Scapular and Humeral

Question 1

Scapular Fractures

Answer 1

Result of high energy trauma. High incidence of concurrent injures.
Surgical intervention depends on anatomic location (scapulohumeral joint), concurrent injuries, animal’s job.

Question 2

Scapular fractures coadaptation

Answer 2

Majority of non articular fractures can be managed without surgery. Abundant periosseous musculature and predominance of cancellous bone- heals readily.

Question 3

Scapular fractures surgical

Answer 3

Grossly displaced body or spine fractures. Acrominon avulsion fractures. Displaced neck fractures. Supraglenoid tubercle and glenoid fractures (articular).
Bilateral or unilateral locking plates.
Moral of the story- neck, supreglenoid, and glenoid tubercle consider surgery everything else coadaptation

Question 4

Proximal humeral physeal fractures

Answer 4

Type 1 or 2 salter harris. Anatomic reduction confers stability. Divergent cross pinning. Be suspicious of pathologic fractures in large dogs.

Question 5

Humeral Fractures

Answer 5

Complete fractures typically requires surgery- interlocking nail, external fixation, or plates.
Most fractures involve the supracondylar region.
The radial nerve must be assessed if a lateral approach used.

Question 6

IM pin- humerus

Answer 6

Retrograde placement most common. Exits proximally though the greater tubercle. Seated distally in or proximal to the medial portion of the condyle.

Question 7

Interlocking nail: humerus

Answer 7

Fracture must be well proximal to the supracondylar region. Can be placed using limited reduction. Proximal bolt must be distal to the greater tubercle.

Question 8

External fixatures: humerus

Answer 8

Essential limited to type 1 constructs, but can place a full-pin distally through the condyle. IM pin provides alignment and bending stability.

Question 9

Plating- humerus

Answer 9

Plate can be placed cranial, medial, caudal, and lateral. Must protect major nerves. Consider plate-rod constructs.

Question 10

Distal humeral fractures

Answer 10

Distal shaft and supracondylar fractures. Unicondylar fracture. Dicondylar fractures.

Question 11

Distal humeral physeal (supracondylar) fractures

Answer 11

Pin fixation alone reserved for simple physeal fractures, Salter Type 1 or 2 that can be anatomically reduced.
Approach via a medial, lateral, or combined approach. Consider plating if can be easily reconstructed. External fixation- unreconstructible fractures.
Purchase in the condylar segment is limited. Locking plates are very advantageous

Question 12

Unicondylar Humeral fractures.

Answer 12

Common fractures. Indirect trauma produces shearing force on the lateral condyle. Salter- harris 4 injuries in skeletally immature dogs. Lag screw fixation.
Advocate use of an interfragmentary screw placed in a lag fashion to promote primary bone healing and mitigate post traumatic DJD.
Screw positioned slightly craniodistal to the epicondyles. Adjunctive anti-rotational kirshner wire

Question 13

Unicondylar and dicondylar complications

Answer 13

Incomplete ossification of the humeral condylar

Question 14

Dicondylar fractures

Answer 14

T or Y fractures. Very challenging fractures with high complication rate. Both approach and stabilize method are critical to achieving an optimal outcome.
Should approach via combined medial and lateral approaches or a triceps tenotomy. Perform an olecranon osteotomy as a last resort.
Condyle stabilized with lag screw fixation. Bilateral plate fixation of Y-T humeral condyle fractures via medial and lateral approaches.

Question 15

Olecranon osteotomy

Answer 15

Affords excellent exposure, but 37% complication rate. Implant failure, implant migration, loss of osteotomy reduction, non-union, or osteomyelitis

Question 16

External fixators- dicondylar

Answer 16

External fixators generally used in small dogs or fractures with supracondylar commination