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How to replace an elbow luxation in a dog | VETgirl Veterinary CE Videos

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In this VETgirl online veterinary continuing education video, we demonstrate how to reduce a luxated elbow in a dog. This is a 9-year-old, female intact, Welsh Corgi who presented after chasing a car and running into the car’s tires. The dog was triaged, stabilized and diagnosed with a left traumatic elbow luxation. While elbow luxations aren’t commonly seen, they can occur with trauma. Most traumatic elbow luxations are lateral. Physical exam findings include a laterally displaced radius and ulna, abduction of the paw, extreme pain, and a flexed elbow, causing a completely non-weight bearing limb. Radiographs under sedation/analgesia should be performed to confirm the diagnosis of an elbow luxation.

Once the patient has been stabilized (focus on the ABCDs: airway, breathing, circulation, and dysfunction and worry about orthopedic-related injuries last!), one can attempt a closed reduction of the elbow. Ideally, this is best performed within the first few days of the trauma. The use of opioid pain medications and general anesthesia are required for full muscle relaxation.

To replace the elbow, first, flex the elbow 100 to 110 degrees. Twist the antebrachium internally to force the anconeus inside the lateral condyle. Then, the elbow joint should be extended slightly while placing pressure on the radial head. Gradually flex the elbow while adducting the antebrachium and abducting the elbow. This uses the anconeal process as a fulcrum, forcing the radial head medially, under the humeral capitulum, resulting in reduction. Once reduced, determine if the collateral ligaments are intact by flexing the elbow and carpus 90 degrees and rotating the paw laterally and medially. If the collateral ligaments are intact, lateral rotation should be limited to 45 degrees, and medial rotation to about 70 degrees. If the collateral ligaments are damaged, the lateral and medial rotation would not be limited and can extend up to 90 degrees laterally and 140 degrees medially. In this dog, you can see that there was severe elbow laxity and rotation, suggesting collateral ligament damage and injury.

In cases of collateral ligament damage, surgical consultation is warranted, as surgery is indicated. One can temporarily immobilize the limb with a spica splint, which may allow fibrosis of periarticular tissues and some degree of stabilization in small breeds until surgical correction is possible. In cases with no ligament damage, a soft splint is usually sufficient for 1 to 2 weeks, with strict rest for 4 weeks. Because the elbow is more prone to loss of range of motion, passive flexion-extension exercises should be implemented immediately after splint removal. When in doubt, rehabilitation therapy should be considered!

For more information, check out our other great VETgirl videos for useful tips!

Reference:
Brinker, Piermattei, Flo; Handbook of Small Animal Orthopedics and Fracture Repair, 3rd Ed.

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