Flexural and Angular Deformities

Question 1

What is an angular deformity?

Answer 1

Postural deformities in the frontal plane of the limbs

Question 2

What are causes of congenital deformities?

Answer 2

Uterine malposition 
Genetics 
Teratogenic agents 
Mare nutrition 
Viral/bacterial infection in mare 
Mare goiter 
Sudan grass ingestion

Question 3

What are the attachments of the inferior check ligaments?

Answer 3

From deep digital flexor tendon to the proximal end of metacarpal

Question 4

What are conservative methods for treating a carpal flexural deformity?

Answer 4

Exercise — stretching of tendons
Shoeing — toe extensions (pushes the fetlock back)
Splints
Oxytetracycline —> binds Ca leading to muscle relaxation
Cast

Question 5

What is another name for contracted tendons causing deformity at the distal interphalangeal joint?

Answer 5

Club-foot

Question 6

Treatment for club foot?

Answer 6

Controlled exercise
Reduce food intake
Trim heel toe extension

Inferior check ligament desmotomy

Question 7

How can you analyze the pivot point ?

Answer 7

Radiograph limb

Cellulose acetate overlay —> trace bone outlines

Bisect the long bone axis
OR
Place lines through joint space

Measure angle

Question 8

What do you call a lateral deviation of the limbs?

Answer 8

Valgus

Question 9

Clinical signs of club-foot?

Answer 9

“Boxy” appearance
Growth at hells
Break in hoof pastern angle
Weight bearing on toe

Question 10

Surgical treatment of a extensor tendon rupture is ______________ and the treatment for club foot is __________

Answer 10

Superior tendon desmotomy; inferior check tendon desmotomy.

Question 11

What do you call a medial deviation of the limbs

Answer 11

Varus

Question 12

How can you diagnose angular limb deformities?

Answer 12

Observation
Limb manipulation
Radiographs

Question 13

How does a flexor tendon rupture appear and what might be another ddx for this?

Answer 13

Flexion at hock —dropped forward

Radial nerve paralysis —> knuckling

Question 14

What surgical method inhibits growth at the physis?

Answer 14

Transphyseal bridging
—screws and cerclage wire
—staples

Question 15

What are causes of articular deviation ?

Answer 15

Periarticular laxity 
Incomplete ossification of carpal bones 
Hypothyroidism 
Limb confirmation 
—overloading 
—Physeal (trauma/infection) 
Twins

Question 16

At what joints are flexural deformities usually located?

Answer 16

Fetlock and carpus

Coffin joint is rare

Question 17

What are clinical signs of digital hyperextending?

Answer 17

Toe elevated from the ground

Skinking fetlock

Question 18

What are the attachments of the superior check ligament?

Answer 18

Attaches from superficial digital flexor to the mid radius

Question 19

What is the surgical procedure for correction of bilateral contracted tendons?

Answer 19

Digital flexor tenotomy

Question 20

What tendons are involved in flexural deformities?

Answer 20

SDF
DDF
Suspensory lig
Joint capsule

Question 21

What are the 3 possible surgical treatments for angular limb deformities?

Answer 21

Hemicircumferential periostal transection and elevation (periosteal stripping)

Growth retardation (temporary transphyseal bridging) 
—screws/wires/staples 

Corrective osteotomy

Question 22

What surgical methods can be used to treat extensor tendon rupture ?

Answer 22

Superior check ligament desmotomy

—> removes stress from SDFT to the muscular portion

Question 23

What surgical method accelerates growth at the physis?

Answer 23

Hemicircumferential periostal transection and elevation (periosteal stripping)

Question 24

What joints can be affected by angular limb deformities?

Answer 24

Carpus
Tarsus
Metacarpophalangeal or metatarsophalangeal

Question 25

What is the prognosis for a digital flexor tenotomy?

Answer 25

Usually good | Full recovery in 2weeks

Question 26

What are conservative treatments for angular limb deformities?

Answer 26

``` Stall rest Hoof trimming External support —splint —cast ```

Question 27

What is a flexural deformity?

Answer 27

Hyperflexion of a limb and results from disparity in length of the musculotendinous unit relative to bone length

Question 28

How does prolonged external coaptation lead to tendon laxity?

Answer 28

Immobilization | Weakening of soft tissue supporting structures —> articular and tendon laxity Rapid in foals

Question 29

What can cause an aquired flexor tendon laxity?

Answer 29

``` OCD Arthritis (septic) Wounds Trauma —> all causing pain ``` Prolonged external coaptation

Question 30

What type of shoe could you use for conservative management of digital hyperextension?

Answer 30

Shoe with extended heel —-> support the back

Question 31

What type of shoes can help fix angular deformities?

Answer 31

Dalmer shoes Contain extensions laterally or medially

Question 32

Common sites for acquired tendon laxity?

Answer 32

Metacarpophalangeal joint (fetlock) Distal interphalangeal joint (coffin)

Question 33

When is corrective osteotomy indicated for angular deformities?

Answer 33

In animals over a year.. no more growth occurring.. Cannot stimulate or decrease growth by other methods

Question 34

What are the locations of “pivot points” in angular deformities?

Answer 34

Growth plate | Joint space

Question 35

What is the cause of club foot?

Answer 35

Fast growing foals Bone grows faster than tendons Pain

Question 36

T/F: flexor tendon rupture looks similar to tendon laxity

Answer 36

True Both have raised toes and dropped hocks