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Orthopaedic disease Flashcards

1
Q

what is physitis
and where does it commonly occur

A

inflammation of the physis (growth plate) at the end of long bones

often around carpus and fetlock (pain, heat, lameness)

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2
Q

when do the growth phases end for
- distal metacaprus
- distal radius
- distal tibia

A
  • distal metacaprus = 4 months
  • distal radius = 18-20 months
  • distal tibia = 18-20 months

limited time to fix angular limb deformities

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3
Q

causes of physitis (4)

A

sudden increase in feed intake (or energy)
abrupt increase in exercise
direct trauma to the physics
yearling physitis

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4
Q

dx and tx of physitis

A

Radiographs

Tx: Exercise restriction
Pain relief
correct underlying cause (like angular limb deformities)

Potential sepsis!!

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5
Q

what are the salter Harris grades for articular fractures

A
  • S = straight across growth plate
  • A = above and comes down into growth plate. Most common
  • L = lower and comes up into growth plate
  • TE = Through everything (inc epiphysis)
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6
Q

what foals are at risk of incomplete ossification

A

dysmature or preamture foals

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7
Q

what bones do you see incomplete ossification in

A

carpus and tarsus

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8
Q

what are the two main angular limb deformaties

A

Varus = ()
Valgus = )(
can have both )) = windswept foal

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9
Q

causes of angular limb deformities

A
  • incomplete ossification (dysmature or premature foal, placentitis, colic during gestation, or heavy parasite burden, abnormal uterine positioning),
  • or peri-articular laxity

Can also be acquired

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10
Q

4 steps to evaluate angular limb deformities

A

Static examination:
- Stand perpendicular to the frontal plane of the limb

Manipulate:
- for peri-articular laxity

Dynamic:
- Assess how foal uses limb

radiograph
- Both limbs, orthogonal views
- DP view and LM
- Need long plates to include middle radius and middle metacarpus

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11
Q

conservative tx for angular limb deformities

A

If entire limb facing one way:
- Box rest and controlled exercise (hand walking)
- Box rest only if incomplete ossification
- Can trim feet (Carpal valgus = trim lateral hoof
Fetlock varus = trim medial hoof wall)
- Glue on shoes (Carpal valgus = medial shoe, fetlock varus = lateral shoe)

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12
Q

what joints do you usually see congenital hyper-extension in

A

fetlock and PIP, DIP joints

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13
Q

signs of congenital hyperextension

A

Toe elevated
fetlock sunken

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14
Q

signs of congenital hyperflexion

A
  • May prevent foal from standing
  • Occurs at DIP, PIP, fetlock, carpal or tarsal joints.
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15
Q

unique treatment for congenital hyperflexion

A
  • Oxytet (3g) in 500ml saline slow IV within a few days of birth.
    → inhibits tractional structuring of collagen fibrils → tendons & ligaments more susceptible to elongation during normal weight bearing.
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16
Q

what drug should be given alongside NSAIDs in neonates

A

Omeprazole as a gastroprotectant

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17
Q

extensions for congenital hyper flexion Vs extension

A

Flexion = toe extensions and heel reduction
Extension = heel extensions

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18
Q

two forms of acquired hyperflexion

A

coffin (DDFT) and fetlock (DDFT, SDFT or suspensory)

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19
Q

age and stage of coffin joint contracture

A
  • 1-4 months old
  • Metacarpal / tarsal bones growing rapidly = Functional shortening of DDFT
  • Stage 1: dorsal hoof wall is not past vertical - good prognosis
  • Stage 2: dorsal hoof wall is past vertical – guarded prognosis
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20
Q

age and stage of fetlock joint contracture

A
  • 10-18 months old
  • Radius / tibia growing rapidly = Functional shortening of SDFT and suspensory ligament.
  • Stage 1: Fetlock is behind vertical
  • Stage 2: Fetlock in front of vertical, but can move behind vertical during weight bearing.
  • Stage 3: Fetlock in front of vertical always.
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21
Q

general treatment principles for acquired hyper-flexion (Surgical and medical)

A

Medical management:
- Toe extension (and heel reduction to stretch DDFT in coffin)
- NSAIDs (and omeprazole).
- Reduce growth rate by reducing nutrition
- Suitable for stage 1 only

surgery:
- in combo with medical
- desmotomy
= coffin = ddft
= fetlock = identify under GA culprit and snip

22
Q

signs of juvenile osteochondritis

A

often not lame
varying degrees of joint effusion

23
Q

causes of JOCC

A

Multifactorial
Focal failure of endochondral ossification (Epiphyseal or metaphyseal growth cartilage)
Polygenetic heritable disease

24
Q

most common sites of OCD

A

FL: shoulder and fetlock
HL; stifle, hock and fetlock

25
common site for OCD on the fetlock
sagittal ridge of the distal metacarpus On DP: middle bit, bottom of bone, along mi-point of the sesamoids
26
what two other conditions lead to fragmentation on the fetlock? and where?
o Plantar/palmar P1: Avulsion fragmentation (due to sesamoidan ligaments) o Dorsal proximal P1: (racehorse hyperextension)
27
views to take for fetlock OCD
Take: DP, LM (+/- Flex lateral), DMPLO, DLPMO
28
sites of OCD lesions on the hock/tarsus
- 1 = distal intermediate ridge of the tibia (DM PL oblique) - 2 = Lateral trochlea ridge of the talus (DM PL oblique) - 3 = medial malleolus of the tibia (DP)
29
views to take for tarsus OCD
- Take: DP*, LM, DMPLO*, DLPMO
30
sites of different stifle joint OCD lesions
Femoral patella joint = Lateral trochlea ridge (lateral medial) Medial femoral tibial joint = on medial femoral condyle (CC view)
31
views to take for all stifle joints
- Take: LM, cranio-caudal, caudolateral-craniomedial oblique o Cranio-caudal highlights femoral condyles o Oblique highlights femoral condyles and lateral trochlea ridges
32
treatment for fetlock, then tarsus and stifle lesions
Fetlock § OCD: Remove fragment § Dorsal P1: Remove fragment § Palmar/plantar P1: Evidence says only remove if high speed tarsus / stifle § Can leave fragments but removal reduces risk of development of OA in the future
33
at what age can stifle and tarsal lesions dissapear
femoral patella = 8 months tarsocrural = 4 months
34
what two conditions can lead to subchondral cysts developing?
- OC: failure of blood supply to growth cartilage = ischemic chondronecrosis of bone - OA: Weight bearing + trauma to articular cartilage = cyst Sites: Medial femoral condyle, phalanges, metaC/T and radius common
35
low motion v high motion joints
o High: DIP, fetlock, tarsocrural, stifle. Can be significantly affected by mild disease o Low: PIP, distal tarsal joints. Can tolerate significant changes, but unpredictable.
36
threshold for improvement after a JOINT block that indicates success
50%
37
most common area for osteoarthritis in the hock
distal tarsal joint
38
views to take when investigating DIP OA
- Dorsal palmar - Lateral medial - Dorsal proximal palmar distal 60 oblique - pedal - Dorsal proximal palmar distal 60 oblique - nav - Palmar proximal palmar distal 45 oblique
39
views to take when investigating tarsal OA
- Dorsal plantar - Lateral medial - Dorsal lateral plantar medial oblique - Plantar lateral Dorsal medial oblique
40
common radiographic signs of hock OA
bone remodelling (third and central tarsal bones) lysis and sclerosis (Distal inter tarsal joint) loss of joint space
41
high motion treatment options for OA
- NSAIDs (bute or flunixin (or Suxibuzone)) - Intra-articular steroids, DMSO, hyaluronic acid, PRP, mesenchymal cells - Controlled exercise - Weight loss diet
42
low motion treatment options for OA
- No radiographic changes = Steroids or other IA meds to calm down inflammation - If not, arthrodesis = minimal effect on performance. - Method: Pain relief and work to naturally arthrodesis, or Surgical arthrodesis
43
methods of arthrodesis
- Intra-articular steroids (lasts 1-3 months so need repeated injections) - Systemic NSAIDs (long term use and toxicity) - Neurectomy (disease continues, consequences of loss of sensation, nerve often regrows) - Chemical arthrodesis: Distal tarsal joints only. (Proximal joint communicates with high motion tarso-crural). Success with MIA or ethanol1,2 Surgical arthrodesis - Tarsal joints – drill cartilage. Requires up to 12 months - PIP and carpometaphalanegal joint – fixation with plate and screws Fetlock can be.. But is high motion joint so effects horses function (salvage procedure)
44
what is associated with an increased risk of SAPO in foals
Omphalophlebitis
45
clinical signs of septic arthritis in foals
- lameness, effusion of the fetlock joint, reluctance to stand, rectal temperature 37.6oC
46
joint fluid signs of sepsis
turbid to opaque high WBC high protein (over 25)
47
what is SAPO
SAPO = septic arthritis, physitis + osteomyelitis * Predominantly E.coli, Actinobacillus, Klebsiella, Staph, Strep, Rhodoccus equi. * Inflammation in 1 or more joints as a result of bacterial infection. * Haematogenous or wound. * Common in neonates secondary to sepsis.
48
4 forms of SAPO
* 4 different forms: Type S = via haematogenous inoculation of the synovial membrane, Type E = in epiphysis, Type P= in physis, Type T = trauma with direct external incoulation. Bacteria normally enter via lungs, GI or umbilicul.
49
tx of SAPO
Antibiotics + surgical removal of infectious and inflammatory material NSAIDs (+ omeprazole)
50
treatment example for septic physitis
* Penicillin + gentamycin IV * Flunixin IV Clinical reassessment of lameness after 5 days of therapy.

Equine (11 decks)

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