Focal humero-ulnar impingement following subtotal coronoid ostectomy in six dogs with fragmented medial coronoid process

Summary

Objective

To report acute eburnation of joint cartilage at the humeral trochlea following subtotal coronoid ostectomy (SCO) in a clinical case series of six elbows.

Material and methods

Six dogs (median BW 27.1 kg; median age 7.5 months) with fragmented medial coronoid process (FCP) and varying degree of radio-ulnar incongruence (RUI) (mean 2 mm) were treated with SCO using an arthroscopic burr. Second look arthroscopy 4–12 weeks later was performed either because of recurrent or persistent lameness in three dogs. In the others, second-look arthroscopy was scheduled prospectively because of RUI, which was thought to be a risk factor for the observed humero-ulnar impingement.

Results

All six elbows had a 1–2 mm wide line of focal full-thickness cartilage loss along the edge of the SCO, while the opposing trochlea had diffuse cartilage damage of Outerbridge grade III–IV, indicating focal humero-ulnar impingement. None of the elbows showed repeated FCP.

Conclusion

In some cases SCO might lead to focal humero-ulnar impingement along the osteotomy line.

Clinical significance

Whether this relays to variations in respect the amount of resected bone (too much vs. too less) or concomitant joint pathologies like RUI or joint instability remains unknown and warrants further studies.

Zusammenfassung

Ziel

Falldarstellung eines akuten Knorpelabriebs im Bereich der Trochlea humeri nach subtotaler Koronoidostektomie (SKO) bei sechs Ellbogengelenken.

Material und Methoden

Bei sechs Hunden (mittlere Körpermasse 27,1 kg; mittleres Alter 7,5 Monate) wurde wegen eines fragmentierten Processus coronoideus medialis ulnae (FPC) eine SKO mit arthroskopischer Fräse durchgeführt. Vier bis 12 Wochen später erfolgte eine Kontrollarthroskopie, in drei Fällen wegen einer erneuten bzw. weiterhin bestehenden Lahmheit und bei den übrigen drei Tieren aufgrund einer radioulnaren Inkongruenz (RUI), die als Risikofaktor vermutet wurde.

Ergebnisse

In allen Gelenken stellte sich eine 1–2 mm breite knorpellose Zone entlang der Osteotomiekante dar. Der Knorpel im Bereich der Trochlea wies als Ausdruck eines humeroulnaren Impingementsyndroms Knorpelschäden Grad III–IV nach Outerbridge auf. In keinem Fall trat ein erneuter FPC auf.

Schlussfolgerung

In manchen Fällen kann eine SKO zu einem fokalen humeroulnaren Impingmentsyndrom entlang der Osteotomiekante führen.

Klinische Relevanz

Inwieweit dies in Zusammenhang mit dem Ausmaß an reseziertem Koronoid (zu wenig bzw. zu viel) oder begleitenden pathologischen Veränderungen wie z. B. RUI oder Gelenkinstabilität steht, ist unbekannt und erfordert weitere Untersuchungen.

Keywords

Dog - elbow joint - radio-ulnar incongruence - arthroscopy

Schlüsselwörter

Hund - Ellbogengelenk - radioulnare Inkongruenz - Arthroskopie

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