Carpus And Tarsus Flashcards
What provides palmar support to the carpus?
Palmar fibrocartilage
Ligaments
.degeneration in shelties leads to a palmigrade stance
Differentials in carpal disease
Luxations / sub-luxations
- antebrachiocarpal joint
- radial carpal bone
- middle carpal bone
- carpometacarpal
- collateral instability
Fractures - radial, accessory, ulnar carpal bones
Hyperextension injuries
Shearing injuries
How should you treat a fracture of the radial carpal bone?
Common
Lag screw
Lateral and caudal splints for 4-6w for support
How should you treat fractures of the accessory carpal bone?
Remove fragments
Lag screw
Lateral and caudal splints for 4-6 weeks for support
Comminuted - conservative management indicated
- lateral and caudal splint for 4-6 weeks
Comminuted fractures and fractures on the cranial ventral spect are common
Dx CT
How can you treat carpal luxations and subluxations?
Partial / pnacarpal Arthrodesis more common
Can reduce and reconstruct ligaments
Or replace ligaments with synthetic sutures
How dos a carpal hyperextension injury present and how can you diagnose it?
Following trauma
Palmigrade stance - no obvious signs of pain after the swelling reduces
Carpometacarpal joint is most commonly affected
Dx: stress view radiographs - opening of the palmar aspect of the joint
How can you treat a carpal hyperextension injury?
Partial or total carpal Arthrodesis
- pin fixation
- plate fixation
How should you treat traumatic shearing injuries?
External fixation - allows wound management
Amputation
Where are you likely see osteophytes in the tarsus on a radiograph?
Cranial and caudal aspect of the tarsal joints
Articular surface roughening is also seen
What are some differentials for tarsal disease?
Luxations / subluxations Fractures Shearing injuries Hyperextension OCD Luxation of SDFT tendon Common calcanean tendinopathy
How can you treat tarsal luxations / subluxations?
Reconstruction of the ligaments
Prosthetic ligaments
Reattach ligaments
Pantarsal Arthrodesis
How can you treat distal calcaneus fractures?
Lateral or plantar plate fixation
How can you treat avulsion fractures of the calcaneus?
Pins and tension bands
How can you treat fractures of the central tarsal bone, talus and numbered tarsal bones?
Reduction and stabilisation with pins, plates or lag screws
Arthrodesis
If very small fragments - conservative
- caudal and lateral splint for 4-6w
How does luxation of the superficial digital flexor muscle present?
Due to rupture of the lateral or medial retinaculum
Intermittent lameness
Popping sensation on the back of the hock when hock moved
Tx: debridement of fibrous tissue and tendon reduction
Suturing tendon retinaculum
Lateral splint for 2-3 weeks
How does common calcanean tendon rupture present?
Acute - plantigrade immediately
Chronic - gradually become plantigrade
Complete rupture - completely plantigrade
Partial - SDFT only - plantigrade with flexed toes
How can you diagnose common calcanean tendon rupture?
ST swelling ++ in tendon
Avulsions
Enthesiopathy of the common calcanean tendon in chronic disease
How can you treat common calcanean tendonopathy?
Debridement of necrotic tendon edges
Surgical repair of tendon
Immobilise the tarsus for 8-10 weeks
- external fixation
- cast or lateral splint
- calcaneotibial screw
How does OCD present in the the tarsus and when should you perform surgery?
Large breeds
Both trochlear ridges of the talus are affected
- medial ridge is more commonly affected
Arthroscopy has a better prognosis if the patient is less than 6mo
There will be long term OA
How should you treat a fracture of the central tarsal bone?
Positional screw to the 4th tarsal bone
Splint support for 4 weeks
What breed is predisposed to tarsal hyperextension? And how should you treat it?
Shetland sheepdog
Tarsal Arthrodesis
How should you perform tarsal Arthrodesis?
Remove articular cartilage Maintain proper joint angles Rigid long standing fixation Bone grafting Additional stabilisation with splints
How can you treat metacarpal / metatarsal fractures and when should you do it?
Conservative - external coaptation
Surgery with IM pins or dorsal plates
- more than 2 bones affected
- involves the articular surfaces
- more than 50% displaced
- large breed or working dogs
How should you treat phalanx fractures?
Toe amputation
Conservative management
How should you treat luxations / subluxations?
Reduction
Toe amputation
