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1
Q

What is the primary determinant of equine joint health?

A

Articular cartilage

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2
Q

What component of equine articular cartilage synthesizes, organizes, and regulates the composition of the extra-cellular membrane?

A

Chondrocytes

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3
Q

What type of collagen is present in equine articular cartilage?

A

Type 2

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4
Q

Which component of equine articular cartilage counteracts the tensile stresses at the joint surface?

A

Collagen

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5
Q

What type of stress does collagen counteract at the joint surface?

A

Tensile

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6
Q

Which component of the equine articular cartilage resists compressive forces?

A

Aggrecan (a proteoglyan)

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7
Q

What force does aggrecan resist?

A

Compressive

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8
Q

How does articular cartilage receive nutrition?

A

Motion!

Cartilage has no blood supply

Compression expels water and soluble waste

Relaxation brings in water and soluble waste

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9
Q

What molecule contributes to synovial fluid viscosity?

A

Hyaluronan

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10
Q

What is the function of the synovial fluid?

A

Lubricate gliding surface

Nutrition supply and waste removal from cartilage

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11
Q

What is the Matrix Metalloproteinase inhibitor?

A

Tissue Inhibitor of Metalloproteinases (TIMP)

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12
Q

What are aggrecanases?

A

A distintegrin and metalloproteinase thrombospondin motifs

ADAMTS

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13
Q

What are the inflammatory cytokines in articular cartilage and what do they do?

A

IL-1 and TNF-a

Increase production of MMPs, oxygen free radicals, and prostaglandins

Inhibit collagen and aggrecan synthesis

Upregulate each other

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14
Q

What is the function of prostaglandins in articular cartilage?

A

Proteoglycan degradation

Sensitizes nerves to mediators of pain

Production stimulated by IL-1

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15
Q

What types of repair does cartilage undergo?

A
  1. Intrinsic: chondrocyte synthetic activity
  2. Extrinsic: cells from marrow cavity, requires penetration of subchondral bone
  3. Matrix flow: cartilage melts into fill lesion
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16
Q

What are the major classes of equine joint disease?

A
  1. Developmental orthopedic disease
  2. Traumatic/degenerative arthritis
  3. Septic arthritis
  4. Immune-mediated polyarthritis
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17
Q

What are examples of equine developmental orthopedic diseases?

A

Osteochondrosis

Osteochondritis dessicans

Subchondral bone cysts

Delayed ossification

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18
Q

T/F: traumatic/degenerative osteoarthritis causes irreversible changes to the joint

A

True

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19
Q

What tissue changes are seen with equine osteoarthritis?

A

Synovitis

Capsulitis

Ligamentous or meniscal injury

Primary cartilage injury

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20
Q

What is the gold standard in diagnosing equine osteoarthritis?

A

Arthroscopy

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21
Q

What clinical signs are associated with equine osteoarthritis?

A

Pain
Synovial effusion
Decreased range of motion
Local inflammation

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22
Q

What would you expect to see on radiographs of a horse with osteoarthritis?

A

Enthesiophytes

Osteophytes

Joint space narrowing

Subchondral bone sclerosis and/or lysis

Osteochondral fragments

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23
Q

For horses with osteoarthritis, does the severity of radiographic changes correlate with the amount of pain?

A

NO

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24
Q

What are the main goals in treating equine osteoarthritis?

A

Remove inciting cause*

Slow the progression of degeneration

Alleviate clinical signs

Restore function

Improve quality of life

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25
How do you treat equine osteoarthritis?
REST Surgery: remove inciting cause, debridement, repair stimulating techniques, *cartilage repair* Medical tx
26
What types or surgery exist for the treatment of osteoarthritis?
Graft procedures Arthrodesis Facilitated ankylosis Joint stabilizing surgeries (TPLO, TTA, etc) Joint replacement
27
What types of medical therapy is used to treat osteoarthritis?
NSAIDs Corticosteroids Hyaluronan Polysulphated glycoaminoglycan Pentosan polysulphate
28
What types of corticosteroids are used to treat equine osteoarthritis and what route of administration is most common?
Methylprednisolone acetate: low motion joints Triamcinolone acetonide: high motion joints Intra-articular administration
29
What is the main functions of hyaluronan in the medical treatment of equine osteoarthritis?
Lubrication and anti-inflammatory
30
What is the function of polysulphated glycosaminoglycan in the medical treatment of equine osteoarthritis?
Stimulates endogenous hyaluronan synthesis Condroprotective effects
31
What is the function of pentosan polysulphate in the medical treatment of equine osteoarthritis?
Decreased fibrillation | For early OA only
32
What biologic therapies exist for the treatment of equine osteoarthritis?
IRAp or ACS PRP Stem cells Gene therpy
33
What are neutraceuticals?
Supposedly help with osteoarthritis Do not require FDA approval for safety and efficacy Glucosamine, chondroitin sulfate, cosequin, herbs, antioxidants etc.
34
What are the 3 types of equine septic arthritis?
Traumatic Iatrogenic Hematogenous
35
T/F: septic arthritis in horses is always an emergency
True
36
What are the different types of equine hematogenous septic arthritis?
Affect foals! S-type: synovial membrane and fluid E-type: subchondral bone of epiphysis -> extends into joint P-type: physis, may extend into joint
37
How do you diagnose equine septic arthritis?
Clinical signs Rads Synovial fluid (clin path and culture)
38
Does a lack of bacteria in synovial fluid analysis rule out septic arthritis?
No, you will rarely see bacteria Mostly will see neutrophils
39
What organisms would you expect in a synovial fluid culture in a horse? Foal? Cow?
Horse: staph aureus Foal: enterobacteriaceae, strep, rhodococcus, actinobacillus Cattle: A. Pyogenes, strep, salmonella, e. coli, mycoplasma
40
How do you treat septic arthritis?
Broad-spectrum systemic antimicrobial Synovial lavage Intra-articular antimicrobials Regional antibiotic perfusion Bandage Analgesia Arthrotomy
41
What type of antibiotic administration results in the highest antimicrobial concentration in the synovium?
Intra-articular
42
When do you stop treatment for septic arthritis?
When there is a significant improvement in effusion and lameness DO NOT rely on WBC count
43
What are the 3 criteria for diagnosing immune-mediated polyarthritis?
1. Inflammatory process affecting synovium of two or more joints 2. No identifiable infectious component 3. Responsive to immunosuppressive therapy
44
What is infraspinatus contracture?
Hyperextension of the forelimb, adduction of the elbow, and abduction of the paw Caused by acute, traumatic injury to the scapular muscle Not painful
45
What is the treatment for infraspinatus contracture?
Tenotomy Excellent prognosis, full return to function
46
What type of scapulohumeral luxations are common in small breed dogs? Large breed dogs?
Small breed: medial Large breeds: lateral
47
Lateral scapulohumeral luxations are a result of the loss of integrity in what structures?
Infraspinatus muscle Lateral glenohumeral ligament Lateral joint capsule
48
In medial scapulohumeral luxations, what is the success of reduction dictated by?
Integrity/conformation of the glenoid cavity
49
What two surgical approaches exist to correct a medial scapulohumeral luxation?
1. Medial transposition of biceps tendon | 2. Arthrodesis
50
What is bicipital tenosynovitis and how do you treat it?
Chronic, often intermittent lameness caused by inflammation of the biceps tendon, resulting in osteophytosis and mineralization of the humerus Tx: intra-articular steroid injection or bicipital tendon release
51
What is the most common type of displacement in traumatic elbow luxations?
Laterally displaced radius and ulna NEED ORTHOGONAL VIEWS!
52
How do you treat traumatic elbow luxations?
Reduce ASAP! Closed or open. Flex the elbow to relocate the anconeal process. Coapt limb in extension
53
What types of dogs are prone to congenital elbow luxation?
Small breeds and bulldogs
54
What is required for normal function to be established in a limb of a dog with a congenital elbow luxation?
Early surgical intervention
55
What are causes of growth plate disturbances that result in angular limb deformities?
Trauma Developmental disturbances Inflammatory disease
56
What results from premature closure of the distal ulnar physis?
Curved radius
57
What types of dogs are affected by carpal hyperextension injuries?
Large breed dogs, particularly hunting dogs
58
What structures are damaged in carpal hyperextension injuries?
Palmar fibrocartilage and ventral carpal ligaments
59
What causes carpal hyperextension injuries?
Usually trauma, but can also be degenerative
60
What are the treatments for carpal hyperextension injuries and which is most effective?
Coaptation Individual ligament repair Partial carpal arthrodesis Pancarpal arthrodesis: *most effective
61
What type of radiographic view do you need to identify the point of instability in a carpal hyperextension injury?
Stressed view
62
What is the definition of osteochondrosis?
A disturbance in the normal process of endochondral ossification
63
In small animals, how do you differentiate between osteochondrosis and osteochondritis dessicans?
With OC, animals will not be lame | With OCD, animals will be lame
64
What are common sites of osteochondrosis in small animals?
``` Humeral head Humeral condyle Coronoid process Anconeal process Femoral condyles Patella Trochlear ridges of the talus ```
65
In small animals, OCD of what bone will reliably cause lameness?
Humeral head
66
What is the prognosis for return to normal function in small animals that have arthrotomy/arthroscopy for OCD?
Excellent
67
What are the subcategories of elbow dysplasia?
Ununited anconeal process OC/OCD of humeral condyle Fragmented coronoid process
68
At what age do clinical signs of elbow dysplasia appear?
5-8 months
69
Mild intermittent lameness, supinated stance, and circumduction of affected limb during the swing phase of stirde are associated with which forelimb disease (small animals)?
Elbow dysplasia
70
What sex and breeds are predisposed to ununited anconeal process?
Male:female 2:1 German shepherd and Basset hounds
71
What radiographic view is best to diagnose ununited anconeal processes?
Flexed lateral
72
At what age can you deem the anconeal process ununited?
20 weeks
73
What is the treatment for an ununited anconeal process?
Excision of the anconeal process Stabilization of the anconeal process (lag screw) Proximal diaphyseal ulnar osteotomoy
74
What approach to the elbow do you take in treatment of ununited anconeal process?
Caudolateral approach
75
In small animals, OCD of the humeral condyle mostly affects what part of the condyle?
Trochlea (medial portion)
76
Which dog breed is most affected by OCD of humeral condyle?
Labrador Retrievers
77
What radiographic view is best for diagnosing OCD of the humeral condyle?
Craniolateral-caudomedial oblique projection
78
How can you diagnose fragmented coronoid process from histopathology?
Diffuse microcracks in the subchondral bone consistent with fatigue microdamage Indicates abnormal biomechanics that lead to asymmetric loading of the elbow
79
What morphological change to the ulnar notch puts pressure on the medial coronoid process?
It's more ovoid
80
How do you diagnose fragmented coronoid process?
Hard to visualize on radiographs Generally look for secondary degenerative changes in the absence of a UAP or OCD Usually not present before 7 months of age
81
What is the treatment for a fragmented coronoid process?
Optimal treatment has yet to be defined Surgery does nothing for development of DJD Better outcomes with arthroscopy/Arthrotomy
82
What is the prognosis for elbow dysplasia?
Degenerative changes are likely to progress regardless of surgical excision Most dogs are functional pets but questionable athletes or working dogs
83
What is panosteitis and how does it present?
Intramembranous ossification that spreads linearly along the central medullary artery and vein +/- endosteal/periosteal reaction Presents as reoccurring shifting lameness, lethargy, anorexia, fever Idiopathic, self-resolving
84
What is the treatment for panosteitis?
Analgesics and anti-inflammatories Will re-occur every 2-4 weeks
85
What is the definition of hip dysplasia?
Abnormal development of the CF joint resulting in subluxation/luxation and/or degenerative joint disease (DJD) Usually large breed dogs
86
What are the consequences of joint laxity in dogs with hip dysplasia?
Capsular thickening Cartilage fibrillation Cartilage erosion Abnormal joint development
87
What is the clinical presentation of hip dysplasia?
Young animals: < 12 mo old, pain, laxity, minimal radiographic degeneration Mature animals: DJD, bony remodeling
88
What key points in the history may suggest a dog has hip dysplasia?
Reluctance to exercise Difficulty rising Bunny hopping Clicking Chronic symmetric hind limb lameness
89
What exam findings will be suggestive of hip dysplasia in a young patient?
Lameness Painful palpation (extension and abduction of hips) Muscle atrophy Joint laxity (+ ortolani sign)
90
What exam findings will be suggestive of hip dysplasia in a mature patient?
Lameness Painful palpation (extension and abduction of hips) Crepitus Decreased range of motion
91
What is the Ortolani test?
Assess joint laxity associated with hip dysplasia Anesthesia required Lateral recumbency, stifle flexed 90 degrees, limb perpendicular to spine Apply axial pressure, abduct limb, feel and listen for a "click" or "thunk" (reduction) Continue axial pressure, adduct limb, feel for subluxation
92
What are possibilities with a negative Ortolani test?
Animal is normal Capsular fibrosis has eliminated laxity Irreducible luxation of the femoral head Acetabular infilling with bone Insufficient force to subluxate the femoral head Inadequate muscle relaxation
93
How will radiographs be different for young vs mature dogs with hip dysplasia?
Young: coxofemoral subluxation, minimal DJD Mature: coxofemoral malformation, moderate DJD
94
What is normal % acetabular coverage over the femoral head?
> 60%
95
What is OFA?
Orthopedic Foundation for Animals Subjective grading of hip dysplasia by radiologist Grading scale 1-7 Animals must be 2 years old
96
What is PennHip?
Objective measurement of hip laxity Greater predictive value than OFA Valid in animals >16 weeks of age
97
What is the Dorsolateral Subluxation Test?
Radiographic study to assess hip subluxation
98
What are non-surgical treatment options for hip dysplasia?
Weight loss Anti-inflammatory Chrondroprotection Controlled exercise
99
What are the surgical treatment options for juvenile hip dysplasia?
Triple pelvic osteotomy (TPO) Pubic Symphysiodesis
100
What is a Triple Pelvic Osteotomy?
Surgical treatment of hip dysplasia Osteotomy of the ilium, ischium, and pubis Acetabulum is rotated dorsally and laterally to increase coverage For animals with little or no DJD and < 10 months of age
101
What is Pubic Symphysiodesis?
Cauterization of pubic symphyseal growth plate causing premature closure Unopposed dorsal growth causes rotation outward acetabular rotation For dogs < 20 weeks of age
102
What are surgical treatment options for hip dysplasia in a mature patient?
Femoral head and neck ostectomy (FHO) Total hip replacement
103
What is the main difference between the results of FHO and total hip replacement?
Total hip replacement results in normal or near normal gait, muscle mass, and range of motion
104
What are the three major stabilizers of the coxofemoral joint?
Round ligament Joint capsule Dorsal acetabular rim
105
What are the ancillary stabilizers for the coxofemoral joint?
Acetabular labrum Pelvic muscles
106
What is the most common type of hip luxation in dogs and cats?
Cranio-drosal
107
What are the goals of hip luxation reduction?
Stable, concentric reduction Preservation of articular cartilage Long-term normal function
108
When is appropriate to do a closed reduction of a hip luxation?
Non-dysplastic hip Short duration of luxation No complicating factors
109
What are indications for an open reduction of a luxated hip?
Femoral or acetabular fractures Irreducibility Instability Complicating factors
110
What patient factors must you take into account when doing an open reduction of a luxated hip?
Body weight Luxation type Activity level Integrity of joint capsule
111
What are indications for a toggle pin in the treatment of hip luxation?
Multiple limb injuries Early use of theleg
112
What are indications for capsulorrhaphy in treatment for hip luxation?
Intact joint capsule Associated to other techniques (Has highest success rate)
113
What are indications for extra-capsular prothesis in treatment for hip luxation?
Non-repairable capsule tears Persistent instability
114
What are complications associated with De-Vita pins in treatment for hip luxation?
Sciatic nerve injury Pin migration Pin-tract drainage Injury to the femoral head Septic arthritis
115
What are the indications for transarticular pins in treatment of hip luxation and what are the complications associated with them?
Indications: recurrent and chronic luxations Complications: rectal perforation, pin migration, pin breakage
116
What are the primary and secondary restraints of the stifle in small animals?
Primary: cranial and caudal cruciate ligaments Secondary: menisci, collateral ligaments, joint capsule
117
What are the primary functions of the CCL?
Primary restraint against: 1. Cranial tibial translation 2. Stifle hyperextension Contributes to control of: 3. Internal tibial rotation (with caudal cruciate ligament)
118
What are the three CCL rupture syndromes?
1. Acute traumatic CCL rupture 2. Early degenerative CCL rupture 3. Chronic degenerative CCL rupture
119
What is early degenerative CCL rupture?
Characterized by progressive, mild lameness, effusion, and mild osteoarthritis No instability Often bilateral More common in mature dogs Progresses to complete rupture
120
What is chronic degenerative CCL rupture?
Characterized by intermittent lameness, periarticular fibrosis (medial > lateral) Instability present Moderate OA Often bilateral
121
What is the mechanism behind Chronic degenerative CCL rupture?
Degeneration begins within the central core and results in loss of fibroblasts and condroid metaplasia Unsuccessful remodeling in response to cyclic loading Progressive transformation in fibrocartilage No reparatory response
122
What is the incidence of concurrent meniscal injury with CCL rupture?
50-90%
123
What structures firmly attach the medial meniscus to the tibia?
Cranial menisco-tibial lig Caudal menisco-tibial lig Joint capsule Medial collateral lig
124
What structures loosely attach the lateral meniscus to the tibia and femur?
Cranial menisco-tibial lig Menisco-femoral lig
125
What is the mechanism of meniscal tear?
Meniscus is a secondary restraint CCL rupture Meniscus becomes primary restraint Caudal pole is trapped between the femoral and tibial condyles
126
What is responsible for meniscal injury?
Wedge phenomenon of the caudal pole of the meniscus
127
What two test can confirm CCL rupture?
Tibial drawer and thrust
128
What is the most important exam finding for dogs with CCL injuries?
PAIN Especially on extension of the stifle
129
Will all dogs with CCL injury have a positive tibial drawer or thrust?
No, can have a partial tear
130
What radiographic finding is indicative of CCL injury?
Joint effusion displacing joint fat pad
131
How do you decide if a patient needs surgical or medical treatment of CCL injury?
Small dogs and cats respond well to cage rest and NSAIDs Large dogs need surgical stabilization
132
What is the goal for *standard* surgical treatments of CCL injury and what are the different types?
Mimic CCL function! Extra-articular Intra-articular Autogenous lig Prosthetic lig
133
What is the function of tibial osteotomies?
Neutralize the cranial tibial thrust DOES NOT replace the ligament
134
What is a TPLO?
Tibial Plateau Leveling Osteotomy Corrective osteotomy for CCL injury Circular cut causal to tibial crest Reduced caudal angulation of plateau
135
What is patellar luxation?
Permanent or intermittent displacement of the patella to either side of the stifle MEDIAL luxation is most common More common small breed dogs
136
What is the most common type of patellar luxation?
Medial
137
What is the etiology for patella luxation?
Disruption of normal extensor mechanism alignment causes the patella to be pulled medially or laterally
138
What is the grading system for patellar luxation?
Grade 1 (IN/IN): Can be manually luxated but will return to normal position, frequently a nonclinical incidental finding Grade 2 (IN/OUT): Usually in normal position, but can be luxated and will remain luxated but will spontaneously reduce Grade 3 (OUT/IN): Luxated most of the time but can be manually reduced. Spontaneously luxates and remains luxated. Grade IV (OUT/OUT): Luxated and cannot be reduced. Usually associated with conformation abnormalities.
139
What are the clinical signs associated with patellar luxation?
Frequently an intermittent non-weight-bearing lameness Lameness tends to increase with grade Grade IV luxations may have severe conformational defects
140
What are the two categories of treatment for patella luxation?
Reconstructive procedures: alter the anatomic abnormalities Stabilizing procedures: attempt to maintain the patella in the normal position
141
What reconstructive procedures exist for treatment of patellar luxation?
Deepening of the femoral trochlea Tibial tuberosity transposition Corrective femoral and tibial osteotomies
142
What stabilizing procedures exist for treatment of patellar luxation?
Retinacular/capsular imbrication Capsulectomy Fabellar to patella suture Fabellar tibial anti-rotational suture
143
What is the prognosis for medial patellar luxation?
Most improve with surgical treatment Reoccurrence is usually a lower grade -> reoperate
144
What is osteochondritis dessicans?
Defect in endochondral ossification that results in cartilage flap Seen in immature large breed dogs Causes synovitis and subsequent osteoarthritis
145
What are the most common sites of osteochondritis dessicans in the hindlimb?
(More common in the forelimb) Stifle: lateral aspect of femoral condyle Hock: medial trochlear ridge (prognosis of this site is worst!)
146
What is the definition of lameness?
An asymmetry of gait due to disorder of appendicular or axial musculoskeletal system
147
Which limb in horses is most commonly affected by lameness?
Forelimb (bears 60+% of weight!)
148
What are the most common causes of lameness in horses?
Osteoarthritis Soft tissue injuries
149
How is active lameness in horses graded?
AAEP Lameness Score 0/5: Lameness not perceptible under any circumstances 1/5: Lameness is difficult to observe and is not consistently apparent, regardless of circumstances 2/5: Lameness is difficult to observe at a walk or when trotting in a straight line but consistently apparent under circumstances 3/5: Lameness is consistently observable at a trot under all circumstances 4/5: Lameness is obvious at a walk 5/5: Lameness produces minimal weight bearing in motion and/or a complete inability to move
150
What is palmar foot pain?
Lameness originating from the podotrochlear apparatus of the forelimb Caused by abnormal, non-physiological biomechanical loading of structures **QH 7-10 YO AKA "Navicular Syndrome"
151
What are the clinical signs of palmar foot pain?
Often bilateral lameness, worse on hard ground or when circling Choppy gait Tripping DDFT thickening, DIPJ effusion Sensitivity to foot testers "Blocks" to low palmar digital nerve block, DIPJ, or navicular bursa
152
How do you diagnose palmar foot pain and how is it treated?
Dx: MRI Tx: Rest and controlled exercise, Therapeutic shoeing, NSAIDs, IA therapies, Shock wave, Surgical
153
What is the surgical treatment of choice for palmar foot pain?
Navicular bursoscopy /- digital flexor tenoscopy Includes debridement of abnormal cartilage and DDFT tears Reduction of adhesions (DDFT to NSLand bursa) Observation of flexor surface of navicular bone
154
What are the surgical treatment options for palmar foot pain?
Navicular bursoscopy +/- digital flexor tenoscopy *best* Palmar digital neurectomy (salvage)
155
What are the 7 types of third phalanx fractures?
1: Wing fracture 2: Articular wing fracture 3: Axial fracture 4: Extensor process fracture 5: Comminuted fracture 6: Solar margin fracture 7: Solar margin fracture in a foal
156
What breed and limb are second phalanx fracture most commonly seen in?
Western performance AQH Hindlimbs
157
What type of surgical fixation exists to treat second phalanx fractures?
Plantar/palmar eminence fractures and comminuted fractures: plating/screw repair with PIPJ arthrodesis Axial (sagittal) fractures: cortical screw in lag fashion Osteochondral fragments: arthroscopic removal
158
What is the treatment for dorsal osteochondral fragments ("chips") of the first phalanx?
Arthroscopic removal, 6 weeks rest, intra-articular therapies
159
What causes diaphyseal fractures of the first phalanx?
Torsional and axial forces "Screwdriver fractures"
160
What are the treatment options for diaphyseal fractures of the first phalanx?
``` Box stall rest ~90 days Internal fixation (cortical bone screw place in lag fashion) Arthrodesis Transfixation pin Euthanasia ```
161
What is palmar/plantar osteochondral disease "POD"?
Due to repetitive stress injury and results in maladaptive bone remodeling, commonly MC/MT III condylar disease Predisposes to MC/MT III fractures
162
What horses are prone to POD and how do you diagnose it?
TB/SB race horses Diagnose by bone scan, MRI, or CT
163
What is the treatment for POD?
REST (90+ days) Continued training worsens and may lead to catastrophic failure!
164
What parts of the bone are MC/MT III fractures seen in and how are they treated?
MC III - lateral condyle MT III- Medial condyle Internal fixation: cortical screw in lag fashion +/- plate
165
What condition is known as "bucked shins", what horses are prone to this, and what does this condition predispose them to?
Maladaptive remodeling of the dorsal cortex of mCIII TB racehorses Dorsal cortical fractures (commonly incomplete)
166
What is a "saucer" fracture?
A complete fracture of the dorsal cortex of mc III
167
What is the treatment for fractures of the dorsal cortex of MC III?
Rest (90+ days) Osteostixis surgery: Place and remove unicortical screw to allow ingrowth of vessels and bone to heal before returning to training
168
T/F: traumatic splint bone fractures are often open
True Usually from a kick from another horse
169
What disease often accompanies exercise-related splint bone fractures?
Suspensory desmitis
170
What is the treatment for splint bone fractures?
Closed: Rest Removal and rehabilitation of SL Internal fixation Open: Partial splint ostectomy Internal fixation
171
What are the three joint compartments of the equine carpus?
Radiocarpal Middle carpal Carpometacarpal
172
What are most equine carpal injuries a result of?
Repetitive axial loading/maladaptive bone remodeling
173
What is osteochondral fragmentation of the equine carpus and how is it treated?
Fragmentation more common along the medial aspect of the carpus, caused by repetitive stress and hyperextension Causes lameness and synovitis Should be removed arthroscopically
174
What is biarticular "slab" fractures of the third carpal bone, where is the most common site of fracture, and how is it treated?
Fracture of the carpal bone caused by repetitive axial loading and maladaptive bone remodeling Radial > intermediate facet Tx: arthroscopic removal or internal fixation
175
What are the 4 joint compartments of the equine tarsus?
Tibiotarsal Proximal intertarsal Distal intertarsal tarsometatarsal
176
What is the most common disorder of the tarsus?
Osteoarthritis
177
What is "bone spavin" and what is the treatment?
Osteoarthritis of the distal intertarsal and tarsometatarsal joints of the tarsus Tx: Medical: IA therapies, NSAIDs, chondroprotective agents, corrective shoeing-- usually very successful with routine management Surgical: facilitated ankylosis, cunean tenectomy
178
What is the largest and most complex joint in the horse?
Stifle 3 bones, 2 menisci, 14 ligaments
179
What are the three joints of the equine stifle?
Femoropatellar Medial femorotibial Lateral femorotibial
180
What is upward fixation of the patella?
Complication of the stay apparatus in horses | Commonly intermittent
181
What types of horses are prone to upward fixation of the patella?
Miniature horses: permanent fixation Young horses (in growth spurts) Mature horses that are rested for other resons
182
What are the treatment options for upward fixation of the patella?
Nonsurgical: Treat primary lameness Corrective shoeing Treat secondary joint pain Pelvic limb and quadriceps strengthening Medial patellar ligament injections Surgical: Medial patellar desmoplasty Medial patellar desmotomy
183
Anesthesia of which nerve can help you localize a proximal suspensory desmitis of the hind limb?
Deep branch of the lateral plantar n.
184
What is the treatment (nonsurgical and surgical) for proximal suspensory desmitis?
Non-surgical: rest and ice Surgical: fasciotomy (retinaculum)
185
What are the degenerative orthopedic diseases seen in horses?
Osteochondrosis (OCD and subchondral cystic lesions) Angular limb deformities (juvenile arthirits) Flexural limb deformities Physitis Cervical Stenotic myelopathy
186
What is the most common clinical sign of osteochondrosis in horses?
Joint effusion
187
What are the most common sites of osteochondrosis in horses?
Tarsus: Distal Intermediate Ridge of Tibia (DIRT OCD) Stifle: Lateral Trochlear Ridge of Femur (LTFR OCD) and Medial Femoral Condyle (MFC subchondral cyst-like lesion) Metacarpo/metatarsophalangeal joint: Dorsal aspect of the sagittal ridge
188
What are the most common horse breeds that have osteochondrosis?
Thoroughbred Quarterhorse Standard bred Warmbloods
189
What is the treatment of osteochondrosis in horses?
Arthroscopy Rest Controlled exercise Drugs (anti-inflammatories, disease modifying agents, regenerative therapies)
190
What is the most common site of a subchondral bone cyst in horses?
Medial femoral condyle
191
What radiographic finding is indicative of a subchondral bone cyst?
Lucent subchondral bone surrounded by sclerosis
192
What are angular limb deformities in horses? What's the difference between valgus and varus?
Deviation of the limb in the frontal plane Valgus: lateral deviation of the limb distal to the location of the deformity (away from the center) Varus: medial deviation of the limb distal to the location of the deformity (towards the center)
193
What perinatal factors contribute to angular limb deformities in horses?
1. Incomplete ossification | 2. Periarticular laxity
194
What developmental factors contribute to angular limb deformities in horses?
1. Unbalanced nutrition | 2. Excessive exercise or trauma
195
T/F: slight external rotation and milld valgus of the forelimbs is normal in young foals (< 2-3 months)
True
196
What treatment options exist for angular limb deformities in horses?
Stall rest Hoof manipulation (trim on same side, hoof extensions on opposite side as deformity points) Periosteal elevation Growth retardation with implant
197
In which equine joint deformity is it especially important to identify and treat early?
Fetlock (distal MC/MT III)
198
What is juvenile arthritis and in which location is it most common?
Sequela to incomplete ossification of cuboidal bones Most common in tarsus
199
What is the treatment for juvenile arthritis?
No treatment, only prevention Can give intra-articular steroid, fusion Poor prognosis
200
What is a flexural deformity and which location is it most common in?
Deviation of the limb in the sagittal plane Includes hyperflexion or hyperextension Carpus/fetlock most common
201
How do you treat congenital contracture deformities in horses?
NSAIDs Oxytetracycline (will inc. tendon laxity) Bandage + splint + stall rest
202
What is the treatment for hyperextension deformities?
Controlled exercise Heel extensions Bandaging Splints/casts
203
What causes acquired flexural deformities and which joints are most commonly affected?
Long bone growth >> flexor tendon growth Genetics, nutrition DIPJ and MCPJ most common
204
What is "club foot"?
DIPJ deformity caused by relative shortening of the DDFT Created upright and boxy hoof Most common in forelimb Good prognosis if < 90 degrees
205
What is the treatment (surgical and nonsurgical) for DIPJ deformity?
Non-surgical: reduction in calories, NSAIDs, controlled exercise, toe extension, trim heels, dynasplint Surgical: Type 1- inferior check lig desmotomy (ICLD) Type 2- (>90 degrees) - may require ICLD and DDF tenotomy
206
What is MCP/TP joint deformity and what are the treatments?
Upright angle or knuckling of fetlock May be due to relative shortness of SDFT +/- suspensory lig Worse prognosis than DIPJ Non-surgical treatment: Same as club foot Surgical treatment: Superior chec lig desmotomy +/- ICLD, SDF tenotomy
207
What is equine physitis, how do you diagnose it, and what is the treatment?
Enlargement of one or more physes causing disruption of normal endochondral ossification Radiographs: increased paraphyseal bone, physeal lysis/sclerosis Tx: rest, NSAIDs, diet reduction

Orthopedic Surgery (2 decks)

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