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EBCM Lecture > Angular and Flexural Limb Deformities > Flashcards

Angular and Flexural Limb Deformities Flashcards

1
Q

What are some growth abnormalities that occur in foals?

A

Angular Limb Deformities
Tendon and Ligament Laxity
Flexural Deformity (Contracted Tendons)

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2
Q

What is the definition of an angular limb deformity?

A

Lateral or medial deviation to the long axis of the bone in the frontal plane

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3
Q

What is the name of the ALD described by a lateral deviation distal to the point pivot point?

A

Valgus

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4
Q

What is the name of the ALD described by a medial deviation distal to the point pivot point?

A

Varus

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5
Q

Who commonly gets ALD?

A

Foals - younger ones, all breeds and either sex

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6
Q

Which limb is the most common location for ALD?
Which site most common for ALD?
What is the most common defomrity?

A

Front limbs
Carpus, Fetlock, Tarsus
Carpal valgus, then fetlock varus

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7
Q

What causes congenital ALD?

A

Ligamentous Joint Laxity
-Worse on weight baring, shift while moving and windswept

Incomplete endochondral ossification of cuboidal bone (premature or dysmature)

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8
Q

What are some perinatal factors that contribute to ALD?

A

-Intrauterine mispositioning
-Over-nutrition of mare
-Hypoplasia of cuboidal bones
(Premature, dysmature, hypothyroidm, OC)
-Incomplete development MT/MC

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9
Q

What are some causes of acquired ALD?

A

-Asynchronous longitudinal growth of physis or physeal dysplasia (genetic, nutritional, physeal or physitis)
-Traumatic luxation or fracture of physis, epiphysis or crapal/tarsal bone

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10
Q

What factors should be considered in ALD?

A

-Inciting cause
-Physis growth
-Bone increase response to increase load

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11
Q

How do you go about evaluating ALD cases?

A

Signalment, HX, visual exam, physical exam, rads, is one present, has it changed over time, define it and what joints are involved

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12
Q

What type of history questions help with ALD?

A

When did they notice it? Has it worsened? Any lameness? Trimming?

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13
Q

What are some key parts of your ALD visual exam?

A

-Watch while standing and walking
-front and back/multiple limbs
-Multiple site on limb
-Estimate degree pivot point
-Lameness in limb or contralateral
-Look at mare

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14
Q

On your visual exam you notice the toe is deviated medially…what deformity will that most likely be?

A

(Fetlock) Varus

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15
Q

What is key when examining the joints and degree of angulation?

A

Need to be standing directly in front of the joint in question

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16
Q

What should be included in your physical exam?

A

Palpate joint laxity, observe angulation when flexed, evaluate hoof balance, palpate both limbs for heat, pain, swelling and crepitus

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17
Q

What should you observe on your radiographs?

A

Pivot Point
Mild: <5
Severe: >15

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18
Q

Is mild carpus valgus protective for carpal injury?
If so what does that make carpal varus?

A

Yes it is
Makes it bad

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19
Q

What may you find on a radiograph of an angular limb deformity?

A

Metaphysis - flaring and sclerosis
Growth Plate - indistinct physis, irregular width
Epiphysis - wedge shape, fracture lines
Cuboidal - abnormal shape, hypoplastic, collapsed, subluxated
MT/MC - shorter or wider joint space
Bone cotes - diaphyseal remodeling
Ulna/fibula - complete

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20
Q

What are treatment goals for ALD?

A

Improve the conformation
Halt worsening angulation
prevent DJD
Improve athletic performance

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21
Q

More intervention is needed if…

A

the foal is older and the deformity is more sever

22
Q

What are some non-surgical treatments for ALD?

A

Stall rest and revaluate 2wks
Tube cast, splint or brace
Corrective trimming, hoof extension and shoeing

23
Q

Prognosis ALD?

A

Hypoplastic cuboidal bones - poor athletic
Tendon and ligament laxity - good

24
Q

What is sickle hock conformation?

A

Incomplete ossification of tarsal bones, collapse dorsal aspect of cartilage template, abnormal conformation, OA and lameness

25
Q

If the horse has a varus deformity, which way should the extension go for correction?

A

Extension Lateral
(Extension medial for valgus)

26
Q

How should you correctively shoe foals?

A

Glue ons, limit normal growth, day on day off, second set if needed, hoof nipper or rasp off

27
Q

What are some surgical treatments for ALD?

A

-Periosteal transection and elevation
-Transphyseal bridging
-Wedge Ostectomy

28
Q

What are some things to remember about transphyseal bridging?

A

Very effective, restrict exercise to prevent implant failure, second surgery to remove the implant, local infection and scarring, can overcorrect

29
Q

When should you treat and when does the physis close of the following joints:
MCP/MTP:
Carpus:
Tarsus:

A

MCP/MTP: 30d, 120d
Carpus: 4m, 18m
Tarsus: 4m, 21m

30
Q

How long should you wait to know if your conservative treatment is working?

A

no more than 3 weeks for MCP, no more than 3 months for carpus or tarsus

31
Q

What is the rule on prognosis for ALD?

A

The more distal the pivot point the poorer the prognosis

32
Q

How do you prevent ALD?

A

Owner education, monitor, proper feeding, look at mare and stallion conformation, foot trim and rasp on schedule, avoid excessive exercise

33
Q

When should fetlocks be treated by?

A

2 months of age

34
Q

What is the general process for fixing ALD?

A

Address inciting cause, restrict exercise, trim and rasp, hoof extension, transphyseal screw, periosteal transection and elevation

35
Q

What are tendon and ligament laxity also known as?

A

Digital hyperextension deformities

36
Q

Where are tendon and ligament laxity commonly found?

A

more in hind limbs

37
Q

What is the cause of tendon laxity?

A

Lack of exercise, systemic illness, bandage or casting

38
Q

What is a sign of tendon and ligament laxity?

A

No weight on toe, walk on heel bulb

39
Q

How can you acquire a tendon and ligament laxity?

A

Hoof overgrowth
Bandaging or casting

40
Q

What are some conservative ways that tendon and ligament can resolve?

A

Moderate exercise, trimming and rasping feet, shoe, light bandage to protect skin

41
Q

Treatment for Tendon and ligament laxity?

A

Heel extension, controlled exercise, no splint or bandage

42
Q

What is a flexural limb deformity?

A

length disparity between tendons and bones, tendon normal on ultrasound

43
Q

Contracted tendons are

A

rare

44
Q

Where does FLD or hyperflexion of a joint commonly occur?

A

DIJ, MCP, Carpus

45
Q

Which limb do flexural deformities typically occur in?

A

Front

46
Q

What causes FLD?

A

Congenital: uterine mispositioning, genetic, teratogen, disease of mare, locoweed, Sudan grass

47
Q

What causes AFLD?

A

Growth disparity between bones, tendons and ligaments
Pain - flexion withdraw reflex (physis, OCD, septic arthritis, wounds, hoof pain, contralateral limb overload)

48
Q

What is critical to assess when it comes to a foal with FLD?

A

Can it nurse

49
Q

How do you know the horse has a DIJ FLD?

A

Walk on toe, cant put heel on ground, club foot, excessive toe wear

50
Q

How do you know you have a metacarpophalangeal joint (fetlock) FLD?

A

Upright or knuckled over, DJD, reducible or non

51
Q

How do you know you have a carpal FLD?

A

Buckling or flex at carpus

52
Q

Treatment FLD?

A

Congenital: assist nursing, increase exercise, NSAID, Oxytet, Toe extension shoe, splint or cast, surgery
DJI - Hoof trim, rasp, lower heel, avoid trimming toe
Carpus- splint or cast

EBCM Lecture (24 decks)

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