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Preeti: SA Surgery > Sx Diseases of the Carpus and Tarsus > Flashcards

Sx Diseases of the Carpus and Tarsus Flashcards

1
Q

How can you tell the lateral and medial sides of the carpus and tarsus

from a radiograph?

A

Carpus: Ulnar carpal bone is lateral

Tarsus: Trochlea of the talus is medial (the bone itself looks like an “m”)

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2
Q

Describe the collateral ligaments in the carpus

A

All carpal ligaments are short ligaments

Radial collaterals: straight and oblique parts

Ulnar collateral: straight part only

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3
Q

Describe the collateral ligaments in the tarsus

A

Both short and long portions for the medial and lateral collaterals

Long portion: Taut in extension only (taut when the limb is long)

Short portion: Taut in both extension and flexion (cross obliquely for rotational stability)

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4
Q

What’s the difference between a short and long ligament?

A

Short ligaments connect adjacent bones only and

do not bridge more than one joint

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5
Q

What is the typical etiology of collateral injury?

A

HBC trauma

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6
Q

Which collateral injuries are most common?

A

Medial

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7
Q

Why do shear injuries commonly accompany collateral injuries?

A

Due to the conformation of the collaterals, trauma results in shearing force

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8
Q

Why do collateral injuries tend to occur on the medial side of the joint?

A

It’s easier for the distal limbs to move in the VALGUS (lateral)

direction, putting more stress on the medial collateral components

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9
Q

What radiographic views are necessary for diagnosing collateral injury?

A

Dorsopalmar stress views

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10
Q

What is valgus stress, and how is it different from varus stress?

A

VaLgus stress = Laterally deviates distal limb

Varus stress = Medially deviates distal limb

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11
Q

What type of stress is applied to identify damage to the medial collateral ligament?

A

VaLgus stress (or pressure from the medial side) moves the limb laterally

and opens the joint on the medial side due to MCL deficiency

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12
Q

What type of stress is applied to identify damage to the lateral collateral ligament?

A

Varus stress (or pressure from the lateral side)

moves the limb medially

and opens the joint on the lateral side due to LCL deficiency

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13
Q

T/F:

Conservative treatment should be pursued first in collateral ligament injuries

A

FALSE! Conservative tx rarely helpful! Need surgery!

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14
Q

What kind of coaptation can be used in collateral ligament injury

(not as a definitive tx though)?

A

Splinting

ESF used in the presence of severe soft tissue trauma (SHEAR)

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15
Q

In broad terms, how is collateral ligament replacement performed?

A

Bone tunnel or screw with

heavy NONabsorbable suture placed (figure-8 pattern) between them

Prosthetic ligaments with screws placed at the origin and insertion of the original ligament (proximal and distal to the joint)

If in the tarsus, BOTH short and long ligaments must be replaced

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16
Q

what structure(s) are damaged in hyperextension injuries?

A

Palmar/plantar support ligaments

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17
Q

What do “flexor retinaculum” and “palmar fibrocartilage” refer to?

A

Both refer to the superficial palmar ligaments

Flexor retinaculum: encloses the DDF tendon

Palmar fibrocartilage: extends from the distal aspect of the proximal carpal bones to the proximal aspect of the metacarpals

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18
Q

What are the common etiologies of hyperextension injury?

A

Trauma

Immune-mediated arthropathy (contributes to b/d of palmar/plantar ligaments)

Corticosteroids

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19
Q

What breeds have a genetic predisposition to bilateral disease

(breakdown of palmar/plantar ligaments in regards to hyperextension injury)

A

Middle-aged Shelties and Collies

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20
Q

What are the 4 joints of the carpus?

A
  1. Hinge joint (Ginglymus)
  2. Antebrachiocarpal joint
    1. between radius/ulna and proximal row of carpal bones
    2. Almost all motion occurs here
  3. Middle carpal joint
    1. Between first and second rows of carpal bones
  4. Carpometacarpal joint
    1. Between second row of carpal bones and the metacarpals
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21
Q

What are the 5 joints of the tarsus?

A
  1. Hinge joint (Ginglymus)
  2. Tibiotarsal (Talocrural) joint
    1. Between tibia (crus) and talus
    2. Almost all motion occurs here
  3. Proximal intertarsal joint
    1. Calcaneoquartel joint
      1. Between the calcaneus and the 4th tarsal bone
    2. Tarsometatarsal joint
      1. Between the tarsal bones and metatarsal bones
22
Q

How do you identify hyperextension injuries on a physical exam?

A

Swollen painful joint with hallmark hyperextended stance (dropped hock)

23
Q

What kinds of radiographs are used in hyperextension injuries?

A

Standard dorsopalmar/plantar view and lateral view - r/o fractures and provide basis for comparison

Stress views (lateral) - determine level of injury

24
Q

How is stress applied to identify hyperextension injuries

on radiographs?

A

Stabilize limb proximal to the carpus/tarsus

then stimulate weightbearing to detect instability

25
Q

What are the treatment options for hyperextension injury?

A

Conservative management NOT USEFUL (but splinting prior to sx)

Arthrodesis (of affected joint and joints distal) is required for definitive tx

26
Q

What is the difference between partial and pancarpal arthrodesis

in regards to hyperextension injury?

A
  1. Partial Carpal Arthrodesis
    1. Indicated if: antebrachiocarpal joint is normal
    2. Joints fused: Middle and carpometacarpal joints
      1. Using T-plate or pins
    3. Function of carpus after: Unaffected
  2. Pancarpal Arthrodesis
    1. Indicated if: antebrachiocarpal joint is abnormal
    2. Joints fused: ALL! (Antebrachiocarpal, middle, carpometacarpal)
      1. Using DCP specialized plates
27
Q

What are the options for arthrodesis of the tarsus for hyperextension injury and what are the differences between the 2 options?

A
  1. Partial Tarsus Arthrodesis
    1. For proximal intertarsal hyperextension injury
      1. Joints fused: calcaneoquartel (lateral half)
        1. Using lag screw or pin/tension band
    2. For tarsometatarsal hyperextension injury
      1. Joints fused: tarsometatarsal
        1. Using laterally applied plate
  2. Pantarsal Arthrodesis (RARE)
    1. For tibiotarsal joint hyperextension
      1. Joint flexes in direction of the injury, rare to be injured this way
      2. Other tarsals/carpals do not flex this way
28
Q

What are the post-op procedures after arthrodesis of the carpus?

A

Coaptation (splint or ESF) - 4 to 8 weeks

Activity Restriction - about 3 months

Radiographs every month to assess healing

29
Q

T/F:

Healing of arthrodesis is prolonged compared to that of a fracture

A

TRUE

30
Q

What is the signalment and presentation of carpal laxity syndrome?

A

1 to 7 months old

Male dogs

PE reveals: Both hyperextension and hyperflexion

31
Q

What are the treatment recommendations for Carpal Laxity Syndrome?

A

Spontaneous recovery in 1 - 4 weeks!

Energy restricted diet

Moderated exercise

Flooring with good traction

NOT SX!

32
Q

What is the prognosis for carpal laxity syndrome?

A

EXCELLENT!

33
Q

What are the components of the common calcanean tendon?

A

Gastrocnemius

Gracilis

Semitendinosus

Biceps femoris

Superficial digital flexor

GGBSS=CCtendon

34
Q

What is the difference between complete and partial rupture

of the common calcanean tendon?

A

Complete = traumatic, complete plantigrade stance

Partial = chronic, flexion of digits

(because superficial digital flexor usually preserved!)

35
Q

Describe the specialized suture pattern required for

common calcanean tendon repair

A

3-loop pulley with monofilament NONabsorbable suture

(tendons are slow to heal, so need non-absorbable)

36
Q

What is the most important part for post-op care

of a common calcanean tendon repair?

What is the prognosis?

A

IMMOBILIZATION using coaptation!

ESF, Splint, or giant lag screw

Prognosis generally GOOD! (75% return to function)

37
Q

What breed is susceptible to OCD of the hock (ankle)?

A

Rottweilers

38
Q

T/F:

OCD of the hock is frequently bilateral

A

TRUE

39
Q

Where does hock OCD most commonly occur?

A

MEDIAL side on the ridge of the talus (articulation of tibia)

40
Q

How does hock OCD common location differ in Rottweilers as compared

to other cases of hock OCD?

A

If lateral location, predominantly will be a Rottweiler (but medial is still most common in rotties)

41
Q

What is the significance of the hock flexion test?

A

Pain at the limits of hock flexion indicates DJD

(not necessarily OCD, but there is a problem)

42
Q

What is interesting about the lameness that occurs with

OCD of the hock/talus?

A

It worsens after REST!

43
Q

What are findings on PE that are indicative of hock OCD?

A

Lameness that worsens after rest

Hock-extended stance

Joint effusion/fibrosis

Pain/crepitus on manipulation

Pain at limits of hock flexion on flexion test

44
Q

How is OCD of the hock diagnosed?

A

Radiographs show articular flattening and lucency

45
Q

What types of radiographic views are necessary for

diagnosis of hock OCD?

A

Standard lateral and craniocaudal views (for most)

Flexed lateral (to expose proximal talus)

Flexed craniocaudal (to see cranial trochlear ridges)

46
Q

What is the most common location of hock OCD?

A

talar ridge (medial or lateral)

47
Q

What are the tx option for hock OCD?

A

Medical tx: Only older dogs with established osteoarthritis

Surgical tx: Fragment excision/debridement (arthroscopy better)

or

Tibiotarsal (tarsocrural) arthrodesis

48
Q

What is the prognosis for hock OCD?

A

Guarded to poor :(

Because sx does not prevent development of osteoarthritis or eliminate lameness, it just improves function somewhat

49
Q

What are the indications for tarsocrural pantarsal arthrodesis?

A

Severe injury to the tibiotarsal (tarsocrural) joint

(comminuted articular fractures, persistent luxation)

Failed common calcanean tendon repair

Osteoarthritis unresponsive to medical tx

50
Q

Describe the process of tarsocrural pantarsal arthrodesis

A

Fuse tibiotarsal (tarsocrural) joint at standing angle (peg leg stance)

Remove articular cartilage

Pack with bone graft

Rigid fixation (Dorsal plate or Type 2 ESF)

51
Q

What is the long-term outcome for tarsocrural pantarsal arthrodesis?

A

Loss of hock ROM (mechanical lameness)

but acceptable function

Pet: GOOD

Working dog: Guarded to poor

Preeti: SA Surgery (10 decks)

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