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Orthopedic Surgery > Final > Flashcards

Final Flashcards

1
Q

What is the primary determinant of equine joint health?

A

Articular cartilage

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2
Q

What component of equine articular cartilage synthesizes, organizes, and regulates the composition of the extra-cellular membrane?

A

Chondrocytes

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3
Q

What type of collagen is present in equine articular cartilage?

A

Type 2

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4
Q

Which component of equine articular cartilage counteracts the tensile stresses at the joint surface?

A

Collagen

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5
Q

What type of stress does collagen counteract at the joint surface?

A

Tensile

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6
Q

Which component of the equine articular cartilage resists compressive forces?

A

Aggrecan (a proteoglyan)

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7
Q

What force does aggrecan resist?

A

Compressive

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8
Q

How does articular cartilage receive nutrition?

A

Motion!

Cartilage has no blood supply

Compression expels water and soluble waste

Relaxation brings in water and soluble waste

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9
Q

What molecule contributes to synovial fluid viscosity?

A

Hyaluronan

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10
Q

What is the function of the synovial fluid?

A

Lubricate gliding surface

Nutrition supply and waste removal from cartilage

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11
Q

What is the Matrix Metalloproteinase inhibitor?

A

Tissue Inhibitor of Metalloproteinases (TIMP)

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12
Q

What are aggrecanases?

A

A distintegrin and metalloproteinase thrombospondin motifs

ADAMTS

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13
Q

What are the inflammatory cytokines in articular cartilage and what do they do?

A

IL-1 and TNF-a

Increase production of MMPs, oxygen free radicals, and prostaglandins

Inhibit collagen and aggrecan synthesis

Upregulate each other

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14
Q

What is the function of prostaglandins in articular cartilage?

A

Proteoglycan degradation

Sensitizes nerves to mediators of pain

Production stimulated by IL-1

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15
Q

What types of repair does cartilage undergo?

A
  1. Intrinsic: chondrocyte synthetic activity
  2. Extrinsic: cells from marrow cavity, requires penetration of subchondral bone
  3. Matrix flow: cartilage melts into fill lesion
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16
Q

What are the major classes of equine joint disease?

A
  1. Developmental orthopedic disease
  2. Traumatic/degenerative arthritis
  3. Septic arthritis
  4. Immune-mediated polyarthritis
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17
Q

What are examples of equine developmental orthopedic diseases?

A

Osteochondrosis

Osteochondritis dessicans

Subchondral bone cysts

Delayed ossification

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18
Q

T/F: traumatic/degenerative osteoarthritis causes irreversible changes to the joint

A

True

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19
Q

What tissue changes are seen with equine osteoarthritis?

A

Synovitis

Capsulitis

Ligamentous or meniscal injury

Primary cartilage injury

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20
Q

What is the gold standard in diagnosing equine osteoarthritis?

A

Arthroscopy

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21
Q

What clinical signs are associated with equine osteoarthritis?

A

Pain
Synovial effusion
Decreased range of motion
Local inflammation

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22
Q

What would you expect to see on radiographs of a horse with osteoarthritis?

A

Enthesiophytes

Osteophytes

Joint space narrowing

Subchondral bone sclerosis and/or lysis

Osteochondral fragments

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23
Q

For horses with osteoarthritis, does the severity of radiographic changes correlate with the amount of pain?

A

NO

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24
Q

What are the main goals in treating equine osteoarthritis?

A

Remove inciting cause*

Slow the progression of degeneration

Alleviate clinical signs

Restore function

Improve quality of life

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25
Q

How do you treat equine osteoarthritis?

A

REST

Surgery: remove inciting cause, debridement, repair stimulating techniques, cartilage repair

Medical tx

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26
Q

What types or surgery exist for the treatment of osteoarthritis?

A

Graft procedures

Arthrodesis

Facilitated ankylosis

Joint stabilizing surgeries (TPLO, TTA, etc)

Joint replacement

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27
Q

What types of medical therapy is used to treat osteoarthritis?

A

NSAIDs

Corticosteroids

Hyaluronan

Polysulphated glycoaminoglycan

Pentosan polysulphate

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28
Q

What types of corticosteroids are used to treat equine osteoarthritis and what route of administration is most common?

A

Methylprednisolone acetate: low motion joints

Triamcinolone acetonide: high motion joints

Intra-articular administration

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29
Q

What is the main functions of hyaluronan in the medical treatment of equine osteoarthritis?

A

Lubrication and anti-inflammatory

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30
Q

What is the function of polysulphated glycosaminoglycan in the medical treatment of equine osteoarthritis?

A

Stimulates endogenous hyaluronan synthesis

Condroprotective effects

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31
Q

What is the function of pentosan polysulphate in the medical treatment of equine osteoarthritis?

A

Decreased fibrillation

For early OA only

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32
Q

What biologic therapies exist for the treatment of equine osteoarthritis?

A

IRAp or ACS
PRP
Stem cells
Gene therpy

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33
Q

What are neutraceuticals?

A

Supposedly help with osteoarthritis

Do not require FDA approval for safety and efficacy

Glucosamine, chondroitin sulfate, cosequin, herbs, antioxidants etc.

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34
Q

What are the 3 types of equine septic arthritis?

A

Traumatic
Iatrogenic
Hematogenous

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35
Q

T/F: septic arthritis in horses is always an emergency

A

True

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36
Q

What are the different types of equine hematogenous septic arthritis?

A

Affect foals!

S-type: synovial membrane and fluid

E-type: subchondral bone of epiphysis -> extends into joint

P-type: physis, may extend into joint

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37
Q

How do you diagnose equine septic arthritis?

A

Clinical signs
Rads
Synovial fluid (clin path and culture)

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38
Q

Does a lack of bacteria in synovial fluid analysis rule out septic arthritis?

A

No, you will rarely see bacteria

Mostly will see neutrophils

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39
Q

What organisms would you expect in a synovial fluid culture in a horse? Foal? Cow?

A

Horse: staph aureus

Foal: enterobacteriaceae, strep, rhodococcus, actinobacillus

Cattle: A. Pyogenes, strep, salmonella, e. coli, mycoplasma

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40
Q

How do you treat septic arthritis?

A

Broad-spectrum systemic antimicrobial

Synovial lavage

Intra-articular antimicrobials

Regional antibiotic perfusion

Bandage

Analgesia

Arthrotomy

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41
Q

What type of antibiotic administration results in the highest antimicrobial concentration in the synovium?

A

Intra-articular

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42
Q

When do you stop treatment for septic arthritis?

A

When there is a significant improvement in effusion and lameness

DO NOT rely on WBC count

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43
Q

What are the 3 criteria for diagnosing immune-mediated polyarthritis?

A
  1. Inflammatory process affecting synovium of two or more joints
  2. No identifiable infectious component
  3. Responsive to immunosuppressive therapy
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44
Q

What is infraspinatus contracture?

A

Hyperextension of the forelimb, adduction of the elbow, and abduction of the paw

Caused by acute, traumatic injury to the scapular muscle

Not painful

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45
Q

What is the treatment for infraspinatus contracture?

A

Tenotomy

Excellent prognosis, full return to function

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46
Q

What type of scapulohumeral luxations are common in small breed dogs? Large breed dogs?

A

Small breed: medial

Large breeds: lateral

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47
Q

Lateral scapulohumeral luxations are a result of the loss of integrity in what structures?

A

Infraspinatus muscle

Lateral glenohumeral ligament

Lateral joint capsule

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48
Q

In medial scapulohumeral luxations, what is the success of reduction dictated by?

A

Integrity/conformation of the glenoid cavity

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49
Q

What two surgical approaches exist to correct a medial scapulohumeral luxation?

A
  1. Medial transposition of biceps tendon

2. Arthrodesis

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50
Q

What is bicipital tenosynovitis and how do you treat it?

A

Chronic, often intermittent lameness caused by inflammation of the biceps tendon, resulting in osteophytosis and mineralization of the humerus

Tx: intra-articular steroid injection or bicipital tendon release

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51
Q

What is the most common type of displacement in traumatic elbow luxations?

A

Laterally displaced radius and ulna

NEED ORTHOGONAL VIEWS!

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52
Q

How do you treat traumatic elbow luxations?

A

Reduce ASAP!
Closed or open. Flex the elbow to relocate the anconeal process.

Coapt limb in extension

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53
Q

What types of dogs are prone to congenital elbow luxation?

A

Small breeds and bulldogs

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54
Q

What is required for normal function to be established in a limb of a dog with a congenital elbow luxation?

A

Early surgical intervention

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55
Q

What are causes of growth plate disturbances that result in angular limb deformities?

A

Trauma

Developmental disturbances

Inflammatory disease

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56
Q

What results from premature closure of the distal ulnar physis?

A

Curved radius

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57
Q

What types of dogs are affected by carpal hyperextension injuries?

A

Large breed dogs, particularly hunting dogs

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58
Q

What structures are damaged in carpal hyperextension injuries?

A

Palmar fibrocartilage and ventral carpal ligaments

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59
Q

What causes carpal hyperextension injuries?

A

Usually trauma, but can also be degenerative

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60
Q

What are the treatments for carpal hyperextension injuries and which is most effective?

A

Coaptation

Individual ligament repair

Partial carpal arthrodesis

Pancarpal arthrodesis: *most effective

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61
Q

What type of radiographic view do you need to identify the point of instability in a carpal hyperextension injury?

A

Stressed view

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62
Q

What is the definition of osteochondrosis?

A

A disturbance in the normal process of endochondral ossification

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63
Q

In small animals, how do you differentiate between osteochondrosis and osteochondritis dessicans?

A

With OC, animals will not be lame

With OCD, animals will be lame

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64
Q

What are common sites of osteochondrosis in small animals?

A 
Humeral head
Humeral condyle
Coronoid process
Anconeal process
Femoral condyles
Patella
Trochlear ridges of the talus
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65
Q

In small animals, OCD of what bone will reliably cause lameness?

A

Humeral head

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66
Q

What is the prognosis for return to normal function in small animals that have arthrotomy/arthroscopy for OCD?

A

Excellent

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67
Q

What are the subcategories of elbow dysplasia?

A

Ununited anconeal process

OC/OCD of humeral condyle

Fragmented coronoid process

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68
Q

At what age do clinical signs of elbow dysplasia appear?

A

5-8 months

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69
Q

Mild intermittent lameness, supinated stance, and circumduction of affected limb during the swing phase of stirde are associated with which forelimb disease (small animals)?

A

Elbow dysplasia

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70
Q

What sex and breeds are predisposed to ununited anconeal process?

A

Male:female 2:1

German shepherd and Basset hounds

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71
Q

What radiographic view is best to diagnose ununited anconeal processes?

A

Flexed lateral

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72
Q

At what age can you deem the anconeal process ununited?

A

20 weeks

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73
Q

What is the treatment for an ununited anconeal process?

A

Excision of the anconeal process

Stabilization of the anconeal process (lag screw)

Proximal diaphyseal ulnar osteotomoy

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74
Q

What approach to the elbow do you take in treatment of ununited anconeal process?

A

Caudolateral approach

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75
Q

In small animals, OCD of the humeral condyle mostly affects what part of the condyle?

A

Trochlea (medial portion)

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76
Q

Which dog breed is most affected by OCD of humeral condyle?

A

Labrador Retrievers

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77
Q

What radiographic view is best for diagnosing OCD of the humeral condyle?

A

Craniolateral-caudomedial oblique projection

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78
Q

How can you diagnose fragmented coronoid process from histopathology?

A

Diffuse microcracks in the subchondral bone consistent with fatigue microdamage

Indicates abnormal biomechanics that lead to asymmetric loading of the elbow

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79
Q

What morphological change to the ulnar notch puts pressure on the medial coronoid process?

A

It’s more ovoid

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80
Q

How do you diagnose fragmented coronoid process?

A

Hard to visualize on radiographs

Generally look for secondary degenerative changes in the absence of a UAP or OCD

Usually not present before 7 months of age

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81
Q

What is the treatment for a fragmented coronoid process?

A

Optimal treatment has yet to be defined

Surgery does nothing for development of DJD

Better outcomes with arthroscopy/Arthrotomy

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82
Q

What is the prognosis for elbow dysplasia?

A

Degenerative changes are likely to progress regardless of surgical excision

Most dogs are functional pets but questionable athletes or working dogs

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83
Q

What is panosteitis and how does it present?

A

Intramembranous ossification that spreads linearly along the central medullary artery and vein +/- endosteal/periosteal reaction

Presents as reoccurring shifting lameness, lethargy, anorexia, fever

Idiopathic, self-resolving

84
Q

What is the treatment for panosteitis?

A

Analgesics and anti-inflammatories

Will re-occur every 2-4 weeks

85
Q

What is the definition of hip dysplasia?

A

Abnormal development of the CF joint resulting in subluxation/luxation and/or degenerative joint disease (DJD)

Usually large breed dogs

86
Q

What are the consequences of joint laxity in dogs with hip dysplasia?

A

Capsular thickening

Cartilage fibrillation

Cartilage erosion

Abnormal joint development

87
Q

What is the clinical presentation of hip dysplasia?

A

Young animals: < 12 mo old, pain, laxity, minimal radiographic degeneration

Mature animals: DJD, bony remodeling

88
Q

What key points in the history may suggest a dog has hip dysplasia?

A

Reluctance to exercise

Difficulty rising

Bunny hopping

Clicking

Chronic symmetric hind limb lameness

89
Q

What exam findings will be suggestive of hip dysplasia in a young patient?

A

Lameness

Painful palpation (extension and abduction of hips)

Muscle atrophy

Joint laxity (+ ortolani sign)

90
Q

What exam findings will be suggestive of hip dysplasia in a mature patient?

A

Lameness

Painful palpation (extension and abduction of hips)

Crepitus

Decreased range of motion

91
Q

What is the Ortolani test?

A

Assess joint laxity associated with hip dysplasia

Anesthesia required

Lateral recumbency, stifle flexed 90 degrees, limb perpendicular to spine

Apply axial pressure, abduct limb, feel and listen for a “click” or “thunk” (reduction)

Continue axial pressure, adduct limb, feel for subluxation

92
Q

What are possibilities with a negative Ortolani test?

A

Animal is normal

Capsular fibrosis has eliminated laxity

Irreducible luxation of the femoral head

Acetabular infilling with bone

Insufficient force to subluxate the femoral head

Inadequate muscle relaxation

93
Q

How will radiographs be different for young vs mature dogs with hip dysplasia?

A

Young: coxofemoral subluxation, minimal DJD

Mature: coxofemoral malformation, moderate DJD

94
Q

What is normal % acetabular coverage over the femoral head?

A

> 60%

95
Q

What is OFA?

A

Orthopedic Foundation for Animals

Subjective grading of hip dysplasia by radiologist

Grading scale 1-7

Animals must be 2 years old

96
Q

What is PennHip?

A

Objective measurement of hip laxity

Greater predictive value than OFA

Valid in animals >16 weeks of age

97
Q

What is the Dorsolateral Subluxation Test?

A

Radiographic study to assess hip subluxation

98
Q

What are non-surgical treatment options for hip dysplasia?

A

Weight loss

Anti-inflammatory

Chrondroprotection

Controlled exercise

99
Q

What are the surgical treatment options for juvenile hip dysplasia?

A

Triple pelvic osteotomy (TPO)

Pubic Symphysiodesis

100
Q

What is a Triple Pelvic Osteotomy?

A

Surgical treatment of hip dysplasia

Osteotomy of the ilium, ischium, and pubis

Acetabulum is rotated dorsally and laterally to increase coverage

For animals with little or no DJD and < 10 months of age

101
Q

What is Pubic Symphysiodesis?

A

Cauterization of pubic symphyseal growth plate causing premature closure

Unopposed dorsal growth causes rotation outward acetabular rotation

For dogs < 20 weeks of age

102
Q

What are surgical treatment options for hip dysplasia in a mature patient?

A

Femoral head and neck ostectomy (FHO)

Total hip replacement

103
Q

What is the main difference between the results of FHO and total hip replacement?

A

Total hip replacement results in normal or near normal gait, muscle mass, and range of motion

104
Q

What are the three major stabilizers of the coxofemoral joint?

A

Round ligament

Joint capsule

Dorsal acetabular rim

105
Q

What are the ancillary stabilizers for the coxofemoral joint?

A

Acetabular labrum

Pelvic muscles

106
Q

What is the most common type of hip luxation in dogs and cats?

A

Cranio-drosal

107
Q

What are the goals of hip luxation reduction?

A

Stable, concentric reduction

Preservation of articular cartilage

Long-term normal function

108
Q

When is appropriate to do a closed reduction of a hip luxation?

A

Non-dysplastic hip

Short duration of luxation

No complicating factors

109
Q

What are indications for an open reduction of a luxated hip?

A

Femoral or acetabular fractures

Irreducibility

Instability

Complicating factors

110
Q

What patient factors must you take into account when doing an open reduction of a luxated hip?

A

Body weight

Luxation type

Activity level

Integrity of joint capsule

111
Q

What are indications for a toggle pin in the treatment of hip luxation?

A

Multiple limb injuries

Early use of theleg

112
Q

What are indications for capsulorrhaphy in treatment for hip luxation?

A

Intact joint capsule

Associated to other techniques

(Has highest success rate)

113
Q

What are indications for extra-capsular prothesis in treatment for hip luxation?

A

Non-repairable capsule tears

Persistent instability

114
Q

What are complications associated with De-Vita pins in treatment for hip luxation?

A

Sciatic nerve injury

Pin migration

Pin-tract drainage

Injury to the femoral head

Septic arthritis

115
Q

What are the indications for transarticular pins in treatment of hip luxation and what are the complications associated with them?

A

Indications: recurrent and chronic luxations

Complications: rectal perforation, pin migration, pin breakage

116
Q

What are the primary and secondary restraints of the stifle in small animals?

A

Primary: cranial and caudal cruciate ligaments

Secondary: menisci, collateral ligaments, joint capsule

117
Q

What are the primary functions of the CCL?

A

Primary restraint against:

  1. Cranial tibial translation
  2. Stifle hyperextension

Contributes to control of:

  1. Internal tibial rotation (with caudal cruciate ligament)
118
Q

What are the three CCL rupture syndromes?

A
  1. Acute traumatic CCL rupture
  2. Early degenerative CCL rupture
  3. Chronic degenerative CCL rupture
119
Q

What is early degenerative CCL rupture?

A

Characterized by progressive, mild lameness, effusion, and mild osteoarthritis

No instability

Often bilateral

More common in mature dogs

Progresses to complete rupture

120
Q

What is chronic degenerative CCL rupture?

A

Characterized by intermittent lameness, periarticular fibrosis (medial > lateral)

Instability present

Moderate OA

Often bilateral

121
Q

What is the mechanism behind Chronic degenerative CCL rupture?

A

Degeneration begins within the central core and results in loss of fibroblasts and condroid metaplasia

Unsuccessful remodeling in response to cyclic loading

Progressive transformation in fibrocartilage

No reparatory response

122
Q

What is the incidence of concurrent meniscal injury with CCL rupture?

A

50-90%

123
Q

What structures firmly attach the medial meniscus to the tibia?

A

Cranial menisco-tibial lig

Caudal menisco-tibial lig

Joint capsule

Medial collateral lig

124
Q

What structures loosely attach the lateral meniscus to the tibia and femur?

A

Cranial menisco-tibial lig

Menisco-femoral lig

125
Q

What is the mechanism of meniscal tear?

A

Meniscus is a secondary restraint

CCL rupture

Meniscus becomes primary restraint

Caudal pole is trapped between the femoral and tibial condyles

126
Q

What is responsible for meniscal injury?

A

Wedge phenomenon of the caudal pole of the meniscus

127
Q

What two test can confirm CCL rupture?

A

Tibial drawer and thrust

128
Q

What is the most important exam finding for dogs with CCL injuries?

A

PAIN

Especially on extension of the stifle

129
Q

Will all dogs with CCL injury have a positive tibial drawer or thrust?

A

No, can have a partial tear

130
Q

What radiographic finding is indicative of CCL injury?

A

Joint effusion displacing joint fat pad

131
Q

How do you decide if a patient needs surgical or medical treatment of CCL injury?

A

Small dogs and cats respond well to cage rest and NSAIDs

Large dogs need surgical stabilization

132
Q

What is the goal for standard surgical treatments of CCL injury and what are the different types?

A

Mimic CCL function!

Extra-articular

Intra-articular

Autogenous lig

Prosthetic lig

133
Q

What is the function of tibial osteotomies?

A

Neutralize the cranial tibial thrust

DOES NOT replace the ligament

134
Q

What is a TPLO?

A

Tibial Plateau Leveling Osteotomy

Corrective osteotomy for CCL injury

Circular cut causal to tibial crest

Reduced caudal angulation of plateau

135
Q

What is patellar luxation?

A

Permanent or intermittent displacement of the patella to either side of the stifle

MEDIAL luxation is most common

More common small breed dogs

136
Q

What is the most common type of patellar luxation?

A

Medial

137
Q

What is the etiology for patella luxation?

A

Disruption of normal extensor mechanism alignment causes the patella to be pulled medially or laterally

138
Q

What is the grading system for patellar luxation?

A

Grade 1 (IN/IN): Can be manually luxated but will return to normal position, frequently a nonclinical incidental finding

Grade 2 (IN/OUT): Usually in normal position, but can be luxated and will remain luxated but will spontaneously reduce

Grade 3 (OUT/IN): Luxated most of the time but can be manually reduced. Spontaneously luxates and remains luxated.

Grade IV (OUT/OUT): Luxated and cannot be reduced. Usually associated with conformation abnormalities.

139
Q

What are the clinical signs associated with patellar luxation?

A

Frequently an intermittent non-weight-bearing lameness

Lameness tends to increase with grade

Grade IV luxations may have severe conformational defects

140
Q

What are the two categories of treatment for patella luxation?

A

Reconstructive procedures: alter the anatomic abnormalities

Stabilizing procedures: attempt to maintain the patella in the normal position

141
Q

What reconstructive procedures exist for treatment of patellar luxation?

A

Deepening of the femoral trochlea

Tibial tuberosity transposition

Corrective femoral and tibial osteotomies

142
Q

What stabilizing procedures exist for treatment of patellar luxation?

A

Retinacular/capsular imbrication

Capsulectomy

Fabellar to patella suture

Fabellar tibial anti-rotational suture

143
Q

What is the prognosis for medial patellar luxation?

A

Most improve with surgical treatment

Reoccurrence is usually a lower grade -> reoperate

144
Q

What is osteochondritis dessicans?

A

Defect in endochondral ossification that results in cartilage flap

Seen in immature large breed dogs

Causes synovitis and subsequent osteoarthritis

145
Q

What are the most common sites of osteochondritis dessicans in the hindlimb?

A

(More common in the forelimb)

Stifle: lateral aspect of femoral condyle

Hock: medial trochlear ridge (prognosis of this site is worst!)

146
Q

What is the definition of lameness?

A

An asymmetry of gait due to disorder of appendicular or axial musculoskeletal system

147
Q

Which limb in horses is most commonly affected by lameness?

A

Forelimb (bears 60+% of weight!)

148
Q

What are the most common causes of lameness in horses?

A

Osteoarthritis

Soft tissue injuries

149
Q

How is active lameness in horses graded?

A

AAEP Lameness Score

0/5: Lameness not perceptible under any circumstances

1/5: Lameness is difficult to observe and is not consistently apparent, regardless of circumstances

2/5: Lameness is difficult to observe at a walk or when trotting in a straight line but consistently apparent under circumstances

3/5: Lameness is consistently observable at a trot under all circumstances

4/5: Lameness is obvious at a walk

5/5: Lameness produces minimal weight bearing in motion and/or a complete inability to move

150
Q

What is palmar foot pain?

A

Lameness originating from the podotrochlear apparatus of the forelimb

Caused by abnormal, non-physiological biomechanical loading of structures

**QH 7-10 YO

AKA “Navicular Syndrome”

151
Q

What are the clinical signs of palmar foot pain?

A

Often bilateral lameness, worse on hard ground or when circling

Choppy gait

Tripping

DDFT thickening, DIPJ effusion

Sensitivity to foot testers

“Blocks” to low palmar digital nerve block, DIPJ, or navicular bursa

152
Q

How do you diagnose palmar foot pain and how is it treated?

A

Dx: MRI

Tx: Rest and controlled exercise, Therapeutic shoeing, NSAIDs, IA therapies, Shock wave, Surgical

153
Q

What is the surgical treatment of choice for palmar foot pain?

A

Navicular bursoscopy /- digital flexor tenoscopy

Includes debridement of abnormal cartilage and DDFT tears

Reduction of adhesions (DDFT to NSLand bursa)

Observation of flexor surface of navicular bone

154
Q

What are the surgical treatment options for palmar foot pain?

A

Navicular bursoscopy +/- digital flexor tenoscopy best

Palmar digital neurectomy (salvage)

155
Q

What are the 7 types of third phalanx fractures?

A

1: Wing fracture
2: Articular wing fracture
3: Axial fracture
4: Extensor process fracture
5: Comminuted fracture
6: Solar margin fracture
7: Solar margin fracture in a foal

156
Q

What breed and limb are second phalanx fracture most commonly seen in?

A

Western performance AQH

Hindlimbs

157
Q

What type of surgical fixation exists to treat second phalanx fractures?

A

Plantar/palmar eminence fractures and comminuted fractures: plating/screw repair with PIPJ arthrodesis

Axial (sagittal) fractures: cortical screw in lag fashion

Osteochondral fragments: arthroscopic removal

158
Q

What is the treatment for dorsal osteochondral fragments (“chips”) of the first phalanx?

A

Arthroscopic removal, 6 weeks rest, intra-articular therapies

159
Q

What causes diaphyseal fractures of the first phalanx?

A

Torsional and axial forces

“Screwdriver fractures”

160
Q

What are the treatment options for diaphyseal fractures of the first phalanx?

A 
Box stall rest ~90 days
Internal fixation (cortical bone screw place in lag fashion)
Arthrodesis
Transfixation pin
Euthanasia
161
Q

What is palmar/plantar osteochondral disease “POD”?

A

Due to repetitive stress injury and results in maladaptive bone remodeling, commonly MC/MT III condylar disease

Predisposes to MC/MT III fractures

162
Q

What horses are prone to POD and how do you diagnose it?

A

TB/SB race horses

Diagnose by bone scan, MRI, or CT

163
Q

What is the treatment for POD?

A

REST (90+ days)

Continued training worsens and may lead to catastrophic failure!

164
Q

What parts of the bone are MC/MT III fractures seen in and how are they treated?

A

MC III - lateral condyle

MT III- Medial condyle

Internal fixation: cortical screw in lag fashion +/- plate

165
Q

What condition is known as “bucked shins”, what horses are prone to this, and what does this condition predispose them to?

A

Maladaptive remodeling of the dorsal cortex of mCIII

TB racehorses

Dorsal cortical fractures (commonly incomplete)

166
Q

What is a “saucer” fracture?

A

A complete fracture of the dorsal cortex of mc III

167
Q

What is the treatment for fractures of the dorsal cortex of MC III?

A

Rest (90+ days)

Osteostixis surgery: Place and remove unicortical screw to allow ingrowth of vessels and bone to heal before returning to training

168
Q

T/F: traumatic splint bone fractures are often open

A

True

Usually from a kick from another horse

169
Q

What disease often accompanies exercise-related splint bone fractures?

A

Suspensory desmitis

170
Q

What is the treatment for splint bone fractures?

A

Closed:
Rest
Removal and rehabilitation of SL
Internal fixation

Open:
Partial splint ostectomy
Internal fixation

171
Q

What are the three joint compartments of the equine carpus?

A

Radiocarpal

Middle carpal

Carpometacarpal

172
Q

What are most equine carpal injuries a result of?

A

Repetitive axial loading/maladaptive bone remodeling

173
Q

What is osteochondral fragmentation of the equine carpus and how is it treated?

A

Fragmentation more common along the medial aspect of the carpus, caused by repetitive stress and hyperextension

Causes lameness and synovitis

Should be removed arthroscopically

174
Q

What is biarticular “slab” fractures of the third carpal bone, where is the most common site of fracture, and how is it treated?

A

Fracture of the carpal bone caused by repetitive axial loading and maladaptive bone remodeling

Radial > intermediate facet

Tx: arthroscopic removal or internal fixation

175
Q

What are the 4 joint compartments of the equine tarsus?

A

Tibiotarsal

Proximal intertarsal

Distal intertarsal

tarsometatarsal

176
Q

What is the most common disorder of the tarsus?

A

Osteoarthritis

177
Q

What is “bone spavin” and what is the treatment?

A

Osteoarthritis of the distal intertarsal and tarsometatarsal joints of the tarsus

Tx:

Medical: IA therapies, NSAIDs, chondroprotective agents, corrective shoeing– usually very successful with routine management

Surgical: facilitated ankylosis, cunean tenectomy

178
Q

What is the largest and most complex joint in the horse?

A

Stifle

3 bones, 2 menisci, 14 ligaments

179
Q

What are the three joints of the equine stifle?

A

Femoropatellar

Medial femorotibial

Lateral femorotibial

180
Q

What is upward fixation of the patella?

A

Complication of the stay apparatus in horses

Commonly intermittent

181
Q

What types of horses are prone to upward fixation of the patella?

A

Miniature horses: permanent fixation

Young horses (in growth spurts)

Mature horses that are rested for other resons

182
Q

What are the treatment options for upward fixation of the patella?

A

Nonsurgical:

Treat primary lameness

Corrective shoeing

Treat secondary joint pain

Pelvic limb and quadriceps strengthening

Medial patellar ligament injections

Surgical:

Medial patellar desmoplasty

Medial patellar desmotomy

183
Q

Anesthesia of which nerve can help you localize a proximal suspensory desmitis of the hind limb?

A

Deep branch of the lateral plantar n.

184
Q

What is the treatment (nonsurgical and surgical) for proximal suspensory desmitis?

A

Non-surgical: rest and ice

Surgical: fasciotomy (retinaculum)

185
Q

What are the degenerative orthopedic diseases seen in horses?

A

Osteochondrosis (OCD and subchondral cystic lesions)

Angular limb deformities (juvenile arthirits)

Flexural limb deformities

Physitis

Cervical Stenotic myelopathy

186
Q

What is the most common clinical sign of osteochondrosis in horses?

A

Joint effusion

187
Q

What are the most common sites of osteochondrosis in horses?

A

Tarsus: Distal Intermediate Ridge of Tibia (DIRT OCD)

Stifle: Lateral Trochlear Ridge of Femur (LTFR OCD) and Medial Femoral Condyle (MFC subchondral cyst-like lesion)

Metacarpo/metatarsophalangeal joint: Dorsal aspect of the sagittal ridge

188
Q

What are the most common horse breeds that have osteochondrosis?

A

Thoroughbred
Quarterhorse
Standard bred
Warmbloods

189
Q

What is the treatment of osteochondrosis in horses?

A

Arthroscopy

Rest

Controlled exercise

Drugs (anti-inflammatories, disease modifying agents, regenerative therapies)

190
Q

What is the most common site of a subchondral bone cyst in horses?

A

Medial femoral condyle

191
Q

What radiographic finding is indicative of a subchondral bone cyst?

A

Lucent subchondral bone surrounded by sclerosis

192
Q

What are angular limb deformities in horses? What’s the difference between valgus and varus?

A

Deviation of the limb in the frontal plane

Valgus: lateral deviation of the limb distal to the location of the deformity (away from the center)

Varus: medial deviation of the limb distal to the location of the deformity (towards the center)

193
Q

What perinatal factors contribute to angular limb deformities in horses?

A
  1. Incomplete ossification

2. Periarticular laxity

194
Q

What developmental factors contribute to angular limb deformities in horses?

A
  1. Unbalanced nutrition

2. Excessive exercise or trauma

195
Q

T/F: slight external rotation and milld valgus of the forelimbs is normal in young foals (< 2-3 months)

A

True

196
Q

What treatment options exist for angular limb deformities in horses?

A

Stall rest

Hoof manipulation (trim on same side, hoof extensions on opposite side as deformity points)

Periosteal elevation

Growth retardation with implant

197
Q

In which equine joint deformity is it especially important to identify and treat early?

A

Fetlock (distal MC/MT III)

198
Q

What is juvenile arthritis and in which location is it most common?

A

Sequela to incomplete ossification of cuboidal bones

Most common in tarsus

199
Q

What is the treatment for juvenile arthritis?

A

No treatment, only prevention

Can give intra-articular steroid, fusion

Poor prognosis

200
Q

What is a flexural deformity and which location is it most common in?

A

Deviation of the limb in the sagittal plane

Includes hyperflexion or hyperextension

Carpus/fetlock most common

201
Q

How do you treat congenital contracture deformities in horses?

A

NSAIDs

Oxytetracycline (will inc. tendon laxity)

Bandage + splint + stall rest

202
Q

What is the treatment for hyperextension deformities?

A

Controlled exercise

Heel extensions

Bandaging

Splints/casts

203
Q

What causes acquired flexural deformities and which joints are most commonly affected?

A

Long bone growth&raquo_space; flexor tendon growth

Genetics, nutrition

DIPJ and MCPJ most common

204
Q

What is “club foot”?

A

DIPJ deformity caused by relative shortening of the DDFT

Created upright and boxy hoof

Most common in forelimb

Good prognosis if < 90 degrees

205
Q

What is the treatment (surgical and nonsurgical) for DIPJ deformity?

A

Non-surgical: reduction in calories, NSAIDs, controlled exercise, toe extension, trim heels, dynasplint

Surgical:

Type 1- inferior check lig desmotomy (ICLD)

Type 2- (>90 degrees) - may require ICLD and DDF tenotomy

206
Q

What is MCP/TP joint deformity and what are the treatments?

A

Upright angle or knuckling of fetlock

May be due to relative shortness of SDFT +/- suspensory lig

Worse prognosis than DIPJ

Non-surgical treatment: Same as club foot

Surgical treatment: Superior chec lig desmotomy +/- ICLD, SDF tenotomy

207
Q

What is equine physitis, how do you diagnose it, and what is the treatment?

A

Enlargement of one or more physes causing disruption of normal endochondral ossification

Radiographs: increased paraphyseal bone, physeal lysis/sclerosis

Tx: rest, NSAIDs, diet reduction

Orthopedic Surgery (2 decks)

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