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Joint Diseases of the Hindlimb > Tarsal Joint 2 > Flashcards

Tarsal Joint 2 Flashcards

1
Q

What injuries can all lead to tarsocrural instability, subluxation or luxation? (3)

A

Malleolar #
Collateral ligament rupture
Shearing injury

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2
Q

Tarsocrural subluxation:
What is present on CE? (3)

A

Severe lameness
Periarticular bruising
Swelling

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3
Q

How can you Differentiate between fractures of the malleolus and collateral ligament ruptures?

A

Xrays

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4
Q

How are malleolar # diagnosed?

A

xrays (orthogonal views)

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5
Q

How are avulsion # of the malleolar treated?

A

Internal stabilisation: Pins and tension band wire

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6
Q

Internal stabilisation of malleolar avulsion #:
A) Size k wire?
B) Orthopedic wire?

A

A) Small diameter
B) Large

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7
Q

With internal fixation of avulsion # - what extra care is needed when placing pins?

A

Care must be taken to angle the pins so that that they do not enter the joint.

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8
Q

Malleolar #:
Early mobility is beneficial - why? (3)

A

minimise joint fibrosis
loss of function
maintain cartilage health.

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9
Q

Malleolar #:
Temporary augmentation of the repair with what (2) is often required as the repair can be tenuous.

A

transarticular external skeletal fixator or external coaptation

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10
Q

Immobilisation alone does not heal # of malleoli alone - what is often needed?

A

of pin/tension band wire

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11
Q

Does collateral ligament rupture or # of malleolar have better prognosis?

A

of malleolar

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12
Q

Collateral ligament rupture can occur as an avulsion from the bone, where? (3)

A

At the tibia
Fibula
Mid substance tear

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13
Q

An avulsedcollateral ligament may be able to be re-attached with a ? but this can be challenging in smaller patients.

A

small pin or screw

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14
Q

How to repair a mid-substance tear?

A

Not possible normally

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15
Q

How can a prosthetic ligament be created?

A

bone anchors or screws placed at the attachment points of the ligament
Wire or nylon is then placed between these anchor points to augment or replace the ligament

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16
Q

What can be used instead of prosthetic ligaments?

A

Transosseous tunnel

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17
Q

Collateral ligament rupture:
Failure to augment or replace the ?parts significantly reduces the immediate stability of the joint function of collateral ligaments

A

short

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18
Q

Primary repair or augmentation of the ligaments - what is the complication rate?
- How well does lameness recover?

A
  • High
  • Persistent lameness expected
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19
Q

When is a temporary transarticular external skeletal fixator removed when used as sole treatment for collateral ligament rupture?

A

4-6 weeks

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20
Q

What remains when a temporary transarticular external skeletal fixator removed when used as sole treatment for collateral ligament rupture is used?

A

Residual instability

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21
Q

Collateral ligament ruptures can be challenging to treat and treatment is not always successful. Some patients need to undergo what surgery?

A

Pantarsal arthrodesis

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22
Q

Shear injury of the tarsus is a common injury in dogs and cats. What is the frequent cause of Shearing injury?

A

It is usually the result of a road traffic accident where the limb has been caught under a tyre and the abrasive road surface causes loss of tissue.

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23
Q

Tarsal shear injury, what must be addressed/ (4)

A

*Contamination and possible infection (open contaminated wound and joint and bone exposed).

*Loss of vital structures.

*Instability of the tarsal joints.

  • Is there sufficient remaining tissue to achieve an acceptable function?
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24
Q

Open or closed wound management for tarsal shear injury?

A

Open
Open wound management should be continued until healthy granulation tissue is present and reconstructive surgery can be considered.

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25
Q

It is advised to treat tarsal shear injuries with?

A

temporary transarticular external skeletal fixator

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26
Q

Using a temporary transarticular external skeletal fixator for shear injuries - what is the benefit of this? (3)

A

Stabilise joint
Minimise ongoing damage
Access for wound management

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27
Q

In the majority of cases, tarsal stability is adequate after removal of the external skeletal fixator- why is this?

A

Due to scar tissue formation so that no further surgery is required.

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28
Q

For those shearing tarsus cases where residual instability following ESF what might be required?

A

Pantarsal arthrodesis

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29
Q

What does Plantar tarsal luxation or subluxation result from?

A

Rupture of plantar ligaments

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30
Q

Plantar tarsal luxation or subluxation:
Breed?

A

Overweight middle-aged Shetland Sheepdogs but other Collie

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31
Q

Due to the strong breed predisposition, what has been hypothesised?

A

intrinsic weakening of the plantar ligament

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32
Q

Progressive Plantar Intertarsal ligament degeneration often means the onset is?

A

Insidious

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33
Q

Progressive Plantar Intertarsal ligament degeneration:
- How is the proximal intertarsal joint affected?

A

Hyperextension

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34
Q

Progressive Plantar Intertarsal ligament degeneration often develop what stance?

A

Plantigrade

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35
Q

Progressive Plantar Intertarsal ligament degeneration:
How is the calcaneus rotate and why?

A

Proximally by the common calcanean tendon

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36
Q

Plantar Intertarsal Luxation:
What instability is there on manipulation?

A

Proximal intertarsal

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37
Q

Plantar Intertarsal Luxation:
Pain levels?

A

Minimal

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38
Q

What can indicate an impending degenerative problem with the Plantar intertarsal lig?

A

Plantar thickening is normally palpable before any instability

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39
Q

Which projections should be used to confirm diagnosis of plantar intertarsal ligament?

A

Orthogonal projections of the tarsus should be obtained to confirm the diagnosis. Stressed projections to hyperextend the proximal intertarsal joint can facilitate this.

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40
Q

plantar intertarsal ligament dx, where are entheseophytes normally visible? (2)

A

Plantar aspect of calcaneous and 4th tarsal bone

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41
Q

Treatment for plantar intertarsal (sub)luxation is..?

A

calcaneoquartal arthrodesis.

42
Q

What is used in calcaneoquartal arthrodesis.?

A

Pin and plantar wire loop, lag screw +/- plantar wire loop or a lateral plate.

43
Q

External coaptation with plantar intertarsal luxation?

A

With plate can be avoided

44
Q

plantar intertarsal luxation prognosis?

A

Good with arthrodesis

45
Q

Complications following plantar intertarsal luxation?

A
  • failure to acheieve arthrodesis –> Implant failure and infect
46
Q

Benefits of calcaneoquartal arthrodesis over pin/tension band wire for plantar intertarsal ligament? (2)

A
  • lower complication rate
  • more readily achieve arthrodesis
47
Q

Dorsal intertarsal subluxation occurs A) and is usually the result of B)

A

A) sporadically
B) a fall

48
Q

What does damage to the short dorsal intertarsal ligaments result in?

A

Instability

49
Q

The instability of the dorsal intertarsal ligament can be difficult to appreciate as the A) aspect is the B) side of the joint and weight bearing holds it in C).

A

A) Dorsal
B) Compression
C) Reduction

50
Q

What imaging diagnoses dorsal intertarsal luxation?

A

Stress xrays

51
Q

How can isolated dorsal intertarsal luxation be treated?

A

Non surgical.
External coaptation for 4-6 weeks

52
Q

How should severe dorsal intertarsal luxation be treated? (2)

A

Augmentation of the ligaments with screws and wires
A temporary transarticular external skeletal fixator can be attempted.

53
Q

How common is arthrodesis following dorsal intertarsal luxation?

A

Very rare

54
Q

Prognosis following dorsal intertarsal luxation?

A

Good

55
Q

Tarsometatarsal luxation or subluxation is normally the result of?

A

severe trauma such as road traffic accident or a fall

56
Q

Where is swollen with Tarsometatarsal Luxation or Subluxation?

A

Distal tarsus

57
Q

How to diagnose Tarsometatarsal Luxation or Subluxation?

A

CE + radiograph

58
Q

Which # are common with Tarsometatarsal Luxation or Subluxation? (3)

A

4th tarsal bone
metatarsal II
Metatarsal V

59
Q

What instability is seen with Tarsometatarsal Luxation or Subluxation? (4)

A
  • Plantar
  • Medial
  • Lateral
    Dorsal may occur
60
Q

What is the treatment for Tarsometatarsal Luxation or Subluxation?

A

Arthrodesis of the tarsometatarsal joint

61
Q

How can arthrodesis of the tarsometarsal joint be achieved? (4)

A

*Intramedullary pin and tension band wire fixation
*Multiple pins inserted through the metatarsal bones to cross the tarsometatarsal joint
*External skeletal fixation
*Plate applied laterally (most reliable) or medially (less commonly performed).

62
Q

Tarsometatarsal Luxation or Subluxation:
True or false

Casting is contraindicated.

A

False

63
Q

Tarsometatarsal Luxation or Subluxation:
True or false

Prognosis in general is guarded.

A

False

64
Q

What is required following arthrodesis with pins for Tarsometatarsal Luxation or Subluxation?

A

Cast for 6-8 weeks

65
Q

What is required following plate fixation for Tarsometatarsal Luxation or Subluxation?

A

Soft padded bandage is all that is required for seven to ten days.

66
Q

Prognosis following repair for Tarsometatarsal Luxation or Subluxation?

A

Good

67
Q

What are the 3 parts of the common calcanean tendon?

A
  • The paired tendons of the gastrocnemius muscle;
    The combined tendon of the gracilis, semitendinosus and biceps femoris muscles;
    The tendon of the superficial digital flexor muscle (SDFT).
68
Q

How can Disruption of the common calcanean tendon be classified?

A

Type 1-3

69
Q

What is type 1 dx of the common calcanean tendon?

A

Complete rupture

70
Q

common calcanean tendon type 1:
A) What stance do they regularly have?
B) What does this often follow?
C) With the stifle held in extension, what can happen to the tarsus?
D) Palpating the tendon..

A

A) Plantigrade
B) Trauma
C) Hyperflex manually
D) May reveal palpable defect

71
Q

common calcanean tendon
DEfine Type IIa

A

Musculotendinous rupture

72
Q

common calcanean tendon
Define Type IIb

A

Common calcanean tendon rupture with in tact paratenon

73
Q

common calcanean tendon
Define Type IIc

A

Avulsions of the tendon of insertion of gastrocnemius with intact SDFT

74
Q

Type 2 lesions of common calcanean tendon:
A) What happens to common calcanean tendon mechanism?
B) What happens to the hock?

A

A) Lengthens
B) Drops

75
Q

Type 2c lesions of common calcanean tendon:
A) Hock position?
B) Digit position?
C) What is the above caused by?

A

A) Slight drop
B) Flex
C) ncreased tension in the SDFT that the partially collapsed tarsus

76
Q

What is a type 3 lesion of the calcanean tendon?

A

Tendinopathy

77
Q

Type 3 lesion of the calcanean tendon:
A) Where is the swelling?
B) Effect of length on common calcanean mechanism?

A

A) Distal part of the gastrocnemius tendon just proximal to the calcaneus
B) No functional lengthening

78
Q

Which x ray view gives most information about the common calcanean tendon?

A

Mediolateral

79
Q

Common calcanean tendon disease:
A) General xray findings?
B) What is found on type 2c and 3?

A

A) Soft tissue swelling in the area of disruption
B) Periosteal new bone formation

80
Q

Common calcanean tendon disease:
True or false:
Ultrasonography can be useful in type 1, 2a, 2b and 3 lesions to identify the site and nature of the injury.

A

True

80
Q

Type 3 Common calcanean tendon disease:
A) Tarsal position?
B) Digit position?
C) Lameness?

A

A) Normal
B) Normal
C) Mild

81
Q

How is Type3 Common calcanean tendon disease managed?

A

non-surgically.

This consists of short lead exercise for six to eight weeks and NSAIDs. If the lameness does not resolve or there are progressive postural changes, surgery is indicated.

82
Q

Type 1, 2a, 2b Common calcanean tendon disease managed?

A

Are managed by primary repair of the tendon. Specialised suture patterns are used such as the locking loop or three-loop pulley.

83
Q

Which suture patten for surgical repair of the Common calcanean tendon? Why?

A

The three-loop pulley has been shown to resist gap formation to a greater extent than other suture patterns so is recommended for use in in common calcanean tendon repairs.

84
Q

Suture material for surgical repair of Common calcanean tendon?

A

Non-absorbable (e.g. Monofilament polypropylene) or long lasting absorbable suture (e.g. PDS) material should be used. Monofilament polypropylene and PDS are ideal due to its good gliding properties, longevity and strength. The tendon junction should then be sutured with horizontal mattress sutures of polydioxanone.

85
Q

Care should be taken to avoid further damage to the tendon ends with common calcanean tendon, how is this achieved?

A

This can be achieved by placing a needle or K-wire through the tendon at 90° a short distance from the end. This can help in manipulating the tendon.

86
Q

The primary repair must be protected during the early phase of healing.
With the calcanean tendon.

How?

A

This can be achieved by a cast or splint, a calcaneotibial screw (protected with a cast or splint) or a transarticular external skeletal fixator.

87
Q

How successful is healing after calcanean tendon immobilization?

A

Successful

88
Q

Complications following calcanean tendon repair? (5)

A

cast sores/rubs
calcaneotibial screw breakage
external skeletal fixator pin loosening
pin tract infection
pin breakage.

89
Q

How to manage acute type 2c calcanean tendon rupture?

A

Type 2c lesions are more challenging to treat. Acute lesions can be managed with primary repair using a modified three-loop pulley suture to re-attach the tendon to the calcaneus by the use of a bone tunnel in the calcaneus.

90
Q

What is the problem of trying to manage chronic type 2c calcanean tendon rupture?

A

extensive scar tissue and it is usually impossible to identify the individual tendons

91
Q

How to approach the surgical repair of chronic type 2c calcanean tendon rupture?

A

A section of abnormal tissue needs to be resected to restore the functional length of the tendon. After resection, a three-loop pulley suture or the modified version used to re-attach the tendon to the calcaneus.

92
Q

What is the new surgical repair of chronic type 2c calcanean tendon rupture?
However needs long term evaluation?

A

Augmentation of the resected degenerated gastrocnemius tendon with a synthetic polyethylene terephthalate prosthesis, which bridges the gap in the tendon and allows tissue ingrowth,

93
Q

True or false
Calcanean tendon:

These repairs need protection during the early healing process as with acute repairs.

A

True

94
Q

True or false
Calcanean tendon:

A calcaneotibial screw can be used to immobilise the tarsus in flexion to allow healing of the tendon without disruptive tensile forces.

A

True

95
Q

If primary repair of the calcanean tendon cannot be achieved - what approach can be taken?

A

A calcaneotibial screw can be used to immobilise the tarsus in extension to allow healing of the tendon without disruptive tensile forces.

96
Q

When would A calcaneotibial screw not be appropriate with calcanean tendon repair? What is the sx option?

A

Significant lengthening of the common calcanean mechanism. If this is the case pantarsal arthrodesis

97
Q

The prognosis after successful surgical management of common calcanean tendon disease is

A

Good

98
Q

What do failures of the surgical management of common calcanean tendon disease relate to? (2)

A

not addressing the functional lengthening
immobilisation failures/complication

99
Q

What is the significance of the knuckled digits with achilles tendon?

A

This suggests that the CCT injury is partial, the superficial digital flexor tendon remains intact contracting the digits, with the tendon of the gastrocnemius having separated from the calcaneus leading to the plantigrade stance.

100
Q

What are the 3 tendon suture patterns?

A

Krackow
Bunnell
Interlocking loop

Joint Diseases of the Hindlimb (10 decks)

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