Multicentric Orthopedic Diseases in Small Animals PDF

Multicentric Orthopedic Diseases in Small Animals Sun Young Kim Purdue University Outline Conditions  Osteochondrosis  Panosteitis Contents for each condition  Definitions and Etiology  Common breeds  Findings in physical/ortho exam  Hypertrophic Osteodystrophy  Hypertrophic osteopathy...

Multicentric Orthopedic Diseases in Small Animals Sun Young Kim Purdue University Outline Conditions  Osteochondrosis  Panosteitis Contents for each condition  Definitions and Etiology  Common breeds  Findings in physical/ortho exam  Hypertrophic Osteodystrophy  Hypertrophic osteopathy  Diagnostics  Treatment and prognosis Learning Objectives  List common multicentric conditions in juvenile dogs  Explain the etiology of osteochondrosis  Describe physical examination findings of multicentric conditions in juvenile dogs  Interpret radiographic findings associated with each multicentric condition  Design treatment for each multicentric condition Osteochondrosis Endochondral ossification Epiphyseal growth (secondary ossification center) Balanced between cartilage production and ossification Blood vessel Osteochondrosis  Failed endochondral ossification Focal interruption of vessels ➔Cartilage retention and thickening ➔Lack of nutrition to deep layer of cartilage ➔Deep layer necrosis  Osteochondrosis Dissecans  Flap dissection → pain / inflammation OCD Osteochondrosis - Signalment Large – Giant breeds (Genetic ?) Bernese, Retriever, Rottweiler, Germans shepherd, Grate Dane, St. Bernard… Immature dogs 4 ~ 12-month old Male > Female (except for tarsal jt.) Osteochondrosis - Locations  Shoulder Caudal aspect of humeral condyle  Stifle Lateral condyle Medial condyle  Elbow Medial Condyle  Tarsal jt. Medial trochlear ridge of Talus Osteochondrosis - Diagnostics Imaging Radiographs +/contrast CT MR Ultrasound Arthroscopy Bone Defect Osteochondrosis Dissecans - Treatment  Surgical  Removal of flap  Stimulate hemorrhage on the subchondral bone → Fibrocartilage formation Hyaline Cartilage Calcified Cartilage Subchondral Bone Plate Mesenchymal Clot  Conservative  For only mildly lame or asymptomatic dogs  Rest and NSAID Osteochondrosis Dissecans (OCD)- Prognosis  Shoulder Good  Stifle Guarded to Poor Graft (auto/allo/synthetic)  Elbow Guarded to Poor OA Long term  Tarsal jt. Initial improvement OA Long term Panosteitis Panosteitis  A self-limiting disease of long bones in growing dogs  No known etiology Panosteitis Signalment  Large breed dogs  German Shepherd  Young growing dogs  Age 5 – 24 months, sometimes older  Male (80%) > female History  Shifting leg lameness  2 ~ 4 week intervals, then shifts  Weight-bearing or sometimes nonweight-bearing  One or more legs  Inappetence, reluctance to move, or play Panosteitis – Examination Physical/Orthopedic Exam Diagnostics  Normal temperature  Radiographs of affected long bones  Generally good attitude  CBC, Serum Chemistry  Weight-bearing lameness of one or more legs  Pin-point pain on long bone palpation (pressure) at Diaphysis  Not specific Panosteitis – Radiographs  Diaphysis of long bones, most near nutrient foramen  Blurring of trabecular pattern with focal increased opacity in medullary canal Panosteitis Treatment Pain management until recovery Rest, Activity increases pain NSAID Prognosis Excellent Be careful to rule out other common developmental diseases Hypertrophic Osteodystrophy (HOD) Hypertrophic Osteodystrophy (HOD) Self limiting disease of metaphyses of long bones causing severe pain and swellings in young growing large breed dogs Unknown etiology Hypertrophic Osteodystrophy (HOD) Signalment Large breed dogs Rapid growing age 4 – 8 months old Males > Females History  Lameness  Usually in multiple legs  Owners may notice swelling at metaphyses  Reluctance to move  Severe pain  Multiple episodes through 8 months of age Hypertrophic Osteodystrophy (HOD) Physical/Ortho Exam  Normal temperature or as high as 106˚F  Lameness  Warm painful swelling at metaphyses  Most common at distal radius, ulna and tibia  May involve all physes, including ribs and vertebrae Diagnostics  Radiographs of long bones  CBC  Normal or leukocytosis with left shift  Serum chemistry  Normal Ca, P  Alkaline phosphatase may be elevated HOD - Radiographs  Long bones  Increased size and opacity of metaphyses  Focal line of radiolucency above physes Double physeal line?  Mostly normal epiphyses  Subperiosteal and extraperiosteal bone growth  Stunted growth in some HOD – Treatment/prognosis Treatment  Supportive care  In severe case  Careful observation with IV fluid  Acute death with unknown cause  NSAID vs Steroid  No improvement in 54.5 % dogs treated with NSAID  Remission within 8 – 48 hours with Steroid Safra et al.JAVMA 2013 Prognosis  Good unless secondary problems develop  Resolves by 8 months of age  Severe enlargement of metaphyses  Stunted growth  Angular limb deformity from synostosis of physes  Rare acute death  Client education!!!! Hypertrophic Osteopathy Hypertrophic Osteopathy  Rare, unknown etiology  Proliferative periosteal reaction in multiple long bones  Secondary to a mass or disease in the thorax and abdomen Hypertrophic Osteopathy Signalment  Dogs (all breeds) middle aged and older  Mean age: 8.7 years old  Cats, horses, cows, deer, fowl, humans Physical/Orthopedic Exam  Lameness in one or more legs  Stilted gait  Firm swellings, pulsatile, not edematous  Pain and stiffness on flexion of joints  Less pain with chronicity Hypertrophic Osteopathy - Diagnostics Radiographs Affected limbs Thorax Abdomen CBC/Serum Chemistry Cytology of a mass (FNA) May have abnormalities associated with a primary problem Hypertrophic Osteopathy Treatment Treatment of primary disease may lead partial regression Supportive care Prognosis Guarded to poor Summary – Multicentric Conditions  Young growing large dogs  OCD Shoulder, elbow, stifle, tarsal jt Genetic component Bone defect in imaging  Panosteitis Include to DDx when bone pain in young dogs  Hypertrophic Osteodystrophy Swelling at Metaphyseal area  Mature – old dogs  Hypertrophic osteopathy Rare secondary condition to primary condition (Mass) Diffuse periosteal reaction Self-limiting conditions Imaging (radiographs) Supported care – excellent prognosis