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Musculoskeletal > LA 13: Simple Eq Fractures > Flashcards

LA 13: Simple Eq Fractures Flashcards

1
Q

Common Fx

A

Metacarpal/metatarsal II and IV fx - splint bone fx

Distal phalanx (P3) fractures

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2
Q

Splint Fx - Facts

A

Splint bones = head, body, button
FL>HL
2 Mechanisms - internal, external

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3
Q

Internal Splint Fx

A

“Pressure” DT concurrent suspensory desmitis
–splint bones aren’t very WB but intimately related to suspensory
Possible prox sesamoid damage

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4
Q

External Splint Fx

A

Skin/SQ IFX
Sequestration
Tendon, suspensory damage

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5
Q

Dx Splint Fx

A

Palp, nerve blocks, RADS

Suspensory ligament US

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6
Q

Tx Splint Fx

A

If distal 1/3 to 50% then can surgically remove distal fragment
If proximal 1/3 req internal fixation

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7
Q

Splint Fx: Proximal Fx req Stabilization

A

Absence of IFX - just need plates or screws to stabilize IFX
If have an IFX, need to wait and treat the IFX first

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8
Q

Why don’t screws need to engage both cortices in a splint fx?

A

For most equine long bone fx, DO want to engage both cortices
Splint bone fx provides some support but not a major WB bone –> unicortical provides enough stability

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9
Q

Splint Fx: callus formation

A

Reasonable to give horse a chance to heal on it’s own

  • -need to warn O that callus formation can cause lameness that req surgery later on
  • -ex: can have a fracture that doesn’t start causing lameness until the callus starts to impinge on the suspensory
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10
Q

P3 Fx Dx

A

Hoof testers
Nerve blocks
RADS

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11
Q

P3 Fx Healing - foals vs adults

A

Foals will heal and look radiographically normal

Adults - coffin bones heal with fibrous union, never appear radiographically normal

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12
Q

EXAMwhich P3 fractures are articular?

A 
III - sagittal 
II - articular wing fracture
IV - extensor process fx 
V (maybe) - comminuted 
VII *foals*
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13
Q

P3 fx: I

A

Non-articular wing fx

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14
Q

P3 fx: II

A

Articular wing fx

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15
Q

P3 Fx: III

A

sagittal fx - articular. Fixation improves progressions

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16
Q

P3 fx: IV

A

Extensor process fx
Causes lameness but not severe lameness
Can cause major coffin jt OA

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17
Q

P3 fx V

A

Comminuted fx

Maybe articular

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18
Q

P3 Fx VI

A

Solar margin fx
Not articular
Caused by seedy toe, hx of laminitis
Prognosis for healing good but usually assoc with underlying pathology - complicates things

19
Q

P3 fx 7

A

Foals
Incidental
Can be articular
Don’t usually see lameness

20
Q

P3 Fx Tx - Non-articular

A

Rest
Shoeing
Neurectomy
Good prog if not complicated by other factors

21
Q

P3 Fx Tx - extensor process (IV)

A

Bigger they are, prog goes down
Small-medium fragment can be removed arthroscopically as long as don’t have preexisting coffin jt OA
Fixation rarely needed
Good prognosis

22
Q

P3 Fx Tx - other articular fx

A

Fixation (screw)
Shoeing
Neurectomy (maybe)
Fair to poor prognosis

23
Q

Common Racehorse Fx

A 
Metacarpal/Metatarsal Fx 
--Stress Fx 'Saucer fx' 
--Distal MC3/MT3 'Condylar fx' 
Osteochondral fx 
--carpal 
--prox phalanx P1 
Prox sesamoid bone (PSB) fx
24
Q

Metacarpal Stress Fx

A 
Bucked shin complex - shin splints 
Saucer fx 
Fatigue failure 
--inappropriate training methods 
--microfx
25
Q

Early Phases MC Stress Fx

A

Sensitive palp, heat, swelling, lame
RADS - no fx, sub-periosteal callus, endosteal thickening
Mostly front limb

26
Q

Dorsal MC3 Fx

A

Sensitive to palpation, lame

RADS: dorsolateral cortical fx, endosteal thickening

27
Q

Tx Metacarpal Stress Fx

A

Drilling 5-7 holes around the fx to increase blood supply, osteoblasts, encourage healing, MSC/open bone marrow
NOT A LAG SCREW - just a placement screw
–will undergo some bending
–More effective than osteosticks
Unicortical
Recruit additional healing factor
Not all need to be repaired sx - if very prox or very distal, generally heal well on their own
If in the middle, don’t heal well - best to do sx

28
Q

Distal MC3/MT3

A

Condylar fx
CS - lame by the time off track work/race, effusion, very sore to flexion
Dx - beware of medial fx - can spiral up cannon bone
Lateral condylar fx RARELY spiral
Medial condylar WILL spiral

29
Q

Distal MC3/MT3 Fx - Repair

A

Don’t have to repair if $$$ is an issue
Displaced = more sore than non-displaced
–non-displaced can progress to displaced quickly
Alignment with jt most important!!! - arthroscopy
Be as close to jt surface as possible
Most done under GA but can done standing w/ good sedation and nerve blocks

30
Q

Osteochondral Fx

A

IA fx

  • -recurrent synovitis
  • -osteoarthritis
  • -shortened athletic career
31
Q

Carpal Osteochondral Fragments

A 
Knee chips 
Etiology: trauma = hyperextension of carpus 
--distal radiocarpal bone 
--distal intermediate carpal bone 
--prox third carpal bone
32
Q

Carpal Osteochondral Fragments CS

A 
Effusion/lameness after calling out 
--typically subside within 24-48 hrs 
--both recur with exercise 
RADS
--4-6 views, both carpi --> lat, flex lateral, D-P, DMPLO, DLPMO, skyline of C3 (flexed separates inner carpal and radiocarpal)
33
Q

Carpal Osteochondral Fragments Tx

A

Arthroscopic sx
Fragment removal
Debridement

34
Q

Carpal Osteochondral Fragments Prognosis

A 
If acute (no OA), and less than 30% cartilage loss, then good for race performance 
Prog also depends on how quickly address and whether there's pre-existing dz
35
Q

Slab Fx

A

usually involve middle carpal and CMC

36
Q

Chip Fx

A

Just corners off the cuboidal bones

37
Q

Dorsal, proximal P1 fx

A

Hyperextension fx
RF medial eminence P1
–bilat RADS
Lameness, tx, prog as for carpal OC fragments

38
Q

Proximal Sesamoid Bone Fx

A

6 basic types

  • -prog decreases as fx becomes more distal (or axial)
  • -Assess concurrent suspensory desmitis
39
Q

PSB CS

A

Jt effusion
Heat on palp
Lameness

40
Q

PSB Tx

A

Arthroscopic removal
Repair: lag screw fixation > circumferential wiring
Nothing: retire
Prog varies by location –> worse prox to distal

41
Q

Which PSB fx have a good prog?

A

Apical

Abaxial

42
Q

Which PSB have a poor prog?

A

Axial
Comminuted
Esp poor prog if combined with condylar fx

43
Q

Medial and lateral (biaxial) PSB fx

A

Biaxial fx lead to loss of suspensory apparatus

Musculoskeletal (10 decks)

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