Third opinion, offers invited

Re: Third opinion, offers invited

Mark Holmes — Thu, 01 Nov 2012 12:14:09 GMT

Medial to head of radius probably fragmented coronoid process and nutrient foremen in proximal 1/3 of radius. New bone on anconeal process.

Re: Third opinion, offers invited

Sarah Keir — Thu, 01 Nov 2012 12:08:31 GMT

[quote user="james herriot lied"]

I'm certain that there's a fracture in the proximal radius;

[/quote]

I can see the nutrient foramen - is that what you are seeing as the fracture in the proximal radius?

Re: Third opinion, offers invited

james herriot lied — Thu, 01 Nov 2012 09:07:11 GMT

[quote user="Bob Russell"]

Where is the swelling and severe acute pain you would expect with a fracture?

[/quote]

Sorry, Bob - slightly crossed wires perhaps. I think this is an older piece of pathology, not acute right now. I certainly think there's been a FCP, and at some point the instability in the joint has caused enthesiophytosis in the medial collateral; I'm just on the hunch that it's come from traumatic origins rather than having been a slowly degenerative change; the other elbow is not too bad at all, although there's some buttressing on the proximal radius.

Re: Third opinion, offers invited

Bob Russell — Thu, 01 Nov 2012 08:57:36 GMT

Where is the swelling and severe acute pain you would expect with a fracture?

Re: Third opinion, offers invited

Colin Thomson — Thu, 01 Nov 2012 08:38:20 GMT

[quote user="Rajat"]In addition to seeing signs of elbow OA, I see a chip fracture on the radius medial to the articular surface [/quote]

I have no great expertise in radiology but I'd be very wary about labelling the changes seen as a chip fracture. Look at the "chip" . Imagine trying to fit it back to the rest of the radius - there's no match between the contours of the two pieces. And if its a chip, its moved medially about half its width. Yet the overall width of the joint space is unaltered - it follows the smooth curve of rest of the joint. Unconvinced.

Colin

Re: Third opinion, offers invited

james herriot lied — Wed, 31 Oct 2012 21:48:14 GMT

[quote user="Rajat"]

I'll play

In addition to seeing signs of elbow OA, I see a chip fracture on the radius medial to the articular surface

[/quote]

Thankyou

I'm certain that there's a fracture in the proximal radius; not so convinced re humerus also. I think, though, that it's one of those situations where you could see what you wish and I don't think owner's pocket will stretch to arthroscopy but I'll be pushing for it. As to whether it'll change management is another question, and we may just repeat rads in a couple of weeks.

Dog isn't THAT lame, but is on-off with a classic pattern of lameness after rest after exercise and isn't that responsive to initial analgesia - hence the xrays. She also looks considerably older than six, but you know how it is with rescue centres.

But equally happy to receive conflicting opinions

Re: Third opinion, offers invited

Rajat — Wed, 31 Oct 2012 21:08:37 GMT

I'll play

In addition to seeing signs of elbow OA, I see a chip fracture on the radius medial to the articular surface Also suspicious for a chip on the medial humeral condyle. I imagine this is what you are also seeing.

Having said all this,given breed, I would stand there being confused I would suspect I am over interpreting, and refer rads to an imaging specialist...

Re: Third opinion, offers invited

Mark Holmes — Wed, 31 Oct 2012 20:59:55 GMT

I think it's just Djd, the lateral looks pretty convincing elbow displasia, probable FCP the craniocaudal enthisiophytes in the collateral ligament?

Re: Third opinion, offers invited

james herriot lied — Wed, 31 Oct 2012 20:31:29 GMT

Sorry, yes it's obviously this joint and it is lame - but do you think it's JUST DJD?

Re: Third opinion, offers invited

Rob Loxley — Wed, 31 Oct 2012 19:59:46 GMT

Assume it's lame and localises to that elbow. Looks like DJD?