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Year 4 Small Animal Studies > Orthopaedics: Common Conditions of the Elbow > Flashcards

Orthopaedics: Common Conditions of the Elbow Flashcards

1
Q

What developmental conditions can affect the canine elbow?

A
  • Medial coronoid disease
  • Ununited anconeal process
  • Osteochondritis dissecans
  • Elbow incongruency
  • Humeral intraconylar fissure
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2
Q

What traumatic elbow diseases can affect the canine elbow?

A
  • Condylar fractures
  • Proximal ulna/radius fractures
  • Luxation/collateral ligement rupture
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3
Q

What degenerative elbow diseases can affect the canine?

A
  • Flexor enthesiopathy
  • Osteoarthritis
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4
Q

What does this radiograph show?

A

A normal eblow

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5
Q

What is the most sensitive modality for diagnostic imaging of the elbow?

A

Arthroscopy
Can assess cartilage and and can surgically intervene

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6
Q

What is the problem with arthroscopy?

A

Requires equipment and excertise

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7
Q

What landmarks are used for arthrocentesis of the elbow?

What needle is used?

A

Immediately distal to medial or lateral condyle

1-1.5” 21-23G

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8
Q

What is analysed about synovial fluid?

A
  • Volume
  • Colour/turbidity
  • Total cell counts
  • Differential cell counts

Cytology
* OA- low cellularity mononuclear cells predominate
* IMPA/BIA- high cellular with neutrophillic inflammation

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9
Q
  1. What breeds are predisposed to elbow dysplasia?
  2. What are the 4 disease entities of elbow dyplasia?
A
  1. Labradors, Rottweilers, Bernese mountain dogs
  2. 4 entities
    * Fragmentation of the mediaaspect of the coronoid process
    * OCD of the medial aspect of the humeral condyle
    * United anconeal process
    * Elbow incongruity
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10
Q

What causes elbow incongruency?

A

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

Top short radius, bottom short ulna
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11
Q

How is elbow incongruency treated?

A

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

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12
Q

What causes medial coronois disease?

A

Multifactorial
* Genetics
* Nutrition
* Biomechanics- sites of greatest load
* Gender- males increased

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13
Q

What is the pathophysiology of medial coronoid disease?

A

incongurency:
* Short radius/ulna

Mechanical overload
* Distrurbance of normal endochondral ossification
* Weak points between retained cartilage and subchondral bone
* Subsequent fissure and fracture formation

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14
Q

What does this CT show?

A

MCD- fracture of medial coronoid process

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15
Q

How is MCD conservatively managed?

A

Analgesia
* NSAIDs
* Paracetamol/codeine
* Amantadine, gabapentin, tramadol

Others
* Neutraceuticals
* Weight control
* Controlled excercise
* Physio/hydrotherapy

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16
Q

How is MCD surgically managed?

A

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

17
Q
  1. What are the clinical signs of OCD?
  2. How is it diagnosed?
A
  1. Lameness, joint effusion
  2. Radiography, arthroscopy, arthotomy
18
Q

What is the pathogenesis of OCD?

A
  • Distrurbance of the nromal orderly process of endochondral ossification
  • Cartilage of increased thickness
  • Necrosis deep with thickened cartilage
  • May develop to cartilage flap
19
Q

How is OCD treated?

A
  • Cartilage flap removal and debridement of subchondral bone
  • Osteochondral autogenous transfer- osteochondral graft
  • Synthetic osteochondral transplant

Fair prognosis

20
Q
  1. What breeds are predisposed to ununited anconeal process?
  2. What is the pathogenesis?
A
  1. Bassets, GSDs, BMD, mastiffs- bilateral commonly
  2. Secondary centre of ossification in some dogs, joint incongruency (short ulna)
21
Q

How is UAP diagnosed?

Ununited anconeal process

A

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

22
Q

How is UAP treated?

A

Conservative if mild lameness

Surgery
* Removal of anconeal
* Anconeal reattachment
* Ulnar osteotomy
* Proximal ulnar osteotomy + reattachment- better outcome?

23
Q

What causes incomplete ossification of the humeral condyle ?

AKA humeral intracondylar fissure

A
  • Humeral condyle formed from two seperate centres of ossification
  • Should fuse at 12 weeks of age
  • The fissure does not ossify

Spaniels overrepresented

24
Q

How does a humeral intracondylar fissure present?

A
  • Acute onset lameness typically secondary to fracture
  • Chronic thoracic limb lameness
  • Aymptomatic
25
Q

How is IOHC diagnosed?

A

Radiograph
* large fissure can be seen on standard craniocaudal radiographic projections

CT
* More sensitive

HIF may be detected in controlateral joint

26
Q

What are the surgical indications of HIF?

A
  • Persistent lameness in the affected limb
  • Early remodelling can be detected on the lateral epicondylar crest
27
Q

How can symptomatic HIF without fracture be treated?

A

Transcondylar scew
* 3.5/4mm cortical screw

Transcondylar screw and lateral condylar plating

28
Q

How can asymptomatic HIF be treated?

A
  • 20% will go onto fracture
  • Prophylactic surgery- high complication rate
  • Medial to lateral screw placement may reduce SSI
29
Q

What breeds more commonly fracture humeral condyles?

A

French bulldogs and English springer spaniels

Mainly lateral condylar fractures

30
Q

How are lateral/medial condylar humeral fractures treated?

A
  • Transcondylar K wire + supracondylar K-wire
  • Transcondylar screw
  • TCS and epicondylar plate

40% complications rate
Good outcome

31
Q

How is a dicondylar fracture surgically treated?

A
  • Reduce the fracture in medial epicondylar crest
  • Stabilise medial cortex with bone plate and screws
  • Approach lateral aspect and manage as a LCF

Year 4 Small Animal Studies (97 decks)

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