Ch. 52-53: Elbow & Total Elbow Flashcards
Griffon Vet Sx 2018 PQ
Radiographic, CT, and arthroscopic diagnosis of radioulnar incongruence in dogs with medial coronoid disease
Joints with RUI > 2 mm incongruent
Single fragmentation most common MCD to CT and arthroscopy (47.1%)
RUI was associated with DJD to CT and with cartilage damage according to arthroscopy
-RUI diagnosis% by each modality?
-imaging agreement?
-associations with incongruence?
-conclusions?
RUI diagnosed in 26% of elbows by radiography, in 35% of elbows by CT (subjective), in 78% elbows according to CT measurements in RUI >2 mm (quantitative), & 57% by arthroscopy
RUI most commonly detected at ulnar commissure with CT & at apex of MCP with arthroscopy
Imaging modalities poor to fair agreement with arthroscopy when evaluating RUI
Incongruence was associated with greater Outerbridge scores to MCP and trochlea
Conclusions: CT doesn’t reliably predict arthroscopic assessment of RUI & associated tx decisions for MCD
Coppietiers VSURG 2016 PQ
Arthroscopic, Computed Tomography, and Radiographic Findings in 25 Dogs With Lameness After Arthroscopic Treatment of Medial Coronoid Disease
Findings?
Arthroscopic findings included a calcified body in 11/29 joints (38%), multiple small calcified bodies in 1/29 joint (3%), loose scar tissue in 12/29 joints (42%), and immobile scar tissue in 2/29 joints (7%). Three of 29 joints (10%) did not have any calcified body or loose scar tissue found but had erosion of the medial compartment as the only pathology diagnosed in the coronoid region. Characteristics of flexor enthesopathy were identified in 9/29 joints (31%).
Arthroscopic treatment of MCD, even with limited cartilage lesions, may not resolve lameness in some dogs. Calcified bodies or loose scar tissue near the medial coronoid process are a frequent followup finding in these joints.
Coghill VCOT 2021 PQ
Mid- to long-term outcome after arthroscopy and proximal abducting ulnar osteotomy versus arthroscopy alone in dogs with medial compartment disease: thirty cases
-tx groups?
-diff in pain between groups?
-diff in MOS bw groups?
-change in pain and NSAID use?
-conclusion?
-how does this procedure compare to arthroscopy alone? PQ
Canine brief inventory pain (CBIP) scores were not different b/w arthroscopy alone & arthroscopy + PAUL
NSAID admin was similar b/w groups
No significant difference b/w modif-Outerbridge score and outcome over median 43mo postop
CBIP and NSAID use were affected by age; dogs >3yrs of age at time of sx had higher CBIP scores & NSAID use regardless of what sx was performed
Owner assessed improvement was not different b/w groups
- Conclusion: PAUL showed no owner assessed benefit over scope alone for fragment removal & MOS of at least 3
Good to excellent outcome in 22/30 dogs irrespective of tx group
Pain progressed over time regardless of tx group -evidence of increased NSAID use over time
Moores JSAP 2017 PQ
The natural history of humeral intracondylar fissure: an observational study of 30 dogs
-% that progressed to fx?
-% total that needed sx?
30 dogs (34 elbows)
6 humeral condyles (18%) with mean fissure size of 50% fractured at a mean of 14 mo after diagnosis
No risk factors were ID for fx/screw placement
For those cases that didn’t fx or have a screw placed mean fissure size was 52% & mean FU time was 56 mo
Conclusions: 18% cases progressed to fx and 24% in total required surgery
Baud JSAP 2020
CT evaluation of elbow congruity in dogs: radial incisure versus apical medial coronoid process fragmentation
- # elbows evaluated
- # incisure?
- # apical
99 elbows (66 dogs)
- 56 had fissure or fragmentation at incisure
- 43 at apical fragment
Mostafa VCOT 2019
Quantitative radiographic evaluation of elbow incongruity in Labrador and Golden Retrievers with confirmed MCD
- what rad view?
- RU step findings for both measurement methods?
Total 131 dogs (197 elbows) included.
Extended mediolateral elbow radiographs compared to controls
Normalized HR and HR distances increased significantly in dogs with MCD
There was a significant increase in traditional & modified RU-step in dogs with MCD
Significant correlation ID between traditional and modified RU-step calculated for control and diseased elbows
Jacqmin VCOT 2023
Use of Ultrasonography in Diagnosis of Medial Compartment Disease of the Elbow in Dogs
- % of elbows US detected a lesion?
- 2 most reported lesions?
15 elbows which rads + CT inconclusive
At least one ultrasonographic lesion was detected in 13/15 (86%) elbows.
The main reported ultrasonographic lesions were joint effusion (10/15 elbows, 66%) and an abnormal shape of the medial coronoid process (irregular, ill-defined or fragmented) (9/15, 60%))
Dempsey VCOT 2019
A comparison of owner-assessed long-term outcome of arthroscopic intervention vs. conservative management of dogs with medial coronoid disease
- diff in LOAD and pain score between tx?
- significance of age?
- conclusion
44 dogs arthroscopic intervention and 23 treated conservatively
Median LOAD and Pain severity score (PSS) for arthroscopic group vs conservative managed group not S different
Older age at diagnosis was all significantly associated with higher LOAD, PSS and PIS
Arthroscopic intervention showed no long-term benefit over conservative management for dogs with MCPD
Hersh-Boyle Vet Sx 2021
Comparison of needle arthroscopy, traditional arthroscopy, and computed tomography for the evaluation of medial coronoid disease in the canine elbow
- how did they compare dx fissure?
- dx fragment?
- accuracy of needle scope?
Still images of NAR, TAR, and CT had similar diagnostic value to identify MCP fissures.
Still images of TAR was superior to NAR and CT to identify MCP fragments.
The diagnostic accuracy of NAR varied on the basis of the coronoid lesion being evaluated.
Danielski Vet Sx 2022
Humero-anconeal elbow incongruity in spaniel breed dogs with humeral intracondylar fissure: arthroscopic findings
- cartilage appearance?
- degree of elbow extension to visualize etiology of pathology?
- conclusion?
All elbows with HIF showed focal cartilage lesion on the caudal aspect of the humeral condyle
In all cases, when the elbow was extended to 120-140, the tip of the anconeal process perfectly matched the HA lesion
Humero-anconeal incongruity was identified in all elbows with HIF as absence of joint space at the point of contact between the tip of the anconeal process and the cartilage lesion
Scheuermann VCOT 2021
Effect of induced incomplete ossification of the humeral condyle on ex vivo humeral condylar biomechanics
Conclusion?
cadaveric humeri were weakened by creation of IOHC lesion and fx secondary to induced IOHC were similar to spontaneous humeral condylar fx (fx through IOHC lesion and lateral epicondylar crest). Supports hypothesis that IOHC weakens the humeral condyle and may predispose to humeral condylar fx
Williams VCOT 2019
Lateral radial head subluxation as a complication following proximal ulnar osteotomy or ostectomy in 8 dogs
- median time to dx radial luxation?
- revision surgery successful?
- conclusion?
6 dogs had PUO 2 dogs had PU ostectomy
Median time to diagnosis of lateral radial head subluxation following surgery was 6.5 weeks.
Five of the eight dogs had surgical revision of lateral radial head subluxation. Resolution of lateral radial head subluxation was achieved in four dogs.
2 dogs had amputation, 1 no surgical tx.
Lateral radial head subluxation is a potentially severe postoperative complication following PUOO or PUOE
Berger VSURG 2023
The use of subchondral bone topography to approximate the center of rotation of the elbow joint in dogs
Conclusion?
Based on CT- derived geometry, the COR of elbow affected with FMCP was generally more caudal than normal.
Jenkins Vet Sx 2022
Medial epicondylar fissure fracture as a complication of transcondylar screw placement for the treatment of humeral intracondylar fissure
- % MEFF
- what increased the risk?
- what complication seen with MEFF?
- diameter screw as % of condyle recommended?
Medial epicondylar fissure fracture was identified in 10 elbows (11%) following medial-to-lateral transcondylar screw placement
A larger relative screw size was found to increase the risk of MEFF (P = .004, OR = 1.5)
Screw loosening was the most frequent complication (n = 9) and was the only complication in dogs with MEFF (n = 3); MEFF tended to increase the risk of perioperative screw loosening (P = .06)
Placing transcondylar screws with a diameter inferior to 41% of the height of the condyle is recommended to avoid MEFF
Danielski Vet Sx 2021
Complications after proximal abducting ulnar osteotomy and prognostic factors in 66 dogs
- % complication? % major?
- list complications
- what variable increased risk of post-op complications?
- conclusion?
Seventy-four PAULs in 66 dogs were included
Post-operative complications were documented in 19/74 limbs (25%), including major complications in 13 limbs (68% of all complications).
Complications consisted mainly of non-union (six limbs), implant failure (two limbs), and infection (two limbs) requiring revision surgery in nine limbs.
Body weight was the only variable associated with an increased risk of post-operative complications
Complications are fairly common after PAUL, particularly in heavier dogs, and post-operative radiographic examination seems unreliable to predict those
