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Patients with orthopaedic disease

image of Patients with orthopaedic disease
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Abstract

Orthopaedic conditions are common in both dogs and cats, and there are two main scenarios where rehabilitation and palliative care are appropriate: acute cases, including fractures, dislocation and ligament ruptures or sprains; chronic conditions, such as degenerative joint disease. The most important considerations for supportive care are: to alleviate pain; and to maintain function and improve mobility of the patient. Leg amputation in a cat; Total hip replacement in a dog; Hip dysplasia in a puppy – conservative management; Cruciate ligament repair in a dog; Tibial fracture repair in a cat; Patellar luxation in a dog; Humeral fracture in a dog; Osteoarthritis in a dog; Elbow arthritis in an elderly cat.

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Figures

Image of Following the accident, pelvic radiographs revealed a right sacroiliac luxation, a long oblique left ilial body fracture and pubic fractures.
Following the accident, pelvic radiographs revealed a right sacroiliac luxation, a long oblique left ilial body fracture and pubic fractures. Following the accident, pelvic radiographs revealed a right sacroiliac luxation, a long oblique left ilial body fracture and pubic fractures.
Image of The pelvic fractures were repaired with a 2.7 mm lag screw across the sacroiliac joint and a dorsally applied 2.0 mm bone plate.
The pelvic fractures were repaired with a 2.7 mm lag screw across the sacroiliac joint and a dorsally applied 2.0 mm bone plate. The pelvic fractures were repaired with a 2.7 mm lag screw across the sacroiliac joint and a dorsally applied 2.0 mm bone plate.
Image of Contraction of digital flexor tendons leads to knuckling of the paw when hindlimb joints are flexed.
Contraction of digital flexor tendons leads to knuckling of the paw when hindlimb joints are flexed. Contraction of digital flexor tendons leads to knuckling of the paw when hindlimb joints are flexed.
Image of The cat’s excessive licking had caused a small lesion on the caudolateral aspect of the thigh.
The cat’s excessive licking had caused a small lesion on the caudolateral aspect of the thigh. The cat’s excessive licking had caused a small lesion on the caudolateral aspect of the thigh.
Image of During recovery from surgery the cat was keen to play with a piece of string, biting and pawing at it.
During recovery from surgery the cat was keen to play with a piece of string, biting and pawing at it. During recovery from surgery the cat was keen to play with a piece of string, biting and pawing at it.
Image of Hydrotherapy can be used successfully in some cats. (© Linhay Veterinary Rehabilitation Centre)
Hydrotherapy can be used successfully in some cats. (© Linhay Veterinary Rehabilitation Centre) Hydrotherapy can be used successfully in some cats. (© Linhay Veterinary Rehabilitation Centre)
Image of The cat is recovering postoperatively in a cage with plenty of bedding. She is on a ketamine CRI for pain relief. She is wearing an Elizabethan collar to prevent interference with the surgical incision.
The cat is recovering postoperatively in a cage with plenty of bedding. She is on a ketamine CRI for pain relief. She is wearing an Elizabethan collar to prevent interference with the surgical incision. The cat is recovering postoperatively in a cage with plenty of bedding. She is on a ketamine CRI for pain relief. She is wearing an Elizabethan collar to prevent interference with the surgical incision.
Image of The cat enjoying a stroll through the garden 14 days after surgery.
The cat enjoying a stroll through the garden 14 days after surgery. The cat enjoying a stroll through the garden 14 days after surgery.
Image of This ventrodorsal extended pelvic radiograph shows bilateral coxofemoral osteoarthritis, worse on the right side.
This ventrodorsal extended pelvic radiograph shows bilateral coxofemoral osteoarthritis, worse on the right side. This ventrodorsal extended pelvic radiograph shows bilateral coxofemoral osteoarthritis, worse on the right side.
Image of A right total hip replacement has been performed.
A right total hip replacement has been performed. A right total hip replacement has been performed.
Image of Effleurage of the hindlimb forms part of immediate postoperative physiotherapy. (Courtesy of Brian Sharp)
Effleurage of the hindlimb forms part of immediate postoperative physiotherapy. (Courtesy of Brian Sharp) Effleurage of the hindlimb forms part of immediate postoperative physiotherapy. (Courtesy of Brian Sharp)
Image of Passive movements should include hip extension, taking care not to take the joint beyond its normal limits. (Courtesy of Brian Sharp)
Passive movements should include hip extension, taking care not to take the joint beyond its normal limits. (Courtesy of Brian Sharp) Passive movements should include hip extension, taking care not to take the joint beyond its normal limits. (Courtesy of Brian Sharp)
Image of Balance exercise using an air cushion. (Courtesy of David Prydie)
Balance exercise using an air cushion. (Courtesy of David Prydie) Balance exercise using an air cushion. (Courtesy of David Prydie)
Image of Use of a sling under the abdomen helps to support a dog’s weight and prevent slipping when walking outside and on smooth or wet surfaces.
Use of a sling under the abdomen helps to support a dog’s weight and prevent slipping when walking outside and on smooth or wet surfaces. Use of a sling under the abdomen helps to support a dog’s weight and prevent slipping when walking outside and on smooth or wet surfaces.
Image of A Labrador puppy with hip dysplasia prefers to sit rather than stand.
A Labrador puppy with hip dysplasia prefers to sit rather than stand. A Labrador puppy with hip dysplasia prefers to sit rather than stand.
Image of Ventrodorsal extended hip radiograph showing bilateral severe hip subluxation.
Ventrodorsal extended hip radiograph showing bilateral severe hip subluxation. Ventrodorsal extended hip radiograph showing bilateral severe hip subluxation.
Image of Electroacupuncture applied to the hip region of a small dog. (Courtesy of Samantha Lindley)
Electroacupuncture applied to the hip region of a small dog. (Courtesy of Samantha Lindley) Electroacupuncture applied to the hip region of a small dog. (Courtesy of Samantha Lindley)
Image of Goniometers can be used to measure angles of joint extension and flexion (see Chapter 9). (Courtesy of Brian Sharp)
Goniometers can be used to measure angles of joint extension and flexion (see Chapter 9). (Courtesy of Brian Sharp) Goniometers can be used to measure angles of joint extension and flexion (see Chapter 9). (Courtesy of Brian Sharp)
Image of Mediolateral radiograph of the stifle, showing a joint effusion and periarticular osteophytosis; these changes are commonly seen with cranial cruciate ligament disease.
Mediolateral radiograph of the stifle, showing a joint effusion and periarticular osteophytosis; these changes are commonly seen with cranial cruciate ligament disease. Mediolateral radiograph of the stifle, showing a joint effusion and periarticular osteophytosis; these changes are commonly seen with cranial cruciate ligament disease.
Image of Hiding food within toys can provide mental stimulation for a dog that is exercise-restricted.
Hiding food within toys can provide mental stimulation for a dog that is exercise-restricted. Hiding food within toys can provide mental stimulation for a dog that is exercise-restricted.
Image of Improving balance and core body strength in a dog, using a ‘physio ball’. (Courtesy of David Prydie)
Improving balance and core body strength in a dog, using a ‘physio ball’. (Courtesy of David Prydie) Improving balance and core body strength in a dog, using a ‘physio ball’. (Courtesy of David Prydie)
Image of A dog undergoing proprioceptive retraining using Cavalletti poles. (Courtesy of David Prydie)
A dog undergoing proprioceptive retraining using Cavalletti poles. (Courtesy of David Prydie) A dog undergoing proprioceptive retraining using Cavalletti poles. (Courtesy of David Prydie)
Image of An adhesive dressing prevents contamination of the surgical site from the environment in the immediate postoperative period.
An adhesive dressing prevents contamination of the surgical site from the environment in the immediate postoperative period. An adhesive dressing prevents contamination of the surgical site from the environment in the immediate postoperative period.
Image of A towel can be used to support a dog’s weight and aid mobility. (Courtesy of Brian Sharp)
A towel can be used to support a dog’s weight and aid mobility. (Courtesy of Brian Sharp) A towel can be used to support a dog’s weight and aid mobility. (Courtesy of Brian Sharp)
Image of There is a mid-diaphyseal simple transverse tibial fracture and a proximal fibular physeal fracture with bending of the mid-diaphyseal fibula.
There is a mid-diaphyseal simple transverse tibial fracture and a proximal fibular physeal fracture with bending of the mid-diaphyseal fibula. There is a mid-diaphyseal simple transverse tibial fracture and a proximal fibular physeal fracture with bending of the mid-diaphyseal fibula.
Image of The fracture was stabilized with an intramedullary pin and a 4-pin unilateral external skeletal fixator.
The fracture was stabilized with an intramedullary pin and a 4-pin unilateral external skeletal fixator. The fracture was stabilized with an intramedullary pin and a 4-pin unilateral external skeletal fixator.
Image of A fentanyl patch can be placed on clipped skin and covered with a flexible dressing to prevent the edges curling and excessive interference from the cat. It takes several hours to provide peak plasma fentanyl concentrations so it should be placed well in advance of surgery, and additional analgesia provided for the first few hours. (Courtesy of Polly Taylor)
A fentanyl patch can be placed on clipped skin and covered with a flexible dressing to prevent the edges curling and excessive interference from the cat. It takes several hours to provide peak plasma fentanyl concentrations so it should be placed well in advance of surgery, and additional analgesia provided for the first few hours. (Courtesy of Polly Taylor) A fentanyl patch can be placed on clipped skin and covered with a flexible dressing to prevent the edges curling and excessive interference from the cat. It takes several hours to provide peak plasma fentanyl concentrations so it should be placed well in advance of surgery, and additional analgesia provided for the first few hours. (Courtesy of Polly Taylor)
Image of This cat is enjoying attention. He has been allowed out of his cage for some controlled exercise and stroking.
This cat is enjoying attention. He has been allowed out of his cage for some controlled exercise and stroking. This cat is enjoying attention. He has been allowed out of his cage for some controlled exercise and stroking.
Image of A cardboard box with a blanket over it will make a hiding area for an anxious cat.
A cardboard box with a blanket over it will make a hiding area for an anxious cat. A cardboard box with a blanket over it will make a hiding area for an anxious cat.
Image of This cat, that presented with ipsilateral humeral and femoral fractures, has an enriched cage environment with a bed, litter tray, food and water bowls, and some fresh grass. The cage is also of a low height which prevents jumping and the mesh is small to prevent the clamps of the external skeletal fixator becoming entangled in the wire. The cage was modified from an outside rabbit run.
This cat, that presented with ipsilateral humeral and femoral fractures, has an enriched cage environment with a bed, litter tray, food and water bowls, and some fresh grass. The cage is also of a low height which prevents jumping and the mesh is small to prevent the clamps of the external skeletal fixator becoming entangled in the wire. The cage was modified from an outside rabbit run. This cat, that presented with ipsilateral humeral and femoral fractures, has an enriched cage environment with a bed, litter tray, food and water bowls, and some fresh grass. The cage is also of a low height which prevents jumping and the mesh is small to prevent the clamps of the external skeletal fixator becoming entangled in the wire. The cage was modified from an outside rabbit run.
Image of The cat has some swelling of the crus and paw.
The cat has some swelling of the crus and paw. The cat has some swelling of the crus and paw.
Image of The skin–pin interface of a cat where the ESF was left on for 18 months due to the owner failing to return for its removal at 10 weeks post-application. A functional seal has formed.
The skin–pin interface of a cat where the ESF was left on for 18 months due to the owner failing to return for its removal at 10 weeks post-application. A functional seal has formed. The skin–pin interface of a cat where the ESF was left on for 18 months due to the owner failing to return for its removal at 10 weeks post-application. A functional seal has formed.
Image of Radiographs taken 4 weeks postoperatively show early callus formation at the tibial fracture site. Further radiographs were scheduled to be taken in another 4 weeks; no change to the external skeletal fixator was made at this stage.
Radiographs taken 4 weeks postoperatively show early callus formation at the tibial fracture site. Further radiographs were scheduled to be taken in another 4 weeks; no change to the external skeletal fixator was made at this stage. Radiographs taken 4 weeks postoperatively show early callus formation at the tibial fracture site. Further radiographs were scheduled to be taken in another 4 weeks; no change to the external skeletal fixator was made at this stage.
Image of Mediolateral radiograph of the right stifle, showing no evidence of concurrent problems.
Mediolateral radiograph of the right stifle, showing no evidence of concurrent problems. Mediolateral radiograph of the right stifle, showing no evidence of concurrent problems.
Image of Craniocaudal view, showing no evidence of concurrent problems.
Craniocaudal view, showing no evidence of concurrent problems. Craniocaudal view, showing no evidence of concurrent problems.
Image of Mediolateral radiograph of the right stifle after surgery, showing better and deeper seating of the patella in the trochlear groove.
Mediolateral radiograph of the right stifle after surgery, showing better and deeper seating of the patella in the trochlear groove. Mediolateral radiograph of the right stifle after surgery, showing better and deeper seating of the patella in the trochlear groove.
Image of Working on body awareness, balance and core strength. This Golden Retriever is standing on two legs on balance disks. (© Janet Van Dyke)
Working on body awareness, balance and core strength. This Golden Retriever is standing on two legs on balance disks. (© Janet Van Dyke) Working on body awareness, balance and core strength. This Golden Retriever is standing on two legs on balance disks. (© Janet Van Dyke)
Image of A bellyband is being used to facility this dog’s mobility within the hospital. (Courtesy of Rachel Lumbis and Catherine Kendall)
A bellyband is being used to facility this dog’s mobility within the hospital. (Courtesy of Rachel Lumbis and Catherine Kendall) A bellyband is being used to facility this dog’s mobility within the hospital. (Courtesy of Rachel Lumbis and Catherine Kendall)
Image of A ‘Y’ fracture of the distal humerus.
A ‘Y’ fracture of the distal humerus. A ‘Y’ fracture of the distal humerus.
Image of A spica splint stabilizes the elbow and humerus. The flat lateral splint is held in place with adhesive tape over a Robert Jones dressing and a body bandage around the thorax. Reproduced from BSAVA Manual of Canine and Feline Emergency and Critical Care.
A spica splint stabilizes the elbow and humerus. The flat lateral splint is held in place with adhesive tape over a Robert Jones dressing and a body bandage around the thorax. Reproduced from BSAVA Manual of Canine and Feline Emergency and Critical Care. A spica splint stabilizes the elbow and humerus. The flat lateral splint is held in place with adhesive tape over a Robert Jones dressing and a body bandage around the thorax. Reproduced from .
Image of The Y fracture was stabilized with a medial bone plate, lateral bone plate and a transcondylar bone screw. Fracture reduction is good but there is a small gap in the condyle, which may indicate that the dog was suffering from incomplete ossification of the humeral condyle prior to acute complete fracture.
The Y fracture was stabilized with a medial bone plate, lateral bone plate and a transcondylar bone screw. Fracture reduction is good but there is a small gap in the condyle, which may indicate that the dog was suffering from incomplete ossification of the humeral condyle prior to acute complete fracture. The Y fracture was stabilized with a medial bone plate, lateral bone plate and a transcondylar bone screw. Fracture reduction is good but there is a small gap in the condyle, which may indicate that the dog was suffering from incomplete ossification of the humeral condyle prior to acute complete fracture.
Image of Gentle interaction with a patient in a quiet area of the ward can help address anxiety.
Gentle interaction with a patient in a quiet area of the ward can help address anxiety. Gentle interaction with a patient in a quiet area of the ward can help address anxiety.
Image of Passive supination of the forearm. (Courtesy of Brian Sharp)
Passive supination of the forearm. (Courtesy of Brian Sharp) Passive supination of the forearm. (Courtesy of Brian Sharp)
Image of Step-over exercise. (Courtesy of Brian Sharp)
Step-over exercise. (Courtesy of Brian Sharp) Step-over exercise. (Courtesy of Brian Sharp)
Image of A bandage ending as proximally as possible in the axilla will help reduce perifracture swelling and increase patient comfort. A body bandage could also be used after surgery, and this would provide more support of the limb.
A bandage ending as proximally as possible in the axilla will help reduce perifracture swelling and increase patient comfort. A body bandage could also be used after surgery, and this would provide more support of the limb. A bandage ending as proximally as possible in the axilla will help reduce perifracture swelling and increase patient comfort. A body bandage could also be used after surgery, and this would provide more support of the limb.
Image of The Rottweiler, showing an abnormal stance due to multiple joints affected by osteoarthritis.
The Rottweiler, showing an abnormal stance due to multiple joints affected by osteoarthritis. The Rottweiler, showing an abnormal stance due to multiple joints affected by osteoarthritis.
Image of Mediolateral elbow and pelvic radiographs showing well established osteoarthritis.
Mediolateral elbow and pelvic radiographs showing well established osteoarthritis. Mediolateral elbow and pelvic radiographs showing well established osteoarthritis.
Image of Mediolateral shoulder radiograph, showing very mild osteophytic changes on the caudal glenoid and humeral head and an area of mineralization in the supraspinatus muscle.
Mediolateral shoulder radiograph, showing very mild osteophytic changes on the caudal glenoid and humeral head and an area of mineralization in the supraspinatus muscle. Mediolateral shoulder radiograph, showing very mild osteophytic changes on the caudal glenoid and humeral head and an area of mineralization in the supraspinatus muscle.
Image of Dorsopalmar view of the forefoot, showing fragmentation of sesamoids II and VII.
Dorsopalmar view of the forefoot, showing fragmentation of sesamoids II and VII. Dorsopalmar view of the forefoot, showing fragmentation of sesamoids II and VII.
Image of Spinal mobilizations may be performed by a veterinary physiotherapist. (Courtesy of Brian Sharp)
Spinal mobilizations may be performed by a veterinary physiotherapist. (Courtesy of Brian Sharp) Spinal mobilizations may be performed by a veterinary physiotherapist. (Courtesy of Brian Sharp)
Image of Acupuncture applied to the infraspinatus muscle to treat the pain of elbow arthritis. (Courtesy of Samantha Lindley)
Acupuncture applied to the infraspinatus muscle to treat the pain of elbow arthritis. (Courtesy of Samantha Lindley) Acupuncture applied to the infraspinatus muscle to treat the pain of elbow arthritis. (Courtesy of Samantha Lindley)
Image of Electroacupuncture applied to hip and back points for the treatment of pain secondary to hip arthritis. (Courtesy of Samantha Lindley)
Electroacupuncture applied to hip and back points for the treatment of pain secondary to hip arthritis. (Courtesy of Samantha Lindley) Electroacupuncture applied to hip and back points for the treatment of pain secondary to hip arthritis. (Courtesy of Samantha Lindley)
Image of A crate with deep comfortable bedding would be most suitable.
A crate with deep comfortable bedding would be most suitable. A crate with deep comfortable bedding would be most suitable.
Image of Ramps can help dogs with limited mobility get in and out of cars.
Ramps can help dogs with limited mobility get in and out of cars. Ramps can help dogs with limited mobility get in and out of cars.
Image of An overweight cat that is reluctant to exercise unless it is feeding time.
An overweight cat that is reluctant to exercise unless it is feeding time. An overweight cat that is reluctant to exercise unless it is feeding time.
Image of The cat is stiff and has difficulty rising from sitting or lying.
The cat is stiff and has difficulty rising from sitting or lying. The cat is stiff and has difficulty rising from sitting or lying.
Image of The hip radiograph shows coxofemoral and intervertebral osteophytosis. The elbow radiograph shows multiple ‘joint mice’.
The hip radiograph shows coxofemoral and intervertebral osteophytosis. The elbow radiograph shows multiple ‘joint mice’. The hip radiograph shows coxofemoral and intervertebral osteophytosis. The elbow radiograph shows multiple ‘joint mice’.
Image of Stepped access to and from favourite areas may help a cat with limited mobility. (© Samantha Elmhurst)
Stepped access to and from favourite areas may help a cat with limited mobility. (© Samantha Elmhurst) Stepped access to and from favourite areas may help a cat with limited mobility. (© Samantha Elmhurst)
Image of An outdoor cat may spontaneously increase activity.
An outdoor cat may spontaneously increase activity. An outdoor cat may spontaneously increase activity.
Image of Short play sessions can be used to provide exercise for cats. (Courtesy of Brian Sharp)
Short play sessions can be used to provide exercise for cats. (Courtesy of Brian Sharp) Short play sessions can be used to provide exercise for cats. (Courtesy of Brian Sharp)

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