Central Texas Veterinary Sports Medicine Orthopedic Injuries and Diseases in Immature Patients Stephen J. Kerpsack, DVM, MS Diplomate ACVS Central Texas Veterinary Specialty and Emergency Hospital tpitaland Emergency Central Texas Veterinary Sports Medicine

Infectious Diseases Neospora caninum Parasite similar to Toxoplasma Transplacental transmission Eating Intermediate Host

Infectious Diseases Neospora caninum -Clinical signs in dogs -rear limb stiffness -primarily quadriceps -differential diagnosis for hip dysplasia -rear limb paralysis

Infectious Diseases Neospora caninum Diagnosis – serum titer Treatment - 4 – 8 weeks - clindamycin - smz – tmp - physical/water treadmill therapy - seek out littermates when possible

Infectious Diseases Hepatozoon - canis - americanum - gulf coast - Tick borne/transplacental transmission - Clincal Signs - rear limb stiffness/lameness - long bone pain - hip pain Diagnosis - high white blood cell count - radiographs - PCR - blood

Hepatozoon

Infectious Diseases Hepatozoan Treatment 4-8 weeks + - clindamycin - smz – tmp - decoquinate (americanum) -doxycycline/imidacarb?

Carpal Hyperflexion

Carpal Hypoflexion

Retained Cartilagenous Cores

Retained Cartilagneous Cores Treatment Treat pain Monitor for growth plate closure Diet Change Less calories

Retained Cartilagenous Cores

Hypertrophic Osteodystrophy  -decreased blood flow to the metaphysis -failure of ossification -necrosis and inflammation of cancellous bone --usually bilateral in the long bones distal radius, ulna, tibia Cause – excessive calcium intake, genetic in Weimaraners

Hypertrophic Osteodystrophy  -

Hypertrophic Osteodystrophy

Hypertrophic Osteodystrophy Diagnosis Fever Radiographs CBC Neutropenia Treatment Corticosteroids Supportive care Monitor for growth plate closure

Septic Arthritis Stifle Elbow Usually Hematogenous

Septic Arthritis Diagnosis Joint tap Cytology – suppurative inflammation Culture – negative culture does not rule out infection

Septic Arthritis Treatment Joint Lavage – needle ingress/egress, LRS Antibiotic therapy Anti-staph Avoid flouroquinalones Based on culture or response to treatment 6 week minimum

Septic Arthritis Treatment Joint Lavage – needle ingress/egress LRS 1 -2 liters

Matacarpal/Metatarsal Fractures -Closed reduction/Splint Application -Approximately 1 week of healing for every month of age up to 9 months. - Fracture can remodel if not anatomic.

Matacarpal/Metatarsal Fractures -Heavy Sedation or Anesthesia -Linear Traction during splint placement. Spoon splint Extend to the calcaneus or just above the carpus Weekly to biweekly splint change

Tibial Tuberosity Fracture Indications for surgery Significant displacement Palpable instability Patella luxation

Tibial Tuberosity Fracture Coaptation - bandage that extends as high up the thigh as possible for 4 – 6 weeks Surgery – two parallel pins in young dogs Avoids growth plate closure Flouroscopic guided closed reduction is preferable

Tibia Fracture

Tibia Fracture

Capital Physis Fracture Shear force – repair with two parallel pins Flouroscopic guided closed reduction prevents femoral head collapse or apple core remodeling Delay in repair can lead to poor outcome

Lateral Humeral Condyle Fracture Often missed if two view/straight radiographs not obtained Low energy fracture Flouroscopic guided closed repair Delay in repair (weeks) can lead to poor outcome

Patella Luxation Repair is not indicated in asypmtomatic patients Younger is better in symptomatic patients Avoid a tension band

Distal Ulna Growth Plate Closure Early Detection and early treatment is key to a good outcome. Treatment – Distal ulnar ostectomy

Distal Ulna Growth Plate Closure

Radius Growth Plate Closure

Elbow Dysplasia

Elbow Dysplasia Goal of treatment is to reduce signs. No change in approximately 20% of dogs. Questionable value in operating older patients with chronic lameness

Osteochondritis dissecans

Osteochondritis dissecans

Hip Dysplasia Juvenile Pubic Symphysiodesis  - puppies less than 4 months of age Triple pelvic osteotomy less than 9 months of age at least 10% coverage of the femoral head no osteoarthritis symptomatic.

Early Intervention is often the key to success