Auer Ch 95 Radius Ulna

Front 1

Back 1

type 1a olecranon fracture (through apophysis)

Front 2

Back 2

type 1b olecranon fracture (starts through apophysis and break into metaphysics to joint)

Front 3

Back 3

type 2 olecranon fracture (simple fracture involves joint)

Front 4

Back 4

type 3 olecranon fracture (simple does not involve joint)

Front 5

Back 5

type 4 olecranon fracture (comminuted, involves joint)

Front 6

Back 6

type 5 olecranon fracture (distal body, minimal articular involvement)

Front 7

Back 7

displaced type 1b olecranon fracture

Front 8

Back 8

type 1b olecranon fracture

Front 9

Back 9

type 1b olecranon fracture

Front 10

Back 10

type 2 olecranon fracture

Front 11

Most common ulnar fracture in horses less than 1 year:

Back 11

type 1 b

Front 12

Most common ulnar fracture on horses older than 1 year:

Back 12

type 5

Front 13

Type 1a ulnar fracture:

Back 13

along apophyseal physis

Front 14

Type 1b ulnar fracture:

Back 14

starts along apophyseal physis and breaks into metaphysis to exit in the joint

Front 15

Type 2 ulnar fracture:

Back 15

simple fracture through body with articular involvement

Front 16

Type 3 ulnar fracture:

Back 16

simple fracture through body without articular involvement

Front 17

Type 4 ulnar fracture:

Back 17

comminuted fracture with or without articular involvement

Front 18

Type 5 ulnar fracture:

Back 18

distal oblique fracture with marginal articular involvement

Front 19

What does marked displacement of ulnar fracture indicate?

Back 19

Disruption of the aponeurosis of the ulnar head of the DDFT (lateral) and ulnar head of the flexor carpi ulnaris (medial)

Front 20

Differential for dropped elbow stance:

Back 20

ulnar fracture, humeral fracture, radial neuropathy

Front 21

First aid for olecranon fracture:

Back 21

wound care, caudal splint from ground to proximal antebrachium

Front 22

Indications for non-surgical management of ulnar fracture:

Back 22

non-displaced, non-articular type 5

Front 23

Non-surgical management of ulnar fracture:

Back 23

full limb splint, prolonged stall rest

Front 24

Disadvantages of non-surgical management of type 5 fractures:

Back 24

communication with joint results in inflammation in joint and development of OA, synovial fluid enters fracture line and disrupts healing and leads to development of pseudarthrosis (non-union)

Front 25

Surgical options for ulnar fractures:

Back 25

tension-band fixation with plate & screws or tension band wire or cable

Front 26

Incisional approach to ulnar for fracture repair:

Back 26

curved skin incision proximally to avoid point of elbow, dissection between ulnaris lateralis and ulnar head of DDFT

Front 27

Access to ulnar for fracture repair (after skin incision):

Back 27

sharp dissection of connective tissue attachments of aponeurosis of ulnaris lateralis and ulnar head of DDFT, sagittal division of insertion of triceps over olecranon tuberocity to accommodate width of plate

Front 28

How many screws are placed during ulnar fracture repair?

Back 28

At least 5 cortices on either side of the fracture

Front 29

Plate selection for ulnar fractures:

Back 29

narrow LCDCP, DCP, LCP in most cases, in large horses or comminuted fractures, a broad plate may be chosen

Front 30

When is double plate fixation of the ulnar indicated?

Back 30

Adult horses with comminuted fractures plates are applied caudally and laterally

Front 31

What occurs with caudolateral plate placement with ulnar fracture:

Back 31

screws can exit medial aspect of olecranon tuberosity proximally or penetrate radial cortex distally

Front 32

How are the first 2 screws placed during ulnar repair?

Back 32

First screw in proximal fragment with neutral guide in compression hole without penetration of medial cortex and not tightened completely, plate is pulled distally and 2nd screw is placed in distal fragment with load drill guide, both screws tightened alternately to compress fragments

Front 33

What results from overcompression of comminuted ulnar fractures?

Back 33

Displacement of articular comminution fragments

Front 34

How is overcompression of comminuted ulnar fractures prevented?

Back 34

Screws are not applied in compression only in neutral

Front 35

Precautions in screw placement in ulnar repair:

Back 35

proximal fragment screws need to avoid concave medial surface penetration, screws at the level of the trochlear notch should not penetrate the joint, distal screws should not engage the caudal cortex of the radius

Front 36

What happens if the caudal radius to fixed to the body of the ulna in foals (< 1 year)?

Back 36

Growth of the proximal radial epiphysis forces the anconeal process into the humeral condylar notch causing luxation of the elbow joint and elbow dysplasia

Front 37

What can be done if the subluxation occurs secondary to fixing the caudal radius to ulnar body in foals?

Back 37

Osteotomy of the body of the ulna distal to the joint and either leaving the gap or cycling the proximal fragment through flexion and extension then bridging the osteotomy with a narrow plate

Front 38

How is the plate fixed in a type 1b ulnar fracture?

Back 38

Contoured to the dorsal aspect of the apophysis and engages the apophysis with 3 short screws, 4th and 5th screws are placed in lag across the metaphyseal portion of the fracture with engagement of the cranial cortex of the olecranon

Front 39

Indications for tension wire/ cable of ulnar fracture:

Back 39

weight < 250kg

Front 40

What can enhance repair with tension wire/ cable of ulnar fractures?

Back 40

Placement of pins or screws cranial to apophysis directed distally into ulnar body

Front 41

Number of wires & wire size for ulnar repair in foals and weanlings?

Back 41

2-3 wires 1.2mm diameter

Front 42

Number of wires & wire size for ulnar repair in older horses:

Back 42

4-6 wires 1.5mm diameter

Front 43

Advantages of tension band wire/ cable repair for ulnar fracture:

Back 43

less expensive than plates, less risk of screws entering joint or engaging caudal radius, less risk of apophyseal fracture, less tissue dissection

Front 44

Complications of ulnar fracture repair:

Back 44

infection, fixation failure, tendon contracture, support limb varus deformity, suspensory apparatus fatigue, support limb laminitis

Front 45

What minimizes risks of apophyseal fracture as a complication to ulnar fracture repair?

Back 45

Placement of place proximal to physeal scar of olecranon

Front 46

Where are locking head screws not indicated in ulnar repair?

Back 46

Distal aspect of the plate because perpendicular placement may weaken bone and cause radial fracture, especially with 5.0 screw

Front 47

Best prognosis for radial fracture repair:

Back 47

weight < 250 kg

Front 48

Tension and compression surfaces of radius:

Back 48

caudal cortex under compression, proximal and distal physis under compression, cranial and craniolateral aspect under tension

Front 49

Etiology of mid-diaphyseal radial fractures:

Back 49

cranial trauma

Front 50

Result of lateral trauma to radius:

Back 50

oblique fracture of proximal metaphysis

Front 51

What occurs with SH type 1 & 2 fractures of the proximal radial physis?

Back 51

Fracture of the ulna

Front 52

What occurs with cranial displacement of the radial metaphysis?

Back 52

Radial nerve dysfunction

Front 53

First aid for radial fracture:

Back 53

wound management, placement of caudal splint to level of elbow and lateral splint to level of mid-scapula

Front 54

Indications for non-surgical management of radial fracture:

Back 54

incomplete, complete non-displaced fractures

Front 55

non-surgical management of radial fracture:

Back 55

stall rest on tie line for 3-4 months, limited use of NSAID to provide some pain relief but not allow overuse of limb

Front 56

Surgical management of radial fracture in adult:

Back 56

cranially applied 4.5 LCDCP or DCP or 5.5 LCP and laterally applied DCS plate with plates offset to prevent interference of screws and prevent plates for ending at same level in transverse plan

Front 57

Surgical management of diaphyseal or comminuted radial fracture in foals:

Back 57

broad DCP, LCDCP, or LCP cranially with 5.5 cortex and 5.0 locking head screws and narrow or broad DCP, LCDCP, or LCP laterally with 4.5 cortex screws and 5.5 cortex or 5.0 locking head screws nearest the fracture and at ends of plate

Front 58

Surgical management of transverse mid-diaphyseal radial fractures in foals:

Back 58

single broad DCP, LCDCP, or LCP applied cranially with 5.5 cortex screws throughout or with LCP 5.0 locking head screws on either side of fracture and plate ends

Front 59

Surgical management of type 3 proximal radial physeal fractures:

Back 59

if non-displaced, conservative management

Front 60

Surgical management of type 1 and 2 proximal radial physeal fractures:

Back 60

plate applied to ulnar fracture engaging both cortices of radius where possible, laterally placed narrow plate with proximal screws in radial epiphysis or transphyseal screw & wire in small foals

Front 61

Surgical management of distal radial physeal fracture:

Back 61

transphyseal bridging with screw and wire or T plate

Front 62

Prognosis for radial fracture repair:

Back 62

poor in adults; excellent for physeal and transverse fractures in foals

Front 63

Complications of radial fracture repair:

Back 63

infection, instability, fixation failure, support limb laminitis, ALD, or suspensory apparatus fatigue

Front 64

Fixation options for ruminant or radial or ulnar fracture:

Back 64

Thomas splint +/- cast, ESF with TPC (closed fracture) or EF (open fracture), internal fixation

Front 65

Type of internal fixation for radial fractures in ruminants:

Back 65

calves < 200kg single 4.5 DCP cranial, > 200 kg double plating (either craniolateral and craniomedial or cranial and lateral), DCS for distal radial SH type 2 fracture, lag or cancellous screws with cast up to elbow in small calves

Front 66

Why are casts not used with internal fixation of the radius?

Back 66

Changes tension surface from cranial cortex to the caudal cortex

Front 67

How does ulnar fracture repair in ruminant differ from horse?

Back 67

Ulna is thin in ruminants, needs to be chiseled to create a flat surface to receive bone plate, must engage caudal cortex of radius

Front 68

How does the ulna of ruminants differ from horses?

Back 68

Complete, articulates with AC joint

Front 69

Use of TPC for radial fracture in ruminants:

Back 69

if <150 kg and pins can be placed proximal and distal to fragment, TPC spans antebrachium only, if >150 kg then full limb cast

Front 70

indications for elbow arthroscopy:

Back 70

septic arthritis, OC chip fracture, assisted reduction of epiphyseal fractures, DOD, staging of OA

Front 71

important neurovascular structures surrounding the elbow:

Back 71

cranial joint pouch is deep to radial nerve, median artery and nerves course over medial and caudomedial radius

Front 72

arthroscopic approaches to elbow:

Back 72

craniolateral, caudomedial, proximocaudal

Front 73

craniolateral approach to elbow joint:

Back 73

2cm cranial to cranial lateral humeral condyle with arthroscope inserted along cranial aspect of humeral condyles caudal to lateral digital extensor, instrument portals made through extensor muscles

Front 74

what is visualized with craniolateral elbow approach?

Back 74

articular surface of medial and lateral humeral condyles, proximal perimeter of radius, synovial fossa between humeral condyles is not an OCD or cartilage lesion

Front 75

caudomedial approach to elbow:

Back 75

3 cm distal to humeroradial articulation with scope directed from distal to proximal to penetrate medial elbow along caudal radius, instrument portals slightly caudal and proximal to scope usually through flexor carpi ulnaris

Front 76

disadvantage of caudomedial approach to elbow

Back 76

greatest risk of inadvertent injury to neuromuscular structures, instrument portals that are made too proximally at level of joint can injure ulnar nerve

Front 77

what is visualized with caudomedial elbow approach?

Back 77

humeral condyles, ulnar notch, humeral head of DDFT

Front 78

caudoproximal approach to elbow:

Back 78

slight flexion, between lateral humeral epicondyle and cranial border of olecranon at the level of the proximal olecranon, angled distal and cranial

Front 79

what is visualized with caudoproximal elbow approach?

Back 79

anconeal process, humeral condyles with flexion & extension, humeral trochlea

Front 80

origin of DDFT

Back 80

3 heads, humeral (medial humeral epicondyle), ulnar (medial olecranon), radial (caudal middle radius)

Front 81

origin of SDFT:

Back 81

2 heads, humeral (medial humeral epicondyle), radial (caudal mid-distal radius)