Elbow: dysplasia

Introduction

• Polygenic hereditary developmental syndrome.
• Characterized by lesions affecting the medial coronoid process of the ulnar, anconeal process, medial humeral condyle, medial epicondyle.
• Specific lesions: Fragmented medial coronoid process (FMCP) , Ununited anconeal process (UAP) , osteochondrosis (OC) of the humeral condyle , and ununited medial epicondyle (UME).
  
  Print off the owner factsheet Elbow dysplasia to give to your client.

Diagnosis

Differential diagnosis

• Articular fracture.
• Incomplete ossification of the humeral condyle (Spaniel breeds, Labrador) .
• Panosteitis .
• Septic arthritis .

Sequelae

Prognosis

• FMCP : 85% fair to good function with ulnar osteotomy and fragment removal. 5075% chance of improvement such as not to require long term non-steroidal anti-inflammatory medication with arthroscopic treatment. 94% of cases not lame by 5 weeks postoperatively with subtotal coronoidectomy.
  A lack of controlled objective prospective studies makes direct comparison and endorsement of specific surgeries difficult.
• UAP : with poorer outcome. Ulnar osteotomy / ostectomy- 50% of dogs good excellent function. Lag screw and ulnar ostectomy / osteotomy 88% good return to function. UAP excision should be considered in adult dogs with lameness that is not responsive to conservative management.
• Osteochondrosis of the humeral condyle : 30-95% good function with removal of flap. Success varies widely between reports.
• UME : prognosis good with appropriate treatment (depending on fragment size see above). Majority of cases no residual lameness and progression of secondary osteoarthritis rare.

Reasons for treatment failure

• Implant breakage if lag screwing UAP. Increased risk of screw breakage if fragment fixed without concurrent proximal ulnar osteotomy / ostectomy.
• In the case of FMCP, UAP and Osteochondrosis of the humeral condyle progression of osteoarthritis is to be expected regardless of the current surgical treatment regimes employed and it is common for lameness to persist or reccur later in the dogs life. UME is seldom associated with severe secondary osteoarthritic change. If this does occur then it is likely that UME is not the only elbow lesion present.

Sources

Publications

Refereed papers

• Recent references from PubMed.
• Innes J (2009) Getting the elbow: diagnosis and management of elbow disease in dogs. JSAP 50 (6) 18-20 PubMed.
• Cook C R & Cook J L (2009) Diagnostic imaging of the canine elbow dysplasia: a review. Vet Surg 38 (2), 144-153 PubMed.
• Burton N J, Comerford E J, Bailey M, Pead M J, Owen M R (2007) Digital analysis of ulnar trochlear notch sclerosis in Labrador retrievers. JSAP 48 , 220 224.
• Meyer-Lindenberg A, Fehr M, Nolte I (2001) Short and long-term results after surgical treatment of an ununited anconeal process in the dog. Veterinary Comparative Orthopaedics and Traumatology 14 , 101-110.
• Ness M G (1998) Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy. JSAP 39 , 15-18.
• Denny H R, Gibbs C (1980) The surgical treatment of osteochondrosis dissicans and ununited coronoid process in the canine elbow joint. JSAP 21 , 323.