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Y4 EQ - Orthopaedics > Foal Orthopaedics > Flashcards

Foal Orthopaedics Flashcards

1
Q

What do the following abbreviations stand for:
DOD
ALD
FLD

A

DOD = Developmental orthopaedics diseases
ALD = angular limb deformity (frontal plane deformity)
FLD = flexural limb deformity (sagittal plane deformity)

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2
Q

What are developmental orthopaedic disease?

A

Group of diseases of the musculoskeletal system that occur during the growth phase or development

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3
Q

An angular limb deformity is a lesion of which plane?

A

A frontal plane deformity!
So will see a lesion medially or laterally

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4
Q

When diagnosing an angular limb deformity what information must be obtained about it?

A
  1. Congenital = born with ALD -> pregnancy problems, premature/dysmature
  2. Acquired = normal at birth; ALD acquired later -> age, duration, uni- or bilateral, nutrition
  3. Which joint?
  4. Which direction?
  5. How much deviation?
  6. Bone or joint centred?
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5
Q

Describe the clinical examination for diagnosis of angular limb deformities

A

The sooner the better!!!
Assessment from distance (standing and dynamic)
- Which joint(s)? Which direction?
- How much deviation?
Palpate and manipulate
- Can you correct the deviation?
- Bone or joint centred?
- Check each single joint separately as multiple can be affected

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6
Q

What are the names given for medial and lateral angular limb deformities?

A

VALGUS – lateral deviation
VARUS –medial deviation

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7
Q

Describe the possible origins of deformity for ALD

A
  1. Bone
    - Physis
    - Epiphysis
    - Cuboidal bones: Carpus, Tarsus
    - Diaphysis (rare)
  2. Soft tissue laxity
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8
Q

How can bone vs soft tissue origin of ALD be confirmed in foals?

A

Neonatal foal
- Can’t straighten limb manually = Bone
- Can straighten limb manually - Dysmature - Peri-articular laxity

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9
Q

Describe radiography of ALD

A

Long cassettes
Centred over deviation site
Views:
- Dorsopalmar (carpus, fetlock)
- Lateromedial (tarsus)

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10
Q

How can the origins of deformity by located on radiography

A

Plumb lines
- Angulation
- Intersection = site of deformity
Are joints and physes parallel?

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11
Q

How should incomplete ossification of carpal bones be managed and monitored?

A
  • High risk of crushing injury to cuboidal bones
  • Restricted exercise
  • Bandage with splint: Light, Digit not within the splint
  • Repeat radiographs every ~2w
  • Balanced nutrition
  • Usually improves unless systemic involvement
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12
Q

How is peri-articular laxity managed?

A

Controlled exercise to strengthen peri-articular soft tissues
Careful with bandaging
Usually resolves unless other systemic problems

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13
Q

List the 3 main causes of acquired ALD

A

Imbalanced nutrition
Genetics (rapid growth)
Trauma

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14
Q

How does imbalanced nutrition lead to acquired ALD

A

Excessive Energy (grain, concentrates)
Mineral imbalance (lack of Cu, excessive Zn)

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15
Q

How does trauma lead to acquired ALD

A

Damage to growth cartilage -> abnormal/asymmetric growth (e.g. Salter Harris fracture)
Overload opposite limb

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16
Q

What does the treatment choice of ALD depend on?

A
  • Aetiology of ALD
  • Age: Remaining growth potential, Before the physis closes
  • Which joint involved?
  • ALD severity
  • Concomitant problems
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17
Q

Describe conservative treatment of ALD

A
  • Limited exercise
  • Bandages, splints
  • Corrective hoof trimming: Medial-lateral foot balance
  • Glue-on shoes
  • Limit mare & foal nutrition
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18
Q

Describe surgical treatment of ALD

A

Growth acceleration
Growth retardation
(Oste-otomy/-ctomy)

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19
Q

How would you hoof balance a foal with Valgus?

A

Lower lateral foot balance
For valgus you want a medial extension to increase the pressure on that side of the leg to try and straighten the leg
The side that you trim and the side you apply the extension are opposite

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20
Q

Describe how and when to hoof balance in ALD cases

A

Every 2-3 weeks
Lightly rasp concave side
Avoid drastic changes&raquo_space; joint problems
Mild cases – as only treatment
Moderate-to-severe cases – combine with surgery

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21
Q

Surgery for ALD is always combined with?

A

Hoof balance, restrict diet, rest

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22
Q

How can you stimulate growth in ALD surgery?

A

On the concave side - Elevate periosteum

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23
Q

How can you prevent growth in ALD surgery?

A

Retard growth (convex side) - Bridge the physis

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24
Q

Where is the surgical site for periosteal elevation?

A

Concave
Just proximal to physis
Elevate periosteum
Does not over-correct

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25
When is ALD prognosis good?
Early treatment Physis or epiphysis
26
When is ALD prognosis fair - poor?
Diaphyseal Crushed cuboidal bones Severe angulation Secondary DJD
27
A flexural limb deformity is a deformity of which plane?
A sagittal plane deformity! Deformed when looking from the side
28
Where is the origin and insertion of the SDFT
Origin - Distal humerus - FL - Proximal radius - HL Insertion: - Accessory ligament - distopalmar radius (AL-SDFT) - Distal PI - Proximal PII
29
What is the function of the SDFT?
Flexion of MCP/MTP joint
30
Where is the origin and insertion of the DDFT
Origin: - Humeral epicondyle - Medial olecranon - Proximal radius Insertion: - Palmar PIII
31
What is the function of the DDFT?
Flexion of DIP joint
32
Describe the main features of digital hyperextension (tendon laxity)
Neonates Relatively common Laxity of flexor tendons
33
How is mild/moderate vs serve digital hyperextension (tendon laxity) managed?
Mild – moderate: - With exercise laxity reduces - Corrects in 1-2 weeks Severe: Protect heel bulbs/palmar fetlocks - Palmar/plantar extensions Bandages: avoid if possible - Light bandages - NO splints…
34
Compare congenital and acquired flexural limb deformities
Congenital = born with FLD Acquired = normal at birth, FLD developed later - Age - Fast growth - Uni- or bilateral - Pain?
35
Describe the aetiology of flexural limb deformities
Lots of suggested aetiologies – little evidence Commonly = intrauterine positioning and genetic predisposition
36
How are flexural limb deformities diagnosed?
Inspection - Lying down and standing Palpation & manipulation: - Can it be straightened? - Palpate each one of flexor tendons to check which one/s most affected
37
Describe conservative treatment of flexural limb deformities
Farriery Physiotherapy Splints Medication
38
Surgical treatment for flexural limb deformities depends on?
Location Response to conservative therapy
39
Why is important that foals with FLD can stand?
Need to be able to nurse
40
How can you force extend joints with FLD?
Splints (cast) BUT Causes pain
41
Describe analgesia for foals with FLD
NSAIDs (risks: GIT ulcers, kidney – GIT protectants, hydration)
42
Describe the use of oxytetracycline in cases of FLD
Oxytetracycline induces a dose-dependent inhibition of collagen gel contraction by equine myofibroblasts AND inhibits tractional structuring of collagen fibrils
43
If using oxytetracycline in foals what MUST be considered?
Hydration as it is nephrotoxic
44
How is farriery used in FLD?
Lower heel Extended toe shoe - Acrylic
45
Describe management of flexural limb deformities of the distal interphalangeal joint
Surgical treatment = Desmotomy of AL-DDFT (distal check ligament) Combine with conservative tx
46
Describe management of flexural limb deformities of the fetlock/carpal joint
Palmar/plantar splint - Mould to limb - Change frequently - Careful pressure sores!! Oxytetracycline ANALGESIA
47
Describe surgical management of flexural limb deformities of the fetlock
Palpate which tendon/s most affected (contracted) when extension is forced: If SDFT >> AL-SDFT desmotomy If DDFT >> AL-DDFT desmotomy +/- AL-SDFT desmotomy Severe cases: Both
48
What is the most commo route of septic synovitis ?
Haemoatogenous
49
What is the most common site of entry for bacteria -> septic synovitis?
Umbilicus
50
Describe the aetiology of septic synovitis in foals
Systemic disease Impaired defences Failure of passive transfer IgG Sub-infective dose of bacteria
51
List the clinical signs of septic synovitis in foals
- May be reluctant to stand - Joint effusion: single or multiple - Peri-articular swelling - Lameness: Often progressively increasing, Not always lame initially - Filling of mare’s udder due to not sucking
52
How is septic synovitis diagnosed?
1. Full history (very important in foals) 2. Complete physical exam: Other joints, Umbilicus (patent urachus, omphalitis…) 3. Radiography - Bone involvement (fracture, osteomyelitis) - Radiographs lag behind pathologic changes in bone 4. Ultrasonography: Umbilicus and affected joint 5. Synoviocentesis
53
Describe the radiographic changes seen which indicate septic physitis
Irregular/widened physis Radiolucency Soft tissue swelling
54
How is a blood culture used to diagnose septic physitis?
Septicaemia Check other physes/synovial structures
55
How is a Synoviocentesis used to diagnose septic synovitis?
Aseptically Away from wound if present Collection tubes: - EDTA – Total & differential nucleated cell count - Plain/with culture media – Culture & sensitivity Total protein: Ideally straight, EDTA can affect reading
56
How will the findings on the fluid from a Synoviocentesis show septic synovitis is present?
Turbid, serosanguineous, reduced viscosity > 20x10^9 nucleated cell/L > 80% neutrophils Total protein >30-35g/L
57
Describe the treatment options for septic synovitis
1. Tx underlying causes - Failure of passive transfer - Umbilical infection 2. Lavage of synovial structure 3. Aggressive antimicrobial therapy 4. NSAIDs - limited and judicious use
58
When is prognosis of septic synovitis fair-good?
Rapid treatment Single joint No bone involvement Systemically well
59
When is prognosis of septic synovitis guarded-grave?
Long time between dx and tx >1 joint involved Bone involvement - epiphyseal or physeal Concurrent systemic illness
60
List the 4 ways of classifying ALD
Congenital or acquired Mild, moderate or severe Bone versus soft tissue Valgus versus varus
61
Compare bone centred and joint centred ALD
Bone centred – disparity in growth rates across physis  Joint centred – dysmature or periarticular laxity 
62
Describe the key points of fetlock ALD
Must act fast – window for treatment is much shorter than other joints - Farriery - Periosteal elevation - Transphyseal bridge

Y4 EQ - Orthopaedics (14 decks)

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