Fractures Elbow surgery & arthroscopy

A deformed dachshund puppy is now back on her feet after corrective surgery at a leading veterinary referral centre in the Midlands with West Midlands Referrals.

A four-week-old puppy, that was intended to grow up as a “ratter” on a farm, presented with a dislocated left elbow. In fact, strictly speaking, this elbow wasn’t “dislocated” as it had never in fact been “located” in the first place! The owners were counselled that there was little chance that this elbow could ever be returned to a functional joint.

The anconeal process is found in the elbow. It is a “keel” of bone on the ulna (one of the bones of the forearm) which slots into the back of the humerus (the bone of the upper arm) and which gives stability to the elbow when that joint is in extension.

Incomplete ossification of the humeral condyle (IOHC) is most frequently see in Spaniels.

Harvey, a gentle, elderly crossbred male, who had serious elbow degenerative joint disease (DJD) – “osteoarthritis” was bought to us at West Midlands Referrals in Burton-Upon-Trent.

Bailey is an 8-year-old Labrador. He has had chronic right elbow degenerative joint disease and lameness, but a left elbow lameness was recently evident. A mobile blob of cartilage and bone was visible on x-ray and palpable in the joint when he was under GA.

We’ve done arthroscopy for some time at West Midlands Referrals in Burton-Upon-Trent, but in early 2016 we revamped and upgraded our kit. We now have 2.4mm and 1.9mm Storz arthroscopes and are seeing many elbows and shoulders for arthroscopic diagnosis and treatment. Maciej leads these procedures. Cases to be considered for arthroscopy are first seen by him in as an outpatient consultation.

Placement of a “camera” into joints – most commonly the elbow or the shoulder – allows for inspection with magnification and for some procedures to be minimally invasive without a fully open surgical procedure.

Arthroscopy is an alternative to CT scan for diagnosing humeral intercondylar fissure (incomplete ossification of the humeral condyle), typically seen in Spaniels. This is a line of weakness in the lower end of the humeral condyle that can propagate into a fracture (see separate articles on condylar fracture and Y fracture, in the case study section on fractures).

Floki, an 11-month-old Cane Corso, presented to us at West Midlands Referrals with right forelimb lameness and an un-united anconeal process. The left elbow anconeal process was united as normal. This large free mass of bone, loose in the elbow joint, was removed through a modest incision.

Pelvic fractures are commonly referred. Modern locking plating techniques have greatly improved the treatment of many of these injuries.

We get a lot of long bone fractures referred to us here in Burton-Upon-Trent, and this case history of a tibial fracture in a middle-aged greyhound illustrate the sorts of things we need to think about and address when managing these cases.

External fixation is a way of fixing fractures that sometimes troubles owners but rarely troubles their pets! Pins come out through the skin and are joined to a connecting bar by a series of clamps.

Nancy, a middle aged grey hound was kicked one weekend by a horse in the London area and suffered a broken humerus. The case was seen promptly at the local Vets Now emergency clinic. The owner rang us as they had been estimated £6000 for specialist fixation of the fracture.

Here at West Midlands Referrals we see this frequently in cats that have been shunted from behind by cars, often in association with other pelvic injuries.

A much loved 13-year-old cat called Chalk presented to us at West Midlands Referrals after severe trauma, including a fracture/luxation on the right side of the pelvis and multiple fractures affecting the left side of the pelvis.

Poppy, a much loved cat, went missing in the Derby area for weeks over the summer of 2013. It is a mystery how she survived with severely displaced and comminuted (fragmented) fractures of the humerus of her upper right forelimb and the femur of her upper left hind limb. She was, almost incredibly, managing to walk on her two remaining legs.

Pelvic fracture is a common injury in cats after road traffic accidents we see them frequently at West Midlands Referrals. We often use modern locking plates to stabilise these injuries. Nice alignment of the pelvis can usually be achieved by placing this from dorsally (ie from the top). This does mean working the plate under the major nerve to the hind limb, the sciatic nerve.

At West Midlands Referrals, we regularly get cats referred for treatment of fractured jaws after being injured in road traffic accidents. We have been doing at least one of these cases weekly for a month or two recently.

Radius and ulna fractures are common in small-breed dogs. These injuries can often affect both forelimbs simultaneously, and these small dogs' fractures have acquired a reputation for being at increased risk of non-union (failure of the bone ends to reunite).