Arthrodesis of the Proximal Interphalangeal Joint Flashcards
Proximal interphalangeal osteoarthritis is also know as what?
High ringbone
“High ring bone” is located in what joint?
Pastern joint or proximal interphalangeal joint
“Low ring bone” is located in what joint?
Coffin joint or distal interphalangeal joint
What type of fracture extends into both proximal and distal joint spaces?
Bi-articular fracture
What is the most common form of medical treatment for osteoarthritis of the proximal interphalangeal joint?
Phenylbutazone and rest
What is important to remember when evaluating radiographs?
Don’t just treat the radiographs.
What are 4 possible indications for pastern arthrodesis?
- High ring bone
- Luxation of the pastern
- Fracture second phalanx
- Septic arthritis of the pastern
What are the 2 main principles of PIP arthrodesis?
- Removal of all articular cartilage
- Maintenance of rigid stability in the joint
What are 3 types of surgical techniques that can be used for pastern arthrodesis?
- Trans-articular lag screws
- Dorsal plate (DCP or LCP)
- Combo of trans-articular lag screw and dorsal plate
What is the currently preferred incision technique for arthrodesis?
Inverted “T” Incision
What tendon is exposed when using an inverted “T” incision for a PIP arthrodesis?
Common digital extensor tendon
What are 3 things that need to be transected once through the skin and SQ for PIP joint arthrodesis?
- Joint capsule
- Medial collateral ligaments
- Lateral collateral ligaments
What needs to be removed with PIP joint arthrodesis?
Cartilage
Surgical puncturing of a bone is known as what?
Osteostixis
What size drill bit is used with PIP joint arthrodesis?
2.5 mm drill bit
What position should the hoof and leg be placed in for PIP joint arthrodesis?
Extend foot and put pastern joint in normal position.
What type of plate is used for PIP joint arthrodesis?
Where is it placed?
- Contour plate
- Place plate on dorsal surface axially
How many holes are drilled for PIP joint arthrodesis?
Where are they placed?
- 3
- 2 holes in P1, 1 hole in P2
How many screws are placed for PIP joint arthrodesis?
Where?
- 2 screws
- Proximal and distal
What are 5 steps to placing a screw for PIP joint arthrodesis?
- Enter joint 1/2 between dorsal and palmar cortices
- Drill glide hole in P1 with 5.5 mm bit
- Drill thread hole in P2 with 4.0 mm bit
- Countersink
- Tap
When using a gliding hole with a 4.5 cortex lag screw, what size does the hole need to be?
4.5 mm
When using a gliding hole with a 5.5 cortex lag screw, what size does the hole need to be?
5.5 mm
When using a thread hole with a 4.5 cortex lag screw, what size does the hole need to be?
3.2 mm
When using a thread hole with a 5.5 cortex lag screw, what size does the hole need to be?
4.0 mm
When using a screw tap with a 4.5 cortex lag screw, what size does the hole need to be?
4.5 mm
When using a screw tap with a 5.5 cortex lag screw, what size does the hole need to be?
5.5 mm
When should radiographs be take with PIP joint arthrodesis?
Intra-op and post-op
Why is it good to do radiographs during and after surgery?
Good to do while horse is still under general anesthesia so you don’t have to put them under again.
When using arthrodesis to treat severe osteoarthritis, 2 or 3 lag screws are placed across the pastern joint engaging as much of what bone as possible?
Middle phalanx
What is usually placed over the limb after a PIP joint arthrodesis?
Distal limb cast
Plate application with PIP joint arthrodesis causes an increase in what?
Stability
What is the success rate for pastern arthrodesis in the forelimb?
81%
What is the success rate for pastern arthrodesis in the hindlimb?
95%
