Elbow Dysplasia - advanced nursing

Question 1

what is the most common cause of forelimb lameness in dogs?

Answer 1

elbow dysplasia or developmental elbow disease (DED)

Question 2

what does developmental elbow disease include?

Answer 2

abnormalities including fragmented medial coronoid process, osteochondritis, joint incongurity and anconeal process

Question 3

when do dogs show signs of elbow dysplasia?

Answer 3

from 5 months old

Question 4

what are the signs of elbow dysplasia?

Answer 4

lameness, elbow swelling, decreased range of motion and joint pain

Question 5

what imagingviews would you do?

Answer 5

cranio-caudal. medio-lateral and flexed lateral

Question 6

what breed does ununited anconeal process usually occur in?

Answer 6

german sheperds

Question 7

when should the anconeal pocess fuse to the proximal ulna?

Answer 7

4-5 months of age

Question 8

what do patients with ununited anconeal prcess usually have?

Answer 8

a short ulnr relative to the legnth of the radius

Question 9

what does the procedure proximal dynamic ular osteotomy do?

Answer 9

allows lengthening of ulna as the radius grows and removes the stress of the anconeal process, which allows it to reunite with the ulnar metaphysis

Question 10

what is elbow incongruity and short radius syndrome?

Answer 10

cartilage wear and fragmentation of the medial coronoid process due to shortened radius relative to the length of the ulna

Question 11

how do you improve congruity of the elbow?

Answer 11

dynamic partial ulnar ostectomy

Question 12

what happens during a dynamic partial ulnar ostectomy?

Answer 12

A small portion of the ulna is excised, allowing improved humeroradial contact

Question 13

what does OsteoChondritis Dissecans affect?

Answer 13

the medial humeral condyle and it usually seen as a subchondral bone defect on a craniocaudal or caudocranial elbow radiograph

Question 14

what can OsteoChondritis Dissecans also be seen with?

Answer 14

fragmented coronoid process

Question 15

how does OsteoChondritis Dissecans appear?

Answer 15

a thickened partially detached flap of cartilage overlying a subchondral bone defect

Question 16

how do you treat Osteochondritis Dissecans?

Answer 16

flap removal and abrasion arthroplasty or microfracture of the subchondral bone

Question 17

what area of gragmentation is most common in fragmented medial coronoid process?

Answer 17

medial coronoid process of the ulna adjacement to the radial head

Question 18

how can underlying necrotic bone and fragments be removed?

Answer 18

arthroscopically or arthrotomy

Question 19

how can the subchondral bone be treated?

Answer 19

burring the bone by abrasion arthroplasty and microfracture to encourage fibrocartilaginous repair

Question 20

what will all dogs with developmental elbow disease /elbow dysplasia have?

Answer 20

osteoarthritis

Question 21

what is the goal of treatment of osteoarthritis?

Answer 21

debridement of necrotic cartilage, removal of sclerotic bone, neovacularization, and recruitment of pluripotential mesenchymal cells

Question 22

how can you debride exposed subchonral bone?

Answer 22

using abrasion arthroplasty or micropick technique

Question 23

how is abrasion arthroplasty performed?

Answer 23

hand burr or power shaver burr inserted through instrument portal or arthrotomy incision, burr spun to remove subchondral bone over area of lesion, joint lavaged if blood seen and removes remaining bone debris

Question 24

how is microfracture performed?

Answer 24

angled micropick pressed against subchondral bone surface, bleeding checked by stopping inflow of fluid

Question 25

what does sliding humeral osteotomy aims for?

Answer 25

transfering weight bearing from medial aspect of the joint to the lateral

Question 26

why is proximal dynami ulna osteotomy performed?

Answer 26

for medial compartment disease, radioulnar incongruence or ununited anconceal process treatment

Question 27

when is elbow arthroscopy indicated?

Answer 27

* Exploration of joints for diagnosis through observation, biopsy and culture * Removal of loose bodies * Topical treatment of OA – microfracture and abrasion arthroplasty * Joint debridement and lavage * Arthroscopic assisted joint stabilization or fracture repair

Question 28

what are the advantages of elbow arthroscopy?

Answer 28

* Decreased morbidity * More rapid recovery than arthrotomy * Decreased complications * Improved outcomes * Decreased surgery, anaesthesia and hospitalization times

Question 29

what are the disadvantages of elbow arthoscopy?

Answer 29

* High level of skill required * Long learning curve * High cost of equipment * Increased cost to client

Question 30

what is the diameter of the scope used for elbow arthroscopy?

Answer 30

1.9-2.7mm

Question 31

what is the lens angle for the arthroscope?

Answer 31

30 degrees

Question 32

what is the working length for the arthroscope?

Answer 32

short 8.5cm or long 13cm

Question 33

what does the camera mount do?

Answer 33

attaches to camera with the image projected on a screen. A high definition camera is best for arthroscopic images

Question 34

what is the flat screen monitor for?

Answer 34

require good quality monitor otherwise it’s a waste of time having a HD camera. It is useful to keep a record of the procedure by saving photos or video clips during arthroscopy

Question 35

what is the light post of the arthroscope for?

Answer 35

for connecting the light source and illuminating the joint

Question 36

what is the light source used in arthroscopy?

Answer 36

halogen and xenon

Question 37

what are the functions of the cannula on the arthroscope?

Answer 37

* Maintains arthroscope portal * Protects the arthroscope * Ingress of fluid

Question 38

what does irrigation do?

Answer 38

keeps the joint inflated and removes debris and blood

Question 39

what pressure is fluid pushed in during irrigation?

Answer 39

60mmHg

Question 40

what is egress systems?

Answer 40

a source for removal of lfuid

Question 41

what are instrumental cannulas?

Answer 41

have a rubber seal that allows insertion of instruments without allowing egress of fluid

Question 42

what type of power tools are used during arthroscopy?

Answer 42

shavers are available for removal of soft and hard tissue e.g. the fat pad, synovial membrane or medial coronoid

Question 43

what is elctrocautery or radiofrequency used for?

Answer 43

used to generate heat for cauterization of vessels or shrinking of tissues

Question 44

how would you prep a patient for elbow arthroscopy?

Answer 44

- aseptic clip and prep around the entire elbow and enough space for conversion to open - hang leg - draping (waterproof drapes) - positioning (dorsal or lateral recumbency and distract the joints ver sandbag or edge of table

Question 45

why might a patient require arthroesis?

Answer 45

if the patient has unilateral lameness, pain relief but gait abnormality

Question 46

what area of the humerus is usually most affcted in dogs with elbow dysplasia?

Answer 46

medial compartment

Question 47

how would you treat ununited anconeal process?

Answer 47

- conservative -removal of anconeal process - proximal dynamic ulna osteotomy - lag screw fixation