Canis ISSN: 2398-2942

Elbow: dysplasia/medial coronoid process disease (MCPD) - surgical options

Synonym(s): Elbow incongurity, Elbow osteotomy

Contributor(s): Neil Burton, Heidi Radke

Introduction

  • A validated objective algorithm for the most appropriate surgical management of medial coronoid process disease (MCPD) in dogs as a function of the precise changes in the joint that are present is currently poorly defined; there is a paucity of prospective objective studies comparing surgical procedures as well as outcome relative to control groups.
  • For dogs with medial compartment disease (MCD, ie substantial cartilage loss affecting the humeral trochlear and trochlear notch of the ulna) techniques to shift load away from the medial compartment (SHO / PAUL, CUE, see below) appear indicated but long term outcomes are currently unknown.
  • In cases where severe cartilage loss is present throughout the elbow, salvage procedures such as total elbow replacement (TER) or elbow arthrodesis can be considered.

Fragment removal

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Subtotal coronoid ostectomy (SCO)

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Biceps ulnar release procedure (BURP)

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Bi-oblique proximal ulnar osteotomy (BPUO)

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Proximal abducting ulnar osteotomy (PAUL)

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Sliding humeral osteotomy (SHO)

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Canine unicompartmental elbow (CUE) arthroplasty

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Salvage procedures

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed Papers

  • Recent references from VetMed Resource and PubMed.
  • Caron A, Fitzpatrick N (2016) Bi-oblique dynamic proximal ulnar osteotomy: surgical technique and clinical outcome in 86 dogs. Vet Surg 45(3), 356-363 PubMed.
  • De Sousa R J, Parsons K J, Owen M R, Grierson J, McKee W M, Kulendra E, Burton N J (2016) Radiographic, surgeon and owner assessment of the BioMedtrix TATE elbow arthroplasty. Vet Surg 45(6), 726-735 PubMed.
  • McConkey M J, Valenzano D M, Wei A, Li T, Thompson M S, Mohammed H O, van der Meulen M C, Krotscheck U (2016) Effect of the proximal abducting ulnar osteotomy on intras-articular pressure distribution and contact mechanics of congruent and incongruent canine elbows ex vivo. Vet Surg 45(3), 347-355 PubMed.
  •  Bräuer S & Böttcher P (2015) Focal humero-ulnar impingement following subtotal coronoid ostectomy in six dogs with fragmented medial coronoid process. Tierarzliche Praxis Kleintiere 43, 156-160 PubMed.
  • Cook J L, Schulz K S, Karnes G J, Franklin S P, Canapp S O Jr, Lotsikas P J, Fitzpatrick N, Wheeler  JL, Stiffler K S, Gillick M, Cross A R, Walls C M, Albrecht M R, Williams N, Crouch D T, Lewis D D, Pozzi A, Ridge P (2015) Clinical outcomes associated with the initial use of the Canine Unicompartmental Elbow (CUE) Arthroplasty System. Can Vet J 56(9), 971-977 PubMed.
  • Fitzpatrick N, Bertran J, Solano M A (2015) Sliding humeral osteotomy: medium-term outcome measures and reduction of complications with a modified technique. Vet Surg 44(2) 137-149 PubMed.
  • Lorenz N D, Channon S, Pettitt R, Smirthwaite P & Innes J F (2015) Ex vivo kinematic studies of a canine unlinked semi-constrined hybrid total elbow arthroplasty system. Vet Comp Orthop Traumatol 28, 29-47 PubMed.
  • Wilson D M, Goh C S & Palmer R H (2014) Arthroscopic biceps ulnar release procedure (BURP): technique description and in vitro assessment of the association of visual control and surgeon experience to regional damage and tenotomy completeness. Vet Surg 43(6), 734-730 PubMed. 
  • Fitzpatrick N, Yeadon R, Smith T (2009) Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg 38, 261-278 PubMed.
  • Fitzpatrick N, Smith T J, Evans R B, O’Riordan J & Yeadon R (2009) Subtotal coronoid ostectomy for treatment of medial coronoid disease in 263 dogs. Vet Surg 38, 233-245 PubMed.
  • De Haan J J, Roe S, Lewis D D, Renberg W C, Kerwin S C & Bebchuk T N (1996) Elbow arthrodesis in 12 dogs. Vet Comp Orthop Traumatol  9, 115-118.

Other sources of information

  • Pfeil I, Böttcher P, Starke A (2012) Proximal abduction ulnar osteotomy (PAUL) for medial compartment disease in dogs with elbow dysplasia. 16th ESVOT Congress Bologna (Italy) 12-15th September, pp 314–318.
  • Fitzpatrick N & Danielski A (2010) Biceps ulnar release procedure for the treatment of medial coronoid disease in 164 elbows. British Veterinary Orthopaedic Association Autumn Meeting: New Horizons in Thoracic Limb Surgery. Dublin (IR) 12-14th November, p 71.


ADDED