Monday 23rd Nov, 2020

How Would You Repair This Elbow?

Clouseau the cat's elbow repair - circumferential suture elbow stabilisation!

Clouseau’s X-rays showed a badly dislocated left elbow with multiple small avulsion fractures, likely due to traumatic avulsions of the medial collateral ligaments.

The elbow was reduced in a closed fashion, but remained unstable and therefore required surgical repair.

What surgical internal stabilisation was chosen for the elbow?

We stabilised Clouseau’s unstable elbow using a circumferential suture. This involves drilling 3 holes in specific locations: across the radial head, humeral transcondylar and also through the ulna (just level with distal olecranon notch).

Two loops of PDS were then passed through the humerus and one tied between the humerus and radius, the other between the humerus and ulna.

This ‘circumferential’ suture technique served to internally replace the collateral ligaments, and was a really effective way of immediately improving elbow stability: without requiring suture anchors or other more invasive techniques.

Following the suture stabilisation, a tear in the triceps muscle was also repaired. The image below shows a pin in each of the holes drilled prior to suture placement, and also the tear of the triceps addressed after the circumferential suture was placed.

How did Clouseau recover?

Despite the significant soft tissue injury, Clouseau recovered remarkably quickly. Only a light dressing was applied so as to encourage early mobilisation and Clouseau was keen to bear weight rapidly as this video from just 3 days post-op shows.

Clouseau’s ‘follow up Xrays’ from 6 weeks post-surgery show some osteoarthritis change, but with good mobility and great use of his leg this was still a good outcome – no mystery!

Next Post: 2020 TPLO+ Client Clinical Outcome and Customer Satisfaction Results

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