Elbow on a Grinder 

D. E. Larsen, DVM

The morning looked like it would be a nice early summer day in Encumclaw. The winter had seemed to run into spring, and anything approaching summer weather was yet to be seen.

I was at the front counter when young Ed Carter came through the door with Max. A large Great Dane, Max was a good dog. I knew Ed from several farm calls. Ed ran a large dairy with his dad. Max was always by his side on the farm.

“Max got hit by a little car a few minutes ago,” Ed said. “I think the car probably got the worst of the deal, but Max was dragged down the road a piece. He seems fine, but it tore up his elbow a little. I was hoping you guys would have time to take care of him.”

I stepped around the counter to get a better look at Max’s elbow. My approach caused Max to take a step back. His right elbow collapsed with the movement, and Max ended up on the floor.

When I looked closer, it looked like someone had taken a grinder to Max’s elbow. The lateral third of the joint was gone, along with all the soft tissue. There was nothing holding the lateral side of the joint together. 

I placed my hand under the elbow and lifted it from the inside. The joint gapped open. The only way to stabilize this joint would be by fusing the joint.

“Ed, this is a major injury,” I said. “The only way to fix this is by fusing this joint.”

“That sounds a little drastic,” Ed said. “Will he be able to use his leg?”

“It will impair the function of the leg, but there is no other way to fix this injury that I know of.”

“Can you do it here?” Ed asked.

“No, that is way above our capabilities at this clinic,” I said. “I was just at a meeting last week with a veterinarian who is starting a new specialty clinic in Seattle. He is an orthopedic guy. He could fix this leg, but it won’t be cheap.”

“Are there any other options?” Ed asked.

“The only other option would be to take the leg off,” I said. “Most dogs do well on three legs, but an old Dane might not do so well.”

“So, I should probably at least go talk with this guy,” Ed said.

“Yes, and the sooner, the better,” I said. “I need to clean up this wound and get a good wrap on the leg and a little splint to stabilize the joint. I will sedate Max just a little to clean any debris from this wound.”

We moved Max back to the treatment table, and I gave him just enough IV Surital to allow me to quickly clean the wound and get a wrap on the leg.

This wound looked like someone had held the elbow against a grinder. The lateral bone of the joint was coarsely ground away. There were deep striations in the bone, tiny bits of gravel in the bone, and soft tissues around the wound.

I cleaned things up the best I could and applied some Furacin Ointment under a non-stick gauze pad. Then I put a large pressure wrap on the entire leg. Max was waking up as I gave him a dose of IV ampicillin.

Let me call Dr. Willard to see if he can see Max right away. He is just starting his practice, and we will probably have no problem getting in to see him.

Dr. Willard was happy with the call and wanted Max as soon as possible.

“With a wound like this, we need to get it really cleaned up and into surgery as soon as possible after the injury,” Dr. Willard said.

We loaded Max into the front seat of Ed’s pickup, and Ed squeezed into the driver’s seat and headed to Seattle.

About an hour later, Dr. Willard called.

“Dave, this is quite a wound, but it looks like you did a good job cleaning it up,” Dr. Willard said. “I am a little concerned about the radial nerve. Were you able to evaluate it before Max was sedated?”

“Max walked into the office if you can believe that,” I said. “The leg gave out on him as he stood at the counter.”

“It is amazing that he could walk on that leg,” Dr. Willard said. “There is nothing holding that joint together. But I guess that answers my question about the radial nerve.”

Dr. Willard was able to do a good arthrodesis on Max’s elbow joint. The procedure was easy compared to working on an intact joint because the injury gave him total access to the joint. And the flat surface where the bone was ground down by the pavement made fitting the plate on the bone much easier.

Max healed well. He did walk with a limp, but it was much better than being without that leg. Ed was pleased with the repair.

Photo by Christian Álvarez on Pexels.