Page 776 - Cote clinical veterinary advisor dogs and cats 4th

Fractures of the Radius and Ulna 367

Fractures of the Radius and Ulna Client Education
Sheet
VetBooks.ir Diseases and Disorders

TREATMENT
• Poor healing of distal radial and ulnar
BASIC INFORMATION
fractures in small or toy breeds
Definition Treatment Overview • Nonunion, delayed union, or malunion
• Fractures of the radius involve the head, shaft, • Initial bandage and caudal splint support secondary to intramedullary pinning of the
or medial styloid process. are useful in reducing patient morbidity radius
• Fractures of the ulna involve the olecranon, (p. 1161).
shaft, or lateral styloid process. • Goals of treatment: Recommended Monitoring
○ Anatomic or functional realignment of Clinical and radiographic evaluations 4-6 and
Epidemiology fractures to maintain elbow and carpus 10-12 weeks after surgery (p. 357)
SPECIES, AGE, SEX congruency and parallelism
Dogs and cats of either sex at any age ○ Tension-band stabilization (pins and PROGNOSIS & OUTCOME
wires or bone plate/screws) of olecranon
RISK FACTORS fractures to neutralize distraction by the • Bone plates/screws and ESF yield the most
Forelimb trauma; toy-breed dogs especially triceps muscles consistent clinical recoveries and return of
susceptible ○ Tension-band pinning/wiring or screw limb function.
fixation of styloid process fractures to • External coaptation (casts or splints) is
Clinical Presentation provide collateral ligament support effective for minimally displaced fractures
HISTORY, CHIEF COMPLAINT in young, healthy patients.
Trauma from motor vehicle/firearm accidents, Acute General Treatment • Intramedullary pinning of the radius causes
falls, and fights causing forelimb lameness • First aid: heavy bandage to limit soft-tissue malunions and carpal joint damage and is
swelling, reduce bone fragment motion, rarely indicated.
PHYSICAL EXAM FINDINGS provide limb support, and cover open
Variable degrees of lameness, bone instability, wounds PEARLS & CONSIDERATIONS
soft-tissue swelling, bruising, and open wounds • Lavage and debridement of open, con-
associated with an antebrachial injury taminated lesions; microbial culture and Comments
sensitivity assay not routinely recommended • Irreparable proximal or distal lesions of the
Etiology and Pathophysiology unless infection is evident. radius and ulna may require arthrodesis of
• Almost 20% of fractures in dogs and cats • Antibiotic (therapeutic or prophylactic), the adjacent joint (elbow or carpus) to salvage
involve the radius and ulna. analgesic, and nonsteroidal antiinflammatory the limb, or limb amputation.
• The radius is the primary weight-bearing therapies as indicated • ESF can be used in a minimally invasive or
bone and is the most often stabilized; con- • Radial shaft fractures are stabilized with bone closed approach to preserve the soft tissues
versely, ulnar fractures can realign during plate/screws applied cranially or external during a biological surgical approach.
repair of the radius and heal in situ. skeletal fixation (ESF) with transfixation • Patients with ESF require more intensive
• The radius and ulna are a paired bone pins angled craniocaudally (type 1a or 1b) postoperative care than those treated with
system connected by annular, collateral, and or applied mediolaterally (type 2). a bone plate/screws.
interosseous ligaments. Growth plate trauma • Fresh autogenous cancellous bone graft or • Infrequently, plate removal is required after
and disturbed growth in either bone causes commercially available allograft should be bone union in dogs that are lame due to cold
forelimb deformation (p. 66). used for enhancing fracture healing. conduction or have radiographic evidence of
• Diminished vascularity in the distal aspect • Ulnar fractures can be stabilized with an osteopenia under the implant.
of the bones in small and toy breeds impairs intramedullary pin or bone plate/screws. • Toy-breed dogs with distal radial/ulnar
bone healing. • Proximal ulnar fracture(s) with cranial fractures often have unsatisfactory healing
displacement of the radial head (Monteg- without surgical intervention (i.e., plating).
DIAGNOSIS gia fracture) requires ulnar fracture repair,
reduction of the radial luxation, and suturing Technician Tips
Diagnostic Overview of the annular ligament. Surgery patients can be placed in lateral
In most cases, the diagnosis is obvious on • Casting of radius/ulna fractures can be recumbency for a craniomedial (down limb)
physical exam. Radiographs are confirmatory recommended only for minimally displaced, or craniolateral (upper limb) approach to the
and help guide treatment decisions. stable lesions in young, non–small-breed dogs fractured bone(s).
and cats.
Differential Diagnosis SUGGESTED READING
• Elbow luxations Chronic Treatment DeCamp CE, et al: Brinker, Piermattei, and Flo’s
• Antebrachial cellulitis After surgical intervention: bandage support, Handbook of small animal orthopedics and fracture
• Humeral condyle fractures sometimes with caudal splint placement, and repair, ed 5, St. Louis, 2015, Elsevier, pp 366-388.
• Carpal luxations and fractures controlled exercise until radiographic and AUTHOR: Joseph Harari, DVM, MS, DACVS
• Radial nerve or brachial plexus injury clinical evidence of bone union EDITOR: Kathleen Linn, DVM, MS, DACVS
Initial Database Possible Complications
• CBC, serum biochemistry panel, urinalysis, • Implant failure, stress protection (osteopenia),
electrocardiogram, and thoracic radiography and cold conduction with the use of bone
to assess anesthetic risk; see American Society plate and screws for stabilization of radial
of Anesthesiologists classification (p. 1196). fractures
• Standard craniocaudal and mediolateral • Pin tract sepsis and instability with ESF pins
radiographic projections of forelimb and frames

www.ExpertConsult.com