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Large Animal Surgery > Splint Bone and Proximal Sesamoid Bone Fractures > Flashcards

Splint Bone and Proximal Sesamoid Bone Fractures Flashcards

1
Q

What do splint bones provide support to?

A

Axial support to the carpus and tarsus

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2
Q

What are 2 main causes of splint bone fracture?

A

Hyperextension of the fetlock

External trauma **More common

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3
Q

How can many splint bone fractures be treated?

A

Rest

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4
Q

What condition may be a cause of persistent lameness in cases of splint bone fractures?

A

Suspensory desmitis

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5
Q

What are 3 treatments for a splint bone fracture?

A

Segmental ostectomy
Removal of the distal portion (midbody fx)
Conservative treatment

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6
Q

How would you manage a proximal splint bone fracture?

A

Wound management and removal of bone fragments with internal fixation.

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7
Q

When using internal fixation to repair a splint bone fracture, what is best?

A

Plates are better than screws.

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8
Q

How do you manage a distal splint bone fracture?

A

Surgical removal.

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9
Q

How much for the distal splint bone can you remove?

A

No more than 2/3 or you run a risk of collapse of proximal segment.

NOTE: Except metatarsal 4, but not guaranteed.

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10
Q

If you HAVE to remove more than the distal 2/3 of the splint bone, what else will be needed for proper repair?

A

Internal fixation

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11
Q

When plating a splint bone, what do you NOT want to engage?

A

MC III

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12
Q

If you DO engage the MC III while using a plate to help repair a splint bone fracture, how long can you leave the plate in for?

A

3-4 months

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13
Q

What can we see if there is a large callus formed during the healing of a fractured splint bone?

A

Can see chronic lameness due to impingement on the suspensory ligament causing suspensory demitis.

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14
Q

What is a splint exostosis?

A

A firm swelling due to a benign outgrowth

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15
Q

What horses do you see splint exostosis in?

A

Young horses

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16
Q

Which splint bone do you usually see exostosis in?

A

MC II

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17
Q

What are 2 causes of splint exostosis?

A

Direct trauma

Ligamentous inflammation

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18
Q

What clinical signs will you see with splint exostosis?

A

Lame initially with a firm, warm and painful swelling on palpation.

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19
Q

What 2 things does ligamentous injury result in?

A

Desmitis

Periostitis

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20
Q

What is a “hidden splint”?

A

The “bump” from a splint exostosis goes inward on the rads so they’re harder to see.

NOTE: More likely to cause impingement on the suspensory ligament.

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21
Q

What are 2 conservative treatments for splint exostosis?

A

Rest and NSAIDs

Local DMSO/infiltration with corticosteroids

22
Q

What is the surgical treatment for splint exostosis, and what is required post-op?

A

Linear incision over side with en bloc removal. EXCELLENT bandaging is required post-op.

23
Q

When performing an en bloc removal of a splint exostosis, what helps to provide better visibility?

A

Application of a tourniquet.

24
Q

What are 3 places to get a pulse on a horse?

A

Facial
Transverse facial
Dorsal metatarsal artery**

NOTE: This is important to remember when performing an en bloc excision of a splint exostosis.

25
Q

What are 3 lay terms for periostitis and fracture of dorsal metacarpal III?

A

Bucked shins
Stress fracture
Sore shins

26
Q

In what horses do we see stress fractures of the dorsal cortex of MC III?

A

Speed horses

27
Q

When do we usually see stress fractures of the dorsal cortex of MC III?

A

Usually in 3 year old horses that had bucked shins as a 2 year old.

28
Q

What does a stress fracture of the dorsal cortex of MC III look like?

A

Fissure extending 60% through the cortex at a 30 degree angle.

29
Q

What should you encourage trainers to do to reduce the incidence of bucked shins?

A

Train more at regular short distances.

30
Q

What is the prognosis for a stress fracture of the dorsal cortex of MC III?

31
Q

What are 4 different medical treatments for a stress fracture of the dorsal cortex of MC III?

A

Rest
NSAIDs
Reduced exercise
Radiographic monitoring

32
Q

What is the surgical treatment for a stress fracture of the dorsal cortex of MC III?

A

Osteostixis (drilling holes into the bone to improve healing)

33
Q

What is osteostixis?

A

Drilling holes into the medullary cavity to access some growth factors and vascular components.

34
Q

What is the advantage of osteostixis alone when treating a stress fracture of the dorsal cortex of MC III?

A

Don’t have to go back to take out any screws.

35
Q

What surgical treatment gives the best result for treatment of a stress fracture of the dorsal cortex of MC III?

A

Osteostixis with screws that are removed at 60 days.

36
Q

How is osteostixis performed?

A

Skin staples are used as a grid to help guide the drilling. Holes are drilled perpendicular to the fracture and TOWARD the medullary cavity. 6-8 holes are drilled 10mm apart. If using a screw, it is placed unicortically across the fracture.

37
Q

How many different types of sesamoid fracture are there?

38
Q

What are the 6 different types of sesamoid fracture?

A 
Apex
Mid-body
Base
Abaxial
Axial
Comminuted
39
Q

What are 2 causes of sesamoid fractures?

A

Excessive tension from the suspensory tendons

Trauma

40
Q

What breed of horse are most affected by sesamoid fracture?

A

Racing breeds and those at high speed.

41
Q

What type of sesamoid fracture is the most common?

A

Apical fractures

42
Q

How is an apical sesamoid fracture treated?

A

Arthroscopic removal if they’re articular (up to 1/3)
If large fragment, internal fixation.

NOTE: The more you remove, the lower the prognosis for return to racing.

43
Q

What is the prognosis for an apical sesamoid fracture?

A

Good

NOTE: Can evaluate the suspensory ligament via ultrasound if needed.

44
Q

How is a mid-body sesamoid fracture repaired?

A

Internal fixation with either a lag screw (for TB and return to racing) or cerclage wire (for SB).

45
Q

Between a lag screw and cerclage, which method is better for fixing a mid-body sesamoid fracture?

A

Screw fixation

46
Q

What is used during recovery and shortly after post-mid-body fx repair?

A

External coaptation

47
Q

How do you treat an intra-articular abaxial sesamoid fracture?

A

Arthroscopic removal of fragments

48
Q

How do you treat an extra-articular abaxial sesamoid fracture?

A

Conservative management

49
Q

What is the prognosis for abaxial sesamoid fractures?

A

Fair to good

50
Q

Why do basilar sesamoid fractures have a poor prognosis?

A

Because it involves the origin of all the distal sesamoidean ligaments and lag screw fixation is challenging due to location.

Large Animal Surgery (30 decks)

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