What are the 4 grades of patellar luxation?
1-Intermittent patellar luxation, reduction immediate (no lameness)
2-Frequent luxation, reduction not always immediate (skipping lameness)
3-Permanent luxation, reduction possible but reluxates (skipping to non-weight-bearing lameness)
4-Permanent luxation but reduction not possible (crouched rear position, unable to extend legs properly)
How do you treat patellar luxation?
-Conservative: only if no instability of patella or infrequent lameness. Restricted, controlled exercise, NSAIDs
-Surgical: if recurrent/persistent clinical signs. Aim to restore normal alignment of quadriceps mechanism eg deepening of trochlear groove
What is the most common cause of HL lameness in the dog?
Cranial cruciate ligament rupture and disease
What are the three basic biomechanical functions of the cranial cruciate ligament?
-To limit cranial drawer movement (translation of the articular surfaces)
-To limit over extension of the stifle
-To limit internal rotation of the tibia with respect to the femur
What are the 2 components of the cranial cruciate ligament?
-Craniomedial band (taut in flexion and extension)
-Caudolateral band (taut in extension only)
Give some causes of cranial cruciate ligament rupture
-Major trauma (uncommon)
-Degeneration of CCL (weakening due to decreaed collagen remodelling)
-Rupture in young dogs of large breeds (partial tear -> chronic OA)
-Rupture associated with inflammatory arthropathies (immune-mediated or infection)
How would you diagnose CLL rupture?
-Radiography (may see a joint effusion and signs of OA)
-Arthrocentesis (increased fluid volume, increased cell count if infected)
-Cranial drawer and tibial compresion/thrust test
How do you treat cranial cruciate ligament rupture?
-Conservative: small dogs <15kg. Rest and restricted exercise for 6-8 weeks with NSAIDs
-Surgical: 3 techniques:
-Intracapsular ('over the top', fascia graft)
-Extracapsular (fabello-tibial nylon sutures)
-Periarticular (eg tibial plateau levelling osteotomy TPLA or tibial tuberosity advancement TTA)
What are the clinical signs of cranial cruciate ligament rupture?
-Chronic/acute onset HL lameness
-Leg carried flexed or 'toe touching'
-Stifle effusion (patellar ligament not pencil-like)
-Medial buttress (thickening of tissues around joint) and OA = chronic
-Tibial compression test/cranial drawer
Dogs with cranial cruciate ligament rupture will have some degree of what?
Give some possible complications of cranial cruciate ligament disease
When should you re-examine cranial cruciate ligament repair after surgery?
Full recovery wont be evident until 12-16 weeks after surgery
How are the menisci anchored to each other?
How are the menisci anchored to the tibia and femur?
Whys is the medial meniscus more prone to damage than the lateral?
It has an attachment to the medial collateral ligament, making it less mobile
When do we see most injuries to the medial meniscus?
When there is rupture of the CCL, the medial meniscus becomes trapped and injured by the rotation of the femoral condyles at full extension
Give the clinical signs of a meniscal tear
-Suddenly lame several weeks to months after initial CCL surgery
-Joint may have an effusion and be unstable upon cranial drawer test
How do you treat a meniscal tear?
-May respond to conservative management for 4-6 weeks
-Surgical removal if persistent lameness
Give some congenital conditions of the elbow joint
-Ununited medial epicondyle of humerus
-Incomplete ossification of the humeral condyle
Give some degenerative conditions of the elbow joint
Give some traumatic conditions of the elbow joint
-Proximal ulna/radius fractures
-Luxation/collateral ligament rupture
What is supination?
Outward rolling of the foot during normal motion
Give some clinical signs of elbow disease
-Thoracic limb lameness
-Short stance phase
-Pain/crepitus on elbow manipulation
How do you diagnose elbow disease?
Elbow dysplasia affects which kinds of dogs?
Medium-large breed dogs eg Labradors, Rottweilers, Bernese Mountain Dogs
Give the 4 disease entities of elbow dysplasia
-Fragmentation of the medial coronoid process (FCP)
-OCD of medial condyle of humerus
-Ununited anconeal process (UAP)
-Elbow incongruity (eg short radius)
Give some causes of fragmentation of the medial
coronoid process (FCP) -> elbow dysplasia
-Biomechanics (sites of greatest load)
-Gender (males > females)
How would you treat fragmentation of the medial
coronoid process (FCP) of the ulna?
-Lead exercise, analgesics, weight control, physio
-Arthroscopic removal of fragments
-Proximal ulnar osteotomy (PUO)
-Biceps ulnar release procedure (BURP)
Describe the pathogenesis of OCD of the elbow
-Disturbance of the normal orderly process of endochondral ossification
-Cartilage of increased thickness
-Necrosis deep within thickened cartilage (? poor nutrition)
-May progress to cartilage flap
How do you treat OCD of the elbow?
Surgery: remove cartilage flap, curettage
Which dog breeds are more prone to an ununited anconela process of the ulna?
Bassets, GSDs, BMD, mastiffs
By what age should the anconeal process have ossified and fused to the ulna?
5 months old (10-11 in Bassets)
How do you treat an uninited anconeal process (ulna)?
-Conservative if mild lameness
-Surgical (to promote union of the anconeus and
maintain congruency of the elbow joint): removal of anconeus or proximal ulnar osteotomy (+/-screw fixation)
What is elbow incongruity?
Either radius or ulna is too short (usually ulna)
How do you treat elbow incongruity?
What is IOHC?
Which dog breeds does it affect?
Incomplete ossification of the humeral condyle (Springers/Cockers/Labradors)
Give some clinical signs of incomplete ossification of the humeral condyle
-May be pain
-Thoracic limb lameness
-May lead to fracture of the distal humeral condyle
How do you treat incomplete ossification of the humeral condyle?
Stabilize humeral condyle eg screws
Give some diseases of the shoulder
-Congenital luxation and dysplasia
-Muscle, tendon and ligament problems
-Glenohumeral ligament tears
-Biceps brachii avulsion, rupture and displacement
-Infraspinatus and supraspinatus contracture
-Infraspinatus bursa mineralisation
-Luxation and fractures
How do you diagnose shoulder disease?
-Clinical examination (gait, posture, palpation, manipulation)
-Synovial fluid analysis
-Ultrasonography (biceps tendon)
How would you identify a ruptured biceps brachii?
-Hyper-extension of the elbow when the shoulder is in full flexion
Which contrast material would you use when doing an arthrography of the shoulder joint?
What kind of lesions would arthrography allow you to see on the shoulder joint?
How would you treat OCD of the shoulder?
Surgical: flap removal, curettage to stimulate fibrocartilage formation
How would you treat glenohumeral tears of the shoulder joint?
-Conservative: rest, sling
-Medical: intra-articular corticosteroids
-Surgical: thermal capsulorrhaphy (capsular shrinkage), prosthetic capsulorrhaphy, subscapularis imbrication, arthroscopic sutures
How long should the shoulder be rested for in cases of lameness?
Give some nutritional bone diseases
-Nutritional Secondary Hyperparathyroidism
-Renal Secondary Hyperparathyroidism
-Hypovitaminosis D (Rickets)
Panosteitis typically affects which dogs?
Young large and giant breed dogs (eg GSD)
-6-8 months old
Describe the pathology of panosteitis
-Degeneration of intramedullary adipocytes
-Stromal cell proliferation
-Intramembranous ossification (pain, new bone formation, becomes attached to endosteum)
Give the clinical signs of panosteitis
-Classically shifting lameness (usually FL)
Which bone condition is known as 'growing pains'?
How would you recognise panosteitis on a radiograph?
-Increased medullary radiodensity (new bone formation), thickened cortices, new endosteal bone formation
How do you treat panosteitis?
Which dogs are more affected by metaphyseal osteopathy?
-Young rapidly-growing medium and large breed dogs
-2-6 months old
What is metaphyseal osteopathy caused by?
-Vitamin C deficiency?
-Inherited immunodeficiency in Weimaraners
Give the clinical signs of metaphyseal osteopathy
-Mild lameness to severe collapse
-Pyrexia, anorexia, depression
How do you confirm metaphyseal osteopathy?
What would you see on a radiograph of metaphyseal osteopathy?
-Band of increased radiodensity (more white) adjacent to physis
-Growth plates may be widened
-Latter stages: calcification proximal to metaphysis
How do you treat metaphyseal osteopathy?
What is craniomandibular osteopathy?
A non-inflammatory, non-neoplastic, proliferative bone disease of immature dogs
Which breeds are affected by craniomandibular osteopathy?
-WHWT (autosomal recessive), Scottish Terrier, Cairn Terrier
What are the clinical signs of craniomandibular osteopathy?
-Inability to open mouth/prehend food
-Anorexia and weight loss
-Pain when eating
How would you identify craniomandibular osteopathy on a radiograph?
-Palisading bone proliferation on the mandible and tympanic bullae
How do you treat craniomandibular osteopathy?
-Usually self-limiting at 11-13 months
Slipped capital femoral epiphysis affects which animals?
-Neutered male, overweight cats <2 years old
Give the clinical signs of slipped capital femoral epiphysis
-Subtle lameness progressing to acute, non-weight bearing lameness
-Inability to jump
-Pain and crepitus on hip manipulation
What would you see on a radiograph of slipped capital femoral epiphysis?
-Early: mild widening and lateral displacement of the capital femoral growth plate
-Late: displacement of proximal femoral metaphysis, resorption and sclerosis of femoral neck
How do you treat slipped capital femoral epiphysis?
-Femoral head and neck excision
-Total hip replacement
Hypertrophic osteopathy occurs secondary to what?
Intrathoracic or abdominal neoplasia
Hypertrophic osteopathy affects which type of animals?
-Older dogs and cats
-Ave. 9 years old
Give the aetiology of hypertrophic osteopathy
-Secondary to neoplasia
-Increased peripheral blood flow
-Vacular congestion in periosteum
-Calcification of periosteum and connective tissue
Give the clinical signs of hypertrophic osteopathy
-Lameness can develop over several months (can be non-ambulatory)
-Single or multiple limbs
-Firm swelling along bone of distal extremities
-Pain in early stages
-?Hyperthermia, weight loss, depression
What radiographic changes would you see with hypertrophic osteopathy?
-Periosteal new bone laid down at right angles to periosteum
-Increased bone density (more white)
How do you treat hypertrophic osteopathy?
-Remove primary cause (neoplasia) -> resolution of new bone formation
Which cysts can be found in bone?
-Simple unicameral bone cysts (fluid-filled cavity lined by fibrous connective tissue)
-Aneurysmal bone cysts (osteolytic lesions containing blood sinusoids)
-Subchondral bone cysts (v. rare)
Give some clinical signs of bone cysts
-May be asymptomatic
-Acute lameness -> pathological fracture
How would you identify a bone cyst on a radiograph?
-Expansile, locally aggressive lucent (black) lesion with little periosteal reaction
-Typically metaphysis and diaphysis
How would you treat a bone cyst?
-If asymptomatic: no treatment, repeat imaging in 4-6 weeks
-Surgical drainage, curettage, cancellous bone grafting
What are muscle contractures?
The abnormal shortening of muscle rendering the muscle highly resistant to stretching
Infraspinatus muscle contracture typically affects which dogs?
Medium sized working/athletic dogs
Give the clinical signs of infraspinatus muscle contracture
-At stance: shoulder abduction, elbow adduction lower limb abduction and external rotation
-Spinatus muscle atrophy
-Reduced ROM in flexion
How do you treat infraspinatus muscle contracture?
Gracilis/semitendinosus muscle contracture typically affects which dogs?
-3-7 years of age
What causes gracilis/semitendinosus muscle contracture?
-Repetitive strain injury/trauma
Give the clinical signs of gracilis/semitendinosus muscle contracture
-Weight-bearing gait abnormality (Affected limb raised in jerk-like fashion, hyperflexion of tarsus, internal rotation of metatarsus)
-Firm gracilis/semitendinosus muscle on caudomedial aspect of thigh
How do you treat gracilis/semitendinosus muscle contracture?
No treatment required
Which dogs may be prediposed to quadriceps muscle contracture?
Young fast-growing dogs
Describe the aetiology of quadriceps muscle contracture
-Secondary to femoral fracture (poor limb use/immobilisation)
-Fibrotic replacement of muscle fibres
-Adhesions between muscle and bone
-Periarticular fibrosis and joint ankylosis
Give the clinical signs of quadriceps muscle contracture
-Extension of stifle and tarsus
-Trauma to dorsal aspect of the pes
-Pain over femur
What is the treatment for quadriceps muscle contracture?
Most likely amputation
Reversible contracture of the flexor carpi ulnaris muscle affects which dogs?
Young dogs, 6-8 weeks old
Give the clinical signs of reversible contracture of the flexor carpi ulnaris
-Flexed carpus that cannot be extended
-Tendon of FCU is taught on palpation
How do you treat reversible contracture of the flexor carpi ulnaris?
-Resolution usually occurs after 2 – 3 weeks
-FCU tendinectomy in rare cases
What are the 2 types of lining that tendons can have?
Which tendons heal faster: paratenon-lined or sheathed?
Paratenon-lined: blood supply derived from paratenon and surrounding soft tissues (eg gastrocnemius, triceps brachii)
Sheathed are slower as they have to rely on intrinsic blood supply (eg flexor tendons)
Give the basic principles of tendon repair
1. Expose severed ends
2. Debride necrotic tissue
3. Perform anastomoses (three-loop pulley for round tendons, locking-loop for flat tendons)
4. Immobilise to protect from strain for 3 weeks
Normal bone production but excessive bone resorption
Describe the aetiology of nutritional secondary hyperparathyroidism
-Diets high in phosphorus or low in calcium (usually meat based)
-Hypocalcaemia -> increased PTH (induces progressive skeletal demineralisation)
Give the clinical signs of nutritional secondary hyperparathyroidism
-Lameness/ inability to stand
What changes would you see on a radiograph of nutritional secondary hyperparathyroidism?
-Decreased bone density and thinned cortices
-Mushroom shaped metaphysis
-Pathological fracture may be seen
How would you treat nutritional secondary hyperparathyroidism?
-Oral calcium supplementation
What is Rickets caused by?
Vitamin D deficiency
Give some clinical signs of Rickets (vit D deficiency)
-Pathological fracture or bowing of long bones
-Enlarged costochondral junction and metaphysis
-Delayed dental eruption, weakness, listlessness, and neurological signs
What would you see on a radiograph of Rickets (vitamin D deficiency)?
-Thickening of growth plates
-Cupping of adjacent metaphysis
-Osteopenia, thinned cortices
How do you treat Rickets (vitamin D deficiency)?
Give some clinical signs of renal osteodystrophy
-Pliable mandible/maxilla (rubber jaw)
-Bowing of long bones
How do you treat renal osteodystrophy?
Reduce phosphate intake/phosphate binder
Calcium or calcitriol supplementation
Hypervitaminosis A affects which animals?
-Cats, esp on liver diets
-2-9 years old
Give the clinical signs of hypervitaminosis A
-Malaise, anorexia, lethargy
-Exopthalmus and scurfy, dull coat
-Early: neck pain
What would you see on a radiograph of a cat with hypervitaminosis A?
-Ankylosis of cervical and cranial thoracic vertebrae
-May see degenerative joint disease and ankylosis of shoulder and elbow
What is the treatment for hypervitaminosis A?
-Feed balanced diet
-Skeletal changes don’t resolve