E2: Angular and Flexural limb deformities

Question 1

_____ limb deformities are postural defomrities in the frontal plane of the limbs with either lateral (valgus) or medial (varus).

Answer 1

Angular

Question 2

A ______ limb deformity is hyperflexion of a limb and results from disparity in length of the musculotendinous unit relative to bone length.

Answer 2

Flexural

Question 3

How far apart should hooves be when a horse is standing normally?

Answer 3

1 hoof-width

Question 4

Which of these (left or right) is a valgus deformity? What is the other one?

Answer 4

Right is valgus

Left is outward rotation

Question 5

On rads of a foal’s joint you note that the carpal bones appear rounded. What does this indicate and what conditions can this lead to?

Answer 5

Incomplete ossification

Vargus or valgus or ligament laxity (leading to deformity)

Question 6

What is indicated by the red arrow?

Answer 6

Pivot point

Question 7

If you determine the pivot point is in the growth plate and you need to accelerate growth on one side of the bone and retard growth on the other, that procedures do you need to perform?

Answer 7

Hemicercumferential periostal transection and elevation (HCPTE)/ Periosteal Stripping for ACCELERATION

Surgical screws and wire for RETARDATION

Question 8

What is indicated when you notice that the deformity that screws and plates were placed to correct has been corrected?

Answer 8

Removal of the implants

Otherwise will overcorrect

Question 9

What is indicated if the pivot point of a deformity is at the end of the growth plate?

Answer 9

Corrective osteoectomy

Question 10

What type of deformity does this 3-week-old foal have?

Answer 10

Carpal valgus

Question 11

Which 4 things are required for selecting the appropriate therapy for angular limb deformities in foals?

Answer 11

Observation at rest

Observation at exercise

Radiography

Manipulation of the affected limb

Question 12

Which of these deformities is NOT manually reducible?

a. Periarticular laxity
b. Hypoplasia of the proximal aspect of the 4th metacarpal bone
c. Asynchronous physeal and/or epiphyseal growth
d. Early hypoplasia of the cuboidal bones

Answer 12

c. Asynchronous physeal and/or epiphyseal growth

Question 13

What type of deformity is seen here, what causes it, and wha tis the characteristic gait associated with this?

Answer 13

Sickle-hock

Hypoplasia of the tarsal bones

Bunny-hop gait when trotting

Question 14

Which statement regarding limb conformation in foals with angular limb deformities is correct?

a. With valgus deformities, there is usually a certain degree of outward rotation of the feet.
b. With varus deformities, there is usually a certain degree of outward rotation of the feet.
c. With valgus defomrities, , there is usually a certain degree of inward rotation of the feet.
d. Rotational deformities are uncommon in foals with angular limb deformities.

Answer 14

a. With valgus deformities, there is usually a certain degree of outward rotation of the feet.

With VARUS see INWARD rotation

Question 15

Which of the following is not a part of the mutifactoral complex implicated in the development of angular limb deformities in foals?

a. Abnormal fetal limb positioning
b. placentitis
c. hypoplasia of the proximal sesamoid bones
d. growth-plate trauma

Answer 15

c. hypoplasia of the proximal sesamoid bones

Question 16

Which statement regarding the diagnosis of angular limb deformities in foals in correct?

a. Regardless of the degree and location of the deformity, all foals should have their limbs radiographed at the initial examination
b. The limb can usually be manually straightened in foals with asymmetric physeal or epiphyseal growth
c. The limb can usually be manually straightened in foals with hypoplasia of the carpal bones
d. Radiography is useful in determining the degree of rotational deformity

Answer 16

c. The limb can usually be manually straightened in foals with hypoplasia of the carpal bones
* Cause of carpal bone hypoplasia = cuboidal bone hypoplasia*

Question 17

T/F: Because of this medial to lateral ossification pattern, foals with hypoplastic carpal bones tend to present with valgus deformities.

Answer 17

True

Question 18

Which statement regarding the diagnostic workup of foals with tarsal angular limb deformities is correct?

a. A dorsoplantar view is especially useful in identifying tarsal bone hypoplasia
b. A lateromedial view is especially useful in identifying tarsal bone hypoplasia
c. Clinicials should rely heavity on dorsoplantar views for exact identification and evaluation of the location and degree of tarsal angular limb deformities
d. Concurrent rotational deformities are best identified using radiography

Answer 18

b. A lateromedial view is especially useful in identifying tarsal bone hypoplasia

Question 19

Which of the following is the most likely cause of carpal angular deformities in newborn foals?

a. Asymmetric growth at the distal radial growth plate
b. Periarticular laxity
c. Delayed ossification of the epiphysis
d. Asymmetric growth at the distal radial growth plate and the epiphyseal growth cartilage

Answer 19

b. Periarticular laxity

Caused by fetal malpostioning

Question 20

Which statement regarding congenital hypothyroidism is correct?

a. It has been implicated as a cause of uneven physeal growth
b. It has been implicated as a cause of delayed ossification of the carpal and tarsal cuboidal bones
c. It has been implicated as a cause of delayed epiphyseal ossification
d. It is often associated with abnormal fetal limb positioning

Answer 20

b. It has been implicated as a cause of delayed ossification of the carpal and tarsal cuboidal bones

Question 21

Foals with tarsal bone hypoplasia tend to present with:

a. Valgus deformity
b. Varus deformity
c. Valgus deformity and straight-hocked appearance
d. Valgus deformity and sickle-hocked appearance

Answer 21

d. Valgus deformity and sickle-hocked appearance

Question 22

Which statement regarding physical exam of foals with angular limb deformities is TRUE?

a. Angular limb deformities are often associated with some degree of lameness in the affected limb(s)
b. Angular limb deformities are normally associated with heat, pain, and swelling at the site of the deformity
c. In most cases, foals with angular limb deformities are not lame
d. A and B

Answer 22

c. In most cases, foals with angular limb deformities are not lame

Question 23

Which statement regarding foals with cuboidal bone hypoplasia is correct?

a. If left untreated, cuboidal bone hypoplasia results in a manually irreducible deformity within 2 weeks
b. If left untreated, cuboidal bone hypoplasia results in a manually irreducible deformity within 2 days
c. Manual reducibility of this condition is not time dependent
d. This condition is never manually reducible

Answer 23

a. If left untreated, cuboidal bone hypoplasia results in a manually irreducible deformity within 2 weeks

Question 24

Angular limb deformities most often originate within the carpal, tarsal, ____________ joint regions

a. Or distal interphalangeal
b. Or proximal interphalangeal
c. Or metacarpo- or metatarsophalangeal
d. Or distal interphalangeal, or metacarpo- or metatarsophalangeal

Answer 24

c. Or metacarpo- or metatarsophalangeal

Question 25

Which statement regarding management of congenital angular limb deformities is correct? a. In most foals born with mild to moderate angular limb deformities, spontaneous resolution is unlikely. b. In most foals born with mild to moderate angular limb deformities, spontaneous resolution occurs within 2 to 4 weeks of life. c. In most foals born with angular limb deformities due to carpal or tarsal bone hypoplasia, spontaneous resolution occurs within 2 to 4 weeks of life. d. In most foals born with angular limb deformities due to carpal or tarsal bone hypoplasia, spontaneous resolution occurs within 4 to 8 weeks of life

Answer 25

b. In most foals born with _mild to moderate_ angular limb deformities, spontaneous resolution occurs within 2 to 4 weeks of life.

Question 26

To avoid development of a contracted foot in a foal, glue-on shoes should not be left on for longer than a. 2 months. b. 3 months. c. 2 weeks. d. none of the above

Answer 26

c. 2 weeks.

Question 27

To allow rapid growth in young foals, tube casts should be changed at _______ intervals. a. 3- to 4-day b. 10 - to 14-day c. 3- to 4-week d. 4- to 6-week

Answer 27

b. 10 - to 14-day

Question 28

Corrective ostectomy or osteotomy is a. preferred in treating tarsal bone hypoplasia. b. preferred in treating severe carpal or tarsal bone hypoplasia. c. generally performed before cessation of physeal growth. d. generally performed after cessation of physeal growth.

Answer 28

d. generally performed after cessation of physeal growth.

Question 29

According to a recent experimental study, HCPTE was a. More effective than stall confinement alone in correcting carpal angular limb deformity. b. Less effective than stall confinement alone in correcting carpal angular limb deformity. c. As effective as stall confinement alone in correcting carpal angular limb deformity. d. As effective as unlimited pasture exercise in correcting carpal angular limb deformity.

Answer 29

c. As effective as stall confinement alone in correcting carpal angular limb deformity.

Question 30

Which statement regarding treatment of foals with carpal bone hypoplasia is correct? a. Foals with carpal bone hypoplasia often require surgical treatment after an initial period of splint bandaging. b. Foals with valgus deformities caused by carpal bone hypoplasia should be treated with confinement and by applying a glue-on shoe with extension to the inside. c. Foals with valgus deformities caused by carpal bone hypoplasia should be treated with confinement and by applying a glue-on shoe with extension to the outside d. Foals with carpal bone hypoplasia should be treated with splint bandaging or tube casting.

Answer 30

d. Foals with carpal bone hypoplasia should be treated with splint bandaging or tube casting.

Question 31

A 6-week-old foal with a significant varus deformity caused by asymmetric growth at the distal metatarsal growth plate in the left hindlimb is best treated with a. splint bandaging and confinement . b. confinement. c. corrective trimming and, possibly, shoeing as well as confinement. d. surgery, corrective trimming, and, possibly, shoeing as well as confinement .

Answer 31

c. corrective trimming and, possibly, shoeing as well as confinement. ## Footnote *Can do surgery once 6 months old*

Question 32

Which statement regarding HCPTE (hemicircumferential periosteal transection and elevation) is true? a. HCPTE temporarily retards longitudinal growth on the convex aspect of the deformity. b. HCPTE temporarily increases longitudinal growth on the concave aspect of the deformity. c. Foals that have undergone HCPTE require a second surgery to prevent overcorrection of the deformity. d. HCPTE exerts its effect for approximately 3 months.

Answer 32

b. HCPTE temporarily increases longitudinal growth on the concave aspect of the deformity ## Footnote *Concave aspect of deformed limb is where HCPTE is performed*

Question 33

Which statement regarding TPB (transphyseal bridging) is correct? a. TPB is primarily used in young foals with severe angular deformities, miniature foals, or foals with significant limb deformity after the rapid growth phase. b. TPB is primarily used in foals with diaphyseal deformities. c. Contrary to HCPTE, overcorrection has not been reported after TPB. d. TPB is primarily used in young foals with severe angular deformities, miniature foals, or foals with diaphyseal deformities.

Answer 33

a. TPB is primarily used in young foals with severe angular deformities, miniature foals, or foals with significant limb deformity after the rapid growth phase.

Question 34

Postoperative treatment of foals using HCPTE includes a. free pasture exercise because it tends to increase the rate of correction. b. confinement. c. splint bandaging. d. none of the above

Answer 34

b. confinement.

Question 35

What flexural deformity is present if the toe is elevated from the ground and the fetlock is sinking?

Answer 35

Digital hyperextension

Question 36

How does oxytetracyline help with digital hyperextension?

Answer 36

It binds calcium causing muscle relaxation ## Footnote *Not always effective*

Question 37

T/F: A tendontomy of the SDFT and DDFT is indicated for a doal with bilateral contracted tendons.

Answer 37

False, can do in calf but not foal

Question 38

If you place a cast on for 2 weeks, how long will it (typically) take to reverse the muscle atrophy?

Answer 38

2 weeks

Question 39

What type of shoe can be used for an animal with a flexor tendon rupture?

Answer 39

Shoe with elongated/extended heel

Question 40

How can callus formation result in an animal being able to walk on a limb but having difficulty advancing the limb forward?

Answer 40

Constriction of the radial nerve

Question 41

What is club-foot? How is it treated surgically?

Answer 41

Flexural deformity at distal interphalangeal joint Inferior check ligament desmotomy