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Radiology Packet 26

Radiology Packet 26. Fracture Complications. 2 yr old FS Mix breed dog. HX = referred with a history of an acute injury that occurred 3 months ago, at that time the rDVM diagnosed a fracture of the left radius and ulna and placed the limb in a cast, the dog remains non weight bearing.

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Radiology Packet 26

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  1. Radiology Packet 26 Fracture Complications

  2. 2 yr old FS Mix breed dog • HX = referred with a history of an acute injury that occurred 3 months ago, at that time the rDVM diagnosed a fracture of the left radius and ulna and placed the limb in a cast, the dog remains non weight bearing

  3. 2 yr old FS Mix breed dog • RF • Large fracture gaps are still evident in the distal diaphysis of both the radius and ulna. • The end of the bones adjacent to the fracture gap appeared widened as a result of callus formation, however the callus does not bridge the fracture gap. • In addition, the ends of the bones appear mildly sclerotic and there is evidence of mild sclerosis of bone in the medullary cavity. • The bones of the carpus and phalanges appear more lucent than normal and have a prominent trabecular pattern which is evidence of loss of bone mineral content. • RD • Non-union(hypertrophic) of the radius and ulna • Disuse osteopenia • Next • Surgical correction

  4. 7 mo old M Gordon Setter“Hamish” • HX = fractured R tibia 5 weeks ago and treated via application of a cast

  5. 7 mo old M Gordon Setter“Hamish” • RF • There is a large amount of osseous callus at the level of the fracture but does not appear to bridge any of the cortices of the bone. • There is an increased opacity of the medullary cavity of the tibia on either side of the fracture which is evidence of bone formation and “sealing” of the marrow cavity. • RD • Non-union(hypertrophic) of the right tibia

  6. 9 yr old M Bull Terrier“Mojo” • HX = fractured right tibia repaired in January using an IM pin, a cerclage wire and a hemicerclage wire

  7. 9 yr old M Bull Terrier“Mojo” • RF • A single pin remains centrally in the mid-diaphysis of the tibia. • There is fluffy and irregular periosteal response on all cortices of the tibia. • In the CC view there is a distinct bone fragment in the central diaphysis. • The soft tissues are mildly thickened. • The patient also has capsular distension and osteoarthritis of the right stifle. • RD • Healing tibial fracture • Resolving osteomyelitis (need prior radiographs to be certain)

  8. 7 mo old M Mix breed dog“Duke” • HX = fractured R radius and ulna two weeks ago which was treated with a cast

  9. 7 mo old M Mix breed dog“Duke” • RF • The fractures are healing by second intention and a callus has formed at the site of each fracture and is undergoing mineralization. • Bridging of the cortex by the callus is visible only on the lateral margin of the radial fracture. • The callus is incomplete on the remaining surfaces of the radius. • The callus has bridged the lateral and medial aspects of the ulnar fracture but is incomplete on the caudal aspect. • The radial fracture has healed in minor mal-alignment and there is cranial angulation of the distal radius. • RD • Healing radial and ulnar fractures • Mal-union of the radial fracture

  10. 7 yr old M Mix breed dog“Pee Wee” • HX = the dog fractured its radius 3 weeks ago and it was repaired with an intramedullary pin but he is not using the leg well currently

  11. 7 yr old M Mix breed dog“Pee Wee” • RF • There are short oblique fractures of the radius and ulna in the proximal diaphysis. • An IM pin has been placed retrograde across the radial fracture. • The fracture fragments are mal-aligned and there is almost no evidence of fracture healing. • The margins of the radius at the level of the fracture are narrow and this is typical of an atrophic non-union. • RD • Implant failure • Delayed healing • Developing non-union?? • Next • Surgical removal of the implant • Surgical correction of the fracture

  12. 2.5 yr old MC GSD“Rex” • HX = The patient was hit by a car and suffered radial and ulnar fractures approximately 1 month ago at which time they were plated. It has been licking excessively at the cranial service of the antebrachium.

  13. 2.5 yr old MC GSD“Rex” • RF • The radial and ulnar fractures appear to be healing(ideally the initial post-op films would be needed to compare). • The implants are stable and there is no evidence of lucency around any of the implants. • There is an irregular periosteal response on the lateral and medial surfaces of the radius and the caudal surface of the ulna. • The soft tissues are circumferentially thickened from the mid-radius distally. • RD • Healing radial and ulnar fractures • Stable implants • Suspected soft tissue infection +/- early osteomyelitis • Next • Initialization of antibiotic therapy

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