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.     

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.     

Histomorphometry of fragmented medial coronoid process in dogs: a comparison of affected and normal coronoid processes

OBJECTIVE: To determine if fatigue microdamage is associated with fragmented medial coronoid process (FMCP). STUDY DESIGN: Prospective study. ANIMALS: Thirty-eight dogs were admitted for subtotal coronoid ostectomy as treatment for FMCP. Surgical specimens of medial coronoid process (MCP) were retrieved from treated dogs. Normal MCP were collected from 5 age- and breed-matched dogs and 2 age-matched research beagles that were euthanatized for reasons other than elbow disease. METHODS: MCP specimens from affected elbows were classified into 4 groups based on disease severity. Specimens were bulk-stained for microdamage using 1% basic fuchsin, embedded in polymethylmethacrylate and sectioned at 130 microm. Specimens were evaluated using epifluorescent microscopy (425-440 excitation, 475 nm barrier filter) for diffuse damage (D.DX), osteocyte loss, and porosity. Cartilage thickness was evaluated using bright field microscopy. Qualitative observations were also made. RESULTS: MCP specimens from affected elbows had increased D.Dx, increased osteocyte loss, and greater porosity than normal groups. Specimens classified as severe FMCP (Classes 3, 4) had the most fatigue microdamage. Some Class 1 specimens, defined as having no visible fissuring of the articular cartilage (AC), had large microcracks in trabecular bone. CONCLUSIONS: Accumulation of subchondral fatigue microdamage, is associated with MCP fragmentation. Fissuring occurs in the subchondral bone before gross fibrillation of articular cartilage develops. CLINICAL RELEVANCE: Accumulation of fatigue microdamage in the MCP is important in the pathogenesis of FMCP. The underlying cause of this microdamage accumulation must be identified before treatment plans that will prevent further osteoarthritis of the elbow joint can be designed.     

Joint angle, moment and power compensations in dogs with fragmented medial coronoid process

Fragmented medial coronoid process (FMCP) is the most common cause of forelimb lameness in juvenile medium and large breed dogs; however methods of assessing the disruption to their gait remain subjective. The purpose of this study was to objectively quantify the mechanical disruptions to gait in dogs with arthroscopically confirmed unilateral FMCP. Seven dogs underwent full inverse dynamic analysis at the time of diagnosis. Kinematic and force data were collected from both forelimbs at trot. Stance phase joint angles, net joint moments and net joint powers were calculated using custom software. There were gross differences in kinetic and kinematic patterns between FMCP affected and compensating forelimbs. Stance time was 0.24 sec on the lame side and 0.26 sec on the compensating side. The shoulder and the elbow were more flexed at ground contact, and elbow, carpal and MCP joints had smaller ranges of motion on the lame side. Net joint moments were significantly reduced (P < 0.05) in the elbow, carpal and MCP joints of the FMCP affected limb. Net joint powers were likewise significantly smaller (P < 0.05). However, the overall moment and power patterns persisted. Total limb support moment was significantly smaller on the affected side (P < 0.05). Total limb power was significantly reduced on the affected side (P < 0.05) being most affected in its propulsive phase in the second half of stance. Inverse dynamic analysis of this clinical condition is an objective means by which to assess the mechanical disruption to gait.     

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.     

Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy

Fragmented coronoid process in 13 elbows (10 dogs) was treated by medial elbow arthrotomy plus osteotomy of the proximal ulnar diaphysis. All the dogs were skeletally immature and had a lameness of at least four weeks' duration. An attempt was made to measure the disease-modifying effect of this procedure by estimating the development of osteophytosis. Complications were infrequent and never serious. Clinical outcome, overall, was good. This preliminary work indicates that proximal ulnar diaphyseal osteotomy may have a place in the management of fragmented coronoid process in young dogs.     

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.     

On the weight-bearing function of the medial coronoid process in dogs

The shape of and proportions between the surface areas of the medial coronoid process (MCP) and the fovea of the radial head were determined in 88 juvenile dogs and 146 adult dogs grouped as giant, large, mid-sized, chondrodystrophic, or small dogs. Thereby, the longitudinal (length) and transverse (width) extension of the MCP and fovea of the radial head have been measured. Original values were used to describe changes of the parameters attributed to growth. Normalized values (i.e. values expected in case of a width of the fovea of the radial head of 20 mm) were used to determine potential differences between constitutional types. All original values increased during growth (P < 0.05) except for the width and length of the MCP in chondrodystrophic and small breeds. Normalized values revealed a proportional decrease in width and length of the MCP during growth (P < 0.05) compared with the radial head. In adults, the normalized MCP was widest in giant dogs followed by large, mid-sized, small, and chondrodystrophic breeds. The MCP was also longest in giant dogs but shortest in large and chondrodystrophic dogs with those of large dogs being significantly (P < 0.05) shorter than those in giant, mid-sized and small dogs. Present results suggest that a deficiency in length-growth of the MCP--which has been present especially in large dogs--results in smaller humeral contact areas and decreased weight-bearing capacity of the MCP. Because loading forces acting on the MCP increase with body weight, the condition noted in large dogs might increase the risk of fragmentation of the MCP in these.     

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.     

Microcomputed tomography and histology of a fragmented medial coronoid process in a 20-week-old golden retriever

A 20-week-old male golden retriever, which was not lame and showed no clinical signs of a fragmented medial coronoid process (FCP), was euthanased for another study and perfused intravenously with formaldehyde. Gross dissection revealed no abnormalities within the right elbow joint. The medial coronoid process was excised, embedded in methylmethacrylate, scanned in a microcomputed tomography (microCT) scanner and sectioned for histology. The microCT scans revealed a dense trabecular bone structure, much denser than in other dogs of similar age, which was considered to be responsible for the sclerosis visible at the base of the coronoid process in radiographs. Three-dimensional reconstructions indicated that there was a small step within the subchondral bone, extending from the apex towards the radial notch. Histology revealed a necrotic lesion between locally thickened articular cartilage and the subchondral bone, characteristic of osteochondrosis.     

Assessment of collagen genes involved in fragmented medial coronoid process development in Labrador Retrievers as determined by affected sibling-pair analysis

OBJECTIVE: To evaluate the involvement of various collagen genes in the development of fragmented medial coronoid process (FCP) in Labrador Retrievers. SAMPLE POPULATION: 93 dogs originating from 13 litters were used in the study; FCP was diagnosed in 35 dogs, and each affected dog had at least 1 sibling that was also affected. Twelve dams and sires were included in the analysis. All dogs were purebred Labrador Retrievers except for 2 litters (offspring of a female Golden Retriever-Labrador Retriever mixed-breed dog). PROCEDURES: For each dog, DNA was isolated from blood samples. Polymorphic microsatellite markers adjacent to 14 candidate genes (ie, COL1A1, COL1A2, COL2A1, COL3A1, COL5A1, COL5A2, COL6A3, COL9A1, COL9A2, COL9A3, COL10A1, COL11A1, COL11A2, and COL24A1) were analyzed by use of PCR assays; genotypes were determined via automated detection of DNA products. The level of allele sharing between pairs of affected siblings was assessed. RESULTS: Among the 93 dogs, allele sharing of the 14 collagen genes was determined as follows: COL1A1, 45%; COL1A2, 47%; COL2A1, 37%; COL3A1, 32%; COL5A1, 43%; COL5A2, 32%; COL6A3, 36%; COL9A1, 45%; COL9A2, 49%; COL9A3, 38%; COL10A1, 46%; COL11A1, 52%; COL11A2, 47%; and COL24A1, 47%. CONCLUSIONS AND CLINICAL RELEVANCE: Because siblings share 50% of their genome at random, the fact that the percentages of allele sharing among the analyzed collagen genes were not significantly > 50% indicates that these genes are not determinant candidates for FCP in Labrador Retrievers. The gene for the vitamin D receptor could also be excluded because of its proximity to COL2A1.     

Prediction of the genetic risk for fragmented coronoid process in labrador retrievers

In a cohort of 252 Dutch labrador retrievers born between 1988 and 1992, seven founders for fragmented coronoid process were identified. The 185 labrador retrievers born to this cohort between January 1, 1993 and January 1, 1997, were examined clinically, and radiographs of both elbows taken in four directions at 12 to 18 months of age, or earlier when they had signs of lameness, were evaluated. The diagnosis of fragmented coronoid process was confirmed by arthrotomy. The incidence of the condition in the 185 dogs was 17.3 per cent, and for each dog a genetic risk factor was calculated on the basis of its relatedness to the seven founders. The risk factors ranged from 0.07 to 0.41. The dogs were divided into classes of increasing predicted risk, and the mean risk for each class was then compared with the clinical outcome. There were no significant differences between the predicted risk and the outcome in any of the classes.     

Fragmentation of the medial coronoid process of the ulna in dogs: A study of 109 cases

The results of a combined retrospective and prospective study of 130 cases of fragmented coronoid process (FCP) in 109 dogs are presented. Sixty-eight cases were treated surgically by medial elbow arthrotomy and 62 were treated medically (rest and anti-inflammatories). Case records were searched with the emphasis on the severity of lameness, physical abnormalities and in surgical cases, the appearance of the coronoid process lesion. Long term follow-up was obtained by a telephone survey. Analysis of case histories and physical data revealed no correlation between severity of lameness before treatment, severity of radiographic changes in the elbow joint and the type of lesion found at surgery. Surgical treatment did not decrease the incidence of post treatment lameness, but the surgically treated dogs were more active and less severely lame than those treated without surgery. It was concluded that young dogs with mild lameness due to FCP in the elbow probably do not benefit from surgical treatment but dogs with chronic, moderate to severe lameness have a better prognosis if treated surgically.     

Clinical, radiographical and pathological aspects of ununited medial coronoid process of the elbow joint in dogs

An ununited medial coronoid process was found in the region of the medial ulnar articular rim of seven elbow joints in four Persian stray dogs in a survey of joint disease in dogs. The clinical, radiographical and pathological aspects of this condition are described and discussed.     

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.