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Eq SX Musc Skel Exam > Fetlock MC/MT-Morton > Flashcards

Fetlock MC/MT-Morton Flashcards

(45 cards)

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1
Q

Categories P1 fractures

A
  1. Dorso-medial/-lateral P1 OCFs
  2. Proximoplantar/palmar P1 OCFs
  3. Diaphyseal fractures
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2
Q

Dorso- medial/-lateral P1 OCFs etiology

A

High speed hyperextension injury

Most common ‘chip’ fx TB racehorses

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3
Q

Dorso- medial/-lateral P1 OCFs DX

A 
PE & LE
-MCP/MTP effusion, + to flexion, mild lameness
-IA analgesia resolves lameness
Rads
-always do both fetlocks
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4
Q

Dorso- medial/-lateral P1 OCFs TX

A

Arthroscopic removal

Screw fixation if large frag (rare)

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5
Q

Dorso- medial/-lateral P1 OCFs Prog

A

Good unless significant OA

> 80% return to athletic function after removal

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6
Q

Proximoplantar/palmar P1 OCFs etiology

A

Controversial
-Manifestation OCD
-Traumatic
Common in young STB racehorses

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7
Q

Proximoplantar/palmar P1 OCFs DX

A

PE & LE
-Effusion, +/- to flexion, rarely lame
Rads
-Incidental (PPE)

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8
Q

Proximoplantar/palmar P1 OCFs TX

A

Smaller frags
-conservative 6-12 weeks rest
Larger frags
-arthroscopic removal (Plantar approach)

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9
Q

Proximoplantar/palmar P1 OCFs progn

A

Good-63% return to prev. level racing

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10
Q

Diaphyseal fractures etiology

A
  • Repetitive use injury
  • Sagittal plane propagate proximally to distally most commonly (sagittal groove)
  • Racehorses, and jumpers
  • Often spiral fx
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11
Q

Diaphyseal fractures DX

A

Rads

Avoid blocking

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12
Q

Diaphyseal fractures TX

A
  • Most require internal fixation

- Poor prognosis (barbaro)

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13
Q

Sesamoid fractures etiology

A

High speed, repetitive use
-most common type of catastrophic breakdown injury (biaxial)
Fore > hind; medial > lateral; uniaxial > biaxial
Apical > basilar > midbody
-apical/basilar=> avulsion fx

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14
Q

Sesamoid fractures DX

A 
PE & LE
-Sudden, acute lameness
-ECP/MTP effusion if articular
-fetlock drop if sig loss sups apparatus
Rads
Blocking-chronic
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15
Q

Sesamoid fractures TX

A

Arthroscopic removal-apical/abaxial (basilar)
-If more than 25% suspensory attachment involved removal not well tolerated
Repair-internal fixation

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16
Q

Sesamoid fractures Internal fixation options

A
  1. Screw in lag fashion +/- bone graft
  2. Tension band wire
  3. Arthroscopy to ensure anatomical reduction
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17
Q

Sesamoid fractures prognosis

A 
Fair-excellent simple apical fx
Fair for mid-body (uniaxial) fx
-difficult to repair, subsequent OA
-horses rested ~ 1yr
Difficult to avoid sesamoiditis and damage to suspensory lig that accompanies fx
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18
Q

POD

A

Palmar/Plantar Osteochondral dz

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19
Q

POD etiology

Study These Flashcards
A
  1. Repetitive stress injury-results in maladaptive bone remodeling
  2. MC3/MT3 condylar dz-subchondral bone injury (‘edema’/necrosis/sclerosis), cartilage damage, supracondylar bone remodeling (resorption)
  3. Leads to osteoarthrosis
  4. predisposes to MC3/MT3 condylar fxs
  5. TB racehorses most commonly affected
20
Q

POD DX

Study These Flashcards
A
  1. Signalment
  2. PE/LE + palmar/plantar metacarpal n. block
  3. BONE SCAN
  4. RADS-sclerosis, trabecular bone changes)
  5. MRI
  6. CT
21
Q

POD TX

Study These Flashcards
A
  1. REST (90+ days)
    - continued training may lead to catastrophic failure
  2. Pain Management
    - NSAIDS
    - IA medication
    - ESWT
    - Bisphosphonates (not young horses)
  3. REPEAT BONE SCAN BEFORE RETURN TO TRAINING
22
Q

Condylar fractures MC3/MT3 etiology

Study These Flashcards
A

Common in racehorses-cannon sustains high loads
-Stress accumulation and micro-fx within distal palmar/plantar condyles leads to acute fx at high speeds
Vertical fxs that propagate proximally and sagittally from joint

23
Q

Condylar fractures MC3/MT3 types

Study These Flashcards
A

Lateral Condyle
-mostly short and complete, more common in MC3
-85% of forelimb condylar fxs are lateral
Medial Condyle
-Usually spiral, more common in MT3, Y shaped
-More prone to catastrophic failure (even after repair)

24
Q

Condylar fractures MC3/MT3 coaptation

Study These Flashcards
A

VERY IMPORTANT

-half/full limb dorsal splint, cast, kimzey splint

25
Condylar fractures MC3/MT3 DX
1. PE: acute, marked lameness 2. Rads: RADIOGRAPH BEFORE BLOCKING 3. Nuclear Scint 4. CT-surgical planning
26
Condylar fractures MC3/MT3 TX
1. Lag screw fixation 2. Arthroscopy to confirm reduction, clean up frags 3. Plating-needs to be removed before return to high speed
27
Condylar fractures MC3/MT3 aftercare
3 month lay-off; mean return to start time 9 months
28
Condylar fractures MC3/MT3 Prognosis
Directly related to severity of injury Soundness depends on perfect reconstruction of joint 65% return to racing
29
Bucked shins
Dorsal metacarpal disease (DMD) -maladaptive remodeling of MC3 Common in young TB racehorses Predisposes to dorsal cortical fractures
30
DMD DX
1. PE - Heat, swelling, pain on palpation - Acute onset lameness after high speed workout 2. Rads - thickened dorsal cortex/periosteal rxn - may be bilateral 3. Nuclear Scintigraphy
31
DMD TX
1. Prevention-training - rest - NSAIDS - appropriate training modifications - counter irritants (pin firing historically, maybe don't do)
32
DMD prognosis
Very good | Risk for dorsal cortical stress fxs
33
Dorsal cortical fx MC3 etiology
Progression maladaptive bone remodeling Usually incomplete Saucer fx - complete DX-similar to DMD
34
Dorsal cortical fx MC3 TX
1. Rest - stall rest with gradual return to exercise - frequent, short breezes once back into full training 2. Soundess to asses healing 3. Extracorporal shockwave therapy 4. Surgery - Osteostixis (cortical drilling): improv vascularization - 3.5 mm unicortical screw-must remove
35
Dorsal cortical fx MC3 prognosis
- Good (85 and 97% return to racing after cortical drilling/ cortical drilling + screw) - Reccurence of fx more common after cortical drilling alone compared to drilling + screw - Recurrence rate higher w/o surgery (anectodally)
36
Splints etiology
Proliferative periostitis of small MCs/MTs Primarily young horses Cyclic strains during exercise Trauma resulting in subperiosteal hemorrhage and lifting of periosteum
37
Splints DX
1. PE/LE - local firm swelling +/- painful to palp - may block to low or high 4-point/6-point 2. Rads 3. Nuclear scintigraphy 4. U/S TO EVAL CONCURRENT SUSPENSORY PATHOLOGY
38
Splints TX
1. Most respond to conservative tx - rest until not sensitive to palpation - bandaging - NSAIDS, cold, topical diclofenac, local steroid inj - ESWT 2. Splint ostectomy for chronic/nonresponsive cases/impinging on suspensory ligament 3. Treatment of any concurrent suspensory desmitis
39
Splints prognosis
Good to excellent
40
Splint fractures etiology
1. Direct trauma-kick 2. Exercise-cyclic strain, strain on suspensory and inter-osseous ligament 3. fx usually distal 1/3 4. 67-81% distal splint fractures have concurrent suspensory desmitis
41
Splint fractures DX
1. PE/LE - typically acute lameness 2. Rads 3. U/S - concurrent suspensory desmitis
42
Splint fractures TX
1. Closed fx-conservative - Stall rest, bandage, cold therapy, NSAIDS, surpass - healing accompanied by large exostosis-impingement ofsuspensory ligament 2. Excessive callous ush needs to be removed 3. Open fx - often form sequestrum - remove and debride
43
Splint removal
Up to 2/3 distal aspect MC/MT II or MC/MT IV | -probs can't actually remove whole MT IV
44
Splint internal fixation
Req'd for proximal unstable fractures
45
Splint bone fractures prognosis
1. Distal 2/3 fractures good prognosis - depends on concurrent SL desmitis 2. Proximal fractures-good unless residual instability of CMC/TMT joint +/- OA, infection into adjacent synovial structures

Eq SX Musc Skel Exam (20 decks)

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