Equine orthopaedics Flashcards
Arthroscopy uses?
- Diagnostic
- Therapeutic
Diagnostic arthroscopy?
Enables visualisation within joint
- Soft tissue structures
- Cartilage lesions not visible radiographically
Arthroscopy for therapeutic?
Osteochondritis Dissecans/ chip fractures
- Removal of osteochondral fragments
- Debidrement of cartilage lesions
- Lavage
Synovial sepsis
- Removal bacterial debris
- Debridement of contaminated / traumatised tissue
- Lavage
Technique for Arthroscopy
- General anaesthetic
- Dorsal recumbency
- Sterile preparation of patient
- Drape – impervious draping system
- +/- Distend joint prior to making skin portal for
insertion of arthroscope - Equipment
- Triangulation technique
Arthroscopy vs bursoscopy vs tenoscopy?
» Arthroscopy→ within a joint
» Bursoscopy→ within a bursa
» Tenoscopy→ within a tendon sheath
what is triangulation?
“bringing one or more operating instruments through separate portals and into the visual field of the arthroscope with the tips of the instrument and the arthroscope forming the apex of a
triangle”
What pathology can be seen in arthroscopy?
- Synovitis
- fibrilation of cartilage
- Articular cartilage defect
Intra-op GA risks?
- Haemarthrosis
- Obstruction of view by synovial villi
- Extrasynovial extravasation of fluid
- Iatrogenic damage to articular
cartilage - Intrasynovial instrument breakage
- Intrasynovial foreign material
Post-op Ga risks?
- Infection
- Postoperative synovitis/distension
- Synovial hernia
- Failure to remove fragments
- Post-operative capsulitis, enthesous
new bone and soft tissue
mineralization - Pain
What do we do with fractures?
Describe fracture fixation?
- GA
- Strict
surgical asepsis - Pre-op planning
- AO/ ASIF fixation systems
- Intra-op radiogrpah
- Bandage or cast for recovery
What intra-op complications of fracture repair
- Myositis
- Soft tissue damage
- Fracture extension
- Joint penetration
- Implant (screw) breakage
- Contamination
Post-op complications of equine fracture repair
- Fracture on recovery
- Neuropathy/myopathy on recovery
- Infection
- Cast sores
- Implant failure
- Contra-lateral laminitis
- Colic
- Arthritis (poor joint alignment)
What is arthrodesis?
‘fusion of bones of a joint’
- best outcomes in low motion joints
- Salvage procedure
Describe tarsal arthrodesis?
- Low motion joint
- Some cases return to modest athleitic activity
- Prognosis hind leg > fore leg
Tarsal arthrodesis?
- Low motion joints
- Indications: OA of TMT and DIT joints NOT responding to medical therapy
- Chemical or mechanical arthrodesis
- Must be no comm with PIT joint
What do we call impingement / overriding of dorsal spinous processes?
‘Kissing spines’
Describe surgical techniques for ostectomy vs desmotomy?
What is a desmotomy?
surgical section of a ligament
Annual lig Vs inferior check lig desmotomies?
INDICATIONS for periosteal transection?
- Angular limb deformity that is non-responsive to conservative
treatment (hoof trimming, corrective shoes) - Has to be done early in life during active growth phase i.e. before 2
months old
Technique of periosteal transection?
“Release” of periosteal tissue on the epiphysis to stimulate growth
Tendon repair indications?
- Partial or complete severance of flexor tendon (extensor tendons can
be managed conservatively) - Repair can only be attempted if severance is clean
Technique for tendon repair?
- Various suture patterns described
- Aim is apposition of severed edges
- Support in cast for extended period post-op
Prognosis of tendon repair?
- Poor
- Salvage procedure only
Post-op care SURGERY-specific ?
- Use dressings/bandage to protect
surgical site - Monitor for swelling or discharge
indicative of infection - Post-op antibiotics? May not be
necessary - Analgesia, phenylbutazone
- Removal of sutures/staples around
7d post-op
Post op care Husbandry?
- Consider effect of movement on
injury repair - Controlled return to exercise
- Low energy diet
- Risk of colic
- Weight-bearing? Analgesia? Foot
support? - Risk of contralateral laminitis
Describe inspection for cast management?
- Integrity? * Heat? (often warmer over joints) * Swelling above cast? * Discharge through cast? * Seal top with bandage * Early removal if signs of discharge or severe discomfort
Duration of cast?
- Maintain for 2 weeks of comfortable/weight-bearing * Remove standing * Many need GA to replace half-limb cast
Return to exercize post op ortho surgery?
- Highly dependent upon nature of injury
- Follow instructions provided by specialist
- Client should not expect instant return to full
function!
