LIFE - Dr. Roberta Dev Anand

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LIFE
“We must be willing to get rid of
the life we’ve planned, so as to
have the life that is waiting for
us.”
-Joseph Campbell
DISEASES OF THE
MUSCULOSKELETAL
SYTEM
FUNCTIONS OF THE MUSCULOSKELETAL SYSTEM
• Support (skeletal system)
– structural support/framework for the entire body
• Storage
– Minerals (calcium) and lipids.
• Blood cell production.
– site of formation for all types of blood cells.
• Protection
– vital organs of the body
•
•
ribs surround the visceral organs
central nervous system is encased within the skull and spinal cord.
• Leverage
– Many of the joints of the body act as levers therefore
assisting with movement.
–Provides a place for muscles, tendons, ligaments to attache
REVIEW - Bone anatomy
Epiphysis is the enlarged area at either end of the bone
Diaphysis is the long shaft in the middle portion of the bone
Metaphysis is the joining point between the epiphysis and diaphysis
The periosteum is the fibrous covering around the outside of the bone not covered with articular
cartilage.
The endosteum is the fibrous and cellular tissue lining the medullary cavity of the bone
REVIEW – Shapes of Bones
vertebrae
and certain facial bones
carpal and
tarsal bones
sternum, ribs,
scapula,
and certain skull
bones
humerus, radius, femur,
tibia,
metacarpals, and
metatarsals
patella,
and proximal and
distal sesamoid
bones of the
digits.
MUSCULOSKELETAL SYSTEM
Flexible articulations
form joints
The skeleton is the rigid frame
Muscles, tendons, and ligaments form a system of pulleys
MUSCULOSKELETAL SYSTEM
FUNCTIONS
MUSCULOSKELETAL SYSTEM
DISRUPTION:
TRAUMA: CLINICAL SIGNS OF LONG BONE
FRACTURES
Lameness, swelling, hx of abuse
lameness
Deformity of bone, swelling
TRAUMA: CLASSIFICATION OF FRACTURES
– Open (compound) – broken skin
– Closed – intact skin
– Simple (1 break): oblique, transverse, incomplete
fractures
– Comminuted –multiple pieces
– Stable – ends opposed and fixed (ie. greenstick)
– Unstable
– Compression: vertebrae
TRAUMA: DIAGNOSIS OF LONG BONE
FRACTURES
Oblique fracture
Transverse fracture
TRAUMA: DIAGNOSIS OF LONG BONE
FRACTURES
Greenstick fracture
Comminuted fracture
TRAUMA: DIAGNOSIS OF LONG BONE
FRACTURES
Fissure fractures
TRAUMA: DIAGNOSIS OF LONG BONE
FRACTURES
Spiral Fractures
TRAUMA: DIAGNOSIS OF FRACTURES
COMPRESSION FRACTURE
SALTER-HARRIS
FRACTURES OF
THE EPIPHYSIS
TRAUMA: OPEN VS. CLOSED
FRACTURES
In open fractures bone is exposed through the skin
TRAUMA: METHODS OF FIXATION OF LONG
BONE FRACTURES
SPLINTS
It is critical that the splint support both the
joint above and below the injury !
TRAUMA: METHODS OF FIXATION OF LONG BONE
FRACTURES
Splints
ROBERT JONES
BANDAGE
METASPLINT
TRAUMA: METHODS OF FIXATION ON FRACTURES
SCHROEDER-THOMAS SPLINT
Immobilize any fracture
Distal to midhumerus or midfemur
CASTS
• Casts can be made for the entire body, as for
spinal injuries, for any portion of the body
(spica cast), or for just the extremities.
TRAUMA: METHODS OF FIXATION OF
FRACTURES
IM (Steinmann) pins with cerclage wires
TRAUMA: METHODS OF FIXATION
• Advantages of IM pins
– Prevent bending forces
• Disadvantages
– Do not prevent rotation or compressive (axial)
forces
• Should be combined with other methods such
as cerclage wire to prevent other forces
TRAUMA: METHODS OF FIXATION OF LONG
BONE FRACTURES
Bone plates and screws
http://www.youtube.com/watch?v=Wls_PyopD0
TRAUMA: METHODS OF FIXATION
External fixators are pins that penetrate the skin and bones
that are attached to fixed bars or acrylic
using special clamps: Kirschner-Ehmer apparatus
TRAUMA: CLIENT INFO
• Restrict activity
• Watch for drainage, swelling, heat
• Metal (plate, pin) stronger than bone –
refracture may occur
• Follow up x-rays necessary
• Metal should be removed after healing
• Metal may cause cold sensitivity
Ligament Injury – Anterior Cruciate Ligament
Rupture
• ACL and PCL (posterior cruciate ligament)
– stabilize knee joint
– Intra-articular structures
• Ruptured ACL – most common stifle injury and
leads to DJD
– May be complete rupture or partial tear =>
unstable joint => DJD
TRAUMA: CRUCIATE LIGAMENT
INJURY/RUPTURE
TRAUMA: CLINICAL SIGNS OF CRANIAL
CRUCIATE LIGAMENT INJURY/RUPTURE
Middle-aged obese dog
Highly active, athletic animals
TRAUMA: CLINICAL SIGNS OF CRANIAL CRUCIATE
LIGAMENT INJURY/RUPTURE
Animal is acutely non wt. bearing
on the rear leg after hyperextending
the stifle joint
Joint effusion
TRAUMA: CRANIAL CRUCIATE LIGAMENT RUPTURE
Cranial drawer test
Tibial compression test
TRAUMA: CRANIAL CRUCIATE LIGAMENT
RUPTURE
http://www.youtube.com/watch?v=9jg9E2nBt_E&feature=related
TRAUMA: CRANIAL CRUCIATE LIGAMENT RUPTURE
REPAIR
Extra-articular Stabilization
*Most successful in patients less than 15kg
TRAUMA: CRANIAL CRUCIATE LIGAMENT
RUPTURE REPAIR
Intra-articular stabilization – Over-the-top patellar tendon graft
TRAUMA: CRANIAL CRUCIATE LIGAMENT
RUPTURE
http://www.youtube.com/watch?v=4nU2QZjjByg
TRAUMA: CRANIAL CRUCIATE LIGAMENT
RUPTURE REPAIR
Intra-articular stabilization technique
TPLO – Tibial Plateau Leveling Osteotomy
TRAUMA: CRANIAL CRUCIATE LIGAMENT
RUPTURE
http://www.youtube.com/watch?v=-1pxxX4TXko&feature=fvw
TRAUMA: CRANIAL CRUCIATE LIGAMENT
RUPTURE – CLIENT INFO
• Restrict activity 3-4 weeks post surgery
– Cage rest
– Leash walk only to urinate and defecate
•
•
•
•
•
•
Gradually increase exercise 4-8 wks post sx
Full activity 8-12 weeks
Opposite cruciate often tears within 1 yr
Weight loss helps
DJD of stifle joint likely
If no surgery, joint thickens - fibrosis
POOR CONFORMATION: LUXATING PATELLA
POOR CONFORMATION: LUXATING
PATELLA
POOR CONFORMATION: LUXATING PATELLA
POOR CONFORMATION: LUXATING PATELLA
PATELLA IN
GROOVE
PATELLA
OUT OF
GROOVE
POOR CONFORMATION
BOW-LEGGED STANCE MAY OCCUR
IN MEDIAL LUXATIONS
KNOCK-KNEED/PIGEON-TOED, OR
COW-HOCKED STANCE MAY OCCUR
IN LATERAL LUXATIONS
POOR CONFORMATION: TREATMENT OF PATELLAR
LUXATION
TROCHLEAR WEDGE RESECTION
POOR CONFORMATION: TROCHLEAR WEDGE RESECTION
POOR CONFORMATION: TIBIAL CREST
TRANSPOSITION
POOR CONFORMATION: TIBIAL CREST
TRANSPOSITION
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