Exam 2: Arthrodesis of the PIJ (Proximal Interphalangeal Joint)

Question 1

surgical immobilization of a joint by fusion of the adjacent bones

Answer 1

Arthrodesis

Question 2

What are the indications for

arthrodesis of the PIJ (pastern joint)?

Answer 2

High ring bone

Pastern luxation

P2 fracture

Pastern septic arthritis

Question 3

What are the 3 surgical techniques that can be used to

accomplish arthrodesis of the PIJ (pastern joint)?

Answer 3

Trans-articular lag screws

Dorsal plate (DCP or LCP)

Screws AND Plate

Question 4

What is the best way to accomplish

arthrodesis of the PIJ (pastern joint) and why?

Answer 4

Transarticular lag screws + dorsal plate

• better stability and comfort*
• less time in cast and hospital*
• less periarticular bone formation on dorsal aspect*

Question 5

What type of incision is used in

arthrodesis of the PIJ (pastern)?

Answer 5

Inverted T incision

Question 6

What are the landmarks for the longitudinal portion

of the inverted T incision?

Answer 6

Junction of the proximal and middle third of the proximal phalanx

to

2 cm above the coronary band

Question 7

What structure is visualized upon

inverted T incision?

Answer 7

Common Digital Extensor (CDE) tendon

Question 8

This type of incision is used to transect the

common digital extensor tendon

in order to elevate and reflect it distally

Answer 8

Inverted V incision

Question 9

For arthrodesis of the PIJ/Pastern joint,

after removing any bony proliferations on the dorsal

surface and the cartilage in the joint capsule,

__________ of the subchondral (P1,P2) bone plates

is done using a 2.5 mm drill bit

Answer 9

Osteostixis (surgical puncture of a bone)

Question 10

How many osteostixis are made

in P1 and P2 for screw placement

in arthrodesis procedure?

Answer 10

TWO glide holes in P1

ONE thread hole in P2

Question 11

After drilling the holes in P1 and P2,

you need to _______ and tap

and enter P1 at an angle to get into P2

Answer 11

countersink

Question 12

What has a better success rate for pastern arthrodesis?

Forelimb or Hindlimb?

Answer 12

HIND limb = 95% success

Question 13

What is the forelimb success rate for pastern arthrodesis?

Answer 13

81%

Question 14

This type of imaging is a must

intra and post op for

pastern arthrodesis sx.

Answer 14

RADS

Question 15

Even though the success rate for pastern arthrodesis

is so high, complications are life threatening and costly.

Name some complications associated with this sx.

Answer 15

cast discomfort

implant (plate) failure

instability

infection (staphylococcus)

pressure sores

ischemia of distal limb

laminitis

Question 16

_______ are the mainstay for

management of complications for pastern arthrodesis

Answer 16

NSAIDS

Question 17

What meds are used to manage complications of

pastern arthrodesis sx?

Answer 17

Nsaids

Morphine, Butorphanol

Bupivicaine

Lidocaine

Gabapentin

Aspirin, Acepromazine, Pentoxyphylline