FRAGMENTATION OF THE MEDIAL MALLEOLUS OF DOGS WITH AND WITHOUT TARSAL OSTEOCHONDROSIS

Fragmentation of the medial malleolus of the tibia was found radiographically in 5 canine tarsi which did not have evidence of osteochondrosis of the medial trochlear ridge. An additional 5 tarsi were found where both medial malleolar fragmentation and osteochondrosis of the medial trochlear ridge were present. Radiographic evidence of degenerative joint disease was present in 3 of 5 dogs with medial malleolar fragmentation alone, and 5 of 5 dogs with medial malleolar fragmentation and medial trochlear ridge osteochondrosis. Eight of the 9 dogs were Rottweilers. Considering the sites of occurrence of osteochondrosis in other species, the authors propose that medial malleolar fragmentation could be secondary to osteochondrosis of the medial malleolus. Osteochondrosis of the medial malleolus has not been previously reported in dogs. Histological examination of the medial malleolar fragmentation was unavailable because surgery was not performed, therefore the hypothesis that the medial malleolar fragmentation is due to osteochondrosis was not proven.     

COMPUTED TOMOGRAPHIC FINDINGS IN CANINE ELBOWS ARTHROSCOPICALLY DIAGNOSED WITH EROSION OF THE MEDIAL COMPARTMENT: AN ANALYTICAL METHOD COMPARISON STUDY

Medial compartment erosion is an advanced stage of medial coronoid disease, an important cause of elbow lameness in dogs, with treatment and the expected prognosis depending on the extent of the cartilage lesions. The identification of specific computed tomographic (CT) findings might facilitate the nonsurgical diagnosis and add to treatment decision making. Aims of this retrospective, analytical, method comparison study were to describe CT findings in elbows of dogs arthroscopically diagnosed with medial compartment erosion and to compare CT vs. arthroscopic findings. A total of 56 elbows met inclusion criteria. Elbows with focal (n = 13), diffuse (n = 11), and complete (n = 32) erosion were compared. Prevalence findings for CT lesions were as follows: periarticular osteophytosis (100%), abnormal shape of the medial coronoid process of the ulna (96.4%), and subchondral bone defect of the medial part of the humeral condyle (MHC; 96.4%). The three groups significantly differed for presence of medial coronoid process fragmentation, radial head subchondral bone sclerosis, and widening of the humeroulnar joint space. No significant agreement was found between CT and arthroscopy for presence of a subchondral bone defect of the MHC. A significant agreement was found between CT and arthroscopy for presence of fragmentation of the medial coronoid process. However, some of the calcified body/fragment(s) visualized on CT in the region of the medial coronoid process could not be identified via arthroscopy. Findings indicated that an accurate estimation of the extent of the elbow cartilage lesions still requires arthroscopic joint inspection.     

BONE SCINTIGRAPHY FOR THE DIAGNOSIS OF AN ABNORMAL MEDIAL CORONOID PROCESS IN DOGS

Few reports have been published regarding the use of scintigraphy in the diagnosis of elbow joint lameness in dogs. Some authors have speculated about the potential use of bone scintigraphy and its suspected high sensitivity for the early diagnosis of abnormalities of the medial coronoid process (MCP) in dogs. Scintigraphy is used routinely in our institution in dogs presented for thoracic limb lameness and/or suspected of abnormalities of the MCP when radiographic findings were equivocal. Radiographic, scintigraphic, and surgical findings of the elbow joints of 17 dogs with elbow joint lameness were compared with radiographic, scintigraphic, and necropsy findings of the elbow joints of 12 clinically healthy Labrador Retrievers. Quantitative evaluation of scintigraphic images was performed to determine relative radiopharmaceutical uptake in the region of the MCP. Maximum relative uptake of the coronoid process in the normal dogs was taken as a threshold value to classify elbows as positive or negative for an abnormal MCP after all 24 elbows of the 12 healthy dogs were confirmed as being normal at necropsy. All 17 elbows from lame dogs were positive on scintigraphy and confirmed as having chondromalacia, a fissure, or fragmentation of the MCP. Based on our results, bone scintigraphy may be a valuable diagnostic tool for the diagnosis of abnormalities of the MCP in dogs, and particularly in older dogs where clinical and radiographic changes may be ambiguous.     

Fragmented Coronoid Process and Incomplete Ossification of the Humeral Condyle in a Rottweiler

Objective —To describe incomplete ossification of the humeral condyle and fragmentation of the medial coronoid process in a Rottweiler.
Study Design —Clinical report.
Animal Population —A 4-year-old sexually intact male Rottweiler.
Methods —Physical examination, radiography, and computed tomography of both elbow joints were performed initially. Drill holes were made across the humeral condyle to promote ossification. Radiography and computed tomography were repeated 14 weeks later. Radiography was repeated 15 months later. A mild, intermittent lameness remained.
Results —Preoperatively a radiolucent line was present across the right humeral condyle. This radiolucent line remained unchanged 14 weeks after drill holes were made across the condyle.
Conclusions —Incomplete ossification of the humeral condyle is present in Rottweilers.
Clinical Relevance —Incomplete ossification of the humeral condyle is present in Rottweilers and may coexist with fragmentation of the medial coronoid process in that breed. The radiographic diagnosis may be difficult because precise positioning is required to see the area of incomplete ossification. Computed tomography may be required to confirm the presence of incomplete ossification of the humeral condyle. Drilling holes across the humeral condyle does not appear to lead to union of the area of incomplete ossification.     

Radiographic diagnosis and surgical management of fragmented medial coronoid process in dogs

The diagnosis of fragmented (ununited) medial coronoid process was made in 21 dogs, with 10 dogs having bilateral lesions. Ten of these dogs were presented to surgery. The diagnosis of fragmented medial coronoid process was made in young and middle-aged large- and giant-breed dogs with a history of intermittent or persistent lameness. Diagnosis was based on history as well as results of clinical examination and radiographic study of both elbows. Concomitant elbow lesions seen with fragmented medial coronoid processes were ununited anconeal process and osteochondritis dissecans of the medial humeral condyle. Avulsion of the medial epicondyle and posteromedial supracondylar ridge of the humerus were thought not to have occurred in these cases. Instead, dystrophic ossification of the synovial membrane and periosteal proliferation on the medial epicondyle and posteromedial supracondylar ridge had taken place. It was concluded that, with a questionable radiographic diagnosis of fragmented medial coronoid process, exploratory arthrotomy may be necessary to confirm the diagnosis. Without surgery, the eventual outcome of fragmented coronoid process is degenerative joint disease. Even with degenerative joint disease, however, clinical improvement was seen following removal of the fragment of the medial coronoid process.     

Review on canine elbow dysplasia: pathogenesis, diagnosis, prevalence and genetic aspects

Elbow dysplasia (ED) is a progressive skeletal disease, which may comprise osteoarthrotic changes, incongruity of the joint, a fragmented medial coronoid process (FCP), osteochondrosis dissecans of the trochlea humeri (OCD), and an ununited anconeal process (UAP). Disturbances of enchondral ossification, as well as asynchronous growth of the antebrachial bones and an increased growth rate may provoke abnormal stresses on specific locations such as the medial coronoid process, the anconeal process of the ulna or the humeral trochlea, which may result in ED. Overnutrition with calcium, vitamin D and energy had important influence on rapidity of growth and proneness to ED. ED manifests most often in young dogs less than 1 1/2 year, causing clinical signs such as (intermittent) lameness, pain on movement and altered posture of the affected limb, and radiographically secondary osteoarthrotic changes such as osteophytes or the aforementioned primary lesions. As radiographic projection of the primary lesions FCP and OCD may be difficult in the commonly used mediolateral flexed and craniocaudal views, additional projections such as mediolateral extended or anteroposterior oblique views and alternative diagnostic means such as computed tomography (CT) may be worth considering. Cases of ED are reported in various breeds, though some breeds are especially predisposed and seem to be prone to specific primary lesions. For the German shepherd dog, a breed-predisposition for UAP may be explained by broad chondral junction in association with an accelerated pattern of skeletal maturation. Heritabilities were estimated in a variety of studies, depending strongly on the type of model used. The mode of inheritance is not yet ascertained, but recently the common assumption of a polygenic mode of inheritance for ED is doubted. Instead, genetic independence was supposed between different primary lesions, and also for ED as well as for FCP major gene influence was discussed. So long, phenotypic mass selection was accomplished in different countries most often resulting in a reduced prevalence of ED. The use of best linear unbiased prediction (BLUP) methods including information on relatives and separate evaluation of genetically independent primary lesions may further improve selection against ED.     

Phenotypic and genetic evaluation of elbow dysplasia in Dutch Labrador Retrievers, Golden Retrievers, and Bernese Mountain dogs

Canine elbow dysplasia encompasses four developmental diseases: ununited anconeal process, osteochondrosis of the medial part of the humeral condyle, fragmented medial coronoid process (FCP), and incongruity of the elbow joint. Four radiographic views per joint were used to evaluate 2693 Labrador Retrievers (LRs), 1213 Golden Retrievers (GRs), and 974 Bernese Mountain Dogs (BMDs) for the presence of elbow dysplasia between 2002 and 2009 in the Netherlands. The views were also graded for signs of osteoarthritis and sclerosis. FCP was diagnosed most frequently in LRs, GRs and BMDs, with an incidence of 6%, 5%, and 15%, and a heritability of 0.17, 0.24, and 0.06, respectively. Heritabilities were estimated using a sire model and all available ancestors. Sclerosis at the base of the medial coronoid process was the radiographic sign most strongly correlated with FCP (r=0.95, 0.92, and 0.95 in LRs, GRs and BMDs, respectively). The sex of the dog was significantly correlated with the presence of osteoarthritis in LRs, but not in GRs and BMDs. Male LRs were 1.7-fold more frequently, but not more severely, affected by osteoarthritis than female dogs. Age at radiographic examination was significantly associated with osteoarthritis in all three breeds. The heritability estimates in Retrievers were high enough to warrant including FCP findings in the breeding policy, but until the biomechanical and genetic background of elbow dysplasia are better understood, correct phenotyping with a sensitive technique is essential.     

Canine elbow dysplasia and primary lesions in German shepherd dogs in France

Five hundred and twenty German shepherd dogs were screened for elbow dysplasia. The following primary lesions were analysed: joint incongruity (JI), fragmented medial coronoid process (FCP), osteochondrosis or osteochondritis of the medial humeral condyle and ununited anconeal process (UAP). Three radiographic views were used for each joint to achieve a definitive diagnosis. The prevalence of elbow dysplasia was 19.4 per cent. The most frequent lesion was JI (16.3 per cent), followed by FCP (11.3 per cent). UAP was diagnosed rarely (1.1 per cent). Combinations of lesions were very frequent (42.2 per cent of the dysplastic elbows). Although these results may be biased due to prescreening of dogs with UAP, it should be highlighted that JI and FCP occur frequently in German shepherd dogs and are probably the most common primary lesions of elbow dysplasia, although they have been under-reported until now.     

Co-existence of ununited anconeal process and fragmented medial coronoid process of the ulna in the dog

OBJECTIVES: To determine the incidence of fragmented medial coronoid process of the ulna in dogs with ununited anconeal process. The efficacy of presurgical radiography to diagnose the co-existence of these diseases was also investigated. METHODS: One hundred and fifty-five joints from 137 dogs with ununited anconeal process were included in the study. For the radiographic examinations, an extended mediolateral projection and a craniolateral-caudomedial oblique projection of each elbow joint were taken before surgery. Inspection of the medial part of the joint was carried out either by arthrotomy or arthroscopy. RESULTS: Seventy-two per cent of the dogs were German shepherd dogs. In 25 joints (16 per cent) a fragmented medial coronoid process was diagnosed and removed via arthrotomy or arthroscopy. The co-existence of a fragmented medial coronoid process was diagnosed correctly in only 13 cases (52 per cent) by radiography. In five of these cases with advanced osteoarthritis, the fragment was directly visible because of its dislocation. Compared with published information, the occurrence of ununited anconeal process with fragmented medial coronoid process is noted more frequently in the present study. CLINICAL SIGNIFICANCE: It can be summarised that if ununited anconeal process is present, it is not usually possible to clearly identify fragmented medial coronoid process by radiography. Therefore, it is important to be able to inspect the medial aspect of the joint concerned during surgery.     

Use of the distomedial-proximolateral oblique radiographic view of the elbow joint for examination of the medial coronoid process in dogs

OBJECTIVE: To describe and evaluate a new radiographic view of the elbow joint in dogs that would potentially enhance observation of the medial coronoid process (MCP). SAMPLE POPULATION: 20 cadaver limbs from 10 dogs and clinical examination of 100 elbow joints of 53 dogs. PROCEDURE: Twenty elbow joints from 10 cadavers were imaged by use of mediolateral, flexed mediolateral, craniocaudal, craniolateral-caudomedial oblique (Cr15L-CdMO), and distomedial-proximolateral oblique (Di35M-PrLO) radiographic views before and after placement of 3 lead pellets placed on the cranial, medial, and craniodistal aspect of the MCP. Three examiners independently reviewed these radiographs. One hundred elbow joints of 53 dogs with forelimb lameness and signs of pain elicited on palpation of the elbow joint were examined. These joints were radiographed and treated by use of arthroscopy. Three examiners independently graded the radiographs. RESULTS: The MCP was identified on all Di35M-PrLO views made during the anatomic study. The Di35M-PrLO view had the largest area under the receiving operating characteristic (ROC) curve for detection of abnormalities of the MCP. Fractured and nonfractured MCP could only be significantly differentiated on Di35M-PrLO and mediolateral views. The Di35M-PrLO view had a higher agreement between examiners than other radiographic views for detection of fractures of the MCP. CONCLUSION AND CLINICAL RELEVANCE: The Di35M-PrLO view enhances the identification of anomalies and fragmentation of the MCP in dogs, compared with other radiographic views. The Di35M-PrLO view may be of benefit for early screening of dogs potentially affected with elbow dysplasia.     

Arthrosis with special reference to the elbow joint of young rapidly growing dogs. II. Occurrence, clinical and radiographical findings.

Occurrence, clinical and radiographical findings in ununited medial coronoid process in the ulna and osteochondritis dissecans in the humeral condyle in dogs are presented. One hundred and twelve dogs were examined because of forelimb lameness. Lesions were mostly seen in young dogs of heavy breeds especially the Rottweiler. The ratio male: female was about 2:1. Most of the dogs had bilateral lesions. The lameness varied between grade 1 and 3, judged according to a scale ranging from 1 to 5. The affected limbs were somewhat rotated outwards from the elbow and down. Since the ununited coronoid process is almost impossible to detect on a plain radiograph, it is necessary to look for the presence of secondary developed osteophytes, indicative of an arthrosis. Diagnosis is based upon clinical and radiographical findings, the age and the breed of the dog taken into consideration. Osteochondritis dissecans in the humeral condyle is usually easily seen on the dorsopalmar radiograph.     

Osteochondrosis of the elbow joint in young dogs

Osteochondrosis is a failure of the normal process of endochondral ossification. In the elbow joint there are three manifestations of osteochondrosis, namely osteochondritis dissecans of the medial condyle of the humerus, ununited coronoid process and ununited anconeal process. This paper describes a series of sixty-eight cases diagnosed at a referral centre over a 10-year period. Ununited coronoid process and OCD of the medial condyle are not readily diagnosed because the lesions are difficult to demonstrate radiographically, but signs of degenerative joint disease of the elbow in young dogs of the medium to large breeds is strongly suggestive. Surgical treatment is indicated and the surgical approach to the medial aspect of the joint is described.     

Use of a radiographic scoring technique for the assessment of dogs with elbow osteochondrosis

A retrospective study was made of 335 dogs with elbow osteochondrosis that had been seen at the Royal Veterinary College in 1977 to 1987. The most commonly affected breeds were the labrador, retriever and rottweiler. Males were affected more often than females. The condition was bilateral in 50 per cent of cases and the peak age for the onset of lameness was four to six months. In rottweilers, the lesions found at exploratory arthrotomy were predominantly abnormalities of the coronoid process, while in retrievers and labradors lesions most commonly affected the medial humeral condyle or the coronoid process. A scoring system for grading the standard projection (lateral and postero-anterior) radiographs was devised and the score was correlated with the lesion found at surgery. Some cases were reviewed radiographically and any alteration in the degree of periarticular arthrosis, seen as an increase in radiographic score, was noted. The exact extent of the lesion found at surgery was recorded diagrammatically in 65 cases. It did not prove possible to predict from the radiographic score the nature and extent of the lesion and no correlation could be found between the radiographic score [and clinical degree of lameness. The scoring system did have some merit for reviewing cases because an increase in score indicated the extent to which joint changes had advanced.     

CORRELATION OF RADIOGRAPHIC, NECROPSY AND HISTOLOGIC FINDINGS IN 8 DOGS WITH ELBOW DYSPLASIA

Elbow dysplasia is osteoarthrosis/degenerative joint disease due to abnormal development of the elbow joint. The abnormaldevelopment is the result of specific inherited etiologies alone or in combination. This paper attempts to clarify the diagnosis of elbow dysplasia based on the presence of degenerative joint disease by correlating rediographic necropsy, necropsy, and histopathologic results using elbows from 8 German Shepherd dogs. All elbows had radiographic changes consistent with osteoarthrosis/degenerativejoint disease which were identified best on the flexedmedial-lateral projection. Radiographically, a specific diagnosis was made inseven elbows; ununited anconeal process(6) and osteochondrosis (1). At necropsy these lesions were confirmed plus 14 elbows were identified that had fragmented medial coronoid process (6), abnormally shaped medial coronoid processes of fissures in the articualr cartilage of the medial coronoid process (8). additionally, histopathologically there was proliferative synovitis at the radial notch of the ulna and degenerative changes on the proximal, nonarticualr surface of the anconeal process at the site of insertion of the olecranon ligament and joint capsule.Therefore, for screening the elbow joint to identify elbow dysplasia, the recognition of osteoarthrosis/degenerative joint disease on an extreme flexed mediolateral rediograph appears to be sufficient.     

Clinical features and heritability of osteochondrosis of the elbow in labrador retrievers

The occurrence of osteochondrosis in a breeding colony of labrador retrievers during an 11-year period was investigated. Management practices and environmental factors were similar for all dogs. In 1247 progeny, elbow lameness was recorded in 259 dogs (21 per cent) and lesions of osteochondrosis on the coronoid process and, or, medial condyle of the humerus were confirmed in 189 dogs (15 per cent). None of 39 labrador crossbred dogs were affected. The incidence in progeny varied between different sires and dams and was associated with the severity of radiographic evidence of elbow arthritis in sires and dams with dams contributing significantly more than sires, suggesting a ‘maternal’ effect.     

COMPUTED TOMOGRAPHIC FINDINGS OF DOGS WITH CUBITAL JOINT LAMENESS

The purpose of this study was to identify the incidence of abnormal computed tomography (CT) findings in dogs with lameness of one or both elbows. CT examinations of 102 elbows in 51 dogs were reviewed individually and by group consensus by 3 examiners and graded for various abnormalities. Frequently encountered abnormalities included abnormal shape and sclerosis of the medial coronoid process of the ulna, irregularity of the radial incisure of the ulna, and ulnar trochlear notch sclerosis. Other abnormalities included distinct/separate or fissure/in situ fragmentation of the medial coronoid; lucency of the radial incisure; ununited anconeal process; sclerosis, lucency, or flattening of the medial aspect of the humeral condyle; osteophyte formation; and joint incongruity. In conclusion, CT of the canine cubital joint is useful in identification of various lesions beyond simple fragmentation of the medial coronoid process of the ulna.     

Spectrum of computed tomographic findings in 58 canine elbows with fragmentation of the medial coronoid process

O bjective : To describe in detail the computed tomographic findings in elbows of dogs with fragmentation of the medial coronoid process of the ulna.
M ethods : Retrospective review of computed tomographic images of 58 elbows that had displaced medial coronoid process fragment(s), non-displaced medial coronoid process fragment or a stable fissure in the articular cartilage of the medial coronoid process at arthroscopy.
R esults : Bone fragments were observed in 85 per cent elbows with a displaced fragment at arthroscopy, in 18 per cent elbows with a non-displaced fragment and in 29 per cent elbows with a stable fissure. Fissures in the subchondral bone were observed in computed tomographic images of 43 per cent elbows that had a stable fissure at arthroscopy. Abnormal shape, sclerosis and lucency affecting the medial coronoid process, subchondral sclerosis of the ulna and humerus, irregular radial incisure of the ulna and periarticular osteophytes were observed in a similar proportion in dogs regardless of the arthroscopic findings. Kissing lesions affecting the medial aspect of the humeral condyle were mainly associated with displaced fragments. Signs of joint incongruity were observed in dorsal and sagittal reconstructed computed tomographic images in 24 per cent elbows.
C linical S ignificance : A wide range of abnormalities may be observed in computed tomographic images of dogs with fragmented medial coronoid process. Computed tomographic is moderately sensitive for detection of fragments.     

THE SUPINATED MEDIOLATERAL RADIOGRAPH FOR DETECTION OF HUMERAL HEAD OSTEOCHONDROSIS IN THE DOG

Mediolateral and supinated mediolateral radiographs of the shoulder joint were compared in 19 dogs. Twenty shoulders, representing 15 dogs (5 had bilateral lesions), had osteochondrosis of the humeral head. The flattened humeral head and subchondral defect were detectable in both views in all affected shoulders. The lesions were slightly more easily detected in the supinated view. The supinated view more consistently demonstrated the presence of a calcified cartilage flap and therefore, could be useful in determining a course of therapy. In four dogs (8 shoulders) without osteochondrosis and six normal shoulders from affected dogs, there were no instances in which a shoulder appeared normal on one view, but demonstrated a lesion on the other. The supinated view should be obtained in addition to the mediolateral view in dogs with osteochondrosis of the humeral head.     

Prevalence of fragmented medial coronoid process of the ulna in lame adult dogs

Over a period of three years, a diagnosis of fragmented medial coronoid process of the ulna was confirmed by arthroscopy in 263 dogs, in 69 of which both elbow joints were affected, giving a total of 332 affected joints; 39 of the joints were also affected by osteochondrosis dissecans of the trochlea of the humerus. More than half of the dogs (51.7 per cent) were over one year old when first examined. In 259 (78 per cent) of the joints there were radiographic changes of secondary osteoarthrosis of different severity, but the other 73 (22 per cent) had no signs of osteophytosis except for a mild sclerosis. Among these 73 there were 14 joints in 13 dogs between 19 and 36 months old and 11 joints in 10 dogs over three years old. A further 12 joints in 11 dogs over three years old showed only mild arthrosis. In five of the 11 joints of the dogs over three years old which had no radiological signs of arthrosis, the fragment was already dislocated. Among the dogs over 18 months old with no arthrosis and the dogs over three years old with mild arthrosis, the most commonly affected breeds were the Bernese mountain dog, rottweiler and boxer.     

Magnetic resonance arthrography of the cubital joint in dogs affected with fragmented medial coronoid processes

OBJECTIVE: To evaluate efficacy of intra-articular injection of gadolinium tetra- azacyclododecane tetraacetic acid (gadolinium-DOTA) for delineating fragmented medial coronoid processes (FMCP) and lesions on the medial aspect of the humeral condyle (MAHC). SAMPLE POPULATION: 14 cubital joints in 9 dogs. PROCEDURE: Magnetic resonance imaging (MRI) was performed with and without intra-articular injection of a solution of 2 mmol of gadolinium-DOTA/L. Arthrographic images obtained after injection of contrast medium were compared with those obtained without contrast medium. Evidence of contrast medium around or in the medial coronoid process and infiltration of contrast medium in subchondral bone lesions was recorded. Twenty-four hours after imaging, arthroscopy was performed, and lesions detected were correlated with results of MRI. RESULTS: An abnormal coronoid process was diagnosed in 13 of 14 joints. A fragmented process (free) was seen in 7 of 14 joints; nondisplaced mineralized medial (in situ) coronoid processes were evident in 4 joints; and nondisplaced unmineralized medial coronoid processes were evident in 2 joints. Lesions on the MAHC were diagnosed in 4 of 12 joints. In 5 joints, a hyperintense signal resulted from contrast medium that infiltrated between the fragmented process and ulna. In 2 joints, contrast medium did not infiltrate completely around the process and was stopped by an isointense structure (ie, abnormal cartilage). Subchondral bone lesions were enhanced by use of contrast medium. CONCLUSION AND CLINICAL RELEVANCE: Use of arthrography enabled us to identify FMCP easily, but did not provide important additional information about changes on the medial coronoid process, compared with MRI performed without contrast medium.