Equine orthopaedics

Question 1

Arthroscopy uses?

Answer 1

• Diagnostic
• Therapeutic

Question 2

Diagnostic arthroscopy?

Answer 2

Enables visualisation within joint
- Soft tissue structures
- Cartilage lesions not visible radiographically

Question 3

Arthroscopy for therapeutic?

Answer 3

Osteochondritis Dissecans/ chip fractures
- Removal of osteochondral fragments
- Debidrement of cartilage lesions
- Lavage

Synovial sepsis
- Removal bacterial debris
- Debridement of contaminated / traumatised tissue
- Lavage

Question 4

Technique for Arthroscopy

Answer 4

• 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

Question 5

Arthroscopy vs bursoscopy vs tenoscopy?

Answer 5

» Arthroscopy→ within a joint
» Bursoscopy→ within a bursa
» Tenoscopy→ within a tendon sheath

Question 6

what is triangulation?

Answer 6

“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”

Question 7

What pathology can be seen in arthroscopy?

Answer 7

• Synovitis
• fibrilation of cartilage
• Articular cartilage defect

Question 8

Intra-op GA risks?

Answer 8

• Haemarthrosis
• Obstruction of view by synovial villi
• Extrasynovial extravasation of fluid
• Iatrogenic damage to articular
  cartilage
• Intrasynovial instrument breakage
• Intrasynovial foreign material

Question 9

Post-op Ga risks?

Answer 9

• Infection
• Postoperative synovitis/distension
• Synovial hernia
• Failure to remove fragments
• Post-operative capsulitis, enthesous
  new bone and soft tissue
  mineralization
• Pain

Question 10

What do we do with fractures?

Answer 10

Question 11

Describe fracture fixation?

Answer 11

• GA
• Strict
  surgical asepsis
• Pre-op planning
• AO/ ASIF fixation systems
• Intra-op radiogrpah
• Bandage or cast for recovery

Question 12

What intra-op complications of fracture repair

Answer 12

• Myositis
• Soft tissue damage
• Fracture extension
• Joint penetration
• Implant (screw) breakage
• Contamination

Question 13

Post-op complications of equine fracture repair

Answer 13

• Fracture on recovery
• Neuropathy/myopathy on recovery
• Infection
• Cast sores
• Implant failure
• Contra-lateral laminitis
• Colic
• Arthritis (poor joint alignment)

Question 14

What is arthrodesis?

Answer 14

‘fusion of bones of a joint’
- best outcomes in low motion joints
- Salvage procedure

Question 15

Describe tarsal arthrodesis?

Answer 15

• Low motion joint
• Some cases return to modest athleitic activity
• Prognosis hind leg > fore leg

Question 16

Tarsal arthrodesis?

Answer 16

• 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

Question 17

What do we call impingement / overriding of dorsal spinous processes?

Answer 17

‘Kissing spines’

Question 18

Describe surgical techniques for ostectomy vs desmotomy?

Answer 18

Question 19

What is a desmotomy?

Answer 19

surgical section of a ligament

Question 20

Annual lig Vs inferior check lig desmotomies?

Answer 20

Question 21

INDICATIONS for periosteal transection?

Answer 21

• 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

Question 22

Technique of periosteal transection?

Answer 22

“Release” of periosteal tissue on the epiphysis to stimulate growth

Question 23

Tendon repair indications?

Answer 23

• Partial or complete severance of flexor tendon (extensor tendons can
  be managed conservatively)
• Repair can only be attempted if severance is clean

Question 24

Technique for tendon repair?

Answer 24

• Various suture patterns described
• Aim is apposition of severed edges
• Support in cast for extended period post-op

Question 25

Prognosis of tendon repair?

Answer 25

• Poor
• Salvage procedure only

Question 26

Post-op care SURGERY-specific ?

Answer 26

• 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

Question 27

Post op care Husbandry?

Answer 27

• 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

Question 28

Describe inspection for cast management?

Answer 28

• 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

Question 29

Duration of cast?

Answer 29

• Maintain for 2 weeks of comfortable/weight-bearing * Remove standing * Many need GA to replace half-limb cast

Question 30

Return to exercize post op ortho surgery?

Answer 30

• Highly dependent upon nature of injury
• Follow instructions provided by specialist
• Client should not expect instant return to full
  function!