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Flashcards in 53.elbows Deck (34):
1

normal ROM, flexion and extension of elbow

ROM 130 degreesextension 165flexion 36(labradors)

2

Campbells test

with the elbow and carpus in 90 degree FLEXION primary stabilization for rotation is through MCL (generally weaker than the LCL)Campbell tests the integrity of the MCL

3

what orientation are 90% of traumatic elbow luxations

LATERAL luxationsthe distal slope of and large medial humeral trochlea prevents medial luxation LCL is stronger than MCL

4

type of elbow luxation associated with radial head luxation

Monteggia fracture1. most frequent; cranial lux of radial head and cranioproximal ulnar fracture2. caudal lux radial head and caudal angulation of ulnar fx3.lateral lux radial head4. fracture of proximal radius and ulnar diaphysis with cranial lunation of radial head

5

dogs and cat species difference in collateral ligament damage and traumatic elbow luxation

cats: both medial and lateral collateral ligaments must be damaged in order to see lunationdogs: at least lateral collateral ligament must be damaged to have luxation

6

characteristic limb position in dog with elbow luxation

NWBantebrachium abduction and externally rotated with elbow in slight flexion

7

sx repair for elbow lux

indicated for chronic fracture, failure of closed reduction, intraarticular fx or avulsion fx present1. reduce2. collateral ligament reconstruction +/- prosthetic repair with nonabsorbable suture and bone anchors/screws with washers, transverse bone tunnels (at humeral epicondyle and radial neck). transcondylar/transradial/transulnar bone tunnel for biaxial suture placement3. joint immobilization: spica splint, modified ESF, flexible ESF 2-3 weeks

8

types of congenital elbow luxations

uncommon1. lateral or caudolateral dislocation of radial head with the ulna in a relatively normal position2. MOST COMMON; disruption of humeroulnar with lateral rotation and sublux of ulna +/- radial head3. luxation of radius and ulna; often in poluarthrodysplastic dogs

9

what is a modified bell-tawse procedure to treat chronic congenital elbow joint luxation

1. approach craniolateral elbow2. radial ostectomy and counterclockwise rotation of proximal radius with bone plate stabilization3. reconstruct annular ligament with extensor carpi ulnaris muscle4. joint immobilization with transarticular Kwire

10

options for sx repair for congenital elbow luxation

1. radial head ostectomy2. Bell Tawse procedure3. arthrodesis4. limb amputationJOINT REPLACEMENT IF A CONTRAINDICATION WITH CONGENITAL ELBOW LUX

11

signalment for dogs with elbow dysplasia

young large-giant breed dogs17% labs70% bernese mountain dogsbilateral in 35% (25-80%); MULTIfactorial; male 2:1FCP or MCP, UAP, OC/OCD, RUI(ununited medial epicondyle is not included YET but may be a component in medial compartment disease)

12

T/Fthe anconeal process in small breed dogs does not have a separate center of ossification

TRUEsmall dogs--not a separate center of ossificationlarge dogs (GSD)--separate center of ossification (should fuse by 5 months GSD)diagnosis should not be made until weeks 22-24

13

most common cause of asynchronous growth in the antebrachium

damage to distal ulnar physis

14

treatment of UAP

1. nothing leads to progression of OA (usually faster and more severe than other components of elbow dysplasia)2. lag screw or Kwires3. excision (90% owner satisfied only 50% dogs free of lameness)4. address RU incongruity: ulnar osteotomy 30-60 mm distal to radial head caudoproximolateral craniodistomedial oblique +/- ulnar pin to prevent tipping +/- surgical reattachment of anneal process

15

distal humeral 3 ossification centers

trochlea, capitulum and medial epicondyletrochlea and capitulum fuse together at 3 monthstrochlea and capitulum fuse to metaphysis at 6 monthsmedial epicondyle should fuse to condyle at 6 months

16

most common concurrent lesions in a study by Remy et al looking at GSD elbows

concurrent lesions in 42% of elbows of GSDmost common combo = RUI and FCP (identified in 34%)

17

top 3 breeds at risk for OC/OCDtop breed at risk for MCP

OC/OCDRott 174 OR, Lab 109 OR, Chow 100 ORMCPBernese 140 OR

18

possible etiologies of medial compartment disease

1. genetic (not ID'd)2. environment3. manifestation of OC/OCD (diffusion nutrients impaired from thickened bone, deep layers die; Histo follow subtotal coronoidectomy disproved)4. Fatigue microdamage/excessive loading from RUI

19

types of elbow joint incongruence

1. abN trochlear notch-->humeroulnar inconcongruence2. uneven alignment of R and U articular surface (short ulna or short radius)

20

short radius vs short ulna and redistribution of forces

1. short radius (can be static, dynamic, temporary): redistribution from radial head to MCP; causes a step (0.5 mm in N, 1.4 mm in dogs with elbow dz CT) at the level of the radial incisor and proximal displacement of MCP/fragmentation; varus deformity2. short ulna: redistribution to anneal process-->UAP

21

theory behind the basis of the BURP procedure

BURP=bicipital ulnar releasing proceduretheory: rotational instability of RU leads to shear forces across and convert to compression of MCP onto radial headalternatively these shear forces could result from imbalance in muscle groups; lack of synchronization leads to bicipital tendon which attaches to ulnar tuberosity (distal to MCP) to create shear forces onto medial aspect of MCP.

22

T/Ffragmentation of MCP occurs at TIP vs fissuring occurs parallel to radial incisures

TRUEfragmentation of MCP occurs at TIP vs fissuring occurs parallel to radial incisures

23

Outerbridge scoring of articular cartilage

0. normal cartilage1. soft and swollen cartilage2. fragmentation and fissuring < 0.5 inch3. fragment and fissuring > 0.5 inch4. erosion present

24

most common radiographic finding in a retrospective of 437 elbows with medial coronoid disease

subtrochlear sclerosis 87%other lesions include osteophytosis on anconeal process, radial head, and lateral epicondyle

25

radiographic view that increased sensitivity of radiographic DX of medial coronoid disease

plain films only 24% SN 100% SPDMPLO 35 degrees 80% SN (still lower than CT SN 88%)

26

T/Fmediolateral radiographs are superior to craniocaudal films for detecting RUI

TRUEbut SN only 78%radioulnar step required for diagnosis ranged 1.5-4 mm

27

two muscle bellies separated for medial arthrotomy to elbow

flexor carpi radialis and pronator teres

28

proposed advantages to arthroscopy over arthrotomy to treat elbows

reduce patient morbidityease of treating >1 joint in single treatmentimproved visualizationMI approach

29

disadvantages to arthroscopy over arthrotomy

cost of equipmentlearning curveextravasation of fluid into tissues iatrogenic cartilage damagenerve palsysynovitis/hemorrhage may obscure view

30

2002 Bubenik study of arthrotomy vs arthroscopy outcomes

groups did NOT differ in postop pain, weight bearing, ROM, or temporal improvement in ground reaction forces(2.7 mm scope was used--now recommend 1.9 mm scope)two other studies showed the opposite

31

T/F in meta-analysis of mgmt of FCP, arthroscopy was superior to medial arthrotomy and medical management, but medial arthrotomy was NOT superior to medical management

TRUEarthroscopy was superior to medial arthrotomy and medical management, but medial arthrotomy was NOT superior to medical management

32

treatment options for elbow MCP disease

1. arthroscopic fragment removal, probing, debridement/curretage, vascular access channels2. open fragment removal, probe, debride/curretage, VAC3. open subtotal coronoidectomy4. arthroscopic subtotal coronoidectomy5. arthroscopic motorized shaver to remove entire MCP

33

treatment options for humeral trochlear lesions

1. open probing, debridement, curretage2. arthroscopic probing, debride, curretage3. osteochondral autogenous transfer (OATS) open appraoch

34

treatment options for treating RUI

1. proximal ulnar ostectomy (PUO)--2 mm step RUI indication; oblique, +/- ulnar IM pin2. radial lengthening with radial osteotomy and bone plate--Slocum technique; not recommended3. Coronoidectomy (subtotal vs total) is incongruence is located at apex of MCP4. Bicipital Ulnar Release Procedure (BURP)--to treat rotation incongruence 5. Sliding humeral osteotomy--shifts forces laterally, locking plate applied medially, still ~20% complications6. humeral medial opening wedge osteotomy or lateral closing wedge osteotomy (10 degrees)--high failure rate 30%7. PAUL8. TER9. Arthrodesis10. limb amputation

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