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.     

In vitro validation of a technique for assessment of canine and feline elbow joint collateral ligament integrity and description of a new method for collateral ligament prosthetic replacement

Objective— To assess the ability of an operator to differentiate intact from transected canine and feline elbow joint collateral ligaments (CL) using a reported manipulative test (Campbell's test) and to determine the potential for elbow joint luxation in canine and feline elbows with intact, transected, and surgically stabilized CL. Study Design— In vitro biomechanical study. Sample Population— Canine (n=6) and feline cadavers (n=3). Methods— Thoracic limb specimens were mounted on a custom‐built jig with the elbows and carpi fixed in 90° of flexion. Angles of pronation and supination were recorded after applying rotational forces to the manus. Attempts were made to manually luxate each elbow with intact CL. Constructs were re‐evaluated after sequential sectioning of the medial (MCL) and lateral (LCL) collateral ligaments and after insertion of a new CL prosthesis. Results— Mean (±SD) angles of rotation in dogs increased from 27.3±8° (range, 16.7–41.3°) in pronation to 58.9±9.2° (range, 38–88.3°) after sectioning the MCL and from 45.5±10.8° (range, 30.7–67.3°) in supination to 68.9±17.2° (range, 45–94°) after sectioning the LCL. Angles of pronation and supination were subject to significant interanimal variability, with a strong correlation between increasing animal weight and smaller angles of rotation. Elbow luxation in dogs was not possible unless at least the LCL was transected. In cats, mean angles of rotation increased from 49.8±14.9° (range, 30.7–70°) in pronation to 99.1±17.6° (range, 79–111.7°) after sectioning the MCL and from 128.7±18.8° (range, 108.3–151.7°) in supination to 166.7±13.1° (range, 157.3–181.7°) after sectioning the LCL. Luxation in cats was not possible unless both CL were cut. Use of the ligament prosthesis without primary CL repair reliably prevented reluxation in all canine and feline elbows. Conclusions— Campbell's test allowed reliable differentiation of intact, transected and surgically stabilized canine and feline elbow joint CL in a cadaveric model. Luxation could not be performed by application of rotational forces to specimens with intact CL. Clinical Relevance— Clinical examination findings, specifically Campbell's test, can be used to determine elbow CL integrity in dogs and cats. The contralateral elbow should be used as a control, because of interanimal variability in angles of rotation.     

Evaluation of a canine total-elbow arthroplasty system: a preliminary study in normal dogs

OBJECTIVE: Short-term, in vivo evaluation of a total-elbow arthroplasty (TEA) system in normal dogs. STUDY DESIGN: Prospective evaluation comparing pre- and postoperative findings. ANIMALS: Six normal, skeletally mature, large-breed dogs. METHODS: Physical, radiographic, and force-plate gait examinations were performed on all dogs before surgery. TEA was performed in the dogs using a canine TEA system. Examinations were repeated every 8 weeks for 24 weeks, with an additional examination at 52 weeks. Pre- and postoperative findings were compared. RESULTS: The TEA led to an excellent outcome in 3 of 6 dogs. Force-plate gait examination found that the dogs continued to improve over time and had a peak vertical force (PVF) in the surgical limb that was 99.6% of normal (range, 95.8% to 106.4%) 52 weeks after surgery. Major problems encountered during the postoperative time period were non-weight-bearing lameness (1 dog), osteomyelitis (1 dog), and fracture of the ulna (1 dog). CONCLUSIONS: TEA can be successfully performed in dogs. CLINICAL RELEVANCE: Based on 1-year data, TEA can be successfully performed in dogs and could be considered as a treatment alternative for adult dogs with severe osteoarthritis and lameness of the elbow joint.     

Computed tomographic evaluation of canine radioulnar incongruence in vivo

OBJECTIVE: To compare radioulnar incongruence (RUI) of normal canine elbows and elbows with arthroscopically confirmed medial compartment disease in vivo using systematic computed tomography (CT) measurements. STUDY DESIGN: Prospective comparison of RUI measurements in normal and dysplastic canine elbows. SAMPLE POPULATION: Right elbows of 25 medium-large breed, adult dogs with medial compartment disease and 9 medium-large breed, adult dogs with no elbow disease. METHODS: Transverse CT images of proximal radioulnar articulation were reformatted to dorsal and sagittal planes. RUI in 3 locations of the forelimb's medial coronoid was measured. Arthroscopy confirmed diagnosis of medial compartment disease in the diseased group. RUI measurements of the diseased and normal elbows were compared. RESULTS: Cumulative statistical analysis of RUI in all planes revealed no significant difference between the normal and abnormal elbows (P = .61). The abnormal elbows had negative mean RUI at the mid (P = .56) and cranial (P = .24) coronoid regions that were not significantly different from normal elbows and mean positive RUI at the base coronoid that was significantly greater than in normal elbows (P = .00082). CONCLUSION: Canine elbows with established medial compartment disease do not have significant RUI at the medial coronoid region at the time of diagnosis when compared with normal elbows. CLINICAL RELEVANCE: If RUI is a significant factor in the pathophysiology of medial compartment elbow disease in the dog, it does not appear to be present at the time of diagnosis of disease. Ulnar or radial osteotomies do not appear to be indicated for restoration of normal radioulnar articular surface alignment.     

Effect of humeral osteotomy on joint surface contact in canine elbow joints

OBJECTIVE: To determine the effect of sliding and wedge osteotomies of the humerus on the joint surface contact areas in anatomically normal elbow joints of dogs. SAMPLE POPULATION: Left thoracic limbs from 5 skeletally mature mixed-breed canine cadavers. PROCEDURE: Joint casting was performed by placement of colored polymethylmethacrylate in the elbow joint cavity followed by loading in a materials testing system at physiologic angle and load. Joint casting was performed in unaltered specimens, after 10 degrees medial opening wedge osteotomy, and after lateral sliding osteotomy of the proximal portion of the humerus. Computer-aided analysis of photographs of proximal radial and ulnar articular surfaces after each casting procedure was performed. RESULTS: The lateral sliding humeral osteotomy and 10 degrees medial opening wedge osteotomy significantly altered joint surface contact regions of the canine elbow joint. Osteotomies resulted in a reduction in the size of the radial, ulnar, and combined radioulnar contact areas. Both osteotomies also resulted in craniolateral migration of the radial contact area and craniomedial recession of the ulnar contact area. Although the reduction in ulnar contact area with these treatments is consistent with our hypotheses, the reduction in radial contact area was not anticipated. CONCLUSIONS AND CLINICAL RELEVANCE: Humeral osteotomies alter joint surface contact areas of the canine elbow joint in vitro. Humeral osteotomies may decrease contact areas on the diseased region of the joint in dogs with elbow dysplasia; however, the overall decrease in joint surface contact area suggests that these procedures may induce focal increases in pressure that may cause iatrogenic cartilage damage when applied in vivo.     

Computed tomographic features of incomplete ossification of the canine humeral condyle

Objectives— To describe computed tomographic (CT) features of canine elbows with incomplete ossification of the humeral condyle (IOHC) and investigate co-existing incongruence in the elbow joint.
Study Design— Case control study.
Animals— Dogs with IOHC (n=20; 38 elbows) and 25 normal elbows.
Methods— Elbows with IOHC and normal elbows were assessed by CT. Standardized dorsal and sagittal reconstructions were created at 3 levels using image analysis software to obtain single measurements of the humero-radial and humero-ulnar joint spaces. On dorsal plane reconstructions, joint space measurements were obtained at the center point of the humero-radial and humero-ulnar articulations. Joint incongruity was defined as the difference between the humero-radial and the humero-ulnar joint spaces.
Results— Nineteen dogs (95%), all Spaniel breeds, had either bilateral IOHC demonstrable as a saw-toothed intercondylar complete or incomplete hypoattenuating defect with hyperattenuating margins, or IOHC with contralateral humeral condylar fracture (HCF). Joint incongruity values for IOHC were compared with those of normal elbows. Significant differences were noted at the levels of the medial coronoid apex ( P <.0001) and base ( P <.004) indicative of humero-ulnar incongruence. Evidence of medial coronoid disease in 10 elbows (26%) and degenerative joint disease in 30 elbows (79%) was also found.
Conclusions— Presence of elbow incongruence may be an underlying factor in failure of ossification centers to fuse leading to IOHC.
Clinical Relevance— IOHC is clearly defined by CT, and it should be considered in larger Spaniel breeds, with a chronic forelimb lameness or HCF.     

COMPUTED TOMOGRAPHIC ARTHROGRAPHY OF THE NORMAL CANINE ELBOW

Comprehensive evaluation of canine elbow joint dysfunction includes assessment of articular cartilage, which can noninvasively be performed with contrast arthrography. Aims of this prospective study were to compare positive contrast computed tomographic (CT) arthrography and histomorphometry measures of cartilage thickness in normal canine elbows, and to determine the optimal contrast medium concentration. Thirty‐two canine cadaver elbows were examined using multidetector CT, before and after intra‐articular administration of iohexol at one of three different concentrations. Articular cartilage thickness was measured on both the CT arthrography images and corresponding histologic specimens. Mean difference (bias) between the CT arthrography and histomorphologic measurements was 0.18 and 0.19 mm in the sagittal and dorsal planes, respectively. Mean bias and precision of CT arthrography measurements made in the sagittal or dorsal reformations were not significantly different from one another. Computed tomographic arthrography measurements from elbows with 75 mg I/ml were significantly larger and had greater bias compared to other contrast medium groups (150 and 37.5 mg I/ml). There was no significant difference in CT arthrography measurement precision between different contrast medium concentrations. Histomorphologic thickness of the articular cartilage overlying the cranial aspect of the ulna (mean 0.32 mm) was significantly thinner than cartilage of the radius (0.36 mm) or humerus (0.36 mm). Findings from this cadaver study indicated that CT arthrography delineates articular cartilage of the normal canine elbow; yields cartilage thickness measures slightly greater than histomorphometry measures; and provides high measurement precision regardless of image plane, contrast medium concentration, or anatomic zone.     

Intraarticular injection of a Tin‐117 m radiosynoviorthesis agent in normal canine elbows causes no adverse effects

This longitudinal prospective exploratory study used serial measurements in five dogs to evaluate safety and retention of a tin‐117 m (^117mSn) colloid after intra‐articular injection in normal elbow joints. Each dog was deemed healthy based on physical examination, laboratory results, and radiographic evaluation of both elbows. While anesthetized, each received an MRI of both elbows, followed by fluorine‐18 fluorodeoxyglucose positron emission tomography scans of both elbow joints and associated lymph nodes. Joint fluid (0.5‐1.0 mL) was withdrawn aseptically from the left elbow joint, followed by intra‐articular injection of ^117mSn colloid (92.5 MBq; 1‐1.5 ml). Post‐injection assessments included blood counts, serum chemistry panels, urinalyses, radiographs, joint fluid analyses, MRI/positron emission tomography scans, scintigraphy, and biodistribution scans. On day 45‐47, each dog was euthanized and a complete postmortem examination was performed. Tissue samples were submitted for histopathology and radioisotope retention studies. Left elbow joints were decalcified and sectioned for future autoradiography. Scintigraphy, 1 day after injection, indicated slight radioisotope escape from the joint to regional lymph nodes. Serial blood, urine, feces, and organ counts indicated >99.1% of the ^117mSn activity was retained in the joint for 45‐47 days. Radiation output levels were below patient release levels the day following injection. Maximum standard uptake value for the injected joint decreased. Joint fluid cytology was unchanged. No dog exhibited lameness during the study. Absence of joint damage and lack of systemic effects after injection of the ^117mSn colloid in normal canine elbow joints indicate that this agent may be safely used for radiosynoviorthesis in dogs with osteoarthritis.     

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.     

Short-term outcome after total elbow arthroplasty in dogs with severe, naturally occurring osteoarthritis

OBJECTIVE: To evaluate limb function in client-owned dogs before and after total elbow arthroplasty (TEA) for severe, naturally occurring osteoarthritis (OA). STUDY DESIGN: Prospective clinical evaluation comparing limb function before and after surgery. ANIMALS: Twenty adult, large breed dogs with elbow OA. METHODS: Physical, radiographic, and force platform gait examinations were performed on all dogs before surgery. TEA was performed, and examinations were repeated at 3, 6, and 12 months after surgery. Pre- and postoperative findings were compared. RESULTS: TEA led to a satisfactory outcome in 16 dogs. In dogs with a satisfactory outcome, function in the operated limb increased over time, with mean peak vertical force (PVF) and vertical impulse (VI) 1 year after surgery being nearly twice the presurgical value. Serious complications encountered included infection (n = 2), luxation (n = 1), and fracture of the humeral condyle (n = 1). CONCLUSIONS: Although TEA, as presented, has significant limitations, it can be successfully performed in dogs with naturally occurring elbow OA. Improvements in technique and implant design should lead to improved prognosis. CLINICAL RELEVANCE: Based on 1-year data, TEA can be successfully performed in dogs and should be considered as a treatment alternative for adult dogs with lameness from severe OA of the elbow joint.     

Use of reconstructed computed tomography for the assessment of joint spaces in the canine elbow

OBJECTIVES: To assess the accuracy of reconstructed computed tomography for imaging canine elbow joint spaces. METHODS: Computed tomography scans of eight cadaveric elbows were obtained and reconstructed computed tomography images were formatted in the dorsal and sagittal planes. Humeroradial and humeroulnar joint space measurements were obtained from these images. Intra-observer and inter-observer variations in joint space measurements were assessed, as was the effect of specimen positioning (inter-image variation). After freezing, four elbows were sectioned in the dorsal plane and four in the sagittal plane. In addition to visual comparison of the frozen sections with reconstructed computed tomography images, joint space measurements were obtained from frozen sections and compared with those from reconstructed computed tomography images. Variation was assessed using statistical calculations and graphical techniques. RESULTS: Both inter-image and intra-observer analyses revealed good agreement and low variation between data sets. Inter-observer correlation was only moderate, though variation was low. Visually, the reconstructed computed tomography images accurately reflected the frozen section anatomy. Agreement between frozen section and reconstructed computed tomography joint space measurements was good, with minimal variation. CLINICAL SIGNIFICANCE: These results indicate that reconstructed computed tomography is capable of accurately imaging elbow joint spaces and precise joint space measurements can be obtained. Reconstructed computed tomography may be useful for determining joint space measurements and detecting elbow incongruencies in dogs with elbow dysplasia.     

Sensitivity of radiographic evaluation of radio-ulnar incongruence in the dog in vitro

OBJECTIVE: To determine the sensitivity and specificity of radiographic evaluation of radio-ulnar incongruence in canine elbow joints in vitro. STUDY DESIGN: Radiographic evaluation of induced radio-ulnar incongruence in canine cadaveric forelimbs by radiologists blinded to study design. SAMPLE POPULATION: Six cadaveric canine left forelimbs. METHODS: Extended lateral, 90 degrees flexed lateral, and cranio-caudal projections were taken of the elbow joint of six cadaveric canine forelimbs. A four-pin, type I external skeletal fixator (ESF) with a linear motor side bar was attached to the medial aspect of the radius, and a 2-cm segment of bone was removed from the mid-diaphysis. A 3.5-mm cortical bone screw placed from the medial to lateral styloid processes prevented relative movement between the distal radius and ulna during radial shortening. The ESF was used to progressively shorten the radius in increments of 0.5 mm to a total of 4 mm. The three radiographic projections were repeated after each incremental change of length. After the study, each elbow joint was disarticulated to confirm the presence of a step defect. The original radiographs and three copies were randomized and then evaluated by four radiologists blinded to the study design. Radiologists were asked to evaluate whether the joint was normal or abnormal and if there was evidence of radio-ulnar incongruence. The ability of each radiologist to correctly identify congruent elbows (specificity) and incongruent elbows (sensitivity) was calculated. RESULTS: The median specificity was 86% using the lateral projection and 82% using the cranio-caudal projection. The median sensitivities using the lateral and cranio-caudal radiographic projections were 78% and 79%, respectively. The degree of radial shortening required for individual radiologists to achieve a sensitivity of 90% ranged from 1.5 mm to greater than 4 mm. CLINICAL RELEVANCE: Standard radiographic evaluation for radio-ulnar incongruence in the dog may be associated with relatively poor sensitivity and specificity. Invasive surgical procedures and screening programs that rely on radiographic diagnosis of radio-ulnar incongruence should be discouraged until a more reliable method of diagnosis of this type of elbow joint incongruence is available.     

SENSITIVITY AND SPECIFICITY OF RADIOGRAPHIC DETECTION OF CANINE ELBOW INCONGRUENCE IN AN IN VITRO MODEL

Canine elbow incongruence is believed to be the consequence of underdevelopment of the radius. The purpose of this study is to determine the sensitivity and specificity of radiography to detect elbow incongruence in an in vitro model and to assess the optimal elbow angle and radiographic beam position. Five normal cadaveric canine left forelimbs were used. A four-pin, type 1 external fixator with a linear motor side bar was fixed to the cranial part of the radius of each limb and a 1 cm segment of bone was removed from the mid-diaphysis to allow radial shortening. Each elbow was subjected to the same protocol. They were radiographed at two different angles (90 degrees and 135 degrees) of flexion, with 10 different radiographic beam positions (centered on the humeral condyle, 3 cm cranial, 3 cm caudal, 3 cm distal, 3 cm proximal, 3 cm cranio-proximal, 3 cm cranio-distal, 3 cm caudo-proximal, 3 cm caudo-distal and on the shoulder joint) and at four different level of radial shortening (0, 1, 2 and 3 mm). In addition, a radiographic view centered on the elbows flexed at 135 degrees was made after simulating weight bearing. The acquired digital images were independently evaluated by three evaluators unaware of the elbows status. The elbows were judged normal, incongruent or borderline based on specific criteria. The sensitivity for detection of elbow incongruence at and beyond 2 mm was excellent at 90 degrees (median = 100% for all views) and good at 135 degrees (median = 80%) of flexion with no difference between examiners. The sensitivity at 1 mm of incongruence was unchanged at 135 degrees but was reduced at 90 degrees of flexion (median = 60%) with a significant difference between the evaluators. The specificity was significantly different between the evaluators and ranged from 70% to 90% at 90 degrees of flexion and from 50% to 80% at 135 degrees. The lowest specificities at 90 degrees were obtained with the proximal displacements of the X-ray beam. Simulating weight bearing significantly decreased the sensitivity at 1 mm (from 80% to 50%) and 3 mm (from 100% to 80%) of incongruence and slightly increased the specificity (from 55% to 65%). Radiography is a sensitive and specific test to detect moderate-to-severe radio-ulnar incongruence (2 mm and over) if the elbow is flexed at a 90 degrees angle regardless of the radiographic beam position. Finally, canine elbow incongruence appeared reduced after an in vitro weight-bearing simulation.     

Traumatic elbow luxation in 14 dogs and 11 cats

Objective To report the presentation and treatment of traumatic elbow luxation and to evaluate success following closed or open reduction. Design Retrospective case series conducted between April 1999 and April 2009. Methods Records of 14 dogs and 11 cats were reviewed for signalment, history, radiographic findings and treatment; 14 owners were contacted via phone questionnaire to assess for limb function following treatment. Fisher's two‐tailed P test was used to evaluate potential risk factors for lameness. Results The majority of luxations were caused by car accident and 96% of the cases luxated in a lateral direction. Closed reduction was successful in all cats and 11 dogs; 3 dogs required open reduction. Owners rated the animals' limb function as excellent (71%), good (7%), fair (22%) or poor (0%). All cats were rated excellent. An excellent result following closed reduction was achieved in 67% of canine cases. All cases of open reduction achieved fair results. All owners were satisfied with the outcome. No risk factors were significantly associated with post‐reduction lameness. Conclusions Elbow joints with good stability following closed reduction have a favourable outcome. Poor stability following closed reduction is an indication for surgery. Results suggest that cats tolerate elbow luxation better than dogs.     

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.     

Correlation of ultrasonographic observations with anatomic features and radiography of the elbow joint in dogs

OBJECTIVE: To define the ultrasonographic appearance of the elbow joint of dogs and to develop an ultrasonographic imaging protocol to reliably accomplish complete evaluation of that joint. ANIMALS: 11 clinically normal mixed-breed dogs. PROCEDURE: Ultrasonographic observations (by use of a 5 to 10 MHz linear array probe) were made of 22 elbow joints in cadaveric forelimbs from clinically normal dogs. Images in standard anatomic planes were recorded with a multi-image camera, on videotape, or onto a computer. The anatomic plane of the ultrasonographic beam and position of the ultrasonographic probe were also recorded. Dissection of each elbow joint was performed, and anatomic features were correlated with ultrasonographic images. RESULTS: Structures clearly identified ultrasonographically included the lateral and medial humeral epicondyles, the humeroradial and humeroulnar joints, anconeal process, medial coronoid process, hyaline cartilage covering the proximal articular surface of the radius, collateral ligaments, tendons of triceps brachii and supinator muscles, and the supinator tendon and sesamoid in the supinator cartilage. An ultrasonographic imaging protocol for examination of the elbow joint was developed. CONCLUSIONS AND CLINICAL RELEVANCE: Precise correlations were established between the gross anatomic appearance of the elbow joint and the ultrasonographic images of its component structures. The ultrasonographic imaging protocol will enable complete examination of all regions of the joint for detection of pathologic lesions.     

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.     

Postamputation Orthopedic Surgery in Canine Amputees: Owner Satisfaction and Outcome

Surgical management of postamputation orthopedic disease (PAOD) in canine amputees has rarely been documented, and no reports describing outcome of stifle surgery in canine amputees are available. The objective of this multisite retrospective case series was to describe cases and evaluate satisfaction with and outcome of postamputation orthopedic surgery in canine amputees. Data was obtained through medical records and owner survey responses; data included signalment, amputation cause, diagnosis, surgical treatment, timeframes, and outcome assessment. Outcome was categorized as acceptable or unacceptable, and complications were classified as catastrophic, major, or minor. Eleven thoracic limb amputees and 6 pelvic limb amputees with surgically treated PAOD were identified. Surgically treated PAOD was reported at a median of 9.7 months (range 0.5-110 months) after amputation. All 17 amputees were treated for pelvic limb disease, predominantly for cranial cruciate ligament disease that occurred in 11 of 17 dogs. Major complications following orthopedic surgeries performed in 3 thoracic limb amputees consisted of infection (n?=?2) and uncontrolled pain (n?=?1). No major complications were reported following orthopedic surgeries performed in pelvic limb amputees. Acceptable mid-to-long-term outcome was achieved in 16 of the 17 canine amputees. Surgical treatment of pelvic limb disease did not appear to be associated with a high number of major complications in this case series. These findings suggest that orthopedic surgery, specifically stifle surgery, in canine amputees might be considered a feasible treatment option. Although there are inherent methodological limitations of retrospective studies and owner surveys, our case series provides new information that might help guide surgical treatment decisions in canine amputees suffering from orthopedic disease. Prospective studies using objective outcome measures evaluating surgical management of PAOD are necessary to confirm the provided information.     

Evaluation of elbow incongruency using reconstructed CT in dogs suffering fragmented coronoid process

OBJECTIVES: A retrospective study was undertaken to evaluate elbow joint congruency in dogs suffering fragmented coronoid process (FCP). METHODS: Based on clinical, radiographic and computed tomographic (CT) examinations, elbows were divided into control and FCP groups. Standardised CT reconstructions were formatted in the frontal and sagittal planes. Humeroradial and humeroulnar joint space measurements were obtained from the Images and incongruencies were calculated by comparing the two measurements. RESULTS: Forty-two FCP and 29 control elbows were identified. No incongruencies were noted at the coronoid base. At the level of the coronoid apex, FCP elbows exhibited a significant radioulnar incongruency compared with controls (P < 0.0001), though incongruency was not identified in all cases. Comparing FCP and control elbows at the level of the apex, the humeroradial joint space was increased in FCP elbows (P = 0.0006) whereas no difference was noted in the humeroulnar space. CLINICAL SIGNIFICANCE: This study supports the hypothesis that joint incongruency is associated with FCP in dogs, though is not present in every case at the time of diagnosis. The precise mechanism of development of this incongruency cannot be determined from these data.