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Surgery 3 > Lecture 16: Sx of the Elbow 2 (Exam 3) > Flashcards

Lecture 16: Sx of the Elbow 2 (Exam 3) Flashcards

1
Q
A
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2
Q

Are most elbow replacement surgery techniques still widely used? Why/Why not

A
  • no
  • HIGH COMPLICATION RATES- joint subluxations ,fractures, loosening, infection
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3
Q

Should general surgeons preform a total elbow replacement?

A

no

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4
Q

Definition

anconeal process does not form bony union with proximal ulnar metaphysis

A

ununited anconeal process

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5
Q

Ununited anconeal process is a disease of what kind of dogs

A

large growing

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6
Q

Definition

arises as secondary center of ossification in elbow at 11-12 wees old

A

anconeal process

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7
Q

Diagnosis of Ununited anconeal process cannot be made until after what age, because the fusion to ulna does not occur until then

A

4-5 months

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8
Q

What breed of dogs is overrepresented in ununited anconeal process? What is the common signalment of ununited anconeal process?

A
  • GERMAN SHEPHERDS
  • large to giant breeds male dogs most common- presents around 6-12 months can be older
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9
Q

Most forelimb diseases cause:
* lameness
* sit and stand with externally tiffness

what is a symptom of ununited anconeal process that can help you differentiate it?

A
  • decrease ROM causing elbow to circumduct laterally during swing phase of gait
  • sit and stand with paw externally rotated
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10
Q

When taking radiographs for a possible ununited anconeal process what view should you ensure to take to bring the anconeal process into view (best visualized on this view)

A

flexed lateral (45 degree and slightly rotated medially)

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11
Q

What 4 radiographic views should you take for possible ununited anconeal process

A
  • craniocaudal
  • lateral
  • flexed lateral
  • oblique craniocaudal (elbow flexed 30 degreed and slightly rotated medially)
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12
Q

Fill in the ?s

Ununited anconeal process on radiographs shows up as a ? separating anconeal process from ulna

A

lucent indistinct line

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13
Q

What would you diagnose this animal with? why?

A
  • ununited anconeal process
  • lucent irregular line between anconeal process and olecranon
  • AS WELL AS subchondral bone sclerosis of olecranon
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14
Q

Does surgical removal of anconeal process after extensive OA stop progression of OA?

A

NO

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15
Q

What conservative management would you use to treat ununited anconeal process

A

FIVE PRINCIPLES OF MEDICAL MANAGEMENT OF OA

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16
Q

What are the five principals of medical management of OA?

A
  1. weight management
  2. nutritional supplementation
  3. exercise moderation
  4. physical therapy
  5. anti-inflammatory medication
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17
Q

What surgical procedures are used to treat ununited anconeal process

A
  • surgical removal of anconeal process
  • surgical reduction with lag screw fixation
  • ulnar osteotomy ( WITH LAG SCREW FIXATION of anconeal process)
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18
Q

What is the standard treatment for UAP if diagnosed before onset of extensive OA?

A

surgical removal of anconeal process

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19
Q

What animals is surgical repair of ununited anconeal process recommended

A

under one year of age with minimal DJD

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20
Q

What should you counsel owners on before performing surgery on patients with UAP

A

probability of progressive osteoarthritis

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21
Q

What surgical method for correction of UAP is seen here?

A

lag screw fixation of UAP

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22
Q

If patient with UAP is <1 year of age and treated surgically what is the prognosis

A

Good

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23
Q

What is the prognosis of Surgery for UAP for normal limb function

A

guarded

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24
Q

Failure of bony union between medial and lateral portions of the humeral condyle

A

Incomplete ossification of the humeral condyle ( IOHC)

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25
Q

Is Incomplete ossification of humeral condyle a classification of elbow dysplasia

A

Not usually (BUT it is a developmental disease and presents the same)

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26
Q

Fill in the ?s

Normal ossification of humeral condyle starts at ? YO and is complete at ? YOs

A
  • Starts @: 2 weeks
  • Completed @: 8 - 12 W
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27
Q

What may occur secondary to IOHC that increases humeroulnar joint space

A

elbow incongruence (based on identification of radioulnar incongruence in CT examination)

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28
Q

Incomplete ossification of humeral condyles is overrepresented in what breeds

A

spaniel (suggest genetic cause)

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29
Q

Fill in the ?s

In one study the incident of bilateral disease of IOHC based on CT examination was ?%

A

90%

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30
Q

What would you diagnose this patient with, why?

A
  • incomplete ossification of humeral condyle
  • B/C of fissure line
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31
Q

What age ranges is it common to see IOHC in?

A

young to middle age (increased incidence of middle age male dogs)

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32
Q

What may IOHC lead to?

A

LATERAL HUMERAL CONDYLAR FRACTURE

33
Q

IF a patient has a humeral condylar fracture, what should you always be sure to do?

A

radiograph other limb for incomplete ossification of humeral condyles

34
Q

What view can you detech a IOHC in?

A

craniocaudal (of elbow joint, ulna is superimposed over lesion = more difficult to see, sclerosis of lateral epicondylar crest)

35
Q

Which is ideal for diagnosing IOHC: rads or CT?

A

CT (new bone formation and increased humeroulnar joint space)

36
Q

What is seen here on this arthroscopic image

A

Incomplete ossification of humeral condyle

37
Q

Is medical management appropriate for IOHC patients

A

No (may lead to complete fracture)

38
Q

What surgical technique can you use to correct IOHC

A

lag screw fixation

39
Q

Why do lag screw fixations fail overtime in IOHC patients

A

cyclic loading

40
Q

What should you use to minimize screw failure in IOHC patients

A

largest diameter screw

41
Q

What used for correction of IOHC is described to create a biologic bone bridge between medial and lateral condyles

A

autogenous cancellous autograft core

42
Q

WHat technique for correcting IOHC is a highly advanced procedure only preformed by experienced surgeons trained in this technique

A

Autogenous bone core grafting

43
Q

What technique was used here to correct an IOHC

A

lag screw fixation

44
Q

What kind of screw is used in lag screw fixation of IOHC

A

partially threaded cancellous bone screw

45
Q

Are patients typically lame after placement of lag screw to correct IOHC

A

No (resolution of lameness but breakage of lag screw and recurrence of clinical signs may occur months to years later)

46
Q

3 reasons for elbow luxation

A
  1. traumatic
  2. luxation/subluxation caused by premature closure of the distal ulnar or radial physis
  3. congenital
47
Q

Fill in the ?s

Traumatic elbow luxation AKA dislocated elbow is usually associated with blunt trauma of elbow joint causing ? displacement of radius and ulna with respect to the humerus

A

lateral (RARE IN CATS)

48
Q

What usually occurs alongside traumatic elbow luxation’s in young animals

A

physeal fractures

49
Q

What is the result of elbow trauma that allows luxation of radius and ulna

A

rupture/avulsion of collateral ligaments (usually luxate laterally- in extreme cases may see avulsion of extensor and flexor origins)

50
Q

Chronic luxation of the elbow can lead to what 3 conditions

A
  • chondromalacia
  • articular cartilage destruction
    *secondary djd
51
Q

In traumatic elbow luxation patient present unable to bear weigh on affected limb and what are two other indicators

A

elbow carried in flexed position and abducted and externally rotated

52
Q

Most luxated elbows can be treated how if done within the first few days

A

closed manipulation

53
Q

If a traumatic elbow luxation is accompanied by avulsion fractures what treatment method should be used?

A

open reduction and stabiization

54
Q

In closed reduction of elbow luxation the limb is suspended from IV pole for 5-10 minutes using the dogs weight to encourage relaxation and distract joint, then dog is placed in lateral recumbency with affected leg up: What is the goal of this procedure

A

hook anconeal process between condyles

55
Q

Technique to facilitate closed reduction of elbow luxation

A

animals own weight by suspending fractured limb from ceiling to encourage fracture distraction

56
Q

Fill in the ?s

Closed reduction of elbow luxation should be done ? and ? should be evaluated after

A
  • ASAP
  • Stability of the elbow
57
Q

What is the prognosis of elbow luxation patients if quickly reduced and stabilized

A

good (djd and diminished ROM may occur secondary to trauma)

58
Q

What is seen in this craniocaudal view?

A

lateral luxation of radius and ulna

59
Q

What is affecting this patient, why do you think this?

A
  • elbow luxation
  • Loss of humero radial joint space
60
Q

Fill in the ?s

  • Flex elbow & inwardly rotate antebrachium to hook ? into ? C Then extend elbow slightly
  • ? and ? rotate antebrachium while placing pressure on radial head
A
  • anconeal process into olecranon fossa
  • Abduct & outwardly
61
Q

What is a good indicator for the need of open stabilization

A

excessive instability

62
Q

Fill in the ?s

Open reduction using ? as a lever
can be performed to eliminate pull of triceps muscle during reduction

A

blunt curved instrument

63
Q

Fill in the ?s

  • A & B To stabilize elbow Replace collateral ligaments using ?
  • C & D To secure an avulsed fragment Use ?
A
  • A & B: 2 screws& figure-8 wire
  • C & D: lag screw with spiked washer
64
Q

Fill in the ?s

Arthrodesis of the elbow:
* make 2 ? and remove portion of proximal ulna
* then use a ? to connect caudal surface of the humerus and caudal surface of the ulna

A
  • osteotomies
  • contour plate
65
Q

Fill in the ?s

What are the two syndromes grouped under elbow subluxation or incongruity:

1: part of pathophysiology of premature closure of ? after trauma in immature dogs
2: primarily in ? breeds

A
  • distal ulnar or radial physis
  • chondrodystrophic breeds (asynchronous growth of radius and ulna)
66
Q

What is seen on this radiograph?

A

Elbow incongruence due to radial shortening

67
Q

Elbow incongruency contributes to what other elbow conditions

A

fractured coronoid process and ununited anconeal process (secondary DJD)

68
Q

Surgical treatment of elbow incongruency is directed at restoring elbow congruity by preforming osteotomies of radius and ulna, what are two commonly used?

A
  • ulnar lengthening osteotomy (ulna too short)
  • ulnar shortening ostectomy or radial lengthening ( radial shortening caused subluxation)
69
Q

What treatment method is seen here?

A

Ulnar lengthening osteotomy

70
Q

What procedure is being preformed

A

ulnar shortening ostectomy

71
Q

Fill in the ?s

Radial lengthening can also be preformed by distraction osteogenesis using ? and motors

A

circular external fixators

72
Q

Fill in the ?s

Congenital elbow luxation results in ? rotation of the proximal ulna subluxation or luxation of humeroulnar joint

A

lateral (ETIOLOGY IS UNKNOWN)

73
Q

Fill in the ?s

In congenital elbow luxation bone malpositioning occurs at a young age because bones do not articulate normally ? do not form

A

congruent joint surfaces

74
Q

Fill in the ?s

In congenital elbow luxation’s, at ? Months of age secondary remodeling occurs and degenerative changes develop

A

3 months of age

75
Q

Signalment for congenital elbow luxation

A
  • small dog breeds(Pugs, Yorkshire Terriers, Boston Terriers, Miniature Poodles, Pomeranians, Chihuahuas, Cocker Spaniels, & English Bulldogs overrepresented)(unilateral and bilateral)
  • usually recognized when puppy begins to walk (3-6 weeks)
76
Q

You have a 6 eek old miniature poodle that presents to your clinic for difficulty walking, you take xrays and find this: What do you suspect is affecting this patient

A

congenital elbow luxation

77
Q

What method is used here to correct congenital elbow luxation after manual reduction

A

trans articular pin

78
Q

In congenital elbow luxation, what provides the best outcome

A

immediate surgical treatment (limited range of motion and DJD occur even with surgery)

Surgery 3 (20 decks)

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