common orthopedic diseases pt 2 Flashcards
Physeal Dysplasia
- Clinical signs, age group
- Age group: 4-8 months (but variable).
- Widening of the metaphyses – “metaphyseal flare”.
- ± Heat and sensitivity/pain on palpation.
- ± Lameness → no lameness, or mild-to-moderate lameness.
Physeal Dysplasia
- Dx
- Tx
- prognosis
Diagnosis:
- Age and clinical signs.
- Radiographs.
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Treatment:
- Dietary: ↓carbohydrates, ↑ roughage (no lush pasture!)
- Exercise restriction.
- ±NSAID therapy.
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Prognosis:
- Typically very good.
- Exceptions → those that develop angular limb deformities.
Angular Limb Deformities
- what is this?
- etiology?
- A deviation of the limb in the frontal plane (i.e. medial or lateral).
- Congenital or acquired.
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4 basic etiologies: - asynchronous longitudinal growth across the physis
- incomplete ossification of the cuboidal bones
- periarticular soft tissue laxity
- acute physeal or articular trauma or fracture
Angular Limb Deformities
- causes or risk factors
- Genetic predisposition.
- Nutritional/metabolic factors?
- Trauma → chronic uneven loading across the physis.
- Nutritional/dietary factors in the dam (in utero).
- In-utero malpositioning.
- Prematurity or dysmaturity.
> Incomplete ossification of the cuboidal bones.
> Periarticular soft tissue laxity.
angular limb deformities, types
- Valgus deformity
- Varus deformity
- The deformity is named for the joint at which the deviation occurs, eg. carups valgus, fetlock varus…
angular limb deformities
- conservative management
- Many mild deviations will correct with normal growth. - Restrict exercise.
- Corrective foot trimming and application of extensions.
> valgus/toe out - trim the lateral wall, apply medial extensions
> varus/toe-in - trim the medial wall. apply lateral extensions
Angular Limb Deformi?es
what to do if we have evident Incomplete Ossification or Soft Tissue Laxity:
- External coaptation (casts or bandage/splints)
- Strict exercise restriction.
Angular Limb Deformities
Surgical Intervention options:
- Periosteal transection and elevation (“periosteal stripping”).
> growth acceleration > performed on the concave side of the limb
<><> - Transphyseal bridging (physeal retardation).
> growth retardation > performed on the convex side of the limb
> 2 screws and figure=-8 wire or 1 transphyseal screw
angular limb deformities
- what age is the latest where we should consider sending for surgery? for:
- MC-3/MT-3
- Tibia
- Radius
- MC-3/MT-3: 2 months
- Tibia: 4-5 months
- Radius: 6-8 months
Flexural Limb Deformities
- what are these?
- how do they arise?
- Relative contraction of the flexor tendons (“contracted tendons”).
- congential or acquired
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Risk factors: - genetic predisposition
- nutritional/metabolic
- in-utero malpositioning (congenital)
- nutritional / dietary factors in the dam (congential)
- prematurity or dysmaturity
common locations for flexural limb deformities
- distal interphalangeal joint
- metacarpo / metatarsophalangeal joint
- carpus
- usually bilateral
Distal Interphalangeal Flexural Deformity
- what is this
- a.k.a.“Clubfoot”.
- Relativecontraction of the deep digital flexor tendon (DDFT).
- At birth (congenital) or 1-4 months of age (acquired).
Distal Interphalangeal Flexural Deformity
- treatment
- oxytentracycline > chelates calcium so that muscle can relax
- corrective trimming (lower the heels) and application of toe extension
- surgery: distal check desmotomy
<><><>- - or you can pick up the foot and stretch it, splint and force to weight bear…
Flexural Deformity of the Fetlock
- what is the cause of this?
- what do we observe?
- when?
- metacarpo/metatarsophalangeal flexural deformity
- relative contraction of the superficial digital flexor tendon (SDFT) and/or DDFT (if it is only superficial, toe will be straight, if deep is involved toe will be curled back)
- fetlock upright/straight or even knuckling over
- at birth or between 4-12 months of age
Flexural Deformity of the Fetlock, treatment
- splinting
- oxytetracycline?
- heel elevation? controversial
- surgery - proximal check desmotomy, (and maybe distal check desmotomy?)
