equis - Articles
Ulna: fracture
Introduction
- Cause: external trauma.
- Signs: acute severe lameness Musculoskeletal: gait evaluation; swelling; dropped elbow, flexed carpus and fetlock if triceps disrupted Musculoskeletal: physical examination - adult; evidence of other trauma, eg radial fracture Radius: fracture.
- Diagnosis: radiography Forelimb: radiography.
- Treatment: internal fixation Ulna: fracture repair.
- Prognosis: good if minimal elbow joint articulation disruption or if surgery re-establishes the articular surface.
Presenting signs
- Acute onset of severe unilateral forelimb lameness Musculoskeletal: gait evaluation.
Acute presentation
- Severe unilateral forelimb lameness.
Age predisposition
- Foals: fracture and distraction of olecranon apophysis are common.
- Weanlings, yearlings: body of olecranon with fracture into the elbow joint.
- Adults: all types of fracture.
Cost considerations
- Cost of diagnostic investigations and treatment.
- Loss of use of animal.
- Loss of animal.
Special risks
- Recovery of animal from general anesthesia Anesthesia: general - overview is a high risk for the surgical repair.
- Ideally, should be assisted recovery.
Pathogenesis
Etiology
- One of the most commonly fractured long bones in the horse.
- Usually results of external trauma from a kick or fall.
Predisposing factors
Specific
- Physis within the olecranon is a specific weak point in foals.
Pathophysiology
Type 1a - apophyseal fracture
- Foals of less than three months old: tensile overload from falls, bucking, and galloping → distraction of the triceps attachment → separation of the olecranon physis and considerable loss of triceps function. More rarely direct impact trauma.
Type 1b - epiphyseal and metaphyseal fracture
- Direct trauma in weanlings/yearlings → metaphysis and epiphysis fracture, with metaphyseal fragment often extending into the elbow joint.
Type 2-5 - olecranon body
- Trauma (yearling, adult) → fracture olecranon diaphysis → distraction by triceps and less usually along the caudal cortex because cranial portion secured by joint capsule, ligaments and tendon attachments. In the adult, most fractures are complete and moderately displaced.
- Although the ulna is an important part of the extensor mechanism of the elbow, it carries less direct weight than the radius and humerus. It does have considerable tension on the bone which can be used in fixation. Fixation, compression and stabilization can be achieved very effectively by tension band wires Bone: internal fixation - wires, or plates Bone: internal fixation - plates and screws Bone: internal fixation - screws.
Timecourse
- Acute onset injury.
Diagnosis
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Treatment
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Jacobs C C, Levine D G & Richardson D W (2017) Use of locking compression plates in ulnar fractures of 18 horses. Vet Surg 46 (2), 242-248 PubMed.
- Levine D G & Aitken M R (2017) Physeal fractures in foals. Vet Clin North Am Equine Pract 33 (2) 417-430 PubMed.
- Janicek J C et al (2006) Racing prognosis of horses following surgically repaired olecranon fractures. Can Vet J 47 (3), 241-245 PubMed.
- Swor T M et al (2006) Results of plate fixation of Type 5 olecranon fractures in 20 horses. Equine Vet J 38, 30-34 VetMedResource.
- Swor T M et al (2003) Results of plate fixation of type 1b olecranon fractures in 24 horses. Equine Vet J 35 (7), 670-675 PubMed.
- Scott E A et al (1998) Surgical repair of bilateral comminuted articular ulnar fractures in a seven-month-old horse. JAVMA 212 (9), 1380-1382 PubMed.
- Hanson P D, Hartwig H & Markel M D (1997) Comparison of three methods of ulnar fixation in horses. Vet Surg 26, 165-171 PubMed.
- Martin F et al (1995) Use of tension band wires in horses with fractures of the ulna: 22 cases (1980-1992). JAVMA 207 (8), 1085-1089 PubMed.
- Richardson M F et al (1995) Use of tension band wires in horses with fractures of the ulna - 22 cases (1980-1992). JAVMA 207, 1085-1089 PubMed.
- Clem M F et al (1988) The effects of fixation of the ulna to the radius in young foals. Vet Surg 17 (6), 338-345 PubMed.
- Denny H R, Barr A R S & Waterman A (1987) Surgical treatment of fractures of the olecranon in the horse - a comparative review of 25 cases. Equine Vet J 19, 319-325 PubMed.
- Wilson D & Riedesal E (1985) Nonsurgical management of ulnar fractures in the horse: a retrospective study of 43 cases. Vet Surg 14, 283-286 VetMedResource.
Other sources of information
- Nixon A J (2020) Fractures of the Ulna. In: Equine Fracture Repair. 2nd edn. Ed: Nixon A J. W B Saunders, USA. pp 545-566.