Osteochondritis dissecans and fragmentation of the coronoid process in the elbow joint of the dog

Bennett, David; Duff, S.R.I.; Kene, R. O. C.; Lee, R

doi:10.1136/vr.109.15.329

Cited by 35 publications

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“…Even when free fragmentation has been subsequently identified by arthroscopy or arthrotomy, identification of disease of the medial aspect of the coronoid process (MCD) has historically proven challenging despite use of diverse imaging modalities including radiography 2,[14][15][16][17] ; computed tomography (CT) 11,18 ; scintigraphy 19 ; and magnetic resonance imaging (MRI). 20 Typically, diagnosis is based on identification of secondary markers of degenerative joint disease in the absence of other discernable discrete pathologic changes.…”

Section: Diagnosismentioning

confidence: 99%

“…28 Other surgical techniques for focal management of MCD include removal of free fragments alone, and varying degrees of debridement, abrasion, or excision of the visibly diseased portion of the medial aspect of the coronoid process, either arthroscopically or via arthrotomy. 4,14,17,[40][41][42][43][44] Although histologic findings suggest that such approaches would leave a substantial portion of diseased subchondral bone in situ, 6 we are unaware of any clinical studies that clearly demonstrate that more aggressive arthroplasty (e.g. SCO) yields superior outcome to less aggressive approaches.…”

Section: Treatment Optionsmentioning

confidence: 99%

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Working Algorithm for Treatment Decision Making for Developmental Disease of the Medial Compartment of the Elbow in Dogs

Fitzpatrick¹,

Yeadon²

2009

Veterinary Surgery

146

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Section: Diagnosismentioning

confidence: 99%

Section: Treatment Optionsmentioning

confidence: 99%

Working Algorithm for Treatment Decision Making for Developmental Disease of the Medial Compartment of the Elbow in Dogs

Fitzpatrick¹,

Yeadon²

2009

Veterinary Surgery

146

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“…Historically, surgical treatment of elbow disease has either been tailored toward the primary lesion where identified, [4][5][6][7][8][9][10] or has involved radial or ulnar osteotomies [11][12][13] to address perceived incongruity or alter load distribution at the elbow. In the case of proximal ulnar osteotomy for incongruity it has been noted that the proximal ulnar articular surface is elevated above the radial articular surface and that varus deformity may result from loading.…”

mentioning

confidence: 99%

Techniques of Application and Initial Clinical Experience with Sliding Humeral Osteotomy for Treatment of Medial Compartment Disease of the Canine Elbow

Fitzpatrick¹,

Yeadon²,

Smith³

et al. 2009

Veterinary Surgery

109

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Objective-To determine medium-term clinical efficacy of sliding humeral osteotomy (SHO) for treatment of lameness and elbow pain associated with clinically diagnosed elbow disease featuring cartilage eburnation of the medial elbow compartment (medial compartment disease-MCD). Study Design-Case series. Animals-Dogs (n ¼ 49) with severe or persistent lameness attributable to MCD. Methods-Signalment, lameness history, and preoperative imaging findings were recorded. A custom, locking, stepped SHO plate was applied to the medial aspect of the humerus, stabilizing a middiaphyseal transverse osteotomy, medially translating the distal segment relative to the proximal segment. Three variants of technique of application were used and outcomes compared between respective patient groups. Outcome measures included lameness scoring, anatomic measures, VAS scoring of elbow pain, and owner assessment of function. Measures recorded preoperatively, 12, and 26 weeks postoperatively were compared. Results-Of 59 limbs that had SHO, 39 had preoperative focal treatment of the diseased medial aspect of the coronoid process. Mean AE SD dog age was 45.5 AE 37.48 months and body weight ranged from 13.6 to 46.7 kg. Mean preoperative duration of lameness was 14.7 AE 18.50 months. Lameness improved for all limbs by 26 weeks, and resolved in 21/32 limbs. Significant improvements in postoperative elbow pain scores and most owner assessments of function were observed. Incidence of major complications requiring surgical intervention was 17.2%, 22.2%, and 4.8% for each of the 3 technique variants described. Histologic examination of 2 elbows at 412 months revealed fibrocartilage cover of medial aspect of humeral condyle. Conclusions-Canine SHO with or without focal treatment of the diseased medial aspect of the coronoid process ameliorates lameness and pain associated with MCD at medium-term follow-up. Application technique is critical to minimizing morbidity. Clinical Relevance-SHO is appropriate for clinical management of pain and lameness in select cases of canine MCD. r

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“…Focal surgical treatment of MCD has included fragment removal and curettage, 7,8,[10][11][12][13][14][15] whereas fragment removal plus abrasion arthroplasty or micro-fracture of the visible extent of cartilage disease has been anecdotally reported. 16 Conventional fragment removal, abrasion arthroplasty or osteostixis of the diseased MCP may provide short-term mitigation of clinical signs but progression of OA invariably occurs and persistence of lameness is common.…”

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confidence: 99%

Subtotal Coronoid Ostectomy for Treatment of Medial Coronoid Disease in 263 Dogs

et al. 2009

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Objective-To document clinical outcomes after subtotal coronoid ostectomy (SCO) for treatment of medial coronoid disease (MCD). Study Design-Prospective clinical study. Animals-Dogs (n ¼ 263) with MCD. Methods-MCD was treated by a combination of SCO via mini-arthrotomy, cage confinement (6 weeks), leash restricted exercise (12 weeks) and pentosan polysulfate administration. Outcomes were assessed by clinical examination in the short-term (324 elbows), owner questionnaires (146 dogs), clinical examination (90 dogs), subjective assessment of gait (110 elbows) and radiographic examination (180 elbows), 4 months to 7 years 7 months after surgery. Results-One intraoperative complication occurred (1 elbow with fissuring of the ulna) and 8.2% elbows had immediate postoperative complications, the most common being wound infection (7%). Improvement in subjective lameness assessment to a score of 0 was noted at 5 weeks in 74.4% of elbows (veterinary) and 45.6% (owner) and at 12 weeks in 71.5% (veterinary), and 91.2% (owner). Subjective assessments of outcomes in the medium-term revealed 81.9% dogs remained sound, with significantly (Po.05) improved daily function scores compared with preoperative values, 83.5% of dogs received no NSAID. Clinical examination revealed good limb function and subjective assessment showed 51% of limbs were free from lameness. Radiographic progression of osteophytosis occurred on average by one grade. Conclusion-Management of MCD using the described management regime, including SCO via mini-arthrotomy, deserves consideration and comparison with existing treatment methods. Clinical Significance-Management of MCD by SCO can be considered when gross fissuring or fragmentation of the MCP is not evident. This technique does not require specialized instrumentation. r Copyright 2009 by The American College of Veterinary Surgeons INTRODUCTION D ISEASE OF the medial aspect of the coronoid process (MCP) of the ulna, medial coronoid disease (MCD), is a component of elbow dysplasia and includes gross fissuring and fragmentation of the MCP, pathology of the overlying cartilage and/or subchondral bone. MCP disease has been reported as a frequently diagnosed cause of thoracic limb lameness in medium to large breed dogs 1,2 and is a common cause of elbow osteoarthritis (OA). The exact cause of MCD is debated but elbow incongruence has been reported as a primary contributor to pathogenesis of MCD. [3][4][5][6] Management of MCD remains controversial and currently no universally agreed approach exists. Results from reported studies vary but in general, describe a [233][234][235][236][237][238][239][240][241][242][243][244][245] 2009 return to normal function in the short-term with progression of OA in the medium-and long-term. 1,4,[7][8][9] Some authors report that surgical intervention does not alter the long-term prognosis and favor solely nonsurgical management. 9Surgical techniques reported for MCD broadly adopt one of two approaches: osteotomy or focal treatment of the MCP, either by arthrotomy or arthr...

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Osteochondritis dissecans and fragmentation of the coronoid process in the elbow joint of the dog

Cited by 35 publications

References 0 publications

Working Algorithm for Treatment Decision Making for Developmental Disease of the Medial Compartment of the Elbow in Dogs

Working Algorithm for Treatment Decision Making for Developmental Disease of the Medial Compartment of the Elbow in Dogs

Techniques of Application and Initial Clinical Experience with Sliding Humeral Osteotomy for Treatment of Medial Compartment Disease of the Canine Elbow

Subtotal Coronoid Ostectomy for Treatment of Medial Coronoid Disease in 263 Dogs

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