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Equine BCM > Angular and Flexural limb deformities > Flashcards

Angular and Flexural limb deformities Flashcards

1
Q

What are the 3 types of foal growth abnormalities?

A

Angular limb deformities, tendon and ligament laxity, flexural deformities (contracted tendons)

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2
Q

What is the definition of ALD?

A

Medial or lateral deviation to the long axis of the bone in the frontal plane

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3
Q

What is lateral deviation distal to the point of deviation called

A

VaLgus

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4
Q

What is medial deviation distal to the point of deviation called?

A

varus

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5
Q

What usually accompanies an ALD in foals?

A

Rotational deformity (outward or inward rotation)
-can grow out of these
-usually due to chest being so wide compared to limbs

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6
Q

What is the typical signalment for ALDs?

A

Usually young foals (rapidly growing), all breeds affected, slightly higher incidence in colts

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7
Q

Where are ALDs most commonly seen?

A

Front limbs
-carpus, fetlock, tarsus
-carpal valgus most common, fetlock varus second most common

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8
Q

What is something that can make a foal appear like they have angulation?

A

Ligamentous joint laxity aka windswept
-due to incomplete endochondral ossification of the cuboidal bones and/or metacarpal/metatarsal bones
-worsens on weight beating and shifts when moving
-can lead to deformity if cartilages ossify in incorrect orientation
-most common in premature/dysmature foals

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9
Q

What are some perinatal factors that contribute to congenital limb deformities?

A

Intrauterine malpositioning, overnutrition of mare, hypoplasia of the cuboidal bones (due to prematurity, hypothyroidism, osteochondrosis), incomplete development of cuboidal bones

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10
Q

T/F: acquired ALDs are more common than congenital

A

True

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11
Q

Describe the pathogenesis of acquired ALDs

A

Asynchronous longitudinal growth of the physis or physeal dysplasia
- due to genetics, nutritional problems, physeal damage, physitis (septic or nah)

Can also be from traumatic luxation/fracture of physis, epiphysis or carpal/tarsal bones

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12
Q

What is Wolffs law

A

Bone growth increases in response to increased load
-causes exacerbation of damage when growing
-can use to target interventions

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13
Q

If you can straighten the limb easily on physical exam, what is the diagnosis?

A

Joint laxity

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14
Q

What radiographic views should you take when working up a ALD case?

A

DP and lateral views while weight bearing
- use large plates if available or hold plate on diagonal

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15
Q

What things are you looking for on radiographs of ALDs?

A

Pivot point: find by bisection long bones above and below joint

Degree of angulation (mild <5, severe >15)

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16
Q

T/F: mild varus may be protective for carpal injury

A

False- valgus may be protective
-varus in carpus is BAD

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17
Q

What are some possible radiographic findings for angular limb deformities?

A

-flaring and sclerosis of the metaphysis
-indistinct physic, irregular width of growth plate
-wedge shape and flaring of epiphysis with fracture lines
-cuboidal bones with abnormal shape, hypoplastic, collapsed or subluxated
-MTII or IV have a shorter or wider joint space
-bone cortex has diaphyseal remodeling
-may see complete ulna or fibula

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18
Q

What are the goals of treatment in angular limb deformity cases?

A

Improve conformation, halt worsening of angulation, prevent secondary changes, improve athletic performance
-more intervention required with older foals or more severe angulation

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19
Q

T/F: hypoplastic cuboidal bones and crush injury has a good prognosis

A

false- poor athletic prognosis depending on degree of angulation

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20
Q

What is the cause of sickle hock?

A

Crush injury at on the dorsal aspect of the tarsus due to incomplete ossification of the tarsal bones
-leads to OA and lameness

21
Q

What is a method to prevent cuboidal bone fracture in foals?

A

Tube casts

22
Q

Match the following with the proper treatment

A. Varus 1. Medial extension
B. Valgus 2. Lateral extension

A

A- 2
B-1

23
Q

What are some rules for glue on shoes?

A

10 days on, 10 days off
-limit normal hoof wall growth
-have to be removed with hoof nippers

24
Q

What are some of the surgical treatment options for angular limb deformities?

A
  1. Periosteal transection and elevation-causes growth acceleration on the concave side, perform laterally for valgus deformity
  2. Transphyseal bridging: growth retardation on the convex side, perform medially for valgus deformity (two screws with wire across physis or single positional screw across one side)
  3. Wedge osteotomy-if in diaphysis
25
Q

What are some of the main considerations of transphyseal bridging?

A

Very effective if enough growth can occur
-monitoring of the foal is critical
-need to restrict exercise to prevent implant fatigue
-need a second surgery to remove implants
-implants can become infected
-local inflammation and scarring are possible
-bilateral or multiple TPBs may need to be removed at different times
-overcorrection is possible with this technique

26
Q

When do fetlock deformities need to be corrected by?

A

Treatment needs to start by 30 days as the majority of growth is completed by 90 days

27
Q

When do you need to start treating carpal and tarsal deformities?

A

By 4 months of age

28
Q

T/F: the more proximal the pivot point, the poorer the prognosis

A

False- the more distal, the worse the prognosis

29
Q

What is the etiology behind tendon and ligament laxity?

A

Musculotendinous weakness
- can be idiopathic, due to a lack of exercise, systemic illness, or from bandaging or casting
-congenital primarily but can be acquired

30
Q

What are the clinical signs associated with digital hyperextension deformities?

A

Walking on heel bulbs, no weight on toe

31
Q

What can cause the acquired form of tendon/ligament laxity?

A

Hoof overgrowth or bandaging/casting for a long period of time

32
Q

Describe the treatment options for tendon/ligament laxity.

A

-moderate exercise, trimming feet, therapeutic shoeing, light bandages to protect skin if needed
-heel extensions to create lever that brings toe down
-good prognosis

33
Q

What is the primary pathology associated with “contracted tendons” or flexural deformity?

A

Don’t trust the name, this is due to a mismatch between the length of tendons compared to bones

34
Q

What do flexural deformities result in?

A

Persistent hyperflexion of the joint (distal interphalangeal joint, fetlock joint, carpus)
-can be congenital or acquired
-hind limb affected more than front limbs
-if can straighten at surgery there is a better prognosis

35
Q

What are the most common flexural deformities that are congenital?

A

Carpus (when <1 month) > front fetlock > hind fetlock > pastern > coffin

36
Q

What are the most common acquired deformities?

A

Coffin when young (1-4 mo)> front fetlock > fetlock

37
Q

What are some of the potential causes for congenital flexural deformities?

A

Uterine malpositioning, genetic influences, teratogens, disease in mare, locoweed ingestion in mare, sudan grass ingestion by mare, idiopathic

38
Q

What are some of the causes of acquired flexural deformities?

A

-growth disparity between bones and tendons/ligaments, pain (due to physitis, OCD, septic arthritis, wound, hoof pain or contralateral limb overload)

39
Q

What are the most common structures involved with flexural deformities?

A

SDFT, DDFT, ulnaris lateralis, joint capsule

40
Q

What are some of the main clinical signs associated with flexural limb deformities of the coffin joint?

A

Walking on toes, unable to place heel fully on ground, club foot, excessive toe wear

41
Q

What is the difference between stage 1 and stage 2 DIP joint FD?

A

Stage one- dorsal hoof wall angle to the ground is <90 degrees–> good prognosis

Stage 2- dorsal hoof wall angle >/= 90 degrees –> poor prognosis

42
Q

What are some characteristics associated with flexural limb deformities of the fetlock joint?

A

Fetlock angle when viewed from the side is upright or knuckled over
-DJD may be present in severe cases

43
Q

What are some characteristics associated with carpal flexural deformities?

A

Buckling/flexion at the carpus, severe cases may be recumbent
-if manual reduction is possible there is a good prognosis
-if manual reduction is not possible there can be a fair prognosis but the longer the duration without trt prognosis is worsened
-look to see if there is incomplete cuboidal bone ossification present

44
Q

What are some of the treatments for congenital flexural deformities?

A

-assistance to nurse
-increase exercise
-NAIDS
-oxytet (chelates calcium leading to musculotendinous relaxation)
-toe extension shoes
-splints or casts
-surgery if necessary

45
Q

What are the shoeing options for treatment of coffin joint flexural deformities?

A

Lower the heel to encourage tendon stretch
-or put cup on toe with shoe extension or place equilox on end of toe

46
Q

What are the main treatment principles with acquired flexural deformities?

A

-correct the nutritional imbalances and energy excess
-correct possible underlying causes
-use hoof trimming and toe extensions
-splinting and casting
-NSAIDs

47
Q

When should you pursue surgical treatment in flexural deformity cases and what are the options available?

A

-perform when conservative treatment is not effective or the deformity is severe or rapidly worsening
-options are distal check ligament desmotomy for coffin joint, proximal check ligament desmotomy for the fetlock, or cutting ulnaris lateralis or flexor carpi ulnaris for carpal joint deformities

48
Q

What are some complications of check ligament desmotomy?

A

cosmetic blemish
-surgical site infection
-carpal sheath breach
-unsuccessful procedure

Equine BCM (13 decks)

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