Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease

Summary

Objective: To assess movement of ulnar segments radiographically, following proximal and midshaft ulnar osteotomy or ostectomy after arthroscopic treatment for dogs diagnosed with medial coronoid disease.

Methods: Fragmentation and cartilage wear were treated arthroscopically and the presence of incongruity confirmed. Osteotomies were performed at the mid-point or proximal third of the length of the ulna. The distance of separation between the ulnar segments and the adjacent radius were measured and followed by serial radiographs postoperatively until healing had occurred.

Results: Proximal oblique osteotomies located at one-third the length of the ulna were associated with the most movement of the ulnar segments, most notably of the proximal segment. Osteotomies or ostectomies performed in the middle demonstrated less segmental movement and on average, slightly longer time to heal. Movement of the ulnar segments in both groups occurred immediately, and then peaked at two to four weeks postoperatively, tending to plateau thereafter.

Clinical significance: Radioulnar incongruity is considered a facet of the aetiopatho-genesis of canine medial coronoid disease. This creates abnormal loads and focal wear along the medial coronoid process. Performing an oblique osteotomy at a location measured at the proximal third of the length of the ulna allows increased movement of the proximal segment, which may result in unloading of the medial compartment. Performing an osteotomy or ostectomy distally dampens segmental movement due to constraint of the interosseous ligament. These findings suggest that a proximal oblique osteotomy at this location creates immediate favourable movement with low morbidity.

Keywords

Ulnar osteotomy - medial coronoid disease - radioulnar incongruity

• References

• 1 Schwartz P. Canine Elbow Dysplasia. In Bojrab MJ. editor. Current Techniques in Small Animal Surgery. 4th ed.. Philadelphia; Lippincott Williams & Wilkins; 1998. pg 1004-1014. 1093.
• 2 Padgett GA, Mostosky UV, Probst CW. et al Inheritance of osteochondrosis dissecans and fragmented coronoid process of the elbow joint in Labrador Retrievers. J Am Anim Hosp Assoc 1995; 31: 327-330.
• 3 Brinker W, Piermattei Flo.. In Brinker, editor. Handbook of Small Animal Orthopedics and Fracture Repair. 3rd ed.. St. Louis; Elsecier; 1997. pg. 258-262. 507-513.
• 4 Samoy Y, Van Ryssen B, Gielen I. et al Review of the literature: Elbow incongruity in the dog. Vet Comp Orthop Traumatol 2006; 19: 1-8.
• 5 Wind A. Elbow incongruity and developmental elbow diseases in the dog, Part I. J Am Anim Hosp Assoc 1986; 22: 711-724.
• 6 Kapatkin AS, Volk SW, Keith DG. et al Elbow dysplasia in a Basset Hound: A case report following serial radiographic, CT, and arthroscopic findings. Vet Comp Orthop Traumatol 2003; 16: 11-15.
• 7 Gortz K, Van Ryssen B, Taeymans M. et al Traumatic fracture of the medial coronoid process in the dog. Vet Comp Orthop Traumatol 2004; 17: 159-162.
• 8 Cook C, Cook J. Diagnostic imaging of canine elbow dysplasia: A review. Vet Surg 2009; 38: 144-153.
• 9 Wosar M, Lewis D, Neuwirth L. et al Radiographic evaluation of elbow joints before and after surgery in dogs with possible fragmented medial coronoid process. J Am Vet Med Assoc 1999; 214: 52-58.
• 10 Murphy ST, Lewis DD, Shiroma JT. et al Effect of radiographic positioning on interpretation of cubital joint congruity in dogs. Am J Vet Res 1998; 59: 1351-1357.
• 11 Mason D, Schulz KS, Sammi VF. et al Sensitivity of radiographic evaluation of radioulnar incongruence in the dog in vitro. Vet Surg 2002; 31: 125-132.
• 12 Trostel TC, McLaughlin RM, Pool RR. Canine lameness caused by developmental orthopedic diseases: fragmented medial coronoid process and ununited anconeal process. Comp Cont Ed Pract Vet 2003; 25: 112-120.
• 13 Kramer A, Holsworth I, Wisner ER. et al Computed tomographic evaluation of canine radioulnar incongruence in vivo. Vet Surg 2006; 35: 24-29.
• 14 Holsworth I, Wisner ER, Scherrer WE. et al Accuracy of computerized tomography evaluation of canine radioulnar incongruence in vitro. Vet Surg 2005; 34: 108-113.
• 15 Bottcher P, Werner H, Ludewig E. et al Visual estimation of radioulnar incongruence in dogs using 3D image rendering: in vitro study based on computed tomographic imaging. Vet Surg 2009; 38: 161-168.
• 16 House MR, Marino DJ, Lesser ML. Effect of limb position on elbow incongruity with CT evaluation. Vet Surg 2009; 38: 154-160.
• 17 Evans RB, Gordan-Evan WJ, Conzemius MG. Comparison of three methods for the management of fragmented medial coronoid process in the dog: A systemic review and meta-analysis. Vet Comp Orthop Traumatol 2008; 21: 106-109.
• 18 Read RA, Armstrong SJ, O’Keefe JD. et al Fragmentation of the medial coronoid process of the ulna in dogs: A study of 109 cases. J Small Anim Pract 2008; 31: 330-334.
• 19 D’Haeseleire P, Thielens P. Are Ag-points, gutta percha, and amalgam still useful as apical filling materials. Acta Stomatol Belg 1989; 84: 243-250.
• 20 Murphy WM. An in vitro model for testing biocompatibility of endodontic materials to bone. Bio-materials 1985; 6: 427-430.
• 21 Dahl JE. Toxicity of endodontic filling materials. Endodontic Topics 2005; 12: 39-43.
• 22 Turner BM, Abercromby RH, Innes J. et al Dynamic proximal ulnar osteotomy for the treatment of ununited anconeal process in 17 dogs. Vet Comp Orthop Traumatol 1998; 11: 76-79.
• 23 Ness MG. Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy. J Small Anim Pract 1998; 39: 15-18.
• 24 Snelling SR, Lavelle RB. Radiographic changes in elbow dysplasia following ulnar osteotomy. Aust Vet J 2004; 82: 278-281.
• 25 Vezzoni A. Dynamic ulna osteotomies in canine elbow dysplasia. Proceedings of the World Small Animal Veterinary Association Congress. 2002. October 3-6. Grenada, Spain. London; Manson Publishing; Available online http://www.vin.com/proceedings/Proceed-ings.plx?CID=WSAVA2002&PID=2668
• 26 Fitzpatrick N, Yeadon R. Working algorithm for treatment decision making for developmental disease of the medial compartment of the elbow. Vet Surg 2009; 38: 285-300.
• 27 Preston CA, Schulz KS, Taylor KT. et al In vitro experimental study of the effect of radial shortening and ulnar ostectomy on contact patterns in the elbow joint of dogs. Am J Vet Res 2001; 62: 1548-1556.
• 28 Miller ME. The Skeleton. In Evans HE, Christiansen SE. editors. Miller’s Anatomy of the Dog. 2nded.. Philadelphia; WB Saunders; 1979. pg 246-248.
• 29 Might KR, Hanzlik KA, Case JB. et al In vitro comparison of proximal ulnar osteotomy with release of the interosseous ligament in a canine model. Proceedings of the Veterinary Orthopedic Society Meeting; 2010 February 20-27; Breckenridge, Colorado. London; Manson Publishing / The Veterinary Press; 2010. pg 35.
• 30 Puccio M, Marino DJ, McKenna B. Clinical evaluation and long term follow-up of dogs having coronoidectomy for elbow incongruity. J Am Anim Hosp Assoc 2003; 39: 473-478.
• 31 Fitzpatrick N, Yeadon R, Smith T. et al Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg 2009; 38: 261-278.
• 32 Fujita Y, Schulz KS, Mason RB. The effect of humeral sliding osteotomy on joint surface contact in canine elbow joints. Am J Vet Res 2003; 54: 506-511.
• 33 Mason D, Schulz K, Fujita Y. et al Measurement of the humeroradial transarticular joint forces in the canine elbow joint after humeral wedge and sliding osteotomies. Vet Surg 2008; 37: 63-70.
• 34 Meyer-Lindberg A, Langhann A, Fehr M. Prevalence of fragmented coronoid process in lame adult dogs. Vet Rec 2002; 1: 230-234.
• 35 Vermote KA, Bergenhuyzen AL, Gielen I. et al Elbow lameness in dogs six years and older: Arthroscopic and imaging findings of the medial coronoid process in 51 dogs. Vet Comp Orthop Traumatol 2010; 23: 43-50.