Distal limb conditions & injuries Flashcards
(44 cards)
Types of conditions affecting the distal limb
Trauma
- fractures
- soft tissue injuries including sprains and associated subluxations
- puncture wounds and lacerations (including flexor tendons)
Infection
- puncture wounds and associated cellulitis
- FB
- pododermatitis
Miscellaneous
- sesamoiditis
- nail injuries
- pad injuries
- corns
What are injuries of the talocrural/tibiotarsal joint commonly associated with? What do they involve?
- RTAs
- involve the medial and lateral malleoli with associated subluxations and luxations
What are injuries of the tarsal bones commonly associated with? Tx?
- injuries involving the tarsal bones including the central and quartile bone or T4 seen in the racing greyhound
- as the UK dogs run anti-clockwise it is the right hind that is most commonly affected
- primary repair is possible but if fracture is comminuted or there is an associated subluxation of the joint, arthrodesis is the most appropriate tx
How are tarsometatarsal subluxations with associated fracture best treated?
- arthrodesis
What is the only high motion joint of the tarsus?
- talocrural/tibiotarsal
Does loss of movement in the intertarsal and tarsometatarsal joints affect function? Why?
- no, they have little effect except in the athletic dog
- they’re low motion joints
What breed is degeneration of the plantar ligaments with subsequent subluxation of the proximal intertarsal joints common in?
- Shetland sheepdog
What is the only high motion joint in the carpus?
- the antebrachiocarpal
Do intercarpal and carpometacarpal arthrodesis affect function?
- no as they are low motion joints
Other injuries of the carpus & what they are associated with
Damage/rupture to the collateral ligaments of the antebrachiocarpal joints
- uncommon cf talocrural
- may be associated with fractures to the medial or lateral styloid processes upon which they originate
- due to a normal degree of varus deformity those of the medial collateral are more significant
Luxation of the radiocarpal bone
- uncommon
- associated with rupture of the medial/radial collateral ligament
Intercarpal and carpometacarpal subluxations
- common
- associated with carpal hyperextension injuries (to the palmar ligaments and palmar fibrocartilage)
Metatarsal, metacarpal and phalangeal fractures - what are they generally a result of? Tx
Generally as a result of trauma e.g. RTA, heavy object falling on paw or trapping and twisting the paw
Several techniques that can be used
- external coaptation with dressings or splints. this can be employed if at least 1 of the metatarsal or metacarpal bones is intact to act as a splint
- pinning combined with external coaptation or inclusion in an external fixator
- application of plates
- phalangeal fractures rarely require surgical tx and coaptation is usually adequate
Antebrachiocarpal and talocrural subluxation tx
- reconstructing the ligamentar support with artificial ligament material or arthrodesis of the joint
How are subluxations of both the intertarsal and intercarpal joints treated?
- arthrodesis
When do shear injuries occur? What damage is generally done? What is the effect of this? Tx?
- when the animal is dragged along the road with the loss of usually the medial soft tissues and occasionally bone
- ligament loss results in joint instability or subluxation
- these instabilities can be managed with the use of artificial ligament material including monofilament nylon, braided nylon and orthopaedic wire anchored around bone screws or especially designed bone anchors
- if external support is required then a transarticular external fixator can be applied
Tendon injuries - what can be damaged? how? tx?
- small lacerations to the palmar or plantar aspect region of the paw may include flexor tendons
- this often occurs between the digital and main pad
- may be accompanied by significant haemorrhage
- to determine the integrity of the flexor tendons make the dog weight bear by picking up the other limb and then examine the toe position
- if knocked up either the superficial or superficial and deep flexor tendons will have been cut
- attempts to repair are rarely successful as you need to prevent weight bearing for several weeks
- the abnormality is generally of cosmetic importance only
- warn the O that the toe may look different due to the loss of 1 or 2 flexor tendons
Puncture wounds - presentation, exploration, tx
- managed as will all soft tissue injuries
- present with acute lameness, soft tissue swelling to affected pad and pain on palpation
- radiographs may be appropriate if the presence of a radiopaque FB is suspected e.g. glass
- surgical exploration with the use of a hypodermic needle may allow the retrieval of glass fragments and blackthorns
- flush the wound with Hartmann’s solution and leave open to drain
- apply dressing to protect the wound and prevent further contamination
- use of broad spec antibiotics can be justified in this situation
What is the most common cause of lameness is cats?
- cellulitis as a result of a bit from another cat
Cellulitis - presentation, CE, tx
- acute onset lameness 2-3d after fight which may have been observed by O
- swelling by O and may be pyrexic and off-colour
- careful palpation may reveal scabs either side of the limb where the canine teeth have punctured the skin
- the limb is swollen and painful and the cat may show a variable lameness up to the point where it is NWB
- treat with drainage, bathing to encourage the pus to drain, and broad spec antibiotics
Common FBs
- grass seeds most common
- thorns
- glass
FB - which species is most commonly affected?
- dogs
FB - seasonality?
- July-September generally
FB - presentation
- swelling to interdigital area and then progression to a swelling proximal to the main pad and in the forelimb to the shoulder and hindlimb to the hip
FB - tx
- avoid antibiotics: these will result in rapid improvement but the swelling will return and the FB may have moved to a less accessible site
- poultices may be helpful e.g. boric acid (Animalintex)
- allow the FB to form a small abscess (point) and then lance (no.11 blade) and explore
— this can be performed in the tractable conscious animal
— if find 1, explore for more
Pododermatitis / interdigital pyoderma - what is it? tx?
- significant cause of lameness in particular breeds including the English bulldog and bull terrier
– multiple discharging sinuses, hair loss, swelling, painful - dermatological condition, beware of localised demodex
– put on some bravest or something to manage potential demodex just in case - pt conformation appears to be significant contributory cause of this condition
- previous tx was with prolonged courses of antibiotics and anti-bacterial washes but laser excision of the affected tissue has proven an effective tx reducing the volume of buried hair shafts and follicles
– the wounds are allowed to heal by 2nd intention - it is managed not cured
- on occasions surgery may be helpful e.g. fusion podoplasty
– this sx removes the interdigital areas and fuses each digital pad to its adjacent one
