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Eq SX Musc Skel Exam > Fetlock MC/MT-Morton > Flashcards

Fetlock MC/MT-Morton Flashcards

1
Q

Categories P1 fractures

A
  1. Dorso-medial/-lateral P1 OCFs
  2. Proximoplantar/palmar P1 OCFs
  3. Diaphyseal fractures
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2
Q

Dorso- medial/-lateral P1 OCFs etiology

A

High speed hyperextension injury

Most common ‘chip’ fx TB racehorses

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3
Q

Dorso- medial/-lateral P1 OCFs DX

A 
PE & LE
-MCP/MTP effusion, + to flexion, mild lameness
-IA analgesia resolves lameness
Rads
-always do both fetlocks
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4
Q

Dorso- medial/-lateral P1 OCFs TX

A

Arthroscopic removal

Screw fixation if large frag (rare)

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5
Q

Dorso- medial/-lateral P1 OCFs Prog

A

Good unless significant OA

> 80% return to athletic function after removal

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6
Q

Proximoplantar/palmar P1 OCFs etiology

A

Controversial
-Manifestation OCD
-Traumatic
Common in young STB racehorses

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7
Q

Proximoplantar/palmar P1 OCFs DX

A

PE & LE
-Effusion, +/- to flexion, rarely lame
Rads
-Incidental (PPE)

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8
Q

Proximoplantar/palmar P1 OCFs TX

A

Smaller frags
-conservative 6-12 weeks rest
Larger frags
-arthroscopic removal (Plantar approach)

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9
Q

Proximoplantar/palmar P1 OCFs progn

A

Good-63% return to prev. level racing

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10
Q

Diaphyseal fractures etiology

A
  • Repetitive use injury
  • Sagittal plane propagate proximally to distally most commonly (sagittal groove)
  • Racehorses, and jumpers
  • Often spiral fx
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11
Q

Diaphyseal fractures DX

A

Rads

Avoid blocking

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12
Q

Diaphyseal fractures TX

A
  • Most require internal fixation

- Poor prognosis (barbaro)

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13
Q

Sesamoid fractures etiology

A

High speed, repetitive use
-most common type of catastrophic breakdown injury (biaxial)
Fore > hind; medial > lateral; uniaxial > biaxial
Apical > basilar > midbody
-apical/basilar=> avulsion fx

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14
Q

Sesamoid fractures DX

A 
PE & LE
-Sudden, acute lameness
-ECP/MTP effusion if articular
-fetlock drop if sig loss sups apparatus
Rads
Blocking-chronic
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15
Q

Sesamoid fractures TX

A

Arthroscopic removal-apical/abaxial (basilar)
-If more than 25% suspensory attachment involved removal not well tolerated
Repair-internal fixation

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16
Q

Sesamoid fractures Internal fixation options

A
  1. Screw in lag fashion +/- bone graft
  2. Tension band wire
  3. Arthroscopy to ensure anatomical reduction
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17
Q

Sesamoid fractures prognosis

A 
Fair-excellent simple apical fx
Fair for mid-body (uniaxial) fx
-difficult to repair, subsequent OA
-horses rested ~ 1yr
Difficult to avoid sesamoiditis and damage to suspensory lig that accompanies fx
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18
Q

POD

A

Palmar/Plantar Osteochondral dz

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19
Q

POD etiology

A
  1. Repetitive stress injury-results in maladaptive bone remodeling
  2. MC3/MT3 condylar dz-subchondral bone injury (‘edema’/necrosis/sclerosis), cartilage damage, supracondylar bone remodeling (resorption)
  3. Leads to osteoarthrosis
  4. predisposes to MC3/MT3 condylar fxs
  5. TB racehorses most commonly affected
20
Q

POD DX

A
  1. Signalment
  2. PE/LE + palmar/plantar metacarpal n. block
  3. BONE SCAN
  4. RADS-sclerosis, trabecular bone changes)
  5. MRI
  6. CT
21
Q

POD TX

A
  1. REST (90+ days)
    - continued training may lead to catastrophic failure
  2. Pain Management
    - NSAIDS
    - IA medication
    - ESWT
    - Bisphosphonates (not young horses)
  3. REPEAT BONE SCAN BEFORE RETURN TO TRAINING
22
Q

Condylar fractures MC3/MT3 etiology

A

Common in racehorses-cannon sustains high loads
-Stress accumulation and micro-fx within distal palmar/plantar condyles leads to acute fx at high speeds
Vertical fxs that propagate proximally and sagittally from joint

23
Q

Condylar fractures MC3/MT3 types

A

Lateral Condyle
-mostly short and complete, more common in MC3
-85% of forelimb condylar fxs are lateral
Medial Condyle
-Usually spiral, more common in MT3, Y shaped
-More prone to catastrophic failure (even after repair)

24
Q

Condylar fractures MC3/MT3 coaptation

A

VERY IMPORTANT

-half/full limb dorsal splint, cast, kimzey splint

25
Q

Condylar fractures MC3/MT3 DX

A
  1. PE: acute, marked lameness
  2. Rads: RADIOGRAPH BEFORE BLOCKING
  3. Nuclear Scint
  4. CT-surgical planning
26
Q

Condylar fractures MC3/MT3 TX

A
  1. Lag screw fixation
  2. Arthroscopy to confirm reduction, clean up frags
  3. Plating-needs to be removed before return to high speed
27
Q

Condylar fractures MC3/MT3 aftercare

A

3 month lay-off; mean return to start time 9 months

28
Q

Condylar fractures MC3/MT3 Prognosis

A

Directly related to severity of injury
Soundness depends on perfect reconstruction of joint
65% return to racing

29
Q

Bucked shins

A

Dorsal metacarpal disease (DMD)
-maladaptive remodeling of MC3
Common in young TB racehorses
Predisposes to dorsal cortical fractures

30
Q

DMD DX

A
  1. PE
    - Heat, swelling, pain on palpation
    - Acute onset lameness after high speed workout
  2. Rads
    - thickened dorsal cortex/periosteal rxn
    - may be bilateral
  3. Nuclear Scintigraphy
31
Q

DMD TX

A
  1. Prevention-training
    - rest
    - NSAIDS
    - appropriate training modifications
    - counter irritants (pin firing historically, maybe don’t do)
32
Q

DMD prognosis

A

Very good

Risk for dorsal cortical stress fxs

33
Q

Dorsal cortical fx MC3 etiology

A

Progression maladaptive bone remodeling
Usually incomplete
Saucer fx - complete
DX-similar to DMD

34
Q

Dorsal cortical fx MC3 TX

A
  1. Rest
    - stall rest with gradual return to exercise
    - frequent, short breezes once back into full training
  2. Soundess to asses healing
  3. Extracorporal shockwave therapy
  4. Surgery
    - Osteostixis (cortical drilling): improv vascularization
    - 3.5 mm unicortical screw-must remove
35
Q

Dorsal cortical fx MC3 prognosis

A
  • Good (85 and 97% return to racing after cortical drilling/ cortical drilling + screw)
  • Reccurence of fx more common after cortical drilling alone compared to drilling + screw
  • Recurrence rate higher w/o surgery (anectodally)
36
Q

Splints etiology

A

Proliferative periostitis of small MCs/MTs
Primarily young horses
Cyclic strains during exercise
Trauma resulting in subperiosteal hemorrhage and lifting of periosteum

37
Q

Splints DX

A
  1. PE/LE
    - local firm swelling +/- painful to palp
    - may block to low or high 4-point/6-point
  2. Rads
  3. Nuclear scintigraphy
  4. U/S TO EVAL CONCURRENT SUSPENSORY PATHOLOGY
38
Q

Splints TX

A
  1. Most respond to conservative tx
    - rest until not sensitive to palpation
    - bandaging
    - NSAIDS, cold, topical diclofenac, local steroid inj
    - ESWT
  2. Splint ostectomy for chronic/nonresponsive cases/impinging on suspensory ligament
  3. Treatment of any concurrent suspensory desmitis
39
Q

Splints prognosis

A

Good to excellent

40
Q

Splint fractures etiology

A
  1. Direct trauma-kick
  2. Exercise-cyclic strain, strain on suspensory and inter-osseous ligament
  3. fx usually distal 1/3
  4. 67-81% distal splint fractures have concurrent suspensory desmitis
41
Q

Splint fractures DX

A
  1. PE/LE
    - typically acute lameness
  2. Rads
  3. U/S
    - concurrent suspensory desmitis
42
Q

Splint fractures TX

A
  1. Closed fx-conservative
    - Stall rest, bandage, cold therapy, NSAIDS, surpass
    - healing accompanied by large exostosis-impingement ofsuspensory ligament
  2. Excessive callous ush needs to be removed
  3. Open fx
    - often form sequestrum
    - remove and debride
43
Q

Splint removal

A

Up to 2/3 distal aspect MC/MT II or MC/MT IV

-probs can’t actually remove whole MT IV

44
Q

Splint internal fixation

A

Req’d for proximal unstable fractures

45
Q

Splint bone fractures prognosis

A
  1. Distal 2/3 fractures good prognosis
    - depends on concurrent SL desmitis
  2. Proximal fractures-good unless residual instability of CMC/TMT joint +/- OA, infection into adjacent synovial structures

Eq SX Musc Skel Exam (20 decks)

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