Pasteurized tumoral autograft and adjuvant chemotherapy for the treatment of canine distal radial osteosarcoma: 13 cases

OBJECTIVE: To report outcome in 13 dogs with distal radial osteosarcoma, without evidence of metastasis, treated by a combination of adjuvant chemotherapy and a pasteurized autograft limb-sparing procedure. STUDY DESIGN: Prospective clinical study. ANIMALS: Thirteen dogs with distal radial osteosarcoma. METHODS: Limb-sparing procedure was performed using an autograft from the excised tumoral segment, pasteurized at 65 degrees C for 40 minutes. Adjuvant chemotherapy (cisplatin or cisplatin and doxorubicin) was administered in all dogs. RESULTS: Mean and median survival times were 531 and 324 days, respectively (range, 180 to 1,868 days). Overall survival was 100% at 6 months, 50% at 12 months, 44% at 18 months, and 22% at 24 months. Lung metastasis occurred in 5 (38%) dogs. Observed complications were local recurrence (2 dogs, 15%), allograft infection (4 dogs, 31%), and implant failure (3 dogs, 23%). Limb function was good in 12 dogs (92%) and fair in 1 dog. CONCLUSIONS: Pasteurized bone autograft derived from the tumoral bone segment was an effective alternative to cortical bone allograft for limb sparing in canine distal radial osteosarcoma, in terms of feasibility, pattern of healing, complications, and survival. CLINICAL RELEVANCE: Use of a pasteurized bone autograft eliminates the need for a canine bone allograft bank and has the added advantage of good fit to the recipient site.     

Limb-sparing surgery in a dog with osteosarcoma of the proximal femur

OBJECTIVE: To report successful limb-sparing surgery in a dog with a proximal femoral osteosarcoma (OSA) using a composite allograft-prosthetic technique. STUDY DESIGN: Case report. ANIMAL: Client-owned dog. METHODS: A stage IIB OSA of the proximal aspect of the femur was resected in accordance with oncologic and limb-sparing principles. The osseous defect was reconstructed with a proximal femoral allograft and cemented, long-stemmed femoral prosthesis. Soft tissue reconstruction was achieved by suturing host tendons to their respective allogeneic tendons on the allograft. Coxofemoral joint function was preserved using standard total hip arthroplasty techniques. RESULTS: Limb-sparing surgery of the proximal aspect of the femur using a composite allograft-prosthetic technique resulted in excellent limb function. Postoperative complications included aseptic loosening of the femoral composite graft and allograft nonunion, which required revision, traumatic implant luxation, and local tumor recurrence. Limb function was excellent after surgical stabilization of the allograft nonunion but deteriorated after implant luxation 270 days postlimb-sparing surgery. Pulmonary and skeletal metastases were diagnosed and local tumor recurrence suspected 596 and 650 days postoperatively, respectively. The dog was euthanatized 688 days after limb-sparing surgery as a result of progressive local and metastatic disease. CONCLUSIONS AND CLINICAL RELEVANCE: Limb-sparing surgery for dogs with primary bone tumors of the proximal aspect of the femur is feasible with good functional results.     

Transverse ulnar bone transport osteogenesis: a new technique for limb salvage for the treatment of distal radial osteosarcoma in dogs

Objective— To develop instrumentation and a technique for transverse ulnar bone transport osteogenesis in dogs.
Study Design— Cadaveric study and in vivo validation (1 dog).
Sample Population— Paired cadaveric antebrachii (n=10 dogs) and 1 live dog.
Methods— Circular fixator constructs were applied and fitted with reeling or linear motors designed to transport an ulnar segment transversely into a defect created by excising the distal 50% of the ipsilateral radius. A longitudinal osteotomy of the adjacent ulna was created and the segment was transported across the radial defect. Pre- and post-distraction CT scans were used to compare the efficacy of each construct. The procedure was performed unilaterally in a live dog using the reeling motor (RM) construct.
Results— Both constructs effectively transported the ulnar segment into the defect. Subjectively, the RMs were easier to apply and operate. No significant differences were observed in the objective measures of efficacy between the 2 construct types. The live dog produced viable regenerate bone after transverse ulnar bone transport.
Conclusions— Transverse ulnar bone transport should be considered a potential method for limb salvage in dogs with osteosarcoma (OSA) of the distal radius. The RMs were effective and clinically applicable.
Clinical Relevance— Transverse ulnar bone transport osteogenesis affords the benefits of longitudinal radial bone transport osteogenesis, allowing resolution of large longitudinal radial defects in a substantially less time as a result of shortening the transport distance. This would be beneficial when treating conditions such as OSA where minimizing convalescence and maximizing quality of life is a priority.     

Loss of implant-bone interface following distal radial locking-plate endoprosthesis limb-sparing surgery in a dog

An eight-year-old, neutered female Rottweiler was presented with lameness of seven days duration. Radiographs were consistent with a distal radial bone tumour. Limb-sparing surgery was performed using a commercially available endoprosthesis with a locking bone plate. Histopathological examination of the resected bone revealed an intraosseous fibrosarcoma, and postoperative adjuvant chemotherapy was initiated three weeks after surgery. Despite initial satisfactory limb function, lameness worsened four months after surgery. Radiographs revealed large areas of bone lysis around the proximal and distal screws, leading to significant resorption of the radius and radial carpal bone with subsequent construct failure. Further treatment was declined by the owner and the dog was subsequently euthanased. This case illustrates that implant failure is not necessarily averted by the use of locking (compared with non-locking) implants combined with an endoprosthesis to treat distal radial tumours in dogs.     

Intercalary bone grafts for joint and limb preservation in 17 dogs with high-grade malignant tumors of the diaphysis

OBJECTIVE: To evaluate postoperative complications, limb function, and tumor control after intercalary resection and reconstruction for preservation of limb and joint function in dogs with high-grade malignant tumors of diaphyseal bone. STUDY DESIGN: Retrospective study. ANIMALS: Seventeen client-owned dogs. METHODS: The bone tumor database and medical records were reviewed (1986-2002) for dogs with diaphyseal tumors treated with intercalary resection and reconstruction with either an allograft or irradiated autograft. Clinical presentation, diagnostic findings, surgical management, and outcome were determined from medical records and telephone interviews with veterinarians and owners. Statistical analyses included chi2 to test associations between intra- and postoperative variables with complications, and Kaplan-Meier survival analysis for disease-free interval, metastasis-free interval (MFI), and median survival time. RESULTS: Intercalary limb-sparing surgery was performed in 17 dogs with diaphyseal tumors: osteosarcoma (OSA) (15), histiocytic sarcoma (1), and solitary metastasis from a pulmonary adenocarcinoma (1). One dog was excluded from further analysis when the spared limb was amputated 4 days postoperatively because of incomplete tumor resection. In 16 dogs, limb function was good to excellent. Complications occurred in 5 dogs (31.3%) and included superficial infection in 2 dogs (12.5%) and implant failure in 4 dogs (25%). All implant failures occurred in the ulna and there was a significant association between implant failure and non-cemented allografts (P=.042). Non-union of 1 or both osteotomies was diagnosed in 10 dogs (83.3%) and, despite lack of clinical signs in all cases, was significantly associated with the use of intracavitary locally released cisplatin (P=.046) and cemented intercalary grafts (P=.046). Local tumor recurrence was diagnosed in 1 dog (6.3%) and metastatic disease in 12 dogs (75.0%), including 10 dogs with OSA. The median MFI was 137 days. The local disease-free and overall limb-salvage rate was 94% and 100%, respectively. Overall median survival time was 393 days and the median survival time for dogs with OSA was 449 days. CONCLUSION: Intercalary limb-sparing surgery results in better postoperative limb function with fewer and less severe complications than historical reports of dogs treated with non-intercalary limb-sparing surgery. CLINICAL RELEVANCE: In dogs with diaphyseal tumors, intercalary limb-sparing surgery preserves normal joint function and results in good to excellent limb use with few complications and good local tumor control.     

Evaluation of a Midhumeral Block of the Radial,Ulnar, Musculocutaneous and Median (RUMM Block) Nerves for Analgesia of the Distal Aspect of the Thoracic Limb in Dogs

Objective: To evaluate a technique for midhumeral peripheral nerve blockade in the dog. Study Design: Cadaveric technique development; in vivo placebo‐controlled, prospective crossover study. Animals: Canine cadavers (n=38) and 8 clinically healthy, adult hound dogs. Methods: A technique for peripheral block of the radial, ulnar, musculocutaneous, and median nerves (RUMM block) was evaluated using cadaver limbs. Eight purpose‐bred, research dogs were anesthetized; a RUMM block was performed on each thoracic limb. One limb from each dog randomly received 0.5% bupivacaine and the opposite limb was assigned to receive sterile saline solution as a control. After recovery from anesthesia, skin sensation at selected dermatomes was evaluated for 24 hours using a mechanical stimulus. Weight‐bearing, conscious proprioception, and withdrawal reflex were also evaluated. One month after initial testing, each dog was reanesthetized and each limb received the opposite treatment. Results: Sensory thresholds were significantly increased over baseline measurements when compared with control limbs for all nerves. Complete sensory block was achieved in radial (15/16), ulnar (3/16), musculocutaneous (8/16), and median (11/16) nerves, using a mechanical stimulus of analgesia. Complete simultaneous block of all nerves was only obtained in 1 of 16 limbs. Conclusion: RUMM block resulted in desensitization of the skin in the associated dermatomes for 4–10 hours. Complete sensory block of the dermatomes supplied by the radial nerve was most consistent. Clinical Relevance: RUMM block may be an effective technique to provide adjunctive analgesia for dogs undergoing surgery of the distal aspect of the thoracic limb.     

Intraoperative radiation for limb sparing of the distal aspect of the radius without transcarpal plating in five dogs

Objectives— To evaluate intraoperative irradiation (IORT) as a method of limb spare with preservation of the radiocarpal joint.
Study Design— Prospective case series.
Animals— Dogs (n=5) with stage II sarcoma of the distal aspect of the radius.
Methods— A bone segment containing the tumor was isolated surgically, treated by IORT, reimplanted, and secured by internal fixation. In 1 dog, the postradiation tumor bed was curetted and filled with bone cement. Dogs were administered alternating adriamycin and carboplatin starting 2 weeks after IORT and monitored at regular intervals.
Results— Four dogs had osteosarcoma and 1 had undifferentiated sarcoma. Implant failure (n=3), deep tissue infection (3), and pathologic fracture (3) resulted in amputation (3) or pancarpal plating (2). The dog with undifferentiated sarcoma was euthanatized because of suspected tumor recurrence 4 months postoperatively. Osteotomy healing was documented by radiography (1), histopathology (2), or by direct observation (2).
Conclusions— A technique for limb-sparing surgery of the distal portion of the radius in dogs using IORT had advantages include healing of the autograft and a source for a perfectly fitting autograft but did not appear to offer any advantage with respect to infection rate. Long-term preservation of the radiocarpal joint was not successful.
Clinical Relevance— It was not possible to preserve the function of the radiocarpal joint and so this technique cannot be recommended currently. Further study is needed to evaluate whether or not IORT can be considered in combination with pancarpal plating and possibly curettage and cementation of the tumor to prevent subchondral bone collapse.     

Ipsilateral vascularised ulnar transposition autograft for limb-sparing surgery of the distal radius in 2 dogs with osteosarcoma

Canine osteosarcoma is the most commonly diagnosed primary bone tumour in the dog, affecting mainly large and giant breed dogs with the predilection site being the metaphysis of long bones, specifically the distal radius, proximal humerus, distal femur and proximal tibia and fibula. Treatment options are either palliative or curative intent therapy, the latter limb amputation or limb-sparing surgery together with chemotherapy. This article describes the use of an ipsilateral vascularised ulnar transposition autograft as well as chemotherapy in 2 dogs with osteosarcoma of the distal radius. Both dogs showed minimal complications with the technique and both survived over 381 days following the surgery. Complications seen were loosening of the screws and osteomyelitis. The procedure was well tolerated with excellent limb use. This technique is indicated for use in cases with small tumour size that have not broken through the bone cortex.     

Longitudinal bone transport for treatment of primary bone tumors in dogs: technique description and outcome in 9 dogs

OBJECTIVE: To describe a surgical technique for bone transport osteogenesis (BTO) limb salvage and report outcome in 9 dogs with primary bone tumors. ANIMALS: Nine dogs with spontaneously occurring primary bone tumors. RESULTS: BTO surgery was performed as a primary means of limb salvage in 7 dogs and as a salvage procedure after catastrophic allograft infection and failure in 2 dogs. Mean defect size was 9.5 cm with a mean of 123 days distraction until docking. Mean time from surgery to fixator removal was 205 days. Minimum follow-up was 9 months. There were 2 histologically confirmed local recurrences where although limb function was excellent, eventually resulted in limb amputation. Limb function was good to excellent in all but 2 dogs; 1 was chronically non-weight bearing before BTO surgery because of complications associated with an allograft limb salvage that had been performed previously on the same limb. The cause of lameness in the other dog was undetermined. CONCLUSIONS: BTO limb salvage can be successful in dogs with primary bone tumors. Whereas allograft limb salvage may be simpler from an initial management perspective, BTO has some unique advantages when compared with the allograft technique. CLINICAL RELEVANCE:BTO has an emerging role in limb salvage surgery for dogs with primary bone tumors. BTO provides excellent long-term outcomes in some dogs with primary bone tumors and will likely become increasingly more attractive as technique modifications allow the duration of the treatment to be shortened.     

Use of a Double Hook Plate for Treatment of a Distal Radial Fracture in a Dog

Attempted stabilization of open, distal radius and ulnar fractures in a 3-year-old German shepherd dog using intramedullary pins and a Schroeder-Thomas splint resulted in malalignment of the limb and osteomyelitis. A double hook plate was used to rigidly stabilize the distal radial fracture after anatomical realignment. An autogenous cancellous bone graft was used where a lateral architectural defect remained after reduction. Culture of the fracture site showed Staphylococcus sp., which responded to chloramphenicol therapy. Fracture union and resolution of osteomyelitis occurred by 9 weeks after surgery, and the dog had no lameness and a normal muscle mass 22 weeks after surgery. The double hook plate provided rigid internal fixation of the radial fracture, allowed a rapid return to function during osteosynthesis, and minimal interference of antebrachiocarpal joint function occurred.     

Use of an ipsilateral vascularized ulnar transposition autograft for limb-sparing surgery of the distal radius in dogs: an anatomic and clinical study

OBJECTIVE: To develop a surgical technique for using the distal aspect of the ulna as a transposition autograft in a distal radial defect and to assess patency of vascular supply and viability of the distal ulna in a heterotopic position. STUDY DESIGN: Cadaveric study and clinical cases. ANIMALS: Twenty-two normal canine thoracic limbs; 3 dogs with distal radial osteosarcoma. METHODS: The arteries and veins of 12 limbs were injected with latex. Barium sulfate suspension was injected into the brachial artery of 10 other limbs after removal of the distal radius only (n = 2), ulna transposition (UT) (n = 6), or no procedure (n = 2). The distal ulna grafts were then harvested and decalcified in formic acid. The grafts were cut into 3-5 mm transverse sections and radiographed with a nonscreen film system to determine filling of intramedullary vessels with barium suspension. UT was performed in 3 dogs with distal radial osteosarcoma. Bone scintigraphy was performed 2-7 days after surgery to assess viability of the transposed ulna graft. RESULTS: Angiography confirmed patency of the caudal interosseous artery in all but 2 limbs in which the UT technique was performed; however, barium-filled vessels were identified in the medullary cavity of all ulnar grafts. Scintigraphy confirmed graft viability in the 3 dogs, all of which had good to excellent limb function. CONCLUSIONS: The distal aspect of the canine ulna can be used as a vascularized transposition autograft to replace distal radial defects, and viability can be maintained. CLINICAL RELEVANCE: The UT technique appears to be an acceptable limb-sparing technique for dogs with tumors of the distal aspect of the radius.     

Radiation therapy for canine appendicular osteosarcoma

Radiation therapy (RT) for the management of canine appendicular osteosarcoma (OSA) can be described as either palliative‐ or curative intent. Palliative RT uses coarsely fractionated external beam RT or radiopharmaceuticals to provide relief of pain and lameness associated with OSA while resulting in minimal, if any, radiation‐induced acute adverse effects. Limb amputation and chemotherapy are considered (together) the standard of care for curative‐intent treatment of canine appendicular OSA. When limb amputation is not possible, RT can be used for limb sparing and is supplemented with chemotherapy for presumed micrometastatic disease. Fractionated tumour irradiation with curative intent appears to be ineffective and local disease control can more likely be achieved when stereotactic radiosurgery or intra‐operative extracorporeal irradiation is combined with strict case selection and adjunctive chemotherapy. The availability of limb‐sparing RT is limited by experience and availability of specialised equipment. When planned and administered appropriately, radiation‐associated adverse effects are often mild and self‐limiting.     

Feline model for the study of frozen osteoarticular hemijoint transplantation: qualitative and quantitative assessment of bone healing

Twenty-four outbred cats underwent massive osteoarticular allograft and control autograft transplantation, using the right distal femur with its articular cartilage, capsule, and medial collateral ligament intact. The cats were monitored clinically and radiographically for 1 year. Groups of cats (4 allografts and 2 control autografts) were euthanatized at 3-, 6-, 9-, and 12-month intervals. At necropsy, the grafts were photographed and assessed for bone healing and replacement by standard radiography, quantitative 99mTc bone scans, microradiography, and histologic examination of decalcified and nondecalcified specimens. The osteosynthesis site of the allografts usually healed by 5 months, compared with the autografts that healed by 3 months. As illustrated by quantitative bone scans, creeping appositional new bone slowly invaded and replaced the allograft bone. Seemingly, the cat can be used as an acceptable and clinically comparable model for the massive osteoarticular allografts currently being used for the reconstruction of joints damaged or destroyed by neoplasm surgery in limb-sparing procedures in human beings. This model may also be used to assess the rate and method of bone healing.     

Vertebrectomy, bone allograft fusion, and antitumor vaccination for the treatment of vertebral fibrosarcoma in a dog

OBJECTIVE: To describe the surgical technique of vertebrectomy with bone allograft fusion and the use of antitumor vaccine for the treatment of a primary vertebral neoplasm in a dog. STUDY DESIGN: Case Report. ANIMALS OR SAMPLE POPULATION: A 3 year old 32 kg female spayed mixed breed dog with progressive paraplegia. METHODS: Myelography was performed to identify an L5 lytic lesion with spinal cord compression. A dorsal laminectomy was performed to decompress the spinal cord and obtain biopsies. Pathologic fracture of the vertebral body two days later was treated with L5 vertebrectomy, cortical allograft implantation, and bilateral plating from L4 to L6. Tumor samples were used to create an autologous cytokine-gene-engineered tumor cell vaccine. Recheck radiographs and neurologic examinations were obtained 1, 2, 7, and 13 months after surgery. RESULTS: The histopathologic diagnosis was fibrosarcoma. Although slight osteopenia of the allograft was noted thirteen months after surgery, the allograft and plate fixation remained stable. The patient tolerated the antitumor vaccination protocol well. Two years after the procedures the dog was able to ambulate normally but remained urinary and fecal incontinent. CONCLUSIONS AND CLINICAL RELEVANCE: Vertebrectomy and cortical allograft implantation with plating permitted this patient to return to a functional lifestyle with its owners.     

Use of radiographic measures and three-dimensional computed tomographic imaging in surgical correction of an antebrachial deformity in a dog

CASE DESCRIPTION: A 1-year-old 7.4-kg (16.3-lb) castrated male mixed-breed dog was evaluated because of intermittent lameness and an antebrachial angular limb deformity. CLINICAL FINDINGS: The left forelimb had gross antebrachial external rotation (approx 90 degrees ) and marked procurvatum. Radiography revealed a severe partially compensated biapical antebrachial angular limb deformity. Measurements of medial proximal radial angle (MPRA) and lateral distal radial angle (LDRA) were obtained from orthogonal radiographs of the proximal and distal segments of the radius, respectively. Elbow joint-to-carpus translation was quantified. Deformities were localized and quantified by the center of rotation of angulation (CORA) method. Computed tomographic 3-dimensional image reconstructions of the antebrachium and carpus were completed to create 3 life-size stereolithographic models. TREATMENT AND OUTCOME: 2 closing wedge radial osteotomies were performed at the level of the CORAs and stabilized with bone plates and screws. RESULTS: Frontal and sagittal plane alignments were corrected to 8 degrees and 15 degrees , respectively (reference limits, 0 degrees to 8 degrees and 8 degrees to 35 degrees , respectively). The MPRA was corrected from 55 degrees to 68 degrees , and LDRA was corrected from 32 degrees to 76 degrees (values considered normal are approx 85 degrees and 87 degrees , respectively). Elbow joint-to-carpus translation was improved by 42.5%. After 8 weeks, radiography revealed bone union. Owners considered the outcome acceptable, on the basis of limb appearance and lack of lameness at 1 year after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: A segmental radiographic planning technique combined with the CORA method, computed tomography, and stereolithography may be useful in the characterization of and planning corrective surgery for forelimb deformities in dogs.     

T-plate fixation of distal radial closing wedge osteotomies for treatment of angular limb deformities in 18 dogs

OBJECTIVE: To describe the surgical technique and clinical results of treatment for forelimb angular limb deformities, secondary to premature distal radial or ulnar physeal closure, by using T-plate fixation of a distal radial closing wedge osteotomy in 18 dogs. STUDY DESIGN: Retrospective clinical study. SAMPLE POPULATION: 18 client-owned dogs. METHODS: The medical records of 18 dogs that underwent a distal radial closing wedge osteotomy with T-plate fixation for correction of a forelimb angular limb deformity were reviewed. Small pins (Kirschner wires) were used to obtain the appropriate alignment of the antebrachiocarpal and elbow joints and proper limb orientation. In-hospital follow-up evaluation was obtained at the time fracture healing was observed radiographically. Further long-term follow-up was obtained by owner interview. RESULTS: Osteotomy sites were radiographically healed within 4 to 12 weeks (mean, 8 weeks) after surgery in the 14 dogs that returned for in-hospital follow-up. Limb function was graded as good or excellent in all dogs. Long-term follow-up by owner interview rated limb function and cosmetic appearance as good to excellent in all dogs. Plate removal was necessary in one dog 7 months after surgery because of osteopenia in the radius. CONCLUSION: This surgical technique was considered successful in the treatment of angular limb deformities in all dogs. A good to excellent prognosis is to be expected with this technique, with minimal complications. CLINICAL RELEVANCE: The use of a T-plate for the correction of angular limb deformities has not been previously described in the literature. This technique permits accurate correction of the angular limb deformity and minimizes postoperative complications.     

Malignant transformation of an aneurysmal bone cyst in a dog

OBJECTIVE: To report malignant transformation of an aneurysmal bone cyst in a dog. STUDY DESIGN: Case report. SAMPLE POPULATION: Client-owned dog. RESULTS: A 5-year-old male Labrador retriever was diagnosed with an aneurysmal bone cyst of the distal aspect of the right ulna. Surgical curettage resulted in remission of clinical signs for 33 months. Because of recurrence of clinical signs, a distal ulnar ostectomy was performed. Histopathologic examination of the excised specimen revealed a moderately differentiated chondrosarcoma at the level of the bone cyst. Limb function was normal for 17 months until a subcutaneous mass, determined to be a chondrosarcoma, occurred at the level of the shoulder. A right forequarter amputation was performed. CONCLUSIONS: Aneurysmal bone cysts are benign but may be transformed into a malignancy after surgical manipulation. Complete surgical excision should be attempted where possible. In this case, distal ulnar ostectomy was an effective means of preserving limb function and preventing local recurrence of chondrosarcoma.     

A case of dorso-medial luxation of the radial carpal bone in a dog

Luxation of the radial carpal bone is an uncommon injury in the dog and cat. Previous clinical cases have reported palmaro-medial luxation with injury to the short radial collateral ligament. In this study a case of dorsomedial luxation of the radial carpal bone in a 10-year-old female Gordon Setter is described. A closed reduction of the luxation was performed and a conservative treatment was carried out. Thirteen months after the reduction, the dog had a satisfactory limb function, despite the presence of degenerative joint disease of the carpus. A pathogenic hypothesis for this dorso-medial luxation of the radial carpal bone is proposed reproducing the luxation on canine cadavers.     

Antebrachial metacarpal arthrodesis for fusion of deranged carpal joints in two dogs

Congenital malformation of the carpal joint in a young dog resulted in a progressive lameness. Traumatic disruption of the carpus in another dog resulted in carpal bone necrosis, infection, and chronic instability. Radial metacarpal arthrodesis was performed in both dogs. The diseased carpal bones were excised, sparing the accessory carpal bone in both dogs. Radial metacarpal arthrodeses were then performed, using bone plate fixation. In the dog with the malformed limb, the gait had improved, but intermittent lameness was still present 8 months later because of an associated malarticulation of the cubital joint. The dog with the traumatized carpus had little or no lameness associated with normal activity for 32 months.