Ortho 4

Question 1

label these

Answer 1

Question 2

describe typical signalment for UAP ununited anconeal process dog

Answer 2

large, giant breed dogs, males > females, 5-12 months although older if bilateral (maybe)
bilateral in 1/3 cases, FCP in 1/3 cases, often radioulnar incongruence

Question 3

pathogenesis of UAP ununited anconeal process

Answer 3

etiology unclear, maybe due to metabolic, OCD, trauma, genetic, we dunno
polygenic mode of inheritance
elbow joint incongruity as cause
changes in joint due to instability and maybe joint mouse

Question 4

diagnosis of UAP ununited anconeal process

Answer 4

PE and radiographs:
gradual onset weight bearing lameness, worse after exercise, significant joint effusion, pain on palpation and extension
rads: CC, neutral lateral, flexed lateral, both elbows
must be 20 weeks since growth plates are not closed before this

Question 5

what is wrong

Answer 5

UAP ununited anconeal process

Question 6

UAP ununited anconeal process: what is treatment?

Answer 6

early intervention to limit DJD, ideally
- anconeal process removal
- anconeal process reattachment
- ulnar osteotomy or osteotomy
- can do combination of reattachment and osteotomy/ectomy

Question 7

medial compartment disease: typical signalment?

Answer 7

• males > females
• young, typically 6-18 months; biphasic pattern: <3 years, >7 years
• large and giant breed dogs: Labrador and Golden retrievers, G shep, Rotties, Bernese Mountain dogs
• elbow incongruity esp. in chondrodystrophic breeds

Question 8

medial coronoid disease: etiology, pathogenesis?

Answer 8

• we don’t totally know, but complex, polygenic, independent traits
• delay in endochondral ossification + supraphysiologic loading of medial coronoid process
• joint incongruence, humeroulnar conflict, joint instability
• at medial humeral condyle, kissing lesion from fragmented coronoid process (joint mouse rubs causing damage to cartilage)

Question 9

medial coronoid disease: PE findings?

Answer 9

• ELBOWS ABDUCTEED AND MANUS EXTERNALLY ROTATED
• lameness, pain on manipulation of elbow joint, generalized muscle atrophy, worse C/S with exercise, as with other DED
• BILATERAL disease, so can be hard to appreciate lameness
• joint effusion and periarticular fibrosis lead to enlarged joint
• if OA develops, decreased ROM and crepitation

Question 10

medial coronoid disease: gold standard for diagnosis?

Answer 10

CT
(- ALLOWS EVALUATION OF SUBCHONDRAL BONE
- allows quantification of incongruity
- inability to image cartilage lesions)

Question 11

besides CT, what other procedure is useful to diagnose medial coronoid disease?

Answer 11

arthroscopy
(VISUALIZE JOINT SURFACES and offers MINIMALLY INVASIVE treatment; often used in combo with CT)
(rads lack sensitivity for this dz)

Question 12

treatment of medial coronoid disease: what factors to consider in decision making?

Answer 12

severity fo OA
age
expected level of activity

Question 13

treatment of medial coronoid disease: best prognosis with what factors?

Answer 13

early surgical treatment in young dogs,
mild or minimal OA,
combined with post-op rehab and preventative measures against OA

Question 14

name 2 surgical procedures used to treat medial coronoid disease

Answer 14

fragment removal and subtotal coronoid osteotomy
BURP biceps ulnar release
ulnar osteotomy/ostectomy (static or dynamic) (different subtypes)

Question 15

name 2 advanced procedures used to treat medial coronoid disease

Answer 15

osteotomy of humerus: sliding humeral osteotomy (SHO) or external rotational osteotomy (SRHO)
unicompartmental elbow replacement (CUE)
total elbow replacement
arthrodesis