Multi‐centre retrospective study of the long‐term outcome following suspected traumatic elbow luxation in 32 cats

Abstract

Objectives To describe reduction techniques and clinical outcome in a series of traumatic elbow luxations in cats. Materials and Methods Retrospective review of unilateral elbow luxations treated at five specialist referral centres. Data included signalment, aetiology, concurrent injuries, luxation direction, time to reduction, primary reduction technique, surgical procedure and complications. Cases were excluded if reduction technique was unknown. Telephone owner questionnaire follow‐up was completed using a Feline Musculoskeletal Pain Index. Results Thirty‐two cats were included. Lateral luxations were most common (n = 21). Time (hours) until attempted initial closed reduction was <24 (n = 12), 24–48 (n = 13), >48 (n = 3) or unrecorded (n = 4). Luxation was treated by closed reduction alone (n = 7) or by surgery (n = 25); 14 of 25 cases underwent primary surgical reduction and 11 of 25 were secondary procedures following failure of closed reduction. Transcondylar bone tunnels and circumferential suture (n = 19) was the most commonly used surgical technique. Catastrophic (n = 1), major (n = 11) and minor complications (n = 5) were recorded; reluxation occurred more frequently after closed reduction (n = 8) than after open reduction with fixation (n = 0). Feline Musculoskeletal Pain Index data were available for 12 cats; outcome was good‐excellent in all 12, with a median function score of 64.5/68 (range: 55–68) and a median pain score of 0/15 (range: 0–5). Outcome was not associated with reduction technique. Clinical Significance Elbow reluxation occurred in 61% of cats following primary closed reduction but did not occur in any open reduction cases. Reluxation rate increased with duration from injury. Most cats had good‐excellent owner‐assessed outcome, regardless of reduction technique.

Type II Monteggia Lesion with Complete Elbow Dislocation in a Cat

“…Traumatic elbow joint dislocation is a rare condition in dogs and cats because of intrinsic bone congruency and contribution of collateral ligaments. 18 Lateral luxation of the radial head and olecranon is more common than medial, occurring in more than 90% of elbow joint dislocation cases [19][20][21][22] due to the anatomical conformation of the distal medial humerus, which presents a large medial epicondyle and a sloped medial condylar ridge. 18,23 Several open reduction techniques have been described for the treatment of elbow joint dislocation-such as primary suture of the torn ligament using a locking loop suture, or ligament prosthesis secured by screws and washers, or placed through bone tunnels.…”

“…18,23 Several open reduction techniques have been described for the treatment of elbow joint dislocation-such as primary suture of the torn ligament using a locking loop suture, or ligament prosthesis secured by screws and washers, or placed through bone tunnels. 19,22,24 Good results have been obtained using prostheses that replace both the radial and the ulnar parts of the collateral ligament through transcondylar, transradial, and transulnar bone tunnels in cats. 23 After reduction, immobilization of the elbow joint is preconised.…”

Traumatic joint luxations in cats: Reduce, repair, replace, remove

“…Elbow luxation is rare in cats due to the inherent stability of the joint courtesy of the anconeus locking into the olecranon fossa unless the elbow is flexed more than 45° (Figure 4). Around 65% of elbow luxations are lateral, 10 thought to be due to a combination of a larger medial humeral trochlea and its more acute distal articular slope minimising medial movement. Based on cadaveric cat studies, both medial and lateral collateral ligaments need to be damaged for elbow luxation to occur.…”

“…11 Elbow luxations, therefore, usually require significant trauma and concurrent injuries can be seen in up to 10% of cats, including fractures of the head and forelimb as well as pulmonary injuries. 10 Note that if the radial head is luxated in association with an ulnar diaphyseal fracture, this is a particular injury called a Monteggia fracture (not covered in this article). Cats will normally present non-weightbearing with the elbow slightly flexed and the antebrachium in slight adduction.…”

“…Closed reduction (see box below) is recommended but is only successful in 50% of cats. 10 After reduction, the elbow is assessed by performing the Campbell's test (see box below); if it re-luxates or is highly unstable, surgery is recommended. If stable, then a Spica splint or Robert-Jones bandage that maintains the elbow in extension is recommended for 3-4 weeks in conjunction with cage rest.…”