Elbows

Question 1

Cuddy LC, Lewis DD, Kim SE, Conrad BP, Banks SA, Horodyski M, et al. Contact mechanics and three-dimensional alignment of normal dog elbows. Vet Surg. 2012 Oct;41(7):818–28.

Answer 1

• pronation increases peak contact pressure in medial compartment and shifts peak point towards apex
  
  • in pronation and supination, radial head rotates more than ulna

Question 2

Stein S, Schmoekel HG, Waibl H, Brunnberg L. Computerized measurements of radiographic anatomical parameters of the elbow joint in Bernese Mountain Dogs. Vet Comp Orthop Traumatol. 2012 May 15;25(3):250–61.

Answer 2

• the Viehmann method of measuring things is less influenced by joint angle than the Muer method
  
  • except for radio-ulnar step – that should be measured at a constant angle

Question 3

Streubel R, Geyer H, Montavon PM. Medial humeral epicondylitis in cats. Vet Surg. 2012 Oct;41(7):795–802.

Answer 3

• 60 feline cadavers
  
  • 10% prevalence of medial humeral epicondylar irregularity
  • always flexor carpi ulnaris muscle, in severe cases there was compression of the ulnar nerve
    remember supinator sesamoid in cats

Question 4

de Bakker E, Saunders J, Gielen I, van Bree H, Coppieters E, van Ryssen B. Radiographic findings of the medial humeral epicondyle in 200 canine elbow joints. Vet Comp Orthop Traumatol. 2012 Sep 13;25(5):359–65.

Answer 4

• 40 % had radiographic epicondylar changes
  - 85% of these had other elbow diseases
  - 15% of these had no other elbow changes (6% of total population) “primary flexor enthesopathy)
  
  • you need both views (mediolateral and 15CC oblique) to catch all the epicondylar changes
  • types of epicondylar change:
    
    • spur alone (most common type noted with other elbow diseases)
    • free calcified body alone ( only seen in dogs with other elbow diseases)
    • spur + free body (most common pattern in dogs with 1 flexor enthesopathy
    • irregular medial epicondyle

Question 5

van Ryssen B, de Bakker E, Beaumlin Y, Samoy YCA, Van Vynckt D, Gielen I, et al. Primary flexor enthesopathy of the canine elbow: imaging and arthroscopic findings in eight dogs with discrete radiographic changes. Vet Comp Orthop Traumatol. 2012 May 15;25(3):239–45.

Answer 5

• 8 dogs (13 elbows), all >=2 years, gradual or acute lameness
  
  • firm swelling in all cases, pain w/pressure not reliable finding
  • spur (11) or radiolucency (2)
  • ultrasound: “outward bowing” & fluid. CT: sclerotic epidondyle, periosteal rxn. MRI: swelling & hyperint
  • visibly ruptured fibers on arthroscopy
  • treatment: 1 dog steroids, other dogs surgical transection, all improved

Question 6

Paster ER, Biery DN, Lawler DF, Evans RH, Kealy RD, Gregor TP, et al. Un-united medial epicondyle of the humerus: radiographic prevalence and association with elbow osteoarthritis in a cohort of labrador retrievers. Vet Surg. 2009 Feb 1;38(2):169–72.

Answer 6

• Purina study dogs
  
  • 15% had “UME” (7 dogs), (6 unilateral – 12.5%) (1 bilateral – 2%)
  • no correlation w/whether or not elbow had OA, most cases unilateral, diet didn’t affect
  • best to see on craniocaudal view

Question 7

Chanoit G, Singhani NN, Marcellin-Little DJ, Osborne JA. Comparison of five radiographic views for assessment of the medial aspect of the humeral condyle in dogs with osteochondritis dissecans. Am J Vet Res. 2010 Jul;71(7):780–3.

Answer 7

• the 15 craniolateral-caudomedial oblique is the best
  
  • the regular craniocaudal view is the next best
  • the 35 distomedial-proximolateral oblique (used for MCP) doesn’t work for OCD

Question 8

Fitzpatrick N, Yeadon R, Smith TJ. Early clinical experience with osteochondral autograft transfer for treatment of osteochondritis dissecans of the medial humeral condyle in dogs. Vet Surg. 2009 Feb 1;38(2):246–60.

Answer 8

• PLIT “plateau intersect of condyle & trochlea” OATS donor site
  
  • 30 of 33 elbows with OCD also had medial coronoid disease
  • OATS worked
  • in dogs w/ concurrent coronoid disease, dogs w/ ulnar ostectomy + SCO did better than w/SCO only
  • 12-18 week follow-up

Question 9

Samoy Y, Gielen I, Van Caelenberg A, van Bree H, Duchateau L, Van Ryssen B. Computed tomography findings in 32 joints affected with severe elbow incongruity and fragmented medial coronoid process. Vet Surg. 2012 May;41(4):486–94.

Answer 9

• same groups as in study below
  
  • CT findings unique to dogs with severe obvious RU incongruence:
• the incongruence is visible
  - pseudocyst at R-U transition
  - “fragmentation of the axial border of the medial coronoid incisure”

Question 10

Samoy Y, Van Vynckt D, Gielen I, van Bree H, Duchateau L, Van Ryssen B. Arthroscopic Findings in 32 Joints Affected by Severe Elbow Incongruity with Concomitant Fragmented Medial Coronoid Process. Vet Surg. 2012

Answer 10

• group 1: normal dogs. G2: FCP but no obvious radiographic incongruity. G3: >=3mm RU step on rads
  
  • arthroscopic findings that were specific for dogs with obvious RU incongruity:
    
    • radioulnar step, increased radiohumeral joint space
    • “fleece blanket” on radial head
    • irregular cartilage at “zona nudata uncisurae”
    • more likely to have radioulnar transition be irregular
  • also: all the severely incongruent elbows had FCP
  • also: radial incisures fragments were mostly in the not-obviously incongruent elbows

Question 11

Burton NJ, Owen MR, Kirk LS, Toscano MJ, Colborne GR. Conservative versus arthroscopic management for medial coronoid process disease in dogs: a prospective gait evaluation. Vet Surg. 2011 Dec;40(8):972–80.

Answer 11

• inverse dynamics analysis
  
  • dogs with really mild MCPD (the arthroscopy group had no kissing lesions)
  • arthroscopy group worse at 4 and 8 weeks
  • groups equivalent at 1 year
  • both groups gradually improved

Question 12

Burton NJ, Perry MJ, Fitzpatrick N, Owen MR. Comparison of bone mineral density in medial coronoid processes of dogs with and without medial coronoid process fragmentation. Am J Vet Res. 2010 Jan 1;71(1):41–6.

Answer 12

• DXA on subtotal coronoidectomy MCP’s and normal Greyhound CPs
  
  • FCPs had lower bone mineral density than normal CPs!
  • all CP’s had less bone mineral density at axial edge and more at abaxial edge!

Question 13

Prink A, Hayashi K, Kim S-Y, Kim J, Kapatkin A. Evaluation of a collagenase generated osteoarthritis biomarker in the synovial fluid from elbow joints of dogs with medial coronoid disease and unaffected dogs. Vet Surg. 2010 Jan;39(1):65–70.

Answer 13

• “C2C” is Col2-3/4Clong mono -> a collagenase-generated cleavage neoepitope of type II collagen
  
  • C2C (CIIC) is higher in synovial fluid of elbows with MCD (coronoid dz) than in normal elbows
  • and the C2C levels (joint fluid) correlated moderately with degree of cartilage damage

Question 14

Vermote KAG, Bergenhuyzen ALR, Gielen I, van Bree H, Duchateau L, van Ryssen B. Elbow lameness in dogs of six years and older: arthroscopic and imaging findings of medial coronoid disease in 51 dogs. Vet Comp Orthop Traumatol. 2010;23(1):43–50.

Answer 14

• distribution of arthroscopic findings in young vs old dogs differs
  
  • finding old dogs > 6 yrs young dogs 5-18 months
    malacia only 2% 0%
    fissures 27.5 % 23%
    nondisplaced fragments 12% 45%
    displaced fragments 0% 29%
    erosions, no fragments 31% 3%

Question 15

Cachon T, Genevois JP, Remy D, Carozzo C, Viguier E, Maitre P, et al. Risk of simultaneous phenotypic expression of hip and elbow dysplasia in dogs: a study of 1,411 radiographic examinations sent for official scoring. Vet Comp Orthop Traumatol. 2010;23(1):28–30.

Answer 15

• radiographic study – 4 major French breeds with rads sent for hip & elbow screening
  
  • risk ratio for dog to have both = 1.67
  • for a dog with ED, the risk of having HD increases as ED gets worse, and visa versa
  • the low (positive) correlation is not enough so that beeding out one will affect the other

Question 16

Spahni AI, Schawalder P, Rothen B, Bosshardt DD, Lang N, Stoffel MH. Immunohistochemical localization of RANK, RANKL and OPG in healthy and arthritic canine elbow joints. Vet Surg. 2009 Aug 1;38(6):780–6.

Answer 16

• IHC on fragmented coronoids and normal coronoids
  
  • in ED samples, RANK/RANKL was over represented and OPG was underrepresented,
  • suggests inbalance btwn osteoclastic & osteoblastic activity

Question 17

Seyrek-Intas D, Michele U, Tacke S, Kramer M, Gerwing M. Accuracy of ultrasonography in detecting fragmentation of the medial coronoid process in dogs. J Am Vet Med Assoc. 2009 Feb 15;234(4):480–5.

Answer 17

• Kappa coefficient indicated no agreement btwn ultrasound and surgical findings
  
  • accuracy for evidence of any MCP dz was 77%

Question 18

Canapp S, Acciani D, Hulse D, Schulz K, Canapp D. Rehabilitation therapy for elbow disorders in dogs. Vet Surg. 2009 Feb 1;38(2):301–7.

Answer 18

• rehabilitation phases after elbow injury or surgery:
  
  • Phase I – immediate motion phase (weeks 1-3) (ROM, massage, cryo, laser, TENS, U/S)
  • Phase II – intermediate phase (weeks 4-6) (hydrotherapy, walking, cavaletti)
  • Phase III – advanced strengthening phase (weeks 7-11) (therabands, steep hill, stairs, plyometric drills)
  • Phase IV – return to activity phase (weeks 12 +)

Question 19

Fitzpatrick N, Yeadon R. Working algorithm for treatment decision making for developmental disease of the medial compartment of the elbow in dogs. Vet Surg. 2009 Feb 1;38(2):285–300.

Answer 19

• Fitzpatrick uses “MCD” to mean medial coronoid dz rather than compartment dz
  
  • “HUC” = humeroulnar conflict
  • causes of incongruency
    
    • static RU incongruence
    • dynamic RU length congruence
    • shape of ulnar notch
    • rotational instability (radius & ulna get jammed into trochlea)
    • mismatch of contour arch
    • musculotendinous mismatch
  • microcracks extend beyond the visible dz
  • SCO approach btwn pronator/F.C.R. and the superficial/deep dig flex, it’s caudal to the MCL

Question 20

Fitzpatrick N, Smith TJ, Evans RB, O’Riordan J, Yeadon R. Subtotal coronoid ostectomy for treatment of medial coronoid disease in 263 dogs. Vet Surg. 2009 Feb 1;38(2):233–45.

Answer 20

• SCO through mini arthrotomy (extension of arthroscope portal incision) in 263 dogs
  
  • most improved especially in long term with minimul perioperative morbidity
  • radiographic OA scores went up by 1 grade
  • osteotomy starts 1-2mm distal to point where sagittal ridge meets incisure

Question 21

Fitzpatrick N, Smith TJ, Evans RB, Yeadon R. Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg. 2009 Feb;38(2):213–23.

Answer 21

• 3% of rads looked normal
  
  • only weak correlation between radiographic & arthroscopic & duration of lameness
  • 49% of these dogs with MCD had kissing lesions
  • 87% subtrochlear sclerosis
  • 70% anconeal process osteophyes
  • 57% lateral epicondyle osteophytes
  • 37% radial head osteophytes

Question 22

Smith TJ, Fitzpatrick N, Evans RB, Pead MJ. Measurement of ulnar subtrochlear sclerosis using a percentage scale in labrador retrievers with minimal radiographic signs of periarticular osteophytosis. Vet Surg. 2009 Feb 1;38(2):199–208.

Answer 22

• method for quantifying subtrochlear sclerosis investigated
  
  • dogs without other radiographic signs of OA only
  • median STS (control) = 0%; median STS (diseased) = 47%
  • pretty repeatable – might be useful in further studies

Question 23

Punke JP, Hulse DA, Kerwin SC, Peycke LE, Budsberg SC. Arthroscopic documentation of elbow cartilage pathology in dogs with clinical lameness without changes on standard radiographic projections. Vet Surg. 2009 Feb 1;38(2):209–12.

Answer 23

• 16 dogs with normal radiographs (dz caught by CT or scintigraphy)
  
  • all had fragmented CP’s, 2 had humeral OCD
  • conclusion: ED can happen with normal rads and if so it’s probably FCP

Question 24

Huck JL, Biery DN, Lawler DF, Gregor TP, Runge JJ, Evans RH, et al. A longitudinal study of the influence of lifetime food restriction on development of osteoarthritis in the canine elbow. Vet Surg. 2009 Feb;38(2):192

Answer 24

• Purina dogs
  
  • none of them had FCP, UAP, or OCD
  • both groups had same numbers of dogs with radiographic OA
  • radiographically more severe in control fed group at 6 years old but not 8 years old
  • at death, no difference in gross or histo findings between groups
  • because the diet-restricted group lived 1.8 yrs longer and they had the same degree of elbow OA at death, the authors say this supports calorie restriction

Question 25

Draffan D, Carrera I, Carmichael S, Heller J, Hammond G. Radiographic analysis of trochlear notch sclerosis in the diagnosis of osteoarthritis secondary to medial coronoid disease. Vet Comp Orthop Traumatol. 2009 Jan 1;22(1):7–15.

Answer 25

- another method to quantitate trochlear notch sclerosis (TNS in this study) – A/B. measured at craniodistal edge of humerus - I don’t understand why their TNS ratio is in mm - using a TNS ratio of

Question 26

Hadley HS, Wheeler JL, Manley PA. Traumatic fragmented medial coronoid process in a Chihuahua. Vet Comp Orthop Traumatol. 2009 Jan 1;22(4):328–31.

Answer 26

- 14 month old Chihuahua, CT showed fragment and elbow incongruity - improved with SCO and ulnar ostectomy - histo of the fragment did not show little microfractures

Question 27

Moores AP, Benigni L, Lamb CR. Computed tomography versus arthroscopy for detection of canine elbow dysplasia lesions. Vet Surg. 2008 Jun 1;37(4):390–8.

Answer 27

- CT can catch stuff that arthroscopy misses and visa versa – therefore they are complementary

Question 28

Evans RB, Gordon-Evans WJ, Conzemius MG. Comparison of three methods for the management of fragmented medial coronoid process in the dog. A systematic review and meta-analysis. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):106–9.

Answer 28

- arthroscopy is superior to arthrotomy and medical management for FCP, based on the data at the time - medial arthrotomy is not superior to medical management

Question 29

Evans RB, Gordon-Evans WJ, Conzemius MG. Comparison of three methods for the management of fragmented medial coronoid process in the dog. A systematic review and meta-analysis. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):106–9.

Answer 29

- arthroscopy is superior to arthrotomy and medical management for FCP, based on the data at the time - medial arthrotomy is not superior to medical management

Question 30

Burton NJ, Dobney JA, Owen MR, Colborne GR. Joint angle, moment and power compensations in dogs with fragmented medial coronoid process. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):110–8.

Answer 30

- 7 dogs with FCP and inverse dynamic analysis - FCP side compared with contralateral side (no normals) - “In conclusion, joint angular excursions, moments and powers were all diminished in the affected forelimb, but their overall patterns were largely conserved” - especially in propulsive phase of stance

Question 31

Burton NJ, Dobney JA, Owen MR, Colborne GR. Joint angle, moment and power compensations in dogs with fragmented medial coronoid process. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):110–8.

Answer 31

- 7 dogs with FCP and inverse dynamic analysis - FCP side compared with contralateral side (no normals) - “In conclusion, joint angular excursions, moments and powers were all diminished in the affected forelimb, but their overall patterns were largely conserved” - especially in propulsive phase of stance

Question 32

Proks P, Necas A, Stehlik L, Srnec R, Griffon DJ. Quantification of humeroulnar incongruity in labrador retrievers with and without medial coronoid disease. Vet Surg. 2011 Dec;40(8):981–6.

Answer 32

- “Subluxation index” (SI) proposed for humeroulnar incongruity - SI = d/r (of trochlear circle) - on 135 extended lateral radiographs - significant difference between the SI of Labs with coronoid disease (18.5%) vs normal labs (1.7%)

Question 33

Proks P, Necas A, Stehlik L, Srnec R, Griffon DJ. Quantification of humeroulnar incongruity in labrador retrievers with and without medial coronoid disease. Vet Surg. 2011 Dec;40(8):981–6.

Answer 33

- “Subluxation index” (SI) proposed for humeroulnar incongruity - SI = d/r (of trochlear circle) - on 135 extended lateral radiographs - significant difference between the SI of Labs with coronoid disease (18.5%) vs normal labs (1.7%)

Question 34

Böttcher P, Werner H, Ludewig E, Grevel V, Oechtering G. Visual estimation of radioulnar incongruence in dogs using three-dimensional image rendering: an in vitro study based on computed tomographic imaging. Vet Surg. 2009 Feb 1;38(2):161–8.

Answer 34

- -2, -1, 0, +1, +2 RU incongruence model. After 3D reconstruction congruence was estimated subjectively - sensitivity 86%, specificity 77%

Question 35

Böttcher P, Werner H, Ludewig E, Grevel V, Oechtering G. Visual estimation of radioulnar incongruence in dogs using three-dimensional image rendering: an in vitro study based on computed tomographic imaging. Vet Surg. 2009 Feb 1;38(2):161–8.

Answer 35

- -2, -1, 0, +1, +2 RU incongruence model. After 3D reconstruction congruence was estimated subjectively - sensitivity 86%, specificity 77%

Question 36

House MR, Marino DJ, Lesser ML. Effect of limb position on elbow congruity with CT evaluation. Vet Surg. 2009 Feb 1;38(2):154–60.

Answer 36

pronation/supination affects elbow congruity measurements on CT

Question 37

House MR, Marino DJ, Lesser ML. Effect of limb position on elbow congruity with CT evaluation. Vet Surg. 2009 Feb 1;38(2):154–60.

Answer 37

pronation/supination affects elbow congruity measurements on CT

Question 38

Werner H, Winkels P, Grevel V, Oechtering G, Böttcher P. Sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence in dogs. An in vitro study. Vet Comp Orthop Traumatol. 2009 Jan 1;22(6):437–41.

Answer 38

- arthroscopy (1.9mm, elbow fixed at 145, no pronation/supination) - was 98% sensitive and 89% specific for detecting RU inconcruity (+2, +1, 0, -1, -2mm)

Question 39

Werner H, Winkels P, Grevel V, Oechtering G, Böttcher P. Sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence in dogs. An in vitro study. Vet Comp Orthop Traumatol. 2009 Jan 1;22(6):437–41.

Answer 39

- arthroscopy (1.9mm, elbow fixed at 145, no pronation/supination) - was 98% sensitive and 89% specific for detecting RU inconcruity (+2, +1, 0, -1, -2mm)

Question 40

Might KR, Hanzlik KA, Case JB, Duncan CG, Egger EL, Rooney MB, et al. In vitro comparison of proximal ulnar osteotomy and distal ulnar osteotomy with release of the interosseous ligament in a canine model. Vet Surg. 2011 May;40(3):321–6.

Answer 40

- A distal ulnar osteotomy with an interosseus ligament release is equivalent to a proximal ulnar osteot - the change in radioulnar incongruence (about 6mm) is not as much as the osteotomy gap (4.5 mm) - the distal osteotomy without an interosseus lig release does not allow radioulnar sliding

Question 41

Might KR, Hanzlik KA, Case JB, Duncan CG, Egger EL, Rooney MB, et al. In vitro comparison of proximal ulnar osteotomy and distal ulnar osteotomy with release of the interosseous ligament in a canine model. Vet Surg. 2011 May;40(3):321–6.

Answer 41

- A distal ulnar osteotomy with an interosseus ligament release is equivalent to a proximal ulnar osteot - the change in radioulnar incongruence (about 6mm) is not as much as the osteotomy gap (4.5 mm) - the distal osteotomy without an interosseus lig release does not allow radioulnar sliding

Question 42

Kranz ST, Lesser AS. Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease. Vet Comp Orthop Traumatol. 2011;24(5):383–8.

Answer 42

- proximal ulnar osteotomy (2.5 cm distal to joint) allowed more ulnar movement than - mid-diaphyseal ulnar osteotomy (i.e. distal ulnar osteotomy) - radiographic ulnar movement peaked around 2 weeks after surgery

Question 43

Kranz ST, Lesser AS. Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease. Vet Comp Orthop Traumatol. 2011;24(5):383–8.

Answer 43

- proximal ulnar osteotomy (2.5 cm distal to joint) allowed more ulnar movement than - mid-diaphyseal ulnar osteotomy (i.e. distal ulnar osteotomy) - radiographic ulnar movement peaked around 2 weeks after surgery

Question 44

Gutbrod A, Guerrero TG. Effect of external rotational humeral osteotomy on the contact mechanics of the canine elbow joint. Vet Surg. 2012 Oct;41(7):845–52.

Answer 44

- 15 external rotation humeral osteotomy shifted PCP from ulna to radius – shifted it 38% laterally - decreased the ulnar pressure from 59% to 27%

Question 45

Gutbrod A, Guerrero TG. Effect of external rotational humeral osteotomy on the contact mechanics of the canine elbow joint. Vet Surg. 2012 Oct;41(7):845–52.

Answer 45

- 15 external rotation humeral osteotomy shifted PCP from ulna to radius – shifted it 38% laterally - decreased the ulnar pressure from 59% to 27%

Question 46

Fitzpatrick N, Yeadon R, Smith T, Schulz K. Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg. 2009 Feb 1;38(2):261–78.

Answer 46

- many dogs had concurrent SCO. 6.5 month follow-up - Generation 1 – 17.2% major complications - Generation 2 – 22.2% major complications - Generation 3 – 4.8% major complications (i.e. 1 of 21 dogs) - the 2.7 plate was adjusted to accept 3.5 mm locking screws for holes 3 & 4 - the 3.5 plate was left the same, but 4.0 mm locking screws were developed for holes 3&4 - plates are 316L SS, 2.7 plate has 7.5 mm slide, 3.5 plate has 10mm slide (standard) or 7.5 mm (reduced) - plates have Combi-holes. They are 8 hole plates - screws broke at 4, then 3, then 2. Never in distal fragment - try to maintain 33% overlap between cortexes - plate is placed in buttress. Medial plate, medial slide - “drill-guide-slide” technique

Question 47

Fitzpatrick N, Yeadon R, Smith T, Schulz K. Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg. 2009 Feb 1;38(2):261–78.

Answer 47

- many dogs had concurrent SCO. 6.5 month follow-up - Generation 1 – 17.2% major complications - Generation 2 – 22.2% major complications - Generation 3 – 4.8% major complications (i.e. 1 of 21 dogs) - the 2.7 plate was adjusted to accept 3.5 mm locking screws for holes 3 & 4 - the 3.5 plate was left the same, but 4.0 mm locking screws were developed for holes 3&4 - plates are 316L SS, 2.7 plate has 7.5 mm slide, 3.5 plate has 10mm slide (standard) or 7.5 mm (reduced) - plates have Combi-holes. They are 8 hole plates - screws broke at 4, then 3, then 2. Never in distal fragment - try to maintain 33% overlap between cortexes - plate is placed in buttress. Medial plate, medial slide - “drill-guide-slide” technique

Question 48

Mason DR, Schulz KS, Fujita Y, Kass PH, Stover SM. Measurement of humeroradial and humeroulnar transarticular joint forces in the canine elbow joint after humeral wedge and humeral slide osteotomies. Vet Surg. 2008 Jan 1;37(1):63–70.

Answer 48

- 4 mm slide -> 25% reduction in ulna pressure - 8 mm slide -> 28% reduction in ulna pressure - wedge (10 or 20) -> no statistically significant reduction in ulnar pressure - ulna pressure approximately equaled radial pressure before procedures

Question 49

Mason DR, Schulz KS, Fujita Y, Kass PH, Stover SM. Measurement of humeroradial and humeroulnar transarticular joint forces in the canine elbow joint after humeral wedge and humeral slide osteotomies. Vet Surg. 2008 Jan 1;37(1):63–70.

Answer 49

- 4 mm slide -> 25% reduction in ulna pressure - 8 mm slide -> 28% reduction in ulna pressure - wedge (10 or 20) -> no statistically significant reduction in ulnar pressure - ulna pressure approximately equaled radial pressure before procedures

Question 50

Jardel N, Crevier-Denoix N, Moissonnier P, Viateau V. Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy. Vet Comp Orthop Traumatol. 2010;23(2):75–80.

Answer 50

- arthroscope portal is 1-7 mm cranial to the ulnar nerve | - instrument portal is 13-30 mm caudal to the median nerve

Question 51

Jardel N, Crevier-Denoix N, Moissonnier P, Viateau V. Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy. Vet Comp Orthop Traumatol. 2010;23(2):75–80.

Answer 51

- arthroscope portal is 1-7 mm cranial to the ulnar nerve | - instrument portal is 13-30 mm caudal to the median nerve

Question 52

Conzemius M. Nonconstrained elbow replacement in dogs. Vet Surg. 2009 Feb 1;38(2):279–84.

Answer 52

- the continuing story of total elbow development - currently reported success rate = 80% (i.e. 20% major complications – require revision) - feature of most recent generation = hybrid cemented and ingrowth humeral component - the sides of the humeral condylar component have porous surfaces for bony ingrowth

Question 53

Conzemius M. Nonconstrained elbow replacement in dogs. Vet Surg. 2009 Feb 1;38(2):279–84.

Answer 53

- the continuing story of total elbow development - currently reported success rate = 80% (i.e. 20% major complications – require revision) - feature of most recent generation = hybrid cemented and ingrowth humeral component - the sides of the humeral condylar component have porous surfaces for bony ingrowth

Question 54

Burton NJ, Owen MR, Colborne GR, Toscano MJ. Can owners and clinicians assess outcome in dogs with fragmented medial coronoid process? Vet Comp Orthop Traumatol. 2009 Jan 1;22(3):183–9.

Answer 54

- 9 dogs with unilateral FCP. Kinematic gait analysis over 1 year - against TSMR as gold standard (symmetry index), owner and surgeon VAS scales of gait are not reliable - owners tend to underestimate lameness over long term – more than 4 weeks post op

Question 55

Burton NJ, Owen MR, Colborne GR, Toscano MJ. Can owners and clinicians assess outcome in dogs with fragmented medial coronoid process? Vet Comp Orthop Traumatol. 2009 Jan 1;22(3):183–9.

Answer 55

- 9 dogs with unilateral FCP. Kinematic gait analysis over 1 year - against TSMR as gold standard (symmetry index), owner and surgeon VAS scales of gait are not reliable - owners tend to underestimate lameness over long term – more than 4 weeks post op

Question 56

Van Vynckt D, Verhoeven G, Saunders J, Polis I, Samoy Y, Verschooten F, et al. Diagnostic intra-articular anaesthesia of the elbow in dogs with medial coronoid disease. Vet Comp Orthop Traumatol. 2012 Jul 12;25(4):307–13.

Answer 56

- 90 dogs with unilateral lameness & MCD and clinicians weren’t sure about the dx before they did CT - mepivacaine 1.5 mg/kg IA into elbow joint - most dogs lameness improved – 13% false negatives - (no negative control group)

Question 57

Van Vynckt D, Verhoeven G, Saunders J, Polis I, Samoy Y, Verschooten F, et al. Diagnostic intra-articular anaesthesia of the elbow in dogs with medial coronoid disease. Vet Comp Orthop Traumatol. 2012 Jul 12;25(4):307–13.

Answer 57

- 90 dogs with unilateral lameness & MCD and clinicians weren’t sure about the dx before they did CT - mepivacaine 1.5 mg/kg IA into elbow joint - most dogs lameness improved – 13% false negatives - (no negative control group)

Question 58

Evans RB, Gordon-Evans WJ, Conzemius MG. Comparison of three methods for the management of fragmented medial coronoid process in the dog. A systematic review and meta-analysis. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):106–9.

Answer 58

- arthroscopy is superior to arthrotomy and medical management for FCP, based on the data at the time - medial arthrotomy is not superior to medical management

Question 59

Burton NJ, Dobney JA, Owen MR, Colborne GR. Joint angle, moment and power compensations in dogs with fragmented medial coronoid process. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):110–8.

Answer 59

- 7 dogs with FCP and inverse dynamic analysis - FCP side compared with contralateral side (no normals) - “In conclusion, joint angular excursions, moments and powers were all diminished in the affected forelimb, but their overall patterns were largely conserved” - especially in propulsive phase of stance

Question 60

Proks P, Necas A, Stehlik L, Srnec R, Griffon DJ. Quantification of humeroulnar incongruity in labrador retrievers with and without medial coronoid disease. Vet Surg. 2011 Dec;40(8):981–6.

Answer 60

- “Subluxation index” (SI) proposed for humeroulnar incongruity - SI = d/r (of trochlear circle) - on 135 extended lateral radiographs - significant difference between the SI of Labs with coronoid disease (18.5%) vs normal labs (1.7%)

Question 61

Böttcher P, Werner H, Ludewig E, Grevel V, Oechtering G. Visual estimation of radioulnar incongruence in dogs using three-dimensional image rendering: an in vitro study based on computed tomographic imaging. Vet Surg. 2009 Feb 1;38(2):161–8.

Answer 61

- -2, -1, 0, +1, +2 RU incongruence model. After 3D reconstruction congruence was estimated subjectively - sensitivity 86%, specificity 77%

Question 62

House MR, Marino DJ, Lesser ML. Effect of limb position on elbow congruity with CT evaluation. Vet Surg. 2009 Feb 1;38(2):154–60.

Answer 62

pronation/supination affects elbow congruity measurements on CT

Question 63

Werner H, Winkels P, Grevel V, Oechtering G, Böttcher P. Sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence in dogs. An in vitro study. Vet Comp Orthop Traumatol. 2009 Jan 1;22(6):437–41.

Answer 63

- arthroscopy (1.9mm, elbow fixed at 145, no pronation/supination) - was 98% sensitive and 89% specific for detecting RU inconcruity (+2, +1, 0, -1, -2mm)

Question 64

Might KR, Hanzlik KA, Case JB, Duncan CG, Egger EL, Rooney MB, et al. In vitro comparison of proximal ulnar osteotomy and distal ulnar osteotomy with release of the interosseous ligament in a canine model. Vet Surg. 2011 May;40(3):321–6.

Answer 64

- A distal ulnar osteotomy with an interosseus ligament release is equivalent to a proximal ulnar osteot - the change in radioulnar incongruence (about 6mm) is not as much as the osteotomy gap (4.5 mm) - the distal osteotomy without an interosseus lig release does not allow radioulnar sliding

Question 65

Kranz ST, Lesser AS. Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease. Vet Comp Orthop Traumatol. 2011;24(5):383–8.

Answer 65

- proximal ulnar osteotomy (2.5 cm distal to joint) allowed more ulnar movement than - mid-diaphyseal ulnar osteotomy (i.e. distal ulnar osteotomy) - radiographic ulnar movement peaked around 2 weeks after surgery

Question 66

Gutbrod A, Guerrero TG. Effect of external rotational humeral osteotomy on the contact mechanics of the canine elbow joint. Vet Surg. 2012 Oct;41(7):845–52.

Answer 66

- 15 external rotation humeral osteotomy shifted PCP from ulna to radius – shifted it 38% laterally - decreased the ulnar pressure from 59% to 27%

Question 67

Fitzpatrick N, Yeadon R, Smith T, Schulz K. Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg. 2009 Feb 1;38(2):261–78.

Answer 67

- many dogs had concurrent SCO. 6.5 month follow-up - Generation 1 – 17.2% major complications - Generation 2 – 22.2% major complications - Generation 3 – 4.8% major complications (i.e. 1 of 21 dogs) - the 2.7 plate was adjusted to accept 3.5 mm locking screws for holes 3 & 4 - the 3.5 plate was left the same, but 4.0 mm locking screws were developed for holes 3&4 - plates are 316L SS, 2.7 plate has 7.5 mm slide, 3.5 plate has 10mm slide (standard) or 7.5 mm (reduced) - plates have Combi-holes. They are 8 hole plates - screws broke at 4, then 3, then 2. Never in distal fragment - try to maintain 33% overlap between cortexes - plate is placed in buttress. Medial plate, medial slide - “drill-guide-slide” technique

Question 68

Mason DR, Schulz KS, Fujita Y, Kass PH, Stover SM. Measurement of humeroradial and humeroulnar transarticular joint forces in the canine elbow joint after humeral wedge and humeral slide osteotomies. Vet Surg. 2008 Jan 1;37(1):63–70.

Answer 68

- 4 mm slide -> 25% reduction in ulna pressure - 8 mm slide -> 28% reduction in ulna pressure - wedge (10 or 20) -> no statistically significant reduction in ulnar pressure - ulna pressure approximately equaled radial pressure before procedures

Question 69

Jardel N, Crevier-Denoix N, Moissonnier P, Viateau V. Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy. Vet Comp Orthop Traumatol. 2010;23(2):75–80.

Answer 69

- arthroscope portal is 1-7 mm cranial to the ulnar nerve | - instrument portal is 13-30 mm caudal to the median nerve

Question 70

Conzemius M. Nonconstrained elbow replacement in dogs. Vet Surg. 2009 Feb 1;38(2):279–84.

Answer 70

- the continuing story of total elbow development - currently reported success rate = 80% (i.e. 20% major complications – require revision) - feature of most recent generation = hybrid cemented and ingrowth humeral component - the sides of the humeral condylar component have porous surfaces for bony ingrowth

Question 71

Burton NJ, Owen MR, Colborne GR, Toscano MJ. Can owners and clinicians assess outcome in dogs with fragmented medial coronoid process? Vet Comp Orthop Traumatol. 2009 Jan 1;22(3):183–9.

Answer 71

- 9 dogs with unilateral FCP. Kinematic gait analysis over 1 year - against TSMR as gold standard (symmetry index), owner and surgeon VAS scales of gait are not reliable - owners tend to underestimate lameness over long term – more than 4 weeks post op

Question 72

Van Vynckt D, Verhoeven G, Saunders J, Polis I, Samoy Y, Verschooten F, et al. Diagnostic intra-articular anaesthesia of the elbow in dogs with medial coronoid disease. Vet Comp Orthop Traumatol. 2012 Jul 12;25(4):307–13.

Answer 72

- 90 dogs with unilateral lameness & MCD and clinicians weren’t sure about the dx before they did CT - mepivacaine 1.5 mg/kg IA into elbow joint - most dogs lameness improved – 13% false negatives - (no negative control group)