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Large Animal Surgery > Disorders of the Equine Forelimb > Flashcards

Disorders of the Equine Forelimb Flashcards

1
Q

How does prognosis associate with odds of returning to work?

A
  • EXCELLENT = >90%
  • GOOD = >75%
  • FAIR = >40%
  • GUARDED-POOR = <40%
  • GRAVE = <10%
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2
Q

What is the most common location of forelimb lameness?

A

foot

  • below carpus
  • carpus
  • above carpus
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3
Q

What are the 2 most common types of second phalangeal (short pastern) fractures? Where?

A
  1. comminutes
  2. chip

palmar process where the SDFT inserts = dropped fetlock

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4
Q

What are the 2 most common etiologies of second phalangeal fractures?

A
  1. trauma
  2. comminuted - twist injury from Western performances, pasture accident
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5
Q

How do horses present with second phalangeal fractures? What 2 treatments are recommended? What is prognosis like?

A

5/5 lame

  1. internal fixation + pastern arthrodesis
  2. coaptation - half-limb or transfixation pin cast

fair to good - decreases if coffin joint is involved

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6
Q

What are 3 possible etiologies of proximal interphalangeal joint OA?

A

(high ring bone / pastern joint)

  1. conformation
  2. trauma - sesamoidean ligament injury (roughened attachments)
  3. osteochondral cysts
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7
Q

What are 4 signs of proximal interphalangeal (pastern) joint OA?

A
  1. moderate lameness
  2. characteristic bony swelling on dorsal surface (roughened attachment)
  3. positive to limb flexion
  4. blocks to abaxial or pastern joint blocks
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8
Q

What are 3 options of treating pastern joint OA?

A
  1. manage OA pain and progression with IA corticosteroids
  2. arthrodesis with advanced cases (lag P1 and P2 together) - better prognosis HL > FL
  3. facilitated ankylosis with ethyl alcohol injection. -destroys articular cartilage to allow direct bony bridging
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9
Q

How is treatment for pastern joint OA done? What is prognosis like?

A
  • mild to moderate = corticosteroid injection
  • moderate to severe = arthrodesis or facilitated ankyloses

fair to good

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10
Q

What are the 3 most common etiologies of metacarpophalangeal (fetlock) joint OA?

A
  1. athletic performance
  2. conformation
  3. trauma
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11
Q

What are 4 signs of metacarpophalangeal )fetlock) joint OA?

A
  1. lame
  2. positive flexion
  3. effusion
  4. blocks to fetlock joint and low 4 point
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12
Q

What treatments are recommended for fetlock joint OA?

A
  • manage OA pain and progression
  • arthrodesis if severe and pasture sound only
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13
Q

Where are forelimb fetlock osteochondral fragments (chips) most commonly found? What are the 2 most common etiologies?

A

dorsal

  1. trauma - jumpers, racehorses
  2. OCD - proximal P1, mid-sagittal ridge of MC3
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14
Q

What are 3 signs of fetlock chips? How are they treated? What is prognosis like?

A
  1. mild to moderate lameness
  2. fetlock effusion
  3. positive to fetlock flexion

arthroscopic removal

good to excellent

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15
Q

What are the 2 most common etiologies of 2nd and 4th metacarpi (splint bones) exostosis?

A
  1. trauma - medial
  2. conformation - bench knee (off-center canon) with toe out = winging in and interference
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16
Q

What are 2 signs of splint bone (2nd and 4th metacarpi) exostosis? When is U/S and MRI used for diagnosis?

A
  1. swelling
  2. usually not lame

rule in or out suspensory ligament involvement

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17
Q

If this view is a DMPLO, which splint is affected?

A

medial structures are highlighted on plantar surface –> 2nd metacarpi exostosis

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18
Q

What treatment is recommended for 2nd and 4th metacarpi (splint) exostosis? What if the suspensory ligament is involved? What is prognosis like?

A

benign neglect - rest, NSAIDs

remove splint - segmental or en bloc ostectomy

excellent

19
Q

What is the most common etiology of 3rd metacarpus (cannon bone) disease?

A

“bucked shins”

  • dorsal MC3 periostitis common in racehorses early in training
  • this remodels dorsomedial MC3, leading to saucer or cortical fractures
20
Q

What are 3 signs of dorsal 3rd metacarpal disease? What 2 diagnostics are recommended?

A
  1. acutely lame with a short stride, especially after hard work (races, breezes)
  2. dorsal swelling
  3. pain on palpation

radiographs & nuclear scintigraphy

21
Q

What are 5 options for treatment of dorsal 3rd metacarpal disease? What is prognosis like?

A
  1. NSAIDs
  2. rest - 10-14 days for mild, months for severe
  3. alter training
  4. shockwave
  5. osteoclast inhibitors

good to excellent

22
Q

What is the most common etiology of 3rd metacarpal fractures in foals and racehorses? What immediate treatment is needed?

A

FOALS - pasture accident

RACEHORSES - cumulative stress

correct coaptation - need to be able to weight bear for proper healing

23
Q

What are the 4 most common types of cannon bone fractures? What horses get each?

A
  1. DIAPHYSEAL - foals and adults; stepped in holes, trauma
  2. PALMAR PROXIMAL - Standardbreds
  3. DISTAL CONDYLAR - Thoroughbreds
  4. SALTER HARRIS TYPE II - foals (metaphysis + physis)
24
Q

Diaphyseal cannon bone fracture:

A
25
Q

How do medial and lateral condylar fractures differ?

A

MEDIAL - typically spirals

LATERAL - typically does not spiral

26
Q

Classify the 5 types of Salter-Harris fractures.

A
  1. Separated growth plate (physis)
  2. Above the growth plate (metaphysis + physis)
  3. beLow the growth plate (epiphysis + physis)
  4. Through the growth plate (all 3)
  5. ERasure of growth plate (compression)
27
Q

Salter-Harris type II fracture:

A

metaphysis + physis

28
Q

What are 2 options for treating cannon bone fractures?

A
  1. internal fixation - 2 plates for diaphyseal, screws for lateral condylar and proximal palmar, screws and dorsolateral plate for medial condylar –> dorsal plate must be removed before returning to work
  2. transfixation pin cats
29
Q

What is prognosis like for open cannon bone fractures, and those in foals and adults?

A

grave

good

  • diaphyseal = fair to poor
  • condylar and proximal palmar = good for life, fair for return to race
30
Q

What are 5 signs of carpal joint disorders?

A
  1. positive to flexion
  2. reduced ROM - stiff-legged gait
  3. external swelling - bony or effusion
  4. over at the knee - fails to keep leg straight
  5. bowed-legged - offloading painful structures
31
Q

In what horses are carpal chip fractures most common? Why?

A

racehorses early in career (2-4 y/o) –> insidious onset

hyperextension of limb at full speed

32
Q

What are 2 signs of carpal chip fractures? What 2 radiographic views are recommended?

A
  1. mild to moderate lameness
  2. carpal effusion**
    (may not need to block!)

flexed lateral to open up the joint or flexed skylines

33
Q

What treatment is recommended for carpal chip fractures?

A

arthroscopic removal of fragments and debridement of affected intercarpal ligaments

34
Q

What does prognosis of carpal chip fractures depend on?

A

concurrent damage - ability to bear weight, structure of intercarpal igaments (poor with extensive damage)

chronicity - good if acute, poor if chronic

35
Q

What is the most common etiology of carpal slab fractures? What are 2 signs?

A

hyperextension of limb at high speeds reached by racehorses (early in career 2-4 y/o)

  1. severe lameness
  2. severe carpal effusion
36
Q

What treatment for carpal slab fractures is recommended? What is prognosis like?

A

arthroscopic assisted internal fixation –> too big to take out

fair to good

37
Q

What 4 structures take part in the stay apparatus of the forelimb?

A
  1. shoulder joint is prevented from flexing by the biceps muscle
  2. elbow is fixed in extension by the triceps
  3. lacertus fibrosus tendon extends out of the biceps tendon and the forearm fascia inserts below the carpal joint and locks this in extension
  4. carpal, fetlock, and pastern joints are prevented from overextension by the tension of the flexor tendons and the suspensory ligament.
38
Q

What are the major differential diagnoses for failure of the stay apparatus? What 3 signs are seen?

A

humeral fracture, radial nerve injury, olecranon fracture

  1. dropped elbow
  2. unable to “fix” carpus - unable to bear weight
  3. inability to extend limb
39
Q

What is the most common etiology of radial nerve injuries? What are 3 signs? How is it diagnosed?

A

trauma - avulsion of brachial plexus, humeral fracture, prolonged lateral recumbency without padding

  1. unable to extend limb and dragging - may need retraining with healing
  2. no loss of cutaneous sensation
  3. muscle atrophy after 2-4 weeks

EMG

40
Q

What 2 treatments are recommended for radial nerve injuries? What is prognosis like?

A
  1. splint to fix limb - fix carpus in place to bear weight
  2. anti-inflammatories - NSAIDs, corticosteroids

good IF recovers function in 6-8 weeks (poor otherwise - risk contralateral limb laminitis)

41
Q

What are the most common etiologies of olecranon fractures in foals and adults?

A

FOALS - most common fracture, Type 1b across growth plate

ADULTS - kick wounds, concurrent wound worsens prognosis (implant + osteomyelitis)

42
Q

What are 3 signs of olecranon fracture? How does the type change treatment?

A
  1. failure of stay apparatus
  2. swelling
  3. crepitus
  • incomplete, non-displaced - stall rest + coaptation with caudal splint
  • complete, displaced - tension band
43
Q

What is prognosis of olecranon fractures like?

A
  • foals and adults, non-articular with surgery - good
  • articular surface involvement - fair
  • open fracture - guarded to grave

Large Animal Surgery (32 decks)

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