Miscellaneous Orthopaedic Conditions 2022 PDF

MISCELLANEOUS ORTHOPAEDIC CONDITIONS ANDREW TOMLINSON BVSC CERTAVP(GSAS) DIPECVS FHEA MRCVS SENIOR LECTURER IN SMALL ANIMAL SURGERY LECTURE OVERVIEW Developmental Bone disease: Paraneoplastic Bone Disease Nutritional Bone Disease: • Panosteitis • Hypertrophic Osteopathy • Nutritional Seconda...

MISCELLANEOUS ORTHOPAEDIC CONDITIONS ANDREW TOMLINSON BVSC CERTAVP(GSAS) DIPECVS FHEA MRCVS SENIOR LECTURER IN SMALL ANIMAL SURGERY LECTURE OVERVIEW Developmental Bone disease: Paraneoplastic Bone Disease Nutritional Bone Disease: • Panosteitis • Hypertrophic Osteopathy • Nutritional Secondary • Metaphyseal Osteopathy • Craniomandibular Osteopathy • Legg-Calve-Perthes Disease • Slipped Capital Femoral epiphysis • Bone Cysts Hyperparathyroidism • Renal Secondary Hyperparathyroidism • Hypovitaminosis D (Rickets) PANOSTEITI S Clinical signs: Diagnosis: • Classically shifting lameness • Signalment, history and clinical signs • Varies in severity from mild to nonweight bearing • Acute onset, no trauma • Radiography I. 0 – 10 days: may appear normal II. 10 – 20 days: subtle, poorly marginated • Forelimb:hindlimb ratio 4:1 increased radiodensity in medullary cavity • Most commonly affected bones: with some corticomedulalry blurring 1. Ulna 42% III. 20 – 70 days: obvious increase in medullary 2. Radius 25% radiodensity, periosteal and endosteal new 3. Humerus 14% bone formation and thickened cortices 4. Femur 11% 5. Tibia 8% IV. 70 – 90 days: remodeling of medullary canal. Medullary canal regains normal appearance PANOSTEITI S Treatment: • Self-limiting • Exercise control/restriction • Analgesics Prognosis: • Good for complete resolution METAPHYSEAL OSTEOPATHY Signalment: Clinical signs: • Young rapidly growing medium and large • Vary from mild lameness to severe breed dogs • Puppies may present between 2 and 6 months old collapse • Pyrexia, anorexia and depression • Swollen metaphysis Aetiology: • Unknown Diagnosis: • ? Vitamin C deficiency • Signalment, history, clinical signs • ?Distemper Virus • Confirmed by radiography • Inherited immunodeficiency in Weimaraners Radiography: METAPHYSEAL OSTEOPATHY • Common in distal radius and ulna • Band of increased radiodensity immediately adjacent to physis • Radiolucent line in metaphysis parallel to physis • Epiphysis and growth plates may appear slightly widened • Latter stages calcification proximal to the metaphysis Treatment Prognosis: Most cases are self-limiting • Good – excellent in mild cases • Supportive care • Analgesics • 25% - 33% euthanasia due to severity of clinical signs • Possible angular limb deformities CRANIOMANDIBULAR OSTEOPATHY Non-inflammatory, non-neoplastic proliferative bone disease of immature dogs Signalment: • Usually present between 4 – 10 months of age • Most common in WHWT, Scottish Terrier and Cairn Terrier Aetiology: • Autosomal recessive in WHWT Clinical signs: Diagnosis: • Mandibular swelling/thickening • Signalment • Inability to open mouth/prehend food • History • Salivation • Clinical findings • Anorexia and weight loss • radiography • Pain when eating CRANIOMANDIBULAR OSTEOPATHY Radiography: • Changes usually bilateral • Palisading proliferation on the mandible and tympanic bullae • Temporal, frontal and maxillary bones can be affected • Occasionally affects long bones Treatment: Prognosis: • Supportive care • Self-limiting at 11 – 13 months • Analgesics • Can be good • ?corticosteroids • Surgery not successful • Euthanasia may be requested LEGG-CALVE-PERTHES DISEASE Signalment: Developmental avascular/ischaemic necrosis of the femoral head • Onset of lameness 4 – 11 months • Commonly affects miniature poodle, WHWT, Cairn Terrier, Manchester Terrier and Yorkshire Terrier • No sex predilection Clinical signs: • Mild cases can be subclinical • Mild intermittent lameness to acute nonweight bearing lameness • Pelvic limb muscle atrophy • Pain and crepitus on manipulation of hip Aetiopathogenesis: • Autosomal recessive mode of inheritance in Manchester Terrier and WHWT • Vascular supply to femoral head from epiphyseal vessels that enter at the level of the joint capsule. • Temporary vascular compromise is suspected: I. Necrotic II. Creeping substitution: bone resorption/bone formation III. Articular cartilage collapse due to failure of subchondral bone support LEGG-CALVE-PERTHES DISEASE Diagnosis: • History, signalment, clinical signs • Confirmation via VD extended or frog leg view Radiography: • Focal bone lysis – “apple core” appearance Treatment: • Conservative • Femoral head and neck ostectomy • Total hip replacement SLIPPED CAPITAL FEMORAL EPIPHYSIS Feline Metaphyseal Osteopathy/Femoral Neck Metaphyseal Osteopathy Signalment: Clinical signs: • Neutered male, overweight cats • Subtle lameness progressing to acute • < 2 years of age • ?Siamese over-represented non-weight bearing • Inability to jump • Pain and crepitus on hip manipulation Aetiopathogenesis: • Unknown • Delayed physeal closure • Gonadectomy • Hypotestosteronism • ?Physeal dysplasia Diagnosis: • History, signalment and clinical signs • Confirmed radiographically SLIPPED CAPITAL FEMORAL EPIPHYSIS Radiographic changes: • Early – mild widening and lateral displacement of the capital femoral growth plate • Late – displacement of proximal femoral metaphysis, resorption and sclerosis of femoral neck Treatment: • FHNE • THR HYPERTROPHIC OSTEOPATHY Hypertrophic Pulmonary Osteoarthropathy/Marie’s Disease Signalment: • Older dogs and cats • Mean age 9 years (6 month – 15 years) Aetiology: • Paraneoplastic: secondary to intrathoracic or abdominal neoplasia • Neural mediated: ?vagus, ?intercostal, other afferents  Increased peripheral blood flow  Vascular congestion in periosteum  Calcification of periosteum and connective tissue Clinical signs: • 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 HYPERTROPHIC Hypertrophic Osteopathy OSTEOPATHY Diagnosis: • History and clinical signs • Thoracic radiographs and abdominal ultrasound • Radiographic changes: • Periosteal new bone formation • New bone laid down at right angles to periosteum • Increased bone density Treatment: • Symptomatic • Remove primary cause  resolution of new bone formation BONE CYSTS Simple, unicameral bone cysts: • Fluid filled cavity lined by fibrous connective tissue • Monostotic or polyostotic Aneurysmal bone cyst: • Benign expansile osteolytic lesions containing blood sinusoids Subchondral bone cysts: • Adjacent to synovial membrane • May communicate with joint space • Associated with OCD • Only one reported veterinary case Clinical signs: • May be asymptomatic • Lameness • Painful swelling • Acute lameness  pathological fracture Treatment: • Asymptomatic no treatment  repeat imaging in 4 – 6 weeks • Surgical drainage, curettage, cancellous bone grafting • Radiation therapy • Excision • Amputation BONE CYSTS Radiographs: • Expansile, locally aggressive lucent lesion with little periosteal reaction • Typically metaphysis and diaphysis • Eccentrically located • Thinned cortices Prognosis: • Good to excellent in most cases MUSCLE CONTRACTURES Reversible contracture of the flexor carpi ulnaris muscle Signalment: • Young dogs 6 – 8 weeks of age Aetiopathogy: • Unknown Clinical signs: • Flexed carpus that cannot be extended • Tendon of FCU is taught on palpation Treatment: • Resolution usually occurs after 2 – 3 weeks • Carpal supports • FCU tendinectomy in rare cases NUTRITIONAL DISORDERS OF BONE Nutritional Secondary Hyperparathyroidism Normal bone production but excessive bone resorption  osteopenia Aetiology: • Diets high in phosphorus or low in calcium • Usually meat based diets • Ideal Ca:P ratio 1.2:1 (dogs) and 1:1 (cats) • Hypocalcaemia  increased PTH • Induces progressive skeletal demineralisation Clinical signs: • Lameness/ inability to stand • Skeletal pain • Swollen metaphysis • Pathological fracture Diagnosis: • History (inappropriate diet) and clinical signs • Radiography NUTRITIONAL DISORDERS OF BONE Nutritional Secondary Hyperparathyroidism Radiography: • Decreased bone density and thinned cortices • Mushroom shaped metaphysis • May have slight relative increase in opacity • Pathological fracture may be seen Treatment: • Rest • Diet correction • Oral calcium supplementation • NSAID NUTRITIONAL DISORDERS OF BONE Hypovitaminosis D (Rickets) Insufficient calcium, phosphorus or both is available for mineralisation of newly formed osteoid Aetiology • Dietary deficiency in Vitamin D Radiography: Clinical signs: • Cupping of adjacent metaphysis • Lameness • Osteopenia, thinned cortices • Pathological fracture or bowing of long bones • Bowed diaphysis • Thickening of growth plates • Enlarged costochondral junction and metaphysis • Delayed dental eruption, weakness, listlessness, and neurological signs Treatment: • Balanced diet NUTRITIONAL DISORDERS OF BONE Renal Osteodystrophy Osteopenia secondary to chronic kidney disease Impaired phosphate excretion: Orthopaedic clinical signs: • Hyperphosphataemia  hypocalcaemia • Pliable mandible/maxilla • Increased PTH secretion • Bone demineralisation (rubber jaw) • Loose teeth • Skeletal pain Impaired vitamin D production: • Depressed enteric calcium absorption • Impaired osteoid mineralisation • Rickets-osteomalacia • Pathological fractures • Bowing of long bones Treatment: • Reduce phosphate intake/phosphate binder • Calcium or calcitriol supplementation The End! 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