Fubini 15 - Cow MSK part I low limb Flashcards
how do you perform anesthesia to the foot?
1) Bier block (IV regional anesthesia with butterfly) with tourniquet in the proximal are to the surgical incision and up 30 mL in one of the veins
▪ Dorsal MTC vein ▪ Dorsal digital vein ▪ Palmar digital vein ▪ Lateral saphenous vein
2) Interdigital surgery
injecting 5 to 10 mL of 2% lidocaine deeply (5 cm) approximately 2 to 3 cm proximal to the interdigital space to desensitize the branches of the medial dorsal and palmar (plantar) axial digital nerves
3) Four point digital block
What is depicted in Figure 15?
A sole ulcer of the left hind lateral digit after debridement.
What condition is shown in the adult Angus cow?
The cow is crossing her front limbs, favoring weight bearing on the lateral claws and relieving the medial claws. She had bilateral white line infection of the medial claws.
What condition is shown in the Holstein heifer?
The heifer has peroneal nerve damage in the right hind limb. Note that knuckling of the fetlocks should alert the examiner of more proximal nerve involvement, such as sciatic nerve injury.
What deformity is depicted in the heifer?
Secondary varus deformity of the left hind limb from chronic lameness in the contralateral limb (i.e., peroneal nerve injury). Note that this is the same heifer as in the previous flashcard.
What condition is shown in the adult Holstein cow?
The cow has a dropped elbow and flexed carpus. She was diagnosed with a torn triceps.
What tx described in the vertical crack?
A vertical crack in the dorsal wall filled up with polymethylmethacrylate and tightened with wires.
What differential diagnoses should be considered for non-weight bearing lameness in cattle?
Sole abscess,
fracture,
joint luxation,
weight-bearing ligament or tendon injury,
nerve injury,
septic arthritis,
and septic tenosynovitis.
What treatment is mentioned for toe tip necrosis?
Toe tip necrosis treatment. After removal of theaffected tip of the hoof, a burr is used to remove the infecteddistal part of the third phalanx (i.e., pedal bone)
What is the typical case of toe tip necrosis, and how is it treated?
Bruising of the corium near the toe tip; amputation of the toe or apex amputated with hoof nippers.
- hoof block on healthy digit
- bandage.
How is a vertical crack in the hoof wall treated?
Corrective trimming.
Diagnsosi and responsible agent?
Interdigital hyperplasia lesion with a verticalcrack on the lateral digit.Bacteriodes nodosus
what is tx of interdigital hyperplasia?
REgional IV anesthesia en bloc resection with Allis tissue forceps to hold the interdigital corn. Wegde shape incision removes the mass
What does the digital radiograph of a digit reveal? treatment?
Lateroproximal-mediodistal obliqueradiographicview of the distalinterphalangeal jointin the bull, showinga chip fragment(arrow) of theextensor process ofthe distal phalanx.(b) Ultrasonogramand schematicrepresentation of thedorsal aspect of thedistal interphalangealjoint of the bull. Abony fragment ispresent as an echoicstructure (1) justcranial to the secondphalanx (2) abovethe coronet (3). 4First phalanx, 5 Thirdphalanx, Ds Dorsal,Pl Palmar(a)DS PlPl1234Ds41325(b)FIG 3: Holstein cow (case 2) with an extensor process fractureof the outer distal phalanx of the left forelimb, showing a gaitcharacterised by placing more weight on the heel during thesupporting phase
Applying a wooden block to a sound claw for three weeks was curative and provided a good prognosis in both cases.
In which cases do you do digit amputation?
To treat:
1. pedal osteitis
2. luxation
3. fracture of the distal phalanx
4. deep sepsis of the digit
5. septic arthritis of the DIP or PIP joint.
Figure 15-21 A, 60-degree dorsoplantar radiographs of a
2-year-old steer with septic osteitis of the lateral claw. B,
Lateral scissor view of the same hoof. Note that bone lysis is
moderate to severe at the distal aspect of the distal phalanx
What is the treatment for fracture of the distal phalanx?
Wooden block on healthy digit. Affected digit is wired in slight flexion to the wooden block to prevent separation of the palmar or plantar fragment from the parent bone caused by the tension of DDFT. Leave the wooden block in place for 6 to 8 weeks with an animal in a small stall.
What are other recommended treatments for a sole ulcer or abscess in cattle?
Rest and isolation; Wooden block.
What is the view?
Plantarodistal and abaxioaxial radiographic views of the lateral claw. The tip of the peal bone is atrophic (arrows) but not osteolytic therefore resection of the tip of the pedal bone was NOT INDICATED
What is the treatment in case of septic osteitis?
Curettage of the digit and lavage with bandage and wooden block on the healthy digit
Digit amputation
What does the radiograph of the digital hind limb show?
Dorsoplantar view of distal hindlimb with Septic arthritis It shows subchondral bone lysis, widening of the digital interphalangeal joint, and new bone formation.
What is the treatment for septic arthritis?
AB for 2 to 3 weeks penicillin
IA AB do not use gent
RLP with cephalosporin
Sodium iodide 20% IV occasionally
NSAIDs meloxicam or ketoprofen
Joint lavage with:
- TIDAL
- THROUGH AND THROUGH LAVAGE
- ARTHROSCOPY/ARTHROTOMY.
What is the primary cause of septic arthritis in adult cattle, and what is a common example of a secondary cause?
Primary cause: direct trauma to the joint; Secondary cause: foot lesion (abscess/ulcer).
What are the 2 surgeries for treatment of the DIP joint sepsis?
The two surgical options are :
- digit amputation
- facilitated ankylosis of the joint (solar and dorsal approach)
What are the clinical signs of DIP septic arthritis?
chronic lameness
Coronary band very swollen
CAUSE: Sole disease, Pododermatitis, Penetrating FB that penetrates distal sesamoid bone, bursa, DDF muscle, DDF
What was applied to minimize weight bearing on the infected digit?
An orthopedic block was applied to the contralateral claw.
Describe digit amputation
IV anesthesia , interdigital skin incised in 45 degree angle.
Advantages and disadvantages of digit amputation?
+ rapid and inexpensive, return to production
- production life is decreased, heavy animal do poorly (>680kg)
Describe the solar approach.
- Sedation and IV regional anesthesia (dorsal metatarsal/metacarpal vein).
- Foot trimming chute on L/R.
- Horizontal incision plantar and 2 cm proximal to coronary band.
- DDFT cut at its insertion with P3 and resected proximal at about 5-7 cm.
- Distal sesamoid bone removed exposing DIP joint.
- 2 collateral ligaments + distal ligaments transected.
- Debridement of joint from solar wound to dorsal hoof wall 1 cm distal to the coronary band with 1.3 cm drill bit.
- Joint curetted and lavage.
- Wooden block on healthy digit and wiring of the 2 claws with affected digit in slight flexion.
- Bandage and lavage.
agents involved in septic arthritis of DIP joint?
Truperella pyogenes
E coli
Staphylococcus sp
Name the techniques for arthrodesis of DIP joint.
- solar approach
- dorsal approach
- modified abaxial approach.
what was performed here?
Figure 15-26 Digit amputation, a few days after the surgery
was performed.
In arthrodesis using the Dorsal Approach, what is the indication for this technique?
When the distal sesamoid bone and the tendinous portion of the DDF tendon ARE NOT affected.
what is the approach for solar arthrodesis?
Foot trimming chute restrained - leg uppermost
Plantar or palmar portion of the sole can be indented easily
Severe extensive infection of the DIP originates from solar the distal sesa and joint can be felt through the wound
Horizontal incision 2 cm proximal to the coronary band along plantar surface
Debridement with 1.3 mm drill bit copious lavage
Wooden block on healthy digiti
Good long term prognosis
Why is it important to preserve intact ligaments and tendons during the arthrodesis procedure?
To keep the affected digit stable during the ankylosis procedure.
what is the approach for dorsal arthrodesis?
Sedate LR IV regional anesthesia
2 arthrotomies with trephine 14 mm in diameter with circular incision with blade
First arthrotomy 0.5 cm proximal to the coronary band abaxial or axial to the CDE or LDE
Second arthrotomy is performed 0.5 cm proximal to coronary band caudal to ABAXIAL ligament of the DIP joint -curttage lavage
wooden block in healthy digit
Indicated when DDFTendon and distal sesamoid not affected
How do you perform a lavage of acute septic arthritis of DIP joint?
A 14-gauge 5 cm needle is inserted proximal to the coronary band, axial or abaxial to the tendinous portion of the extensor muscle and at a 60-degree angle to the coronary band. The joint is distended with 10 mL of NaCl.
Do the SDFT and DDFT communicate?
Each branch of the SDFT and DDFT has its own sheath, and they rarely communicate
What is the treatment of sepsis of the common digital flexor sheath?
Tenosynovioscopic lavage
Tenosynoviotomy with resection of affected tendon tissue + drain
What are the microorganisms of septic arthritis?
Trueperella pyogenes, E. coli, Histophilus somnus, Mycoplasma
How is the second needle placed for the DIP joint?
Palmar or plantar to the axial collateral ligament of DIP joint above coronary band at a 45 degree angle.
What is the incision level for treating septic arthritis of the DIP joint?
Incision to the level of the distal aspect of the proximal phalanx at interdigitial skin with 45° angle to proximal digital abaxially.
What is the preferred antibiotic for T. pyogenes in septic arthritis?
Penicillin is first choice due to T. pyogenes being the most common isolate
What is the treatment protocol for joint lavage?
3 days of lavage + AB + NSAID.
What is the recommended duration for continuing antimicrobial treatment in cattle with septic arthritis?
2 to 3 weeks after clinical improvement.
What factors in synovial fluid analysis suggest septic arthritis in cattle?
Nuclear cell counts greater than 25,000/µL, polymorphonuclear cell counts greater than 20,000/µL, and total protein greater than 4.5 g/dL.
What factors influence the prognosis of septic arthritis in cattle?
Time of presentation, amount of bone lysis and proliferation, and the degree of extracapsular ankylosis.
How do you perform diagnosis of spastic paresis of quadriceps?
By US guided femoral nerve block.
What is she doing?
Drawer test - Examiner stands immediately behind the affected leg and places both hands on the tibial crest by encircling the limbs.
Positive if displacement or crepitation can be felt after firm caudal traction on the tibial crest followed by a sudden release.
What is a potential alternative technique for diagnosing CCL rupture in cattle?
Standing cranial and lateral to the affected limb, applying a firm, rapid thrust to the proximal tibia, and observing for displacement and crepitus.
diagnosis?
The right tibia is displaced cranially as evidenced by the cranial position of the intercondylar eminence relative to the middle third of the femoral condyle.
Extensive irregular new bone formation associated with the
intercondylar eminence and tibial plateau is present.
What is the treatment for cranial cruciate ligament injury?
Stifle joint imbrication + CCL replacement with gluetobiceps tendon
Stifle joint imbrication and synthetic nylon cable placement (Hamilton)
Describe stifle joint imbrication
S-shaped incision 5cm proximal from the patella and 5cm distal to the tibial crest
Removal of synovial fluid
Limb in full extension a first row of imbricating sutures at the level of the lateral and medial femoropatellar ligament followed by a 2nd and 3rd if possible.
Antirotating suture – can encroach the common peroneal nerve
Describe the replacement of CCL gluteobiceps tendon + lateral patellar ligament
Incision from the major trochanter to the later aspect of the patella and curved back to the lateral distal patellar ligament and extended to the tibial crest
Full thickness 2cm strip of gluteobiceps muscle and the plantar part of the lateral patellar ligament
Arthrotomy between the lateral and middle patellar ligaments
Passage of a curved graft passer followed by CMC lubricated gauze while the limb is in flexion, back and forward motions prepares the way for the graft.
Entering of the graft in 100 degree flexion and exit in extension.
Stifle placed in 140 degree flexion and the tibia slightly rotated and the graft is stapled or attached with a 3 hole narrow dynamic compression plate to the epicondyle under tension.
what should be done before imbrication?
collection of synovial fluid
How do you close incision after gluteobiceps as replacement of CCL?
Multilayer closure - gluteobiceps + vastus lateralis closed with USP 2 Polyglactin 910
simple continuous
Joint capsule in simple cruciate pattern
Transected femoropateallar ligament with 3 interrupted horizontal matterss USP 3 910
Superficial fascia polyglactin 910 continuous pattern
Skin simple interrupeted USP 2 and FORD INTERLOCKING in the proximal third
Stent bandage for 7 days
AB AINS
How is the synthetic cranial cruciate ligament placed?
40 cm Incision of the lateral femoropatellar joint and medial luxation of the patella
3 bone tunnels with a 6.2mm drill bit
1. Just proximal to the lateral femoral condyle and aims towards the intercondylar space
2. Medial aspect of the tibial crest exciting at the insertion site of the CCL
3. Medial tibial crest to lateral
Nylon cable
Secured to the lateral epicondyle with a 5-hole plate
Closure + lateral imbrication
what are the complications of the surgeries for CCL?
43% success
Heavy bulls catastrophic
Complications: incisional dehiscence, septic arthritis, catastrophic graft failure
diagnosis?
Craniocaudal radiographic view of a 10 year old Holstein with an injury to the lateral collateral ligament
Note the mineralization at the proximal aspect of the lateral collateral ligament
US IS ALSO KEY FOR DIAGNOSIS
Medial collateral ligament injury occurs with which other pathology?
In conjuction with CCL injury and medial meniscus injury
What is the treatment options for medial collateral injury?
6 to 8 weeks of rest can heal ruptured collateral ligamnets. If the injury is not associate diwth CCL
Surgical - meniscopexy
Describe the surgical treatment for medial collateral ligament injury - meniscopexy
Surgical procedure
DR and limb in 90 degree flexion
Horizonal skin incision centered on the MCL.
3-4 non-absorbable sutures (Nº 5 polyester) used to secure the meniscus to the medial joint capsule just proximal to the tibia
Stabilization of the MCL
Option 1: 5.5 cortical screw placed on the insertion sited on the femur and tibia and 2-3 sutures are placed in a figure of 8 pattern between the 2 screws
Option 2: Imbrication of the medial periarticular tissues by placing 4-6 lambert sutures. (no5 polyester)
Stall confinement for 2-3 months
why MCL is injured easier?
the MCL is attached to the medial meniscus and joint instability due to CCL injury can predispose
Lateral collateral FT ligament injury is rare
What are the advantages of ankylosis of the DIP joint over digit amputation in cattle?
Surgical procedure
DR and limb in 90 degree flexion
Horizonal skin incision centered on the MCL.
3-4 non-absorbable sutures (Nº 5 polyester) used to secure the meniscus to the medial joint capsule just proximal to the tibia
Stabilization of the MCL
Option 1: 5.5 cortical screw placed on the insertion sited on the femur and tibia and 2-3 sutures are placed in a figure of 8 pattern between the 2 screws
Option 2: Imbrication of the medial periarticular tissues by placing 4-6 lambert sutures. (no5 polyester)
Stall confinement for 2-3 months
What injury is?
A ruptured gastrocnemius tendon in the left hind limb.
treatment for this?
Treatment in young cattle only
Robert jones or transfixation casting
if the cow is unable to stand and is plantigrade for gastrocnemius rupture?
If in plantigrade and unable to stand
Euthanasia
Notice that the stifle is extended and hock is flexed!!
What is going on?
Transfixation cast applied in a calf with gastrocnemius rupture
diagnosis
US of healthy SL branch on A and rupture in B
What is the treatment?
8-15 months of age
Closed rupture of the suspensory ligament
Treatment by short fiberglass cast for 3 months
and box rest for 6 months
diagnosis? what would be the radiographic result?
Suspensory ligament rutpure
Sinking of sesamoid bones
hyperflexion of fetlock
hyperextension of PIP joint
What is the posture of a cow with laminitis?
Standing with the back arched and the feet placed under the body, reluctance to walk.
Which organisms originate septic arhtritis in calf?
Contagious diseases like Histophilus somni or Mycoplasma bovis.
