Radiology Packet 26

1
Radiology Packet 26

• Fracture Complications

2
2 yr old FS Mix breed dog

• HX referred with a history of an acute injury
  that occurred 3 months ago, at that time the rDVM
  diagnosed a fracture of the left radius and ulna
  and placed the limb in a cast, the dog remains
  non weight bearing

3
2 yr old FS Mix breed dog

• RF
• Large fracture gaps are still evident in the
  distal diaphysis of both the radius and ulna.
• The end of the bones adjacent to the fracture gap
  appeared widened as a result of callus formation,
  however the callus does not bridge the fracture
  gap.
• In addition, the ends of the bones appear mildly
  sclerotic and there is evidence of mild sclerosis
  of bone in the medullary cavity.
• The bones of the carpus and phalanges appear more
  lucent than normal and have a prominent
  trabecular pattern which is evidence of loss of
  bone mineral content.
• RD
• Non-union(hypertrophic) of the radius and ulna
• Disuse osteopenia
• Next
• Surgical correction

4
7 mo old M Gordon SetterHamish

• HX fractured R tibia 5 weeks ago and treated
  via application of a cast

5
7 mo old M Gordon SetterHamish

• RF
• There is a large amount of osseous callus at the
  level of the fracture but does not appear to
  bridge any of the cortices of the bone.
• There is an increased opacity of the medullary
  cavity of the tibia on either side of the
  fracture which is evidence of bone formation and
  sealing of the marrow cavity.
• RD
• Non-union(hypertrophic) of the right tibia

6
9 yr old M Bull TerrierMojo

• HX fractured right tibia repaired in January
  using an IM pin, a cerclage wire and a
  hemicerclage wire

7
9 yr old M Bull TerrierMojo

• RF
• A single pin remains centrally in the
  mid-diaphysis of the tibia.
• There is fluffy and irregular periosteal response
  on all cortices of the tibia.
• In the CC view there is a distinct bone fragment
  in the central diaphysis.
• The soft tissues are mildly thickened.
• The patient also has capsular distension and
  osteoarthritis of the right stifle.
• RD
• Healing tibial fracture
• Resolving osteomyelitis (need prior radiographs
  to be certain)

8
7 mo old M Mix breed dogDuke

• HX fractured R radius and ulna two weeks ago
  which was treated with a cast

9
7 mo old M Mix breed dogDuke

• RF
• The fractures are healing by second intention and
  a callus has formed at the site of each fracture
  and is undergoing mineralization.
• Bridging of the cortex by the callus is visible
  only on the lateral margin of the radial
  fracture.
• The callus is incomplete on the remaining
  surfaces of the radius.
• The callus has bridged the lateral and medial
  aspects of the ulnar fracture but is incomplete
  on the caudal aspect.
• The radial fracture has healed in minor
  mal-alignment and there is cranial angulation of
  the distal radius.
• RD
• Healing radial and ulnar fractures
• Mal-union of the radial fracture

10
7 yr old M Mix breed dogPee Wee

• HX the dog fractured its radius 3 weeks ago and
  it was repaired with an intramedullary pin but he
  is not using the leg well currently

11
7 yr old M Mix breed dogPee Wee

• RF
• There are short oblique fractures of the radius
  and ulna in the proximal diaphysis.
• An IM pin has been placed retrograde across the
  radial fracture.
• The fracture fragments are mal-aligned and there
  is almost no evidence of fracture healing.
• The margins of the radius at the level of the
  fracture are narrow and this is typical of an
  atrophic non-union.
• RD
• Implant failure
• Delayed healing
• Developing non-union??
• Next
• Surgical removal of the implant
• Surgical correction of the fracture

12
2.5 yr old MC GSDRex

• HX The patient was hit by a car and suffered
  radial and ulnar fractures approximately 1 month
  ago at which time they were plated. It has been
  licking excessively at the cranial service of the
  antebrachium.

13
2.5 yr old MC GSDRex

• RF
• The radial and ulnar fractures appear to be
  healing(ideally the initial post-op films would
  be needed to compare).
• The implants are stable and there is no evidence
  of lucency around any of the implants.
• There is an irregular periosteal response on the
  lateral and medial surfaces of the radius and the
  caudal surface of the ulna.
• The soft tissues are circumferentially thickened
  from the mid-radius distally.
• RD
• Healing radial and ulnar fractures
• Stable implants
• Suspected soft tissue infection /- early
  osteomyelitis
• Next
• Initialization of antibiotic therapy