Orthopaedics: Common Conditions of the Elbow Flashcards
What developmental conditions can affect the canine elbow?
- Medial coronoid disease
- Ununited anconeal process
- Osteochondritis dissecans
- Elbow incongruency
- Humeral intraconylar fissure
What traumatic elbow diseases can affect the canine elbow?
- Condylar fractures
- Proximal ulna/radius fractures
- Luxation/collateral ligement rupture
What degenerative elbow diseases can affect the canine?
- Flexor enthesiopathy
- Osteoarthritis
What does this radiograph show?
A normal eblow
What is the most sensitive modality for diagnostic imaging of the elbow?
Arthroscopy
Can assess cartilage and and can surgically intervene
What is the problem with arthroscopy?
Requires equipment and excertise
What landmarks are used for arthrocentesis of the elbow?
What needle is used?
Immediately distal to medial or lateral condyle
1-1.5” 21-23G
What is analysed about synovial fluid?
- Volume
- Colour/turbidity
- Total cell counts
- Differential cell counts
Cytology
* OA- low cellularity mononuclear cells predominate
* IMPA/BIA- high cellular with neutrophillic inflammation
- What breeds are predisposed to elbow dysplasia?
- What are the 4 disease entities of elbow dyplasia?
- Labradors, Rottweilers, Bernese mountain dogs
- 4 entities
* Fragmentation of the mediaaspect of the coronoid process
* OCD of the medial aspect of the humeral condyle
* United anconeal process
* Elbow incongruity
What causes elbow incongruency?
Short radius
* premature closure of the proximal/distal growth plate
* Contirubtion to MCD
Short ulna syndrome
* Premature closure of the distal ulna physis
* Contribution to MCD and UAP
How is elbow incongruency treated?
Bone lengthening procedures
* Osteosomies to improve
* Most common: short ulna syndrome
* Ulna osteotomy/ectomy
* BODPUO
* Proximal vs distal
Proximal upto 6 months- more commonly distal
What causes medial coronois disease?
Multifactorial
* Genetics
* Nutrition
* Biomechanics- sites of greatest load
* Gender- males increased
What is the pathophysiology of medial coronoid disease?
incongurency:
* Short radius/ulna
Mechanical overload
* Distrurbance of normal endochondral ossification
* Weak points between retained cartilage and subchondral bone
* Subsequent fissure and fracture formation
What does this CT show?
MCD- fracture of medial coronoid process
How is MCD conservatively managed?
Analgesia
* NSAIDs
* Paracetamol/codeine
* Amantadine, gabapentin, tramadol
Others
* Neutraceuticals
* Weight control
* Controlled excercise
* Physio/hydrotherapy
How is MCD surgically managed?
There are a lot of options: Don’t memorise
Fragment removal- most common
* ±PUO
* BODPUO
* DUO
Subtotal coronoidectomy
Biceps ulnar release procedure
Load-transfer procedures
* Sliding humeral osteostomy
* Proximal abducting ulnar ostesotomy
* Proximal ulnar rotational osteotomy
Bone resurfacing procedures
* Canine unicompartmental elbow
Salvage
* total elbow replacement
* Elbow arthrodesis
- What are the clinical signs of OCD?
- How is it diagnosed?
- Lameness, joint effusion
- Radiography, arthroscopy, arthotomy
What is the pathogenesis of OCD?
- Distrurbance of the nromal orderly process of endochondral ossification
- Cartilage of increased thickness
- Necrosis deep with thickened cartilage
- May develop to cartilage flap
How is OCD treated?
- Cartilage flap removal and debridement of subchondral bone
- Osteochondral autogenous transfer- osteochondral graft
- Synthetic osteochondral transplant
Fair prognosis
- What breeds are predisposed to ununited anconeal process?
- What is the pathogenesis?
- Bassets, GSDs, BMD, mastiffs- bilateral commonly
- Secondary centre of ossification in some dogs, joint incongruency (short ulna)
How is UAP diagnosed?
Ununited anconeal process
Clinical exam
* Thoracic limb lameness
* Large joint effusion
Radiography
* Flexed ML
* Consolidation of AP not present until between 16 and 20 weeks
CT- diagnosis of concurrent disease
How is UAP treated?
Conservative if mild lameness
Surgery
* Removal of anconeal
* Anconeal reattachment
* Ulnar osteotomy
* Proximal ulnar osteotomy + reattachment- better outcome?
What causes incomplete ossification of the humeral condyle ?
AKA humeral intracondylar fissure
- Humeral condyle formed from two seperate centres of ossification
- Should fuse at 12 weeks of age
- The fissure does not ossify
Spaniels overrepresented
How does a humeral intracondylar fissure present?
- Acute onset lameness typically secondary to fracture
- Chronic thoracic limb lameness
- Aymptomatic
How is IOHC diagnosed?
Radiograph
* large fissure can be seen on standard craniocaudal radiographic projections
CT
* More sensitive
HIF may be detected in controlateral joint
What are the surgical indications of HIF?
- Persistent lameness in the affected limb
- Early remodelling can be detected on the lateral epicondylar crest
How can symptomatic HIF without fracture be treated?
Transcondylar scew
* 3.5/4mm cortical screw
Transcondylar screw and lateral condylar plating
How can asymptomatic HIF be treated?
- 20% will go onto fracture
- Prophylactic surgery- high complication rate
- Medial to lateral screw placement may reduce SSI
What breeds more commonly fracture humeral condyles?
French bulldogs and English springer spaniels
Mainly lateral condylar fractures
How are lateral/medial condylar humeral fractures treated?
- Transcondylar K wire + supracondylar K-wire
- Transcondylar screw
- TCS and epicondylar plate
40% complications rate
Good outcome
How is a dicondylar fracture surgically treated?
- Reduce the fracture in medial epicondylar crest
- Stabilise medial cortex with bone plate and screws
- Approach lateral aspect and manage as a LCF
