Download Y-fracture of the humeral condyle

Thai J Vet Med Suppl. 2017, 47 : S89
Y-fracture of the humeral condyle
L.F.H. Theyse
Anicura Referral Centres Dordrecht & Rijswijk, Netherlands
the sliding bone tunnel optimally in the lateral part of the
condyle. After reduction the screw tunnel in the medial
condylar part is drilled from lateral to medial. The
medial condylar part can be tapped or a self-tapping
screw is used and placed with compression. At this stage
the fracture should be aligned anatomically, but is not
sufficiently stable to bear any weight. A smaller lateral
LCP or similar locking plate is used either lateral or
caudal on the lateral epicondyloid crest. The aim is to
divert all loading forces from the epiphysis to the shaft
of the humerus while maintaining compression over the
humeral condyle. In dogs with condylar fissures
responsible for the bicondylar fracture formation, bone
healing of the condyle is either extremely slow or nonexisting. This is the reason these dogs should receive a
shaft screw whenever possible. In these dogs,
osteostyxis of the sclerotic fracture zone can be
performed but there is no hard evidence that this
provides better outcomes. In traumatic cases and young
dogs prognosis is favourable as long as the technical
requirements are met.
Salter-Harris type IV fractures or the lateral condylar
part of the distal humerus are quite common in young
small breed dogs. A fall from a height usually is the
cause. In contrast, Y- or bicondylar fractures are quite
uncommon. The can present as a more severe variety of
the lateral condylar fracture but also occur in adult dogs
after severe trauma including road traffic accidents. The
English springer spaniel breed is known for fissure
formation (former incomplete ossification) of the
humeral condyle rendering these dogs vulnerable to
lateral condylar and bicondylar fractures of the distal
humerus. As these fractures are intra-articular
meticulous reduction and stabilisation is eminent to
preserve optimal function and prevent osteoarthritis (3).
It should be clear that in any circumstance there will be
damage to the articular cartilage and any unstable
fragments should be removed. Stabilisation can be
performed by using a locking compression plate (LCP)
on the medial side of the humeral shaft and epicondyloid
crest first and then reducing and stabilising the lateral
part of the humeral condyle consistent with the treatment
of lateral humeral condylar fractures (2). The
stabilisation of both lateral condylar and bicondylar
fractures relies on the compression of the condyle over
the fracture line. This is technically best performed by
placing a lag screw or shaft screw from lateral to medial
(1). The screw is directed from lateral to medial as the
medial half of the condyle is larger than the lateral part
offering the surgeon a larger safe corridor. In most cases
an inside-out technique for drilling is used to position
The dogs will develop osteoarthritis in the elbow joint
with variable influence on the performance.
1.
2.
3.
S89
References
Moores AP et al. 2014. Vet Comp Orthop
Traumatol 27(3):179-85.
Ness MG. 2009. Vet Comp Orthop Traumatol
22(6):492-7.
Nortje J et al. 2015. N Z Vet J 63(2):110-6.