Elbow dysplasia and arthroscopy Flashcards
What conditions may cause elbow dysplasia?
Fragmented medial coronid process (FCP)
Osteochondrtis dissecans (OCD)
joint incongrutiy
ununited anconeal process (UAP)
When do clinical signs arise for dogs with elbow dysplasia?
from 5 months of age and prior to reaching 2 years of age Lameness swelling decreased ROM joint pain
What imaging can be used to assess elbow dypslasia?
Radiography orthogonal views CrCd view, medio-lateral, flexed lateral
What may oblique elbow views aid in diagnosis of?
Fragmented coronid process
When does ununited anconeal process occur and what does it cause?
German shepherd dogs
anconeal process should fuse at 4-5 months of age
Elbow stability compromised, osteoarthritis ensues
What are the clinical effects of the ununited anconeal process?
Shortened ulna relative to the radius
Humerus pushes onto anconeal process does not fuse with the unla
What are the treatment options of ununited anconeal process?
Proximal dynamic ulnar osteotomy (PDUO) (lengthening of the ulna as the radius grows removes shear stress on anconeal process
R-attachment using a lag screw
Fragment removal
What is involved in incongruity and short radius syndrome?
Incongruity of the joint surface occurs
Weight bearing on the medial aspect of the joint
fragmentation of the medial coronoid process
sclerosis and cartilage wear of the medial humeral condyle
What is a dynamic partial ulnar ostectomy used for and what is the procedure?
Correction of incongruity in the elbow joint
Small proportion of the ulna is removed
improves radius ulnar contact
What is osteochondritis dissecans?
Effects medial humeral condyle
subchondral bone defect
can occur in combination with FCP
Appear on the humeral trochlea as a thickened flap of cartilage
How is osetochondritis dissecans treated?
Removal of the thickened cartilage flap
Abrasion arthroplasty or microfracture of the sub-chondral bone
Replacement of medial humeral condyle with osetochondral graft
What is a fragmented coronid process?
Most common elbow pathology
crainolateral aspect of the medial coronid
Bone fragments dead and yellow
Fragments may be displaced or non displaced
What are the treatment options fro elbow dysplasia?
Arthroscopic debridement Abrasion arthroplasty Microfracture Long bone osteotomy Elbow replacement Elbow arthrodesis
What is involved in arthroscopic debridement in the elbow?
Fragments are removed via arthroscopy
Joints treated via abrasion and microfractur
joint is flushed with saline to remove small fragments
How is osteoarthritis managed?
Medically (weight loss, NSAIDs, hydro and physio)
Evaluated using an arthroscope
motorised shaver or instruments debride the necrotic cartilage
sclerotic bone is removed
Neovasucularisation recruitment of pluripotent stem cells
Exposed sub-chondral bone is treated via micro pick technique
What is abrasion arthroplasty?
Hand burr or power shaver is spun over sub-chondral bone over the area of the lesion
when bleeding is observed the joint is lavaged to remove debris and inflammatory mediators
What is microfracture?
insert an angled micropick into the joint and press teh tip against the sub-chondral bone surface
apply diffusely across diseased area
check for bleeding
when bleeding occurs lavage the joint
What are the three types of long bone osteotomy in elbow dyspepsia treatment?
Sliding humeral osteotomy
Prosimal abducting ulnar
Dynamic ulna osteotomy
What takes place in the sliding humeral osteotomy?
aims to shift the weight to the lateral side of the joint
What is a proximal abducting ulnar?
Abduction of the ulna by 4 to 6 degrees to the lateral side. Weight shifting to the lateral side of the joint
What is a dynamic ulna osteotomy?
The bone is cut and left unstabilised
What is elbow arthrodesis?
Fusion of the elbow joint last resort
What is arthroscopy?
Endoscopy of the joint
When may a animal need arthroscopy?
Exploration of the joint Osteoarthritis ostecans disseans removal joint debridement and lavage Arthroscopic assisted joint stabalisation Bone fragment removal
What are the advantages of arthroscopy?
Decreased morbidity more rapid recovery decreased complications improved outcomes Decreased surgery, anaesthesia and hospitalisation times
What are the disadvantages of arthroscopy?
High skill required
long learning curve
high cost of equipment
increased cost to client
What equipment should you prepare for arthroscopy?
Arthroscope Camera mount light post cannula irrigation Ergess system (a source for removal of fluid) Hand instruments Instrument cannulas Power tools Electrocautery/radiofrequency Long needles haemostats fluid bowl
What are the usual measurements of the arthroscope and how should it be kept?
Diameter for the elbow 1.9-2.7mm
lens angle- 30 degrees
working length 8.5cm to 13cm
What is the camera mount for in arthroscopy?
Attaches to camera with image projected on screen
Good quality flat screen monitor is required
What is a typical light source for an arthroscope?
Xenon or halogen
What is a cannula for in arthroscopy?
All arthroscopes are inserted through a cannula
maintains arthroscope portal
protects the arthroscope
ingress of fluid
What is irrigation for in arhtroscopy?
Continual flushing is required to keep joint blood free and inflated
What hand instruments are available for arthroscopy?
probes, hand burrs
What power tools are used in arthroscopy?
shavers remove soft and hard tissue
How do you prepare a patient for arthroscopy?
Clip the medial elbow with enough removed to allow for conversion to an open approach
Consider waterproof drapes
Patient is positioned in dorsal or lateral recumbency Elbow needs to be held abducted and pronated
over a sandbag or the edge of the table
List the procedure for arthroscopy?
Check camera working and white balance is done, fluid is connected
aspirate joint fluid with needle and syringe
place needle at the location when the arthroscope will enter
enlarge the whole with scalpel
place the cannula into the joint
remove cannula and place arthroscope
turn on fluids and light source
inspect the joint
make an instrument portal (using a needle)
enlarge the hole with a scapel
place blunt switching stick through the hole
use a variety of instruments to debride the joint
flush the joint
remove all equipment, place skin sutures
bandage if extravasation
