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EXAM 2 > Bone Spavin-P1 fractures > Flashcards

Bone Spavin-P1 fractures Flashcards

1
Q

What is one of the most common causes of hindlimb lameness in the horse?

A

Bone Spavin

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2
Q

What is Bone Spavin?

A

DJD of the distal tarsal joints specifically:

  • Distal intertarsal (DIT)
  • Tarsometarsal (TMT)
  • if severe enough it will be visible on the medial aspect of the joint
  • May see significant osteophyte formation
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3
Q

How do you Diagnose Bone Spavin?

A
  • history
  • PE
  • Lameness evaluation
  • Blocks
  • radiographs
  • nuclear scintigraphy
  • MRI
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4
Q

How many joints are there in the HOCK?

A

the hock is not a joint!!! it is comprised of 5 joints:

1) tibiotarsal joint
2) Proximal intertarsal joint
3) Distal intertarsal joint
4) tarsometatarsal ojint
5) talocalcaneal joint

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5
Q

What does poor conformation predispose to ?

A

OSTEOARTHRITIS

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6
Q

Where would Bone spavin be visible on a horse if it was severe enough?

A

on the medial aspect of the hock

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7
Q

What type of conformation is typically associated with Bone spavin?

A

Sickle hocked

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8
Q

When evaluating a horse for conformation what should you make sure to check/ do so that you do not get an artifact conformation?

A
  • horse should be standing on even ground

- horse should be standing square

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9
Q

What is a Cow hocked horse?

A

KNOCKING

-hocks are more axially placed under the limb

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10
Q

What breed of horse tend to have abnormal conformations?

A

Western performance horses used for:

  • cutting
  • reining
  • roping
  • barrel racing

*bone spavin is commonly seen in these horses

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11
Q

GO through YOUR radiographic views

A

cant put pics :(

DLPMO = macdonalds sign or old man on a ledge
DMPLO =
Lateral = no separation of trochelar ridges, talocalcaneal joint visible

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12
Q

When evaluating bone spavin in a horse how many grades are there?

A

4 grades

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13
Q

What are the causes of Bone Spavin?

A

1) poor conformation
2) chronic repetitive
- compression
- torsion
- shear strains

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14
Q

What are the qualities of Nuclear scintigraphy that make it useful in diagnosing Bone Spavin?

A

1) sensitive
2) non specific
3) details cortical bone disease and stress fracture

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15
Q

What are the qualities of MRI that make it useful in diagnosing Bone spavin

A

Sensitive and Specific for examination of soft and hard tissue in joints!!!!!

*can be as good as arthroscopy for detecting subchondral lesions

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16
Q

What is the most common form of treatment conservative or surgical ?

A

Conservative- medial management

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17
Q

What surgical treatment can be done for Bone Spavin?

A
  • Ankylosis of the TMT and DIT joints

- Cunean tenectomy (good outcome (83%)

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18
Q

What does medical management as a treatment for Bone spavin involve?

A

1) IA injections
- corticosteroids
- chondroproteectants
- autologous anti-inflammatories

2) Phenylbutasone (systemic)
3) exercise adaptation
4) corrective shoeing

*Olden days: Bute em and Ride em !

19
Q

What is a Cunean tenectomy used to treat?
How does it work?
What is the prognosis?

A
  • Bone Spavin
  • decreases rotational and shearing on the distal tarsal joints, providing comfort for the patient.
  • REALLY GOOD (83% in a large study)
20
Q

What are the two methods of Ankylosis for Bone Spavin?

A

Ankylosis of the TMT and DIT joints

1) Mechanical
- drill out joints using drill bit
- Nd: YAG or Diode laser

2) Chemical
- 70% ethanol
- MIA (monoiodoacetate) NO LONGER DONE…. DONT do it…its causes severe pain

21
Q

Why can you not use chemical ankylosis in the pastern joint?

A

there is too much movement!!!!

22
Q

Which joint can you use Chemical ankylosis in and why?

A

TMT and DIT joints!!!!!

  • this is because their primary job is absorption of compressive forces so there is not alot of movement in the joint
  • they respond really well to Ethanol (70%) injections

unlike the PASTERN!!!!

23
Q

MIA (monoiodoacetate) can be used to chemically ankylose a joint?

A

it can but it should NOT

24
Q

When mechanically ankylosising a joint what function drilling have?

A
  • a method for getting rid of cartilage
25
Q

Describe Transarticular drilling

A

-Medial approach, distal to cunean tendon
-3.2mm, then 4.5mm drill bit
-create 3 drill tracts at 30 degree diverging angles
(one entry site, 3 different directions)

spot welding, to stabilise site

26
Q

What diagnositc tools can and should be used during Transarticular drilling?

A

-Fluroscopy or Radiographs

27
Q

What post-operative care should be taken when drilling?

A

1) phenylbutazone
2) bandaging x2 weeks
3) hand walking 2 weeks post op
4) light riding 3-4 weeks post op
5) most improved 4-5 months post op (back to work)

28
Q

What is the return to soundness after surgical ankylosis? (DRILLING)

A

59-85%

ave 7.5 months

29
Q

How does laser facillitated ankylosis work?

What benefit does it have compared to drilling

A

destroys cartilage by superheating and vaporizing synovial fluid

  • less pain/ discomfort post op
  • promotes partial ankylosis

But significantly less fusion of the distal tarsal joints compared with other techniques!!!

30
Q

What is the prognosis after treatment with Ethyl alcohol?

A
  • lameness resolved in 86% of horses with Bone spavin within 3 months
  • lameness improved in 52% of horses evaluated after TMT injection of ethanol
31
Q

How much ethyl alcohol can be injected for chemical ankylosis?

A
  • 3ml 70% ethyl alcohol

- lameness eliminated within 3days to 3months

32
Q

What joint always communicates with the Tibiotarsal joint?

A

Proximal intertarsal

33
Q

Why dont we want to chemically ankylose the PIT or TT joint?

A
  • Tibiotarsal has the most movement

- PIT joint communicates with the TT joint

34
Q

Fractures of the first phalanx are common in which breed of horse? WHY

A

Race horses: 3 yr TB, acutely lame (grade 5/5)

-Torsion with axial weightbearing!!!!

35
Q

Why should you not block a horse with P1 fracture?

A
  • horse usually presents acutely lame (grade 5/5)
  • Painful
  • Likely to make it worse!!!!
36
Q

How Do you Diagnose a P1 fracture?

A

Radiographs!!!

  • complete/incomplete
  • closed / open (would see gass opacity)
  • sagital etc…
37
Q

How do you treat a P1 Fracture?

A

Internal fixation with screws and cast

  • first screw proximally in order to align the articular surface!!!!!!! (within 5mm of sagittal groove)
  • rest of the screws should be 2 cm apart
  • LAG screw placement
38
Q

How long should a distal limb cast for a P1 fracture stay on?
What is the prognosis?

A

2-6 weeks

prognosis dependent upon resultant fetlock and pastern DJD

39
Q

Why is the prognosis for P1 dependent on DJD?

A

How well did you realign the articular surface, because there is a lot of movement here

ITS an articular surface!!!!!!

40
Q

What would conservative treatment of a P1 fracture include?

A

STRICT stall rest
-short incomplete sagittal fractures

but if they dont do well need to go back and put lag screws and cast

41
Q

What is the return to function for Comminuted P1 fractures in a horse?
Why?

A

POOR

  • significant articular damage
  • worry about contralateral limb laminitis
  • OA
42
Q

When would you do Fetlock Arthrodesis?

Why?

A

SALVAGE procedure

  • complete rupture of SDF, DDF and SL
  • septic arthritis
  • Fractures: medial and lateral sesamoid, cannon bone and P1

To keep a breeding (valuble) horse, to maintain genetics!

43
Q

Why is the prognosis for fetlock arthrodesis and pastern joint arthrodesis different?

A 
fetlock = POOR
Pastern = GOOD

due to motion in the fetlock, its an articular surface
-huge range of flexion and extension

44
Q

What are the indications for Fetlock Arthrodesis?

A

1) complete rupture of SDF, DDF, SL
2) septic arthritis
3) fractures: medial and lateral sesamoid, cannon bone and P1

EXAM 2 (19 decks)

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