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Small animal surgery I > Diseases of the carpus and tarsus > Flashcards

Diseases of the carpus and tarsus Flashcards

1
Q

Which side is medial and which is lateral?

A
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2
Q

Which side is medial and which is lateral?

A
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3
Q

What is the difference between a short collateral ligament and a long collateral ligament?

A
  • Short portion
    • Taut in both flexion and extension
    • Cross joint obliquely–> rotational stability
    • Anatomically divided into 2 parts
    • Connect adjacent bones only
    • Do not bridge more than 1 joint
  • Long portion
    • Spans entire tarsus–tibia to metatarsals
    • Taut in extension only
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4
Q

T/F: All ligaments in the carpus are short ligaments

A

TRUE

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5
Q

What is the typical etiology of collateral injuries?

A

Typically arise from HBC or other trauma

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6
Q

T/F: Collateral injuries can lead to permanent damage, so you should always treat them ASAP following any kind of trauma

A

FALSE

Always treat life-threatening trauma FIRST

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7
Q

T/F: You should always assess the thorax in major trauma

A

TRUE

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8
Q

T/F: Collateral injuries frequently occur on the medial side of the joint and have loss of both soft tissue and bone

A

TRUE

“Road rash”

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9
Q

How do you assess collateral injuries?

A

PE and rads

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10
Q

Which radiograph views are necessary and why?

A
  • Standard dorsopalmar and lateral views
  • Rule out fractures
  • Stress radiographic views
  • Necessary even when collateral injury is obvious
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11
Q

What is meant by “valgus stress” and “varus stress”?

A
  • Valgus = Laterally deviates distal limb
  • Varus = medialy deviates distal limb
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12
Q

What stress radiographic views are used to assess collateral injury?

A
  • Dorsopalmar stress views
    • Dorsopalmar views with valgus/varus stress
    • Documents injury
  • Wooden spoon can act as fulcrum
  • Tape pulls distal limb medially or laterally
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13
Q

How will both valgus and varus stress affect the distal limb following a medial collateral injury?

A
  • Valgus stress–pressure from the medial side moves the distal limb laterally
    • Pressure opens the joint on the medial side due to MCL deficiency
  • Varus stress–pressure from the lateral side moves the distal limb medially
    • Pressure does NOT open the joint because the LCL is intact
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14
Q

What are the treatment options for collateral injury?

A
  • Conservative management is rarely useful
    • Splinting + rest unhelpful as sole treatment
    • May be necessary if sx is delayed
    • ESF in the presence of soft tissue trauma (instead of coaptation)
  • Coaptation may be used, but not as sole treatment
  • Surgical treatment is preferred
    • Reconstruct/replace collateral
  • Salvage necessary with excessive trauma
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15
Q

How is collateral ligament replacement performed?

A
  • Screw or bone tunnel in origin and insertion of each ligament
  • NONabsorbable, large diameter suture placed in figure 8 pattern
  • Take ligamet anatomy into account:
    • Carpus: stimulate short ligament(s)
      • Medial: straight, oblique (2)
      • Lateral: straight only
    • Tarsus: stimulate short AND long ligaments
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16
Q

What kind of suture is needed for collateral ligament replacement?

A

Large diameter, NON-absorbable suture

Ex: #2 (MUCH larger than 2-0)

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17
Q

What structures are damaged in hyperextension injuries?

A
  • Palmar/plantar support ligaments
  • Allows abnormal motion (hyperextension) between rows of tarsal/carpal bones
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18
Q

What do the terms “flexor retinaculum” and “palmar fibrocartilage” refer to?

A
  • Flexor retinaculum encloses DDF tendon
  • Palmar fibrocartilage extends from the distal aspect of the proximal carpal bones *radial, ulnar) to the proximal aspect of the metacarpals
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19
Q

What are the common etiologies of hyperextension injuries?

A
  • Trauma
  • Immune-mediated arthropathy
    • Disease weakens palmar/plantar stabilizers
    • Corticosteroids also tend to weaken ligaments
  • Breed-related: middle-aged shelties/collies
    • Chronic, progressive breakdown
    • Genetic weakness suspected
    • May be bilateral
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20
Q

Name/describe the joints of the carpus

A
  • Antibrachiocarpal joint
    • Between radius/ulna and proximal row
    • Almost all motion occurs here
  • Middle carpal joint
    • Between 1st and 2nd rows
  • Carpometacarpal joint
    • Between 2nd row and metacarpal bones
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21
Q

Name/describe the joints of the tarsus

A
  • Tarsocrural (tibiotarsal) joint
    • Between tibia (crus) and talus
    • Almost all motion occurs here
  • Proximal intertarsal
  • Calcaneoquartal–calcaneus and 4th tarsal
  • Tarsometatarsal
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22
Q

How do you identify hyperextension injuries on a PE?

A
  • Hallmark: hyperextended stance
    • ​Tarsus: dropped hock
      • Tarsus touches but calcaneous tilted proximally
    • Plantigrade stance: calcanean tuberosity touches
    • Dropped hock does NOT equal ‘plantigrade stance’
      • ​Dropped hock = joint sitting lower than it should
      • Plantigrade = heel touching ground
        *
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23
Q

How are radiographs used in hyperextension injuries?

A
  • Standard views
    • Rule out other injuries
    • Provide basis for comparison
  • Stress views
    • Determine diagnosis
    • Determine level of injury
      • Use lateral views for hyperextension injury
      • Stabilize limb proximal to carpus/tarsus
      • Stimulate wt.-bearing to detect instability
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24
Q

Diagnosis?

A

Hyperextension of the carpus

25
Q

T/F: Conservative management of hyperextension injuries is rarely useful

A

TRUE

Use prior to surgery only

26
Q

Can coaptation be used as definitive treatment for hyperextension injuries?

A

NO

27
Q

What is the preferred treatment for hyperextension injuries?

A

Surgery

Arthrodesis of affected joint + joints distal

Required for definitive treatment

28
Q

What is partial carpal arthrodesis?

A
  • Indicated if antebrachiocarpal joint is healthy
  • Middle and carpometacarpal joints are fused using a T-plate or pins
  • Function of carpus is almost unaffected–almost all motion at antebrachiocarpal joint
29
Q

What is pancarpal arthrodesis?

A
  • Antebrachiocarpal joint is abnormal
  • All 3 joints fused
  • DCP applied–specialized plates
    • Dorsal application is typical
    • Lateral application is described
30
Q

T/F: The tibiotarsal joint is rarely injured by hyperextension

A

TRUE

31
Q

What are the differences between arthrodesis of the calcaneoquartal and proximal intertarsal joint?

A
  • Calcaneoquartal
    • Lateral half of proximal intertarsal joint
    • Lag screw or pin/tension band
    • Applicable for most situations
  • Proximal intertarsal
    • Entire joint
    • Lateral plate
32
Q

Compare and contrast proximal intertarsal arthrodesis to tarsometatarsal arthrodesis

A
  • Proximal intertarsal
    • Partial tarsal arthrodesis
    • Plate engages calcaneus
    • No effect on tibiotarsal articulation
    • Full ROM is maintained
  • Tarsometatarsal
    • Lateral plate
    • Partial tarsal arthrodesis
    • No effect on tibiotarsal articulation
    • Full ROM is maintained
33
Q

Diagnosis?

A

Proximal intertarsal hyperextension

34
Q

What procedure was performed on this hyperextension injury?

A

Calcaneoquartal arthrodesis

35
Q

Diagnosis?

A

Tarsometatarsal hyperextension

36
Q

What post-op management is required following arthrodesis (regardless of location)?

A
  • Coaptation
    • 4-8wks
    • Splint or external fixator
  • Activity restriction until bony fusion
    • Expect 3mo minimum
    • Radiographs Q4wks to assess healing
  • Explantation occasionally required
37
Q

What is the signalment/presentation of carpal laxity syndrome?

A
  • Young (5-27wks)
  • Usually male (predisposed)
  • Lots of breeds
38
Q

How is carpal laxity syndrome recognized?

A
  • Loose joint
  • Hyperextension, hyperflexion, flexural deformity w/ palpable injury
39
Q

What are the treatment recommendations for carpal laxiy syndrome?

A
  • Spontaneous recovery in 1-4wks
    • Diet (energy-restricted)
    • Controlled exercise
    • Flooring w/ good traction
40
Q

What is the prognosis for carpal laxity syndrome?

A

Excellent

41
Q

What are the components of the common calcanean tendon?

A
  • Gastrocnemius tendons
  • Combined tendons of the gracillis, semitendinosis, biceps femoris
  • Tendon of the SDF
42
Q

What is the difference in signalment between complete and partial rupture of the calcanean tendon?

A
  • Complete: plantigrade stance
  • Partial
    • SDF usually preserved
    • Partial hyperflexion
    • Flexion of digits
43
Q

What is the difference in history of complete and partial rupture of the calcanean tendon?

A
  • Complete
    • Acute
    • Usually trauma
  • Partial
    • Chronic
    • Minimal to no trauma
    • Medium and large-breeds (lab, doberman)
    • Older female cats
    • Cause unknown (repetitive trauma suspected)
44
Q

What is the procedure for calcanean tendon repair?

A
  • Debride tendon ends
  • Primary tendon repair
    • 3-loop pulley > locking loop
  • Immobilize tarsus in extension
    • 6-8wks
45
Q

What type of suture is indicated in tendon repair? Why?

A

Heavy, monofilament non-absorbable suture

The tendon has very poor blood suppy–need suture to last long enough for the tendon to heal (6-8wks)

46
Q

T/F: Post-op coaptation is required following tendon repair

A

TRUE–cannot repair well enough for it to be weight-bearing while healing

External fixator, splint, or giant lag screw

47
Q

What is the prognosis for tendon rupture following treatment?

A
  • Generally good
    • Most (>75%) dogs and cats return to fx
    • Working dogs more guarded
  • Immobilizing post-op is VERY important
  • Complications related to coaptation method
48
Q

What is the breed susceptibility for OCD of the hock?

A

Rotweilers predisposed

Same breeds as with OCD anywhere

49
Q

T/F: OCD of the hock is frequently unilateral

A

FALSE–frequently bilateral

50
Q

Where on the hock does OCD usually occur?

A

Lesion is usually located on the medial ridge of the talus

(Rotweilers commonly have OCD on the lateral ridge)

51
Q

What is the hock flexion test?

A
  • Flex the limb and hold in hyperflexion and have the dog walk away–see if lameness is aggravated
  • Only tells that there is a problem in the hock–will not diagnose OCD
52
Q

How is OCD of the hock diagnosed?

A

Radiographs–articular flattening, lucency

53
Q

What radiographic views are necessary for diagnosis of OCD in the hock?

A
  • Standard lateral and craniocaudal views (might not see lesion)
  • Flexed lateral–expose proximal talus
  • Flexed craniocaudal–cranial trochlear ridges
54
Q

What are the treatment options for OCD of the hock?

A
  • Medical therapy–older dog, established OA
  • Surgery
    • Fragment excision/debridement
      • Young dog, no OA
      • Heals w/ fibrocartilage
      • Arthroscopy vs. arthrotomy
    • Tibiotarsal (aka tarsocrural) arthrodesis
55
Q

What is the prognosis for OCD of the hock?

A
  • Guarded to poor
  • Sx intervention
    • Arthrotomy and fragment removal may be no better than medical management
    • Arthroscopy = ideal
    • Sx doesn’t prevent development of OA
  • Current wisdom
    • Sx improves function somewhat
    • Does not eliminate lameness
56
Q

What are the indications for tarsocrural arthrodesis?

A
  • Fractures–comminuted articular
  • Luxation–persistent instability
    • Failed collateral injury repair
    • Failed partial arthrodesis
  • Failed calcanean tendon repair
  • OA not responsive to medical management
    • End-stage OCD
    • Previous trauma
57
Q

Explain the tarsocrural arthrodesis procedure using the basic principles

A
  • Fuse tibiotarsal joint at standing angle
  • Remove articular cartilage
    • Sagittal saw–distal tibia/proximal talus
    • Burr-small joints
  • Pack with bone graft
  • Rigid fixation
    • Plate–dorsal, lateral, or medial
    • Type 2 external skeleton fixator
58
Q

What is the expected long-term outcom for pantarsal arthrodesis?

A
  • Loss of hock ROM
    • Mechanical lameness
    • Most dogs have acceptable function
  • Pet: good
  • Working dog: guarded to poor

Small animal surgery I (25 decks)

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