Congenital elbow luxation in the dog

Four cases of bilateral and two cases of unilateral congenital elbow luxation in the dog were reviewed. In all cases, lameness was severe, osseous abnormalities were marked, and the dislocations primarily involved the humeroulnar articulation. Treatment consisted of closed reduction and external support in one dog and surgical reduction and stabilization in four dogs. One dog died before surgery could be performed. Treatment resulted in return of function to the affected limbs, even though osseous abnormalities and varying degrees of malarticulation persisted. Posttreatment observations, for as long as 4 years, demonstrated the persistence of near normal function of the limbs and minimal elbow deformity.     

Bilateral angular carpal deformity in a dog with craniomandibular osteopathy

A four-month-old West Highland White Terrier was presented to the Small Animal Teaching Hospital at the University of Liverpool with the complaint of a bilateral angular carpal deformity. A 20° valgus deformity was present in both thoracic limbs, centred on the distal radial physes. Both distal ulnas were grossly thickened and there was concomitant thickening of the rostral mandible and calvarium. The dog exhibited signs of resentment on palpation of the mandible and signs of pain were elicited on flexion and extension of both elbow joints. No signs of pain were evident on palpation of the ulnas or calvarium. Radiographic images of both ulnas showed marked amorphous periosteal new bone formation. The distal ulnar physes were closed centrally and both elbow joints had humeroulnar subluxation. Radiographic changes to the calvarium and mandibular rami were consistent with a diagnosis of craniomandibular osteopathy. A bilateral ulna ostectomy was performed to correct the angular limb deformity and elbow subluxations. Histology of the ostectomised pieces showed changes consistent with craniomandibular osteopathy.     

Ulnocarpal arthrodesis for the treatment of radial agenesis in a dog.

Forelimb deformity caused by radial agenesis was diagnosed in a one-year-old Shih Tzu dog. In contrast to most of the previously reported cases of radial agenesis, the humeroulnar joint was inherently stable. The deformity was treated by means of a one-stage ulnocarpal arthrodesis with the application of an eight hole dorsolateral arthrodesis bone plate and autogenous corticocancellous bone graft from the ilial wing. Radiographic evaluation at the eighth and sixteenth post-operative week showed evidence of union of the arthrodesis. At sixteen weeks post-operatively, the dog had much improved limb function. In humans afflicted with radial agenesis, ulnocarpal arthrodesis is used to restore forearm function by minimizing pain and decreasing the magnitude of angular deformity and instability at the level of the ulnocarpal joint. However, to our knowledge, this is the first report of treatment of radial agenesis in the dog by means of a one-stage, ulnocarpal arthrodesis.     

A novel surgical treatment of type 3 congenital elbow luxation in a dog

Congenital luxation of the ulnar and radius is a rare orthopaedic condition in the dog. This case report describes a novel surgical treatment for congenital elbow luxation in a medium-breed dog. A 6-week-old Kelpie presented for left forelimb lameness and deformity. Radiographs and computed tomography (CT) confirmed the diagnosis of unilateral ulnar and radius luxation. The surgical repair involved open reduction followed by fixation with an extraarticular pin and a transarticular external fixator. The outcome of surgery was improved leg function and weight-bearing, however, reluxation of the radial head was diagnosed 7 weeks following surgery. This technique may offer an alternative surgical option to improve clinical signs, as well as insight into improving the management of this condition.     

Type IV Monteggia fracture in a cat

A one-year-old neutered male cat was referred for a grade IIIA open radius and ulna fracture. The mid-diaphyseal radial and ulnar fractures were associated with lateral radio-humeral and radio-ulnar dislocations. From these abnormalities, a diagnosis of type IV Monteggia fracture was made. The annular ligament was found to be intact on examination and the radial head was correctly positioned and stable after fracture reduction and plate fixation. Eighteen months postoperatively, the cat did not exhibit any signs of lameness or any signs of pain on palpation and mobilisation. Signs of mild osteoarthritis were present on radiographs. Type IV Monteggia fractures are very rare in animals. The combination of a radial head dislocation with an intact annular ligament is uncommon. This pattern allowed a single reconstruction with two plates without a radio-ulnar screw.     

Reduction of humeroulnar congenital elbow luxation in 8 dogs by using the transarticular pin

The purpose of this study was to evaluate the clinical and radiographic outcome in 8 dogs of surgical reduction of congenital humeroulnar luxation by using the transarticular pin. Five cases were bilateral and 3 were unilateral, for a total of 13 elbows. The treatment was performed in animals between 45 and 150 days of age. Articular stabilization was achieved by using a transarticular pin driven from the caudal aspect of the olecranon into the body of the humerus or into the distal condyle and distal metaphysis of the humerus. The follow-up period was between 1 and 19 months. There were 5 postsurgical reluxations, 3 related to the insertion of the pin into the humeral condyle and 2 related to the insertion into the humeral body. These animals needed further surgery. Six animals showed near normal return to limb function and 2 had lameness. We conclude that the use of the transarticular pin is an effective and simple method for the treatment of humeroulnar congenital elbow luxation.     

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.     

Presumptive congenital radial head sub‐luxation in a shih tzu: successful management by radial head ostectomy

Congenital radial head sub‐luxation was diagnosed in a 7‐month‐old, neutered male shih tzu that presented with a limb deformity and severe lameness of the right fore limb. Radiography revealed a craniolateral sub‐luxation of the right radial head, which was treated by radial head ostectomy, fixation of the radius to the ulna with a screw and joint stabilisation with suture‐anchors and cerclage wire. Surgical treatment followed by physiotherapy resulted in a fully functional, well‐aligned and non‐painful elbow. To the authors’ knowledge this is the first case report of a congenital radial head sub‐luxation in a craniolateral direction in a dog and also one successfully managed with radial head ostectomy and radioulnar synostosis.     

Traumatic partial elbow luxation in a dog

Traumatic partial elbow luxation (unilateral medial humeroulnar) was diagnosed in a 2.5-year-old crossbreed dog. Previous reports of traumatic elbow luxation in the dog described lateral and less frequently medial humeroradioulnar luxations. The treatment consisted of closed reduction of the affected joint under general anaesthesia. The functional outcome was excellent.     

In vitro determination of contact areas in the normal elbow joint of dogs

OBJECTIVE: To evaluate areas of articular contact of the proximal portions of the radius and ulna in normal elbow joints of dogs and the effects of axial load on size and location of these areas. SAMPLE POPULATION: Forelimbs obtained from cadavers of 5 adult mixed-breed dogs. PROCEDURE: After forelimbs were removed, liquid-phase polymethyl methacrylate was applied to articular surfaces of the elbow joint, and limbs were axially loaded. Articular regions void of casting material were stained with water-soluble paint. Relative articular contact areas were determined by computer-assisted image analyses of stained specimens. Repeatability of the technique was evaluated by analyses of casts from bilateral forelimbs of 1 cadaver. Incremental axial loads were applied to left forelimbs from 4 cadavers to determine effects of load on articular contact. RESULTS: Specific areas of articular contact were identified on the radius, the craniolateral aspect of the anconeus, and the medial coronoid process. The medial coronoid and radial contact areas were continuous across the radioulnar articulation. There was no articular contact of the medial aspect of the anconeus with the central trochlear notch. Coefficients of variation of contact areas between repeated tests and between contralateral limbs was < 20%. Significant overall effects of axial load on contact area or location were not identified. CONCLUSIONS: Three distinct contact areas were evident in the elbow joint of dogs. Two ulnar contact areas were detected, suggesting there may be physiologic incongruity of the humeroulnar joint. There was no evidence of surface incongruity between the medial edge of the radial head and the lateral edge of the medial coronoid process.     

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.     

Radiographic assessment of humeroulnar congruity in a medium and a large breed of dog

Elbow joint incongruity is recognized as an important factor in the development, treatment, and prognosis of canine elbow dysplasia. Elbow incongruity has been measured based on radiographic joint space widths, however these values can be affected by the degree of elbow joint flexion. Recent studies have reported radiographic curvature radii as more precise measures of humeroulnar congruity in dogs. The aim of this prospective observational study was to describe radiographic curvature radii measured from flexed and extended elbow radiographs for a sample of dogs representing a medium breed (Portuguese Pointing Dog) and a large breed (Estrela Mountain Dog). The curvature radii from the ulnar trochlear notch and humeral trochlea were measured in 114 mediolateral elbow extended radiographic views (30 Portuguese Pointing Dog and 27 Estrela Mountain Dog), and 84 mediolateral flexed views (22 Portuguese Pointing Dog and 20 Estrela Mountain Dog). The sampled animals' ages ranged from 12 to 84 months (34.6 ± 17.8 months). Good agreement was observed between curvature radii measurements for flexed vs. extended views in both breed groups. Ulnar trochlear notch curvature radii measurements were greater than humeral trochlea curvature radii measurements in both breed groups. Both curvature radii were greater in the large‐breed dog group vs. the medium‐breed dog group. Both breed groups had ulnar and humeral curves with similar typology. However, the large breed group had greater intermediate differences between the humeroulnar surface curvature radii. Results from this study supported the use of curvature radii as measures of humeroulnar congruity in mediolateral flexed elbow radiographs of medium and large breed dogs.     

Unilateral congenital elbow luxation in a dachshund

Congenital elbow luxation was diagnosed in a 12-week-old, intact male, dachshund with a lateral elbow prominence and mild lameness of the right forelimb. Closed reduction of the radial head, ulnar ostectomy, and external stabilization of the joint were performed. Function was returned to the limb, but radial head and ulnar subluxation persisted.     

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.     

Bilateral radial hemimelia and multiple malformations in a kitten

Hemimelia is a congenital disease of complete or partial absence of one or more bones. The most important hypothesis is that radial agenesis is a consequence of neural crest injury. Treatment selection depends on the degree of the deformity and the reduction of limb function. This report describes a case of bilateral radial hemimelia and multiple malformations in a kitten aged 2 months treated conservatively with splint bandage, until bone maturity. The re-evaluation was performed 4 years later.     

A case of unilateral pelvic limb adactyly in a puppy dog

A case of unilateral hindlimb adactyly is described in a 3-month-old female Pointer dog. Clinical and radiographic findings are described. Adactyly or transverse hemimelia is a rare condition in most animal species. In dogs, this condition has been reported only three times as a deformity of the forelimb. To the authors' knowledge, the congenital pelvic limb deformity described here is the first case documented in a dog.     

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.     

Asynchronous growth of the canine radius and ulna: effects of retardation of longitudinal growth of the radius.

After 2,000 rads of x-radiation to the right distal radial physis of eight 70-day-old dogs, the longitudinal growth of the right radius was retarded 42.1% when compared with the growth of the nonirradiated left radius. Asynchronous growth of the right radius and ulna resulted. The gross and radiographic changes that occurred over the subsequent 75 days were described. Subluxation of the humeroradial and humeroulnar joints occurred and was first observed 31 days after irradiation. By 75 days after irradiation, the radius was puller 7.8 mm distally by the radioulnar ligament. However, subluxation of the humeroradial joint was minimized by accelerated growth from the proximal radial physis and articular cartilage. Acceleration of growth also occurred at the distal radial articular cartilage. Growth from the distal ulnar physis and styloid process was retarded. It was thus apparent that after retardation of growth from the distal radial physis, considerable adjustment occurred in the relationship between the radius and the ulna and also in growth from their other physes, which reduced the deleterious effects of the growth retardation.     

Surgical Management of Lateral Luxation and Subluxation of the Canine Radial Head

The causes and pathogenesis of radial head luxation and subluxation are reviewed. A surgical technique is described for repair of the condition that permits direct visualization of the joint, reestablishment of normal joint anatomy by ulnar osteotomy, and stabilization of the radioulnar articulation with a lag screw. Two clinical cases are presented.