Bilateral Luxation of the radial head

April 25, 2008

Hi everyone,

A current client of mine just purchased a 15 week old female bulldog

who was diagnosed with bilateral luxations of the radial head. I have

never seen this before and have yet to speak to the surgeon but she

said he wants to do surgery this week. One of the surgeons suggested

immediate euthanasia, the other apparently was quite confident that

it was fixable. Does anyone have any experience with this either

doing rehab or otherwise? I apologize for having no more information

than this but offered to investigate with our group for my client to

see if there is any vast wealth of (or any) information about this!

Thanks in advance.

Gallagher McMahon CCRT/ CCMT

Two Hands Four Paws

11301 W. Olympic Blvd. #651

Los Angeles, CA 90064

www.twohandsfourpaws.com

April 26, 2008

,

These cases can be very challenging. Below please find an abstract

by Dr. sen on this condition from VOS. Please let me know if

you would like additional information. There are many tricks to

correcting these, you just need to find a surgeon willing to try.

PETERSEN, SW

Veterinary Specialists of Nevada, Reno/Lake Tahoe, Nevada

DYNAMIC REDUCTION OF CONGENITAL ELBOW LUXATION USING THE IMEX™

CIRCULAR FIXATOR SYSTEM AND OLIVE WIRES.

Introduction: Elbow diseases of any type can be very disabling.

Elbow dysplasia, in any form, can result in varying degrees of early

and crippling osteoarthritis. Congenital elbow luxation is a unique

and uncommon form of elbow disease. Three different types of

congenital elbow luxation have been described: 1) isolated

humeroulnar, 2) isolated humeroradial, and 3) combined humeroradial

and humeroulnar luxations. Exact etiology of these deformities is

uncertain and speculative; however, failure of formation of the intra-

articular ligaments is assumed. Regarding isolated humeroradial

luxations, previous reports have identified premature closure of the

distal ulnar physis as an underlying cause. Disability associated

with congenital elbow luxations varies with the severity of the

displacement.

Case Material: The patient described in this report is a 2.5 month

old, male, chocolate Labrador retriever. This patient presented to

the referring veterinarian for routine vaccinations. Physical exam

at that time identified a prominent bump over the lateral aspect of

the right elbow. Range of motion in this elbow was normal and there

was no clinical history of lameness in the right thoracic limb.

Radiographs of the right elbow documented isolated caudolateral

luxation of the right radial head. The left elbow appeared

radiographically normal. The dog was referred for evaluation and

surgical treatment. Additional radiographs confirmed an isolated

right radial head luxation. There was some thickening of the distal

ulna compared to the contralateral side but no evidence of distal

radial or ulnar growth plate injury. The luxated right proximal

radius appeared slightly longer then the left side, consistent with

unopposed proximal growth due to lack of articulation of the radial

head with the lateral humeral condyle.

Surgical Treatment: A 3-ring, transarticular, hybrid circular fixator

was constructed and secured to the distal humerus and mid radius/ulna

of the right thoracic limb. Two olive wires were placed through the

proximal radial head just distal to the proximal growth plate and

secured to the medial aspect of the middle ring. These wires were

tensioned sequentially on alternative days (in a medial direction)

over an 11-day period of time to slowly manipulate the radial head

into a more normal anatomical position under the lateral humeral

condyle. The elbow joint itself was distracted by several

millimeters (via the transarticular fixator) to open the joint and

facilitate reduction of the radial head. Progression of luxation

reduction was monitored radiographically. Upon completion of

luxation reduction, medial distraction was halted, the radial head

was secured in its reduced position via k-wires placed through the

distal proximal ulna into the proximal radius, and the circular

fixator was removed. Passive range-of-motion physical rehabilitation

was initiated. The k-wires remained in place for 10 days to help

create a fibrous and/or bony union between the proximal radius and

ulna to prevent reluxation of the radial head. A dynamic ulnar

osteotomy was then completed to control potential humeral ulnar

subluxation that might result from continued proximal radial growth

with a fixed proximal ulnar/olecranon segment.

Results: Radial head reduction was achieved in a closed manner via

percutaneous placement of olive wires and distraction using a

transarticular, hybrid circular fixator frame. The transarticular

frame design allowed for distraction of the joint to facilitate

reduction. Total surgical duration required 22 days: from fixator

application, through radial head distraction and k-wire fixation, to

ulnar osteotomy. Final radial head reduction was judged to be near

anatomical. Despite excellent reduction, progressive osteoarthritis

was visible on follow-up radiographs suggesting generalized elbow

dysplasia. Clinical outcome and function evaluated at 8 months and

3.5 years postoperatively was very good.

Discussion: Congenital luxation of the radial head is uncommon.

Treatment options include: 1) conservative management, 2) surgical

reduction and stabilization, 3) radial head ostectomy, and 4)

arthrodesis. Dynamic closed reduction, as used in this case, has not

been previously reported but appears to be a successful alternative

to open surgical reduction. IMEX™ circular frames have great

versatility for application in numerous conditions. Olive wires are

equally versatile for manipulation of bone in many situations. A

distinct advantage of circular frames and olive wires is the closed

or percutaneous manner in which the system can be applied.

Best Regards,

Sherman

Sherman O. Canapp Jr., DVM, MS

Diplomate ACVS

Veterinary Orthopedic &

Sports Medicine Group

10270 Baltimore National Pike

Ellicott City, MD 21042

Phone:

Fax:

http://www.vosm.org

>

> Hi everyone,

>

> A current client of mine just purchased a 15 week old female

bulldog

> who was diagnosed with bilateral luxations of the radial head. I

have

> never seen this before and have yet to speak to the surgeon but she

> said he wants to do surgery this week. One of the surgeons

suggested

> immediate euthanasia, the other apparently was quite confident that

> it was fixable. Does anyone have any experience with this either

> doing rehab or otherwise? I apologize for having no more

information

> than this but offered to investigate with our group for my client

to

> see if there is any vast wealth of (or any) information about this!

>

> Thanks in advance.

>

> Gallagher McMahon CCRT/ CCMT

> Two Hands Four Paws

> 11301 W. Olympic Blvd. #651

> Los Angeles, CA 90064

> www.twohandsfourpaws.com

>

April 28, 2008

I have helped two small chihuahuas with severe elbow luxations without surgery,

granted

they were only 2-3 pounds. The surgeon I work with took the forelimbs (under

anesthesia)

and straightened the legs and we splinted/bandaged them for 2 months, changing

them

every week or two under anesthesia. After removing the bandages I did a lot of

water

therapy (swimming and UWTM) and PROM, etc. Both dogs are doing great, they are

not

totslly normal but they function very well.

Combs RVT, CCRP

>

> Hi everyone,

>

> A current client of mine just purchased a 15 week old female bulldog

> who was diagnosed with bilateral luxations of the radial head. I have

> never seen this before and have yet to speak to the surgeon but she

> said he wants to do surgery this week. One of the surgeons suggested

> immediate euthanasia, the other apparently was quite confident that

> it was fixable. Does anyone have any experience with this either

> doing rehab or otherwise? I apologize for having no more information

> than this but offered to investigate with our group for my client to

> see if there is any vast wealth of (or any) information about this!

>

> Thanks in advance.

>

> Gallagher McMahon CCRT/ CCMT

> Two Hands Four Paws

> 11301 W. Olympic Blvd. #651

> Los Angeles, CA 90064

> www.twohandsfourpaws.com

>

April 28, 2008

,

I actually have seen this once before. I used to work at a veterinary emergency and specialty hospital. There was a case with a 12 week old Bull dog that had the same condition. The surgeons operated and casted the legs. I didn't work directly with the surgeons so I am unsure of details. What I can tell you is that the surgery was successful and the puppy was doing well 3 weeks post op. However I am unsure how she did beyond that point. I was amazed at how well the puppy was doing at 3 weeks post-op considering her condition. I hope this puppy you speek of does well also!

Subject: Bilateral Luxation of the radial headTo: VetRehab Date: Friday, April 25, 2008, 3:33 PM

Hi everyone,A current client of mine just purchased a 15 week old female bulldog who was diagnosed with bilateral luxations of the radial head. I have never seen this before and have yet to speak to the surgeon but she said he wants to do surgery this week. One of the surgeons suggested immediate euthanasia, the other apparently was quite confident that it was fixable. Does anyone have any experience with this either doing rehab or otherwise? I apologize for having no more information than this but offered to investigate with our group for my client to see if there is any vast wealth of (or any) information about this!Thanks in advance. Gallagher McMahon CCRT/ CCMTTwo Hands Four Paws11301 W. Olympic Blvd. #651Los Angeles, CA 90064www.twohandsfourpaw s.com

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April 28, 2008

Well that’s better than euthanasia! Thanks so much everyone.

lgm

From: VetRehab

[mailto:VetRehab ] On Behalf Of Bracke

Sent: Sunday, April 27, 2008 8:37 PM

To: VetRehab

Subject: Re: Bilateral Luxation of the radial head

,

I actually have seen this once before. I used to work at a veterinary

emergency and specialty hospital. There was a case with a 12 week old Bull

dog that had the same condition. The surgeons operated and casted the legs. I

didn't work directly with the surgeons so I am unsure of details. What I can

tell you is that the surgery was successful and the puppy was doing well 3

weeks post op. However I am unsure how she did beyond that point. I was

amazed at how well the puppy was doing at 3 weeks post-op considering her

condition. I hope this puppy you speek of does well also!

From: Gallagher

McMahon

Subject: Bilateral Luxation of the radial head

To: VetRehab

Date: Friday, April 25, 2008, 3:33 PM