Estimation of Joint Incongruence in Dysplastic Canine Elbows Before and After Dynamic Proximal Ulnar Osteotomy

Outcomes of 11 dogs with short radius syndrome treated with acute arthroscopically assisted ulnar shortening

OBJECTIVE

To describe the short-term outcome of acute arthroscopically assisted ulnar shortening (AUS), to treat short radius syndrome in dogs.

STUDY DESIGN

Case series.

ANIMALS

Eleven client owned dogs.

METHODS

Records of dogs that had undergone AUS for treatment of short radius syndrome were reviewed for inclusion. Reporting data included among others pre- and postoperative radioulnar, humeroradial and humeroulnar distances, lameness scores, surgical times, complications and clinical outcome.

RESULTS

Following AUS, radiohumeral articulation was improved in all dogs. Median presurgery radioulnar, humeroradial and humeroulnar values were 4.5, 3.2, and 2.2 mm and were improved with surgery by a median of 3.2, 1.8, and 1.2 mm, respectively. Median surgery time was 140 min. Median time to bone healing was 8 weeks (range: 4-14). Median time to last follow-up was 9 weeks (4-468). Median lameness score (scale 0-4) improved from 2 to 1. No major complications were reported. Short-term clinical outcome was graded by the surgeons as full function in four cases and acceptable function in seven.

CONCLUSION AND CLINICAL RELEVANCE

Radiographic and arthroscopic radiohumeral articulation were improved and short-term clinical improvement was documented following AUS in all 11 dogs.

Proximal Ulnar Osteotomy as a Treatment for Humeral Intracondylar Fissure in a Shetland Sheepdog

A seven-month-old male Shetland Sheepdog was presented for assessment of thoracic limb lameness of 3 weeks duration. Orthopaedic examination revealed severe discomfort in elbow extension, bilaterally. CT-scan confirmed presence of a complete humeral intracondylar fissure (HIF), bilaterally, and arthroscopic examination of both elbows confirmed the presence of the cartilaginous lesion previously reported in dogs suffering from HIF. A staged oblique proximal ulnar osteotomy was performed to address the humero-anconeal incongruency believed to be the cause of HIF formation. Orthopaedic examination performed 5 weeks after each surgical procedure confirmed that pain previously present on elbow manipulation had subsided. Follow-up examination performed 8 months after the second surgery revealed the dog to be sound at walking on the thoracic limbs with no discomfort present on elbow manipulation. Repeated CT scan confirmed complete healing of both HIFs. This is the first report documenting the presence of HIF in a Shetland sheepdog and complete healing of both HIFs following a proximal ulnar osteotomy.

Short term outcomes and complications of distal ulnar ostectomy in 23 juvenile dogs with carpal valgus secondary to discordant radial-ulnar physeal growth

Objective

The goal of this study was to report short term clinical and radiographic outcomes after distal ulnar ostectomy in dogs with carpal valgus due to discordant radial-ulnar growth.

Study design

Retrospective case study.

Sample group

Client owned dogs under 1 year of age with carpal valgus and open distal radial physes pre-operatively.

Methods

Medical records from four veterinary referral centers were searched from January 1, 2015 to January 1, 2022 for juvenile dogs that had been treated with distal ulnar ostectomy for carpal valgus due to premature closure of the distal ulnar physis. Patients were excluded if they were skeletally mature at the time of ostectomy; medical records were incomplete; radial physis was closed at surgery; or definitive corrective osteotomy was performed. Radiographs were evaluated pre-operatively and for short term follow up at ~8 weeks. Complications and short term clinical outcomes were evaluated also.

Results

31 limbs from 23 dogs were evaluated. Patients ranged from 4 to 10.8 months of age. All dogs presented for visible carpal valgus and varying degrees of thoracic limb lameness. Sixty-four percent of patients showed resolution of lameness while an additional 13% showed an improvement in clinical lameness without complete resolution. Complications were seen in 32% of patients with 70% percent of those being minor, bandage related complications. Radiographically, 38% of limbs showed bridging callus formation of the ostectomy at an average of 7.5 weeks post operatively and 75% percent of patients with elbow incongruity improved radiographically. There was no significant difference in radial joint angles pre-operatively and at the time of follow up.

Conclusion

Distal ulnar ostectomy ameliorates lameness in juvenile dogs with premature distal ulnar physeal closure and shows lack of progression of distal carpal valgus deformity, but does not improve joint angulation.

Clinical significance

Distal ulnar ostectomy is associated with mild bandage-related complications and halting of progressive limb deformity within the time frame evaluated, and should therefore be considered a treatment for premature closure of the distal ulnar physis. It does not lead to deformity correction at 8 weeks following surgery but is associated with improved elbow congruity.

Performing a Three-Dimensional Finite Element Analysis (FEA) to Simulate and Quantify the Contact Pressure in the Canine Elbow Joint: A Pilot Study

OBJECTIVE

 The aim of this study was to measure surface pressures and force distribution on radius and ulna in healthy and dysplastic elbow joints in different positions using the finite element analysis (FEA).

STUDY DESIGN

 FEA was performed on computed tomographic data of healthy and fragmented coronoid process diseased elbow joints of Labrador Retrievers. It considered the articular cartilage, collateral ligaments, triceps and biceps muscle. The analysis of each joint was performed in four positions (standing position: 145 degrees and three positions of the stance phase of gait: beginning: 115 degrees, middle: 110 degrees, end: 145 degrees joint angle) in consideration of different ground reaction forces (standing: 88.3 N; stance phase of gait: 182.5 N).

RESULTS

 Mean values of total force of 317.5 N (standing), 590.7 N (beginning), 330.9 N (middle) and 730.9 N (end) were measured. The percentual force distribution resulted in a total of 49.56 ± 26.58% on the ulna with a very inhomogeneous distribution. A significant difference was detected between the positions 'standing' and 'end' (p = 0.0497) regardless of the joint condition. In some FEA results, visual assessment of the surface pressures indicated an increase in pressure in the region of the medial compartment without a uniform pattern. An increase in pressure resulted in an area increase in the pressure marks on the joint surface and measurable pressure was increased at a larger joint angle.

CLINICAL SIGNIFICANCE

 FEA can provide information about the transmission of force in the joint. Prior to the use of FEA in scientific clinical research for the simulation of force, further model improvements are necessary.

Clinical and Radiographic Evaluation of Short- and Long-Term Outcomes of Different Treatments Adopted for Elbow Medial Compartment Disease in Dogs

Medial compartment disease is a common occurrence in dogs affected by elbow dysplasia. Despite many treatments suggested in the literature, only few studies reported comparative outcomes in the short and long term. The aim of this study is to report and compare short- and long-term clinical and radiographic outcomes of dogs treated for medial compartment disease (MCD) by distal dynamic ulnar ostectomy (DUO), bi-oblique dynamic proximal ulnar osteotomy (BODPUO) and conservative management (CM). From 2016 to 2018, all medium to large dogs, aged between 5 and 12 months, affected by uni/bilateral MCD and treated by DUO, BODPUO or CM, were enrolled in this study and followed up for 24 months. Orthopedic and radiographic examinations were performed at T₀, T₂, T₁₂ and T₂₄ months after treatment. Lameness score, elbow arthralgia, elbow range of motion (ROM), osteoarthritis (OA) score and percentage of ulnar subtrochlear sclerosis (%STS) were evaluated at each time point. According to the treatment performed, dogs were divided into three groups: DUO, BODPUO and CM. Forty-five elbows from twenty-six dogs, treated with DUO (n = 17), BODPUO (n = 17) or CM (n = 11), were prospectively enrolled in the study. The patients enrolled in the CM group were older and showed more severe radiographic signs of OA, compared to those enrolled in the other two groups. Lameness and arthralgia scores (p < 10⁻⁴) were significantly decreased in patients that underwent surgical treatment and increased in patients managed conservatively (lameness p < 10⁻⁴, arthralgia p = 0.3068), at T₁₂ and T₂₄. OA score (p < 0.0040) and ROM (DUO, CM p < 10⁻⁴; BODPUO p = 0.0740) worsened in every study group, but %STS decreased in DUO (p = 0.0108), increased in the CM group (p = 0.0025) and remained unchanged in the BODPUO group (p = 0.2740). This study supports the clinical efficacy of DUO and BODPUO in reducing lameness, arthralgia and progression of %STS. Early diagnosis and surgical attention in patients affected by MCD can improve the short- and long-term outcome and reduce the progression of secondary changes.

Mid- to Long-Term Outcome after Arthroscopy and Proximal Abducting Ulnar Osteotomy Versus Arthroscopy Alone in Dogs with Medial Compartment Disease: Thirty Cases

OBJECTIVE

 The aim of this study was to determine owner-assessed mid- to long-term outcome for dogs with medial compartment disease treated arthroscopically with fragment removal with or without proximal abducting ulnar osteotomy (PAUL).

STUDY DESIGN

 This was a retrospective clinical study.

MATERIALS AND METHODS

 Records from 30 dogs with medial compartment disease treated with arthroscopy with or without PAUL were retrospectively reviewed over a 5-year period. Proximal abducting ulnar osteotomy cases were matched to arthroscopy-alone controls based on bodyweight and modified Outerbridge score. Outcome was assessed via owner questionnaire using the Canine Brief Pain Inventory (CBPI), frequency of non-steroidal anti-inflammatory drug (NSAID) administration and owner-assessed overall improvement.

RESULTS

 Canine Brief Pain Inventory score for dogs in the PAUL group was not significantly different from the control group (p = 0.54). Non-steroidal anti-inflammatory drug administration was similar between groups (p = 0.61) and there was no significant difference between modified Outerbridge score and outcome (p = 0.57) over a median of 43 months post-surgically (range: 7-66 months). Canine Brief Pain Inventory and NSAID use were affected by the age of the dog with dogs greater than 3 years of age at the time of surgery having a higher CBPI score and increased NSAID use regardless of the surgery that was performed. Overall, owner-assessed improvement was not different between groups (p = 0.72).

CLINICAL SIGNIFICANCE

 Proximal abducting ulnar osteotomy showed no owner-assessed benefit over arthroscopic medial coronoid fragment removal for dogs with medial compartment disease and modified Outerbridge score of 3 or greater. A prospective, blinded, controlled clinical trial is warranted to determine the appropriate clinical application of the PAUL procedure.

Bi-Oblique Dynamic Proximal Ulnar Osteotomy: Surgical Technique and Clinical Outcome in 86 Dogs

OBJECTIVE

To describe the technique of bi-oblique dynamic proximal ulnar osteotomy (BODPUO) and report the clinical outcome in a series of dog with medial compartment disease and other developmental elbow diseases.

STUDY DESIGN

Retrospective case series.

ANIMALS

Dogs (n=86; 120 elbows) treated for elbow disease with BODPUO.

METHODS

Medical records and diagnostic images were reviewed. Type and frequency of complications and treatment required were recorded. Force plate data were reported in dogs for which data had been recorded preoperatively and at follow-up.

RESULTS

Mean (standard deviation) final follow-up was 23.4 (35.6) weeks. There were minor complications in 15 elbows (12%, 14 dogs). There were no major complications. The caudo-cranial and latero-medial mean osteotomy angles were 55° (7°) and 48° (10°), respectively. The most caudo-proximal point of the osteotomy was located at a mean of 39% (5%) of the total ulnar length from the olecranon. Sixty of 68 elbows (88%) were considered healed by 4 months postoperative based on radiographs. Subjective lameness scores were significantly decreased by final follow-up for all dogs. For dogs treated with BODPUO alone for medial compartment disease, peak vertical force was significantly higher at 6 months postoperative.

CONCLUSION

Dogs with medial compartment disease undergoing BODPUO showed clinical improvement in the 6 month follow-up. No complications required surgical intervention.

Focal humero-ulnar impingement following subtotal coronoid ostectomy in six dogs with fragmented medial coronoid process

OBJECTIVE

To report acute eburnation of joint cartilage at the humeral trochlea following subtotal coronoid ostectomy (SCO) in a clinical case series of six elbows.

MATERIAL AND METHODS

Six dogs (median BW 27.1 kg; median age 7.5 months) with fragmented medial coronoid process (FCP) and varying degree of radio-ulnar incongruence (RUI) (mean 2 mm) were treated with SCO using an arthroscopic burr. Second look arthroscopy 4-12 weeks later was performed either because of recurrent or persistent lameness in three dogs. In the others, second-look arthroscopy was scheduled prospectively because of RUI, which was thought to be a risk factor for the observed humero-ulnar impingement.

RESULTS

All six elbows had a 1-2 mm wide line of focal full-thickness cartilage loss along the edge of the SCO, while the opposing trochlea had diffuse cartilage damage of Outerbridge grade III-IV, indicating focal humero-ulnar impingement. None of the elbows showed repeated FCP.

CONCLUSION

In some cases SCO might lead to focal humero-ulnar impingement along the osteotomy line.

CLINICAL SIGNIFICANCE

Whether this relays to variations in respect the amount of resected bone (too much vs. too less) or concomitant joint pathologies like RUI or joint instability remains unknown and warrants further studies.

Arthroscopic-guided ulnar distraction for the correction of elbow incongruency in four dogs

Four skeletally immature, small breed dogs (five elbows) with elbow incongruency were evaluated for forelimb lameness. Findings on clinical examination included pain, effusion and decreased range of motion of the affected elbow. Radiography, computed tomography and arthroscopy demonstrated elbow incongruency in all dogs. Fragmented medial coronoid process was diagnosed arthroscopically in three dogs (four elbows). Arthroscopic subtotal coronoidectomy was performed in all cases of fragmented medial coronoid process. Incongruency was corrected with acute ulnar lengthening under arthroscopic visualisation. The ulna was stabilised with a plate following correction. In two elbows an ostectomy of the anconeal process was performed to prevent impingement against the olecranon fossa. All dogs demonstrated improvement in lameness scores and client-scored visual analogue scale scores. Postoperative computed tomography showed significant improvement in elbow incongruency in all dogs. Arthroscopic-guided ulnar lengthening may be considered as a valid treatment in severe cases of elbow incongruency.