Surgery STAT: Traumatic fragmented medial coronoid process: Diagnosis - DVM
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Surgery STAT: Traumatic fragmented medial coronoid process: Diagnosis
Signs, diagnostic testing of this painful condition that can affect any dog.


Photo 2: An arthroscopic image of a dog with TFMCP.
Further diagnostic tests to help differentiate causes of elbow pathology include arthrocentesis, imaging and arthroscopy. Radiographs are of little value in identifying the fragment or line of separation seen with classic FMCP or TFMCP (Photo 1). More advanced imaging techniques such as computed tomography, magnetic resonance imaging and arthroscopy may help confirm the condition. Arthroscopic evaluation of the elbow joint has the advantages of direct observation and magnification of all principal intra-articular structures, dynamic evaluation of tissues during range-of-motion exercises and palpation of intra-articular tissues with arthroscopic instruments. Consequently, arthroscopic exploration can help definitively diagnose TFMCP when a fragment or cartilage fissure is observed (Photo 2). In a small percentage of cases, advanced imaging (computed tomography, magnetic resonance imaging) indicates fragmentation of the coronoid not seen with arthroscopy. In such cases, the microcracks are thought to be within the coronoid bone beneath the cartilage surface.

Treatment basics

Treatment of TFMCP is multimodal, including medical, surgical and rehabilitation therapy. The goals of such treatment are to relieve the patient's pain, maintain its limb function and return the patient to a normal level of activity and competition.

Photo 3: Arthroscopic removal of a fragment in a dog with TFMCP.
Depending on the severity of the disease, arthroscopic treatment may include fragment removal (Photo 3), débridement of diseased tissues, creation of vascular access by abrasion arthroplasty, forage, microfracture and subtotal coronoid ostectomy. Compared with a traditional surgical arthrotomy, arthroscopy results in better visualization of structures within the joint, less soft tissue trauma, shorter surgery and hospitalization times, decreased risk of infection and shorter recovery times.

After arthroscopic treatment, rehabilitation therapy and medical management are initiated. These topics will be covered in Parts 2 and 3 of this series.

Dr. Canapp is an ACVS board-certified surgeon who practices orthopedic surgery and sports medicine at the Veterinary Orthopedic & Sports Medicine Group in Annapolis Junction, Md.


Source: DVM360 MAGAZINE,
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