INTRAMEDULLARY
PINNING OF RADIUS
AND ULNA
CONTENTS
ANATOMY OF RADIUS AND ULNA.
ANAESTHESIA
TYPES OF FRACTURES OF RADIUS AND ULNA.
INTRAMEDULLARY PINNING.
STEINMANN PINS.
POST OPERATIVE CARE.
RADIUS
It is larger but not longer of two bones
Radius forms elbow joint with humerus above carpal
joint with carpal bones below
It presents four surfaces
1.Anterior surface
2.Posterior surface
3.Medial surface
4.Lateral surface
The proximal end articulates with condyles of humerus
so it has 2 articular surfaces separated by a groove
The Anterior surface is convex & smooth , is occupied by extensor
muscles
At the middle of upper part is a rough elevation known as
RADIAL TUBEROSITY where biceps brachii muscle inserts
The posterior surface is concave & it is attached with cranial surface
of shaft of ulna . The interosseous space is narrow and is extended
throughout the length of bones
The radial surfaces of spaces are smooth for passage of interosseous
vessels
The lateral surface is rounded and smooth, this surface has formed a
vascular groove with surface of ulna for accommodation of
interosseous artery
The medial surface is smooth and continuous with anterior & posterior
surfaces at upper part
A little above the middle, there is a rough area for insertion of
Brachialis muscle
The cranial rim of articular surface presents a projection known as
CORONOID PROCESS
The medial and lateral tuberosities are placed at corresponding aspect
of this end just below the margin of articular surface
DOG:
They are two separate bones and are in contact with each other at
ends
The interosseous space is narrow and is extended through out the
length of bones
Proximal end of radius presents only one articular facet for lateral
condyle of humerus and medial condyle articulates with facet on
semilunar notch of ulna
Ulna:
Is divided into a body, or shaft, and two
extremities. The proximal extremity is the
olecranon and the distal extremity is the head.
Proximally it articulates with the humerus by the
trochlear notch and with the articular
circumference of the radius by the radial notch .
Distally it articulates with the ulnar notch of the
radius and with the ulnar carpal and accessory
carpal bones .
The olecranon includes the olecranon tuber, the
anconeal process and the proximal part of the
trochlear notch.
The m. triceps brachii, anconeus, and tensor
fasciae antebrachii attach to the caudal part of
the olecranon; the mm. flexor carpi ulnaris and
the flexor digitorum profundus arise from the
medial surface of the olecranon .
The pointed, enlarged distal extremity of the
head is the styloid process.
NERVE SUPPLY TO RADIUS &
ULNA
RADIAL NERVE:
It supplies to extensors of carpus & digits
It passes around caudal aspect of humerus to reach
lateral side of arm
Continues distally , it branches into superficial & deep
branches to forearm
The superficial branch of the radial nerve supplies the
skin of craniolateral forearm in all domestic animals
ULNAR NERVE
It provides motor innervations to some caudomedial
forearm muscles (flexor group) & muscles of manus
It runs from brachial plexus on medial side of forearm
with median and musculocutaneous nerves
At the elbow it seperates from these nerves to reach to
caudal aspect of forearm
In dog it gives innervation to fifth (lateral) digit
MEDIAN NERVE
The median nerve runs with the brachial vessels and the
musculocutaneous and ulnar nerves in the arm
It continues on the medial side of forearm to divide into
medial and lateral palmar nerves just proximal to
carpus
AXILLARY NERVE:
Its cutaneous branches supply the lateral surface of arm and cranial
aspect of forearm
MUSCULOCUTANEOUS NERVE:
It innervates the flexors of elbow (biceps brachii & brachialis muscle)
It gives off the median cutaneous antebrachial nerve
CLINICAL ASPECTS
Radial nerve paralysis(trauma):-
It is the most common & clinically significant nerve
problem of forelimb
It is due to traumatic injury
Clinical manifestations vary with location of injury
High radial nerve paralysis
Low radial nerve paralysis
High radial nerve paralysis:
Proximal to where the nerve innervates the triceps brachii muscle
This results in an inability to extend the elbow ,thus inability to bear
weight on the limb
Low radial nerve paralysis:
Occurs distal to triceps innervation , thus weight can be bear on limb.
The extensor muscles of carpus & digits are affected, manifested clinically
as knuckling over
Most of animals compensate by flipping the foot forward when moving the
limb so foot lands in proper position
Brachial plexus avulsion:
Results in damage to many nerves of the limb , resulting in a flaccid limb
that is dragged
Ulnar or medial nerve damage:
Has little clinical manifestations due to overlap of motor innervations.
ANAESTHESIA
PREANAESTHETIC MEDICATION:
Preanaesthetic drugs are used to prepare the
patient for induction and contribute to the maintenance
and smooth recovery from anaesthesia.
Specifically these drugs are choosen to:
Calm down the patient.
Induce sedation.
Provide analgesia and muscle relaxation
Decrease the airway secretion.
To supress or prevent vomiting or regurgitation during anaesthesia.
Decrease anaesthetic requirement and promotes smooth induction and
recovery.
PREMEDICATION:
1.
ATROPINE SULFATE:
Cattle 0.04 -0.06 mg/kg
Dog- 0.04 mg/kg
2.GLYCOPYROLATE:Robinol
Dog-0.011 mg/kg
>ANTIBIOTICS
>ANALGESICS
PREANAESTHETICS:
1.XYLAZINE:(XYLO-B)
Dog 0.5 1.0 mg/kg
Cat- 0.5 1.0 mg /kg
2.DIAZEPAM(LORI,VALIUM)
Dog- 0.5 mg/kg
Cat-0.5 mg/kg.
ANAESTHETICS:
1.THIOPENTONE SODIUM:
1.25%,2.5%,5%,10%
Cattle- 12.5 mg/kg (with PM)
25 mg/kg(with out PM)
Horse- 6-15 mg/kg
2.PROPOFOL:
Dog- 4-6mg/kg (with out PM)
8 mg/kg(with PM)
FRACTURE AT DIFFERENT
LOCATIONS
Fracture at proximal ulna- Monteggia fracture
Fracture at proximal radius
Fracture at diaphysis of radius and ulna
Simple transverse
Long oblique
Comminuted
Fracture at Distal radius
Fracture at distal ulna- Styloid process
APPLICATION OF INTRA MEDULLARY PINS
IM pins are difficult to use in the radius because of
the narrow radial medullary canal and the
necessity of entering the carpal joint to position
the pin.
Complications include rotation, osteomyelitis,
delayed union, degenerative joint disease of
carpus.
So IM pins and interlocking nails are
contraindicated as a treatment for radial fracture.
Instead an IM pin can be used to align the ulna,
stabilize a simple ulnar fracture, and add support
to the primary fixation of a comminuted fracture
of radius.
INTRAMEDULLARY PINNING OF ULNA
Site:
Intramedullary pin is either inserted
normograde, starting at the proximocaudal aspect of
the olecranon, just caudal to the insertion of triceps
tendon.
Procedure:
Make an incision through the skin and
subcutaneous tissue over the caudoproximal ulna.
Elevate the flexor carpi ulnaris and deep digital
flexor muscles to expose bone surface.
Reflect the origin of flexor carpi ulnaris muscle to
expose the trochlear notch then the pin is driven
in an antegrade manner to the fracture surface.
Keep the lateral cortex of the ulna parallel to the
pin to maintain the pin within the medullary
canal. Reduce the fracture and drive the pin
distally as far as possible without penetrating the
cortex. Cut the excess proximal pin below the
level of the skin, over the proximal Ulna.
INTRAMEDULLARY PINNING OF RADIUS
For a craniomedial approach to radial diaphysis,
make an incision through skin and sub cutaneous
tissue at the site of fracture. Retract the extensor
carpi radialis muscle laterally to expose the
diaphysis.
A double pointed pin is introduced into the
medullary cavity of the distal fragment at the
fracture line and driven through the bone to
emerge from the carpal end of the radius.
Before the pin is extruded distally, the carpus has
to be placed in full flexion to avoid damaging the
radial carpal bone.
The hand drill had to be secured on the distally
extruded pin and the reduction is completed by
forcing the pin across the fracture line up into the
proximal medullary cavity of the radius.
ALTERNATIVE TECHNIQUES
External Skeletal fixators
Bone plate and screw
Size of the pins used
1.0-1.4 mm pins are usually used in cats.
3-6 mm pins are usually used in dogs depending upon the
size of the animal.
It is recommended that the pin size is at least 70% of
medullary diameter.
Material of IM pin
316L Stainless Steel
Titanium
POST OPERATIVE CARE
7 -10 days Antibiotics.
Alternative days dressing adviced.
Suture removal after 10 days.
Wound healing occurs by periosteal callus
formation.
Reference
Small animal surgery, fossum
Veterinary surgery, small animals Tobias Johnston
Feline orthopedic surgery and musculoskeletal diseases,
Montavon VossLangley- Hobbs
Anatomy of domestic animals, Pasquini
Small animal surgery, Douglas Slatter
Textbook of small animal orthopedics, Charles D Newton and
David M Nunamaker
www.ncbi.nlm.nih.gov
http://cal.vet.upenn.edu/projects/saortho/chapter_24/24m
ast.htm
SUBMITTED TO:
Dr.Mahesh .V
Assistant prof.
Dept. of VSR
SUBMITTED BY:
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