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Surgery 3 > Lecture 11: Tarsus, Metatarsus, & Phalanges (Exam 2) > Flashcards

Lecture 11: Tarsus, Metatarsus, & Phalanges (Exam 2) Flashcards

1
Q

What is a plantigrade stance

A

When the foot is positioned so the plantar surface of the calcaneus contact ground

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2
Q

What is valgus position

A

An outward deviation

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3
Q

What is a varus position

A

An inward deviation

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4
Q

T/F: Tarsal fractures are rare in animals

A

True

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5
Q

Why are tarsal fractures ofte disabling

A

b/c the tarsal joints serve a major weight bearing function

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6
Q

What can happen if tarsal fractures are not treated

A
  • Joint incongruity
  • Dev of osteoarthritis
  • Severe lameness
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7
Q

Who is fractures of the tarsus commonly seen in

A

Working breed dogs

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8
Q

What causes a calcaneal fractures

A
  • Distracted by pull of the gastrocnemius m.
  • Prevents bone contact btw/ fragments & interferes w/ healing
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9
Q

Who are fractures of the central tarsal bone commonly seen in

A

Racing greyhounds

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10
Q

How are fractures of the central tarsal bone repaired

A

W/ one or more small lag screw

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11
Q

What will be seen in a PE of a px w/ acute fractures of the tarsus

A

When they attempt to place wt. on the limb it will cause the tarsus to collapse in plantigrade stance

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12
Q

What diagnostic imaging should be done

A
  • Req sedation or general ax
  • Dorsoplantar, medial lateral & oblique projections
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13
Q

How are calcaneal fractures differentiated from lacerations/ruptures of the achilles tendon

A
  • Laceration/rupture: Open wound & soft tissue swelling around the area proximal to the calcaneal tuberosity
  • Fracture: Swell caudal to tarsus & crepitation elicited on palpation
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14
Q

What is the surgical tx for calcaneal fractures

A

Pull of the gastrocnemius muscle resisted w/ tension band wire, lag screws, or plates

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15
Q

What is the surgical tx for articular fractures of the talus

A

Anatomically reduced & rigidly stabilized for optimal outcome

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16
Q

What if tarsal fracture repair is not feasible

A

Arthrodesis of the tarsocrural joint is considered

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17
Q

Describe the calcaneus

A
  • Largest of the tarsal bones
  • The tuber calcaneus forms prominence for insertion of the achilles tendon
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18
Q

Describe the talus

A
  • Second largest of the tarsal bones
  • Side of the trochlea articulate w/ the medial & lateral malleoli
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19
Q

What is occurring in these pictures

A

Stabilization of a calcaneal fracture

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20
Q

How are transverse calcaneal fracture

A

W/ a tension band or wire plate

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21
Q

How are oblique or slab fracture stabilized

A

W/ lag screws

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22
Q

What is occurring in these pictures

A

Stabilization of a talus fracture

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23
Q

How are talus articular surface fractures stabilized

A

W/ diverging K-wires or lag screws

24
Q

How is the neck of the talus stabilized

A
  • Lag screw angled from caudal medial surface of the head of the talus into the trochlea or the talus (A)

OR

  • A screw is placed from caudal medial base of the talus into the calcaneus (B & C)W
25
hat is the most important post op care for most dogs
Coaptation w/ a splint for up to 6 weeks
26
What can occur w/ pins for tension band stabilization of the calcaneal fracture
* May irritate soft tissue * Can be removed after healing if needed
27
When are screws from reconstruction of the talus removed
They are not removed unless they cause a problem
28
What are some complications of tarsal sx
* Degenerative joint disease may occur after articular fractures & may be severe * Delayed union or nonunion if the calcaneal fracture is not adequately stabilized
29
How do metatarsal bone fractures occur
From direct blow or force to paw or hyperextension injuries
30
Who is complete metatarsal fractures commonly seen in? What causes it?
* Grey hounds * Can be b/c of fatigue or the normal bone has been loaded beyond its yield strain
31
Where are metatarsal fractures located
* The base (proximal end of the bone) * The head (Distal end of the bone)
32
What is done for metatarsal, phalangeal fractures & luxations
* Early surgical repair (better results that closed reduction & splintage) * Depends heavily on conditions * Splinting may be necessary
33
What can chronic instability lead to
* DJD * Less optimal function
34
Where do MC/MT avulsion fractures mostly occur
Most often on the 2nd & 5th bones
35
Who are metacarpophalangeal joints or interphalangeal joints most commonly seen in
* Working dogs * Racing greyhounds
36
What diagnostic imaging should be done for MC/MT fractures
* Dorsoplantar & mediolateral views from the tarsus to ends of the digits * Oblique view w/ the digits spread * Lateral view w/ the affected digit pulled cranially
37
What medical management can be used for MT fractures
* Conservative treatment w/ fiberglass bivalve cast or metasplint (For closed nondisplaced metatarsal diaphyseal fractures of 1 or 2 bones) * Coaptation
38
Describe coaptation medical management for MT fractures
* Cats w/ comminuted nonreducible fractures * Most phalangeal fractures & acute sesamoid bone fractures
39
When are cast or splints removed
* Not removed until there is radiographic evidence of the fracture bridged w/ bone * Usually 4 to 8 W
40
When is sx tx done for metatarsal fractures
* In athletic or racing dogs for optimal return to racing * Plates & screws are used
41
When is plate fixation done
When FAS is low or when athletic function is desired
42
What type of plate fixation can be used on MT/MC fractures
* Bridging plate used to span & support comminuted fractures (digit 2) * Compression plates applied to transverse fracture (digit 3 & 4) * Lag screw compression is used for oblique fracture lines protected by neutralization plates (digit 5)
43
What is done for large avulsed fragments (from the base of the second & 5th MT)
* Req open reduction & internal fixation * Ligamentous insertions cause fragment distraction * Lag screws are used to counteract pull of adjacent ligaments or compress oblique fractures
44
What are the Tx considerations for MT/MC fractures
* Fractures of 1 or 2 bones w/ splint or cast (the unaffected bones form an internal splint to prevent deformity) * Fractures of 3 or 4 bones txed w/ internal fixation * Large displaced avulsion fractures are txed w/ lag screws * Splint or bivalve cast applied after internal fixation until radiographic evidence of bone healing is achieved
45
When is the Intramedullary (IM) pinning tech done
Tx multi transverse or short oblique fractures in px w/ high FAS
46
Describe fractures of the phalanges
* Less frequent * Most often amendable to splinting
47
Who is acute phalangeal luxations commonly seen in
Working or racing dogs
48
How are acute phalangeal luxations txed
W/ open reduction or suturing of the joint capsule & collateral lig
49
How is chronic luxations of the 2nd or 5th toe txed
Amputation
50
What is the result of arthrodesis of the metatarsophalangeal & interphalangeal joints
* Good function * Pain relief
51
What fixation systems can be used for MT & phalangeal fractures
* Ortho wire * IM pins * External fixation * Plates & screws
52
What determines the which fixation method is used
* Fracture Assessment Score * Fracture location
53
Which MT phalangeal fracture implants can be used for a FAS of 0 to 3
* Bridging plates * External fixators * Lag screws for avulsion fractures
54
Which MT phalangeal fracture implants can be used for a FAS of 4 to 7
* Bone plates & screws * IM pins * Lag screws for avulsion fractures
55
Which MT phalangeal fracture implants can be used for a FAS of 8 to 10
* Splint or cast * IM pins * Tension band wire for avulsion fractures
56
How can MT fractures be externally fixated
* Connect the fixation pins w/ acrylic bars to provide rigid stabilization of comminuted fractures (A) OR * Place pins in Type Ib configuration & connect w/ acrylic (B)

Surgery 3 (20 decks)

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