Premature Closure of the Distal Radial Physis in the Dog A Review of Eleven Cases

Premature distal radial physeal closure, while not as commonly diagnosed as premature closure of the distal ulnar physis, presented a surgical problem in the 11 cases reviewed. The diagnosis was suggested by clinical signs including lameness, angular deformity of the forelimb, pain, crepitation, and limited range of motion in the elbow. Radiographic examination confirmed the diagnosis. Surgical treatment depended on the abnormalities present. Two animals with growth potential were treated by resecting the restricting physeal bone bridge and placing an autogenous fat graft in the defect. Corrective osteotomy procedures for seven animals with total closure of the physis were directed toward re-establishing functional elbow anatomy by radial osteotomy or correcting angular limb deformity with an oblique radial osteotomy. Two animals did not receive treatment. Surgical treatment resulted in improved use of the forelimb.     

Premature closure of the proximal physis of the humerus in a dog as a result of harvesting a cancellous bone graft

A 5-month-old castrated male mixed-breed dog was evaluated because of lameness of the right forelimb. Physical examination revealed pain on manipulation of the right elbow joint, and radiography revealed premature closure of the distal physis of the radius with subluxation of the right elbow joint. Corrective osteotomy of the radius was performed to increase the length of the radius and establish congruity of the elbow joint. Cancellous bone was obtained from the proximal portion of the humerus and used as a graft at the osteotomy site. The dog did well after surgery. Four months after surgery, the dog again was lame on the right forelimb. Physical examination revealed instability of the right shoulder, and manipulation of that area elicited signs of pain. Radiography revealed caudomedial subluxation of the right shoulder as well as deformity of the humeral head and hypoplasia of the greater tubercle. It was presumed that these changes were associated with collection of the cancellous bone graft during the initial surgery, which resulted in premature closure of the proximal physis of the humerus. To our knowledge, this is the first report of premature closure of the proximal physis of the humerus as a result of procurement of a bone graft.     

Distraction osteogenesis to treat premature distal radial growth plate closure in a dog

A 4-month-old Labrador was presented for forelimb lameness and elbow pain. Radiography revealed asymmetric premature closure of the distal radial physis resulting in humeroradial and humero-ulnar subluxation. A four-ring circular external fixator applied to the antebrachium was used to perform distraction osteogenesis. After a 4 day latency period, varying rates of linear distraction were used to lengthen the radius by 50% of its original length, which is significantly longer than has been previously reported. By 69 days after performing the radial osteotomy, the distraction callus had achieved clinical union and the fixator was removed. One year postoperatively, mild lameness was present after exercise and minimal elbow osteo-arthritis was evident radiographically. Complications observed included pin tract drainage, transient carpal contracture and radio-ulnar synostosis.     

Treatment of Humeroulnar Subluxation with a Dynamic Proximal Ulnar Osteotomy A Review of 13 Cases

Humeroulnar subluxation was treated surgically in 13 dogs with 18 affected elbows using a proximal osteotomy of the ulna that allowed the ulna to elongate dynamically. Distal humeroulnar subluxation was secondary to premature closure of the distal ulnar physis in 16 elbows. One distal subluxation was secondary to a radioulnar synostosis, and one proximal subluxation developed after premature closure of the distal radial physis. The mean follow-up time was 22 months. Twenty-eight percent of the elbows were judged to have excellent results, 22% good results, 50% fair results, and none was judged to have a poor outcome. The presenting lameness grade and the severity of preoperative and postoperative humeroulnar subluxation had significant correlations with the prognosis. Associated orthopedic abnormalities and complications of concurrent surgical procedures affected the outcome in several dogs. Overall, the dynamic proximal ulnar osteotomy was a simple and effective technique for the treatment of uncomplicated humeroulnar subluxation.     

Surgical management of radial physeal growth disturbance in dogs.

Premature closure of the distal radial physis can result in severe developmental deformities of the involved forelimb. Recognition of the problem early in its course is necessary to minimize valgus deformity and secondary osteoarthritis of the elbow and carpus. By forcing the radius to elongate, following radial osteotomy and use of a Stader apparatus, these deformities can be minimized.     

Cryosurgical Epiphysiodesis in the Dog

Transphyseal freezing of the canine distal femur was evaluated to determine its effect on physeal growth and closure. A specially designed cryoprobe was used to freeze the distal right femoral physis in 17 immature dogs. The left distal femoral physis was sham operated to serve as a control. Dogs were radiographed weekly and euthanized from 2 days to 8 weeks following surgery. The rate of long bone growth decreased in all dogs, and the physis was closed at 6 to 8 weeks.
Histologic studies on the distal femoral physes revealed that immediately after freezing, there was extensive hemorrhage in the epiphysis and metaphysis with disruption of the physis. Inflammation and death of the physeal cartilage followed. Blood vessels invaded the physis, and eventually bone was formed between the epiphysis and metaphysis, resulting in complete and premature physeal closure.     

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.     

THE EFFECT OF PREPUBERAL AND POSTPUBERAL GONADECTOMY ON RADIAL PHYSEAL CLOSURE IN MALE AND FEMALE DOMESTIC CATS

Male (n=6/group) and female (n=6/group) kittens were gonadectomized at 7 weeks (prepuberally) or 7 months of age (postpuberally), or left intact. Lateral radiographic projections of the right forelimb were made from 4 months of age until the distal radial physis was closed, or 24 months of age. In males, distal radial physeal closure was delayed in both groups of gonadectomized animals, compared to intact males (p<0.01). In females, proximal radial physeal closure was significantly delayed in prepuberally gonadectomized animals (p=0.02), and distal radial physeal closure was significantly delayed in both groups of gonadectomized animals, compared to intact animals (p<0.01). Final radial length (females p<0.01, males p=0.01), and age and radial length at time of the growth plateau (p<0.01) were significantly increased in all gonadectomized animals. Age at gonadectomy had no effect on age and radial length at time of the growth plateau. No puberal growth spurt was observed in any of the cats.     

The management of elbow instability caused by premature closure of the distal radial growth plate in dogs

The clinical and radiographic findings associated with premature closure of the distal radial growth plate are described in 17 dogs. An increase in the humero-radial joint space with elbow instability and pain was noted in all cases. Radial lengthening procedures were used to treat three dogs, while in seven others, the ulna was shortened to correct elbow instability. Seven dogs were treated conservatively. The results of treatment are discussed in the light of previously published findings.     

Trauma-induced growth abnormalities of the distal radius in three cats

Three immature cats with growth abnormalities of the distal radius secondary to trauma were presented between July 2001 and July 2003. Initial injuries included a Salter-Harris type II fracture of the distal radial physis in one cat, fractures of the styloid process of the ulna in two cats, and metacarpal fractures in one cat. The cats were between 3.5 and 4.5 months of age at the time of injury. Damage to the distal radial physis resulted in a variable degree of shortening of the radius in all cats. Asymmetrical closure caused widening of the lateral aspect of the radiocarpal joint space in two cats. Elbow incongruity was not observed. One cat was treated with osteotomies of the radius and ulna and realignment of the radius, stabilised with external skeletal fixation. Another was treated by ulnar ostectomy alone. Radius and ulna osteotomies and distraction osteogenesis of the radius were performed in the third cat. Clinical outcome was satisfactory in all three cases.     

Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity

A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.     

Effects of electrostimulated acupuncture on ground reaction forces and pain scores in dogs with chronic elbow joint arthritis

OBJECTIVE: To determine whether use of electrostimuluated acupuncture (ESA) would result in significant improvements in ground reaction forces and lameness scores in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia. DESIGN: Randomized, controlled, crossover clinical trial. ANIMALS: 9 dogs with chronic forelimb lameness and radiographic evidence of elbow joint osteoarthritis. PROCEDURES: All dogs had a 3-week control acclimation period during which gait analysis was performed weekly. Dogs then received ESA once weekly for 3 weeks followed by a sham treatment once weekly for 3 weeks or received the sham treatment followed by ESA. Gait analysis was repeated prior to each treatment, and owners were asked to provide pain scores by use of a visual analog scale method. RESULTS: Treatment (control, acupuncture, or sham) did not have a significant effect on ground reaction forces for any limb. Owners of 8 of the 9 dogs were able to correctly guess the time period when ESA was delivered. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that ESA did not have any significant effects on severity of lameness, as determined by measurement of ground reaction forces, or severity of pain, as determined by visual analog scale pain scores, in dogs with chronic elbow joint osteoarthritis secondary to elbow joint dysplasia.     

Abnormal canine bone development associated with hypergravity exposure.

Chronic centrifugation of 85- to 92-day-old Beagles at 2.0 X g and 2.6 X g for 26 weeks during the time of active skeletal growth caused skeletal abnormalities in the radius and the ulna of ten of 11 dogs. The pattern of change mimicked that found in naturally occurring and experimentally induced premature distal ulnar physeal closure or delayed growth at this physis. Minimal changes in bone density were detected by sensitive photon absorptiometric techniques. Skeletal abnormalities also were found in five of the six cage-control dogs, although the run-control dogs were radiographically normal.     

Surgical management of suspected congenital luxation of the radial head in three dogs

Abstract

CASE HISTORIES: Three dogs, aged between 11 and 20 weeks, were presented with unilateral forelimb lameness, with an associated bony prominence on the lateral elbow.

CLINICAL FINDINGS AND DIAGNOSIS: Radiographs revealed a caudolateral luxation of the radial head in all cases, consistent with a diagnosis of suspected congenital luxation of the radial head. Surgical reduction and stabilisation involved open reduction of the radial head, and in two cases the use of a trans articular pin.

CLINICAL RELEVANCE: Congenital luxation of the radial head is an uncommon condition that has conflicting reports in the literature regarding its cause, heritability, breed predisposition, treatment and prognosis. The three cases here occurred in young dogs of English Bull Terrier, Jack Russell Terrier, and Staffordshire Bull Terrier breeds. Surgical reduction and stabilisation provided successful outcomes, in all cases. Only six cases of congenital luxation of the radial head managed surgically have previously been reported in the literature.     

Prospective evaluation of techniques for differentiating shoulder pathology as a source of forelimb lameness in medium and large breed dogs

Objective— To assess lameness evaluation, shoulder abduction angles, radiography, and ultrasonography for determining presence, location, and severity of forelimb pathology. Study Design— Prospective cohort study. Animals— Dogs ≥20 kg (n=30). Methods— Each dog was assigned lameness scores. Shoulder abduction angles were determined. Radiographs of shoulders and elbows were subjectively graded for pathology. One investigator unaware of dog history (lameness, radiographic findings) performed ultrasonographic assessment of shoulders with subjective grading of pathology. Another investigator unaware of dog history (lameness, radiographic, ultrasonographic findings) performed arthroscopic assessment of shoulders with subjective grading of pathology. Elbows were disarticulated and evaluated for gross pathology. Histologic pathology scoring of shoulder tissues was performed. Data were compared for differences among groups, sensitivities, specificities, positive and negative predictive values, and positive and negative likelihood ratios were calculated. Results— Twenty‐seven forelimbs were considered clinically normal, 26 had shoulder pathology, 5 had elbow pathology, and 2 had pathology of both the shoulder and elbow. Dogs with shoulder pathology were twice as likely to be lame compared with dogs with elbow pathology. Limbs with medial shoulder instability had significantly higher abduction angles than normal limbs and those with elbow pathology. Radiographs were clinically useful for diagnosing elbow, but not shoulder, pathology. Ultrasonography was clinically useful for diagnosing shoulder pathology other than instability. Abduction angles, ultrasonographic evaluation, and arthroscopic assessments had strong, significant correlations with reference standards. Conclusions— Clinically relevant diagnostic techniques yielded characteristic, repeatable differences in objective and subjective assessments for distinguishing presence, location, and severity of forelimb lameness in dogs. Clinical Relevance— The diagnostic approach to forelimb lameness in dogs should include shoulder pathology as a differential with multiple assessments used to determine the clinical cause of lameness.     

Compensatory load redistribution in naturally occurring osteoarthritis of the elbow joint and induced weight-bearing lameness of the forelimbs compared with clinically sound dogs

The current study investigated the compensatory load redistribution due to osteoarthritis of the elbow joint using ground reaction forces of all four legs, simultaneously measured on a treadmill with integrated force plates. Three groups of dogs were used: the first group was clinically sound; the second group suffered from a naturally occurring osteoarthritis of the elbow joint, and a reversible lameness was induced in the third group. The naturally occurring osteoarthritis resulted in a compensatory gait pattern to reduce the stress on the affected limb. The load was reduced on the lame limb and increased on the contralateral hindlimb. The symmetry index indicated a weight-shift to the contralateral forelimb and diagonal hindlimb, which resulted in a more balanced weight distribution than in normal dogs. Dogs with induced lameness showed comparable but less pronounced alterations. These results suggested that forelimb lameness could lead to overload on non-affected extremities and the vertebral spine.     

Mastocytoma in the common carpal sheath of the digital flexor tendons of a horse

A 13-year-old Morgan gelding was examined for right forelimb lameness and tenosynovitis of the right common carpal sheath of the digital flexor tendons. The horse had moderate right forelimb lameness at the trot and marked effusion of the right common carpal sheath of the digital flexor tendons. Ultrasonographic examination revealed a soft tissue mass within the proximal pouch of the affected tendon sheath, located adjacent to the distal physis of the radius. Cytology and culture of the fluid revealed a sterile, eosinophilic tenosynovitis. Tenoscopic exploration confirmed the presence of a capsulated soft tissue mass. Thecotomy was required to fully debride the mass, which histology revealed to be a mast cell tumour. At 22 months postoperatively, the horse developed mild right forelimb lameness and eosinophilic tenosynovitis because of recurrence of the mastocytoma. Mastocytosis is a possible differential diagnosis in any horse exhibiting lameness associated with tenosynovitis. Surgical excision combined with rest and postoperative intrasynovial and systemic corticosteroids may be palliative.     

Sequential measurements of the tibial plateau angle in large-breed, growing dogs

OBJECTIVES: To determine the earliest age that canine tibial plateau angles (TPAs) can be reliably measured and determine whether TPAs change during long bone growth. ANIMALS: 10 Labrador Retrievers and 20 Labrador Retriever-hound crossbreeds. PROCEDURE: Stifle joints were radiographed every 2 months from 8 weeks of age to radiographic closure of the tibial physes. Four examiners radiographically evaluated TPA, physeal closure status (ie, complete or incomplete) of the proximal and distal tibial physis, and whether anatomic TPA measurement landmarks were sufficiently visible (LSV) or insufficiently visible (LIV) for accurate measuring. Linear regression analysis was performed to detect change in TPAs over time. Mean ages with 95% confidence intervals (CIs) were determined for dogs with radiographs classified as LIV and LSV. RESULTS: TPAs did not change from 90 days of age to physeal closure. Mean age for dogs with radiographs classified as LIV was 70.2 days (95% CI, 68.12 to 72.28 days), with no dog with LIV radiographs over 81 days of age. Mean age for dogs with radiographs classified as LSV was 85.5 days (CI, 76.73 to 94.27 days). CONCLUSIONS AND CLINICAL RELEVANCE: TPAs in Labrador Retrievers and Labrador Retriever-hound crossbreeds can be measured accurately after 90 days of age, and earlier attempts to measure result in falsely low TPA measurements. Measuring TPAs in growing dogs may allow earlier detection of premature physeal closures. As more is learned about the role of theTPA in cranial cruciate ligament injury, early treatment may be possible for growing dogs with cruciate ligament injuries and excessive tibial slope.