Incomplete ossification of the humeral condyle as the cause of lameness in dogs

Abstract

SummaryIn a retrospective and prospective trial over six years, 17 joints from 13 dogs presented with incomplete ossification of the humeral condyle (IOHC) were included. All dogs showed lameness of the forelimb but no humeral condylar fractures. One dog showed a fracture of the olecranon. Four of the bilaterally affected dogs showed only unilateral lameness. 53.8% of the dogs (7/13) were younger than one year. With regard to breed distribution, the German Wachtel was most frequently represented with three dogs. In 12 dogs the diagnosis was made by radiography in a craniocaudal view, and seven dogs could be further investigated by computed tomography. In one dog the diagnosis was only made during arthroscopy. Two joints showed an additional fragmented medial coronoid process of the ulna and another two an osteochondrosis dissecans of the medial humeral condyle. During arthroscopy, all joints showed a clearly visible fissure line in the joint cartilage between the humeral condyles. In ten joints the I0HC was treated with a transcondylar lag screw under arthroscopic control. Three of the four bilaterally affected dogs were treated only unilaterally because of a lack of lameness on the other side. In the dog with the olecranon fracture, only the fracture was treated. The patients were rechecked clinically and radiologically (n = 10) or by means of a questionnaire (n = 1) at an average of 26 months post operation. Seven cases, six of them treated by lag screw fixation, did not show any lameness. Three joints (one dog with olecranon fracture, two unilaterally affected dogs with lag screw fixation) showed some degree of lameness after heavy strain and one dog showed a continuous slight lameness. The four bilaterally affected and only unilaterally treated dogs showed no lameness on the untreated joint. With regard to development of arthrosis, six radiographically examined joints showed no increase in arthroses. In five joints the increase was mild and in two joints moderate. In six joints with lag screw fixation, the IOHC was radiographically unified and was confirmed by computed tomography in three cases.

Long-Term Outcome and Complications after Transcondylar Screw Placement for Canine Humeral Intracondylar Fissure

“…34 The prevalence of HIF in dogs in the United Kingdom is unknown 15 but likely relatively low, as reflected in the sample sizes of this study and that of previous studies. 6,14,16,18,19 A downward trend in complication rate is expected as surgeons become more proficient with the procedure. Indeed, other authors 14 recently reported a complication rate of 24.9%, although this was not their primary objective.…”

“…A medial or lateral approach to the humeral condyle is made, and a variably sized screw 13 is placed in position or lag fashion. 14,15 Complementary use of fluoroscopy, arthroscopy, three-dimensional (3D)-printed drill guides or cannulated drill systems has been described [16][17][18][19] and an autograft or allograft may be placed at the fissure site. 20,21 Various HIFspecific implant systems have been reported.…”

“…Transcondylar screw placement has been associated with a high postoperative complication rate between 35.7 and 69.2%, 6,14,16,18,19 which includes transcondylar screw failure or loosening, seromas and surgical site infection. The presence of complications has been associated with poorer outcomes.…”

Correlation between the Insertion Side of a Transcondylar Screw for the Surgical Management of Humeral Intracondylar Fissures in Dogs and the Incidence of Postoperative Surgical Site Infection

“…Surgical site infection (SSI) is the most commonly reported complication following humeral intracondylar fissure surgical management. [1][2][3][4][5][6] Despite the high prevalence of SSI following humeral intracondylar fissure surgery, a notable variability between studies has been observed, with some authors documenting no postoperative SSI [7][8][9] and others recording SSI rates ranging between 5 and 42%. [1][2][3][4][5][6]10,11 In some of these studies, the incidence of SSI considerably exceeds the average reported SSI rates associated with other commonly performed clean, elective orthopaedic surgeries in the dog (1.3-11%).…”

Computed Tomography Topographical Analysis of Incomplete Humeral Intracondylar Fissures in English Springer Spaniel Dogs

“…Humeral intracondylar fissure (HIF) is an uncommonly reported cause of thoracic limb lameness in dogs. [1][2][3] English Springer Spaniels are reported to have a high incidence of HIF, which has been observed in 14% of English Springer Spaniels with no recent history of lameness. 4 In one study, 18% of elbows with HIF managed nonsurgically progressed to fracture and 24% required surgery.…”