Intro to neonate orthopaedic disease

Question 1

name 6 neonatal orthopaedic diseases

Answer 1

Incomplete ossification of cuboidal bones
Septic arthritis / physitis / osteomyelitis (SAPO)
Physitis
Physeal fracture
Angular Limb deformity
Flexural deformity

Question 2

When is the foetal cartilage ossified?
What foals does incomplete ossification of cuboidal bones affects?
How is it assessed and diagnosed?
How is it treated?

Answer 2

Normally ossify in last 2-3 months of gestation (months 9-11)

• Affects premature / dysmature foals
• Placentitis / colic / abnormal positioning during gestation
• Peri-articular laxity at birth
• Radiograph to assess ossification

Excess exercise may cause damage to soft cartilage
Lead to joint and limb malformations

Treatment:
* Restrict exercise
* Splint limbs if laxity exists
* Wait for bones to ossify (2-3 weeks, repeat radiographs until ossified)

Question 3

name the cuboidal bones of the horse

Answer 3

Carpus – radial, intermediate, ulnar, 2nd, 3rd, 4th
Tarsus – central 2nd, 3rd, 4th

Question 4

What is physitis?

Answer 4

• Inflammation of the physis (growth plate) at the end of a long bone.
• Physis normally very active in young animals - growth

Question 5

Until what time are the following growth phases active until?
Distal metacarpus: ……
Distal radius: ……
Distal tibia: …….
When can physitis occur?

Answer 5

Distal metacarpus: 4 months
Distal radius: 18-20 months
Distal tibia: 18-20 months

Physitis can occur anytime until closure of the grown plates.

Question 6

what are the potential triggers of physitis?

Answer 6

Rapid growth
- specific growth phases / increased feed intake
Trauma to the physis (? type 5 Salter-Harris injury)
- indirectly through exercise
- indirectly through severe contra-lateral limb lameness
(increased weight bearing in non-lame limb)
- directly through external injury
Genetic predisposition

Question 7

what are the clinical signs of physits?
what bones is this common in in foals vs yearlings?

Answer 7

Heat
Swelling
Pain on palpation
Possibly lameness

Distal metacarpus 3-6mo foals
Distal radius yearlings
Commonly bilateral

Question 8

What are you goign to see on radiographs of physitis?
What is the treatment?

Answer 8

Radiographs
Widening - of growth palte - bright white line
Sclerosis
Periosteal new bone with bridging
- Risk of angular limb deformities (ALD)

Treatment:
Exercise restriction
Analgesia
Correction of underlying cause

Question 9

Draw the different types of physeal fractures
What is the name for this classification system?

Answer 9

Salter-harris classification
type 5 - crushing injury
type 4 - minimal affect to the growth plate

Question 10

What is the most common type of physeal fractures in horses?
What is the treatment?
What is the concequence of physeal fractures?

Answer 10

Type II most common
Conservative management - cast coaptation & confinement
Surgical correction – internal fixation
Damage to physis creates risk of growth deformities
- ALD or flexural deformity