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The radius and ulna
/content/chapter/10.22233/9781910443279.chap21
The radius and ulna
- Author: Sarah Girling
- From: BSAVA Manual of Canine and Feline Fracture Repair and Management
- Item: Chapter 21, pp 227 - 256
- DOI: 10.22233/9781910443279.21
- Copyright: © 2016 British Small Animal Veterinary Association
- Publication Date: January 2016
Abstract
Fractures of the radius and ulna account for 17/18% of all fractures in small animals, predominantly affecting the middle and distal third of the diaphysis. This chapter looks at anatomy; proximal fractures, diaphyseal fractures, distal radial and ulnar fractures. Operative techniques: Tension-band application to the proximal ulna; Plate application to the caudal ulna for simple fractures; Stabilization of comminuted proximal ulna fractures; Fractures of the ulna with concurrent luxation of the radial head (Monteggia fractures); Fractures of the proximal radius; Ulnar diaphyseal fractures – intramedullary pinning; Radial diaphyseal fractures – external fixation; Radial diaphyseal fractures – bone plating; Distal radial fractures – mature dog; Distal radial fractures – Salter-Harris type I; Styloid fractures.
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Figures
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21.1
Avulsion fracture of the olecranon. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.1
Avulsion fracture of the olecranon. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.2
Simple, intra-articular fracture through the trochlear notch. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.2
Simple, intra-articular fracture through the trochlear notch. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.3
Comminuted fracture of the proximal ulna. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.3
Comminuted fracture of the proximal ulna. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.4
Avulsion fracture of the olecranon and fractured anconeal process. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.4
Avulsion fracture of the olecranon and fractured anconeal process. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.5
Type I Monteggia fracture. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.5
Type I Monteggia fracture. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.6
Type I Monteggia fracture in a 4-year-old, 45 kg Dobermann. Preoperative (a) craniocaudal and (b) mediolateral radiographs. Postoperative (c) mediolateral and (d) craniocaudal radiographs. The radial head was reduced in a closed fashion and the ulnar fracture stabilized with lag screws and a 3.5 mm locking compression plate. Note the fracture of the medial coronoid process ventromedial to the humeroulnar joint on the postoperative craniocaudal view. © 2016 British Small Animal Veterinary Association
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21.6
Type I Monteggia fracture in a 4-year-old, 45 kg Dobermann. Preoperative (a) craniocaudal and (b) mediolateral radiographs. Postoperative (c) mediolateral and (d) craniocaudal radiographs. The radial head was reduced in a closed fashion and the ulnar fracture stabilized with lag screws and a 3.5 mm locking compression plate. Note the fracture of the medial coronoid process ventromedial to the humeroulnar joint on the postoperative craniocaudal view.
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21.7
(a) Type I Monteggia fracture with rupture to the annular and medial collateral ligaments in a 3-year-old cat. (b) Following open radial head reduction, the joint was stabilized with sutures from the fascia over the radial head to a transverse bone tunnel in the humerus, and additional sutures between the humerus and ulna. The ulnar fracture was stabilized with an IM pin and cerclage wire. © 2016 British Small Animal Veterinary Association
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21.7
(a) Type I Monteggia fracture with rupture to the annular and medial collateral ligaments in a 3-year-old cat. (b) Following open radial head reduction, the joint was stabilized with sutures from the fascia over the radial head to a transverse bone tunnel in the humerus, and additional sutures between the humerus and ulna. The ulnar fracture was stabilized with an IM pin and cerclage wire.
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21.8
Salter–Harris type I fracture of the proximal radius. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.8
Salter–Harris type I fracture of the proximal radius. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.9
(a–b) Comminuted fracture of the radius and mid-diaphyseal fracture of the ulna in a 2-year-old German Shepherd Dog. (c–d) The fractures were stabilized with a 14-hole 2.7 mm locking compression plate applied to the cranial radius and a 10-hole 2.7/3.5 mm hybrid dynamic compression plate applied to the caudal ulna. © 2016 British Small Animal Veterinary Association
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21.9
(a–b) Comminuted fracture of the radius and mid-diaphyseal fracture of the ulna in a 2-year-old German Shepherd Dog. (c–d) The fractures were stabilized with a 14-hole 2.7 mm locking compression plate applied to the cranial radius and a 10-hole 2.7/3.5 mm hybrid dynamic compression plate applied to the caudal ulna.
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21.10
(a) Craniocaudal and (b) mediolateral radiographs taken 6 weeks postoperatively of an antebrachial fracture in a 1-year-old Lurcher, stabilized with a 16-hole 2.7 mm locking compression plate placed using the minimally invasive osteosynthesis technique. © 2016 British Small Animal Veterinary Association
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21.10
(a) Craniocaudal and (b) mediolateral radiographs taken 6 weeks postoperatively of an antebrachial fracture in a 1-year-old Lurcher, stabilized with a 16-hole 2.7 mm locking compression plate placed using the minimally invasive osteosynthesis technique.
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21.11
(a) Craniocaudal and (b) mediolateral radiographs of a mid-antebrachial fracture in a 3-year-old Yorkshire Terrier. Revision surgery had already been performed to replace the original implant with a T-plate; the bone then fractured through one of the original screw holes. (c) Mediolateral and (d) craniocaudal radiographs showing stabilization of the fracture with a 2mm titanium plate applied to the cranial radius. © 2016 British Small Animal Veterinary Association
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21.11
(a) Craniocaudal and (b) mediolateral radiographs of a mid-antebrachial fracture in a 3-year-old Yorkshire Terrier. Revision surgery had already been performed to replace the original implant with a T-plate; the bone then fractured through one of the original screw holes. (c) Mediolateral and (d) craniocaudal radiographs showing stabilization of the fracture with a 2mm titanium plate applied to the cranial radius.
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21.12
Salter–Harris type I fracture of the distal radius with concurrent fracture of the distal ulna. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.12
Salter–Harris type I fracture of the distal radius with concurrent fracture of the distal ulna. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.13
Avulsion fracture of the radial styloid process with resultant instability of the antebrachiocarpal joint; note that the fracture line is intra-articular. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.13
Avulsion fracture of the radial styloid process with resultant instability of the antebrachiocarpal joint; note that the fracture line is intra-articular. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.14
Dorsal recumbency with hanging limb preparation. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.14
Dorsal recumbency with hanging limb preparation. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.15
Caudolateral approach to elbow. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.15
Caudolateral approach to elbow. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.16
Caudomedial exposure of the proximal ulna. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.16
Caudomedial exposure of the proximal ulna. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.17
Repair of a proximal ulnar fracture. (a–b) Two parallel K-wires are driven into the fracture surface. (c) The fracture is reduced. (d) The K-wires are driven into the distal segment. (e) A double twist, figure-of-eight tension-band wire is applied. (See text for more details.). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.17
Repair of a proximal ulnar fracture. (a–b) Two parallel K-wires are driven into the fracture surface. (c) The fracture is reduced. (d) The K-wires are driven into the distal segment. (e) A double twist, figure-of-eight tension-band wire is applied. (See text for more details.). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.18
Repair of a proximal ulnar fracture using pins and a tension-band wire applied with a parallel drill guide. Following reduction of the fracture and placement of the first pin, the second pin is placed using the parallel drill guide. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.18
Repair of a proximal ulnar fracture using pins and a tension-band wire applied with a parallel drill guide. Following reduction of the fracture and placement of the first pin, the second pin is placed using the parallel drill guide. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.19
Olecranon fracture stabilized with K-wire and tension-band wire, with orthopaedic wire placed through bone tunnels in the olecranon and ulnar metaphysis distal to the fracture line. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.19
Olecranon fracture stabilized with K-wire and tension-band wire, with orthopaedic wire placed through bone tunnels in the olecranon and ulnar metaphysis distal to the fracture line. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.20
Lagged cortical or cancellous screw plus tension-band wire. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.20
Lagged cortical or cancellous screw plus tension-band wire. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.21
(a) Intra-articular trochlear notch fracture in a 2-year-old Bernese Mountain Dog. (b) The fracture was stabilized with two parallel K-wires, a figure-of-eight tension-band wire and a caudally applied 3.5 mm dynamic compression plate in neutralization function. © 2016 British Small Animal Veterinary Association
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21.21
(a) Intra-articular trochlear notch fracture in a 2-year-old Bernese Mountain Dog. (b) The fracture was stabilized with two parallel K-wires, a figure-of-eight tension-band wire and a caudally applied 3.5 mm dynamic compression plate in neutralization function.
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21.22
(a) Type II Monteggia fracture in a 3-year-old cat. (b) Closed radial head reduction was performed and the ulnar fracture stabilized with an IM pin, figure-of-eight tension-band wire and transarticular fixator. © 2016 British Small Animal Veterinary Association
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21.22
(a) Type II Monteggia fracture in a 3-year-old cat. (b) Closed radial head reduction was performed and the ulnar fracture stabilized with an IM pin, figure-of-eight tension-band wire and transarticular fixator.
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21.23
Trochlear notch intra-articular fracture (single) stabilized with a caudal compression plate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.23
Trochlear notch intra-articular fracture (single) stabilized with a caudal compression plate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.24
Anconeal fracture plus avulsion of the olecranon stabilized with parallel K-wires and a tension-band wire, plus a lag screw into the anconeal process. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.24
Anconeal fracture plus avulsion of the olecranon stabilized with parallel K-wires and a tension-band wire, plus a lag screw into the anconeal process. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.25
Proximal intra-articular single fracture of the ulna stabilized with a lag screw and anti-rotational K-wire. If the triceps tendon is attached to the proximal fragment, pins and a tension-band wire or a bone plate should also be applied to counteract the pull of triceps muscle. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.25
Proximal intra-articular single fracture of the ulna stabilized with a lag screw and anti-rotational K-wire. If the triceps tendon is attached to the proximal fragment, pins and a tension-band wire or a bone plate should also be applied to counteract the pull of triceps muscle. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.26
Comminuted proximal ulnar fracture stabilized with a laterally applied hybrid dynamic compression plate; note with this plate that a greater number of smaller screws can be placed proximally. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.26
Comminuted proximal ulnar fracture stabilized with a laterally applied hybrid dynamic compression plate; note with this plate that a greater number of smaller screws can be placed proximally. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.27
Addition of a caudally applied plate to the proximal ulna. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.27
Addition of a caudally applied plate to the proximal ulna. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.28
Managing Monteggia fractures. Once reduced, the radial head can be temporarily held in position using pointed reduction forceps. The cross-section shows the position of a transfixing screw to maintain the reduction during healing. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.28
Managing Monteggia fractures. Once reduced, the radial head can be temporarily held in position using pointed reduction forceps. The cross-section shows the position of a transfixing screw to maintain the reduction during healing. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.29
Monteggia fracture with the proximal ulnar fracture stabilized with an IM pin and figure-of-eight tension-band wire. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.29
Monteggia fracture with the proximal ulnar fracture stabilized with an IM pin and figure-of-eight tension-band wire. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.30
Monteggia fracture with the proximal ulnar fracture stabilized with a caudally applied plate with one screw placed into the radial head. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.30
Monteggia fracture with the proximal ulnar fracture stabilized with a caudally applied plate with one screw placed into the radial head. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.31
Repair of proximal radial fractures: the patient is positioned in dorsal recumbency with caudal extension of the affected limb along the body. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.31
Repair of proximal radial fractures: the patient is positioned in dorsal recumbency with caudal extension of the affected limb along the body. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.32
Repair of proximal radial fractures: lateral exposure of the proximal radius. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.32
Repair of proximal radial fractures: lateral exposure of the proximal radius. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.33
Repair of a Salter–Harris type I fracture of the proximal radius using crossed K-wires. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.33
Repair of a Salter–Harris type I fracture of the proximal radius using crossed K-wires. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.34
Simple distal ulnar fracture stabilized with an IM pin. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.34
Simple distal ulnar fracture stabilized with an IM pin. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.35
Comminuted proximal ulnar fracture stabilized with caudal plate application in bridging function. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.35
Comminuted proximal ulnar fracture stabilized with caudal plate application in bridging function. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.36
External skeletal fixator frame configurations. (a) Type 1a; unilateral, uniplanar. (b) Modified type 1 using a bent connecting rod or acrylic tubing. (c) Modified type 1b; unilateral, biplanar. (d) The addition of connecting rods joining the two type 1 elements increases the strength of the type 1b configuration. (e) Modified type 2b with full pins proximally and distally, and half pins distributed along the length of the bone. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.36
External skeletal fixator frame configurations. (a) Type 1a; unilateral, uniplanar. (b) Modified type 1 using a bent connecting rod or acrylic tubing. (c) Modified type 1b; unilateral, biplanar. (d) The addition of connecting rods joining the two type 1 elements increases the strength of the type 1b configuration. (e) Modified type 2b with full pins proximally and distally, and half pins distributed along the length of the bone. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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21.37
Craniomedial exposure of the radial diaphysis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.37
Craniomedial exposure of the radial diaphysis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.38
Craniolateral exposure of the radial diaphysis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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21.38
Craniolateral exposure of the radial diaphysis. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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21.39
(a) Cranio caudal and (b) medio lateral radiographs showing a distal third simple transverse antebrachial fracture in 3-year-old Weimaraner stabilized with a 12-hole 2.7 mm dynamic compression plate applied to the medial aspect of the radius and an IM pin in the ulna. © 2016 British Small Animal Veterinary Association
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(a) Cranio caudal and (b) medio lateral radiographs showing a distal third simple transverse antebrachial fracture in 3-year-old Weimaraner stabilized with a 12-hole 2.7 mm dynamic compression plate applied to the medial aspect of the radius and an IM pin in the ulna.
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(a) Craniocaudal radiograph showing a fracture of the distal radius and ulna in a 6-year-old German Shepherd Dog. (b) The fracture was stabilized with a 3.5 mm T-plate applied to the cranial radius and an 8-hole 2.7 mm locking compression plate applied to the lateral ulna. © 2016 British Small Animal Veterinary Association
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(a) Craniocaudal radiograph showing a fracture of the distal radius and ulna in a 6-year-old German Shepherd Dog. (b) The fracture was stabilized with a 3.5 mm T-plate applied to the cranial radius and an 8-hole 2.7 mm locking compression plate applied to the lateral ulna.
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Articular fracture of the distal radius stabilized with lag screws. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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Articular fracture of the distal radius stabilized with lag screws. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Articular fracture of the distal radius stabilized with lag screws placed through a medial plate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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Articular fracture of the distal radius stabilized with lag screws placed through a medial plate. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
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Two configurations of K-wire repair of type I Salter–Harris fractures of the distal radius: (a) crossed and (b) parallel. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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Two configurations of K-wire repair of type I Salter–Harris fractures of the distal radius: (a) crossed and (b) parallel. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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(a) Craniocaudal radiograph showing a distal Salter–Harris type I fracture in a 5-month-old West Highland White Terrier. (b) The fracture was stabilized with crossed K-wires. © 2016 British Small Animal Veterinary Association
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(a) Craniocaudal radiograph showing a distal Salter–Harris type I fracture in a 5-month-old West Highland White Terrier. (b) The fracture was stabilized with crossed K-wires.
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Cranial exposure of the distal radius. It is not always necessary to perform a tenotomy of the abductor pollicis longus tendon. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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Cranial exposure of the distal radius. It is not always necessary to perform a tenotomy of the abductor pollicis longus tendon. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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Medial styloid fracture stabilized with K-wires and cerclage wire. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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Medial styloid fracture stabilized with K-wires and cerclage wire. Drawn by Vicki Martin Design, Cambridge, UK and reproduced with her permission.
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Two positions for pin placement for the repair of ulnar styloid fractures: (a) into the ulna and (b) into the medial radial cortex. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2016 British Small Animal Veterinary Association
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Two positions for pin placement for the repair of ulnar styloid fractures: (a) into the ulna and (b) into the medial radial cortex. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.