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Y4 EQ - Orthopaedics > Upper hindlimb > Flashcards

Upper hindlimb Flashcards

1
Q

How many joints make up the stifle?

A

3

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2
Q

Name the 3 main bones of the stifle

A

Distal femur
Proximal tibia
Patella

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3
Q

Name the joints of the stifle

A

Femoropatellar
Medial femorotibial
Lateral femorotibial

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4
Q

Describe the communication between the joints of the stifle

A

Femoropatellar and medial femorotibial = 80%
Femoropatellar and lateral femorotibial = 10%

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5
Q

Name the soft tissue structures of the stifle

A
  • Menisci: medial and lateral
  • Meniscotibial/femoral ligaments
  • Cruciate ligaments
  • Patellar ligaments: medial, lateral and middle
  • Collateral ligaments: medial and lateral
  • Joint capsule
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6
Q

Which muscle attaches to the patellar?

A

Quadriceps

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7
Q

How does the quadriceps act on the tibia?

A

Through the patellar ligaments

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8
Q

Where do the patellar ligaments insert?

A

On the tibial tuberosity

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9
Q

If the ligaments of the stifle cannot be easily palpated what should be expected?

A

Effusion?

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10
Q

How is radiography used as an imaging modality for the stifle?

A

Imaging the stifle can be a challenge
Caudocranial; lateromedial; flexed LM; Caudolateral-Craniomedial Oblique; (skyline patella)
Check other limb!

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11
Q

How is ultrasound used as an imaging modality for the stifle?

A

Image patellar ligaments, collateral ligaments, part of meniscus and some of joint
Difficult for cruciate ligaments and most of meniscus

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12
Q

Osteoarthritis dissecans is seen most commonly in which horses?

A

WBs>TBs
6mo-4years

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13
Q

Where in the stifle is most commonly affected by osteochondritis dissecans?

A

Lateral trochlear ridge>patella»>medial trochlear ridge

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14
Q

How does osteochondritis dissecans of the stifle present?

A

Stifle effusion
(Lameness)

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15
Q

How does osteochondritis dissecans of the stifle present on radiography?

A

Subtle flattening
Subchondral bone lysis
Overt fragmentation

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16
Q

Describe conservative treatment for osteochondritis dissecans of the stifle

A

<12 mo
Dietary advice; exercise restriction
Monitor lameness

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17
Q

Describe surgical treatment for osteochondritis dissecans of the stifle

A

If >12 mo +/- lameness
Removal of osteochondral fragments
Curettage to healthy subchondral bone
Prognosis:
- 54-78% depending of lesion size
- If severe lesion = euthanasia

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18
Q

What is another term for subchondral bone cyst?

A

Osseous cyst-like lesion (OCLL)

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19
Q

When do horses most commonly present with Osseous cyst-like lesions?

A

Usually present later than OCD (1-3yrs+)
Also secondary to trauma

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20
Q

Where in the stifle is most commonly affected by with Osseous cyst-like lesions?

A

Usually medial femoral condyle
Also proximal tibia

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21
Q

How do horses with osseous cyst like lesions of the stifle present?

A

Lameness ++ - Can be intermittent/severe
+/- MFT/FP joint effusion - May require stifle block to confirm

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22
Q

Describe the treatment options for osseous cyst like lesions?

A

Inject joint - Intra-articular corticosteroids
Inject cyst under GA – Corticosteroids
Debride cyst under GA
Bone screw across cyst

23
Q

Describe the prognosis following treatment for osseous cyst like lesions of the stifle

A

Age-dependent
- 64% returned to soundness if <3yo
- 35% returned to soundness if >3yrs
Injecting cyst = 77% soundness

24
Q

Are meniscal and mensicotibial ligament injuries more common on the medial or lateral side?

A

Medial

25
Q

Describe the importance of osteoarthritis in the stifle

A

The stifle is an unforgiving joint
High motion

26
Q

List the causes of osteoarthritis in the stifle

A

Trauma/soft tissue injury
Secondary to fracture
Sequelae to sepsis
OCD/OCLL

27
Q

How does osteoarthritis in the stifle appear on radiography?

A

New bone formation – osteophytes on multiple areas
Mineralisation of the meniscus

28
Q

How is osteoarthritis in the stifle diagnosed?

A

Moderate lameness
+ve response to diagnostic analgesia
Radiography
(ultrasonography/scintigraphy)

29
Q

How is osteoarthritis in the stifle treated?

A

Palliative
NSAIDs; intra-articular medication

30
Q

What is the most common cause of upper hindlimb fractures?

A

Usually traumatic in origin
- Hitting fence/kick
- Tibial stress fractures in racehorses

31
Q

Tibial tuberosity fractures must not be misdiagnosed as?

A

Growth plate - Radiograph both legs to determine

32
Q

Describe tibial tuberosity fractures

A

Kick injury +/- wound
Conservative management good outcome (can repair)

33
Q

How are patellar fractures managed?

A

Surgical removal (<1/3) or fixation

34
Q

How are complete fractures of the femur/tibia treated?

A
  • Adult or >250kg and/or comminuted/open = euthanasia
  • Foal or weanling = Possible to repair but need expertise+++ and high risk of complications!
35
Q

Describe the aetiology of upward fixation of the patella

A

Medial pole of patellar hooks over medial trochlear ridge of femur (stay apparatus)
Unlocked by quadriceps contraction
Patellar has locked and then is stuck in that position – why?
- Patellar ligaments are too tight
- Quadriceps are too weak

36
Q

Describe the clinical signs of upwards fixation of the patellar

A
  • Poorly muscled/rested/muscle loss/straight hind limb conformation
  • Limb locked in extension and dragged -> Dorsal toe wear
  • Intermittent or persistent
37
Q

Describe the treatment options for upwards fixation of the patellar

A
  • Exercise/build up quadriceps muscle
  • Look for concurrent problem!
  • Splitting/injecting medial patellar ligament
  • Medial patellar desmotomy – associated with secondary patella fragmentation
38
Q

Describe the main features of osteoarthritis of the coxofemoral joint

A
  • Secondary to dysplasia, rupture of the teres ligament, trauma
  • Moderate to severe lameness
  • Intra-articular medication poor results
  • Usually results in euthanasia
39
Q

Describe the main features of subluxation of the coxofemoral joint

A

Miniature breeds overrepresented
Reports of repair (toggle/pin)

40
Q

What is the main function of the pelvis?

A

Main role is to transfer hindlimb impulsion through to the back and propel the horse forwards

41
Q

Describe the articulation of the sacroiliac joint

A

Atypical articulation:
Sacral surface = hyaline cartilage
Ilial surface = fibrocartilage

42
Q

Where is the hemipelvis joined?

A

Pubic symphysis

43
Q

Name the 4 bones of the pelvis

A

Ileum
Ischium
Acetabulum
Pubis

44
Q

Where in the pelvis can fractures occur?

A

Tuber coxae (“knocked down” hip)
Ilial wing
Ilial shaft
Pubis/ischium
Acetabulum

45
Q

Why are ilial shaft fractures life threatening?

A

Iliac shaft fractures that are displaced are life threatening as this is where the iliac artery is located – sharp bone ends can sever artery and the horse will bleed out

46
Q

Describe the aetiology of pelvic fractures

A

Trauma - Any horse
End stage bone fatigue
- Commonly racehorses
- Ilial wing fractures in skeletally immature TBs

47
Q

List the clinical signs of pelvic fractures

A
  • Pain/swelling/muscle spasm/asymmetry
  • Lameness: may resolve quickly if the fracture is incomplete
  • Rectal examination (care!): Sharp discontinuity, Sub-fascial haematoma, Gentle rocking
  • Signs of shock
  • Nerve damage: muscle and anal tone
  • Muscle atrophy: chronic >2wks
48
Q

Ultrasound is useful for diagnosis of which pelvic fractures?

A

Ilial wing, ilial shaft, tuber ischii and tuber coxae

49
Q

How are pelvic fractures treated?

A

Pain relief - NSAIDs
Box rest:
- Major pelvic fractures: cross-tie for >1 month
- Feed from floor several times daily
- Can still displace!
- 2 months box rest with daily walking out
- 2 months field rest

50
Q

Describe how horses with sacroiliac disease may present

A
  1. Large-framed horses with long backs and weak quarter
    - Associated with Warmblood breeds
    - Dressage/showjumper activity
  2. Lameness
    - Variable – severe in acute
    - Chronic, low grade, intermittent
  3. Poor performance
    - Lack of impulsion
    - Resisting jumps
  4. Pelvic asymmetry - Not always a feature!
    - Muscle atrophy
  5. Pain/swelling - Sacroiliac pain +/-thoracolumbar pain
51
Q

Describe the aetiology of sacroiliac disease

A

The ligamentous junction between the ileum and sacrum gets strained/stressed through poor performance and movement which leads to further poor performance and movement which then leads to lameness

52
Q

Describe the acute treatment of sacroiliac disease

A

4-8 weeks box rest
NSAIDs
Physiotherapy - Massage/pain relief

53
Q

Describe the chronic treatment of sacroiliac disease

A
  1. Work + NSAIDS
  2. Aim to build up limb/pelvic muscles
    - Pole work; weighted shoes/boots
    - Water treadmill
    - Lumbosacral stretching
  3. Perilesional injection - Corticosteroids
  4. Physiotherapy
  5. Shockwave Analgesia

Y4 EQ - Orthopaedics (14 decks)

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