Fractures of the Elbow in Dogs


Key Points

Elbow fractures occur most commonly in young dogs

Surgery should be done soon after the fracture has occured

Accurate surgical reduction of the fracture results in the best outcome

Some arthritis may develop in the elbow joint in the future, but is minimized by having surgery done

 

Anatomy

  • The elbow joint is made of three bones that join together
    • Radius bone
      • The radius bone bears most of the weight versus the ulna which is a supporting bone
      • The head of the radius articulates with the lateral or outer half of the humerus bone
    • Ulna bone
    • Humerus bone
    • Below is a side view of a model of the elbow

 

Fracture types of the elbow joint

  • An impacting force such as jumping off of a deck, chair, or out of an owner’s arms causes this type of fracture
  • The most common type of elbow fracture is a lateral condylar fracture of the lower part of the humerus bone
  • In the illustration below, a force up the radius bone can cause the lateral condyle to shear off (remember that weight from the paw goes primarily up the radius bone then to the humerus)
  • Young dogs are susceptible to this fracture, because the bones are soft
  • In mature dogs, Spaniel breeds and some Rottweilers are predisposed to developing this fracture with minimal trauma
    • In these breeds, the line of where the fracture occurs is a soft line of cartilage matrix (due to incomplete calcification of the condyles)
  • The T or Y-shaped fracture is less common, but is a complex fracture that can be difficult to repair

 

 

Considerations

  • If not repaired early, scar tissue which develops can prevent the surgeon from accurately reducing the fracture
  • The fracture should be reduced very well so that the surface of the joint which has the cartilage will be lined up
  • If an elbow fracture is not repaired, the limb usually is not very functional after healing takes place
  • If the elbow is not flexed and extended soon after surgery, scar tissue will stiffen the joint and the limb could become essentially a peg leg
  • Some arthritis of the elbow is expected to develop after the fracture heals; this may cause some lameness associated with heavy exercise or the dog gets up from laying down
  • The radial nerve wraps around the humerus bone and could get damaged by the fracture fragments or surgery

 

Surgery

  • In order to surgically approach the elbow joint in dogs (with a Y-fracture) over 8 months of age, the olecranon which is the top part of the ulna usually must be cut in order to open the elbow joint; on occasion this piece of ulna bone will not heal properly and additional surgery is needed
  • A relatively small incision is made to approach and repair a lateral condylar fracture
  • The lateral condylar fractures are repaired using a screw and pin, or multiple screws
  • A medial condylar fracture as seen in the radiograph below was repaired successfully with 3 screws

 

  •   Below is an illustration of a Y fracture, which splits the medial and lateral condyles apart.  These fractures are repaired with a screw and two pins; in some cases these fractures are repaired using screws and plates.

 

Aftercare

  • A bandage is kept on for about 3 days after surgery
  • Rehabilitation therapy which includes hot packing the elbow and putting the elbow joint through range of motion exercises is very important
  • Exercise is restricted to house activity until the fractures have healed
  • Jumping, running and rough play are forbidden until the fractures have healed

 

Potential complications

  • Anesthetic death
  • Non-healing of the fractures
  • Fibrosis (or scar tissue deposition) of the joint making it stiff and peg-leg like
  • Breakage of the metal screws/pins/plates
  • Arthritis of the elbow joint resulting in stiffness
  • Infection
  • Radial nerve damage

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