Old fracture and elbow dislocation in 7 month old puppy

[WendyRobinson]

Apparently, this is my week for difficult elbow cases.

My technician just adopted a 7 month old, female Doberman puppy from our local shelter this week. The shelter guessed that she had and old poorly healed l humeral fracture. She was at the shelter for over a month, so I suspect whatever trauma was a couple months prior to her arrival at the shelter.
She is ambulatory on this limb. There is lateral deviation of the distal limb at the elbow and the elbow has marked lateral laxity. She has shoulder muscle atrophy.
We took radiographs of her today.
Radiology report:
There is proximal, cranial, and lateral displacement of the left humeral condyles with respect to the humeral diaphysis. The left humeral metaphyseal
region is poorly defined and increased in mineral opacity, with heterogeneity of the medial condylar region. The intercondylar fossa is not well delineated. The lateral condyle of the left humerus is seated within a portion of the elbow joints, the medial humeral condyle is not well seated within the elbow joints and is rotated cranially. The right thoracic limb is normal.
Radiographic Conclusions/Recommendations:
Suspected healed malunion fracture of the left humeral condyle with associated luxation of the elbow joint.
I believe this is a surgical case but I am also not sure if there is much to be done. I am concerned that arthrodesis of the elbow joint may be the only option.
Is there anything I can do for this pup with my rehab tools?

I have attached radiographs.

Thank you Again
Wendy Robinson

[lehughes]

Hello again Wendy!

Indeed... you are abundant with weird elbow cases! How lucky!

Okay... so here's a case where, based on my past experiences... I don't think there is a wrong answer or way to proceed.

1. Sure, you can pass this pup off to a surgeon and see what magic they can do. BUT, this will always be a less than perfect elbow.

2. You can do nothing surgical and work on strength, function, limb use, learn where and how the pup compensates and put those areas into consideration as areas needing forever maintenance. (Which, even if surgery is done, this same line of thinking applies.)

3. Surgery could be an arthrodesis. (I've made this its own category apart from category 1.) Here, we take away elbow discomfort (presumably) but we also add in forcing the dog to move differently and add new issues to the carpus, foot, shoulder and spine.

So then, I want to take you down the path of asking, What are the goals?
a) Pain management. (So then you ask, how much pain are you finding at the elbow with ROM, palpation, etc?)
b) Improve function / use of the limb. The dog is using the leg right now. Do you realistically think that you can improve/increase use of the limb?

Next, I offer up a case of a German Shepherd patient of mine. Bilateral premature closure of the radial physis. 4 surgeries on EACH limb later... the dog still looked like a mess (despite the owner being 'sold' on the lie' that the dog would be normal). His carpals and elbows had reduced motion, and he had that 'elbows turned out' posture (characteristic of crappy elbows).
HOWEVER... he always used them. Despite his lack of range, he never exhibited pain in those forelimbs. I could do whatever I wanted to them. He never complained. (Yet, he was a total ass if sometime was painful in his back end - i.e hips and stifles).
All to say, that I think dogs are pretty amazing at what they accommodate for!

So... back to your case.
You would not be wrong in choosing any of the paths outlined above.

If it were MY dog. I would focus on Function, Joint health (via modalities, supplements), monitor for pain and address as needed (meds), Find and manage secondary issues, and encourage the owner to find what the dog can do and tolerate in regards to exercise, activities, fun, etc.

My 2 cents anyways!

Cheers,
Laurie