Small Ani. Sx- Ortho- Elbow dysplasia

wilsbach's version from 2015-12-07 00:05


Question Answer
Elbow dysplasia definition--> elbow dysplasia can be caused by what 3 problems?FCP (Fragmented coronoid process) (red), OCD (Osteochondritis Dissecans) (yellow), UAP (Ununited anconeal process) (light blue)
where is the coronoid process on the elbow? is the lateral or medial more affected in elbow dysplasia?usually MEDIAL coronoid process is affected. coronoid process is red on the pic
which is the medial and which is the lateral epicondyle of the humerus? straight is medial and curve down is lateral
whats the circle? anconeal process
whats the circle? This is the MEDIAL coronoid process
whats the circle? This is the MEDIAL CONDYLE of the humerus and is where the OCD occurs (distal humerus has only one condyle and 2 epicondyles)
**which condyle of the femur is affected by ED? which coronoid process?always medial!!
who is prone to ED? (age? breed?)Young, large & active dogs (breed related)
is ED hereditary or environmental?both... so dont breed them
what kinda diet will predispose to ED? how does this happen? what can you do?if you feed them high energy, high protein, high Ca, they start to grow REALLY fast and get fat+ long bones but they dont yet have enough mm to support the joints. Also, lots of Ca+ stops bone remodeling (remodeling has osteoclastic and osteoblastic activity, if already lots of free Ca, no stimulation to the osteoclasts). SO, just feed them a little slower! they will still reach their adult size
how does OCD relate to ED?ED (FCP, UAP and OCD) may be part of the OCD complex (affects articular cartilage and growth plates)
how does elbow incongruency relate to ED? Which incongruence? which specific problems can arise from this?Small trochlear notch may cause UAP or FCP (creates too much pressure between humerus and ulna, can lead to fx)
Asynchronous growth of radius and ulna can lead to ED....explain how the radius and ulna can cause the diff probs of EDShort Ulna may cause UAP (too much pressure on the growth plate), and Short Radius may cause FCP (bc then coronoid process is supporting all of the weight of the animal)
short ulna can cause..UAP
short radius can cause..FCP
what are the three ddx for front leg lameness? (in young growing dogs)OCD Shoulder , Panosteitis , Hypertrophic Osteodystrophy (HOD)
WHICH PROBLEM IS THE MOST COMMON FORM OF OCD?fracture of the coronoid process
which breeds are prone to FCP?Large breeds like labrador, German Shepherds, Newfoundlander
when (age) do you usually see FCP and how common is this?First signs @ 5-10 Months.... MOST COMMON FORM OF ED
what are the clinical signs of FCP?Stiff after rest, try to keep leg close to body, Pain on hyperextension and rotation, often crepitus in advanced cases, Reduced ROM. Can be Uni or bi lateral
which side of the elbow is affected by FCP? hence, which directions of manipulation will elicit a pain response?since MEDIAL elbow is affected, will see Pain on hyperextension and rotation
what will you see on rads which will give you a dx of FCP? (3)Osteophytes, Subchondral sclerosis, Fissures, Fragmentation of Coronoid process (not easy to see)
you can also dx FCP via CT Arthroscopy....(pic)
how can you MEDICALLY treat FCP?Weight control, Nutritional supplementation, Exercise reduction, NSAIDs (start with normal dose and reduce to effect)
what three SX treatments can you do for FCP?(1) Arthrotomy or arthroscopy (2) FCP removal (3) Ulna ostectomy
does a bigger or a smaller FCP frament really mean you should do sx?smaller= do sx (too small to fix need to remove)
why can you do an ulna ostectomy to help with FCP?If the radius is too short, that means the ulna is too long. That means the ulna is taking all the weight/pressure, and the coronoid process is at the bottom of the articulation of the ulna it it's taking most of the pressure. This is why it fractures. So, if you cut out a chunk of the ulna, it lets the ulna be a closer length to the radius and the radius takes the pressure instead of the ulna.
what is the prog of FCP?Depending on severity at treatment, OA progress always
how common is elbow OCD + FCP?40 % with FCP
is there a breed predilection for elbow OCD?(Same breeds FCP) Large breeds like labrador, German Shepherds, Newfoundlander
what age do you usually see elbow OCD at?5-7 months (FCP is 5-10mo so basically the same)
what are the clinical signs of elbow OCD?(same as FCP)-> Stiff after rest, try to keep leg close to body, Pain on hyperextension and rotation, often crepitus in advanced cases, Reduced ROM. Can be Uni or bi lateral
which part of the elbow gets the OCD?Medial portion humeral condyle
what should you do to dx elbow OCD radiographically? what ELSE should you remember to do?need Oblique views, you are looking for BONE DEFECT/SCLEROSIS. Radiograph the shoulder always! (often concurrent shoulder OCD with ED)
how do you sx treat OCD of the elbow?(I think he said in class we dont have to know this, that this is just here so we know what they do...I'm just sticking it in here just cause) do Arthrotomy / Epicondylotomy (cut the epicondyle)--> Curettage and Osteostixis--> Osteochondral autograft transfer---> Arthroscopy--> reattach epicondle with screw (want lag screw, articular fx so want compression for 1* bone healing)
which breeds are predisposed to UAP?German shepherd + Great Danes
**after how long is the anconceal process considered ununited?Failure of the anconeal process to fuse to the proximal ulna at ***20 weeks (5mo)
what must you do if you want to dx UAP with rads?need FLEXION RADS so it is not obscured by the humerus. Remember that you are looking at a GROWTH PLATE bc it is ununited
(fun fact mentioned in class) why is there only UAP in big dogs?small dogs dont have a growth plate there. lol..
what are the two options for sx tx of UAP?(1) Lateral Arthrotomy (2) Proximal ulna osteotomy
UAP tx--> Lateral Arthrotomy--> what are the two things you can do with this kinda sx approach for tx?(1) fixation- if fragment is big enough (2) removal- remove if too small....caution tho, removal--> INSTAbiLITY
UAP tx--> Proximal ulna osteotomy--> explain why this workscut the bone and it will slide up and relieve tension
summary: ED can be one or more of which three conditions?UAP, FCP, OCD