What Is Your Diagnosis?

Ameet Singh Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Noel M. M. Moens Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Stephanie Nykamp Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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Charles W. Bruce Department of Clinical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada.

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History

A 1-year-old sexually intact male Coonhound was referred for surgical treatment of injuries sustained from motor vehicle trauma 3 days earlier. Initial treatment, including cardiovascular stabilization and administration of analgesics, was performed by the referring veterinarian. A non–weight-bearing left forelimb lameness was apparent.

Figure 1—
Figure 1—

Lateromedial (A) and craniocaudal (B) radiographic views of the elbow joint and antebrachium of a 1-year-old sexually intact male Coonhound evaluated for a non–weight-bearing left forelimb lameness sustained after motor vehicle trauma 3 days earlier.

Citation: Journal of the American Veterinary Medical Association 231, 9; 10.2460/javma.231.9.1345

At the time of referral, the dog was dragging its left forelimb. Physical and orthopedic examinations revealed moderate soft tissue swelling in the areas of the left elbow joint and antebrachium. Manipulation of the left elbow joint revealed a fracture or dislocation. Signs of pain could be elicited on the medial and lateral as well as dorsal and palmar aspects of the left foot. Radiographic views of the left elbow joint were obtained (Figure 1).

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page

Radiographic Findings and Interpretation

A mid-diaphyseal oblique fracture of the ulna and craniolateral luxation of the head of the radius are evident on orthogonal radiographic views of the left forelimb (Figure 2). In combination, these findings are consistent with a type I Monteggia fracture.

Figure 2—
Figure 2—

The same lateromedial (A) and craniocaudal (B) radiographic views as in Figure 1. A mid-diaphyseal oblique fracture of the ulna (arrow) and craniolateral luxation of the head of the radius (arrowhead) are apparent.

Citation: Journal of the American Veterinary Medical Association 231, 9; 10.2460/javma.231.9.1345

Comments

In 1814, Giovanni Monteggia first described a fracture in humans involving the proximal or middle third of the ulna in combination with luxation of the head of the radius.1 Monteggia fractures have since been reclassified into 4 types according to the direction of luxation of the head of the radius.2

The radius and ulna are in direct contact at the proximal and distal radioulnar joints. Proximally, the medial and lateral collateral, annular, and oblique ligaments serve to maintain the radioulnar joint in reduction. The radius and ulna are joined along their length by a thick interosseous ligament.3 A consequence of the close anatomic association between the radius and ulna is that when either bone suffers trauma, the other bone will likely also be affected.

Monteggia fractures are rare in small animals, but when reported are most often the result of motor vehicle trauma to the caudal aspect of the antebrachium while the limb is bearing weight.4–7 In cats, the Monteggia lesion is most often the result of a fall.4 The most common Monteggia fracture reported in small animals, and in humans, is a type I fracture.1,6

In the dog of this report, surgery was performed to repair the fractured ulna and luxation of the head of the radius. Open reduction and internal fixation were performed; a 2.7-mm dynamic compression bone plate was applied to the caudal aspect of the ulna along with cerclage wires. Two positional screws that penetrated the head of the radius were also placed; however, severe laxity of the elbow joint remained after fixation. The lateral collateral ligament was repaired by use of 2 screws and washers and No. 1 wirea suture. Eight weeks after surgery, the dog was ambulating with a mild lameness.

a.

FiberWire, Arthrex, Naples, Fla.

  • 1.

    Ramisetty NM, Revell M & Porter KM, et al. Monteggia fractures in adults. Trauma 2004;6:1321.

  • 2.

    Bado JL. The Monteggia lesion. Clin Orthop 1967;50:7176.

  • 3.

    Evans HE. Arthrology. In: Miller's anatomy of the dog. 3rd ed. Philadelphia: WB Saunders Co, 1993;219257.

  • 4.

    Piermattei DL, Flo GL, DeCamp CE. Fractures of the radius and ulna. In: Brinker, Piermattei, and Flo's handbook of small animal orthopedics and fracture repair. 4th ed. Philadelphia: WB Saunders Co, 2006;359381.

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  • 5.

    Prassinos NN. Fractures combination of the proximal antebrachium in an immature dog that resembles Monteggia fracture. Vet Comp Orthop Traumatol 2006;19:184186.

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    • Export Citation
  • 6.

    Schwarz PD, Schrader SC. Ulnar fracture and dislocation of the proximal radial epiphysis (Monteggia lesion) in the dog and cat: a review of 28 cases. J Am Vet Med Assoc 1984;185:190194.

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    • Export Citation
  • 7.

    Boudrieau RJ. Fractures of the radius and ulna. In: Slatter D, ed. Textbook of small animal surgery. 3rd edition. Philadelphia: WB Saunders Co, 2003;19531973.

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    • Export Citation
  • Figure 1—

    Lateromedial (A) and craniocaudal (B) radiographic views of the elbow joint and antebrachium of a 1-year-old sexually intact male Coonhound evaluated for a non–weight-bearing left forelimb lameness sustained after motor vehicle trauma 3 days earlier.

  • Figure 2—

    The same lateromedial (A) and craniocaudal (B) radiographic views as in Figure 1. A mid-diaphyseal oblique fracture of the ulna (arrow) and craniolateral luxation of the head of the radius (arrowhead) are apparent.

  • 1.

    Ramisetty NM, Revell M & Porter KM, et al. Monteggia fractures in adults. Trauma 2004;6:1321.

  • 2.

    Bado JL. The Monteggia lesion. Clin Orthop 1967;50:7176.

  • 3.

    Evans HE. Arthrology. In: Miller's anatomy of the dog. 3rd ed. Philadelphia: WB Saunders Co, 1993;219257.

  • 4.

    Piermattei DL, Flo GL, DeCamp CE. Fractures of the radius and ulna. In: Brinker, Piermattei, and Flo's handbook of small animal orthopedics and fracture repair. 4th ed. Philadelphia: WB Saunders Co, 2006;359381.

    • Search Google Scholar
    • Export Citation
  • 5.

    Prassinos NN. Fractures combination of the proximal antebrachium in an immature dog that resembles Monteggia fracture. Vet Comp Orthop Traumatol 2006;19:184186.

    • Search Google Scholar
    • Export Citation
  • 6.

    Schwarz PD, Schrader SC. Ulnar fracture and dislocation of the proximal radial epiphysis (Monteggia lesion) in the dog and cat: a review of 28 cases. J Am Vet Med Assoc 1984;185:190194.

    • Search Google Scholar
    • Export Citation
  • 7.

    Boudrieau RJ. Fractures of the radius and ulna. In: Slatter D, ed. Textbook of small animal surgery. 3rd edition. Philadelphia: WB Saunders Co, 2003;19531973.

    • Search Google Scholar
    • Export Citation

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