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6th MELEAH Sur-Gur-RAYYY final lezzzz ace dis shit > Distal Joints > Flashcards

Distal Joints Flashcards

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1
Q

What types of injuries commonly plague the carpus and tarsus? (2)

A
  • Collateral ligament injuries
  • hyperextension injuries
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2
Q

WHAT ARE THE PROXIMAL BONES IN THE CARPUS and state whether or not they are medial or lateral?

A
  • Radial carpal (medial)
  • Ulnar carpal (lateral)
  • Accessory carpal (lateral-caudal to ulnar carpal
  • Sesaomoid (abductor to pollicus longus)
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3
Q

Distal carpals are numbered _____ to ______ I-IV

A

medial to lateral

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4
Q

Metacarpal bones are numbered ____ to _____

A

medial to lateral

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5
Q

Metacarpal 1 is known as the _____

A

dewclaw

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6
Q

Metacarpal __-__ articulate with phalanges

A

2-5

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7
Q

How many tarsal bones are there?

A

7

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8
Q

In terms of the tarsal we have ___ irregular rows

  • Proximal
    • ____
    • ____
  • Middle
    • ____ ____
  • Distal
    • numbered tarsal bones __-___
A
  • 3 irregular
  • Proximal
    • talus (tibial tarsal)
    • Calcaneous (fibular tarsal)
  • Middle
    • central tarsal
  • Distal
    • numbered tarsal bones from 1-4
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9
Q
  • All carpal ligaments are _____ ligaments.
  • Do they bridge more than one joint?
  • What do they connect?
A
  • short
  • connect adjacent bones only
  • do not bridge more than one joint
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10
Q

Radial carpal connects the _______ and _____ parts versues the ulnar that is the ______ part only

A

Radial carpal connects the striaght and oblique parts versues the ulnar that is the straight part only

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11
Q

The long portion of the tarsal collaterals span the entire ____ and is taught in ____ but not in _____

A

The long portion of the tarsal collaterals span the entire tarsus and is taught in extension but not in flexion

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12
Q

Compare and contrats the short portion of the tarsus with the long portion with extension and flexion

A
  • Long portion taught in extension but not in flexion
  • Short portion taught in both flexion and extension
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13
Q

Collateral injury concepts apply to both the carpus and tarsus and typically arise from ____ or other trauma?

A

HBC

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14
Q

With collateral injuries especially if HBC, treat the life threatening trauma first and always assess the _____ in major trauma. Some times you will see road rash and collateral injury is usually on the ______ side of the joint

A
  • thorax
  • medial
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15
Q
  • Valgus stress _____ deviates the distal joint
  • Varus stress _____deviates distal joint
A
  • VaLgus stress Laterally deviates the distal joint
  • VaRus stress Medially deviates distal joint
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16
Q

When assessing the carpus position the limb in _____ and how is this different from the tarsus?

A
  • carpal-extension
  • tarsus- assess in both flexion and extension
    • tarsus is different from carpus due to long collaterals
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17
Q

What view radiographically do we need to look at for valgus/varus stress

A

dorsopalmar

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18
Q

What do you often need to act as a fulcrum when doing radiographic positioning for stress views. _______ _____ and _____

A

Wooden spoon and tape(pulls medially or laterally)

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19
Q

When the medial collateral ligament is torn we get _____ stress. pressure from the _____ side moves the distal limb ______

A

When the medial collateral ligament is torn we get valgus** stress. pressure from the **medial** side moves the distal limb **laterally

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20
Q

When the lateral collateral ligament is torn we get ___\_ stress. pressure from the____ side moves the distal limb _______

A

When the lateral collateral ligament is torn we get varus** stress. pressure from the **lateral side moves the distal limb medially

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21
Q

With valgus stress pressure opens the joint on the _____ side due to _____ _____

A

With valgus stress pressure opens the joint on the medial** side due to **MCL deficiency

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22
Q

With varus stress what happens in terms of pressure that is different from valgus stress?

A

Pressure does not open the joint because the LCL is intact!

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23
Q

What is recommended in terms of treatment and what is avoided for collateral injury?

A
  • Splinting and rest unhelpful as SOLE treatment
  • Surgical mngt. is recommended to reconstrcut/replace collateral ligaments
24
Q

In terms of callateral ligament replacement ____ or ____ ____ placed in origin and insertion of each ligament. What type of suture and how is it placed in these replacements?

A
  • Screw or bone tunnel
  • Non absorbable large diameter suture placed in figure 8 pattern
25
Q

With collateral ligament replacement:

  • The carpus simulates _____ligaments
    • Medial: _____, _____
    • Lateral: _____ only
  • Tarsus: simulate ____ and ____ ligaments
A

With collateral ligament replacement:

  • The carpus simulates short ligaments
    • Medial:straight, olbique
    • Lateral: striaght only
  • Tarsus: simulate short and long ligaments
26
Q

What is the best for collateral ligament replacement in terms of suture use?

A

40-80 lb test monofilament nylon (deep sea fishing line)

27
Q

When replacing the tarsal lateral collateral replacement the animal will also need _____ or _____ until healed

A
  • splint
  • ESF
28
Q

When a hyperextension injury takes place the same concepts apply to both the carpus and tarsus but instead of medial and lateral collateral ligaments they are called _____ support ligaments

A

palmar/plantar support ligaments

29
Q

With the palmar ligaments (supercifical), the _____ _____ encloses the ____ tendon

A
  • flexor retinaculum encloses the DDF tendon
30
Q

Palmar ______ is what merges the joint capsule and ligaments on the palmar surface of the carpus.

A
  • fibrocartilage
31
Q

State the joints in the carpus and their articulations (fill in the blank)

  • _____ joint (ginglymus)
  • _____ joint
    • between radius/ulna and proximal row
    • almost all motion occurs here
  • _____ joint
    • between second row and metacarpal bones
  • ______ carpal joint
    • between first and second row
A
  • Hinge joint (ginglymus)
  • Antebrachiocarpal joint
    • between radius/ulna and proximal row
    • almost all motion occurs here
  • Carpometacarpal joint
    • between second row and metacarpal bones
  • Middle carpal joints
    • between first and second row
32
Q

Almost all of the motion in the carpus takes place from what joint?

A
  • Antebrachiocarpal joint
33
Q

What joints are in the tarsus

  • ______joint (ginglymus)
  • ______joint
    • between tibia(crus) and talus
    • Almost all motion occurs here
  • _____ ______
  • ________-calcaneous and 4th tarsal
  • _______
A
  • Hinge joint (ginglymus)
  • Tibiotarsal (talocrural) joint
    • between tibia(crus) and talus
    • Almost all motion occurs here
  • Proximal intertarsal
  • Calcaneoquartal-calcaneous and 4th tarsal
  • Tarsometatarsal
34
Q

What disease can cause a hyperetension injury that weakens palmar and plantar stabilizers, also ______drugs do this

A

Immune mediated arthropathy

corticosteroids

35
Q

What breeds/age commonly get hyperextension injuries

A

middle aged/shelties/collies

36
Q

Are dropped hock and plantigrade stance the same thing?

A

NOPE, dropped hock is seen in hyperextension injuries (tarsus touches but calcaneous tilted proximally), plantigrade the calcanean tuberosity touches

37
Q

With radiography methods for hyperextension the standard ddorsopalmar/plantar and lateral view are indicated but what view do we need to ID stress views?

A

lateral

38
Q

What is the treatment for hyperextension?

A
  • Consists of splint application and rest but not useful as sole tx
  • Surgical management is indicated: arthrodesis of affected joint + joints distal, required for definiton treatment
39
Q

When performing an arthrosdesis for hyperextension the general idea is to do with with the affected joint + ______

A

all joints distal

40
Q

What joint is rarely injured by hyperextension, and what joint commonly is affected

A
  • Rarely: tibiotarsal (pantarsal arthrodesis rarely necessary)
  • Often: antebrachiocarpal involed: pancarpal
41
Q

____ carpal arthrodesis is indicated if _____ joint is healthy

A
  • Partial
  • antebrachiocarpal
42
Q

For partial carpal arthrodesis the ____ and _____ joints are fused using a T plate or pins

A

middle and carpometacarpal

43
Q
  • What are the indications for pancarpal arthrodesis?
  • What is applied with specialized plates
  • what application is typical?
A
  • Antebrachiocarpal joint is abnormal
  • All 3 carpal joints fused
  • DCP applied with specialized plates
    • dorsalapplication is typical
44
Q

What application is for most situations in the tarsus for partial arthrodesis and what is used?

A
  • Proximal intertarsal
    • CALCANEOQUARTAL (lateral half) most situations
  • Lag screw or pin/tension band
45
Q

What method is used for partial arthrodesis of the tarsus with the tarsometatarsal joint

A

lateral plate

46
Q

Proximal intertarsal arthrodesis is a ____ tarsus arthrodesis and the plate enages the ______. No effect on tibiotarsal articulation. Full ____ is maintained.

  • Also name another arthrodesis that does the same exact thing but just doesnt enage the calcaneus?
A

Proximal intertarsal arthrodesis is a Partial tarsus arthrodesis and the plate enages the calcaneus. No effect on tibiotarsal articulation. Full ROM is maintained

  • Tarsometatarsal arthrodesis
47
Q

What must you have post op after a arthrodesis/ also how long? Keet acitivty restricted until ____ ____

A
  • Coapatation for 4-8 weeks
  • either a splint or ESF
  • Activity Restricted until bone fusion ~3 months
48
Q

What comprises the common calcanean tendon?

A

TENDONS OF THE:

  • GASTROCNEMIUS
  • GRACILLIS
  • SEMITENDINOSIS
  • BICEPS FEMORIS
  • SUPERFICIAL DIGICAL FLEXOR
49
Q

When there is a complete rupture of the common calcanean tendon what CS will we see?

A

plantigrde stance

50
Q

When there is a partial rupture of the common calcanean tendon the ____ is usually preserved? What CS will we see (2)?

A
  • SDF preserved
    • Partial hyperflexion of hock
    • flexion of digits
51
Q
  • Compare and contrast acute presentation with chronic and whethere it not is more than likely a complete or partial rupture of the calcanean
  • What breeds and sizes usually get acute or chronic
A
  • Acute: usually from trauma, COMPLETE RUPTURE
  • Chronic
    • usually a partial rupture
    • minimal or no trauma
    • older female cat
    • medium and large breeds
      • Lab
      • Doberman
52
Q
  • What do you do to tendon ends in terms of calcanean rupture treatment?
  • Primary tendon repair (what to use, suture, and healing time like is it good or bad slow or fast?)
  • Should we immobilize and if so how/what does it do for healing and for how long is healing expected to take?
A
  • Debride tendon ends
  • Primary tendon repair
    • 3 loop pulley >locking loop
    • monofil. nonabs. suture
    • slow poor tendon healing
  • Immobilize the tarsus
    • allows for poor slow tendon healing
    • 6-8 weeks
53
Q
  • Describe the prognosis for calcanean tendon?
  • What is super important to do to maintain a good prognosis
A
  • Generally good for most >75% of dogs and cats return to function
  • working dogs more guarded
  • Immobilization postop is VERY IMPORTANT
    • (External fixator, Splint, Giant lag screw)
54
Q

What are the indications for Tarsocrural arthrodesis

  • Severe injury to ______ joint
    • Fracture: _____ _____ fractures
    • ______: causing persistant instability
      • failed _____ injury repair
      • Failed partial arthrodesis
    • Failed ______ tendon repair
    • OA Not responsive to MM
A
  • Severe injury to tibiotarsal joint
    • Fracture: comminuted articular fractures
    • Luxation: causing persistant instability
      • failed collateral injury repair
      • Failed partial arthrodesis
    • Failed calcanean tendon repair
    • OA Not responsive to MM
55
Q

When performing a tarsocrural arthrodesis fuse the tibiotarsal joint at _____ ____. Remove ______ cartilage using a ____ ____ for distal tibia/proximal talus and ____ for small joints. Pack it with a ____ ____

A

When performing a tarsocrural arthrodesis fuse the tibiotarsal joint at standing angle**. Remove **articular** cartilage using a **saggital saw** for distal tibia/proximal talus and **burr** for small joints. Pack it with a **bone graft

56
Q

When performing a rigid fixation with a tarsocrural arthrodesis we can use a _____ for dorsal lateral or medial or a type ____ ESF?

A
  • Plate
  • type 2 ESF
57
Q

What is the outcome with tarsocrural arthrodesis?

  • Loss of ____ ____
    • mechanical _____
    • Most dogs have _____ function
  • Pets: _____(good or bad?)
  • Working dogs: _____?
A
  • Loss of hock ROM
    • mechanical lameness
    • Most dogs have acceptable function
  • Pets: good(good or bad?)
  • Working dogs: guarded to poor?

6th MELEAH Sur-Gur-RAYYY final lezzzz ace dis shit (15 decks)

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