Elbow Dysplasia Flashcards
What possible issues can cause developmental elbow disease?
Ununited anconeal process of ulna
OCD of medial humeral condyle
Fragmented medial coronoid process of ulna
Asynchronous growth of radius and ulna leading to joint incongruity
When do patients typically present with elbow dysplasia, and what signs are shown?
6 months +
Low grade mild lameness, bilateral
What can we see on physical examination of a patient with elbow dysplasia?
Elbow effusion
Decreased ROM, pain on extremes of flexion/extension
What radiograph views should be taken to differentiate between causes of elbow issues?
Craniocaudal
Mediolateral
Flexed lateral
Ununited anconeal process, fragmented coronoid process, osteochondrosis dissecans (OCD)
What do we see on flexed mediolateral radiograph views?
Dorsal anconeal process and radial head
Sclerosis of ulna notch
Flattened/blurred FCP
Increased humeroradial joint space
Looking for primary lesion/secondary DJD
What can we see with neutral lateral radiograph views?
Joint incongruity
What can we see on fully flexed mediolateral radiograph views?
Dorsal osteophytes
Ununited anconeal process
What can we see with cranio-caudal (orthogonal) radiograph views?
Osteophytes/OCD on medial lateral condyle
How can we treat ununited anconeal process?
Conservative
Surgical - removal of anconeal process, proximal dynamic ulna osteotomy, lag screw fixation
How can we treat elbow incongruity/short radius?
Dynamic partial ulnar ostectomy
+/- intramedullary pin
Describe a dynamic partial ulnar ostectomy.
Small portion of ulna excised, allowing improved humeroradial contact
Ulna not rigidly stabilised to allow it to shift to ‘best fit’ position
OR small intramedullary pin placed to decrease pain/prevent excessive caudal translation of proximal ulna
What is OCD?
Osteochondritis dissecans
Affects medial humeral condyle
Usually appears on humeral trochlea as thickened flap of cartilage overlying relatively deep (1-2mm) subchondral bone defect
How can we treat OCD?
Conservative - restricted exercise 4-6 weeks, NSAIDs
Surgical if no improvement - arthrotomy and debridement / arthroscopy and debridement (flap removal and abrasion arthroplasty/microfracture of subchondral bone)
Where does fragmented coronoid process most commonly occur?
Craniolateral aspect of medial coronoid adjacent to radial head
How can we treat FCP?
Arthroscopic debridement
Medical management of OA
What medical management of OA can be attempted prior to surgery?
NSAIDs
Weight loss
Hydrotherapy
Physiotherapy
How can we best assess the severity of OA?
Arthroscopy
What are the aims of treatment of OA?
To stimulate healing with hyaline/fibrocartilage
How can we surgically treat OA?
Abrasion arthroplasty
Subchondral bone burred off over area of lesion
Joint lavaged to remove remaining bone debris
Describe a long bone osteotomy.
Elbow dysplasia - medial compartment disease
Shifting weightbearing from medial to lateral side to allow medial cartilage loss to heal
Ulna cut similar to ununited anconeal process
Describe elbow replacement.
Valid and viable possibility for the right patients
Complications can occur - may lead to arthrodesis/amputation
New implants have low(er) complication rate
Describe arthrodesis.
Final salvage procedure for end-stage painful joint
Small dogs with unilateral lameness
Results in pain relief but marked gait abnormality
What are the indications for arthroscopy?
Explore joints
Remove bits
Surface treatment
Lavage
Assisted repair
What equipment do we need for elbow arthroscopy?
Arthroscope (diameter 1.9-2.7mm, lens angle usually 30 degrees, length 8.5 or 13cm)
Camera mount
Flat screen monitor
Light post
Describe prep for arthroscopy.
Clip medial elbow and large for conversion to open approach
Waterproof drapes to prevent patient getting wet and cold
Positioning - dorsal (bilateral) or lateral (unilateral)
What are the multiple functions of the arthroscope cannula?
Maintains arthroscope portal
Protects the arthroscope
Ingress of fluid
What equipment is needed for removal of fragments?
Power tools
Electrocautery / radiofrequency
Long needles, syringe, fluid bowl, haemostats etc.
