Page 8
PART I
Orthopaedic and Neurology
CASE BASED EXAMINATION
SIX MINUTES
A two year old Hungarian Puli is referred for persistent lameness after fracture repair, with a draining tract on the affected limb. The dog had sustained a radius ulna fracture due to a hunting injury two months previously.
The image shows the cranio-caudal radiograph of the antebrachium.
1.) List SIX important findings with regard to the orthopaedic repair. 3pt
2.) What is your diagnosis? 2pt
3.) List FOUR ways in which the current type of fixation could have been optimized. 2pt
4.) List THREE key steps in treating this case 3pt
10pt
SIX MINUTES
After removal of the implants and the devitalized bone segments, the dog was placed in a splinted bandage for 3 months. The dog was also treated with antibiotics according to bacteriology results. The dog remained lame and re-presents for further evaluation.
Image A shows the lateral radiograph of the antebrachium and image B shows the cranio-caudal radiograph.
1.) List FOUR important radiographic findings. 2pts
2.) What is your radiographic diagnosis? Be specific for the radius and the ulna. 4pts
3.) List FOUR essential steps necessary to treat this fracture. 4pts
10pt
SIX MINUTES
Internal fixation was performed after debridement of both fracture sites and bone grafting.
Image A shows the lateral radiograph of the antebrachium and image B shows the cranio-caudal radiograph. Image C shows an intraoperative picture.
1.) What kind of bone graft is shown in image C 1pt
2.) What are the common sites for harvesting this kind of bone graft? 2pts
3.) List the functions of an ideal bone graft. 4pts
4.) Which of these functions does not apply to the bone graft of image C? 1pt
5.) Tricalcium phosphate can also be used as a substitute for bone graft. Which function of an ideal bone graft does tricalcium phosphate have? 1pt
6.) The fracture repair shown in the radiographs used exclusively locking screws. What disadvantage does this fixation type have for treatment of a non union fracture? 1pt
10pt
SIX MINUTES
The dog returns for radiographic re-evaluation with good limb function 3 months post operatively.
Image A: lateral radiograph of the antebrachium 2 weeks post operatively
Image B: lateral radiograph of the antebrachium 3 months post operatively
1.) What are the radiographic findings at the 3 month follow-up? Be specific for the radius and the ulna. 4 pts
2.) What are your radiographic diagnoses? 2pts
3.) Based on your radiographic interpretation, what is the next step in managing this case and why?
2pts
Reason: 2pts
10pt
SIX MINUTES
Three years later the dog is re-presented with a progressive lameness of the CONTRALATERAL thoracic limb. On orthopaedic examination you detect moderate supra- and infraspinatus muscle atrophy as well as discomfort on forced EXTENSION of the shoulder joint.
Image A shows the lateral view of the right shoulder and image B shows a skyline view of the bicipital groove.
1.) Briefly describe or draw patient positioning to obtain a SKYLINE view of the bicipital groove. 2pts
2.) List TWO key radiographic findings. BE SPECIFIC. 4pts
reflex dyssynergia or urinary dyssynergia
3.) What are the radiographic diagnoses? 2pts
4.) What is the most appropriate diagnostic investigation to further evaluate the clinical signficance of each of these radiographic abnormalities? BE SPECIFIC for each diagnosis. 2pts
10pt
SIX MINUTES
You perform an arthroscopy to evaluate the separate centre of ossification of the caudal glenoid. The video shows the arthroscopy of the affected shoulder performed using the standard lateral scope portal.
1.) List the basic steps when establishing a portal for diagnostic arthroscopy of any joint (not the working portal). 4pts
2.) What specific technical modification of a standard shoulder arthroscopy has been performed in this case as shown in the video? 2pts
3.) List the proposed aetiopathogenic contributing factors leading to degeneration of the supraspinatus tendon. 2pts
4.) What is the Outerbridge classification of the cartilage lesion in the supraglenoid region? 1pt
Type IV
5.) What is the most probable cause for this lesion? 1pt
10pt
SIX MINUTES
After evaluating the shoulder joint in a hanging limb position, you approach the cranial aspect of the shoulder for resection of the calcification in the supraspinatus tendon.
There is no image for this question.
1.) List the passive stabilizers of the shoulder joint. 3pts
2.) List the active stabilizers of the shoulder joint. 2pts
3.) List possible postoperative complications after resection of the calcification in the supraspinatus tendon. 3pts
4.) List two suture patterns used best to suture FLAT tendons. 2pts
10pt