Diseases of bones Prof. MVDr. Alois Nečas, PhD, MBA University of Veterinary and Pharmaceutical Sciences Brno Synonym: panostitis eosinofilica, panosteitis, osteomyelitis chronica, juvenile osteomyelitis, enostosis, fibrose osteodystrophy disease of diaphyses and metaphyses of long bones young dogs, large breeds development of enostoses in medullary cavity occasionally subperiosteal bone proliferation the most commonly in German shepherds other large, medium and rarely small breeds usually in 5-12 months from 2 months till 5 years more often in males in bitches during the first oestrus Etiologic factors not proved Hypotheses: bacterial and viral osteomyelitis metastásis from focal purulent area hereditary predisposition temporary vascular abnormalities alergic conditions metabolic disturbances autoimmune reaction after viral infections hyperestrogenism stress S y m p t o m s acute severe lameness persistent or intermitent one or more legs usually forelegs humerus, ulna, radius, femur and tibia deep palpation pain Concomitant signs intermitent febrilia lethargy
anorhexy muscle atrophy (in prolonged disease) Signs disappear in 18-20 months! Panostitis Dg.: History Clinical signs Radiography Panostitis No correlation between: X-ray signs Severity of lameness Pain leukocytosis, eosinophilia and neutrophilia might be find Panostitis iuvenilis Symptomatic goal = pain alleviation Rest and NSAIDs, and ATB respectivelly If steriodal, short term spontaneous recovery from clinical signs good, but: possible relapses warn owners! Synonym: canine scorbut", Möller-Barlow disease, osteodystrophy I (II), metaphyseal osteopathy Developmental disease in growing dogs of large breeds Enlarged metaphyses and pain Long bones distal radius, ulna, tibia, fibula large breeds, 2-8 months also in bassethound and some terriers Etiology unknown incorrect theory vitamin C deficiency Supplementation of vitamin C had clinically no relevancy. S i g n s lameness
metaphyseal enlargement, warm, painfull bilateral, symetric sometimes systemic changes letharghy, anorexy, pyrexy rarely physeal closure carpus valgus, radius curvus Dg.: History Clinical signs Radiology supportive and symptomatic NSAIDs fluid and electrolyte replacement No vitamin C! spontaneous resolution of systemic changes within 7-10 days bone changes can resorb within several months or can be permanent of secondary infection antibiotics in mild cases good, in severe guarded Hyperthrophic pulmonary osteopathy (HPO) secondary pathologic process periosteal proliferation and new bone production usually in distal part of all four limbs metacarpus, metatarsus, fingers and long bones Synonym: Marie s disease, hyperthrophic osteopathy, hypertrophic pulmonary osteoarthropathy (HPOA), pulmonary osteoarthropathy dogs cats, horses, cattle, primates, people older animals in correlation with neoplasia E t h i o p a t h o g e n e s i s paraneoplastic syndrom
e.g. neoplasia, incl. lung tumors granulomatous lesions bacterial endocarditis dirofilariosis pathogenesis not clear Hypotheses: functional lung disease higher blood flow in periphery new bone formation from periosteum S y m p t o m s acute or chronic lethargy reluctance to walk enlargement of distal part of the limb might be warm D g history and clinical signs goal = to find primary disease X-rays of chest and abdomen abdominal ultrasound X-rays joints without pathological changes T x treatment of primary lesion tumour excision, tx of dirofilariosis. in pain analgesia good if primary lesion treated periosteal reactions spontaneously resolve primary and secondary elevated production and release of PTH higher resorption of bone cortex Synonym: paper bone disease, all meat syndrome, juvenile osteoporosis Secondary HPTH: renal or nutrition
puppies, kittens in the past quiet often recently rare complete diet formulas also adults E t h i o p a t h o g e n e s i s metabolic disturbance nutrition hypocalcemia, hyperphosphatemia with normal or low level of Ca, or vitamin D deficiency elevated PTH In puppies and kittens on meet diet high P, low Ca intake Clinical signs in young within weeks in adult months D g history and clinical signs na dlouhých kostech končetin tenké kortexy důsledek zvýšené resorpce dřeňové dutiny abnormálně široké radiodenzita kostí snížena Blood levels of Ca and P might be normal or abnormal T x change of diet optimal mineral intake controled activity risk of pathologic fx stabilize fxs + correction of deformity slow healing During treatment Ca and P intake in diet in ratio 2:1 radiographically monitored after adequate bone mineralization (8-10 weeks) - ratio 1,2:1 good, if there is no substantial deformity Synonym: Westie s disease lion jaw CMO proliferative bone disease in growing dogs
no neoplasia occipital bones, bullae tympanicae and rami mandibulares predispositions Scottish terrier, West Highland white terrier, cairn terrier, Boston terrier also English buldog, labrador, dobermann, boxer and Great Dane 5-7 months E t h i o l o g y unknown Newly formed trabecular bone proliferates in area of rami mandibulares occipital bones bullae tympanicae T x Resolved after reaching of maturity! pain management feeding tube can not open mouth pharyngostomy antibiotics and/or steroids Theoretical Sx methods of resection of processus condylaris mandibulae parcial hemimandibulectomy Mild form - good Severe form - guarded Do not breed affected animals! Retained cartilage core Ddg: HOD, HPO Other bone diseases Osteochondrodysplasia disturbance of endochondral and/or intramembranous ossification prenatal (embryonal and fetal) and postnatal axial and apendicular skeleton single gene defect in some is known type of inheritance
Other bone diseases Bone cysts rare in dogs till 1 year of age large breeds Other bone diseases Multiple cartilaginous exostoses (MCE) proliferative disease of cartilage and bone dogs, cats, horses vertebrae, ribs and long bones younger 18 months no breed and sex predisposition Angular deformities Prof. MVDr. Alois Nečas, Ph.D., MBA VFU Brno Radius and ulna growth - enchondral ossification in physes radius - 60% distal, 40% proximal ulna - 85% distal, 15% proximal intensity of growth (related to breed) highest in 4.- 6. months 90% of length in 7.-9. months Physeal closure = no growth Premature closure of distal ulnar physis 1. young (5-6 months) segmental ulnar ostectomy Premature closure of distal ulnar physis 2. adult Goals: a) definitive correction of angular and rotational deformity oblique osteotomy of radius + ESF wedge ostectomy + plate and screws b) humeroulnar subluxation proximal ulnar osteotomy Premature closure of distal radial physis Continual ulnar growth
elbow malarticulation secondary OA Premature closure of distal radial physis Premature closure of distal radial physis 1. young dogs extention osteotomy of radius (Ilizarov) distraction 1 mm/day segmental ostectomy of radius Post op 3 months post op 3 months post op Premature closure of distal radial physis 2. adult dogs extention osteotomy of radius Dobermann, female, 9 months Right foreleg lameness Trauma 2 months ago Cast Dbr Dbr post op Dbr distraction osteogenesis Dbr distraction osteogenesis Dbr distraction osteogenesis Dbr consolidation Osteotomies Chihuahua, Lilly, female, 8 months Intermitent lameness Stacionar patellar luxation Lilly, 1st surgery Function post op Abduction Internal rotation of the knee X-rays post op Revision 8 months post op Questions? Transplantation of chondrocytes and MSCs Research
Transplantation of MSCs Separation of MSCs Growth of MSCs MRI