Elbow Dysplasia

Question 1

What possible issues can cause developmental elbow disease?

Answer 1

Ununited anconeal process of ulna
OCD of medial humeral condyle
Fragmented medial coronoid process of ulna
Asynchronous growth of radius and ulna leading to joint incongruity

Question 2

When do patients typically present with elbow dysplasia, and what signs are shown?

Answer 2

6 months +
Low grade mild lameness, bilateral

Question 3

What can we see on physical examination of a patient with elbow dysplasia?

Answer 3

Elbow effusion
Decreased ROM, pain on extremes of flexion/extension

Question 4

What radiograph views should be taken to differentiate between causes of elbow issues?

Answer 4

Craniocaudal
Mediolateral
Flexed lateral
Ununited anconeal process, fragmented coronoid process, osteochondrosis dissecans (OCD)

Question 5

What do we see on flexed mediolateral radiograph views?

Answer 5

Dorsal anconeal process and radial head
Sclerosis of ulna notch
Flattened/blurred FCP
Increased humeroradial joint space
Looking for primary lesion/secondary DJD

Question 6

What can we see with neutral lateral radiograph views?

Answer 6

Joint incongruity

Question 7

What can we see on fully flexed mediolateral radiograph views?

Answer 7

Dorsal osteophytes
Ununited anconeal process

Question 8

What can we see with cranio-caudal (orthogonal) radiograph views?

Answer 8

Osteophytes/OCD on medial lateral condyle

Question 9

How can we treat ununited anconeal process?

Answer 9

Conservative
Surgical - removal of anconeal process, proximal dynamic ulna osteotomy, lag screw fixation

Question 10

How can we treat elbow incongruity/short radius?

Answer 10

Dynamic partial ulnar ostectomy
+/- intramedullary pin

Question 11

Describe a dynamic partial ulnar ostectomy.

Answer 11

Small portion of ulna excised, allowing improved humeroradial contact
Ulna not rigidly stabilised to allow it to shift to ‘best fit’ position
OR small intramedullary pin placed to decrease pain/prevent excessive caudal translation of proximal ulna

Question 12

What is OCD?

Answer 12

Osteochondritis dissecans
Affects medial humeral condyle
Usually appears on humeral trochlea as thickened flap of cartilage overlying relatively deep (1-2mm) subchondral bone defect

Question 13

How can we treat OCD?

Answer 13

Conservative - restricted exercise 4-6 weeks, NSAIDs
Surgical if no improvement - arthrotomy and debridement / arthroscopy and debridement (flap removal and abrasion arthroplasty/microfracture of subchondral bone)

Question 14

Where does fragmented coronoid process most commonly occur?

Answer 14

Craniolateral aspect of medial coronoid adjacent to radial head

Question 15

How can we treat FCP?

Answer 15

Arthroscopic debridement
Medical management of OA

Question 16

What medical management of OA can be attempted prior to surgery?

Answer 16

NSAIDs
Weight loss
Hydrotherapy
Physiotherapy

Question 17

How can we best assess the severity of OA?

Answer 17

Arthroscopy

Question 18

What are the aims of treatment of OA?

Answer 18

To stimulate healing with hyaline/fibrocartilage

Question 19

How can we surgically treat OA?

Answer 19

Abrasion arthroplasty
Subchondral bone burred off over area of lesion
Joint lavaged to remove remaining bone debris

Question 20

Describe a long bone osteotomy.

Answer 20

Elbow dysplasia - medial compartment disease
Shifting weightbearing from medial to lateral side to allow medial cartilage loss to heal
Ulna cut similar to ununited anconeal process

Question 21

Describe elbow replacement.

Answer 21

Valid and viable possibility for the right patients
Complications can occur - may lead to arthrodesis/amputation
New implants have low(er) complication rate

Question 22

Describe arthrodesis.

Answer 22

Final salvage procedure for end-stage painful joint
Small dogs with unilateral lameness
Results in pain relief but marked gait abnormality

Question 23

What are the indications for arthroscopy?

Answer 23

Explore joints
Remove bits
Surface treatment
Lavage
Assisted repair

Question 24

What equipment do we need for elbow arthroscopy?

Answer 24

Arthroscope (diameter 1.9-2.7mm, lens angle usually 30 degrees, length 8.5 or 13cm)
Camera mount
Flat screen monitor
Light post

Question 25

Describe prep for arthroscopy.

Answer 25

Clip medial elbow and large for conversion to open approach
Waterproof drapes to prevent patient getting wet and cold
Positioning - dorsal (bilateral) or lateral (unilateral)

Question 26

What are the multiple functions of the arthroscope cannula?

Answer 26

Maintains arthroscope portal
Protects the arthroscope
Ingress of fluid

Question 27

What equipment is needed for removal of fragments?

Answer 27

Power tools
Electrocautery / radiofrequency
Long needles, syringe, fluid bowl, haemostats etc.