Distal Joints

Question 1

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

Answer 1

• Collateral ligament injuries
• hyperextension injuries

Question 2

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

Answer 2

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

Question 3

Distal carpals are numbered _____ to ______ I-IV

Answer 3

medial to lateral

Question 4

Metacarpal bones are numbered ____ to _____

Answer 4

medial to lateral

Question 5

Metacarpal 1 is known as the _____

Answer 5

dewclaw

Question 6

Metacarpal __-__ articulate with phalanges

Answer 6

2-5

Question 7

How many tarsal bones are there?

Answer 7

7

Question 8

In terms of the tarsal we have ___ irregular rows

• Proximal
  
  • ____
  • ____
• Middle
  
  • ____ ____
• Distal
  
  • numbered tarsal bones __-___

Answer 8

• 3 irregular
• Proximal
  
  • talus (tibial tarsal)
  • Calcaneous (fibular tarsal)
• Middle
  
  • central tarsal
• Distal
  
  • numbered tarsal bones from 1-4

Question 9

• All carpal ligaments are _____ ligaments.
• Do they bridge more than one joint?
• What do they connect?

Answer 9

• short
• connect adjacent bones only
• do not bridge more than one joint

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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

Question 12

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

Answer 12

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

Question 13

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

Answer 13

HBC

Question 14

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

Answer 14

• thorax
• medial

Question 15

• Valgus stress _____ deviates the distal joint
• Varus stress _____deviates distal joint

Answer 15

• VaLgus stress Laterally deviates the distal joint
• VaRus stress Medially deviates distal joint

Question 16

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

Answer 16

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

Question 17

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

Answer 17

dorsopalmar

Question 18

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

Answer 18

Wooden spoon and tape(pulls medially or laterally)

Question 19

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

Answer 19

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

Question 20

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

Answer 20

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

Question 21

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

Answer 21

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

Question 22

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

Answer 22

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

Question 23

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

Answer 23

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

Question 24

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?

Answer 24

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

Question 25

With collateral ligament replacement: * The carpus simulates \_\_\_\_\_ligaments * Medial: \_\_\_\_\_, \_\_\_\_\_ * Lateral: _____ only * Tarsus: simulate ____ and ____ ligaments

Answer 25

With collateral ligament replacement: * The carpus simulates **_short_** ligaments * Medial:**_straight, olbique_** * Lateral: **_striaght_** only * Tarsus: simulate **_short and long_** ligaments

Question 26

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

Answer 26

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

Question 27

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

Answer 27

* splint * ESF

Question 28

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

Answer 28

**_palmar/plantar_** support ligaments

Question 29

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

Answer 29

* **_flexor retinaculum_** encloses the **_DDF_** tendon

Question 30

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

Answer 30

* fibrocartilage

Question 31

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

Answer 31

* **_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

Question 32

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

Answer 32

* Antebrachiocarpal joint

Question 33

What joints are in the tarsus * \_\_\_\_\_\_joint (ginglymus) * \_\_\_\_\_\_joint * between tibia(crus) and talus * Almost all motion occurs here * _____ \_\_\_\_\_\_ * \_\_\_\_\_\_\_\_-calcaneous and 4th tarsal * \_\_\_\_\_\_\_

Answer 33

* **_Hinge_** joint (ginglymus) * **_Tibiotarsal (talocrural)_** joint * between tibia(crus) and talus * Almost all motion occurs here * **_Proximal intertarsal_** * **_Calcaneoquartal_**-calcaneous and 4th tarsal * **_Tarsometatarsal_**

Question 34

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

Answer 34

Immune mediated arthropathy corticosteroids

Question 35

What breeds/age commonly get hyperextension injuries

Answer 35

middle aged/shelties/collies

Question 36

Are dropped hock and plantigrade stance the same thing?

Answer 36

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

Question 37

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

Answer 37

lateral

Question 38

What is the treatment for hyperextension?

Answer 38

* 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

Question 39

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

Answer 39

all joints distal

Question 40

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

Answer 40

* Rarely: tibiotarsal (pantarsal arthrodesis rarely necessary) * Often: antebrachiocarpal involed: pancarpal

Question 41

\_\_\_\_ carpal arthrodesis is indicated if _____ joint is healthy

Answer 41

* Partial * antebrachiocarpal

Question 42

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

Answer 42

middle and carpometacarpal

Question 43

* What are the indications for pancarpal arthrodesis? * What is applied with specialized plates * what application is typical?

Answer 43

* Antebrachiocarpal joint is abnormal * All 3 carpal joints fused * DCP applied with specialized plates * dorsalapplication is typical

Question 44

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

Answer 44

* Proximal intertarsal * **CALCANEOQUARTAL (lateral half) most situations** * Lag screw or pin/tension band

Question 45

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

Answer 45

lateral plate

Question 46

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?

Answer 46

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

Question 47

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

Answer 47

* Coapatation for 4-8 weeks * either a splint or ESF * Activity Restricted until bone fusion ~3 months

Question 48

What comprises the common calcanean tendon?

Answer 48

TENDONS OF THE: * GASTROCNEMIUS * GRACILLIS * SEMITENDINOSIS * BICEPS FEMORIS * SUPERFICIAL DIGICAL FLEXOR

Question 49

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

Answer 49

plantigrde stance

Question 50

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

Answer 50

* SDF preserved * Partial hyperflexion of hock * flexion of digits

Question 51

* 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

Answer 51

* Acute: usually from trauma, COMPLETE RUPTURE * Chronic * usually a partial rupture * minimal or no trauma * older female cat * medium and large breeds * Lab * Doberman

Question 52

* 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?

Answer 52

* 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

Question 53

* Describe the prognosis for calcanean tendon? * What is super important to do to maintain a good prognosis

Answer 53

* 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)

Question 54

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

Answer 54

* 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

Question 55

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 ____ \_\_\_\_

Answer 55

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_**

Question 56

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

Answer 56

* Plate * type 2 ESF

Question 57

What is the outcome with tarsocrural arthrodesis? * Loss of ____ \_\_\_\_ * mechanical \_\_\_\_\_ * Most dogs have _____ function * Pets: \_\_\_\_\_(good or bad?) * Working dogs: \_\_\_\_\_?

Answer 57

* Loss of **_hock ROM_** * mechanical **_lameness_** * Most dogs have **_acceptable_** function * Pets: **_good_**(good or bad?) * Working dogs: **_guarded to poor_**?