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Equine Surgery: QOD > Orthopedics > Flashcards

Orthopedics Flashcards

1
Q

Draw and name the types of ulnar fracture

A
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2
Q

Draw and name the types of Salter-Harris fracture

A
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3
Q

What are the options for pastern arthrodesis (medical and surgical)? Include names/descriptions of implants also

A

Injection of 75% ethyl alcohol

Casting

Ideally: PIP arthrodesis LCP - 3 hole narrow LCP with 2 transarticular cortex screws

Dorsal 3-hole narrow DCP or LCP combined with 2 transarticular cortex screws

2 places, T-plate, Y-plate also possible (requires 5.5mm transarticular screws)

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4
Q

Describe the tarsal drilling technique for tarsal arthrodesis

A

GA, lateral/dorsal recumbency

From dorsomedial aspect of tarsus

Sterile prep and drape

3cm skin incision on dorsal medial aspect of TMT and DIT joints

Drill entry midway between line extending form groove between proximal MTII and MTIII and most dorsal asset of distal tarsus (plantar to saphenous vein).

Needles used to identify joint spaces with rads/fluoroscopy

Tracts drilled in pairs (TMT and DIT). 4.5mm drill bit

20mm directed to lateral palpable extremity of MTIV

20mm angled 30 degree to first tract in plantar direction

35mm tract angled 30 degrees to first in dorsal direction

Incision closed subcutaneous (continuous 2-0 absorbable) and skin (interrupted 2-0 absorbable)

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5
Q

Which is the most common digit to be a supernumerary digit

A

Medial aspect of forelimb in 80% of cases

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6
Q

List the causes of exostosis of the splint bones

A

Trauma:

Subperiosteal hemorrhage

Elevation of periosteum

Instability between MCIII and MCII

MCII fractures

Inflammation of intercarpal ligament:

Can result from circles on a hard surface

Or conformation abnormalities (bench knees)

Carpal varus

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7
Q

Describe the post-op care after splint bone removal

A

Post-op:

Pressure bandage for 2 weeks

Stall rest 1 month

2 months handwalking/small paddock turnout

Radiography to assess stability of proximal fragment

Drain may be required for 2-3 days

NSAIDs

ABs depending on drainage and incision

Full limb cast may be required for recovery and post-op if whole MTIV removed

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8
Q

What is the endurance limit of metallic implants

A

Maximum stress below which a material can endure an infinite number of stress cycles

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9
Q

What is shot peening

A

Done before electropolishing

Implant subjected to high-velocity impaction by metallic or ceramic particles

Produces roughened surface with increased residual compressive stress for enhanced fatigue life

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10
Q

List all the medical and surgical options for management of strain-induced tendinitis

A

Non-surgical therapies:Physical therapies:

Cold therapy:

Compression and coaptation:

Corrective shoeing

Controlled exercise:

Extracorporeal shock wave therapy:

Therapeutic ultrasound, laser and magnetic fields:

Counter-irritation: (not effective)

Pharmacologic management:Systemic medication:

Corticosteroids:

NSAIDs:

DMSO

Intralesional medication:

PSGAGs:

HA:

Component of tendon matrix

Beta-aminopropionitrile fumarate

Methylprednisolone: (avoid)

New advances: Tissue engineering approaches:

IGF-1:

Recombinant equine growth hormone:

TGF-B:

PRP:

TGF-B

VEGF

ACELL VET:

Bone marrow:

MSCs:

Surgical therapies:

Tendon splitting:

Desmotomy of the accessory ligament of the superficial digital flexor tendon:

Tenoscopy:

Bursoscopy:

Annular ligament desmotomy:

Fasciotomy and neurectomy of the deep branch of the lateral plantar nerve for the treatment of proximal suspensory ligament desmopathy:

Desmotomy or desmectomy of the accessory ligament of the deep digital flexor tendon

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11
Q

List the methods of diagnosis of strain-induced tendinitis

A

Clinical history

Palpation

Ultrasonography

Molecular markers:

PICP

COMP

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12
Q

Why do intrathecal tendon lesions heal more slowly than other tendon lesions

A

No paratenon

Reduced extrinsic repair

Synovial fluid slows repair

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13
Q

Describe the phases of tendon healing

A

Inflammatory reaction:

Increased blood flow

Edema

Neutrophils, macrophages, monocytes

Proteolytic enzymes

Also further damages tendon

Reparative phase:

After a few days, lasts several months

Angiogenesis

Fibroblastic cellular infiltration (extrinsic repair)

Limited intrinsic repair

Scar:

Higher ratio of Collage III to collage I (50% cf 10% in normal tendon)

Higher hydration

Higher GAGs

Reparative phase:

Type III to type I collagen as scar matures

Thicker collagen fibrils and cross-links increase

Mature scar less stiff than tendon but as there is more tissue, scar tissue actually more stiff

Result: strong but functionally inferior tendon, predisposing to reinjury

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14
Q

What are the most common intrathecal tendon lesions in the forelimb and the hindlimb

A

Forelimb: Bursting of lateral border of DDFT

Hindlimb: Manica flexor of SDFT

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15
Q

What is the prognosis for horses with a peroneus tertius rupture

A

78% midbody/insertion returned to previous level of work

21.7% euthanized

Premature return to exercise assocaited with re-injury

Monitor with U/S

If avulsion fracture: guarded

Age, open/closed injury, U/S size, location, duration of rehab had no influence on return on exercise

Racing at time of injury reduced prognosis

If additional structures damaged, 8 times less likely to return to soundness

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16
Q

What is the prognosis for horses with a peroneus tertius rupture

A

78% midbody/insertion returned to previous level of work

21.7% euthanized

Premature return to exercise assocaited with re-injury

Monitor with U/S

If avulsion fracture: guarded

Age, open/closed injury, U/S size, location, duration of rehab had no influence on return on exercise

Racing at time of injury reduced prognosis

If additional structures damaged, 8 times less likely to return to soundness

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17
Q

Describe the procedure for semiteninosus tenectomy

A

GA, lateral recumbency

Landmarks:

Tibial insertion of muscle on caudomedial aspect of tibia just distal to medial femorotibial joint and caudal to saphenous vein overlying gastrocnemius muscle

8cm vertical incision made over palpable tendon and through subcutaneous and crural fascia until tendon exposed

Kelly/crile forceps passed under tendon to isolate from muscle and tendon transected

Resection of 3cm segment (prevents of delays recurrence)

Fascial layers closed with interrupted or continuous synthetic absorbable sutures

Skin closed with interrupted or continuous non-absorbable suture

Pull limb forward; if tendon of insertion of semitendinosus muscle onto calcaleal tuber taut:

3-4cm incision directly over tendon (caudal and distal to first incision)

Isolate and transect

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18
Q

How does fibrotic myopathy occur

A

Adhesions and fibrosis of semitendinosus (or semimembranosus, biceps femoris, gracilis) muscle

Secondary to IM injections, trauma (lacerations, slipping, kicks) or tearing insertion of semitendinosus while barrel racing, lameness

Can be caused temporarily by breach bar

Can occur as neonates

If involves both limbs, likely neuropathy is the cause

Ossifying myopathy: when bone forms in affected tissue

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19
Q

Describe the procedure of a lateral digital extensor penectomy and partial myectomy

A

Remove distal 2-10cm of LDE muscle and entire tendon

Standing or GA (can remove more muscle under GA)

Sites:

Junction of LDE tendon with log digital extensor tendon on lateral aspect of metatarsus

LDE 2cm proximal to lateral malleolus

Distal incision made directly over tendon just proximal to junction with long digital extensor tendon

Blunt dissection beneath tendon with curved kelly or Ochsner forceps

Proximal incision on lateral aspect of limb 6cm above lateral malleolus (skin, subQ and fascia directly over lateral digital muscle parallel with muscle fibers)

Blunt dissection to expose muscle belly and heavy curved instrument placed underneath it

Sever at distal incision and pull through by traction on proximal section with curved Ochsner forceps of Mayo scissors

Muscle severed at proximal aspect of incision, ensuring at least 2cm muscle removed

Close fascia proximally with simple interrupted or continuous USP 0 absorbably suture

Subcutaneous 2-0 absorbable simple continuous

Skin non-absorbable simple continuous

Distal incision with skin sutures only

Sterile dressing and whole limb bandage 10-14 days

Stall rest 2 weeks

1 week hand-walking

Normal exercise in 2-4 weeks

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20
Q

What are the treatments for cribbing (medical and surgical)

A

Non-surgical:

Pasture turnout

Remove objects that horse cribs on

Cribbing straps

Acupuncture

Aversion therapy

Surgical:

Forssell procedure

Modified Forssell procedure

Bilateral neurecomy of the ventral branch of the spinal accessory nerves

Surgery of choice is to combine modified Forssell procedure with bilateral neurectomy

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21
Q

Puncture of the sole of the foot by a nail can involve which structures

A

P3

Navicular bone

DIP jt

Navicular bursa

DDFT

DFTS

Sole

Digital cushion

Laminae

Heel bulbs

Palmar cartilages of P3

Collateral ligaments of DIP jt

Impar ligament

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22
Q

How should keratomas be managed

A

Remove keratoma up to origin:

Can resolve inflammatory process first or can remove immediately - depends on level of lameness

Altered horn and altered sensitive lamina must be removed

Surgery:

Tourniquet

Standing/ring block or GA

Remove as much horn as possible with horse standing until Dremel tool exchanged for scalpel and curettes

Aseptic prep

Altered lamina and entire keratoma removed in toto

Aseptic pressure bandage applied to plalangeal region

Bandage changes at 3-4 days intervals under aspectic conditions

Support to hoof wall

Medication plate can be applied as soon as granulation tissue

Fill hoof wall defect with artificial horn as soon as sensitive lamina healed

Shoe with large clips on either side of defect

Post-op:

Stall rest 4-6 weeks

Reshod

Light walking after 2-4 months if healing good

If re-infection, remove all affected tissues and start process again

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23
Q

List the methods of treating canker

A

Removal of abnormal tissue surgically using knife/blade

Cryotherapy

Surgery likely to be repeated

Clean with povidone-iodine with bandage changes every 2-3 days

Apply shoe with pad

Daily bandage changes with 20g iodoform iodine, 20g zinc oxide, 20g tannic acid, 40g metronidazole

OR Chloramphenicol + metronidazole

Systemic ABs if more than one hoof affected (doxycycline or oxytetracycline)

Biotin and zinc added to feed

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24
Q

List and draw the types of P3 fracture

A
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25
Q

What are the surgical options for treating laminitis

A

DDF tenotomy (mid carpal or pastern approach)

Hoof wall resection

26
Q

List all the causes of ALD

A

Perinatal:Incomplete ossification:Mare:

Placentitis

Metabolic disease

Parasite infection

Colic

Foal:

Premature

Twins

Uneven loading of joints due to mild ALD

Osteochondral fractures may occur in severely dysmature (esp dorsal aspect small tarsal bones)

Laxity of periarticular structures:

If ALDs of several regions and rotational deformities

Due to laxity or soft tissue trauma

Laxity lead to abnormal loading and can incide ALD if incomplete ossification

Causes:

Hormonal imbalance

Intrauterine positioning

Aberrant intrauterine ossification:

Deformed long bone at birth

Caused by mechanical factors leading to deformation of precursor cartilage

Distal physeal region on MTIII involved; triangular epiphysis and varus deformity

Developmental:Unbalanced nutrition:

Excessive intake - too much grain from crib feeding

Unbalanced trace minerals:Caused by:

Zinc toxicity

Copper deficiency

Ca:P

Excessive exercise and trauma:

Microfractures/crushing of proliferative zone

Type V Salter-Harris

Epiphyseal fractures from kicks

Physeal trauma:

Salter-Harris type V or IV

Local retardation on medial or lateral aspect

Compensatory:

Proximal phalanx due to prolonged loading distal to deviation

27
Q

List the methods of treatment for ALD

A

Stall rest

Controlled exercise

Splints and casts

Hoof manipulation

Radial pressure wave therapy

HCPTE

Transphyseal staple

Transphyseal bridge (screws and wire)

Transphyseal screw

28
Q

At what age does the rapid growth stage end for: MCIII/MTIII and proximal phalanx; tibia and radius

A

MCIII/MTIII proximal phalanx: 2 months

Tibia: 4 months

Radius: 6 months

29
Q

What are the landmarks for PE at the distal radial physis

A

3cm vertical incision between CDE and LDE tendons, starting from point 4-5cm proximal to distal physis of radius and continuing proximally

30
Q

Which ALD, when it is mild, is protective against carpal fracture and effusion

A

Carpal valgus

31
Q

List the causes of congenital flexural limb deformity

A

Intrauterine malpositioning:

Rare

If large foal

Diseases acquired by mare during pregnancy

Agents ingested during pregnancy:

Locoweed

Hybrid Sudan grass

Dominant gene mutation in sire

Equine gioter

Influenza

Neuromusclar disorders

Lathyrism:

Defects in cross-linking of elastin and collagen

Glycogen branching enzyme deficiency:

QH (transient flexural deformity)

32
Q

What are the treatment options for digital hypertension deformities

A

Swimming

Farriery:

Shorten toe

Rasp palmar half of foot

Heel extensions

Bandaging :

Phalangeal region

Tenoplasty: Mini foals - NOT recommended

33
Q

How does oxytetracycline work

A

3g in 250-500mL physiologic saline administered slowly IV. Administer 2-3 times in first week.

Induces dose-dependent inhibition of collagen gel contraction by equine myofibroblasts and indices a dose-depended decrease in MMP-1 mRNA expression by myofibroblasts. Basically oxytetracycline inhibits tractional structuring of collagen fibrils by equine myofibroblasts through an MMP-1-mediated mechanism.

34
Q

What are the treatment options for treating acquired flexural limb deformity of the DIP jt

A

Nutrition:

Early weaning

Decrease mare ration

Decrease foal concentrate ration

Evaluate soil and water for trace mineral composition

Physiotherapy and exercise:

Controlled exercise

Analgesia:

Farriery:

Protect toe

Toe extension if small deformity

Rasp heels if in contact with ground

Cast:

10-14 days maximum

Surgery:

Desmotomy of ALDDFT

DDFT tenotomy

35
Q

Which vessel can be damaged and is usually ligated in a medial approach to performing desmotomy of the ALSDFT

A

Cephalic

36
Q

List the type of sesamoid fracture

A

Apical

Midbody]Basal

Abaxial

Sagittal

Comminuted

37
Q

Regarding all types of sesamoid fractures, what percentage returned to racing after surgical and conservative management

A

Surgery: 64%

Conservative: 37%

38
Q

What are the 4 types of P2 fracture

A

Dorsal or palmar/plantar intra-articular osteochondral chip fractures

Palmar/plantar eminence fractures

Axial fractures

Comminuted fractures

39
Q

What are the treatment options for lunation/subluxation of the PIP jt

A

Arthrodesis

But some cases are due to excessive tension on DDFT so transection of medial head of DDFT can help

40
Q

What the tenoscopy landmarks for transection of the PAL

A

The arthroscope is inserted just distal to the PAL halfway between the digital neurovascular bundle and the ergot. The lateral or medial entrance portal is positioned lateral or medial to the respective edge of the SDFT.

The instrument portal is made 5 to 10 mm proximal to the PAL in the DFTS out pouching almost lateral to the SDFT.

41
Q

Where should the distal screw be placed in a lateral condylar fracture

A

Centrally in the lateral condylar fossa

42
Q

What is the prognosis for return to racing for displaced lateral condylar fractures

A

50%

43
Q

Overall, what percentage of condylar fractures return to racing

A

70-80%

44
Q

Where should plates be positioned for diaphyseal fractures of MCIII

A

Dorsolaterally and dorsomedially

45
Q

Define a saucer fracture

A

A dorsal cortical fracture that curves proximal and courses back to the dorsal cortex

46
Q
A
47
Q

List the ultrasonographic features that indicate tendon injury

A

Enlargement

Hypoechogenicity

Reduced striated pattern

Changes in shape, margin, position

Irregular striated pattern indicates fibrosis

Heterogenous pattern indicates chronic tendinopathy

48
Q

What intralesional medications can be used in tendon injury

A

PSGAGs:

Inhibit collagenases and metalloproteinases

Inhibit macrophage activation

Intralesion or M

76% return to work vs 46% controls

Improved echogenicity of U/S

HA:

Component of tendon matrix

Contains:

D-glucuronic acid

N-acetyl-D-glucosamine

Peritendinous, intralesional, intrathecal, systemically

No difference in reinjury

Less tendon enlargement cf controls

Peritendinous injection may reduce lameness

Decreases adhesions when administered intrathecally

Decreases inflammation and hemorrhage

Beta-aminopropionitrile fumarate

Methylprednisolone:

Dystrophic mineralization and tissue necrosis - avoid

Ultrasonographic guidance standing or GA

2.5cm 22Ga needle for not treatments

NOT for first 3 days after injury as can increase hemorrhage

Large volumes can be damaging

New advances: Tissue engineering approaches:IGF-1:

Stimulates extracellular tendon matric synthesis

Mitogen

Decreases initial swelling

Recombinant equine growth hormone:

IM

Decreased yield point and ultimate tensile strength

TGF-B:

Fewer reinjuries at site but more on contralateral limbs

More tendon enlargement

PRP:

Plasma with at least twice the platelet concentration of normal plasma

Contains:

PDGF

TGF-B

VEGF

Stimulates cell proliferation and matrix synthesis

ACELL VET:

Intralesional therapy using acelllular tissue from porcine urinary bladder submucosa

Bone marrow:

Intralesional

MSCs:

Differentiate into tenocytes to regenerate tendon matrix

Functionally superior repear

Reinjury rate 26% (in 3 years) - improved from conventional treatment

49
Q

What is the purpose of tendon splitting

A

Decompresses core lesion by evacuating serum or hemorrhage and facilitate vascular ingrowth, may reduce propagation of lesion

Faster resolution of lesion, quicker revascularization and increased collagen deposition cf controls

50
Q

What is the prognosis for return to function following busoscopy for DDFT tears

A

28%

51
Q

Describe the procedure for a neurectomy and fasciotomy for hindlimb proximal suspensory desmitis

A

GA, dorsal recumbency

4-6cm incision adjacent to lateral border of SDFT, originating proximally from level of chestnut

Plantar metatarsal fascia incised and incision extended deep to SDFT by blunt dissection, facilitated by retraction of SDFT

Deep branch of lateral plantar nerve located and transected using scalpel and 3cm section removed

Fasciotomy performed adjacent to lateral splint bone

52
Q
A
53
Q

Describe the pathophysiology of P2 plantar eminence fractures

A

Uniaxial or biaxial

Result of hyperextension of PIP jt, with tension on palmar/plantar attachments of SDFT, middle scutum and distal sesamoidean ligaments

Occasionally, soft tissues can be disrupted without bone damage

54
Q

List the treatment options for a subchondral cystic lesion of P2

A

IA HA - temporary pain relief

Surgical curettage:

Transosseous drilling

Small drill bit under fluoroscopic control (inject saline into joint to confirm correct placement of drill)

Enlarge to 5.5mm drill bit

Allows access of curette to evacuate cyst

Lavage joint

Cyst and drill hole filled with tricalcium phosphate granules (or fibrous gel with PTH1-34)

Arthrodesis (but multiple lesions have a poor response)

55
Q

What is the ethology of proximodorsal osteochondral fractures of P1

A

Common in racehorses and non-racehorses

Caused by hyperextension of MCP jt with impact of proximal and dorsal aspect of proximal phalanx onto dorsal region of MCIII

Does not seem to be genuine OC

56
Q

List the consequences of not removing proximodorsal osteochondral fractures of P1

A

Erosion of opposing metacarpal condyle (lameness)

Synovitis

Cartilage degeneration

Villonodular synovitis

57
Q

What are the two types of palmar/plantar osteochondral fractures of P1

A

Type I fractures:

Avulsed from axial, proximal, plantar or palmar rim of proximal phalanx and are mostly articular

Insertion of short sesamoidean ligament still attached to avulsed fragment

Minimal lameness, usually at trot

Type II fractures:

Larger, abaxially located, partly articular osteochondral fragments

Extend distad 2-3cm and contain minimal articular cartilage

No persistent lameness

May constitute delayed form of ossification

58
Q

How should a closed fetlock lunation be treated?

A

Cast 6 weeks

Apply under GA

59
Q

Discuss the treatment of chronic proliferative (villonodular) synovitis of the fetlock and how size of the lesion influences treatment

A

If <4mm:

IA atropine and steroids

If >4mm:Surgery:Arthroscopy:Small masses:

Synovectomy instruments, guarded scalpels, biopst suction punch rongeur, radiofrequency probe

Large masses:

Large biopsy punch rongeurs, CO2 or diode laser

Athrotomy

60
Q

Describe the treatment of sagittal fractures of the proximal sesamoid bone

A

3.5mm cortex screws in lag fashion in lateral-to-medial orientation

MCP arthrodesis occasionally necessary:

If injury to intereseamoidean ligaments or P1 fracture also

Post-op:

Cast for 2-3 weeks

Then heavy bandage

Retire from racing as usually concurrent condylar fracture

61
Q

What is the prognosis for return to function for basilar sesamoid fractures?

A

Poor

Inverse relationship between dorsopalmar fragment length and likelihood of return to racing

Basal osteochondral fragments that do not extend to palmar surface: 59% return to racing

57% return to racing if fragment involves <25% of base

40% return to racing if fragment involves >25% of base

62
Q

What is the aetiology of palmar osteochondral disease (POD) of the fetlock joint?

A

Trauma:

Accumulated stress and sclerosis developing during racing, particularly hyperextension

Degenerate metacarpal condyle has acellular and necrotic bone, with zone of new bone formation deep to this: remodelling and fracture changes

Early lesions have little cartilage damage, however, eventual fracture and displacement of subchondral bone results in complete bone and cartilage loss

Equine Surgery: QOD (13 decks)

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