Texas Equine Veterinary Association

www.teva-online.org • Page 25 be locked in extension so that weight can be supported on the affected limb (Figure 2). A strong (schedule 40) PVC splint should be placed from the point of the elbow to the ground; extra padding should be added to proximal aspect of the splint to prevent underlying skin damage. The splint should be applied over a full-limb bandage with non-elastic tape (duct tape or athletic tape). Olecranon fracture treatment options include conservative therapy 5 and surgical intervention 4 . Nonsurgical management is typically reserved for treatment of non-displaced or non- articular fractures. Conservative management consists of strict stall confinement with a variable and unpredictable convalescent time (typically a minimum of 90 to 120 days). 5 A splint is applied in cases where there is an inability or reluctance to bear full weight on the affected limb. Serial radiographs are necessary to determine fracture healing or development of bone displacement. Surgical management of olecranon fractures is the treatment of choice for displaced or articular fractures (Figure 3). Open reduction and internal fixation is accomplished by placement of a bone plate along the caudal aspect of the olecranon/ulna. Internal fixation allows for stable fixation of most fracture configurations and results in less convalescent time and a more rapid return to chad marsh, dVm, ms, dacVs Texas A&M Univeristy Veterinary Medical Teaching Hospital Figure 3. Example of a type 5 displaced articular fracture of the ulna (left). The fracture was repaired with ope reduction and internal fixation (right). The repair resulted in a horse that was able to return to its intended use. comfort. Prognosis following surgical management of ulnar fractures is good. Return to full function following surgical treatment ranges from 70-81 percent. 4, 6-8 Additionally, when fractures are amenable to conservative therapy (non-articular/ nondisplaced) prognosis is also favorable (approximately 70 percent); however, convalescent time can be lengthy and unpredictable. 5 elbow Joint Luxation and subluxation Elbow joint subluxation and luxation are uncommon; however both do occur. Elbow joint subluxation most commonly occurs because of partial or complete rupture of the medial collateral ligament. Elbow joint subluxations result in acute, severe lameness characterized by mild-to-moderate swelling on the affected side. Elbow manipulation elicits pain. Within a relatively short period of time, swelling decreases and lameness can become less significant (grade 2–3). Diagnosis of subluxations can be more difficult and may require diagnostic anesthesia of the elbow. Radiographic findings can be variable based on the lameness duration. If subluxation is suspected, a stressed cranial-to-caudal radiographic projection of the elbow should be obtained. Ultrasonographic examination of the collateral ligaments can also be performed; however, examination of the medial collateral ligament is technically challenging and interpretation is often difficult. If diagnosis of subluxation is prolonged, there are often signs of significant elbow joint osteoarthritis. 9 Treatment of subluxations consists primarily of three to four months of stall rest with controlled handwalking. 9 Additionally, intra- articular, anti-inflammatory medication will likely be required if secondary osteoarthritis develops. If significant secondary osteoarthritis develops, then prognosis decreases. 9 Partial ruptures are likely to have a better prognosis than complete ruptures. Clinical presentation of complete elbow luxations always resembles that of an olecranon fracture. Radiographically, complete elbow joint luxation typically results in proximal radius fracture, radius and ulna separation, olecranon fracture, and complete rupture or injury to the lateral and medial collateral ligaments (Figure 4). Treatment of complete luxations requires open reduction and internal fixation (Figure 4). Prognosis for survival and return to function of complete fractures with concurrent luxations is fair. subchondral Defects and subchondral osseous cysts of the elbow Subchondral defects, subchondral cysts, and articular cartilage injuries are an uncommon source of elbow lameness that occurs in any age or breed of horse. Elbow subchondral cysts are most commonly located in the medial aspect of the proximal radius (Figure

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