Fubini 18 - Calf MSK Flashcards
What is polydactyly a mutation in which genes?
EVC and EVC2
What is the treatment for polydactyly?
Removal of skeleton including flexor tendons.
Under GA Abnormal digit uppermost
Are flexural and hyperflexion deformities congenital or acquired?
Both
when do you do medical tx of the flexural deformity?
Medical treatment when the limb can be manually straightened
Bilateral
What is the treatment of hyperextension?
Exercise if mild
Correction shoeing if severe
What is the prognosis for hyperextension?
Favorable for congenital
Less favorable for extreme cases pf arthrodesis
Are flexural deformities common joints? Uni or Bilat?
Fetlock and carpus, bilateral
What is the conservative management of flexural deformities?
Controlled exercise
Medical treatment when the limb can be manually straightened
* Splint on the palmar aspect of the limb starting at the heel leaving the claws out
* Changed every 2-3 days or a cast changed every 2-3 weeks
* Tetracycline should be avoided in calves
Bandage or cast with changes 2/3 days or 2-3 weeks respectively
What is the dose of oxytetracycline? Contraindication?
3 gr iv
Neprotoxic in calves
Surgical correction of metacarpal flexural deformities? Which tendons and insertions?
Sequential transection of the SDFT, DDFT and the suspensory until the deformity is released
* Each branch of SDFT receives a branch of suspensory ligament. These are resected first. If not sufficient the DDFT is resected and if that is not enough then the main suspensory ligament is resected.
* If the DDFT is resected a splint must be placed for 30 days, if the suspensory is resected the splint must go up to the radius
SDF muscle is attached to the med epicondyle of humerus: Deep tendon in carpal canal, Superficial tendon outside carpal canal and they fuse in MIDCANON BONE. DDF muscle ingo carpal canal dorsal to SDF. SL proximal metacarpal bone and sending a band that joins SDFT.
Surgical tx of carpus flexural deformity?
Transection of flexor carpuolnaris and ulnaris lateralis
Lateral incision from the ACB and proximally, identification and resection of the FCU and UL
* Splint placed on the palmar aspect of the knee until full correction is achieved.
Carpuolnaris is in the medial epicondyle of humerus to ACB. Ulnaris lateralis is in the lat epicondyle to ACB.
Describe transection of ulnaris lateralis and flexor carpi ulnaris
Lateral incision from the ACB and proximally, identification and resection of the FCU and UL
* Splint placed on the palmar aspect of the knee until full correction is achieved.
What should be done if there is not enough transection of DDF?
Splint 30 degrees
What should be done if there is not enough transection of SL?
Placement of palmar splint on carpus
What is the objective of surgical correction in flexural deformity of MCP?
To ensure the hoof contacts ground without fetlock knuckling
What is the difference between angular and rotational limb deformities?
Angular is a deviation of lower limb in lateral medial axis; rotational is the long axial bone aligned but hoof pointing external.
Is carpal valgus at 7 days of age normal in calf?
Yes
What is the medical treatment of angular deformities?
Trimming in the same side of deformity +/- acrylic
What are the surgical treatments for angular deformities?
- Transphyseal screws
- Closing wedge osteotomy
- Step-wise osteotomy
- Cylindrical (dome) osteotomy
Describe the surgical steps of screw insertion.
2-3 cm above growth plate in convex side of bone except for tarsus where screw in distal to proximal direction.
Describe the surgical technique of closing wedge.
GA, LR, limb uppermost; dorsolateral or dorsomedial skin incision.
What is the prognosis for angular deformities?
Good if there is growth plate imbalance. Fair if osteotomy is performed. Poor if associated with orthopedic disease.
What are the causes of septic joints in calves?
Umbilicus, pneumonia, diarrhea, septicemia, passive immune failure if serum TP < 55 g/L.
What are the microogranisms that causes of septic arthritis?
Mycoplasma bovis and histophilus somnus.
How to diagnose septic arthritis of calves?
TP < 55 g/L, blood culture in febrile calf for M. bovis, arthrocentesis with macroscopic and cellular analysis, radiographs.
What is the treatment for septic arthritis if less than 5 days?
Removal of infected umbilicus +/- marsupulization
* ABX for 2-3 weeks after clinical improvement
* RLP, join lavage and systemic abx.
* If not better after 2-4 days -> arthrotomy and if not
better -> arthrodesis
What is the treatment for septic arthritis if more than 5 days?
IA and IVRLP administration.
What procedures are indicated for septic arthritis?
Needle lavage, arthroscopy, arthrotomy if fibrin, arthrodesis in refractory cases.
Describe the surgical steps for carpal arthrodesis.
GA, DR, limb in extension, transverse skin incision over the joint, infected tissue is curetted and removed, entire row of carpal bone is removed. Do NOT disrupt palmar ligaments, excessive skin is trimmed, full limb cast or TFC at least 3 months.
Describe the surgical steps for tarsus arthrodesis.
GA, DR, vertical incision over most distended DM pouch of TC until joint is reached, caudolateral lateral skin incision between lat malleolus and tuber calcanei. Similar final arthrotomy is made on caudal to the medial malleolus. Care for the tarsal sheath DO NOT ENTER INADVERTLY IN TARSAL SHEATH.
What is the incision technique for distal intertarsal joints?
Vertical incision over craniomedial side centered target joint.
What is the ID joint curettage technique?
3.2 mm drill bit is placed parallel to joint surface.
How is the skin closed in ID joint curettage?
Skin is closed with simple interrupted sutures.
What is the post-operative care for both cases?
Full leg cast in both cases for 12 weeks with regular cast changes.
What medications are essential for pain management and inflammatory response?
AINs essential for pain management and IA inflammatory response: flunixin 1-2 mg/kg, aspirin 100 mg/kg bid po, ketoprofen 3 mg/kg sid im, and meloxicam 0.5 mg/kg every 48 h.
What is the dosage of sid and meloxicam?
3 mg/kg sid and meloxicam 0.5 mg/kg every 48 h
What is the prognosis if rapid intervention occurs?
Prognosis is good if rapid intervention and poor when?
When is the prognosis poor?
If > 2 joints affected
What is the percentage of full WB after chronic septic joint?
69% full WB after chronic septic joint
What are the types of patellar luxation?
Patellar luxation is congenital (LATERAL) or traumatic (MEDIAL or LATERAL)
+++ congenital
How are the grades of patellar luxation classified?
Grade I: intermittent luxation and in extension patella luxate manually easily but return in trochlea when released
Grade II: Occasional patella luxation, patella easily luxated at full extension but not return to normal position
* Grade III – Permanent luxation, can be repositioned
* Grade IV - Permanent luxation, repositioning is not possible
What is the conservative management for femoral paralysis?
Rest and AINS meloxicam 0.5 mg/kg every 48 h and normal return is expected in 30 d
Which grades patellar luxation require surgical treatment?
Grades 3 and 4
What can result from femoral nerve damage and trauma?
Femoral nerve damage and trauma can result in quadriceps unit dysfunction as patellar luxation.
What is the timing of surgery?
Early in life in the first 3 months when ossification of patella, femoral trochlea and trochlear groove occurs if not calf will have OA and progression to grade IV
Avoid in newborn and wait few weeks to prevent neonatal infection
Describe name of surgical treatment of patellar luxation
Surgical techniques
Lateral release and medial imbrication
* Transection of the tendon of the gluteobiceps and lateral femoropatellar ligament
* Imbrication of the medial aspect at the level of the medial patellar ligament
* Trocheoplasty if the trochlear groove is not normal
* Watch out for trochlear fractures – maintain 75% of the trochlea
* Luxation of the patella medially
* Wedge resection
* Rectangular trocheoplasty
* In grade IV tibial crest positioning might be necessary
What are the surgical steps of lateral release, medial imbrication and trochleoplasty?
LR limb uppermost abducted give AB
S shape incision 5cm proximal to patella
5 cm distal to
Tibial crest curving first medially
Transection of gluteobiceps on patella (lat release)
What is the medial imbrication technique?
Medial imbrication involves the first and second row of lembert pattern over medial patellar ligament from patella to tibial crest with limb full extension.
What is trochleoplasty?
Trochleoplasty is an incision of the femopatellar joint capsule between medial and lateral patellar ligaments from the patella to the tibial crest.
What are the types of trochleoplasty?
Types include wedge, rectangular, and curettage of trochlear groove.
What does the wedge technique create?
Wedge creates a triangle fragment in the femoropatellar groove.
What is the rectangular technique in trochleoplasty?
Rectangular creates a 90-degree angle, 2 parallel and abaxial to trochlear groove incision, keeping 75% of medial and lateral trochlear groove width.
What happens to the rectangular segment of bone?
Rectangular segment of bone is removed.
What is the curettage technique in trochleoplasty?
Curettage with burr or curette deepens the floor and replaces back the rectangular segment of bone.
What is the prognosis for unilateral spastic paresis?
Prognosis is fair to good.
What is spastic paresis?
Spastic paresis is a progressive neuromuscular disease with spastic contraction of gastrocnemius muscles.
What are the clinical signs of spastic paresis?
Signs include hocck and stifle hyperextended, unilateral or bilateral, manifesting first time under 6 months.
What is the main difference with fixation of patella?
No resistance to passive flexion of the limb.
What are surgical treatments for spastic paresis?
Partial tibial neurectomy
Tenectomy of 2 insertions of grastrocnemius
What are the surgical steps for partial tibial neurectomy?
Incision along the fibers of the gluteobiceps from the caudal aspect of the greater trochanter to the
tibial crest
* Branches of the tibial nerves that are going to the lateral and medial bellies of the gastrocnemius are
identified with a nerve locator and a 2cm section is removed and ligated with a non-absorbable suture
What is the prognosis for neuroectomy of tibial nerve?
80% improvement.
What are the surgical steps of tenectomy?
Incision along the fibers of the gluteobiceps from the caudal aspect of the greater trochanter to the
tibial crest
* Branches of the tibial nerves that are going to the lateral and medial bellies of the gastrocnemius are
identified with a nerve locator and a 2cm section is removed and ligated with a non-absorbable suture
What are the grades of patellar luxation?
Grade I: Intermittent luxation and in extension patella luxates manually easily but returns in trochlea when released. Grade II: Occasional patella luxation, patella easily luxated at full extension but not return to normal position. Grade III: Permanent luxation, could be replaced at full extension but luxate in flexion. Grade IV: Permanent luxation reposition impossible.
What is the difference between femoral nerve trauma and patellar luxation?
Femoral nerve trauma is usually bilateral due to difficult birth. Test with hemistate the skin area in the medial distal femur the calf does not feel when nerve is affected
What is the common feature of congenital patellar luxation and femoral nerve damage?
Both do not cause pain.
