Large Animal Surgery

Front 1

When a forelimb lameness is involved, how does the head and front end of the animal's torso move?

Back 1

They both move dorsally

Front 2

When a hindlimb lameness is involved, how does the croup and rear end of the animal move?

Back 2

They both move dorsally

Front 3

What gait/speed is the best for lameness evaluation of a horse?

Back 3

trot

Front 4

What is a trot?

Back 4

gait in which the right fore - left rear limbs and left fore - right rear limbs hit the ground at the same time

Front 5

What will you see with a subtle lameness?

Back 5

-the animal does not "settle into the lame leg"
-the fetlock does not extend/drop to the same degree as the sound limb

--consider which limb the animal bears weight on most comfortably

Front 6

What are 3 ways to test for lameness of jogging doesn't work?

Back 6

try moving on a harder surface
move in a circle (lunge line)
evaluate w/rider in the saddle

Front 7

95% of forelimb lameness occurs where?

Back 7

in the carpus of below

Front 8

Rear limb lameness most commonly involves what?

Back 8

the foot and hock

Front 9

When doing digital flexion of the forelimb, where is stress applied? (ex joint)

Back 9

navicular, coffin joint, pastern join, and fetlock

Front 10

When doing digital flexion of the forelimb, when do you start evaluating the lameness of the animal?

Back 10

evaluate the lameness after the initial 100 foot distance

Front 11

When doing digital flexion of the rearlimb, when do you start evaluating the lameness of the animal?

Back 11

immediately - if there is any incr in lameness (no 100 foot allowance as with the forelimb) it is a positive finding

Front 12

When doing flexion of the hock, how long do you hold the position and how is the horse moved afterwards?

Back 12

apply pressure on the metatarsus for approximately 2 minutes, then have the horse jogged off at a TROT (not a walk then trot)

Front 13

When doing hock flexion, when do you start evaluating the lameness of the animal?

Back 13

right away - any incr in lameness is significant

Front 14

How do you perform a stifle flexion? This is similar to what other flexion/extension test?

Back 14

pick up the limb, pull it to the rear and apply upward pressure to the metatarsus

hip extension

Front 15

How do you start regional nerve blocks?

Back 15

always start DISTAL and move proximal

Front 16

What is the preferred anesthetic for regional and intra-articular anesthesia in the horse and why?

Back 16

Mepivicaine (carbocaine) bc it is less irritating and has a similar onset but lasts longer than lidocaine

Front 17

Where do you do a palmar digital nerve block? Where is the anesthetic injected?

Back 17

palmar aspect of the pastern joint, just proximal to the collateral cartilages

just axial to the neurovascular bundle if you can feel it (light horses)

Front 18

What does a palmar digital nerve block anesthetize?

Back 18

the palmar 1/3 of the foot and sole (navicular complex is blocked) (heel block)

Front 19

What nerve are you blocking with a foot block?

Back 19

the dorsal brance of the palmar digital nerve

Front 20

When combined with the palmar digital nerve block, what is anesthetized when doing a foot block?

Back 20

all structures within the hoof

Front 21

When doing an abaxial sesamoid block, where is the local anesthetic injected?

Back 21

immediately caudal to the neurovascular bundle, which is at the abaxial surface of the sesamoid bone

Front 22

What does the abaxial sesamoid block anesthetize?

Back 22

all structures distal to the midpastern including the pastern joint (foot should already be blocked by the palmar digital and foot blocks)

Front 23

Where are the injections made with a low four point block?

Back 23

at the level of the distal end of metacarpals/tarsals II & IV (end of the splint bones)

palmar nerves are blocked medially and laterally just dorsal to the deep digital flexor tendon

palmar metacarpal nerves are blocked medially and laterally just distal to end of metacarpal II & IV (just dorsal to the interosseous muscle)

Front 24

What areas are anesthetized using the low four point block?

Back 24

all areas distal to the injection site (fetlock and below)

Front 25

What is scintigraphy effectively used for in evaluating lameness?

Back 25

it is effective for determining the area of involvement by not the exact problem

Front 26

What is thrush?

Back 26

a degernative condition of the frog characterized by a black necrotic odoriferous material

Front 27

What can cause thrush?

Back 27

filthy conditions
failure to clean the foot regularly
lack of pressure on frog (interferes with natural cleaning)

Front 28

Name a medication commonly used to treat thrush

Back 28

Coppertox

Front 29

Thrush: What do you do if sensitive tissue is not involved, therefore the animal is not lame?

Back 29

application of 10% formalin will clear the condition rapidly, though overuse will make the frog extremely hard

Front 30

Thrush: What do you do if sensitive tissue is involved, therefore the animal is lame?

Back 30

trim the frog to remove all abnormal tissue
apply mild disinfectants as a wet dressing and bandage daily

Front 31

What is the prognosis for thrush?

Back 31

good

Front 32

What is "corns?" On which feet is it usually found?

Back 32

bruising of the sole at the angle of the wall and the bar (bruising of the sole in any other area is called a sole bruise)

front feet

Front 33

Name the different classifications of "corns" and describe them

Back 33

dry - reddened area of the sole
moist - serum under the sole
suppurating - secondary infection as a result of bruising

Front 34

What usually causes corns?

Back 34

improper shoeing or leaving the shoes on for too long a time (heels of the shoes apply pressure to the sole rather than the hoof wall)

Front 35

T/F: horses that are barefoot seldom develop corns

Back 35

true

Front 36

What are the clinical signs of corns?

Back 36

lameness with a tendency to protect the heel

Front 37

How do you diagnose corns? What type or nerve block would help diagnose it?

Back 37

reaction to hoof testers when applied to the angle of the wall and bar
significant decrease in lameness following a PALMAR DIGITAL NERVE BLOCK

Front 38

How do you fix/manage corns?

Back 38

-if the shoe is the problem, remove it
-trim the involved sole so that there is no contact w/the shoe when weight is born on the foot
-drain if suppurating
-rest if possible
-shoeing following trimming to minimize pressure on affected area

Front 39

NSAIDs help with corns when?

Back 39

with rest (with work, they usually prolong the problem)

Front 40

Corns: What type of shoe would be useful to protect the involved area?

Back 40

wide web shoe or a bar shoe

Front 41

What are bruised soles?

Back 41

the same sort of lesion as corns involving any area of the sole EXCEPT the angle of the wall and bar

Front 42

How do you diagnose bruised soles?

Back 42

reaction to hoof testers
discolored areas on the sole (evidence of chronic bruising)
response to nerve blocks
radiographs (determine if the condition has progressed to pedal osteitis)

Front 43

What nerve blocks may be of diagnostic use to dx bruised soles?

Back 43

heel block (reduced lameness)
foot block (sound)

Front 44

What is recommended for management of bruised soles?

Back 44

-rest and NSAIDs
-wide webshoe w/the axial side thinned by grinding or beating it down to that pressure if not applied to the sole
-pads (sometimes recommended)

Front 45

prognosis of bruised soles

Back 45

good w/proper tx and rest (sometimes up to a year if necessary)
excessive traums for long periods will result in pedal osteitis

Front 46

What is pedal osteitis?

Back 46

an inflammatory condition involving the third phalanx that has resulted in a loss of bone density in P3

Front 47

What is pedal osteitis caused by?

Back 47

a chronic inflammatory process involving P3 - severe sole bruising (repeated concussion), laminitis, chronic subsolar abscesses

Front 48

Which foot/feet does pedal osteitis usually affect? Why?

Back 48

front feet

more weight --> more trauma

Front 49

What clinical signs may you see with pedal osteitis?

Back 49

if excessive work it will be bilateral
short choppy gait

Front 50

How do you diagnose pedal osteitis?

Back 50

incr rxn to hoof testers
evidence of chronic bruising (discolored areas)
response to nerve blocks
radiographic changes

Front 51

What nerve blocks would be diagnostic with pedal osteitis?

Back 51

palmar digital block - improves lameness
foot block - usually sound

Front 52

What radiographic changes might you see with pedal osteitis?

Back 52

lack of density of P3
roughening of the distal border of P3

these radiographic changes can be mimicked when normal feet are x-rayed with an incr in kV setting

Front 53

pedal osteitis is most commonly secondary to what?

Back 53

laminitis

Front 54

How do you protect the foot with pedal osteitis?

Back 54

wide web shoe (axial border thinned to prevent contact w/the sole)
complete pads
rim pads

Front 55

How do you manage pedal osteitis?

Back 55

protect the foot (pads/shoes)
rest from FORCED exercise
stall confinement NOT necessary or desires

Front 56

What is the prognosis of pedal osteitis?

Back 56

guarded

Front 57

Which animals are prone to develop pedal osteitis?

Back 57

animals worked on rough terrain
animals used in endurance competition

Front 58

What is the most common cause of lameness?

Back 58

subsolar abscess

Front 59

What is a subsolar abscess?

Back 59

an abscess under the sole of the foot (anytime an animal is lame, this MUST be ruled out)

Front 60

T/F: subsolar abscesses usually cause mild lameness

Back 60

false: usually severe lameness is caused (sometimes very acute)

Front 61

Subsolar abscess: If drainage is not established, wounds close to the white line will drain where?

Back 61

at the coronary band (referred to as "gravel")

Front 62

Subsolar abscess: If drainage is not established, wounds of or close to the frog will drain where?

Back 62

at the heel

Front 63

How do you diagnose subsolar abscesses?

Back 63

-lameness (usually severe)
-incr rxn to hoof testers (means POSSIBLE subsolar abscess, though no response usually means NOT abscess)
-incr rxn to tapping on hoof wall
-incr pulse in digital arteries
-discoloration - pare for purulent exudates
-

Front 64

Why not radiograph a possible P3 fracture right after it occurs?

Back 64

they are sometimes difficult to diagnose right after

Front 65

What is essential when healing a subsolar abscess?

Back 65

ventral drainage must be established (be careful using a hoof knife as the corium of the hoof wall may prolapse and prolong healing - can drill through the hoof wall as an alternative)

Front 66

What do you do if a subsolar abscess is draining at the coronary band?

Back 66

establish ventral drainage

Front 67

How long must drainage be maintained with a subsolar abscess?

Back 67

until the corium of the sole is healthy - approx 1 week

Front 68

What is suggested for a subsolar abscess after drainage is established?

Back 68

wet bandage w/mild antiseptic and a hypertonic soln (ex magnesium sulfate + a mild antiseptic in water)

Front 69

With subsolar abscess, when is antibiotic therapy suggested

Back 69

in immature animals and in complicated infections to prevent osteomyelitis (not necessary in mature horses w/a routine foot abscess)

Front 70

With what disease/problem is tetanus prophylaxis very important? When and how is it done?

Back 70

subsolar abscesses

if never had tetanus vaccination: consider toxoid and antitoxin (though antitoxin contraindicated in horses >2yrs)

if tetanus vaccinated: give 2 doses of tetanus toxoid w/o antitoxin

Front 71

Prognosis of subsolar abscesses

Back 71

good when ventral drainage is established prior to involvement of deeper tissues

Front 72

Sheared heels is aka...

Back 72

wry heels

Front 73

What are sheared/wry heels?

Back 73

marked difference in the length of the hoof wall at the heels resulting in variation of the pressure applied to each side of the foot

Front 74

What causes sheared/wry heels?

Back 74

improper footwear or trimming (poor shoeing)

Front 75

What should be done if you find sheared/wry heels but no lameness exists?

Back 75

probably best to shoe the horse so as to not worsen the condition, but not try to correct it

Front 76

What should be done if you find sheared/wry heels and the animal is lame?

Back 76

balance the foot- trim so that in time, weight will be born evenly on the medial and lateral hoof walls
apply a bar shoe and trim the elevated hoof slightly more so that weight is not born on that portion but on the frog and the contralateral side

Front 77

Prognosis of sheared/wry heels

Back 77

no lameness- little significance
lame- fair prognosis

Front 78

What are contracted heels?

Back 78

heels are closer together than normal

Front 79

What can cause contracted heels?

Back 79

usually the result of the animal not bearing adequate weight on heels- due to pain, being shod w/an overly long foot (as with gaited horses), 2ndary to nonweight bearing lameness or cast application

Front 80

T/F: increasing frog pressure if the key to treating contracted heels

Back 80

false: that was recommended in the past, but has found to be untrue

Front 81

What should be done in a horse with contracted heels but no lameness exists?

Back 81

take measure to prevent the problem from worsening

Front 82

How do you treat contracted heels?

Back 82

-if nonweight bearing due to pain, identify underlying cause and tx
-proper trimming to reduce length of the heel and balance the foot
-shoe so that the shoe is slightly wide at the quarters and heels and the heel of the shoe extends to the rear of the foot
-apply slipper shoes
-thin the quarters (in severe cases)
-grooving (in severe cases)

Front 83

What are slipper shoes?

Back 83

the shoe is thicker on the axial sides so that when weight is born the hoof wall moves slightly abaxially

Front 84

What is grooving?

Back 84

a cast cutter is used to cut down to the whtie line

Front 85

Prognosis for contracted heels

Back 85

good if primary cause can be identified and corrected

Front 86

How would you prevent contracted heels?

Back 86

proper trimming and weight bearing
in horses that need to have a long foot (gaited horses) consider the use of a Chadwick spring

Front 87

What is a Chadwick spring

Back 87

it is inserted in the sulcus of the frog under a pad and provides continual pressure in an abaxial direction

Front 88

What is the navicular apparatus made up of?

Back 88

navicular bone
collateral ligaments of the navicular bone
distal sesamoidean ligament (aka impar ligament)
navicular bursa
deep digital flexor tendon
distal annular ligament

Front 89

What is navicular disease?

Back 89

a complex syndrome involving the navicular apparatus

Front 90

What age group is most commonly affected by navicular disease?

Back 90

ages 4-9 (middle age)

Front 91

What breed is most commonly affected by navicular disease?

Back 91

quarter horses

Front 92

What sex is most commonly affected by navicular disease?

Back 92

geldings

Front 93

2 possible causes for navicular disease

Back 93

abnormal mechanical forces- hard work, small feet in proportion to body size, upright pasterns and shoulders
circulatory disturbances- once thought that ischemia due to capillary thrombosis was a major factor, but this is now known to be of minimal significance

Front 94

In which foot/feet is navicular disease usually found?

Back 94

most always a front foot lameness
usually bilateral w/one foot mroe severely involved

Front 95

c/s of navicular disease

Back 95

short, choppy gait (rider reports "rough riding") - short anterior phase of stride
owners reports horse has sore shoulders
foot worn excessively at toe
horse tends to stumble
horse points the foot

Front 96

Why does the owners report sore shoulder on a horse with navicular disease?

Back 96

a myositis of the Brachiocephalicus muscle is common causing the horse to respond to pressure proximal to the shoulder

Front 97

Why does the horse stumble w/navicular disease?

Back 97

it moves with the foot very close to the ground

Front 98

How do you dx navicular disease?

Back 98

-typical gait (short anterior phase, foot close to ground)
-incr rxn (hoof testers across the heel from the wall to the frog; pressure applied to brachiocephalicus muscle)
incr lameness (on hard surfaces, turns, following hoof testers, following digital flexion)

Front 99

Which blocks can be used to help dx navicular disease? Are they specific enough?

Back 99

-palmar digital nerve block at the level of the lateral cartilages (heel block)
-injection into the distal interphalangeal joint (after heel block if it gets a positive response)

no, not specific enough

Front 100

What % of animal w/navicular disease do not have radiographic signs? Many of those animal w/radiographic signs are what?

Back 100

50%

sound

Front 101

What are some typical radiographic signs of navicular disease?

Back 101

-lollipop-like appearance to the vascular channels on the distal border (normal channels are cone shaped)
-spurs or periosteal proliferation on the lateral borders of the navicular bone where the suspensory (collateral) ligaments of the navicular bone attach
-incr size of synovial fossa

Front 102

How could a gamma camera be used to look for navicular disease?

Back 102

look for an incr amount of isotope gathered (incr amount of radioactivity)

Front 103

How do you manage navicular disease in an animal that does NOT have to perform athletically?

Back 103

no tx necessary

Front 104

How do you manage navicular disease with shoeing?

Back 104

-trim foot to correct balance problems
-trim or shoe foot to maximize heel expansion and aid in break over
-egg bar shoes could minimize tension on the DDF tendon

Front 105

Name the most frequently used NSAID used for navicular disease

Back 105

Phenylbutazone (max dose 8.8mg/kg/day - long term dose cut in half)

Front 106

T/F: NSAIDs are much more toxic to ponies than horses

Back 106

true, so use a dose approximately 1/2 that of horses

Front 107

What can you use if an animal wil not take oral NSAIDs for navicular disease?

Back 107

Boswella- an herbal anti-inflammatory

Front 108

What does isoxsuprine hydrochloride do for navicular disease? What animals do not respond to it?

Back 108

incr blood flow as a result of vasodilation or altering the malleability of RBCs

those w/severe radiographic changes

Front 109

How can sodium hyluronate be given to get a good result in navicular disease?

Back 109

by injecting it into the coffin joint and IV injection

Front 110

Name 3 long-lasting corticosteroids that can be used for either intra-articular therapy or intra-bursal therapy for navicular disease

Back 110

Celestone soluspan (Betamethasone)
Depo-Medrol (Methylprednisolone acetate)
Vetalog (Triamcinolone acetonide)

Front 111

Name2 short/medium lasting corticosteroids that can be used for either intra-articular therapy or intra-bursal therapy for navicular disease

Back 111

Flucort (Flumethasone)
Predef 2X (Isoflupredone acetate)

Front 112

In what joint is intra-articular corticosteroid therapy done for navicular disease?

Back 112

distal interphalangeal joint

Front 113

In what bursal is intra-bursal corticosteroid therapy done for navicular disease?

Back 113

navicular bursa

Front 114

Drugs or procedures used to decrease nerve conduction in navicular disease last for how long?

Back 114

3 to 6 months

Front 115

Why should you not use percutaneous injections of ethyl alcohol in navicular disease?

Back 115

can result in painful neuroma formation

Front 116

name some drugs that can be used to decr nerve conduction in navicular disease and how would you use each of them?

Back 116

Ethyl alcohol- only used after sx exposing the nerve and inj into neurolemma
Sarapin- inj percutaneously (over the nerve) w/corticosteroid
Cobra venom- inj percutaneously
Dicumerol/Warfarin- inproves blood flow, can cause bleed out
Adequan/polysulfated glycosaminoglycans
Skelid/Tiludronate- alters bone remodeling

Front 117

name 3 procedures that can be used to manage navicular disease

read how to do each of these (pg 2-14/15)

Back 117

percutaneous freezing of palmar digital nerves (casues white hair growth)
palmar digital neurectomy
desmotomy of the suspensory/collateral ligaments of the navicular bone

Front 118

What are you worried about cutting when doing a palmar digital neurectomy?

Back 118

the ligament of the ergot, thinking it is the palmar digital nerve

Front 119

When doing a palmar digital neurectomy, how do you differentiate between the palmar digital nerve and the palmar digital artery?

Back 119

the artery is elastic and the fibers of the nerve can be palpated

Front 120

What is the most common technique used to manage the nerve when doing a palmar digital neurectomy?

Back 120

the guillotine technique (apply tension to the nerve and cut as far proximal as possible, then cut distally to remove a 2-3 cm segment of the nerve)

Front 121

What other techniques can be used to manage the nerve when doing a palmar digital neurectomy?

Back 121

electrocoagulation of the proximal nerve end
epineural sheathing (aka epineural capping)
laser
drill a hole in proximal phalanx and insert proximal nerve end in the hole
two incision technique

Front 122

Where is a bandage applied after doing a palmar digital neurectomy?

Back 122

from the hoof to carpus (stall rest w/leg in bandage for 1 month)

Front 123

T/F: Initial reports of the effectiveness of a desmotomy of the suspensory/collateral ligaments of the navicular bone, as well as long term reports, were very encouraging with a 70-80% success rate

Back 123

False: while initial reports were encouraging, the long term effects are not as encouraging - usually results in an INITIAL reduction or correction of lameness

Front 124

T/F: desmotomy of the suspensory/collateral ligaments of the navicular bone can be done either standing or in lateral or dorsal recumbency

Back 124

false: desmotomy of the suspensory/collateral ligaments of the navicular bone can only be done in dorsal recumbency while a palmar digital neurectomy can be done either standing or in dorsal or lateral recumbency

Front 125

When doing a desmotomy of the suspensory/collateral ligaments of the navicular bone, what ligament are you going to transect?

Back 125

the collateral distal sesamoidean ligament

Front 126

How do you manage the leg/horse after doing a desmotomy of the suspensory/collateral ligaments of the navicular bone?

Back 126

bandage and stall rest until the sutures are removed in 10 days

some say slow return to work over 3 months, some say rapid return

Front 127

What is a perivascular sympathectomy and fasciolysis?

Back 127

a technique used to tx navicular disease in which the sympathetic nerve supply to the medial and lateral digital arteries is stripped

Front 128

Where is a perivascular sympathectomy and fasciolysis performed?

Back 128

over the length of the proximal sesamoid bones w/the arteries being freed from their perivascular tissues

Front 129

What is the result of a perivascular sympathectomy and fasciolysis supposed to be?

Back 129

it is supposed to result in vasodilation of the region and return horses w/navicular disease to soundness

Front 130

T/F: navicular disease cannot be cured

Back 130

true: all methods just allow the animal to perform WITH the condition

Front 131

How do you prevent navicular disease?

Back 131

well-balanced shoeing
judicious use

Front 132

Where do fractures of the navicular bone mainly occur? Are they common or rare?

Name the 4 types of fractures

Back 132

more commonly in forelimbs
quite rare

avulsion, frontal, comminuted, simple body fractures

Front 133

What are most fractures of the navicular bone a result of?

Back 133

trauma (excessive and repetitive loading), though sometimes associated w/navicular disease

Front 134

What c/s can be used to help dx fractures of the navicular bone?

Back 134

marked incr in pain and lameness on turning
marked rxn to physical dx tests for navicular disease

Front 135

what is definitive for fractures of the navicular bone?

Back 135

radiographs- care must be taken to prepare and pack the foot to prevent artifacts

Front 136

What can be confusing on radiographs of a fracture of the navicular bone?

Back 136

a bipartite navicular bone (2 ossification centers)

Front 137

What are the two types of management for fractures of the navicular bone?

Back 137

conservative and surgical

Front 138

What does conservative management entail with fractures of the navicular bone?

Back 138

elevated bar shoe- stall rest (4-6 mos), small paddock exercise (additional 6 mos)
fiberglass cast w/the limb in marked flexion (6 mos)

Front 139

What does surgical management entail with fractures of the navicular bone?

Back 139

insertion of a lag screw- requires special aiming devise, 6-8 mos rest, and neurectomy

Front 140

What percentage of horses with fractures of the navicular bone return to soundness?

Back 140

68%

Front 141

What is the prognosis for horses with fractures of the navicular bone with both conservative and surgical management?

Back 141

conservative- guarded for pleasure horse riding

surgical- guarded for athletic competition

Front 142

How should acute laminitis be treated?

Back 142

AS AN EMERGENCY!! (to delay is very bad news)

Front 143

Why treat acute laminitis early?

Back 143

early tx --> early recovery --> better prognosis

Front 144

What is chronic laminitis?

Back 144

chronic to acute foot pain associate w/prolonged abnormalities in the lamina

Front 145

how is chronic laminitis developed?

Back 145

-exists when animals have not responded to therapy for acute laminitis
-some animals have developed laminitis, especially as a result of being on lush pasture, that takes a chronic course from the start

Front 146

T/F: laminitis is more common in a pony than a horse

Back 146

true

Front 147

What is the ideal bedding for horses, especially those with laminitis?

Back 147

turf (ex golf course), peat moss

Front 148

c/s of chronic laminitis

Back 148

-marked foot pain of prolonged duration
-3rd phalanx peaking thru the toe of the hoof wall)
-"sinker"- meaning the whole 3rd phalanx sinks in the hoof and "bottoms out"

Front 149

In which feet is chronic laminitis most common?

Back 149

more common in front feet
sometimes all 4 feet
seldom, if ever, only rear feet

Front 150

How do you dx chronic laminitis?

Back 150

hx of acute laminitis
marked evidence of foot pain (reluctance to move, incr reluctance to turn, incr digital pulse, resists picking up foot, marked rxn to hoof testers, marked rxn to tapping on foot)

Front 151

What could sand/styrofoam under the hooves do for chronic laminitis?

Back 151

distributes pressure from wall to the hoof to even out pressure on the toe and sole

Front 152

How would you manage chronic laminitis?

Back 152

-judicious use of NSAIDs
-maintain normal BP
-nursing care (comfortable stall, nonirritable bedding), adequate but not excessive feed)
-sx

Front 153

How could you surgically manage chronic laminitis?

Back 153

-frog/heart bar shoes or wood shoe/"clog"
-trimming the foot so the sole is parallel to the distal aspect of the 3rd phalanx
-removal of the dorsal hoof wall (grinding down of the toe so the anterior surface of the hoof is parallel to the anterior surface of P3 aka "beveling the toe")
-completely remove full thickness of the hoof at the toe

Front 154

What does removal of the dorsal hoof wall do for chronic laminitis? What shoe is recommended to support the hoof after these techniques are used?

Back 154

allows the hoof to grow down parallel with the anterior surface of P3

bar shoe with clips

Front 155

What does a deep digital flexor tenotomy do for chronic laminitis?

Back 155

markedly reduces the pressure on the lamina at the toe and pressure of the third phalanx against the corium of the sole

Front 156

T/F: after a DDF tenotomy and adequate recovery time, a horse will be sound for any type of work/labor

Back 156

fales: following this procedure, a few horses will be sound for pleasure riding but in general one should only hope for pasture soundness

Front 157

When considering a DDF tenotomy to tx chronic laminitis, what should be done prior to surgery?

Back 157

horse should be shod with a trailer shoe

Front 158

Where on the leg can a DDF tenotomy for chronic laminitis be done?

Back 158

either at midpastern or midcannon (metacarpus)

Front 159

What are the advantages of doing a DDF tenotomy midmetacarpus/midcannon bone when dealing with chronic laminitis?

Back 159

can be performed with the horse standing
tendon sheath is not invaded
some support of the distal interphalangeal join is maintained
less chance of postoperative infection

Front 160

What direction and where is the incision made when doing a DDF tenotomy midmetacarpus/midcannon bone for chronic laminitis?

Why is it made there?

Back 160

a vertical incision is made on the lateral edge of the DDF at the junction of the middle and proximal thirds of the metacarpus

there is no tendon sheath in this area (between the carpal sheath and the great digital sheath)

Front 161

What do you need to separate the DDF from when doing a DDF tenotomy midmetacarpus/midcannon bone for chronic laminitis?

Back 161

separate from the superficial flexor and the neurovascular bundle

Front 162

What is the problem - when doing a DDF tenotomy midmetacarpus/midcannon bone for chronic laminitis - with doing this technique with the animal bearing weight on the leg?

Back 162

must be done blind
greater chance of incision the neurovascular bundle- primary blood supply to the distal limb involves the medial palmar artery!!

Front 163

When would you normally do a DDF tenotomy at the midpastern area when treating chronic laminitis?

Back 163

normally only when a second tenotomy is indicated bc it is more difficult to perform in this area

Front 164

In which direction and where do you make the incision when doing a DDF tenotomy at the midpastern area for treating chronic laminitis?

Back 164

make a vertical midline incision in the palmar pastern through the skin and flexor tendon sheath

Front 165

In which approach to a DDF tenotomy (midmetacarpus or midpastern) do the tendon ends separate farther and why?

Back 165

midpastern because there is no attachment to supporting structures

Front 166

What type of nerve block do you do when doing a DDF tenotomy at the midpastern area when treating chronic laminitis?

Back 166

an abaxial sesamoid nerve block

Front 167

What is the prognosis for a DDF tenotomy done for chronic laminitis?

Back 167

guarded

reduction of pain and allows for derotation of P3

long and painful recovery from the laminitis, NOT from the surgery

Front 168

What is the result of an inferior check ligament desmotomy for treating chronic laminitis?

Back 168

reduction in the pull of the DDF tendon on P3

animals can be expected to perform athletically following this procedure

Front 169

What is the prognosis for chronic laminitis?

Back 169

always guarded

Front 170

What do hoof cracks look like and how are they described/characterized?

Back 170

fissures that usually run parallel to the laminae

some are surface cracks, some are perforating

described according to their location and direction

Front 171

What are the descriptive/characterizing terms for hoof cracks?

Back 171

toe, quarter, heel, and transverse (perpendicular to the laminae)

Front 172

What can cause hoof cracks?

Back 172

poor horn quality
thin hoof walls
abnormal hoof angles
long hooves

Front 173

Long hooves causing hoof cracks are more of a problem in... ?

Back 173

gaited horses, where long hooves are maintained to cause a desired gait

Front 174

Where do distal hoof cracks originate, do they cause lameness, and what is the problem with them?

Back 174

originate at the bearing surface

don't usually cause lameness if cared for

might become deeper (perforating) --> involve lamina --> lameness

Front 175

Where do proximal hoof cracks originate and what are they usually caused by?

Back 175

originate in the coronary band

caused by trauma or scar tissue at the coronary band

Front 176

T/F: Only distal hoof cracks may extend the entire length of the hoof

Back 176

false: proximal or distal hoof cracks can extend the entire length in time

Front 177

How do you get hoof cracks that extend the entire length?

Back 177

excessive hoof wall stress as a result of an overly long hoof or poor shoeing practices (may result in perforating cracks)
long shoeing intervals

Front 178

C/s with superficial hoof cracks

Back 178

just a slight crack in the hoof wall with no indication of pain

application of hoof tester does not cause a response

Front 179

C/s with perforating hoof cracks

Back 179

routinely cause lameness and response to hoof tester

Front 180

How do you manage a superficial hoof crack?

Back 180

-cutting a horizontal groove slightly proximal to the crack that extends to the white line
-drilling a hole at the proximal extension of the crack down to the white line
-cross nailing- horseshoe nails driven parallel to the bearing surface across the crack

Front 181

How are these types of management of superficial hoof cracks helpful?

Back 181

they distribute pressure more evenly

Front 182

What is a perforating hoof crack?

Back 182

one that extends to the lamina

Front 183

How do you manage perforating hoof cracks?

Back 183

stabilize it

Front 184

How do you stabilize a perforating hoof crack?

Back 184

-hoof wall adjacent to crack cleaned w/burr and dremel tool
-hoof acrylic
-metal of leather patch

Front 185

Describe how you would use hoof acrylic to stabilize a hoof crack

Back 185

drill holes in hoof wall --> lace wire or fiberglass across crack --> apply acrylic to hoof wall incorporating wire/fiberglass
--if hoof wall removal involved sensitive tissue, tx for several days until would is dry (place drain next to sensitive tissue and then apply acrylic)

Front 186

Describe how you would use a metal or leather patch to stabilize a hoof crack

Back 186

a plate of metal or strip of shoe leather is fastened to each side of the crack with metal screws

Front 187

What is another way to manage a perforating HEEL crack?

Back 187

application of a bar shoe and trimming the hoof caudal to the crack so that no weight is born on the hoof wall caudal to the crack

Front 188

Are horizontal crack pathogenic or non-pathogenic?

Back 188

non-pathogenic

Front 189

What is the prognosis for hoof cracks?

Back 189

prognosis is generally good, but perforating cracks with a defect in the coronary band sometimes persist for life

Front 190

How do you prevent hoof cracks?

Back 190

proper foot care

Front 191

What is a keratoma?

Back 191

a tumorous mass that develops in the dorsal aspect of the hoof wall (consists of poor quality horn)

Front 192

What is thought to cause a keratoma?

Back 192

it is thought to start as an inflammatory reaction possibly due to trauma at the coronary band

Front 193

What are the c/s of a keratoma?

Back 193

-bulging of the hoof wall beginning at the coronary band
-not painful initially but becoming painful as the mass grows and puts pressure on the lamina
-sometimes assoc w/chronic foot abscesses
-occasionally assoc w/ development of conical plugs of abnormal horn extending upward from the sole surface

Front 194

How can you diagnose keratomas?

Back 194

abnormal swelling of the hoof wall
sometimes abnormal conformation of the white line
radiographs

Front 195

What could you see on radiographs of a hoof with a keratoma?

Back 195

sometimes show a lytic area involving P3

Front 196

How should you manage a keratoma?

Back 196

removal of the hoof wall over the keratoma and debride to completely remove all abnormal tissue

Front 197

Describe how you would remove the hoof wall when managing a keratoma

Back 197

anesthetize patient or foot (can be done standing) --> Eschmarch bandage --> make vertical cuts in wall on either side of involved area w/cast cutter --> grasp distal surface w/hoof nippers and elevate hoof wall (completely remove it)

Front 198

Describe what you'd do after removing the hoof wall when managing a keratoma

Back 198

debride all abnormal tissue --> bandage wound to control hemorrhage --> remove Eschmarch bandage --> apply bar shoe w/clips to stabilize wall --> maintain wound under bandage until wound healthy --> reshoe every 6 wks until hoof grows down to bearing surface

Front 199

When removing the hoof wall (managing a keratoma), approximately how long iwll it take until the hoof grows back down to the bearing surface?

Back 199

approximately 9 months

Front 200

What is the prognosis for keratomas?

Back 200

83% success rate

should show marked/quick improvement of the animal's demeanor

Front 201

What can cause an infection of the navicular bursa?

Back 201

puncture wounds through or close to the frog

Front 202

What are infections of the navicular bursa sometimes associated with?

Back 202

subsolar abscesses

Front 203

How can you tell the difference between a subsolar abscess that might involves the navicular bursa and a subsolar abscess that does NOT?

Back 203

-if the abscess is drained and there is still significant lameness --> possible involvement of the navicular bursa
-if the abscess is drained and the animal shows a marked reduction in lameness w/i a day or (at the most) 2, most likely no navicular bursa involvement

Front 204

T/F: a puncture wound through or close to the frog does not always result in involvement of the navicular bursa

Back 204

true

Front 205

How do you dx an infection of the navicular bursa?

Back 205

evidence of a puncture would near or through the frog
persistent and severe lameness following the drainage of a subsolar abscess in the area of the frog

Front 206

What is an Eschmarch bandage?

Back 206

it is a rubber tourniquet

Front 207

How would you drain the navicular bursa if it were infected?

Back 207

clean and trim foot --> wet antiseptic dressing overnight --> anesthetize & eschmarch bandage --> cut a window approx 2.5cm square in the frog halfway between dorsal and palmar/plantar aspect --> dissect down to the DDF tendon and cute a window in it --> flush the bursa

Front 208

How would you close the holes made in the foot after draining the navicular bursa?

Back 208

pack defect in DDF tendon and frog w/antiseptic gauze (infused with iodoform) --> maintain sterile dressing until defects fill to close the bursa

Front 209

T/F When you flush the navicular bursa bc of infection, you expect only a small amount of purulent exudate

Back 209

true bc the bursa is quite small

Front 210

What may be required to make the horse sound after draining the navicular bursa of infection?

Back 210

a palmar digital neurectomy

Front 211

What is considered the best technique for draining the navicular bursa of infection?

Back 211

arthroscopic guidance

Front 212

T/F: when using the arthroscope to drain the navicular bursa of infection, you also go through the frog

Back 212

true

Front 213

T/F: animals have a better prognosis when using the classical technique to drain the navicular bursa of infection

Back 213

false: better prognosis when using the arthroscopic technique

Front 214

What technique(s) is said to possibly cure an infection of the navicular bursa?

Back 214

early diagnosis and use of regional limb perfusion (however, there are no reported results/studies for this)

Front 215

Prognosis of an infection of the navicular bursa when using the classic street nail procedure and the arthroscopic flushing technique

Back 215

classic- 33% (neurectomy commonly required)
arthroscope and flushing/lavage- 75%

Front 216

When is the prognosis for an infection of the navicular bursa the best?

Back 216

when it is caught early and the arthroscopic technique is used

Front 217

List the 6 types of fractures that could occur in the 3rd phalanx

Back 217

I Abaxial fractures w/o joint involvement
II Abaxial fractures w/joint involvement
III Axial fractures w/joint involvement
IV Fractures of the extensor process
V Multifragment fractures w/joint involvement
VI Solar margin fractures

Front 218

Which feet are most commonly involved with P3 fractures?

Back 218

front feet

Front 219

How can one get a P3 fracture?

Back 219

acute trauma (kick against a hard nonmoveable structure
excessively hard or fast work

Front 220

What are the c/s of P3 fractures? What other problem does it resemble?

Back 220

acute severe lameness- will also be fount in a foot abscess but a fx should be kept in mind

Front 221

How do you go about diagnosing a P3 fracture?

Back 221

soak the foot for a couple days (allows abscess to mature if that's what it is) --> no response --> consider radiographs --> take a number of views (esp in fx that don't involve the joint)

Front 222

When evaluating a foot with acute severe lameness for a P3 fracture, why not just take radiographs the first day?

Back 222

many times fracture lines are more easily detected a couple to 10 days after they occur (more displacement and osteolysis has occurred)

Front 223

What are some different ways to manage a P3 fracture?

Back 223

remove fragments
stabilize w/fiberglass cast
stabilize w/bar shoe and clips, then stall rest
compression screw
just stall rest
palmar digital neurectomy
attach hoof to block of hard wood with hoof acrylic

Front 224

With what type of P3 fracture would you remove the fragment(s)?

Back 224

possibility with type VI (solar margin)

Front 225

With what type of P3 fracture would you stabilize it with fiberglass cast? What would you do following the cast?

Back 225

types I and II (abaxial w/o and w/joint involvement) in young animals

apply a bar shoe and clips

Front 226

With what type of P3 fracture would you stabilize with a bar shoe and clips and stall rest? For how long?

Back 226

type III (sagittal/axial fracture w/joint involvement) in animals < 3yrs

stall rest for 9 months

Front 227

With what type of P3 fracture would you apply a compression screw

Back 227

type III (sagittal/axial fx involving the distal interphalangeal joint in animals >3 yrs

Front 228

When placing a compression screw with a P3 fracture, what do you need to avoid?

Back 228

foot vasculature and the coffin joint

Front 229

When placing a compression screw with a P3 fracture, how long do you soak the foot in a wet antiseptic bandage? Before or after?

Back 229

overnight

before

Front 230

T/F: placing a compression screw with a P3 fracture is done under general anesthesia

Back 230

true

Front 231

Describe the process of placing a compression screw for a P3 fracture

Back 231

mark hoof wall where screw should go --> drill hole in wall to P3 --> pilot hole drilled thru P3 to fx using fluroscopic guidance of intraoperative radiographs--> drill sleeve inserted, then smaller bit --> when small bit reaches far side of P3, remove and the far segment is tapped and the screw inserted and tightened

Front 232

When placing a compression screw for a P3 fracture, what do you do once the screw is in?

Back 232

take radiographs to make sure the screw doesn't protrude into lamina, then packthe defect in the hoof wall with antibiotic impregnated polymethylmethacrylate

then shoe for bar shoe and clips and stall rest for 6-9 months

Front 233

With which type of P3 fracture could you just stall rest? For how long?

Back 233

type VI (solar margin) (moreso than fragment removal, I think)

4 months

Front 234

With a P3 fracture, when/with which type of fracture would you possibly do a palmar digital neurectomy on the side of the fracture?

Back 234

for type I fractures (abaxial w/no joint involvement) in animals that are in training that must continue

Front 235

How do you manage P3 fractures in foals and weanlings?

Back 235

stall rest of attaching the foot to a block of hardwood w/hoof acrylic 9Equilox) is usually adequate

Front 236

Prognosis of P3 fractures

Exception?

Back 236

good w/proper management in animals < 3yrs

guarded in older animals for return to competition

exception: type V

Front 237

What type of fracture involves the extensor process of P3?

Back 237

Type IV

Front 238

What could cause a fracture of the extensor process of P3?

Back 238

hyperextension
avulsion as a result of stress by the extensor tendon
separate center of ossification

Front 239

T/F: most commonly animals with a ffracture of the extensor process of P3 have no c/s and it's only an incidental finding on a radiograph

Back 239

false: most commonly an animal is lame, but sometimes no c/s are present and the finding is incidental

Front 240

How would you confirm a dx of a fracture of the extensor process of P3?

Back 240

radiograph

Front 241

how should you manage a fracture of the extensor process of P3 with small chips?

Back 241

they would routinely be removed w/the aid of an arthroscope

Front 242

How could you manage a a fracture of the extensor process of P3 with large chips or fragments?

Back 242

there is no definite rule:
-conservative- stall rest
-remove small fx
-stabilize larger fx with screw

Front 243

What is the problem with using the conservative tx for a fracture of the extensor process of P3?

Back 243

stall rest runs the risk of developing low ring bone

Front 244

How would you remove fragments of a fracture of the extensor process of P3 with an arthroscope?

Back 244

the arthroscope and isntrument portals are usually on opposite sides of the common or long digital extensor tendon

Front 245

What is/are the problem(s) of trying to stabilize a fracture of the extensor process of P3 rather than remove it?

Back 245

exposure is limited which makes it difficult, so it routinely requires an arthrotomy

it is difficult to place more than one screw and if the stabilization is not complete there is a good chance there will be boney proliferation (aka low ring bone)

Front 246

What would help when stabilizing a fracture of the extensor process of P3?

Back 246

thinning the proximal hoof wall with a rasp so that it is possible to make an incision through the proximal hoof wall to gain better access to the extensor process

Front 247

What is the prognosis with a fracture of the extensor process of P3?

Back 247

fairly good if small fragments can be removed

guarded with fragments that, bc of their size, have to be stabilized

Front 248

Give the other names for periostitis of the extensor process of P3

Back 248

Low Ring Bone
Buttress Foot
Pyramidal Disease

Front 249

What is periostitis of the extensor process of P3?

Back 249

a periosteal proliferation secondary to fractures of the extensor process or hard work on hard surfaces

involves the coffin joint (?)

Front 250

What can cause periostitis of the extensor process of P3

Back 250

trauma resulting in fracture of the extensor process
inflamm of the attachments of the joint capsule to the extensor process and/or the 2nd phalanx and secondary periostitis

Front 251

What will you see with periostitis of the extensor process of P3?

Back 251

chronic lameness
boney proliferation that sometimes is extnesive which causes bulging of the anterior hoof wall (a "buttress" like appearance)

Front 252

How can you dx periostitis of the extensor process of P3?

Back 252

chronic lameness
lameness decreases w/a foot block
radiographs showing boney proliferation

Front 253

How do you manage periostitis of the extensor process of P3?

Back 253

there is no effective management

Front 254

What is the prognosis for periostitis of the extensor process of P3?

Back 254

poor for return to athletic performance but the animal should be pasture-sound w/no therapy

Front 255

How could you prevent periostitis of the extensor process of P3?

Back 255

early removal of any chip fx of the extensor process
if possible, refrain from hard work on hard surfaces

Front 256

What is the condition known as side bones?

Back 256

ossification of the lateral cartilages

Front 257

What causes side bones?

Back 257

usually thought to be associated w/hard work in heavy horses
part of the natural aging process (though sometimes present in young animals)

Front 258

Are side bones reported to be more common mares, stallions, or geldings?

Back 258

mares

Front 259

Which cartilage is most commonly affected: the lateral lateral cartilage or the medial lateral cartilage?

Back 259

the lateral lateral cartilage

Front 260

What could you see (c/s) with side bones?

Back 260

many times it is an incidental finding on radiographs w/no lameness present
animal is sometimes lame during ossification
occasionally the ossified lateral cartilage fractures

Front 261

An apparent fracture in side bones is sometimes due to what?

Back 261

two centers of ossification

Front 262

How do you dx side bones?

Back 262

lameness
pain on palpation of the cartilage
radiographs showing ossification
scintigraphy showing uptake of a radiopharmaceutical

Front 263

What gives a definitive diagnosis of side bones?

Back 263

scintigraphy showing uptake of a radiopharmaceutical plus pain and radiographic evidence of ossification

Front 264

T/F: Ossification of side bones cannot be stopped once it's started

Back 264

true

Front 265

How do you manage side bones?

Back 265

-feet should be carefully examined for balance and any imbalance corrected
-toe should be rolled/trimmed so that breakover point is moved caudally
-expansion of the heels should be encouraged
-small fractures removed

Front 266

How do you encourage heel expansion when treating side bones?

Back 266

slipper shoes
leaving the most caudal nail out so the heels can move

Front 267

How do you remove small fractures of side bones?

Back 267

by making an incision over the cartilage (horizontally and parallel to the coronary band)

Front 268

With side bones, What do you do if you find large fractures?

Back 268

they should NOT be removed
if they are causing a problem, they usually respond to prolonged periods of rest (4-6 months in a stall or small paddock)

Front 269

Can you see large fractures of side bones on a radiograph?

Back 269

they are usually always visible bu surrounded by considerable proliferative bone

Front 270

What is quittor?

Back 270

infection and then necrosis of the lateral cartilage

Front 271

What is the most common cause of quittor?

Back 271

most commonly results from a wound involving the lateral cartilage

Front 272

What could quittor be a complication of? is it likely? Why/why not?

Back 272

a subsolar abscess

unlikely bc a subsolar abscess that is not drained ventrally usually breaks out at the coronary band w/purulent material following a tract between the sensitive and insensitive lamina which is abaxial to the lateral cartilage.

Front 273

What are the c/s of quittor?

Back 273

chronic draining tract associated w/an infection of the lateral cartilage

Front 274

How can you dx quittor?

Back 274

obvious involvement of the lateral cartilage
enlargement of the area w/draining tract(s) from the infected cartilage

Front 275

Name the biggest problem w/quittor

Back 275

the infected cartilage WON'T heal bc cartilage has minimal blood supply and as a result minimal resistance to infection

Front 276

What is the only solution to quittor?

Back 276

surgical removal of all diseased cartilage

Front 277

Explain how you remove all the diseased cartilage

Back 277

anesthetize animal & apply eschmarch bandage --> infuse dilute methylene blue into draining tracts to identify diseased cartilage --> maximally extend coffin joint to retract joint capsule and minimize chance of dissecting the joint --> incise over proximal aspect of the involved cartilage and remove all diseased tissue

Front 278

Is it common in quittor that the diseased cartilage extends distally to the coronary band? What do you do when surgically removing that diseased cartilage?

Back 278

yes, it's common

the hoof wall must be thinned or a hole drilled in it so that all the diseased tissue can be removed and ventral drainage established

Front 279

What is the most important thing to remember when doing a surgery for quittor?

Back 279

preserve the coronary band!!

Front 280

prognosis for quittor

Back 280

depends to a degree on the amount of cartilage involved

Front 281

How do you prevent quittor from happening?

Back 281

prevent penetrating wounds involving the lateral cartilage
treat wounds in this area aggressively with adequate antibiotic support and ventral drainage

Front 282

What are the four types of fractures that can occur in P2?

Back 282

small chip fx
palmar/planter eminence fx
axial fx
comminuted fx

Front 283

What is the most common cause of a P2 fracture?

Back 283

abnormal internal stress (not commonly associated w/trauma)

Front 284

A P2 fracture is most commonly seen in what animals? Why?

Back 284

horses used for western games

they are asked to turn at high speed, slide, and stop quickly
their shoes are commonly modified to increase traction

Front 285

What else can cause a P2 fracture?

Back 285

also seen when an animal is first turned out after a long period of confinement (never a good idea to turn animals so they can run at will after being confined)

Front 286

70% of P2 fractures occur in what limb(s)?

Back 286

hindlimbs

Front 287

Which type(s) of P2 fractures can cause a severe leg carrying lameness (animal does not bear weight on the limb) and causes a marked instability?

Back 287

comminuted fx

Front 288

How would you diagnose a P2 fracture?

Back 288

chip fx and eminence fx show varying degrees of lameness, so they would be detected on radiograph following lameness workup

Front 289

Why is diagnosing a comminuted P2 fracture quite obvious?

Back 289

because of the marked instability

radiographs are taken to better determine prognosis and to decide method of repair

Front 290

T/F: few full sized horses with complete fractures of the radius, ulna, and femur have been treated successfully

Back 290

false: few full sized horses with complete fractures of the radius, TIBIA, and femur have been treated successfully

Front 291

T/F: with the continued development of improved methods and nursing care, successful repair of a radius, tibia, or femur fracture of likely

Back 291

false: successful repair is possible, but NOT likely

Front 292

What do you need to consider with animals that have radius, tibia, or femur fx?

Back 292

euthanasia

Front 293

When moving an animal with a fracture limb, when will you give analgesia?

Back 293

only after the fx is stabilized bc if it is used prior to stabilization, analgesia encourages movement and this usually results in more damage

Front 294

Where and how do you stabilize a limb fracture?

Back 294

joints above and below the fx should be stabilized
end of splints or casts must extend well beyond the fx
don't allow the end of the splint to be in the middle of a diaphysis

Front 295

Fractures of what 2 bones would you not apply a splint to? Why?

Back 295

humerus and femur

splints applied to these generally cause increased motion at the fx site

Front 296

What can be used to stabilize the limb fracture when moving an animal?

Back 296

Robert Jones Bandage

splint over robert jones bandage

Front 297

What is a Robert Jones Bandage?

Back 297

a large bulky bandage that is applied by applying rather thin layers of padding under tight bandages

Front 298

Describe how you make a Robert Jones bandage?

Back 298

layer of cotton or towling
moderately tight bandage on the first couple layers
succeeding layers of padding (1/2-1" thick)
adequate bandage is approx 3 times the size of the leg and the binders are applied tight enough that you can "thump" the bandage with a finger

Front 299

Splints over a RJB are best applied how? A PVC piper could work as a splint when it is cut to what size?

Back 299

at 90 degree angles

1/4" of the original diameter

Front 300

T/F: splints over a RJB must be tightly applied with unyielding material

Back 300

true

Front 301

Stabilization of which bones must include firm material and where should the splint be placed?

Back 301

radius and tibia

on a high radial fracture, a firm splint must be on the lateral side

Front 302

When you trailer a horse with a limb fx, how should it be trailered?

Back 302

with the fx leg to the rear (incase you slam on the breaks)
limit the movement of the animal by limiting the space
don't turn the animal loose
have a handler int he trailer
slings can be helpful
vans and stock trailers are best

Front 303

How can you best manage a fracture of the ulna?

Back 303

with a splint that stabilizes the carpus so that the animal can bear weight on the limb (since the triceps is nonfunctional when its attachment to the ulna is compromised the animal cannot extend the carpus to allow weight bearing)

Front 304

how would you best manage a chip fracture of P2?

Back 304

arthroscopic surgery to remove the fragment

Front 305

How would you manage a comminuted fracture of P2 involving the distal interphalangeal joint (coffin joint)?

Back 305

the joint surfaces need to be reconstructed perfectly to regain soundness

Front 306

What is the prognosis for a comminuted fx of P2 that involves the distal interphalangeal joint?

Back 306

poor for return to athletic soundness (residual lameness is most likely)

Front 307

What should be done for a fracture that involved only the proximal interphalangeal joint (pastern)?

Back 307

arthrodesis (fusing the joint)

internal fixation
a half limb cast

Front 308

What would you use for internal fixation in a P2 fracture that involved only the proximal interphalangeal joint (pastern)? Benefits?

Back 308

remove the joint cartilage and stabilize with screws and plates

shorter recovery time

Front 309

What should the half limb cast include when stabilizing a P2 fracture that involved only the proximal interphalangeal joint (pastern)? how long does recovery take?

Back 309

should include the foot and up to the proximal metacarpus/tarsus

6-8 weeks recovery w/or w/o internal fixation

Front 310

What do you need to check on with daily observation of a cast for stabilization of a fracture of P2?

Back 310

is the animal more lame today than yesterday
is the cast intact
is the limb above the cast swollen
are there abnormal smells
are the flies attracted to the cast
is the animal alert, moving and eating as well as today as yesterday

Front 311

Prognosis if only the proximal interphalangeal joint is involved in a P2 fx

Back 311

30% return to soundness

Front 312

Which has a better prognosis: P2 fx in a forelimb or rearlimb?

Back 312

rearlimb

Front 313

What are some possible complications of a P2 fracture?

Back 313

-the pressure applied by P1 could separate and displace the fx fragments
-considerable expense for a cast
-development of laminitis of the supporting (good) leg

Front 314

How can you prevent P2 fractures?

Back 314

-minimize the use of devices that incr foot traction
-exercise animals prior to turning them out when they have been stalled for a period of time

Front 315

What is osteochondrosis of the pastern joint usually associated with?

Back 315

small cysts rather than cartilage flaps

Front 316

What can cause osteochondrosis of the pastern joint?

Back 316

problems with endochondral ossification
hereditary
nutritional

Front 317

What are the c/s of osteochondrosis of the pastern joint?

Back 317

mild lameness

Front 318

How do you diagnose osteochondrosis of the pastern joint?

Back 318

lameness w/positive flexion test that's blocked w/an abaxial sesamoid block or local anesthetic in the pastern joint
radiographic evidence

Front 319

What is the most common way to manage osteochondrosis of the pastern joint/

Back 319

arthrodesis

Front 320

What are the other ways you can manage osteochondrosis of the pastern joint?

Back 320

curet the cyst- transosseus drilling through the phalanx w/fluroscopic guidance and then drilling out the cyst- difficult
intra-articular hyaluronan injections
NSAIDS or steroids

Front 321

What is a High ringbone?

Back 321

osteoarthritis of the proximal interphalangeal joint (pastern)

Front 322

What can cause high ringbone?

Back 322

relatively common in animals asked to make quick turns and stops
wear and tear- continual irritation due to stresses or poor conformation
secondary to chip fractures and osteochondrosis of the joint

Front 323

In which animals might high ringbone be due to quick turns and stops?

Back 323

Western performance horses

Front 324

In which animals might high ringbone be due to secondary osteochondrosis of the pastern joint?

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young horses

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What are the c/s of high ringbone?

Back 325

chronic lameness increased w/increased amount of work
advanced cases- boney proliferation that can be palpated
reduced range of motion

Front 326

in high ringbone, where will you see boney proliferation in early cases?

Back 326

at the sight of the joint capsule but not in the joint itself

Front 327

how do you dx high ringbone?

Back 327

chronic lameness
enlarged joint
pain w/digital flexion and/or torsion
localize pain w/abaxial sesamoid block (PD --> foot block --> abaxial sesamoid block)

Front 328

How do you confirm high ringbone? What are the two types?

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radiographs

False Ringbone- periosteal reaction at the attachment of the joint capsule but NO joint involvement
True Ringbone- preiosteal proliferation extends into the joint - usually a reduction of joint space

Front 329

What can you do conservatively with high ringbone?

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NSAIDs
intra-articular corticosteroid

if animal moves in a sound manner w/conservative therapy, continue until no longer effective

Front 330

What can you do surgically for high ringbone?

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arthrodesis (surgical fusion) of the pastern joint

Front 331

What is ankylosis?

Back 331

natural fusion of the joint

Front 332

T/F: a functional pastern joint is not necessary for athletic soundness

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true

Front 333

Describe the simple technique for performing an arthrodesis for high ringbone

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skin incision on lateral and medial side of the joint at the level of the joint surface --> use a bone drill to destroy as much of the joint surface as possible

Front 334

What do you do after the simple arthrodesis technique for high ringbone? How long should this be done?

How long until the horse is sound?

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place the leg in a half limb cast (just below carpus/tarsus to and including the foot)
keep foot in cast and horse in stall for 8 weeks
animal should be sound 4-6 months after sx

Front 335

Where do you make the incisions for the more complex technique for doing an arthrodesis for high ringbone

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joint approached from dorsal midline --> longitudinal incision made in the common or long digital extensor tendon --> at prox and distal extent of incision make lateral incisions on opposite sides so the anterior surface of the joint is exposed

Front 336

For the more complex technique for doing an arthrodesis for high ringbone, what do you do once all the incisions are made?

Back 336

--> divide medial or lateral collateral ligaments so joint can be disarticulated --> all cartilage is removed from articular surfaces of P1 and P2

Front 337

once all the articular surfaces are free of cartilage,how do you stabilize the joint when doing the more complex technique for doing an arthrodesis for high ringbone?

How do you finish the procedure?

Back 337

stabilization is best with 5.5mm screws to compress the joint and a plate applied to the anterior surface of P1 and P2

collateral ligament and the common or long digital flexor tendon are repaired and a cast is required but for a much shorter time than with the simple technique

Front 338

For how long is a cast required after doing the more complex technique for doing an arthrodesis for high ringbone?

What % actually become sound after this procedure?

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2-4 weeks

75%

Front 339

how do you prevent high ringbone?

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judicioius use
early removal of chip fractures

Front 340

In which directions does the pastern joint luxate or subluxate?

Back 340

dorsal or palmar

Front 341

In which animals does dorsal luxation/subluxation of the pastern joint occur bilaterally?

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in horses with upright conformation in the hindlimbs

Front 342

What can cause dorsal luxation/subluxation of the pastern joint?

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damage to the suspensory ligament or contracture of the distal sesamoidean ligaments

Front 343

What can cause palmar luxation/subluxation of the pastern joint?

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failure of the palmar supporting structures (distal sesamoidean ligaments and superficial digital flexor tendon) insertions

Front 344

What does the superficial digital flexor tendon do?

Back 344

prevents knuckling over (hyperflexion)

Front 345

What are the c/s of dorsal luxation/subluxation of the pastern joint?

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marked dorsal swelling over the interphalangeal joint

Front 346

What are the c/s of palmar luxation/subluxation of the pastern joint?

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hyperextension of the interphalangeal joint and sinking of the metacarpophalangeal joint

Front 347

How do you confirm diagnosis of luxation/subluxation of the pastern joint?

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radiographs

Front 348

How can you sometimes manage dorsal bilateral luxation/subluxation of the pastern joint?

Back 348

NSAIDS and controlled exercise

Front 349

What can you do if the conservative tx for dorsal subluxation of the pastern joint is in effective?

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arthrodesis of the interphalangeal joint

Front 350

What can you do to manage palmar subluxation of the pastern joint?

Back 350

arthrodesis of the interphalangea joint