Review of the literature

Relationship between Radioulnar Incongruity of Elbow Joints and the Type of Fragmented Processus Coronoideus Medialis

The aim of the study was to find the difference between actual and anticipated frequencies of individual types of FCP (fragmented coronoid process) in relation to the extent of radioulnar incongruity. We evaluated the radiographs of elbow joints (n = 135) of dogs (n = 77) with arthroscopically (n = 109) or arthrotomically (n = 26) proven fragmented coronoideus medialis ulnae. Radioulnar incongruity was classified as a congruent joint (0-0.5 mm), moderate incongruity (0.6-2 mm) and marked incongruity (> 2.1 mm). In elbow joints without radiologically identifiable radioulnar incongruity (0-0.5 mm) significantly higher occurrence of fissured PCM (processus coronoideus medialis) was found (p < 0.01). In elbow joints with pronounced radioulnar incongruity (> 2.1 mm) we found significantly higher occurrence of FCP with a dislocated fragment (p < 0.001). The results of this study suggest the possibility of using the assessment of radioulnar incongruity from radiographs of elbow joints in mediolateral projection for specifying the X-ray diagnosis of FCP with regard to the type of FCP lesion.

Fragmented coronoid process in the dog: a heritable disease

Fragmented coronoid process (FCP) is one of the main diseases associated with elbow dysplasia. FCP is often diagnosed in medium-to-large breed dogs with front leg lameness, for instance in Rottweilers, Labrador Retrievers and Bernese Mountain dogs. Dogs with FCP develop osteoarthrosis of the elbow joint despite conservative or surgical treatment. Although FCP is considered a hereditary condition, the gene or genes causing FCP have yet to be identified. This article provides an overview of different aspects of FCP, including elbow joint development, hypotheses about disease pathogenesis, the genetic background of FCP, and genetic methodology to identify gene or genes responsible for FCP.

Diagnostic imaging of canine elbow dysplasia: a review

Canine elbow dysplasia (CED) is a common developmental disorder of the cubital joint of dogs. CED is comprised of fragmented medial coronoid process (FMCP), ununited anconeal process (UAP), osteochondrosis (OC), and elbow incongruity. Multiple imaging modalities have been used to assess this complex of disorders and the severity of the pathologic changes. Radiography has been used as a surveying tool for assessment of CED for many years. Recently, alternate techniques and modalities have expanded our knowledge of CED and our clinical approach to this disorder. Nuclear medicine has been used to aid in localizing lameness to the elbow joint. Ultrasonography has proven helpful for imaging the soft tissue structures adjacent to the joint as well as superficial bone abnormalities, including visualization of FMCP. Computed tomography and magnetic resonance imaging are advanced imaging modalities that allow visualization of the elbow in multiple planes and into three-dimensional reconstructions, thus allowing lesions to be more accurately and comprehensively visualized. Assessment of elbow incongruity in particular has been benefitted by these advanced imaging techniques because of the importance of sagittal and dorsal plane imaging and reconstructions for accurately determining the relationships between radial and ulnar articular surfaces. Comparative studies using multiple techniques and imaging modalities with correlation to reference standards and patient outcomes will be vital to continued progress in this area.

Prevalence of hip dysplasia, elbow dysplasia and humeral head osteochondrosis in dog breeds in Belgium

The official screening results of the Belgian National Committee for Inherited Skeletal Disorders, an affiliate of the Belgian Kennel Club, have been used to estimate the prevalence of hip dysplasia, elbow dysplasia and humeral head osteochondrosis in the dog breeds in Belgium, and these have been compared with reported prevalence data from other countries. In some breeds, the prevalence of hip and elbow dysplasia is very high, both in Belgium and in other countries. Comparisons of the prevalence of hip dysplasia are not always feasible because different systems are used to evaluate the quality of the hips and because there is no strict consensus on what should be considered a diseased hip joint.

Reliability of radiological assessment of ulnar trochlear notch sclerosis in dysplastic canine elbows

OBJECTIVES

The objectives of this study were to quantify the sensitivity and specificity of visual assessment of radiographs of the canine elbow in detecting ulnar trochlear notch sclerosis, to establish interobserver and intra-observer variation for the presence and grade of sclerosis and to quantify the effect of radiographic exposure on observer grading.

METHODS

Mediolateral elbow radiographs were obtained from Labrador retrievers (n=34) aged between six and 18 months. Radiographs from dogs with an arthroscopic diagnosis of fragmented medial coronoid process (n=17) and those from a control population (n=17) were subjected to observer grading for the presence or absence of and the grade of ulnar trochlear notch sclerosis. Interobserver and intra-observer variation and observer sensitivity and specificity were calculated. Digital data from the ulnar trochlear notch were correlated with mean observer grade to quantify the effect of radiographic exposure on observer grade.

RESULTS

Interobserver agreement was "fair" (kappa=0.251 to 0.369) and intra-observer agreement was "moderate" to "substantial" (kappa=0.462 to 0.667). The sensitivity of observer assessment was 72 per cent with a specificity of 22 per cent. Mean observer grade was not significantly correlated with the degree of radiographic exposure (P=0.70).

CLINICAL SIGNIFICANCE

Ulnar trochlear notch sclerosis is a phenomenon associated with fragmented medial coronoid process. However, interobserver agreement in grading this feature is only fair, being identified by observers with moderate sensitivity but with relatively poor specificity. This low specificity may predispose to overdiagnosis in clinical cases. Intra-observer agreement is moderate to substantial, suggesting that individuals can reliably quantify this radiological feature on multiple occasions. The ability of observers to assess the degree of sclerotic change is not significantly affected by radiographic exposure.

Fragmented coronoid process in the dog: is there a role for incongruency?

Fragmented coronoid process in the dog is a common yet frustrating and poorly understood condition. Elbow joint incongruency, which refers to malalignment of the joint surfaces of the elbow, has been proposed as a key factor in the pathogenesis of fragmented coronoid process, and various surgical procedures have been devised to treat the proposed incongruency. However, precise characterisation of incongruency present in cases of fragmented coronoid process has not been reported consistently. In this article, the literature relating to the pathogenesis of fragmented coronoid process, the role of incongruency and its implications are reviewed.