Auer Ch 90 Foot

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Back 1

Front 2

Back 2

Front 3

Back 3

Front 4

Back 4

Front 5

Disorders of the hoof capsule:

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thrush, white line disease, hollow or loose hoof wall, hoof cracks

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Treatment for hoof cracks:

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assess/ correct shoeing abnormalities, remove horn adjacent to crack down to sensitive lamina, cover defect with betadine gauze, apply bar shoe with sole packing +/- metal treatment plate, fixation device placed over crack

Front 7

What is the goal of applying a fixation device to a hoof crack?

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Unite 2 separate hoof parts to reduce individual movements at transition of normal horn at the level of the coronary band

Front 8

Methods of fixation for hoof cracks:

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artificial hoof horn products, umbilical tape around screws in hoof wall, metal hoof wall clamps, metal plates that are glued or screwed to the hoof wall

Front 9

What is the effect of a keratoma?

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Unphysiologic pressures exerted on sensitive lamina leading to inflammation and lysis of P3

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Treatment of keratoma:

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entire keratoma is removed, aseptic bandage, once granulation tissue covers defect a medication plate shoe is applied, stall rest for 4-6 weeks, depending on healing light riding after 2-4 months

Front 11

What are the avenues of chronic hoof abscesses?

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Along dorsal and lateral wall to break at coronary band, invasion of DIP joint, along and undermining sole resulting in septic P3

Front 12

Treatment of chronic hoof abscesses:

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debridement of abscess and infected tissues (P3, DIP joint)

Front 13

Types of P3 fractures:

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1: abaxial (wing) without joint involvement; 2:abaxial (wing) with joint involvement; 3: axial (sagittal) or perisagittal with joint involvement; 4: extensor process; 5:comminuted with joint involvement; 6: solar margin

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Treatment of type 1 P3 fractures:

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cast with sole pack or bar shoe with large side clips, NSAIDs, stall rest for 2-4 months

Front 15

Healing time of type 1 P3 fracture:

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4-6 months

Front 16

Radiographic healing time of type 1 P3 fractures:

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6-12 months

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Treatment of type 2 P3 fractures:

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cast with sole pack or bar shoe with large side clips, NSAIDs, stall rest for 2-4 months if not significantly displaced; if displaced, arthroscopic reduction and lag screw fixation

Front 18

Non-surgical management of type 3 P3 fracture:

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cast with sole pack or bar shoe with large side clips, NSAIDs, stall rest for 4 months followed by 4 months of hand walking

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Prognosis for non-surgically managed type 3 P3 fractures:

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better for horses younger than 2, poorer for riding horses

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Surgical management of type 3 P3 fracture:

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arthroscopic reduction, imaging guided placement of lag screw across fracture plane with 1 or 2 4.5 or 5.5 cortex screws

Front 21

Post-operative care for surgical management of type 3 P3 fracture:

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stall rest for 4 months, hand walk for 4 months

Front 22

Complications of surgical management of type 3 P3 fractures:

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infection, abscess formation, screw may have to be removed

Front 23

Etiologies of extensor process fractures:

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hyperextension, avulsion of CDE, osteochondrosis (from separate center of ossification)

Front 24

Treatment of type 4 P3 fractures:

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small fragments removed arthroscopically; large fragments can be managed conservatively, lag screw fixation, or removed arthroscopically

Front 25

Types of NB fractures:

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avulsion, simple body, comminuted, frontal

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What should NB fracture be distinguished from?

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Bi- or tripartate NB

Front 27

Non-surgical management of NB fracture:

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elevated bar shoe for 4 months, small paddock exercise with a wide web shoe for 4+ months or fixation in extremely flexed position in fiberglass cast for up to 6 months

Front 28

Healing time for NB fracture:

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10-12 months

Front 29

Surgical management of NB fracture:

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lag screw fixation with 3.5 mm cortex screw with radiolucent aiming device & imaging or computer assisted guidance or palmar digital neurectomy

Front 30

Disadvantages of lag screw fixation of NB fracture:

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difficulty in placing screw without penetration of DIP joint of DFTS

Front 31

Healing of lag screw fixation of NB fracture:

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6-8 months

Front 32

Arthroscopic approaches to DIP joint:

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dorsal (2 cm proximal to CB, 1.5 cm abaxial to dorsal midline, directed dorsolateral to dorsomedial); palmar (axial to collateral cartilage and neurovascular bundle, abaxial to DDFT at palmar outpouching of joint, directed toward apex of frog); lateral (5mm proximal to convavity of collateral cartilage, 5mm palmar to distal P2, directed parallel to palmar P2)

Front 33

What is visualized with dorsal DIP arthroscopic approach?

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Extensor process fragments, distal P2, dorsal synovial membrane

Front 34

What is visualized with palmar DIP arthroscopic approach?

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Midsagittal ridge of dorsal border of NB, proximal border of NB, medial and lateral aspect of joint, collateral sesamoidean ligaments

Front 35

Post-op care for PD neurectomy:

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stall rest 4 weeks, hand walking 4 weeks

Front 36

Complications of PD neurectomy:

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neuritis, neuroma formation, laminitis secondary to blood vessel injury

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Methods to prevent neuroma/ neuritis after PD neurectomy:

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epineural capping, inserting nerve end into hole drilled in P1, ligating nerve, cryoneurectomy, CO2 laser

Front 38

Approaches for PD neurectomy:

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1 skin incision, pull-through (2 incision)

Front 39

Goal of high lateral and medial palmar neurectomy:

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disrupt afferent and efferent nerve tracts proximal to the division into palmar and dorsal branches to prevent pain from chronic disease

Front 40

Where is high lateral and medial palmar neurectomy performed?

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Proximal to DFTS

Front 41

Surgical management options for navicular disease:

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navicular suspensory desmotomy, PD neurectomy, periarterial sympathectomy

Front 42

Mechanism of navicular suspensory desmotomy:

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reduces forces on the NB and perinavicular structures with caudal weight bearing phase of stride (when navicular suspensory ligaments are loaded), transection of sensory fibers within CSL

Front 43

What are the suspensory ligaments of the NB?

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Collateral sesamoidean ligament (from distal P1 to NB), impar ligament (from distal NB to palmar P3) and chondrosesamidean ligament (from abaxial NB to abaxial P3)

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Approaches to desmotomy of CSL:

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open, arthroscopic

Front 45

Describe open CSL desmotomy:

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4cm vertical incision midway between CDE and distal eminence of P1 from eminence to CB, retract superficial vessels, isolate CSL, transect with scalpel, repeat on opposite side

Front 46

Describe arthroscopic CSL desmotomy:

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palmar arthroscopic approach medial and lateral, identification of CSL, transection with hook knife, repeat on opposite side

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Post-op care for CSL desmotomy:

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bandaging and stall rest for 10 days until suture removed, hand walking for 3 weeks, gradual return to full work at 3 months

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Conditions associated with poor response to CSL desmotomy:

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flexor cortex defects, proximal border enthesiophytes, mineralization of DDFT, medullary sclerosis of NB

Front 49

Indications for CSL desmotomy:

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new bone growth at insertion of CSL

Front 50

Describe perivascular sympathectomy and fasciolysis:

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10cm skin incision centered over PSB, isolation of neurovascular bundle, removal of perivascular tissues and perineural tissues, close incision

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Mechanism of perivascular sympathectomy:

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dissection of sympathetic nerve supply to vessels resulting in prolonged vasodilation

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Surgical management options for chronic laminitis:

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DDFT tentomy

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Approaches to DDFT tenotomy:

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mid-pastern, mid-MC

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Mechanism of DDFT tenotomy:

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reduces palmar directed forces of DDFT on P3 which decreases shear stress on dorsal lamina, reduces pressure on apex of P3 on corium of sole, lowering of heel to allow more natural alignment of P3

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Benefits of mid-MC DDFT tenotomy:

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easier to perform, can be performed standing, does not invade DFTS so less risk of post-op infection, leaves some support for DIP joint

Front 56

Describe mid-MC DDFT tenotomy:

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vertical incision lateral aspect of proximal to mid-third of MC, DDFT separated from neurovascular bundle, ALDDFT, SDFT and elevated from incision, leg lifted, DDFT transected OR blind transection with blunt bistoury knife while standing

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Complications of mid-MC DDFT tenotomy:

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damage/ laceration of neurovascular structures

Front 58

Describe mid-pastern DDFT tenotomy:

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3 cm vertical incision in pastern region, 1 cm proximal to heel bulbs, DDFT exposed, elevated, transected

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Which DDFT tenotomy approach has the most separation of the DDFT?

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mid-pastern because no other attachments of DDFT except for distal P3

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Post-op care for DDFT tenotomy:

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bandage and stall rest for 6 weeks, shoe with heel extension for 6-8 weeks

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Complications of DDFT tenotomy:

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infection, post-op pain

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Source of post-op pain for DDFT tenotomy:

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overloading SDFT, OA DIP joint, chronic infection of P3

Front 63

What ruminant digit is mostly likely to be affected by disease?

Back 63

Lateral hind

Front 64

Most common location of digital fracture in ruminants?

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Lateral hind, medial fore

Front 65

Treatment of ruminant digital fracture:

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wooden block on healthy digit, affected digit wired to healthy digit in slight flexion

Front 66

Surgical options for septic DIP joint in ruminants?

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Digit amputation, facilitated ankylosis

Front 67

Advantages of ruminant digit amputation:

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rapid, inexpensive procedure, all infected tissue removed, rapid return to production

Front 68

Disadvantages of ruminant digit amputation:

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production life is reduced, poor cosmesis, heavy animals do poorly

Front 69

Advantages of facilitated ankylosis of ruminant DIP joint:

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longer production life, better for heavier animals or when lateral hind or medial front affected, more cosmetic, more mechanically stable

Front 70

Disadvantages of facilitated ankylosis of ruminant DIP joint:

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expensive, technically challenging, more post-op care, slower return to production

Front 71

Approaches to facilitated ankylosis of ruminant DIP joint:

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solar, dorsal

Front 72

Advantages of solar DIP ankylosis in ruminants:

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good visualization of joint, excellent drainage, good long term prognosis

Front 73

Disadvantages of solar DIP ankylosis in ruminants:

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difficult approach, resection of distal sesamoid bone, DDFT, and tendon sheath cause instability

Front 74

Advantage of dorsal DIP ankylosis in ruminants:

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DDFT and distal sesamoid bone are not affected, easy & less invasive, more stable approach compared with solar approach