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Large Animal Surgery > Equine Developmental Orthopedic Disease > Flashcards

Equine Developmental Orthopedic Disease Flashcards

1
Q

What is the difference between flexural and angular deformities?

A

FLEXURAL - sagittal plane; persistent hyperflexion or
hyperextension of the limb (tendon sheaths too short for associated bone)

ANGULAR - frontal plane; originating at a joint and/or
growth plate

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2
Q

What is the difference between congenital and acquired flexural limb deformities?

A

CONGENITAL - present at birth, “contracted tendons” and laxity

ACQUIRED - develops after birth, carpal, metacaropophalangeal (fetlock), proximal interphalangeal joint (pastern), distal interphalangeal (coffin)

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3
Q

What are 4 possible causes of congenital flexural limb deformities?

A
  1. exposure of mare to toxic plants or substances - sudan grass, locoweed, iodine deficiency
  2. dysmaturity or prematurity
  3. intrauterine malpositioning
  4. genetics
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4
Q

What 2 joints are most commonly affected by congenital FLD? In what foals is it especially common?

A

carpus and fetlock

premature foals –> incomplete ossification (advanced imaging not needed)

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5
Q

What are 5 parts of the medical management of congenital contracted tendons (FLD)? Is surgery commonly needed?

A
  1. bandaging
  2. splints
  3. controlled exercise
  4. IV Oxytetracycline
  5. toe extensions

NO

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6
Q

Congenital contracted tendons (FLD):

A

surgery rarely needed!

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7
Q

What is the purpose of bandaging and splinting in cases of congenital contracted tendons (FLD)? What schedule is used?

A

induce laxity to contracted tendons

keep on for periods at a time - 6-12 hours

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8
Q

What 2 things are required for successful bandaging and splinting?

A
  1. analgesics
  2. bandaging –> avoid sores
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9
Q

What are 5 options for analgesia in foals? What 2 side effects are most common?

A
  1. Flunixin meglumine
  2. Meloxicam
  3. Ketoprofen
  4. Firocoxib
  5. Phenylbutazone (not the best option)

gastric ulceration and nephrotoxicity (monitor bloodwork while using NSAIDs!)

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10
Q

What type of splints are recommended for contracted tendons? Why?

A

homemade PVC pipe —> cut to length of 1/2 or 1/3 of diameter, melt to shape and pad at the top or bottom

commercial splints are expensive and not as adaptable

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11
Q

How does the foal dose of Oxytetracycline compare to adults? What is required for proper healing of congenital contracted tendons (FLD) with contracted tendons?

A
  • FOAL = 44 mg/kg
  • ADULT = 6.6 mg/kg
  • give 3 g in 500-1000 mL slowly 1-3x in first week of life

weight bearing –> should see improvement in 24-48 hr

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12
Q

What 2 mechanisms of action are proposed for Oxytetracycline in treating congenital FLD? What side effect can be seen?

A
  1. calcium chelation –> muscle relaxation
  2. inhibits collagen structuring in myofibroblasts

acute renal failure - check kidney function (creatinine) before treating!

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13
Q

What can be added to hooves of foals with congenital FLD? What are the 2 most common options?

A

toe extensions - helps foals bearing weight on the palmar/plantar aspect of the foot

  1. acrylic
  2. glue on shoes
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14
Q

What treatment plan is recommended for mild cases of congenital contracted tendons (FLD)?

A
  • OTC if < 1 week
  • confine with controlled exercise
  • bandaging
  • analgesia

typically resolves on its own

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15
Q

What treatment plan is recommended for moderate cases of congenital contracted tendons (FLD)?

A
  • OTC if < 1 week
  • splinting
  • analgesia
  • confinement with controlled exercise as the foal improves
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16
Q

What treatment plan is recommended for severe cases of congenital contracted tendons (FLD)? What is ultimately recommended?

A
  • OTC if < 1 week
  • splinting
  • analgesia –> especially intense pain
  • confinement with controlled exercise as the foal improves
  • surgery is a LAST resort

REFER - foal is likely unable to stand and nurse and will need additional supportive care

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17
Q

What is prognosis of congential contracted tendons (FLD) like?

A
  • mild to moderate = good to excellent
  • severe = fair to guarded depending on response to treatment
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18
Q

How do foals with congenital tendon laxity (FLD) present? What is it commonly associated with?

A

born with mild hyperextension, often corrects on its own

prematurity/dysmaturity

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19
Q

When do cases of congenital laxity (FLD) require treatment? What 2 methods are used? What doesn’t typically work?

A

severe cases

  1. light bandages - just enough to protect fetlocks/heels from sores (usually course more laxity)
  2. heel extensions - careful of hoof wall deformities or heel contractors

splints

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20
Q

What causes acquired FLD? What are 3 etiologies?

A

mismatch of bone and tendon/ligament growth –> musculotendinous unit contracts due to pain

  1. overnutrition, over-conditioning
  2. rapid growth from 4 weeks to 4 months –> DIP contracture
  3. rapid growth after 1 year –> fetlock contracture
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21
Q

What signalment is associated with acquired FLD? What 5 breeds are associated?

A

young, fast-growing - 6 month to 2 years old

  1. Warmbloods
  2. Standardbreds
  3. Thoroughbreds
  4. Quarter horses
  5. Andalusians
22
Q

What joints are affected by the acquired FLD seen in these pictures?

A
  • DIP joint (coffin)
  • MCP +/- PIP (fetlock +/- pastern)
23
Q

What parts of the physical exam are necessary for diagnosing acquired FLD?

A
  • observe joints
  • palpate tendons to see which one feels tighter and for surgical planning

(early intervention is key!)

24
Q

What is club foot?

A

acquired FLD –> DIP (coffin) joint contracture

  • upright, long heel due to DDFT contraction pulls on and rotates the coffin bone downward in the hoof
25
Q

What limbs are most commonly affected by club foot (FLD)? When does it typically start? What structure is commonly involved?

A

forelimbs

1-4 months

DDFT

26
Q

What are the 2 stages of club foot?

A

I - dorsal hoof wall is 60-90 degrees

II - dorsal hoof wall is >90 degrees

27
Q

What are 4 options for treating club foot?

A
  1. analgesics
  2. nutritional management to slow growth
  3. farrier work - gradually rasp heels, toe extensions after surgery
  4. inferior check ligament desmotomy
28
Q

What 2 approaches are used for inferior check ligament desmotomy? What 2 complications are associated? What is especially important post-op?

A
  1. MEDIAL - more cosmetic
  2. LATERAL - avoids neurovascular bundle

seroma formation and fibrosis at surgical site

bandaging

29
Q

When is fetlock contracture (FLD) most commonly seen? What structures are commonly involved?

A

10-18 month old horses, forelimbs > hindlimbs

SDFT +/- DDFT

30
Q

What are 5 options for treating fetlock contracture?

A
  1. analgesics
  2. reduce nutrition
  3. farriery
  4. splinting - early, mild cases
  5. superior +/- inferior check ligament desmotomy
31
Q

What 2 changes are made in farriery work for causes of fetlock contracture?

A
  1. heel elevation - relaxes DDFT and increases SDFT strain
  2. toe extension - increases strain on both tendons
32
Q

What are 2 indications for surgical treatment of fetlock contractions with superior check ligament desmotomy? What 2 approaches are used?

A
  1. failure of conservative management
  2. > 180 degree contacture
  • tenoscopic - through flexor carpii radialis tendon sheath
  • open - incisional (complications common!)
33
Q

What are the 2 most common acquired FLDs in adults?

A
  1. carpal contracture - severe OA
  2. DIP (coffin) contracture - chronic lameness on affected limb
34
Q

What are the 3 types of ALDs?

A
  1. vaLgus - Lateral deviation
  2. varus - medial deviation
  3. windswept - limbs are slanted in one direction in one limb (valgus) and in the opposite direction (varus) in the other
35
Q

What are 4 etiologies of ALDs?

A
  1. incomplete ossification of the cuboidal bones
  2. laxity of periarticular surfaces
  3. unbalanced nutrition
  4. excessive exercise/trauma
36
Q

How do the results following manipulation of the limb in cases of ALDs indicate?

A

leg straightens - periarticular laxity, incomplete ossification

NO straightening - osseous structures not involved

37
Q

What is required to determine the origin and degree of ALDs?

A

radiographs

38
Q

How does the location of ALDs alter treatment plan?

A

centered on physis = correctable with surgery

centered on joint = not correctable with surgery, horse will likely develop OA

39
Q

What 3 things alter treatment plans for ALDs?

A
  1. age of foal - need growth plate potential left!
  2. severity of angulation
  3. origin of angulation - joints vs. physis
40
Q

When is medical management used for ALDs? What is part of the plan?

A

mild cases where foal is MOT past the rapid growth phase + <8 degrees of angylation

  • exercise restriction
  • hoof trimming and extensions
  • splint and casts in SOME cases
  • if there is no improvement within 4-6 weeks, do something else!
41
Q

What kind of trimming and extensions are recommended for hooves in horses with valgus/varus ALD?

A

VALGUS = trim outer half of foot, place medially

VARUG = trim inner half of foot, place laterally

42
Q

In what 2 cases of splints indicated for ALDs? How are they placed?

A
  1. incomplete ossification of the cuboidal bones
  2. laxity of the periarticular structures

elbow to fetlock (sleeve cast) - change splints every 3-4 days and casts every 10-14 days –> may take 2-4 weeks for signs of correction

43
Q

What are 3 indications for surgical management of ALD? What process is recommended?

A
  1. severe angulation (>8 degrees)
  2. non-responsive to medical treatments
  3. horse nearing end of their growth potential

growth acceleration/retardation (or combo)

44
Q

What is the ideal timing for surgical treatment of ALD depending on joint affected?

A

FETLOCK = <3 months (6 weeks recommended)

CARPUS = 6-12 months (6 months recommended)

TIBIA = 6-9 months

45
Q

How is growth accelerated to treat ALD? How is this performed? What is a major pro to this procedure?

A

periosteal transection and elevation performed on the CONCAVE side of the limb

incise and elevate periosteum + removal of the ossified ulna –> results seen in a few weeks

can NOT overcorrect

46
Q

How is growth retardation performed to treat ALD? In what 3 ways does it compare to growth acceleration?

A

transphyseal bridging - place screws and wires on the CONVEX side of the limb across the physics

  1. not always a good cosmetic outcome
  2. implant failure is possible –> requires frequent recheck exams
  3. CAN overcorrect - must remove implants as soon as limbs are straight (may need to remove implants on one limb before the other if bilateral)
47
Q

When can a single screw be used for transphyseal bridging for growth retardation? How does it compare to the other method of retardation?

A

(CONVEX) distal MC3/MT3 physis

easier and more cosmetic

48
Q

What 2 complications are associated with single screw transphyseal bridging for growth retardation?

A
  1. can cause physitis in distal radius or distal tibia
  2. CAN overcorrect - remove screw when straight
49
Q

What treatment is recommended for ALD due to incomplete ossification? What is prognosis like?

A

stall rest and sleeve cast –> must be early or may result in a permanent deformity

more collapsed + concurrent issues (prematurity) = worse prognosis

50
Q

What is physitis? What 3 signs are associated?

A

inflammation of the growth plate (aka epiphysitis)

  1. flared distal physis - distal radius in 8mo-2yrs; distal cannon in 3-6 mo
  2. pain on palpation
  3. mild lameness
51
Q

What 3 treatments are recommended for physitis? What complication is associated if left untreated?

A
  1. stall rest +/- hand walking - NO uncontrolled exercise until inflammation is gone
  2. NSAIDs
  3. dietary modification - decrease carbs (no grain!)

can lead to ALD

Large Animal Surgery (32 decks)

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