Lecture 6: Elbow Dysplasia Flashcards
T/F
Elbow dysplasia s the most common cause of K9 forelimb lameness affecting 1 in 15 dogs at tertiary referral
TRUE.
What is the normal elbow anatomy of a dog?
three bone system, semi-independent movement of each bone
T/F
The 3 bone system does not allow as much pronation/supination as would a a pure hinge joint
FALSE
it allows for more of those things
T/F
The anatomy is complex, unforgiving, and allows for individual movement of each of the three bones resulting in a lot of issues
FALSE
anatomy is complex, unforgiving, all 3 must move together in flexion, extension, pronation, supination
What is a fragmented medial coronoid process?
thought to be caused by excess force placed on the coronoid, secondary to unequal weight distribution between radius and ulna
How common is a fragmented medial coronoid process?
When do the signs appear?
Thought to be most common/clinically significant component of ED
Appear 4-7 months, typically bilateral
What is an ununited anconeal process?
when radius is linger than the ulna, humeral condyle forced into the anconeal process
What breed has a predisposition for having a ununited anconeal process?
Most common in german shepards and basset hounds, not seen in small breeds.
T/F
Ununited anconeal process is uncommon in small breeds because it is only a site of secondary ossification in large breeds
TRUE
Osteochondritis/osteochondrosis dissecans
If you dont know this one just leave scrub
What dictates normal growth of bones?
Hueter-Volkman law; compression forces inhibit growth and tensile forces stimulate it
Joint incongruence is caused by:
radio/ulnar incongruence-> UAP
semilunar incongruence- mismatch of humoral condyle and ulna
How do you diagnose ED vie PE findings?
effusion, pain on palpation, loss of ROM, standing/walking/running lameness, thickened joint capsule
often stand holding limb up
What images do you look for radiographically for ED?
mediolateral,
hyper-flexed mediolateral,
15 degree supinated mediolateral,
true lateral of the coronoid process,
cranial cauadal
T/F
Rads are the most important tool in diagnosing a fractured coronoid process resulting in ED
FALSE
They are not that helpful at all
T/F
Congruence is difficult to measure unless very significant differences present
True
Corroborative evidence of incongruence is:
osteophytes present on the dorsal aspect of anconeal process, medial compartment, and sclerosis of sub coronoid region and ulnar semilunar notch
What is trochlear notch sclerosis associated with?
increased trochlear notch scelrosis is correlated with increasing severity of coronoid disease based on CT
What is CT useful for?
looking at early subtle lesions
evaluating incongruence
subchondral bone changes
fast and inexpensive
What is the best modality for evaluating elbows?
CT
What do you do if clinical signs and image from CT are not matching up?
Arthroscopy can allow direct evaluation of the joint in question
Which is better and why, arthroscopy or arthrotomy?
arthroscopy
superior field of view
minimal invasiveness
reduced Sx time
lower patient morbidity
faster recovery
reduced risk of infection, superior functional outcome in cases of FCP
T/F
Arthroscopy allows diagnosis by visualization and plapation of FCP and OCD, however it does not allow debridement of unhealthy tissue
FALSE
it allows debridement and has a low complication ratge
What is a subtotal coronoidectomy (SCO)?
can be done as mini-arthrotomy
removal of the diseased coronoid, improves radio graphic incongruence, 97% resolution of lameness by 24 weeks 7% infection rate
UHow do you Tx a UAP?
removal if it is free floating
arthrotomy, slight increase in risk for elbow lx
repair often resutls in failure and pin needing replacement- not done anymore
What is a dynamic ulnar osteotomy?
can be done as osteotomy or a partial ostecotomy
aloows ulna to realign and decrease inconguence
Ulnar osteotomy creates a ____ rotation around the humoral condyle, altering the position of the ____ ____ down away from the joint surface
Ulnar osteotomy creates a CRANIAL rotation around the humoral condyle, altering the position of the CORONOID PROCESS down away from the joint surface
T/F
Like a THR, a total elbow replacement is relatively easy to perform and has good results
FALSE
it is a last resort option, has high complication rates and is NOTHING LIKE A HIP JOINT
T/F
You are better of amputating the limb than performing joint arthrodesis on the the elbow
TRUE
surgical fusion of the elbow is a n end stage salvage procedure, persistent lameness and loss function is common, better option is to lop it off
What is the prognosis of UAP, FMC and OCD?
UAP- genrally good with dynamic ulnar osteotomy
FMC- 1/3 return to normal, 1/3 improve, 1/3 remain lame
OCD- generally improve with some residual lameness
T/F
medical management is used to supplement the surgical Tx of ED
True
