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LAS - RUSS > Arthrodesis of PIJ / Bone Spavin > Flashcards

Arthrodesis of PIJ / Bone Spavin Flashcards

1
Q

Indications for Pastern Arthrodesis:

1.
2.
3.
4.

A
  1. High Ring Bone
  2. Pastern Luxation
  3. Fracture of P2
  4. Septic arthritis of Pastern
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2
Q

What is High Ringbone?

Low ringbone?

A

Osteoarthritis/osteophytes of proximal pastern joint (PIP)

OA/osteophytes of coffin joint

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3
Q

T/F:

Natural ankylosis as healing for OA of PIP joint is unlikely

A

T

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4
Q

2 Main Goals of PIP arthrodesis

1.
2.

A
  1. Removal of all articular cartilage

2. Maintenance of rigid stability of the joint

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5
Q

3 main surgical techniques for pastern arthrodesis

1
2.
3.

A
  1. Trans-articular lag screws
  2. Dorsal plate (DCP or LCP)
  3. Both! This is the best way to do it
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6
Q

Benefits of TA screws + Dorsal Plate as tx choice for Pastern Arthrodesis:

1.
2.
3.
4.
5.
6.
A
  1. Enhanced stability
  2. Improved comfort post-op
  3. Shorter time in a cast
  4. Shorter return to function
  5. Shorter hospitalization time
  6. Less peri-articular new bone formation on dorsal aspect
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7
Q

Surgical Technique for TA Screws + Dorsal Plate Arthrodesis:

  1. _______ incision
  2. Dissect through SQ to the _____-
  3. Elevate and retract…..
  4. Transect ____ with ___ incision
  5. Remove….
A
  1. Inverted T incision
  2. CDE tendon
  3. 2 skin triangles
  4. CDE inverted V
  5. bony proliferation
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8
Q

Surgical Technique for TA Screws + Dorsal Plate Arthrodesis:

You’ve already made the incision and remove bony proliferation. Next steps:

  1. Transect ___, ____, ___-
  2. Remove _____
  3. Osteostixis of ______
  4. Drill bit?
A
  1. joint capsule, MCL, and LCL.
  2. Cartilage
  3. subchondral bone plates (P1 and P2)
  4. 2.5 mm
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9
Q

Drilling during Surgical Technique for TA Screws + Dorsal Plate Arthrodesis:

  1. Drill through what?
  2. Purpose of drilling?
A
  1. through subchondral bone plate into medullary canal

2. Promote bone healing by bringing in bone factors and mesenchymal cells.

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10
Q

Surgical Technique for TA Screws + Dorsal Plate Arthrodesis:

  1. (extend/flex) foot?
  2. ___-hole plate on dorsal surface (axially/abaxially)?
  3. use ____ plate
  4. How many holes in P1? in P2?
  5. Place how many screws?
A
  1. extend
  2. 3-hole axially
  3. contour
  4. 2, 1
  5. 2 (proximal and distal)
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11
Q

Surgical Technique: TA screws:

  1. Enter joint how far between dorsal and palmar cortices?
  2. Drill (glide/thread) hole in P1 with ___mm bit
  3. Drill (glide/thread) hole in P2 with __ mm bit
A
  1. halfway
  2. glide hole, 5.5
  3. thread hole, 4.0
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12
Q

Arthrodesis to treat severe OA of pastern joint

  1. # of screws placed? Type of screw?
  2. engages as much of the ____ as possible.
A
  1. 2 or 3 lag screws

2. middle phalanx

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13
Q

A horse has lameness after insertion of 5-hole CDP and screws 8 months post surgery.
Tx?

A

Plate removal

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14
Q

Success rate for pastern arthrodesis is higher for forelimbs or hindlimbs?

A

hindlimbs

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15
Q

Clinical signs/Diagnostics of Complications from Pastern Arthrodesis:

1.
2.
3. Often due to ___
4.

A
  1. Increasing lameness
  2. Imaging
  3. cast
  4. CBC/ SAA, Fever = monitoring for infection
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16
Q

Bone spavin is a common cause of (forelimb/hindlimb) lameness

A

hindlimb

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17
Q

Bone Spavin definition:

A

DJD of distal intertarsal (DIT) and tarso-metatarsal (TMT) joints.

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18
Q

Bone spavin affects the (medial/lateral) aspect of the joint, and can result in significant _____ formation

A

medial

osteophyte

19
Q

describe a horse with a “camped under” conformation

A

hindlimb is not caudal enough, and the cannon bone is not perpendicular to the ground

20
Q

Radiographic Grading of Bone Spavin:

Describe Grade 1:

A

a very small osteophyte distolateral central tarsal bone

21
Q

Radiographic Grading of Bone Spavin:

Describe Grade 2:

A

a small osteophyte proximal dorsolateral MTIII

22
Q

Radiographic Grading of Bone Spavin:

Describe Grade 3:

A

A medium osteophyte distomedial central tarsal bone

23
Q

Radiographic Grading of Bone Spavin:

Describe Grade 4:

A

A large osteophyte proximal dorsolateral MTIII bone

24
Q

Causes of bone spavin?

A

chronic repetitive compression, torsion, and shear strains.

Common in western performances performing cutting/reining/roping/barrel racing

25
Q

T/F: Distal limb flexion is a test used to diagnosis bone spavin

A

F, PROXIMAL limb flexion. Can also use blocks/radiographs/imaging

26
Q

What is the main surgical treatment for bone spavin?

A

ankylosis

27
Q

Medical managment of bone spavin involves:

  1. 2.
    3.
    4.
A
  1. IA injections of corticosteroids/chondroprotectives/autologous anti-inflammatories
  2. Phenylbutazone
  3. exercise adaption
  4. corrective shoeing
28
Q

What surgical treatment for bone spavin decreases rotational and shearing forces?

Prognosis of this treatment method?

A

Cunean tenectomy

good to excellent

29
Q

Performing ankylosis of TMT and DIT joints:
Methods:

1.
2.

A
  1. Mechanical - drill out joints using drill bit

2. Chemical - 70% ethanol, MIA (monoiodoacetate, no longer used), or Nd: YAG/Diode laser

30
Q

Trans-articular drilling as tx of Bone Spavin:

  1. (medial/lateral) approach.
  2. approach distal to ____
  3. drill bit size?
  4. goal is to create…
A
  1. medial
  2. distal to cunean tendon
  3. initially 3.2mm, than 4.5mm
  4. create 3 drill tracts at 30 degree diverging angles
31
Q

Pos-op care after drilling for Bone Spavin tx?

A

phenylbutazone, bandagin every 2 weeks, handwalking for 2 weeks post op, light right riding 3-4 weeks post op.

32
Q

Surgical Ankylosis (drilling) tx method for bone spavin:

  1. What percentage range of horses return to soundness?
  2. Average time it takes?
A
  1. 59%-85%

2. 7.5 months

33
Q
  1. How does laser facilitated ankylosis for bone spavin work?
A
  1. destroys cartilage by superheating and vaporizing synovial fluid.
34
Q

what is the benefit of using laser facilitated ankylosis to treat bone spavin?

A

less pain/discomfort post op, and promotes partial ankyloses

35
Q

What is the drawback of using laser facilitated ankylosis as treatment for bone spavin?

A

significantly less fusion of the distal tarsal joints compared with other techniques

36
Q

Ethyl alcohol facilitated ankylosis:

Lameness resolved in ___% of horses with bone spavin within 3 months

A

86%

37
Q

Why do we no longer use monoiodoacetate injections as a chemical method of treating bone spavin?

A

is has considerable morbidity, severe post-op pain, and has the potential for severe complications (PIT joint communication)

38
Q

Fracture of proximal phalanx:

75% are in the (forelimb/hindlimb)?

A

forelimb

39
Q

Drilling for P1 fracture:

Describe the location of the most proximal screw?

additional screws placed at ___-___mm intervals

A

within 5 mm of sagittal grove

20-22mm

40
Q

P1 fracture:

  1. Post-op care?
  2. Prognosis depended upon _____ and ____
A
  1. Distal limb cast 2-6 weeks

2. resultant fetlock and pastern DJD

41
Q

How would you treat an incomplete P1 fracture?

A

Lag screw or cast only, STRICT STALL REST

42
Q

Treatment of comminuted P1 fracture?

A

fetlock arthrodesis as a salvage procedure. They aint returning as athletes

43
Q

Indications for Fetlock Arthrodesis?

1.

2.

3.

A
  1. complete rupture of SDF, DDF, and suspensory ligament
  2. septic arthritis
  3. Fractures: Medial and lateral sesamoid, cannon bone, P1

LAS - RUSS (32 decks)

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