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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
What limbs are most commonly affected by club foot (FLD)? When does it typically start? What structure is commonly involved?
forelimbs 1-4 months DDFT
26
What are the 2 stages of club foot?
I - dorsal hoof wall is 60-90 degrees II - dorsal hoof wall is >90 degrees
27
What are 4 options for treating club foot?
1. analgesics 2. nutritional management to slow growth 3. farrier work - gradually rasp heels, toe extensions after surgery 4. inferior check ligament desmotomy
28
What 2 approaches are used for inferior check ligament desmotomy? What 2 complications are associated? What is especially important post-op?
1. MEDIAL - more cosmetic 2. LATERAL - avoids neurovascular bundle seroma formation and fibrosis at surgical site bandaging
29
When is fetlock contracture (FLD) most commonly seen? What structures are commonly involved?
10-18 month old horses, forelimbs > hindlimbs SDFT +/- DDFT
30
What are 5 options for treating fetlock contracture?
1. analgesics 2. reduce nutrition 3. farriery 4. splinting - early, mild cases 5. superior +/- inferior check ligament desmotomy
31
What 2 changes are made in farriery work for causes of fetlock contracture?
1. heel elevation - relaxes DDFT and increases SDFT strain 2. toe extension - increases strain on both tendons
32
What are 2 indications for surgical treatment of fetlock contractions with superior check ligament desmotomy? What 2 approaches are used?
1. failure of conservative management 2. >180 degree contacture - tenoscopic - through flexor carpii radialis tendon sheath - open - incisional (complications common!)
33
What are the 2 most common acquired FLDs in adults?
1. carpal contracture - severe OA 2. DIP (coffin) contracture - chronic lameness on affected limb
34
What are the 3 types of ALDs?
1. vaLgus - Lateral deviation 2. varus - medial deviation 2. windswept - limbs are slanted in one direction in one limb (valgus) and in the opposite direction (varus) in the other
35
What are 4 etiologies of ALDs?
1. incomplete ossification of the cuboidal bones 2. laxity of periarticular surfaces 3. unbalanced nutrition 4. excessive exercise/trauma
36
How do the results following manipulation of the limb in cases of ALDs indicate?
leg straightens - periarticular laxity, incomplete ossification NO straightening - osseous structures not involved
37
What is required to determine the origin and degree of ALDs?
radiographs
38
How does the location of ALDs alter treatment plan?
centered on physis = correctable with surgery centered on joint = not correctable with surgery, horse will likely develop OA
39
What 3 things alter treatment plans for ALDs?
1. age of foal - need growth plate potential left! 2. severity of angulation 3. origin of angulation - joints vs. physis
40
When is medical management used for ALDs? What is part of the plan?
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
What kind of trimming and extensions are recommended for hooves in horses with valgus/varus ALD?
VALGUS = trim outer half of foot, place medially VARUG = trim inner half of foot, place laterally
42
In what 2 cases of splints indicated for ALDs? How are they placed?
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
What are 3 indications for surgical management of ALD? What process is recommended?
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
What is the ideal timing for surgical treatment of ALD depending on joint affected?
FETLOCK = <3 months (6 weeks recommended) CARPUS = 6-12 months (6 months recommended) TIBIA = 6-9 months
45
How is growth accelerated to treat ALD? How is this performed? What is a major pro to this procedure?
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
How is growth retardation performed to treat ALD? In what 3 ways does it compare to growth acceleration?
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
When can a single screw be used for transphyseal bridging for growth retardation? How does it compare to the other method of retardation?
(CONVEX) distal MC3/MT3 physis easier and more cosmetic
48
What 2 complications are associated with single screw transphyseal bridging for growth retardation?
1. can cause physitis in distal radius or distal tibia 2. CAN overcorrect - remove screw when straight
49
What treatment is recommended for ALD due to incomplete ossification? What is prognosis like?
stall rest and sleeve cast --> must be early or may result in a permanent deformity more collapsed + concurrent issues (prematurity) = worse prognosis
50
What is physitis? What 3 signs are associated?
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
What 3 treatments are recommended for physitis? What complication is associated if left untreated?
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

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