Term
| What are the 4 common types of P2 fractures that occur in a hrose? |
|
Definition
-osteochondral articular chip fractures
-palmar/plantar eminence
-axial
-comminuted |
|
|
Term
| What are the clinical signs of P2 fractures? |
|
Definition
-acute lameness often during or immediately following exercise, especially during turns or jumps
-visible swelling/or palpable instability of the pastern region |
|
|
Term
| How do we diagnose a P2 fracture? |
|
Definition
|
|
Term
| What do we treat P2 fractures? |
|
Definition
-small OC fraturs can be surgically removed: arthroscopy or arthrotomy
-other types require internal fixation with arthrodesis of the PIP jt
-severely comminuted fractures may require transfixation pin casting |
|
|
Term
| What diagnostic tool is frequentl used for P2 fracture assessment and surgical panning? |
|
Definition
|
|
Term
| What is the prognosis for P2 fractures? |
|
Definition
-OC fx: good with surgical removal
-Palmar/plantar eminence fx with arthrodesis: pastrue and breeding sound but ony fair to good for athletes
-axial/comminuted with DIP jt: fair for pasture/breeding but guarded-poor for athletes |
|
|
Term
| What are the 3 common types of P1 fractures? |
|
Definition
-OC articular chip fractures: dorsal, palmar/plantar
-axial
-comminuted |
|
|
Term
| Which of the three common types of P1 fractures is common in racing horses? |
|
Definition
| -OC articular chip fractures |
|
|
Term
| What are the clinical signs of an OC articular fracture of P1 in a hrose? |
|
Definition
-incosistent degree of lameness
-may be incidental finding on rads
-mild/moderate MCP/MTP jt effusion |
|
|
Term
| What are the clinical signs of an axial P1 fracture in a horse? |
|
Definition
-mod-severe MCP/MTP effusion
-3-4/5 lame |
|
|
Term
| What are the clinical signs of a comminutred P1 fracture in a horse? |
|
Definition
-severe MCP/MTP effusion and distal limb swelling
-4-5/5 lameness with fetlock instability |
|
|
Term
| How do we diagnose P1 fractures in a horse? |
|
Definition
-history
-clinical signs
-rads
-no local anesthesia should be performed until a fracture has been completely ruled out |
|
|
Term
| How do we treat an OC P1 fracture? |
|
Definition
| -arthroscopic removal iff clinical |
|
|
Term
| How do we treat axial P1 fractures? |
|
Definition
-lag screw fixation:force bones together
-conservative |
|
|
Term
| How do we treat comminuted P1 fracture with intact strut of bone? What if the fracture is without an intact strut of bone? |
|
Definition
-lag screw fixation
-transfixation pin casting +/- lag screw fixation |
|
|
Term
| What is the prognosis of OC P1 fractures? |
|
Definition
| -good to excellent for everybody |
|
|
Term
| What is the prgnosis of axial P1 fractures? |
|
Definition
-good for athletes
-excellent for breeding/pasture
-fractures entering PIP jt have poorer prognosis |
|
|
Term
| What is the prognosis of comminuted P1 fractures? |
|
Definition
| -guarded to fair for breeding/pasture |
|
|
Term
| In which horses are proximal sesamoids commonly fractured? |
|
Definition
| -performance horses, especially racehorses |
|
|
Term
| What are the 5 classifications of proximal sesamoid bone fractures? |
|
Definition
-apical
-basialr
-abaxial
-mid-body
-comminuted |
|
|
Term
| What type of proximal sesamoid bone fractures are most common? |
|
Definition
| -apical > basilar/mid-body |
|
|
Term
| What are the clinical signs of proximal sesamoid bone fractures? |
|
Definition
-actue lameness
-suspensory br swelling
-joint effusion |
|
|
Term
| How do we diagnose proximal sesamoid bone fractures? |
|
Definition
|
|
Term
| How do we treat proximal sesamoid bone fractures? |
|
Definition
-small articular fractures shoud be remobed
-nonarticular fractures can be treated conservatively with stall rest and rehab
=mid-body treated with internal fixation (lag screw or circumferential wiring)
-comminuted fractures can be managed conservatively with casting and stall confinement |
|
|
Term
| What is the prognosis with an apical proximal sesamoid bone fracture? |
|
Definition
|
|
Term
| What is the prognosis with abaxial proximal sesamoid bone fractures? |
|
Definition
|
|
Term
| What is the prognosis of basilar or mid=body fractures? |
|
Definition
-fair for athletic performance
-good for pasture/breedign |
|
|
Term
| What is the prognosis fo biaxial prximal sesamoid bone fractures? |
|
Definition
|
|
Term
| Physiologically, what results from a biaxial sesamoid bone fracture? |
|
Definition
-complete disruption of the suspensory apparatus
-hyperextension of hte fetlock
-complete fetlock luxation and/or neuro damage to the digit is possible |
|
|
Term
| What is MCP/MCT arthodesis? When do we perform it? |
|
Definition
-srugical fusion of the fetlock of the jt
-salvage at best |
|
|
Term
| What leads to distal sesamoidean desmitis? |
|
Definition
-pastern hyperextension injury
-activities involving torsion of the pastern |
|
|
Term
| What are the clinical signs of distal sesamoidean demsitis? |
|
Definition
-acute lameness grade following exercise
-reluctance to place heel on the ground
-may see digital sheath effusion |
|
|
Term
| In which horses do we see distal sesamoidean desmitis? |
|
Definition
|
|
Term
| How do we diagnose distal sesamoidean desmitis? |
|
Definition
-lameness usually improves with a basilar sesamoid block
-rads are unremarkable in acute cases but enthesopathy may be seen in chronic cases
-US will reveal enlargement, dec echogenicity and/or lsos of fiber pattern |
|
|
Term
| How do we treat distal sesamoidean desmitis? |
|
Definition
-rest
-therapeutic shoeing: egg bar for heel support
-NSAIDs/corticosteoirds
-controlled exerise
-ESWT
-laser light therapy
-Hyaluronate, PRP, stem cells
-surgical ligament splitting |
|
|
Term
| What is the pronosis of distal sesamoidean desmitis? |
|
Definition
-good with appropiate therapy
-duration of rest and quality of rehab are very important |
|
|
Term
| What is digital sheath syndrome? |
|
Definition
-inflammation and effusion of digital sheath
-palmar/plantar annular ligament constricts the sheath creating a compartment like syndrome
-as dz progresses, pain and inflammation inh fetlock extension |
|
|
Term
| What is the common name for early stage digital sheath syndrome? |
|
Definition
|
|
Term
| What are the 3 stages of digital sheath syndrome? |
|
Definition
-1: subclinical synovial effusion
-2: synovial proliferation accompanied by mild to mod lameness
-3: intense inflammatory process resulting in severe lameness |
|
|
Term
| How do we diagnose digital sheath syndrome? |
|
Definition
-lameness sometimes improves with a low 4(6) point block but may be mechanical issues to
=US evaluate amount of effusion, synovial prolifeation, and tendon pathology |
|
|
Term
| How do we treat stage 1 digital sheath syndrome? |
|
Definition
-many go untreated
=acute effusion can be treated with rest and systemic NSAIDs |
|
|
Term
| How do we treat stage 2 and 3 digital sheath syndrome? |
|
Definition
-rest and NSAIDs
-local infection of anti-inflammatories
-tenoscopic eval
-if really severe: desmotomy of the palmar/plantar annular ligament |
|
|
Term
| What is the prognosis of digital sheath syndrome? |
|
Definition
-Stage 1 = good
-Stage 2 = fair to good if treated appropriately
-Stage 3 = guarded for full ahtletic function
-desmotomy only temporary relief and will recurr |
|
|
Term
| What are MC/MT III condylar fractures? Describe them and incidece. |
|
Definition
-cyclic fatuigue fracture rather than an acute fracture to normal bone
-common in racehorses
-forelimb > hindlimb
-lateral > medial
-displaced or non-displaced |
|
|
Term
| What are the clinical signs of MC/MT III condylar fractures? |
|
Definition
-acute onset severe lameness during or immediately following intense exercise
-mode-severe effusion of fetlock jt |
|
|
Term
| How do we diagnose MC/MT III condylar fractures? |
|
Definition
-rads dorsopalmar view
-medial fx often spiral into canon |
|
|
Term
| How do we treat non-displaced MC/MT III condylar fractures? |
|
Definition
-conservative: stall confinement for 1-3m
-lag screw fixation |
|
|
Term
| How do we treat displaced MC/MT III condylar fractures? |
|
Definition
-lag screw fixation
-arthroscopic eval
-halflimb cast: especially for hindlimbs |
|
|
Term
| How do we treat medial MC/MT III condylar fractures with spiral components? |
|
Definition
-significant risk of complete fracture
-screws placed along entire fracture
-dynamic or locking compression plate
-recover in full limb cast |
|
|
Term
| What is the prgnosis for MC/MT III condylar fractures? |
|
Definition
-non-displaced = good
-displaced = guarded
-hindlimb better than forelimb |
|
|
Term
| What is the most common major long bone fractured in the horse? |
|
Definition
|
|
Term
| What are the most common MC/MT III diaphyseal fractures in foals? |
|
Definition
|
|
Term
| What are the most common MC/MT III diaphyseal fractures in older horses? |
|
Definition
|
|
Term
| How do we treat MC/MT III diaphyseal fractures? |
|
Definition
-first-aid and external coaptation
-casting as sole treatment rarely successful
-internal fixation is the treatment of choice (double-plate fixation) |
|
|
Term
| What are the factors that impact the decision to treat a long bone fracture in a horse vs humane euthanasia? |
|
Definition
-size of horse
-open vs closed: open worse
-concurrent soft tissue damage
-fracture configuration
-financial commitment of owner
-owners expectations |
|
|
Term
| In which horses are dorsal metacarpal disease common? |
|
Definition
| -young, flat-racing horses in early training |
|
|
Term
| What is dorsal metacarpal disease? |
|
Definition
-periostitis and/or microfractures occur on dorsomedial aspect of the left or both forelimbs
-result from concussion and stress on a bone which has not been appropriately conditioned |
|
|
Term
| What are the clinical signs of dorsal metacarpal disease? |
|
Definition
-acute onset lameness or stiffness following intense exercise
-heat, swelling and/or pain on palpation over dorsal medial aspect of MC III |
|
|
Term
| How do we diagnose dorsal metacarpal disease? |
|
Definition
-history
-rads
-nuclear scintigraphy |
|
|
Term
| How do we treat dorsal metacarpal disease? |
|
Definition
-rest and rehab
-topical andti-inflammatory therapies: cold hydrotherapy, cold compression, sweat bandages
-Prognosis: good with appropriate treatment |
|
|
Term
| What is proliferative periostitis of MC/MT II and IV injury? |
|
Definition
| -inflammatory lesions usually resulting from repetitive strain or tearing of the interosseous ligament |
|
|
Term
| What age group of horses usually get proliferative periostitis of MC/MT II and IV? |
|
Definition
|
|
Term
| Is MC/MT II or IV more often affected by proliferative periostitis? Forelimb or hindlimbs? |
|
Definition
|
|
Term
| What are the clinical signs of MC/MT II and IV proliferative periostitis? |
|
Definition
-acute onset mild lameness
-focal area of firm, painful swelling |
|
|
Term
| How do we diagnose MC/MT II and IV prolifrative periostitis? |
|
Definition
-history
-clinical signs
-rads
-nuclear scintigraphy |
|
|
Term
| How do we treat MC/MT II and IV proliferative priostitis? |
|
Definition
-rest
-NSAIDs
-local injection of corticosteroids |
|
|
Term
| What is the prognosis of MC/MT II and IV proliferative periostitis? |
|
Definition
| -good with approriate therapy |
|
|
Term
| What are the three types of splint bone fractures? |
|
Definition
|
|
Term
| Which type of splint bone fracture are most common? |
|
Definition
|
|
Term
| What are the clinical signs of splint bone fractures? |
|
Definition
-mild/moderate soft tissue swelling of the MC/MT
-sweling may be more pronouced in open fractures
-degree of lameness depends on the type and chronicity and degree of suspensory involvement |
|
|
Term
| How do we diagnose splint bone fractures? |
|
Definition
|
|
Term
| How do we treat splint bone fractures? |
|
Definition
-conservative management often results in delayed healing with extensive callus formation
-distal and middle fx respond well ot surgical excision
-proximal fx must be managed with internal fixation
-complete excision of MT IV can be performed with good results |
|
|
Term
| How do we treat an open splint bone fracture? |
|
Definition
-appropriate preop wound management: clean, lavage, bandage to reduce swelling
-systemic and regional antimicrobials
-tetanus prophylaxis |
|
|
Term
| What is the prognosis with each type of splint bone fracture? |
|
Definition
-distal: excellent if no concurrent suspensory desmitis
-middle: good iwth excision and appropriate rest period
-proximal: fair to good with interna fixation |
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