Elbow Flashcards
Elbow dysplasia is a collection of what conditions?
Ununited anconeal process (UAD)
Medial compartment disease
—fragmented medial coronoid process (FCP)
—osteochondritis dissecans (OCD) of medial humeral condyle
—joint incongruity
The medial coronoid process articulates with the?
Radius
What is the definition of incongruity?
Mismatch in articular surfaces
- length discrepancy (radius vs ulna)
- diameter discrepancy (humeral condyle vs trochlear notch)
What is the age distribution for presentation of elbow dysplasia?
Biphasic
Young — pain due to defect in joint surface
Old — pain due to osteoarthritis
T/F: elbow dysplasia is heritable
True
Large and giant breed dogs
GSD especially for UAP
A patient with elbow dysplasia usually presents with what history?
Most from 5-12months of age
—chronic, progressive lameness
—aggravated by activity
Bilateral disease can delay presentation
Young dogs are often active still
What do you find on a PE of a dog with elbow dysplasia?
Lameness
Elbow effusion
Pain on manipulation of joint
— UAP: pain on extension (anconeal pressure)
—MCD: flexion + supination (medial compartment)
Creptius: osteoarthritis
What is the proposed etiology of elbow dysplasia?
Incongruity — alters stress on the joint
UAP/FCP are associated with incongruity
What is the proposed etiology for UAP?
Radioulnar incongruity — length discrepancy
Shorted ulna displaces humerus proximally
Excess force on developing anconeal process
Ossification fails d/t disrupted microcirculation
—standard OCD
The the anconeal process has not fused by ______ weeks, you have UAP
24
Normally fuses by 16-20weeks
What is the proposed etiology of FCP?
Microtrauma
Incongruity — short radius displaces humerus distally —> stress on coronoid process and fragmentation
How do you make a diagnosis of elbow dysplasia?
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
How can you surgically treat UAP?
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
What is the surgical treatment for FCP/OCD?
Arthroscopic treatment is gold standard
- fragment removal
- debridement of lesion bed
What is the prognosis for elbow dysplasia?
Arthroscopy > arthrotomy + medical mgmt
Arthrotomy + medical mgmt = medical mgmt
OA progresses despite treatment
Early intervention is best chance, medical therapy expected long term
What do you call a failure of unction between the medial and lateral portions of the humeral condyle?
Incomplete ossification of the humeral condyle
What breed is predisposed and signalment usually seen with incomplete ossification of the humeral condyle?
Spaniel breeds
Males predisposed
What is the common presentation of incomplete ossification of the humeral condyle?
Young to adults
Mild weight bearing lameness — indicates micromotion
Worse after activity
Acute NWB lameness — indicates pathological fracture
Methods of diagnosis for IOHC?
Radiographs/ CT
No fracture — see fissure between the condyle (craniocaudal view)
Fracture — lateral condyle or bicondylar fracture
Arthroscopy — fissure on joint
90% bilateral
What is the treatment for IOHC?
Medial therapy contraindicated
Surgical
- no fracture — lag screw only
- fracture — treat based on fracture configuration
Prognosis — excellent
Traumatic elbow luxation causes rupture of the _______ ligaments
Collateral
T/F: most elbow luxation are lateral
True
— due to large medial epicondyle
How should you treat an animal with traumatic elbow joint luxation and severe DJD?
Total elbow replacement.
Arthrodesis
How should you treat a dog with acute traumatic elbow luxation and no DJD?
Close reduction with splint or modified external skeletal fixator
How should you treat a dog with chronic elbow luxation that failure closed recursion?
Open reduction and ligament reconstruction
After you have done a closed reduction on an elbow luxation, what do you do?
Flex/extend through ROM — hematoma
Assess collateral ligaments: Campbells test
- elbow at 90degrees
- supination: lateral collateral
- pronation: medial collateral
If joint unstable —> open reduction
T/F: open reduction is usually the best option for reducing elbow luxation
True
How is an open reduction done for elbow luxation?
Osteotomy of the olecranon —> reduce
Stabilize by suture prosthesis or repair of avulsion rapture with lag screw
How do you manage an animal post correction of elbow luxation?
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
What is the prognosis for traumatic elbow luxation?
Good to excellent after stable closed reduction
Fair after open reaction
What are salvage procedures for the elbow?
Canine unicompartmental elbow (CUE)
Total elbow replacement
Arthrodesis
What is canine uniicompartmental procedure? When is it indicated?
Partial joint replacement
Medial joint resurfacing
Indicated for end stage medial compartment disease
What are complications to total elbow replacement?
Fracture
Infection
Joint luxation
Implant loosening
— outcomes poor
What is elbow arthrodesis?
Complete fusion of the joint at standing angle
‘Peg leg’
Marginally better outcome than amputation (amputation is contraindicated with severe contralateral disease)
