11.7.2025 - SAS

Introduction

  • Presentation begins with greetings and well-wishes.

  • Introduction of the topic: FCP (fragmented medial coronoid process).

Fragmented Medial Coronoid Process (FCP)

  • FCP refers to a condition affecting a small area of the ulna.

  • Theories suggest that microtrauma may contribute to the condition.

  • Importance of congruency in joint health.

Characteristics of FCP

  • FCP is marked by:

    • Complete fragmentation of the medial coronoid process.

    • Possible separation of the fragmented area.

    • Partial fingering of the coronoid.

    • Potential osteonecrosis or necrosis at the site.

  • These conditions can lead to degenerative joint disease (DJD).

Anatomy Overview

  • Line drawing provided shows:

    • Humeral condyle, ulna, and radius.

    • Area of the coronoid process visualized with the humerus displaced distally due to a shorter radius.

  • Increased pressure on the medial coronoid leads to fragmentation.

Visual Examination

  • Cadaveric dissection shows the detailed structure of the ulna and the fragmented area.

  • Cartilage lining the medial coronoid process is observed with signs of damage.

Clinical Signs and Diagnosis

  • Upon examination, symptoms include:

    • Pain during elbow hyperextension.

    • Presence of fluid and swelling around the joint.

  • Progression may show decreased range of motion, muscle atrophy, and crepitus indicative of osteoarthritis.

  • Recommendations include radiographing both elbows, particularly in young animals suspected of having elbow dysplasia.

Radiography and Imaging Techniques

  • Challenges noted in diagnosing FCP via radiography.

  • Possible radiographic signs include:

    • Sclerosis at the distal aspect of the trochlear notch.

    • Increased whiteness of bone (sclerosis).

  • CT and arthroscopy are crucial for definitive diagnosis:

    • CT provides a clear view of the separated area of bone.

    • Arthroscopy allows direct visualization of FCP and subsequent treatment.

Associated Conditions

Osteochondritis Dissecans (OCD)

  • OCD often co-exists with FCP.

  • Recognized lesions can be seen on radiographs as concavities in the medial humeral condyle.

  • Through advanced imaging techniques and arthroscopy, both lesions may be addressed.

Treatment Strategies

  • Optimal treatment for FCP and OCD involving:

    • Removal of bone fragments from the joint.

    • Debridement of lesions to encourage fibrocartilage health.

    • Importance of utilizing arthroscopy for best results versus traditional methods.

  • Prognosis varies based on cartilage damage observed during treatment.

    • If cartilage remains intact, prognosis improves significantly.

    • If extensive prior damage exists, prognosis is more guarded, with risk of progressive DJD.

Incomplete Ossification of the Humeral Condyle (IOHC)

Definition and Background

  • IOHC defined as failure to fuse medial and lateral humeral condyles, with expected fusion by 12 weeks of age.

  • Primarily observed in spaniel breeds; genetic predisposition noted.

  • Can be bilateral but may present unilaterally.

Clinical Presentation

  • May cause mild lameness or severe non-weight bearing lameness due to pathologic fractures.

  • Suspected in young animals presenting with fractures from minimal trauma.

  • Radiographic findings: lucent lines indicating incomplete ossification.

    • Presence of fractures may necessitate more intensive treatment and monitoring.

Surgical Treatment

  • Treatment for IOHC involves placing a lag screw across the joint to promote union of the condyles.

  • Essential to check the contralateral side for similar conditions.

Traumatic Elbow Luxation

Description and Etiology

  • Elbow luxation results from collateral ligament rupture/avulsion.

  • Most common direction of luxation is lateral, often correlated with high-trauma events (e.g., being hit by a car).

Clinical Signs

  • Animals typically present non-weightbearing on the affected limb.

  • Radiographic evaluation is critical to confirm luxation and assess for fractures.

Management Techniques

  • Close reduction attempted if elbow appears normal and has no fractures observed on radiographs.

  • Surgical intervention may be required in cases of recurrent luxation or associated fractures.

  • Collateral ligament assessment via Campbell's test after reduction; to determine structural integrity.

Surgical Procedures

  • Open reduction may be necessary if closed reduction fails.

  • Techniques may involve collateral ligament reconstruction or stabilization via prosthetics.

Congenital Elbow Luxation

Definition

  • Characterized by lateral rotation of proximal ulna, causing joint luxation.

  • Present from birth, typically noted by 3 months of age.

    • Remodeling may lead to DJD.

Clinical Presentation

  • Small breed dogs (e.g., pugs, miniature poodles) are commonly affected.

  • Symptoms may appear early, including reluctance to extend the elbow.

Management and Prognosis

  • Conservative management through joint stabilization options possible.

  • Surgical management requires complex corrective osteotomies but offers poor long-term joint function outcomes.

Salvage Procedures for Elbow Conditions

Options

  • Unique compartmental elbow procedures for severe medial compartment DJD.

  • Total elbow replacement involves extensive surgical expertise and specialized technology; prognostic outcomes vary significantly.

  • Arthrodesis (fusion) provides more stability but eliminates joint motion, a less desirable option.

Conclusion

  • Summary of the complex nature of elbow conditions, including FCP, IOHC, luxations, and potential salvage procedures.

  • Emphasizes the need for accurate diagnosis and tailored treatment strategies based on each condition's severity and implications for joint health.

  • Note that further lectures will cover related topics like hip conditions.