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Joint Diseases of the Forelimb > Carpal Arthrodesis > Flashcards

Carpal Arthrodesis Flashcards

1
Q

What anatomical involvement means a pancarpal arthrodesis is recommended? (3)

A
  • Antebrachial joint
  • Middle carpal joint damages accessory carpal bone
  • Carpometacarpal joint causes damage to accessory carpal bone
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2
Q

What are the conditions where pancarpal arthrodesis is indicated? (3)

A

Collateral ligament damage;
Articular fractures;
Degenerative joint disease associated with moderate to severe clinical signs.

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3
Q

Which side of the joint would be most appropriate to apply a plate for a pancarpal arthrodesis? Why?

A

The palmar aspect of the carpal joint would be the most appropriate location to apply a plate due to being the tension side (i.e. the palmar aspect of the carpus).

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4
Q

What anatomy can hinder the application of a palmer plate for pancarpal arthrodesis? (3)

A
  • Digital flexor tendons
  • Palmar ligaments
  • Accessory carpal bone
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5
Q

What is the standard location of plate positioning for pancarpal arthrodesis?

A

Dorsally

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6
Q

In cases of more extensive soft tissue damage what other approach do you think can be useful in pancarpal arthrodesis?

A

via external fixation can be useful

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7
Q

Why is Internal fixation preferrable if at all possible for pancarpal arthrodesis?

A

Clinically when using an external fixator there is a race between bony union and the external fixator becoming loose or needing removing

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8
Q

What force does a circular fixator offer during a pancarpal arthrodesis?

A

Compression across joint levels

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9
Q

Where is the Cancellous bone graft is harvested from?

A

from the ipsilateral proximal humerus at the level of the tendon of insertion of the infraspinatus muscle.

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10
Q

How to store a harvested bone graft? (2)

A

Moist bloody swab
In a syringe

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11
Q

What is the minimum time interval that should be allowed if repeating the harvesting bone graft from the proximal humerus?

A

8 weeks

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12
Q

How is a cancellous bone graft harvested?

A

A hole is drilled into the lateral cortex of the greater tubercle of the humerus with a large diameter drill bit until the medullary cavity is reached.

A curette is used to harvest the bone graft which is inserted within the denuded surfaces of each joint following lavage of the surgical field.

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13
Q

During pancarpal arthrodesis, what aid intraoperative haemostasias and surgical visibility? (2)

A

Exsanguination with and Esmarch bandage and tourniquet

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14
Q

Pancarpal arthrodesis:
If you are not using a custom plate it should be contoured to a ?degree angle at the level of the radiocarpal joint.

A

10

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15
Q

What force is required at the rthrodesis site is desirable to improve stability of the plate bone construct.?

A

Compression

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16
Q

When using a 3.5mm / 2.7mm hybrid pancarpal arthrodesis plate which screw should be placed first?

A

The central screw into the radiocarpal bone

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17
Q

Pancarpal arthrodesis - dorsal approach:
A) What is incised?
B) What are retracted/direction?

A

A) Subcutaneous tissues B) extensor carpi radialis and common digital extensor tendons retract medially and laterally to expose the joints.

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18
Q

Pancarpal arthrodesis:
Which joints are incised? (3)

A

antebrachiocarpal, middle carpal and carpometacarpal joints.

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19
Q

How can articular Cartlidge be removed during a pancarpal arthrodesis? (2)

A
  • Curette
  • Spinal burr
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20
Q

What coverage should the pancarpal arthrodeiss plate have?

A

Distal third of radius
at least 50% MC bone

21
Q

The pancarpal arthrodesis plate needs to be contoured at an angle of ? of carpal extension if it is not pre-contoured.

A

10°

22
Q

The Pancarpal arthrodesis plate should be placed centrally along the ?axis of the distal radius carpus and third metacarpal bone.

A

longitudinal

23
Q

The 1st screw is placed in the A). The second and third screws are placed as B) screws into the C) bone and the D) bone to apply compression across all joint spaces.

A

A) Radial carpal bone
B) Compression
C) 3rd MC D) radial

24
Q

What should be used following pancarpal arthrodesis if there is excessive tension to reduce chances of severe limb swelling, wound dehiscence, and, in severe cases, necrosis and death of the foot.?

A

Tension release incisions

25
Q

During pancarpal arthrodesis- where are the cancellous bone graft inserted?

A

within the denuded surfaces of each joint.

26
Q

ESF Pancarpal arthrodesis:

For a type II external fixator place two to three threaded pins from A) in the metacarpal bones and two to three pins in the B). The pins are connected with clamps and rods or acrylic.

A

A) medial to lateral
B) radius

27
Q

ESF Pancarpal arthrodesis:
For a type Ib external fixator place pins at an angle (craniomedial and craniolateral) into two of the A) bones and the distal radius. The pins are connected with clamps and rods or acrylic.

A

A) metacarpal

28
Q

Why is open pin placement advised in the proximal location?

A

As this area is challenging an unsafe

29
Q

You are presented with four-year-old 4kg Chihuahua with a simple transverse fracture of the distal diaphysis of the radius. Which of the following is the most appropriate method of fixation?

A

Internal fixation with anatomical reconstruction with a dynamic compression plate

30
Q

Following pancarpal arthrodesis, what should happen whilst under GA? (2)

A

Xrays to confirm placement
A modified Robert Jones bandage is applied for two to three days to counteract postoperative swelling

31
Q

Do you think postoperative splinting would be beneficial with pancarpal arthrodesis?

A

Postoperative splitting has been associated with a large number of postoperative complications, however, there is no evidence of significant protection of the construct apart from some reduction of strain to the implant.

32
Q

What is the exercise regime following pancarpal arthrodesis?

A

Strict confinement with short controlled lead walks is indicated for six weeks followed by gradual return to normal exercise by 12 weeks.

33
Q

What is the complication rate of pancarpal arthrodesis?

A

50%

34
Q

Complications include screw loosening, implant failure, metacarpal fracture, failure of bony fusion, ________ and continual gait abnormality.

A

Infection

35
Q

How to reduce pancarpal arthrodesis complications? (5)

A

Using screws that do not exceed 40% of metacarpal bone diameter;
Using bone plates that span at least 50% of the length of metacarpal bone;
Using additional cross pins to support plate fixation;
Ensuring good alignment of distal extremity;
Thorough removal of articular cartilage.

36
Q

One study concluded excellent limb function in approximately ?% of patients treated with pancarpal arthrodesis for hyperextension injuries.

A

80

37
Q

Bony bridging after PCA using plates is expected after ? weeks

A

9-30

38
Q

When is partial carpal arthrodesis indicated anatomically?

A

If the antebrachiocarpal joint is not involved and only the accessory carpal ligaments, the carpo-metacarpal ligaments, and the palmar fibrocartilage are damaged, without displacement of the accessory or ulnar carpal bones

39
Q

Partial Carpal Arthrodesis using Bone Plates:
Which joint surfaces are exposed? (2)

A

middle carpal and carpometacarpal joints

40
Q

Partial carpal arthrodesis:
The tendon of insertion of the extensor carpi radialis muscle can be cut from ? to facilitate placement of the plate.

A

metacarpal III (and sutured to the similar tendon of insertion on metacarpal II)

41
Q

Partial Carpal Arthrodesis with Intramedullary Pins:

The pinning technique is performed with the carpal joint in A) so that the IM pins can be placed into the metacarpal bones.

A

A) flexion

42
Q

Partial Carpal Arthrodesis with Intramedullary Pins:

A slot is created in the dorsal cortex of ? at the distal end and a pin is driven proximally into the medullary canal of each bone.

A

metacarpals III and IV

43
Q

Partial Carpal Arthrodesis with Intramedullary Pins:

The carpus is flexed 90 degrees ? (2) pressure on the metacarpal bones is placed.

A

and proximal and palmar

44
Q

Partial Carpal Arthrodesis with Intramedullary Pins:
The pins are driven ? into the radiocarpal bone avoiding penetration of the proximal articular surface.

A

proximally

45
Q

The cross-pinning technique involves placement of ? from metacarpal bone II into the ulnar carpal bone and from the metacarpal bone V into the intermedio-radial carpal bone

A

K-wires

46
Q

How/direction of pins in Partial Carpal Arthrodesis with Cross Pins

A

The fusion is stabilised by placing a pin from medial to lateral, entering the bone near the head of the second metacarpal and penetrating the radiocarpal bone.

A second pin is placed from lateral to medial, entering the bone near the head of the fifth metacarpal and penetrating the ulnar carpal bone.

47
Q

Post operative management of partial carpal arthrodesis:
If bandages/splints are used; how long do they stay in place for?

A

6-8 weeks

48
Q

How much of carpal movement is the antebrachial joint responsible for?

A

85%

Joint Diseases of the Forelimb (10 decks)

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