Pastern-Morton

Question 1

Proximal Interphalangeal joint motion and load

Answer 1

Low motion

High load

Question 2

PIP joint OA

Answer 2

High ringbone
Chronic, progressive, forelimb lameness
-ush starts very mild
Long, upright pasterns, long toes, low heels, splay-footed, pigeon toed

Question 3

PIP joint OA DX

Answer 3

PE-exostosis, effusion
LE-IA anesthesia, PDN ASN blocks
Rads (MRI not nec)

Question 4

PIP joint OA TX

Answer 4

1. Rest, controlled exercise
2. Chondroprotectants
   - PSGAG (Adequan)-IM
   - Hyaluronic acid (Legend)-IV
   - Oral glucosamine/chondroitin
3. NSAIDS PRN
4. Bisphosphonates

Question 5

PIP joint OA shoeing

Answer 5

1. Reduce toe length
2. Elevate heel
3. EASE BREAKOVER

Question 6

Most PIP OA manageable with

Answer 6

local, medical therapy for awhile

Question 7

Conservative tx PIP OA

Answer 7

expect spontaneous ankylosis with unpredictable soundness (unlikely to be sound)

Question 8

PIP joint pastern arthrodesis

Answer 8

reserved for cases no longer responding to medical therapy

Question 9

PIP joint facilitated ankylosis

Answer 9

ethyl alcohol + cast

Question 10

PIP joint surgical arthrodesis

Answer 10

Transarticular fixation and cast

Question 11

PIP joint OA prognosis

Answer 11

1. Medical therapy-variable
2. Surgical arthrodesis-85% return to work
   - takes about 1 yr
3. Hindlimb better than forelimb

Question 12

Phalangeal fx P2

Answer 12

Hind > fore
Reiners
Acute onselt 3-5/5 lameness
Often non-displaced
-DON'T BLOCK THIS
Prognosis-fair to good

Question 13

Phalangeal fractures, second phalanx OCFs

Answer 13

1. Proximal P2
2. Arthroscopic removal
3. Uncommon
4. Difficult and limited access

Question 14

Axial/sagittal fx sx

Answer 14

-Less common

Lag screw fixation like P1

Question 15

Plantar/Palmar eminence fxs sx

Answer 15

• Lag screw fixation

- Plating combined with PIP arthrodesis

Question 16

Comminuted P2 fxs sx

Answer 16

-Plating with lag fixation with PIP arthrodesis

Question 17

Soft tissue injuries of pastern DDX

Answer 17

1. Distal sesamoidean ligament desmopathies
   - oblique, straight (cruciate)
2. Axial and abaxial ligament of PIPJ desmopathies
3. SDFT extensor branch injuries
4. DDFT
5. Strain induced injuries

Question 18

TX soft tissue pastern injuries (Acute)

Answer 18

Acute

1. Cold therapy (20-30 min/session)
2. NSAIDS
3. Compression (bandaging)
4. Topical diclofenac (Surpass)
5. Rest

Question 19

TX soft tissue pastern injuries (Long term)

Answer 19

Long-term

1. Rest and controlled return to exercise (rehab imp)
2. PSGAGs (Adequan)
3. Intralesional regenerative (stem cells, PRP)
4. ESWT
5. Physical therapy modalities

Question 20

Soft tissue inj pastern prognosis

Answer 20

Good
Rehab takes several months
-longer in more proximal injuries