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RUSVM Small Animal Surgery 1 > Elbow > Flashcards

Elbow Flashcards

1
Q

Elbow dysplasia is a collection of what conditions?

A

Ununited anconeal process (UAD)

Medial compartment disease
—fragmented medial coronoid process (FCP)
—osteochondritis dissecans (OCD) of medial humeral condyle
—joint incongruity

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2
Q

The medial coronoid process articulates with the?

A

Radius

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3
Q

What is the definition of incongruity?

A

Mismatch in articular surfaces

  • length discrepancy (radius vs ulna)
  • diameter discrepancy (humeral condyle vs trochlear notch)
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4
Q

What is the age distribution for presentation of elbow dysplasia?

A

Biphasic

Young — pain due to defect in joint surface
Old — pain due to osteoarthritis

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5
Q

T/F: elbow dysplasia is heritable

A

True

Large and giant breed dogs
GSD especially for UAP

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6
Q

A patient with elbow dysplasia usually presents with what history?

A

Most from 5-12months of age
—chronic, progressive lameness
—aggravated by activity

Bilateral disease can delay presentation
Young dogs are often active still

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7
Q

What do you find on a PE of a dog with elbow dysplasia?

A

Lameness
Elbow effusion
Pain on manipulation of joint
— UAP: pain on extension (anconeal pressure)
—MCD: flexion + supination (medial compartment)
Creptius: osteoarthritis

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8
Q

What is the proposed etiology of elbow dysplasia?

A

Incongruity — alters stress on the joint

UAP/FCP are associated with incongruity

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9
Q

What is the proposed etiology for UAP?

A

Radioulnar incongruity — length discrepancy

Shorted ulna displaces humerus proximally
Excess force on developing anconeal process

Ossification fails d/t disrupted microcirculation
—standard OCD

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10
Q

The the anconeal process has not fused by ______ weeks, you have UAP

A

24

Normally fuses by 16-20weeks

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11
Q

What is the proposed etiology of FCP?

A

Microtrauma

Incongruity — short radius displaces humerus distally —> stress on coronoid process and fragmentation

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12
Q

How do you make a diagnosis of elbow dysplasia?

A

Based on history, breed, PE

Radiographs
UAP- flexed lateral view required
OCD visible on well positioned craniocaudal
FCP - sclerosis may be the only sign

CT scan
Excellent for FCP

Arthroscopy
Gold standard for FCP and OCD

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13
Q

How can you surgically treat UAP?

A

Fragment excision

  • acceptable in older dogs with DJD, instability remains
  • good to fair for pet dogs, guarded for working dogs

Osteotomy + fixation

  • young dogs with minimal DND
  • distraction of ulna
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14
Q

What is the surgical treatment for FCP/OCD?

A

Arthroscopic treatment is gold standard

  • fragment removal
  • debridement of lesion bed
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15
Q

What is the prognosis for elbow dysplasia?

A

Arthroscopy > arthrotomy + medical mgmt

Arthrotomy + medical mgmt = medical mgmt

OA progresses despite treatment

Early intervention is best chance, medical therapy expected long term

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16
Q

What do you call a failure of unction between the medial and lateral portions of the humeral condyle?

A

Incomplete ossification of the humeral condyle

17
Q

What breed is predisposed and signalment usually seen with incomplete ossification of the humeral condyle?

A

Spaniel breeds

Males predisposed

18
Q

What is the common presentation of incomplete ossification of the humeral condyle?

A

Young to adults
Mild weight bearing lameness — indicates micromotion
Worse after activity

Acute NWB lameness — indicates pathological fracture

19
Q

Methods of diagnosis for IOHC?

A

Radiographs/ CT
No fracture — see fissure between the condyle (craniocaudal view)
Fracture — lateral condyle or bicondylar fracture

Arthroscopy — fissure on joint
90% bilateral

20
Q

What is the treatment for IOHC?

A

Medial therapy contraindicated

Surgical

  • no fracture — lag screw only
  • fracture — treat based on fracture configuration

Prognosis — excellent

21
Q

Traumatic elbow luxation causes rupture of the _______ ligaments

A

Collateral

22
Q

T/F: most elbow luxation are lateral

A

True

— due to large medial epicondyle

23
Q

How should you treat an animal with traumatic elbow joint luxation and severe DJD?

A

Total elbow replacement.

Arthrodesis

24
Q

How should you treat a dog with acute traumatic elbow luxation and no DJD?

A

Close reduction with splint or modified external skeletal fixator

25
Q

How should you treat a dog with chronic elbow luxation that failure closed recursion?

A

Open reduction and ligament reconstruction

26
Q

After you have done a closed reduction on an elbow luxation, what do you do?

A

Flex/extend through ROM — hematoma

Assess collateral ligaments: Campbells test

  • elbow at 90degrees
  • supination: lateral collateral
  • pronation: medial collateral

If joint unstable —> open reduction

27
Q

T/F: open reduction is usually the best option for reducing elbow luxation

A

True

28
Q

How is an open reduction done for elbow luxation?

A

Osteotomy of the olecranon —> reduce

Stabilize by suture prosthesis or repair of avulsion rapture with lag screw

29
Q

How do you manage an animal post correction of elbow luxation?

A

Leg is maintained in extension
—olecranon provides stability
—spica splint 2-3weeks (stable closed reduction)
—flexible ESF 3-4wks (open/unstable reduction)

After apparatus removal
— exercise restriction 4-6weeks
—physical therapy

30
Q

What is the prognosis for traumatic elbow luxation?

A

Good to excellent after stable closed reduction

Fair after open reaction

31
Q

What are salvage procedures for the elbow?

A

Canine unicompartmental elbow (CUE)

Total elbow replacement

Arthrodesis

32
Q

What is canine uniicompartmental procedure? When is it indicated?

A

Partial joint replacement
Medial joint resurfacing

Indicated for end stage medial compartment disease

33
Q

What are complications to total elbow replacement?

A

Fracture
Infection
Joint luxation
Implant loosening

— outcomes poor

34
Q

What is elbow arthrodesis?

A

Complete fusion of the joint at standing angle

‘Peg leg’

Marginally better outcome than amputation (amputation is contraindicated with severe contralateral disease)

RUSVM Small Animal Surgery 1 (39 decks)

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