Antebrachial and Manus

Question 1

Proximal Ulnar fractures

Answer 1

Inability to extend the affected elbow. May have articular component. Often have a short proximal fracture segment. Must account for distractive forces of the triceps muscle.
Need to strive for anatomic reduction. Pin and tension band fixation generally yields secondary bone healing.
Plate (lateral and caudal) fixation preferably. With possible supplemented fixation.

Question 2

Monteggia fracture- proximal ulna

Answer 2

Uncommon. Ulnar fracture (at or distal to the elbow with concurrent radial head luxation.
Annular ligament disruption.
Must restore the integrity of the annular ligament (lag screw or replace/repair the ligament). Must restore normal length of the ulna to properly reduce radial head luxation
Keep reduction stable, Screws may loosen overtime because of strong forces with pronate and supinate. Place at least 2 screws proximally. Jousting injury

Question 3

Diaphyseal radial and ulnar fractures

Answer 3

Can be open injuries. Radius is the major weight bearing bone and stabilization focused on the radius. Poor healing predictable in toy and min. dogs. Can have angular deformity.
Minimally displaced transverse non-comminuted fractures- coadaptation. Immobilize both carpus and elbow. Avoid pressure on the olecranon process.

Question 4

Antebrachial fractures: external skeletal fixation

Answer 4

Fixator can be applied using an open limited open or closed reduction. Consider using handing limb prep. Circular, hybrid, and linear constructs. Place fixation pins in craniomedial and craniolateral corridors.

Question 5

Hybrid constructs: antebrachial

Answer 5

Use a complete ring if possible especially in larger dogs. Type 1b constructs preferable. Fixation pins placed craniolateral and craniomedial- radius elliptical, limits muscular impingement.
Want the ring construct situated perpendicular to the anatomic axes

Question 6

Antebrachial: plate fixation

Answer 6

Typically placed on the radius without stabilizing the ulna. Can place an IM pin In the ulna for adjunctive treatment. Can apply MIPO. Preferred method for min and toy dogs

Question 7

MIPO

Answer 7

K wire through proximal and distal radius to help with placing the plate.
Initial indirect reduction performed using a circular fixator construct to distract and align the fracture.
Slide the plate through the epiperiosteal tunnel. Place screws through the insertion incisions.

Question 8

Intramedullary fixation: radius

Answer 8

Do not pin the radius- mess with articular surface. Doesn’t make great contact with cortices
Stress pinning of physeal fractures is acceptable.

Question 9

Distal antebrachial fractures in toy and min dogs

Answer 9

Predisposed to nonunion. Typically short oblique fractures: high shear forces. Poor intraosseous circulation. Limited periosseous soft tissues. Propensity for bone resorption.
Optimal management: plate fixation

Question 10

Carpal bone fractures

Answer 10

Radial carpal bone and accessory. Multiple bone fractures. Multiple bone fractures with ligamentous insufficiency. Metacarpal bone fractures treated with pancarpal arthrodesis or conservative.

Question 11

Metacarpal bone fractures

Answer 11

Many fractures can be managed effectively with closed reduction and coadaptation. Fractures involving the central two bones or all may require surgery. IM pins, plates, or external fixators can be used.