Osteomyelitis is inflammation of bone and related structures, often caused by bacterial or fungal infection, but sometimes secondary to trauma or bone surgery. Fungal infection is most commonly due to one of the Systemic Fungal Diseases, while bacterial infections often occur secondary to bite or other wounds, fractures, foreign objects such as foxtails and movement of infections occurring in other areas, such as dental or ear infections.
Clinical signs will include pain, lameness, fever, swelling of the area, lethargy, poor appetite and many cases will have open draining sores present. If such an infection occurs in relation to a fracture or fracture repair, inhibition of bone healing will occur. Diagnosis is based on history, physical examination, blood counts, X-rays, cytology, cultures of the exudates and possibly biopsy of the tissues involved. Bone infections are considered serious and should be treated as aggressively as possible. ((Osteomyelitis))
TREATMENT OF OSTEOMYELITIS
If Systemic Fungal Disease is involved, treat accordingly. Bacterial osteomyelitis should be treated with antibiotics given intravenously and orally; it is best if your veterinarian performs a culture to determine what medications are likely to optimally treat the infection. Open wounds or draining tracts should be cleaned and flushed with antibiotic solutions and fractures or infected fracture repairs should be treated accordingly. This may involve surgical exploration and removal of damaged tissues or attempting a secondary method of repair if the first has failed. Repeat X-rays will be used to determine how the infection is resolving and the fracture, if any, is healing. It is important to note that osteomyelitis can be or become a chronic problem so proper, aggressive and continuing treatment is highly recommended.
Panosteitis is an inflammatory disease of the bones of large and giant breed dogs that usually occurs in dogs under one year of age. The cause of this condition is unknown but stress, allergies and hormonal conditions may all contribute to the cause. The disease will typically go away without treatment but lameness may persist for months.
Clinical symptoms include lameness that comes and goes and may seem to involve one or more legs. Pain, which will be most notable along the shafts of the leg bone, will come and go and vary in severity. Diagnosis is based on history, clinical exam and X-rays of the affected bones. Blood counts and related tests will reveal little. ((Panosteitis))
TREATMENT OF PANOSTEITIS
This disease will usually go away without specific treatment, but carprofen, deramaxx, meloxicam and other NSAIDs can all be given to alleviate pain. Restricted exercise is advised and patience is needed as several months may pass before the dog is back to 100%.
HOD is an inflammatory disease of young, rapidly growing, large breed dogs wherein the growth areas of the bones (called the metaphysis) becomes swollen and inflamed. The condition is rare and the cause completely unknown. Most dogs exhibit a very sudden onset of lameness, some dogs being reluctant to stand or move at all; pain and swelling will occur near the joints, with a loss of appetite, fever and weight loss occurring concurrently. Diagnosis is based on history, clinical signs and specific bone changes that can be seen on X-rays.
TREATMENT OF HYPERTROPHIC OSTEODYSTROPHY (HOD)
HOD is another disease that will run its course and then go away. The dogs, however, are in severe pain so the use of carprofen, deramaxx, meloxicam and other NSAIDs is highly advisable. Good nursing care to keep dogs moving and free from bedsores. (Some will lie down and not be willing to move) Making sure the pet is consuming food and proper amounts of liquids is also very important.
As this is a condition of rapidly growing dogs, it is advisable to feed a ration lower in protein and calories than the dog is used to, thus slowing growth of the bones which seems to speed the recovery. Vitamin C is often given but no real mode of action for this vitamin has been proven. Given time and good nursing care, most dogs can completely recover.
HO is a rare inflammatory reaction of the outer tissues of the bones near the feet, which occurs for unknown reasons, but only when masses are present in the chest/lungs. Neoplasia that has spread to the lungs or abscesses and other infections in the lungs are commonly associated with this problem. The mechanism of how and why this occurs is poorly understood.
Clinical signs include lameness and swelling of all four legs, which progresses gradually from time of onset in an older dog. Early recognition may give clue to search for the underlying condition months before the symptoms of that exact illness are present. Diagnosis is based on clinical signs, X-rays of the limbs and chest, blood testing and possibly serology.
TREATMENT OF HYPERTROPHIC OSTEOPATHY (HO)
Treatment here is based on identification and cure of the underlying condition. If a lung abscess is identified and removed for example, the lameness and swelling will go away in a few weeks. If widespread cancer is present, a cure is less likely for either condition.
Osteochondrosis defines conditions where bone formation (endochondral ossification) does not proceed properly and some notable defect occurs. If the defect causes a piece of surface cartilage (articular cartilage or joint cartilage) to separate from the underlying bone and then inflammation of the joint occurs, the condition is called Osteochondritis dissecans (OCD). Otherwise, the usual defect will be one where sections of developing bone do not fuse together properly and a free piece is formed. These problems are most common in dogs that are under 1 year of age and of larger, rapidly growing breeds. ((OCD))
The most common site for OCD lesions is the head of the humerus, but the elbow, stifle (knee) and ankle can all be involved. Ununited Anconeal Process (UAP) and Ununited Coronoid Process (aka Fragmented Coronoid Process) are the other common osteochondrosis lesions involving the elbow joint. The clinical signs for these conditions include lameness which often becomes worse with exercise, pain upon joint manipulation and possibly swelling of the joint or atrophy (shrinking) of muscles in the area due to disuse.
Diagnosis of these conditions is based on history, physical examination and X-rays. In some cases, dye may need to be injected into the joint to expose any flaps of cartilage that might otherwise not be readily identifiable.
TREATMENT OF OSTEOCHONDROSIS
While some dogs may receive temporary benefit from rest and exercise restriction, most dogs need surgical removal of either the cartilage flap or loose cartilage in the joint, or removal of the ununited process from the joint. Some veterinarians will also curette (scrape) the surface of the defect to stimulate healing. Strict rest, confinement and passive exercise for about 4 weeks after surgery will be needed. Some advise the use of Cosequin, Adequan, SynoviCre, or Cartiflex after surgery; while unproven for these cases, these drugs should provide benefits and certainly have minimal risks.
Also known as avascular necrosis, this disease involves a noninflammatory dissolution of the femoral head and neck in small dogs. The exact cause of this disease is unknown, but it seems to involve loss or restriction of blood flow to this area. The condition may be genetic and inherited.
Clinical signs include variable degrees of pain, chewing at the hindleg, lameness and grinding as the hip is manipulated. The affected leg(s) may be shorter than the opposite. Lameness generally becomes worse with time with loss of muscle mass often being present. Diagnosis is based on history, physical examination and X-rays.
TREATMENT OF LEGG-CALVE'-PERTHES DISEASE
Most dogs should undergo removal of the dissolved area of bone surgically, smoothing of the remaining femoral shaft surface and the possible formation of a muscular sling to assist healing and motion. This is known as a femoral head and neck resection surgery. As most dogs having this condition are small, those undergoing this surgery do very well and are able to use the previously affected leg.
In general, osteopenia defines a decrease in bone density that is most often secondary to some other disease process. Osteoporosis is a loss of mineral from the bones and is most commonly secondary to disuse, hormonal, or nutritional factors. Osteomalacia is the failure of bone to properly mineralize. The overall effect is to weaken the skeleton, which in the early stages may cause little outward symptoms.
Later, as this disease progresses, the dog may exhibit lameness and possibly fracture a leg spontaneously. Bones may become soft and more moveable and be painful when deeply palpated. Diagnosis is based on physical exam and X-rays, which will exhibit a notable loss of bone density and possibly small cracks or fractures in the bones. Often blood testing or special testing may be needed to diagnose the disease, which is causing the bone weakness.
TREATMENT OF OSTEOPENIA
Treatment for this condition centers primarily on identification of the cause of the bone loss. Treatment of that condition or correction of any dietary abnormalities will often lead to an increase in bone density. Prevention of trauma should be a high priority to prevent (further) fractures.
Understanding terminology here is very important. Arthritis would imply inflammation of a joint, which is usually transient and uncommon. Arthrosis, which implies a noninflammatory degeneration of a joint, is most common in dogs. Osteoarthrosis/Osteoarthritis is the common form of "arthritis" seen in the dog; it is characterized by progressive joint degeneration with minimal actual inflammation of the joint. The proper description, then, Degenerative Joint Disease (DJD) describes the process of joint change usually seen in the dog.
DJD in its primary form reflects degeneration of joint cartilage (hyaline cartilage), progressing to erosion of the cartilage, fissures of the cartilaginous surfaces, hardening of underlying bone, the production of bone spurs, with mild to moderate inflammation of surrounding tissues. The basic cause could be none other than wear and tear on the joint(s) that occurs over time and/or with aging. ((DJD)) ((DJD2))
DJD, however, may be secondary to other conditions including congenital deformities of the joints, osteochondrosis, joint instabilities, trauma, inflammatory joint disease, soft tissue damage (ligaments, tendons) and neurologic diseases. While the initiating cause may differ, the characteristics and progression of the disease is similar in any instance. While a long and detailed discussion could be included herein, it will suffice that this is the disease that most commonly affects the mobility of dogs
The primary clinical signs of DJD include pain, stiffness and crepitus (which is a "grinding" of the joint as the joint moves). While some owners seem to intuitively know that their animal is in pain, all dogs may not manifest their pain in a manner that is obvious to everyone. To say the least, a stiff or slow moving dog IS a painful dog. Pain may also disappear when a dog is nervous or excited, often when visiting the veterinarian!
Obvious signs of pain would include crying, yelping, whining, biting when touched, wincing or tightening while being examined or when trying to move and resisting movement of a limb(s) when examined. The less obvious but equally certain signs of pain include stiffness, lameness or limping, exhibiting a reluctance to perform normal or usual movements such as ascending a stair or jumping onto a chair, a decreased tolerance to exercise and changes in the dog's gait. Pain from DJD often becomes worse in cold and damp weather or after exercising more than usual. The pain a dog feels will not always correlate to how severe the arthritis; each animal, just like each human, will respond to and tolerate pain differently.
DJD will also tend to be worse in dogs that are overweight and, of course, older dogs. Diagnosis is based on the clinical signs, X-rays and ruling out other generalized conditions which could cause weakness, stiffness and so forth. Inflammatory arthritis can occur secondary to joint infection, Lyme disease, rheumatoid arthritis, SLE and other chronic diseases. Clinical signs are similar but may include joint swelling and fevers, along with symptoms typical of those specific conditions. Aspiration of joint fluid may be performed to aid diagnosis of these other arthritic conditions.
TREATMENT OF DEGENERATIVE JOINT DISEASE
If there is an actual initiating disease causing the DJD, that should obviously be treated. For true primary degenerative arthritis, resting the dog for a period of time, then returning the pet to moderate and controlled exercise, physical therapy including swimming, heat applied to affected joints, the use of anti-inflammatory medications including carprofen, deramaxx, meloxicam and other NSAIDs and less often, cortisone can all provide relief from pain and stiffness.
Weight reduction and limiting traumatic activities such as jumping is very important and special weight control diets may be indicated. Obese dogs that seem hard to reduce should be examined for other conditions including hypothyroidism. Newer medications such as Adequan, SynoviCre, Cartiflex and Cosequin have proven highly effective in improving mobility and long term improvement in clinical conditions.
There are surgical procedures available including surgical removal of cartilage flaps and bone spurs, muscle cutting procedures which reduce pull on the joints, fusion of certain joints, reconstruction of certain joints, removal of part of a joint, joint replacement, nerve cutting and even amputation of very badly affected joints. Many dogs undergo reconstruction of hip joints and even total hip replacement. Some of the other procedures are used when cost prohibits these more advanced procedures and often can be very successful in relieving pain and still allowing good patient mobility.
Many dogs, if not most, will respond well to weight reduction, the use of pain relieving drugs and the reconstructive medications previously mentioned. Physical therapy including swimming, heat and passive joint manipulation is often overlooked but should be used in most cases. These medical treatments are often successful in providing most dogs with DJD pain free mobility into their later years.
Hip dysplasia refers to an abnormal or faulty development of the hip joint which leads to an abnormal laxity of the joint, deformation of normal joint architecture and ultimately, degenerative joint disease. Most dog owners erroneously say that their arthritic dog has hip dysplasia, which most often will not be the case; most dogs with hip dysplasia develop degenerative joint disease, but most dogs with degenerative joint disease of the hips do not have hip dysplasia. The disease, however, is quite prevalent, more so in larger breeds of dogs and is considered a genetic, inheritable trait.
Clinical signs are similar to those of DJD including lameness, pain, stiffness and crepitation of the joints. One or both hips may be affected, with some dogs showing clinical disease as early as 6 months of age, but most showing signs in later years. Diagnosis is based on clinical signs, history and X-rays. Owners of valuable breeding dogs should have their dogs X-rayed at 2 to 2 1/2 years of age and certified by the Orthopedic Foundation of America, with dogs not being used for breeding until after they are certified to have good or excellent hips. Even so, this will not be a 100% guarantee against having a dysplastic pup. ((Hip Dysplasia))
TREATMENT OF HIP DYSPLASIA
Symptomatic therapy for dogs with hip dysplasia is as for DJD and that section should be referred to. For dogs with severe DJD, especially those with the problem at a young age, there are several options for surgical procedures that can be employed. Total hip replacement is common, with many larger cities having veterinary surgeons qualified to perform such a procedure. Over 95% of dogs treated this way show a good response, but the cost may be several thousand dollars per hip. (A real medical bargain if you consider the cost of a human hip replacement)
Many surgeons perform a procedure known as the triple pelvic osteotomy, which in short, rearranges pelvic bones to improve capture of the femoral head and limit subluxation of the hip. Many dogs show a good response to this procedure and the cost is generally less than for total hip replacement. Another procedure called a pectineal myectomy can be employed as a simplistic and inexpensive method of alleviating joint pain. A small muscle in each thigh is cut near the tendon on the femur; this seems to reduce pressure within the joint. It does not, however, alter the progression of DJD.
Another procedure, the femoral head and neck resection which involves removing the femoral head and making somewhat of a fake joint out of muscle tissue. This considered a salvage procedure. It is best performed on dogs under 40lbs; most canines move in a pain free manner, often with little or no limp. Lastly, the intertrochanteric osteotomy, a procedure uncommonly performed, involves rearranging the femoral head by taking small wedges from areas of the femur. Many dogs can function free of pain after such a procedure, but DJD can still develop.
A luxation implies a dislocation of a joint whereby normal mechanical function is impaired. Most luxations occur secondary to trauma although a few can be predisposed by defects in bone or surrounding soft tissues. The most commonly luxated joints are the hip (coxofemoral joint) and the elbow (humeroradioulnar joint) but any joint can become luxated. Spinal luxations will be the most severe as damage to the spinal cord would occur. ((Luxation))
SUBLUXATION is the term used to describe a luxation which is not as severe or as complete as a full luxation and most often used to describe incomplete articulation of the hips, often in relation to dogs with hip dysplasia. In chiropractic terms, the word subluxation is used to describe any abnormal physical and functional relationship of a joint, as it is believed that all misalignments ultimately lead to dysfunction. Diagnosis of luxation and subluxation is based on history, physical examination and X-rays.
TREATMENT OF LUXATION/SUBLUXATION
Any true luxation is serious and should be treated as soon as possible. The hip and elbow can often be manipulated back into position if early care is administered. Later, bleeding or soft tissue changes can inhibit the ability of the doctor to put the joint back together and surgery may be the only means of restoring normal integrity of the joint. Once in place, luxated joints may need to be stabilized with some type of bandage or splint for 1-4 weeks to allow soft tissues to heal. After this treatment and with some physical therapy, most animals can lead a very normal life. Subluxation is almost always treated with medications, manipulation and physical therapy with most dogs showing good improvement. This may not apply, however, in cases of hip dysplasia.
A fracture is a complete or partial break in a bone and/or cartilage and will probably include some associated damage to nerves, blood vessels, muscles, tendon and ligaments or other organs near the fracture site. Most are caused by some type of traumatic injury, with car accidents said to account for almost 80% of all canine fractures. While trauma is most common, repeat stresses, nutritional weakness and cancers of the bones can all lead to fractures.
The fracture types are so numerous, depending on which bone is involved and how it was broken; an exact discussion of any one break is impossible in any text. Our goal herein will be to provide at least basic terminology to understanding the different types of fractures.
Clinical signs of fractures include pain, deformity, or alteration in bony angles, altered mobility or lameness, swelling, a grinding when the area is manipulated (this should be avoided) and a general loss of function. Other clinical symptoms would depend on which other structures have been likewise injured by the trauma or as a result off a fracture itself. Diagnosis is based on history, clinical signs and X-rays. First aid to stabilize the fracture should be performed until care can be obtained to prevent further damage.
Closed Fractures have no opening to the outside and no break in the skin along with the fracture.
Open Fractures communicates with the outside, likely to become infected.
Green-stick Fractures have one side of the bone broken and one side bent; these are often seen in young dogs.
Fissure Fractures are small, long cracks in the bone.
Complete Fractures are where total and complete disruption of the bone has occurred.
Transverse/Oblique/Spiral Fractures describe at what angles the bone(s) is broken.
Comminuted Fractures are where fragments or splinters occur as part of the fracture.
Multiple Fractures are where three or more pieces are present in a fracture site.
Avulsion Fracture is where a piece of bone is broken at the site of a muscle, ligament or tendinous attachment.
Impaction Fractures are where ends of a fracture are pushed or driven together.
Physeal Fractures occur at a line or point of growth; these are serious.
Condylar Fracture is fractures between condyles, rounded areas at end of some bones.
Stable Fractures are those which lock and are not too moveable.
Unstable Fractures are those where pieces do not naturally hold together well.
TREATMENT OF FRACTURES
As stated previously, as the types of fractures possible is beyond numbering, to give an exact discussion of each specific fracture repair would be most impossible. The basic principles of healing a fracture include the following: stabilization which is holding the pieces of a fracture in alignment so healing can occur; maintain vascularity which indicates how well the bone's blood supply is maintained; and the less tangible factor of how well the individual dog's body does at the task of new bone production.
The veterinarian must first deal with soft tissue injuries and bleeding, then reduce the fracture, which means to put the pieces back as they should be, or as close as humanly possible and lastly, to stabilize the fracture so that the healing can ultimately occur. This may be termed fracture fixation. While most fractures in and of themselves do not require emergency repair, they should be temporarily stabilized as soon as possible and then properly fixated within a few days.
Reduction can be accomplished with or without surgery. After a fracture occurs, muscles will pull the pieces in different directions and will make it difficult to realign them. Left too long, contraction of the muscles may occur and nearly lock the bones into abnormal locations. Under anesthesia or at least some level of sedation, the bones may be manipulated to near their proper location. This is called a Closed Reduction. If this is not accomplished, or if the fracture is too complicated for such a procedure, then the veterinarian must surgically open the site and then align the pieces. This is called an Open Reduction. After reduction, then fixation must be undertaken. These include:
CASTS AND SPLINTS are most often used for fractures well below the elbow or the knee. Often owners' request that these be used to control cost but only certain fractures in these locations will benefit from this type of fixation. The veterinarian can use many differing materials, but all casts should fit well without causing damage to the limb. Dog owners will have to keep these devices clean and dry and prevent their pet from chewing or otherwise damaging the cast. With the right type of fracture, casting or splinting can produce excellent results. ((Splint)) ((Cast))
INTRAMEDULLARY PINS AND WIRES are another commonly used method of fracture repair and in skilled hands can produce excellent results for a moderate cost. Some fractures can be repaired in a closed fashion, reduced and fixated by driving a pin(s) in from the outside. Most fractures, however, will be reduced in the open fashion, with pins driven in and sometimes wires used to additionally stabilize the fracture site. Pins and wires are also sometimes used along with screws and plates as well as with kirschner fixators. The possible configurations of this and these other devices are almost limitless. ((Fracture Pin and Wire Repair))
SCREWS AND PLATES are sometimes necessary to repair a fracture. Often multiple, more complicated fractures are best treated this way. Given good technique, there is often a high rate of success using this method of repair. Most general practitioners, however, will not have the equipment and advanced training to properly perform these techniques and a surgical specialist will have to be sought. In some cases where pieces of bone are so shattered as to be unrepairable, plating the fracture and grafting in bone can be used successfully to result in proper repair. Plates and screws are also useful in fractures of and around certain joints. ((Bone Plate and Screws))
KIRSCHNER FIXATORS (EXTERNAL FIXATORS) involve driving pins crosswise into bone and attaching the free ends to a bar or bars to establish the stabilization. This method also may be combined with other techniques. The advantages of using this technique include external application, relative simplicity of the technique and adjustability and adaptability to other techniques. Some veterinarians may be able to perform this technique, but often a specialist will have to be sought. Removal of these pins is much easier. ((KE Device))
No matter which type of repair and stabilization is selected, complications can occur. Infections, poor blood supply, imperfect fixation, excessive movement by the dog and other conditions can all produce imperfections or failure of the fracture to mend. Carefully follow your veterinarian's recommendations for home care and follow up visits and being vigilant for any abnormalities that could signal trouble is important. Fractures will generally take 4-12 weeks to heal, with younger animals healing faster, older animals slower. The type of fixation chosen will also influence how quickly and how well your dog will heal from its injuries.