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Canine Juvenile Orthopedic Disease

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Canine Juvenile Orthopedic Disease STEP 1: Comprehensive Overview CLINICAL SUITE | JUVENILE ORTHOPEDIC DISEASE ment is key to reduce the typical life- Canine Juvenile long progressive arthritis associated with this disease.2 Orthopedic Disease Hip dysplasia Jonathan Miller, DVM, MS, DACVS Hip dysplasia can be diagnosed as Oradell Animal Hospital early as 4 months of age3; ventrodor- Paramus, New Jersey sal and distracted hip radiographs are useful for diagnosis. Early diagnosis Most juvenile orthopedic disease is developmental in nature, and early allows early medical treatment and, in some cases, certain therapeutic surgi- treatment is key. In addition to a thorough patient history, the orthopedic cal procedures. A bunny-hopping gait examination is a critical first step. Once the abnormal joint(s) is identified, when running, lower energy level, and radiographs should be obtained. difficulty climbing stairs or jumping are often seen in hip dysplasia patients. MOST COMMON DISEASES Avascular necrosis OTHER DISEASES Puppies often present with single Avascular necrosis of the femoral Less common diseases include con- leg lameness; however, anecdotally, head typically manifests as hip pain genital joint luxations, panosteitis, many juvenile diseases are bilateral, in small-breed dogs <1.5 years of hypertrophic osteodystrophy, cranio- so a thorough orthopedic exam- age. Treatment is surgical (ie, femo- mandibular osteopathy, and angu- ination is always warranted, with ral head and neck excision, total hip lar limb deformity. Dogs of any age special attention to the hips, knees, replacement), whereas patellar lux- may present with a fracture that may and elbows. Familiarity with typical ation treatment can be medical or manifest as severe pain with non- historical findings is important, be- surgical depending on clinical signs. weight-bearing lameness. cause different pathologies present at different ages. Osteochondritis dissecans PROGNOSIS & TREATMENT Osteochondritis dissecans (OCD) is a Prognosis depends on disease type developmental disease most common- and severity, likelihood of arthritis ly noted in the shoulder but also seen development, and patient response to in the stifle, elbow, or tarsus.1 Most treatment. Some form of treatment is OCD lesions are best treated with ar- available for most cases. throscopic debridement, but an open surgical approach with a bone or carti- lage graft may also be performed. A thorough Elbow dysplasia orthopedic Elbow dysplasia refers to 4 different examination is diseases affecting the elbow joint: fragmented medial coronoid process, always warranted. OCD of the medial portion of the humeral condyle, united anconeal process, and elbow incongruity. The most common form is fragmented STEP 2 medial coronoid process; early treat- Treatment Plan h March 2015 Veterinary Team Brief 27 STEP 2: Treatment Plan CLINICAL SUITE | JUVENILE ORTHOPEDIC DISEASE in dogs under 12 months of age Examination, Radiographs, with mild to moderate hip dyspla- sia and no evidence of osteoarthritis; FHO works best in dogs under 50 & Treatment Options pounds; THR is available for dogs of Jonathan Miller, DVM, MS, DACVS almost any size. Oradell Animal Hospital Paramus, New Jersey Patients with hip and elbow dysplasia can be treated medically, but often Early diagnosis and treatment before osteoarthritis formation are often surgery is the best option. Fractures key to successful management. Congenital problems frequently man- can be fixed with casts, plating, or external fixators. Elbow dysplasia can ifest before 1 year of age, so a limp lasting longer than a day should be treated with arthroscopic corrective be examined by a veterinarian. Thorough orthopedic examination and osteotomy, which also works well for radiographs are the foundation of diagnosis and allow formulation of patella luxation. an appropriate treatment plan. Exercise restriction is typically required after a procedure and should be dis- Physical examination findings help the femoral head pops back into the cussed with clients. determine if limping (ie, lameness) acetabulum following subluxation. will resolve independently. Pain med- In many areas of the United States, ications often help, but a definitive SURGICAL OPTIONS veterinary orthopedic specialists are diagnosis and radiographs are pru- Dogs younger than 6 months of age available for consultation or nonsur- dent to avoid long-term problems; can be treated via juvenile pubic gical recommendations, as well as re- however, although radiographs show symphysiodesis.4 Other surgical op- ferral for surgical therapies. bone and joint spaces clearly, ten- tions include triple pelvic osteotomy dons, ligaments, and cartilage are not (TPO), femoral head and neck exci- MEDICAL MANAGEMENT represented. sion (FHO), and total hip replace- Some diseases (eg, panosteitis, hyper- ment (THR). TPO is most useful trophic osteodystrophy) respond well THE ROLE OF ANESTHETICS to medical management. While pup- The difference in radiographs of a se- pies may grow out of these diseases, dated dog compared with those of an other diseases (eg, hip dysplasia, elbow alert dog is astounding, because small dysplasia) require lifelong monitoring changes in rotation or limb extension and management. Treatment consists can be crucial to identify the problem. of weight management, diet modifica- For example, femur rotation can hide tion, nutraceuticals, physical rehabili- subtle hip dysplasia, or an OCD lesion tation, and NSAIDs. could be missed with only a rotated or cranial-caudal view of a shoulder. Se- dation also allows for Ortolani testing to indicate excessive hip laxity second- ary to hip dysplasia; with the dog in lateral recumbency, the pelvic limb is pushed dorsal as the limb is abducted. STEP 3 A distinct clunk can be palpated when Team Roles h 28 veterinaryteambrief.com March 2015 STEP 3: Team Roles CLINICAL SUITE | JUVENILE ORTHOPEDIC DISEASE Team Roles & Responsibilities Jonathan Miller, DVM, MS, DACVS, Oradell Animal Hospital, Paramus, New Jersey Patient and client bonding expert, Patient caregiver, client educator client educator • Triage the patient • Encourage clients calling about • Take a thorough history, including a limping puppy to come to when the lameness started, its the practice for an orthopedic progression, and any medications examination • Evaluate for pain • Mention that pain control is very important • Walk the patient down a hallway during the examination • Offer a gurney if multiple limbs are affected TECHNICIAN • Know how to obtain high-quality radiographs • Reinforce information about adverse RECEPTIONIST effects of medication • Be familiar with physical therapy modalities • Be familiar with common surgical treatments • Educate clients about commonly used medications Medical expert, client Workflow facilitator, team and team educator and education coordinator • Conduct an orthopedic examination • Develop a brochure of common • Recommend a radiographic juvenile orthopedic diseases examination with the patient sedated • Encourage the team to support early or anesthetized aggressive treatment • Confirm a diagnosis • Encourage the veterinarian to provide • Devise a medical plan consisting an overview presentation of pain medication, diet, weight management or loss, and nutraceuticals VETERINARIAN • Consider referral to an orthopedic specialist PRACTICE MANAGER STEP 4 Team Training Plan h March 2015 Veterinary Team Brief 29 STEP 4: Team Training Plan CLINICAL SUITE | JUVENILE ORTHOPEDIC DISEASE • Ways to ensure compliance with Training a treatments and recommended exercises or physical restraint. Knowledgeable Team Although role-playing and client communication are very important Jennifer Potts, RVT to team training, team members Chimney Hills Animal Hospital must also understand why they are Tulsa, Oklahoma giving the clients the information. Veterinarians play an important role Proper knowledge of juvenile ortho- tions (eg, medications, supplements, in helping team members under- pedic diseases is important for the surgery). They should also understand stand the “why” of juvenile ortho- entire team. An established plan that the importance of obtaining a com- pedic diseases. Veterinarian presen- includes all team members and is re- plete patient history, including over- tations should include: viewed and revised periodically is cru- the-counter medications or supple- cial. Proper training allows each team ments the client administers at home. • A general explanation of juvenile member to know his or her role and orthopedic diseases and the typical how to effectively communicate with Practice management training should presenting signs clients. include team exercises around the fol- • Availability and types of testing lowing topics to build effective client (eg, PennHIP, OFA, radiographs) Practice managers and veterinarians communication skills: • Treatments (eg, physical must train the team to ensure that rehabilitation, nutraceuticals every team member is knowledgeable • The importance of preventive care and supplements, medications, about the practice’s protocol for treat- examinations for juvenile patients surgery) and possible adverse ing juvenile orthopedic diseases. All • Costs, and ways to help clients effects team members should be well-versed with financial constraints • The importance of at-home care on the different diseases, diagnostic • Client education about at-home and compliance with discharge testing options, and treatment op- care instructions. It is also important to attend CE meetings to learn about new diagnos-
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