Most forelimb diseases cause: lameness sit and stand with externally tiffness what is a symptom of ununited anconeal process that can help you differentiate it?

decrease ROM causing elbow to circumduct laterally during swing phase of gait sit and stand with paw externally rotated

Lecture 16: Sx of the Elbow 2 (Exam 3) Flashcards by Shelby Rainbolt

Are most elbow replacement surgery techniques still widely used? Why/Why not

no
HIGH COMPLICATION RATES- joint subluxations ,fractures, loosening, infection

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Should general surgeons preform a total elbow replacement?

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Definition

anconeal process does not form bony union with proximal ulnar metaphysis

ununited anconeal process

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Ununited anconeal process is a disease of what kind of dogs

large growing

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Definition

arises as secondary center of ossification in elbow at 11-12 wees old

anconeal process

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Diagnosis of Ununited anconeal process cannot be made until after what age, because the fusion to ulna does not occur until then

4-5 months

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What breed of dogs is overrepresented in ununited anconeal process? What is the common signalment of ununited anconeal process?

GERMAN SHEPHERDS
large to giant breeds male dogs most common- presents around 6-12 months can be older

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Most forelimb diseases cause:

lameness
sit and stand with externally tiffness

what is a symptom of ununited anconeal process that can help you differentiate it?

decrease ROM causing elbow to circumduct laterally during swing phase of gait
sit and stand with paw externally rotated

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When taking radiographs for a possible ununited anconeal process what view should you ensure to take to bring the anconeal process into view (best visualized on this view)

flexed lateral (45 degree and slightly rotated medially)

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What 4 radiographic views should you take for possible ununited anconeal process

craniocaudal
lateral
flexed lateral
oblique craniocaudal (elbow flexed 30 degreed and slightly rotated medially)

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Fill in the ?s

Ununited anconeal process on radiographs shows up as a ? separating anconeal process from ulna

lucent indistinct line

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What would you diagnose this animal with? why?

ununited anconeal process
lucent irregular line between anconeal process and olecranon
AS WELL AS subchondral bone sclerosis of olecranon

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Does surgical removal of anconeal process after extensive OA stop progression of OA?

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What conservative management would you use to treat ununited anconeal process

FIVE PRINCIPLES OF MEDICAL MANAGEMENT OF OA

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What are the five principals of medical management of OA?

weight management
nutritional supplementation
exercise moderation
physical therapy
anti-inflammatory medication

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What surgical procedures are used to treat ununited anconeal process

surgical removal of anconeal process
surgical reduction with lag screw fixation
ulnar osteotomy ( WITH LAG SCREW FIXATION of anconeal process)

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What is the standard treatment for UAP if diagnosed before onset of extensive OA?

surgical removal of anconeal process

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What animals is surgical repair of ununited anconeal process recommended

under one year of age with minimal DJD

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What should you counsel owners on before performing surgery on patients with UAP

probability of progressive osteoarthritis

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What surgical method for correction of UAP is seen here?

lag screw fixation of UAP

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If patient with UAP is <1 year of age and treated surgically what is the prognosis

Good

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What is the prognosis of Surgery for UAP for normal limb function

guarded

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Failure of bony union between medial and lateral portions of the humeral condyle

Incomplete ossification of the humeral condyle ( IOHC)

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Is Incomplete ossification of humeral condyle a classification of elbow dysplasia

Not usually (BUT it is a developmental disease and presents the same)

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# **Fill in the ?s** Normal ossification of humeral condyle starts at **?** YO and is complete at **?** YOs

* Starts @: 2 weeks * Completed @: 8 - 12 W

What may occur secondary to IOHC that increases humeroulnar joint space

elbow incongruence (based on identification of radioulnar incongruence in CT examination)

Incomplete ossification of humeral condyles is overrepresented in what breeds

spaniel (suggest genetic cause)

# **Fill in the ?s** In one study the incident of bilateral disease of IOHC based on CT examination was **?%**

90%

What would you diagnose this patient with, why?

* incomplete ossification of humeral condyle * B/C of fissure line

What age ranges is it common to see IOHC in?

young to middle age (increased incidence of middle age male dogs)

What may IOHC lead to?

**LATERAL HUMERAL CONDYLAR FRACTURE**

IF a patient has a humeral condylar fracture, what should you always be sure to do?

radiograph other limb for incomplete ossification of humeral condyles

What view can you detech a IOHC in?

craniocaudal (of elbow joint, ulna is superimposed over lesion = more difficult to see, sclerosis of lateral epicondylar crest)

Which is ideal for diagnosing IOHC: rads or CT?

CT (new bone formation and increased humeroulnar joint space)

What is seen here on this arthroscopic image

Incomplete ossification of humeral condyle

Is medical management appropriate for IOHC patients

No (may lead to complete fracture)

What surgical technique can you use to correct IOHC

lag screw fixation

Why do lag screw fixations fail overtime in IOHC patients

cyclic loading

What should you use to minimize screw failure in IOHC patients

largest diameter screw

What used for correction of IOHC is described to create a biologic bone bridge between medial and lateral condyles

autogenous cancellous autograft core

WHat technique for correcting IOHC is a highly advanced procedure only preformed by experienced surgeons trained in this technique

Autogenous bone core grafting

What technique was used here to correct an IOHC

lag screw fixation

What kind of screw is used in lag screw fixation of IOHC

partially threaded cancellous bone screw

Are patients typically lame after placement of lag screw to correct IOHC

No (resolution of lameness but breakage of lag screw and recurrence of clinical signs may occur months to years later)

3 reasons for elbow luxation

1. traumatic 2. luxation/subluxation caused by premature closure of the distal ulnar or radial physis 3. congenital

# **Fill in the ?s** Traumatic elbow luxation AKA dislocated elbow is usually associated with blunt trauma of elbow joint causing **?** displacement of radius and ulna with respect to the humerus

lateral (RARE IN CATS)

What usually occurs alongside traumatic elbow luxation's in young animals

physeal fractures

What is the result of elbow trauma that allows luxation of radius and ulna

rupture/avulsion of collateral ligaments (usually luxate laterally- in extreme cases may see avulsion of extensor and flexor origins)

Chronic luxation of the elbow can lead to what 3 conditions

* chondromalacia * articular cartilage destruction * secondary djd

In traumatic elbow luxation patient present unable to bear weigh on affected limb and what are two other indicators

elbow carried in flexed position and abducted and externally rotated

Most luxated elbows can be treated how if done within the first few days

closed manipulation

If a traumatic elbow luxation is accompanied by avulsion fractures what treatment method should be used?

open reduction and stabiization

In closed reduction of elbow luxation the limb is suspended from IV pole for 5-10 minutes using the dogs weight to encourage relaxation and distract joint, then dog is placed in lateral recumbency with affected leg up: What is the goal of this procedure

hook anconeal process between condyles

Technique to facilitate closed reduction of elbow luxation

animals own weight by suspending fractured limb from ceiling to encourage fracture distraction

# **Fill in the ?s** Closed reduction of elbow luxation should be done **?** and **?** should be evaluated after

* ASAP * Stability of the elbow

What is the prognosis of elbow luxation patients if quickly reduced and stabilized

good (djd and diminished ROM may occur secondary to trauma)

What is seen in this craniocaudal view?

lateral luxation of radius and ulna

What is affecting this patient, why do you think this?

* elbow luxation * Loss of humero radial joint space

# **Fill in the ?s** * Flex elbow & inwardly rotate antebrachium to hook **?** into **?** C Then extend elbow slightly * **?** and **?** rotate antebrachium while placing pressure on radial head

* anconeal process into olecranon fossa * Abduct & outwardly

What is a good indicator for the need of open stabilization

excessive instability

# **Fill in the ?s** Open reduction using **?** as a lever can be performed to eliminate pull of triceps muscle during reduction

blunt curved instrument

# **Fill in the ?s** * A & B To stabilize elbow Replace collateral ligaments using **?** * C & D To secure an avulsed fragment Use **?**

* A & B: 2 screws& figure-8 wire * C & D: lag screw with spiked washer

# **Fill in the ?s** Arthrodesis of the elbow: * make 2 **?** and remove portion of proximal ulna * then use a **?** to connect caudal surface of the humerus and caudal surface of the ulna

* osteotomies * contour plate

# **Fill in the ?s** What are the two syndromes grouped under elbow subluxation or incongruity: 1: part of pathophysiology of premature closure of **?** after trauma in immature dogs 2: primarily in **?** breeds

* distal ulnar or radial physis * chondrodystrophic breeds (asynchronous growth of radius and ulna)

What is seen on this radiograph?

Elbow incongruence due to radial shortening

Elbow incongruency contributes to what other elbow conditions

fractured coronoid process and ununited anconeal process (secondary DJD)

Surgical treatment of elbow incongruency is directed at restoring elbow congruity by preforming osteotomies of radius and ulna, what are two commonly used?

* ulnar lengthening osteotomy (ulna too short) * ulnar shortening ostectomy or radial lengthening ( radial shortening caused subluxation)

What treatment method is seen here?

Ulnar lengthening osteotomy

What procedure is being preformed

ulnar shortening ostectomy

# **Fill in the ?s** Radial lengthening can also be preformed by distraction osteogenesis using **?** and motors

circular external fixators

# **Fill in the ?s** Congenital elbow luxation results in **?** rotation of the proximal ulna subluxation or luxation of humeroulnar joint

lateral (ETIOLOGY IS UNKNOWN)

# **Fill in the ?s** In congenital elbow luxation bone malpositioning occurs at a young age because bones do not articulate normally **?** do not form

congruent joint surfaces

# **Fill in the ?s** In congenital elbow luxation's, at **?** Months of age secondary remodeling occurs and degenerative changes develop

3 months of age

Signalment for congenital elbow luxation

* small dog breeds(Pugs, Yorkshire Terriers, Boston Terriers, Miniature Poodles, Pomeranians, Chihuahuas, Cocker Spaniels, & English Bulldogs overrepresented)(unilateral and bilateral) * usually recognized when puppy begins to walk (3-6 weeks)

You have a 6 eek old miniature poodle that presents to your clinic for difficulty walking, you take xrays and find this: What do you suspect is affecting this patient

congenital elbow luxation

What method is used here to correct congenital elbow luxation after manual reduction

trans articular pin

In congenital elbow luxation, what provides the best outcome

immediate surgical treatment (**limited range of motion and DJD occur even with surgery**)