Arthrodesis of the Pastern Joint (Proximal Interphalangeal Joint) Flashcards
What is the layman terms for the Proximal Interphalangeal Joint?
Pastern Joint
What are the indications for Arthrodesis of the Proximal Interphalangeal Joint?
1) DJD of the pastern joint (High ring Bone)
2) Pastern Luxation
3) Fracture second Phalanx
4) Septic arthritis of the Pastern Joint
What breed of horse is commonly affected with injury to the Pastern Joint (PIP)
Barrel racing QH
-present acutely lame
What is the laymans terms for Osteophyte/ DJD formation of the Pastern joint?
High ring Bone
What is the laymans terms for Osteophyte formation/ DJD of the coffin joint?
Low ring bone
What are some clinical signs in a horse with High ring bone or low ring bone?
- Hx chronic lamness (2/5)
- lameness is worse following distal limb flexion
In a Case of High ring bone or low ring bone, why does the body make proliferative bone?
Bone proliferation is made to try and stabilize the joint
What medical treatment can be used for High Ring bone (OA of PIP)?
- NSAIDs
- reduce work
- Natural ankylosis (unlikely)
What are the Primary principles of PIP (Pastern joint) arthrodesis?
1) remove all articular cartilage
2) Maintain rigid stability in the joint
Why do you want to maintain rigid stability in the joint for PIP arthrodesis?
*minimizes new bone formation
What surgical techniques can be used for Pastern Joint arthrodesis?
1) Trans-articular lag screws
2) Dorsal plate (DCP or LCP)
3) trans-articular lag screw and dorsal plate
What is the best surgical technique for arthrodesis of the PIP?
-WHY?
trans-articular lag-screws and dorsal plate
- better rigidity
- better stability
- better comfort
- shorter time in cast
- shorter return to function
- decreased hospitalization time
- less peri-articular new bone formation on dorsal aspect
What type of incision in required for PIP arthrodesis?
Inverted T incision
- Longitudinal incision from middle P1 distally to 2cm proximal to the coronary band
- transverse incision extended laterally and medially
REMEMBER to stay 2 cm proximal to the coronary band!!!!
What structure is exposed during a inverted T incision for PIP arthrodesis?
Common digital extensor Tendon
What type of incision is made into the extensor tendon during PIP arthrodesis?
Inverted V incision
What ligaments need to be transected in a Pastern joint arthrodesis to gain access to the joint?
Collateral ligaments
What is osteostixis?
- Holes made into the subchondral bone plate
- uses a 2.5mm drill bit
- mesenchymal cells from bone marrow (which provide growth factors)
What is the surgical technique for PIP arthrodesis?
- extend foot (pastern in normal position)
- 3 hole plate on dorsal surface axially
- Contour Plate
- 2 holes in P1, 1 hole in P2
- place 2 screws (proximal and distal)
What is the surgical technique for TA screw placement?
-enter join mid way between dorsal and palmer corticies
-drill glide hole in P1 (5.5mm bit)
Drill thread hole in P2 (4.0 mm bit)
-Countersink
-Tap. (5.5mm)
Tap and glide always the same!!!
Which has the bigger hole the Glide or the thread!!!
-which has bigger screws?
The Glide hole has bigger screws and is bigger
What do you take radiographs intra-op and post-op ?
-check placement
-for later comparison (healing check)
-check strain post op : recovery is when they put the most amount of strain on
-
Which is better to chose for PIP arthrodesis?
4.5 screws or 5.5 screws and why?
5.5 better purchase and stronger!
T/F: A cast should not be place after surgery for PIP arthrodesis?
FALSE
- a distal limb cast should be placed
- or transfixation pin cast
What is the preferred technique for PIP arthrodesis?
Trans-articular screws and dorsal Plate
For increased stability!!!!!!!
