INTRAMEDULLARY

PINNING OF RADIUS
AND ULNA

CONTENTS

ANATOMY OF RADIUS AND ULNA.

ANAESTHESIA

TYPES OF FRACTURES OF RADIUS AND ULNA.

INTRAMEDULLARY PINNING.

STEINMANN PINS.

POST OPERATIVE CARE.

RADIUS

It is larger but not longer of two bones

Radius forms elbow joint with humerus above carpal

joint with carpal bones below

It presents four surfaces

1.Anterior surface

2.Posterior surface

3.Medial surface

4.Lateral surface

The proximal end articulates with condyles of humerus

so it has 2 articular surfaces separated by a groove

The Anterior surface is convex & smooth , is occupied by extensor

muscles

At the middle of upper part is a rough elevation known as

RADIAL TUBEROSITY where biceps brachii muscle inserts

The posterior surface is concave & it is attached with cranial surface

of shaft of ulna . The interosseous space is narrow and is extended
throughout the length of bones

The radial surfaces of spaces are smooth for passage of interosseous

vessels

The lateral surface is rounded and smooth, this surface has formed a
vascular groove with surface of ulna for accommodation of
interosseous artery

The medial surface is smooth and continuous with anterior & posterior
surfaces at upper part

A little above the middle, there is a rough area for insertion of

Brachialis muscle

The cranial rim of articular surface presents a projection known as

CORONOID PROCESS

The medial and lateral tuberosities are placed at corresponding aspect

of this end just below the margin of articular surface

DOG:

They are two separate bones and are in contact with each other at
ends

The interosseous space is narrow and is extended through out the

length of bones

Proximal end of radius presents only one articular facet for lateral
condyle of humerus and medial condyle articulates with facet on
semilunar notch of ulna

Ulna:

Is divided into a body, or shaft, and two

extremities. The proximal extremity is the
olecranon and the distal extremity is the head.

Proximally it articulates with the humerus by the

trochlear notch and with the articular
circumference of the radius by the radial notch .

Distally it articulates with the ulnar notch of the

radius and with the ulnar carpal and accessory
carpal bones .

The olecranon includes the olecranon tuber, the

anconeal process and the proximal part of the
trochlear notch.

The m. triceps brachii, anconeus, and tensor

fasciae antebrachii attach to the caudal part of
the olecranon; the mm. flexor carpi ulnaris and
the flexor digitorum profundus arise from the
medial surface of the olecranon .

The pointed, enlarged distal extremity of the

head is the styloid process.

NERVE SUPPLY TO RADIUS &

ULNA
RADIAL NERVE:

It supplies to extensors of carpus & digits

It passes around caudal aspect of humerus to reach

lateral side of arm

Continues distally , it branches into superficial & deep

branches to forearm

The superficial branch of the radial nerve supplies the

skin of craniolateral forearm in all domestic animals

ULNAR NERVE

It provides motor innervations to some caudomedial

forearm muscles (flexor group) & muscles of manus

It runs from brachial plexus on medial side of forearm

with median and musculocutaneous nerves

At the elbow it seperates from these nerves to reach to

caudal aspect of forearm

In dog it gives innervation to fifth (lateral) digit

MEDIAN NERVE

The median nerve runs with the brachial vessels and the
musculocutaneous and ulnar nerves in the arm

It continues on the medial side of forearm to divide into

medial and lateral palmar nerves just proximal to
carpus

AXILLARY NERVE:

Its cutaneous branches supply the lateral surface of arm and cranial
aspect of forearm

MUSCULOCUTANEOUS NERVE:

It innervates the flexors of elbow (biceps brachii & brachialis muscle)

It gives off the median cutaneous antebrachial nerve

CLINICAL ASPECTS

Radial nerve paralysis(trauma):-

It is the most common & clinically significant nerve

problem of forelimb
It is due to traumatic injury

Clinical manifestations vary with location of injury

High radial nerve paralysis
Low radial nerve paralysis

High radial nerve paralysis:

Proximal to where the nerve innervates the triceps brachii muscle

This results in an inability to extend the elbow ,thus inability to bear
weight on the limb

Low radial nerve paralysis:

Occurs distal to triceps innervation , thus weight can be bear on limb.

The extensor muscles of carpus & digits are affected, manifested clinically
as knuckling over
Most of animals compensate by flipping the foot forward when moving the
limb so foot lands in proper position

Brachial plexus avulsion:

Results in damage to many nerves of the limb , resulting in a flaccid limb

that is dragged

Ulnar or medial nerve damage:

Has little clinical manifestations due to overlap of motor innervations.

ANAESTHESIA
PREANAESTHETIC MEDICATION:
Preanaesthetic drugs are used to prepare the
patient for induction and contribute to the maintenance
and smooth recovery from anaesthesia.
Specifically these drugs are choosen to:

Calm down the patient.

Induce sedation.

Provide analgesia and muscle relaxation

Decrease the airway secretion.

To supress or prevent vomiting or regurgitation during anaesthesia.

Decrease anaesthetic requirement and promotes smooth induction and

recovery.

PREMEDICATION:

1.

ATROPINE SULFATE:
Cattle 0.04 -0.06 mg/kg
Dog- 0.04 mg/kg

2.GLYCOPYROLATE:Robinol
Dog-0.011 mg/kg
>ANTIBIOTICS
>ANALGESICS

PREANAESTHETICS:

1.XYLAZINE:(XYLO-B)
Dog 0.5 1.0 mg/kg
Cat- 0.5 1.0 mg /kg
2.DIAZEPAM(LORI,VALIUM)
Dog- 0.5 mg/kg
Cat-0.5 mg/kg.

ANAESTHETICS:

1.THIOPENTONE SODIUM:
1.25%,2.5%,5%,10%
Cattle- 12.5 mg/kg (with PM)
25 mg/kg(with out PM)
Horse- 6-15 mg/kg
2.PROPOFOL:
Dog- 4-6mg/kg (with out PM)
8 mg/kg(with PM)

FRACTURE AT DIFFERENT
LOCATIONS

Fracture at proximal ulna- Monteggia fracture

Fracture at proximal radius

Fracture at diaphysis of radius and ulna

Simple transverse
Long oblique
Comminuted

Fracture at Distal radius

Fracture at distal ulna- Styloid process

APPLICATION OF INTRA MEDULLARY PINS

IM pins are difficult to use in the radius because of

the narrow radial medullary canal and the
necessity of entering the carpal joint to position
the pin.

Complications include rotation, osteomyelitis,

delayed union, degenerative joint disease of
carpus.

So IM pins and interlocking nails are

contraindicated as a treatment for radial fracture.

Instead an IM pin can be used to align the ulna,

stabilize a simple ulnar fracture, and add support
to the primary fixation of a comminuted fracture
of radius.

INTRAMEDULLARY PINNING OF ULNA

Site:

Intramedullary pin is either inserted

normograde, starting at the proximocaudal aspect of
the olecranon, just caudal to the insertion of triceps
tendon.

Procedure:

Make an incision through the skin and

subcutaneous tissue over the caudoproximal ulna.
Elevate the flexor carpi ulnaris and deep digital
flexor muscles to expose bone surface.

Reflect the origin of flexor carpi ulnaris muscle to

expose the trochlear notch then the pin is driven
in an antegrade manner to the fracture surface.

Keep the lateral cortex of the ulna parallel to the

pin to maintain the pin within the medullary
canal. Reduce the fracture and drive the pin
distally as far as possible without penetrating the
cortex. Cut the excess proximal pin below the
level of the skin, over the proximal Ulna.

INTRAMEDULLARY PINNING OF RADIUS

For a craniomedial approach to radial diaphysis,

make an incision through skin and sub cutaneous
tissue at the site of fracture. Retract the extensor
carpi radialis muscle laterally to expose the
diaphysis.

A double pointed pin is introduced into the

medullary cavity of the distal fragment at the
fracture line and driven through the bone to
emerge from the carpal end of the radius.

Before the pin is extruded distally, the carpus has

to be placed in full flexion to avoid damaging the
radial carpal bone.

The hand drill had to be secured on the distally

extruded pin and the reduction is completed by
forcing the pin across the fracture line up into the
proximal medullary cavity of the radius.

ALTERNATIVE TECHNIQUES

External Skeletal fixators

Bone plate and screw

Size of the pins used

1.0-1.4 mm pins are usually used in cats.

3-6 mm pins are usually used in dogs depending upon the

size of the animal.

It is recommended that the pin size is at least 70% of

medullary diameter.

Material of IM pin

316L Stainless Steel

Titanium

POST OPERATIVE CARE

7 -10 days Antibiotics.

Alternative days dressing adviced.

Suture removal after 10 days.

Wound healing occurs by periosteal callus

formation.

Reference

Small animal surgery, fossum

Veterinary surgery, small animals Tobias Johnston

Feline orthopedic surgery and musculoskeletal diseases,

Montavon VossLangley- Hobbs

Anatomy of domestic animals, Pasquini

Small animal surgery, Douglas Slatter

Textbook of small animal orthopedics, Charles D Newton and

David M Nunamaker

www.ncbi.nlm.nih.gov

http://cal.vet.upenn.edu/projects/saortho/chapter_24/24m
ast.htm

SUBMITTED TO:
Dr.Mahesh .V
Assistant prof.
Dept. of VSR

SUBMITTED BY:
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