Bone Lameness Flashcards
What are the ways you should think about disease?
○ Definition of term(s)
○ Cause
§ Pathology
○ Clinical signs
○ Diagnosis
○ Treatment
○ Prognosis
○ Prevention
What is periostitis?
○ Bone bruising or contusion
§ Inflammation of the periosteum
What are the causes of periostitis?
direct trauma
What are the signs of periostitis?
pain on direct pressue
What is the diagnosis of periostitis?
subjective
radiographs, CT, MRI
What is the treatment of periostitis?
rest, cold hosing, bandaging, NSAIDs
What are bucked shins?
types of periostitis
thickening of the bone cortex: dorsal MCIII and MTIII
What is the signalment of bucked shins?
young (2-3 y.o.) fast-gaited horses
thoroughbreds, quarter horses, and standardbreds
What are the causes of bucked shins?
increased strain on developing bones
body responds with bone remodeling
What are the signs of bucked shins?
swelling and pain upon palpation
worse after exercise or race
often bilateral (L>R)
variable lameness
What are diagnosis of bucked shins?
clinical findings and signalment
imaging
radiographs
thermography
nuclear scintigraphy
AKA bone scan
What are the treatments of bucked shins?
catch early: rest with hand-walking, decrease training
mild: NSAIDs, cold hosing, bandaging with DMSO
moderate to severe: shockwave, electrical stimulation, laser therapy, magnets, intralesional steroid injection, thermocautery (pin firing), chemical vesication (blistering), cryotherapy (point freezing)
Which kind of horses develop dorsal cortical pain?
80% of 2 y.o. TBs develop dorsal cortical pain
Who develops a dorsal cortical fracture of MCIII?
12% of TBs develop dorsal cortical fracture
stress fracture
How might you treat a dorsal cortical fracture of the MCIII?
surgical screw and drilling (osteostixis)
What is osteitis?
inflammation involving periosteum and cortex
What is osteomyelitis?
inflammation involving periosteum, cortex, and medullary cavity
What is pedal osteitis?
pedal = PIII
inflammation reaction localized along solar margin of PIII
can cause bone demineralization
What are the causes of pedal osteitis?
constant concussive trauma, laminitis, navicular syndrome, sole abscess
usually associated with animals exercised over hard service
What are the signs of pedal osteitis?
reluctant to extend stride
often bilateral
What is the diagnosis of pedal osteitis?
hoof testers: positive along the solar margin
palmar/plantar digital (PD) or abaxial nerve block
radiographs
How do you treat pedal osteoitis?
proper hoof trimming and corrective shoeing: keel sole away from ground
medications: isoxsuprine, NSAIDs
palmar digital neurectomy: chronic disease
What is infectious osteitis?
There is both bacteria and inflammation in the periosteum and cortex
What causes infectious osteitis?
break in skin
Nearby septic process
Where is infectious osteitis found?
common in distal extremities of horse
sparse soft tissue coverage
metacarpal/metatarsals
What is sequestrum?
piece of dead bone
often from local trauma
What is required for infectious osteitis with sequestrum?
need avascularity and infection
not just blunt trauma
infection comes from break in skin or systemically
develop draining tract
often need to be removed surgically
What are the signs of infectious osteitis?
severity of lameness variable
sensitive to palpation
+/- draining tract
How do you diagnose infectious osteitis?
radiographs
initially: soft tissue swelling
1-2 weeks: periosteal proliferation
2-3 weeks: sequestrum visible
How do you treat non-infectious osteitis?
rest, cold hosing, NSAIDs
How do you treat infectious osteitis with sequestrum?
surgical removal of sequestrum with debridement of bone and necrotic tissue
antibiotics: systemic often fail, can try regional limb perfusion
What is osteomyelitis?
more extensive inflammation of bone
begins within or extends into medullary cavity
What are the 3 categories of osteomyelitis?
hematogenous
traumatic
iatrogenic
What is hematogenous osteomyelitis?
primary in neonates, rarely in adults
What is traumatic osteomyelitis?
usually from penetrating wound or open fracture
What is iatrogenic osteomyelitis?
surgery - internal fixation of fractures
intra articular injection of medications
What are the signs of osteomyelitis?
pain on palpation
fever (foals)
lameness
soft tissue swelling
ineffective wound healing
How do you diagnose osteomyelitis?
radiographs: bone lysis (10-14) days after insult, sequestrum formation, bone thickening
How do you treat osteomyelitis?
antibiotics: systemic, regional limb perfusion, placement of antibiotic infused beads
NSAIDs
surgical debridement of affected bone
What is overriding/impingement of dorsal spinous process
AKA kissing spines
most common location: T5-T18
often show jumpers and hunters
What is the cause of overriding/impingement of dorsal spinous process?
repetitive contact between dorsal processes
What are the signs of kissing spines?
mobility: reduced ventrodorsal mobility from impingement, limited lateral mobility from muscle spasm
palpation: irregularity of dorsal spinous process, pain with localized digital pressure
How do you diagnose kissing spines?
palpation
local anesthetic
radiographs: bony changes
ultrasound: contact, remodeling, abnormal ligament
nuclear scintigraphy: active bone remodeling, remodeling
How do you treat kissing spines?
rest
NSAIDs
local injections: corticosteroids, sarapin
acupuncture
shockwave
surgical removal of affected spinous processes
What is an interspinous ligament desmotomy (ISLD)
surgically transect interspinous ligament
physical therapy
What are bone tumors?
primary bone neoplasia rare in horses
more common in skull, but can occur in limbs
What are fractures?
bone loses structural continuity
function impaired to some degree
What is the severity of lameness from fracture determined by?
bone fracture
level of function impaired
SHOULD ALWAYS BE ON DDX FOR NON-WEIGHT BEARING LAMENESS
How do you diagnose a fracture?
clinical signs: crepitus (cracking sound), deviation of limb, open fracture
imaging: radiographs, ultrasound, bone scan, computed tomography (CT), magnetic resonance imaging (MRI)
What are the goals in stabilizing and immobilizing a fracture?
minimizes further damage
maintain limb in proper position and condition to facilitate repair
What does splint or bandage application do for fractures?
immobilize joint above and below
What are external fracture fixations?
casts
fixators
What are internal fraction fixations?
screw: lag, cortical
bone plates
wires
intramedullary pins
How do you come up with fracture prognosis?
depends on:
bone affected
fracture characteristics: articular vs non-articular, simple vs comminuted (bomb goes off)
horse’s temperature
horse’s age and size
expertise of surgeon
What are the signs of humeral fractures?
non-weight bearing
forelimb appears shorter
How do you treat humeral fracture?
bone plating
stall rest
What are signs of radial fractures?
non-weight bearing
valgus limb because of lateral musculature
How do you treat radial fractures?
sx- bone plate, pins
cast
Who usually gets olecranon fractures?
foals
What are signs of olecranon fractures?
non-weight bearing
dropped elbow
How do you treat olecranon fractures?
rest, bandage
sx- bone plate
What are chip fractures?
found in carpal
one articular surface
partially attached or loose within a joint
often radial carpal bone
what are slab fracture
usually found in carpal
two articular fractures
often 3rd carpal bones
What are signs of carpal fractures?
moderate to severe lameness
How do you diagnose carpal fractures?
radiographs - flexed lateral, skyline
How do you treat carpal fractures?
surgery - arthroscopic for chips, lag screw for slab
Where are cannon fractures found?
MCIII>MTIII
Where are transverse cannon found?
mid-cannon
50% open
immobilize with Robert Jones bandage
Where are condylar cannon fractures found?
distal and lateral
articular
What are signs of cannon fractures?
moderate to non-weight bearing
articular - positive flexion, effusion
How do you treat cannon fractures?
surgery
transverse - bone plate
condylar - lag screw
casting after surgery
Where are splint bone fractures found?
distal third fx > upper and middle fx
What are the signs of splint bone fractures?
variable
What are the treatments of splint bone fractures?
conservative - rest, bandage
surgery: remove up to 80%
What are the complication of splint bone fractures?
suspensory desmitis
sequestrum
callus
Describe a chip PI fracture
often dorsal eminence just medial to midline
Describe a sagittal PI fracture
fetlock and pastern joints involved
What are the signs of PI fractures?
variable lameness
articular - effusion, positive flexion
How do you treat PI fractures?
sx - chip removal, lag screws for sagittal
What often happens to PII fractures?
often communited
How do PII fractures happen?
combination of compression and torsion
PI often involved
What are signs of PII fractures?
variable lameness
What are treatments of PII fractures?
sx - bone plate, arthrodesis
casting
What are the type of PIII fractures?
wing, articular wing, sagittal articular fractures, extensor process fractures, comminuted articular and nonarticular, chip
Describe PIII wing fractures
most common, nonarticular, oblique across palmar process
Describe articular wing PIII fractures
oblique across palmar process, enters joint
Describe sagittal articular PIII fractures
from joint distally, dividing bone into two even halves
Describe extensor process PIII fractures
occur at site of insertion of digital extensor tendon
Describe comminuted articular and nonarticular PIII fractures
numerous fracture lines
Describe chip fractures of the PIII
nonarticular, solar margin
What are the signs of PIII fractures?
acute onset
moderate to severe lameness
increased digital pulse and heat
How do you diagnose PIII fractures?
hoof testers - PAINFUL!
PD or abaxial nerve block
rads, CT
How do you treat nonarticular PIII fractures?
immobilize fracture, prevent expansion of hoof
bar shoe with quarter clips or foot cast
6-8 months with resets every 4-6 weeks
How do you treat articular PIII fractures?
surgery with internal fixation: complication of infectious osteitis because hard to disinfect these tissues prior to surgery
palmar digital neurectomy if still lame after sx
What are the types of proximal sesamoid fractures?
apical (most common)
abaxial (least common)
basal
mid-body
comminuted
What are the signs of proximal sesamoid fractures?
acute severe lameness
What is the treatment for proximal sesamoid fractures?
stall rest, cast
surgery: surgical excision (<1/3 of bone), lag screw fixation, circumferential wiring
What predisposes distal sesamoid fractures?
navicular syndrome, predisposing cause of foot chip fx
What are the signs of distal sesamoid fractures?
non-specific foot lameness
How do you diagnose distal sesamoid fractures?
hoof testers, PD nerve block
radiograph
How do you treat distal sesamoid fractures?
PD neurectomy
Describe pelvic fractures
often unilateral and involve multiple bones
What are the signs of pelvic fractures?
acute severe lameness
toe out, hock in
How do you diagnose pelvic fractures?
rads, U/S (ultrasound)
rectal exam
How do you treat pelvic fractures?
sling, stall rest, NSAIDs
euthanasia
What is the prognosis of an acetabular fracture?
poor prognosis
What are the signs of a femoral fracture?
non-weight bearing
limb appears short, hock held higher
How do you treat femoral fractures?
euthanasia - most adults
sx - intramedullary pin, bone plate
What is the prognosis of a femoral fracture?
very poor if > 1 y.o.
What are the signs of a patellar fracture?
acute non-weight bearing
What are the treatments of non-articular patellar fractures?
stall rest and NSAIDs
How do you treat articular patellar fractures?
surgical excision if <1/3 of bone
internal fixation
What are the signs of tibial fractures?
non-weight bearing
anxious, sweating
How do you treat tibial fractures?
euthanasia - most adults
sx with internal fixation - young
Describe tarsal fractures
slab fractures
central and third tarsal bones
What are the signs of tarsal fractures?
acute lameness
effusion, positive flexion
What is this a picture off?
Periostitis
Bucked shins
bucked shins
Bucked shins
nuclear scintigraphy of bucked shins
dorsal cortical fracture of MIII
bone inflammation
hoof tester
normal coffin bone
pedal osteitis
pedal osteitis
infectious osteitis with sequestrum
kissing spines
normal (L) and kissing spine (R)
olecranon fracture
carpal fracture
cannon fracture
Describe the types of PIII fractures
Describe proximal sesamoid fractures
describe the distal sesamoid fractures
Describe heat view of fractured tibia
