Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity

 

 Buy Article Permissions and Reprints

Summary

The purpose of this study was to investigate the long-term treatment results of fragmented coronoid process (FCP) in joints with a radio-ulnar step greater than 3 mm. Treatment of these patients only consisted of fragment removal, without correction of the incongruity.

The eight Bernese Mountain Dogs (11 joints) included in this study showed obvious clinical signs of elbow disease and were diagnosed with severe elbow incongruity and concomitant FCP in the time period from 1999–2003. At that time, elbow radiography, computed tomography, and arthroscopy were performed. The mean follow-up period was 5.6 years. The follow-up consisted of a telephone questionnaire combined with a clinical and radiographic re-evaluation at our clinic.

The questionnaire revealed that all dogs were either free of lameness or only lame following heavy exercise. One dog sporadically required medication after heavy exercise. The owner satisfaction rate was 100%. The clinical re-evaluation did not reveal any signs of pain or lameness in all cases. Range-of- motion was decreased in nine of the 11 elbows. Radiographs revealed an increase in severity of osteoarthritis in every case.

In this case series, arthroscopic fragment removal without treatment of incongruity was demonstrated to be a valuable treatment option and may provide a satisfactory long-term outcome.

• References

• 1 Kirberger RM, Fourie SL. Elbow dysplasia in the dog: pathophysiology, diagnosis and control. J S Afr Vet Assoc 1998; 69: 43-54.
  CrossrefPubMedGoogle Scholar
• 2 Ness MG. Treatment of fragmented coronoid process in young dogs by proximal ulnar osteotomy. J Small Anim Pract 1998; 39: 15-18.
  CrossrefPubMedGoogle Scholar
• 3 Wind AP. Elbow inconguity and developmental elbow diseases in the dog: Part I. J Am Anim Hosp Assoc 1986; 22: 712-724.
  PubMedGoogle Scholar
• 4 Samoy Y, Van Ryssen B, Gielen I. et al. Review of the literature: elbow incongruity in the dog. Vet Comp Orthop Traumatol 2006; 19: 1-8.
  Article in Thieme ConnectPubMedGoogle Scholar
• 5 Janach KJ, Breit SM, Kunzel WW. Assessment of the geometry of the cubital (elbow) joint of dogs by use of magnetic resonance imaging. Am J Vet Res 2006; 67: 211-218.
  CrossrefPubMedGoogle Scholar
• 6 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; 38: 285-300.
  CrossrefPubMedGoogle Scholar
• 7 Gemmill TJ, Clements DN. Fragmented coronoid process in the dog: is there a role for incongruency?. J Small Anim Pract 2007; 48: 361-368.
  CrossrefPubMedGoogle Scholar
• 8 Kramer AL, Holsworth IG, Wisner ER. et al. Computed tomographic evaluation of canine radioulnar incongruence in vivo. Vet Surg 2006; 35: 24-29.
  CrossrefPubMedGoogle Scholar
• 9 Meyer-Lindenberg A, Fehr M, Nolte I. Co-existence of ununited anconeal process and fragmented medial coronoid process of the ulna in the dog. J Small Anim Pract 2006; 47: 61-65.
  CrossrefPubMedGoogle Scholar
• 10 Meyer-Lindenberg A, Langhann A, Fehr M, Nolte I. Prevalence of fragmented medial coronoid process of the ulna in lame adult dogs. Vet Rec 2002; 151: 230-234.
  CrossrefPubMedGoogle Scholar
• 11 Puccio M, Marino DJ, Stefanacci JD. et al. Clinical evaluation and long-term follow-up of dogs having coronoidectomy for elbow incongruity. J Am Anim Hosp Assoc 2003; 39: 473-478.
  CrossrefPubMedGoogle Scholar
• 12 Van Ryssen B, van Bree H. Arthroscopic findings in 100 dogs with elbow lameness. Vet Rec 1997; 140: 360-362.
  CrossrefPubMedGoogle Scholar
• 13 Samoy Y, Gielen I, Van Caelenberg A. et al. Computed tomography findings in 32 joints affected with severe elbow incongruity and fragmented medial coronoid process. Vet Surg 2012; 41: 486-494.
  CrossrefPubMedGoogle Scholar
• 14 Samoy Y, Van Vynckt D, Gielen I. et al. Arthroscopic findings in 32 joints affected by severe elbow incongruity with concomitant fragmented medial coronoid process. Vet Surg 2012; 41: 355-361.
  PubMedGoogle Scholar
• 15 Burton N, Owen M. Canine elbow dysplasia 1. Aetiopathogenesis and diagnosis. In Pract 2008; 30: 508-512.
  CrossrefPubMedGoogle Scholar
• 16 Danielson KC, Fitzpatrick N, Muir P. et al. Histomorphometry of fragmented medial coronoid process in dogs: a comparison of affected and normal coronoid processes. Vet Surg 2006; 35: 501-509.
  CrossrefPubMedGoogle Scholar
• 17 Fitzpatrick N, Smith TJ, Evans RB. et al. Subtotal coronoid ostectomy for treatment of medial coronoid disease in 263 dogs. Vet Surg 2009; 38: 233-245.
  CrossrefPubMedGoogle Scholar
• 18 Fitzpatrick N, Smith TJ, Evans RB. et al. Radiographic and arthroscopic findings in the elbow joints of 263 dogs with medial coronoid disease. Vet Surg 2009; 38: 213-223.
  CrossrefPubMedGoogle Scholar
• 19 Boulay JP. Fragmented medial coronoid process of the ulna in the dog. Vet Clin N Am Small Anim Pract 1998; 28: 51-74.
  CrossrefPubMedGoogle Scholar
• 20 van Bree H, Van Ryssen B. Arthroscopy in the diagnosis and treatment of front leg lameness. Vet Q 1995; 17 Suppl 1 S32-S4.
  CrossrefPubMedGoogle Scholar
• 21 Van Ryssen B. editor. Role of arthroscopy in elbow diseases in the dog. Proceedings of the 12th International Small Animal Arthroscopy Workshop, refresher course. 2001. January 27 Merelbeke, Belgium:
  Google Scholar
• 22 Meyer-Lindenberg A, Langhann A, Fehr M. et al. Arthrotomy versus arthroscopy in the treatment of the fragmented medial coronoid process of the ulna (FCP) in 421 dogs. Vet Comp Orthop Traumatol 2003; 16: 204-210.
  Article in Thieme ConnectPubMedGoogle Scholar
• 23 Mason DR, Schulz KS, Samii VF. et al. Sensitivity of radiographic evaluation of radio-ulnar incongruence in the dog in vitro. Vet Surg 2002; 31: 125-132.
  CrossrefPubMedGoogle Scholar
• 24 Holsworth IG, Wisner ER, Scherrer WE. et al. Accuracy of computerized tomographic evaluation of canine radio-ulnar incongruence in vitro. Vet Surg 2005; 34: 108-113.
  CrossrefPubMedGoogle Scholar
• 25 Blond L, Dupuis J, Beauregard G. et al. Sensitivity and specificity of radiographic detection of canine elbow incongruence in an in vitro model. Vet Radiol Ultrasound 2005; 46: 210-216.
  CrossrefPubMedGoogle Scholar
• 26 N. N. International Elbow Working Group Protocol. Vet Radiol Ultrasound. 1995; 36: 172-173.
  PubMedGoogle Scholar
• 27 De Rycke LM, Gielen IM, van Bree H. et al. Computed tomography of the elbow joint in clinically normal dogs. Am J Vet Res 2002; 63: 1400-1407.
  CrossrefPubMedGoogle Scholar
• 28 Gielen I, Van Ryssen B, Buijtels J. et al. Canine elbow incongruity evaluated with computerised tomography (CT), radiography and arthroscopy. In: Proceedings of the 8th Annual EAVDI Conference. 2001. July 18-21 Paris, France: pg. 22.
  Google Scholar
• 29 van Bree HJ, Van Ryssen B. Diagnostic and surgical arthroscopy in osteochondrosis lesions. Vet Clin North Am Small Anim Pract 1998; 28: 161-189.
  CrossrefPubMedGoogle Scholar
• 30 Van Ryssen B, vanBree H, Simoens P. Elbow arthroscopy in clinically normal dogs. Am J Vet Res 1993; 54: 191-198.
  PubMedGoogle Scholar
• 31 Preston CA, Schulz KS, Taylor KT. et al. In vitro experimental study of the effect of radial shortening and ulnar ostectomy on contact patterns in the elbow joint of dogs. Am J Vet Res 2001; 62: 1548-1556.
  CrossrefPubMedGoogle Scholar
• 32 Bardet JBS. Traitement de l'apophyse coronoide fragmentée par arthrotomie et ostéotomie ulnaire: étude retrospective de 103 cas [Treatment of fragmented coronoid process using arthrotomy and ulnar osteotomy: a retrospective study of 103 cases]. Prat Méd Chir Anim Comp 1996; 31: 451-463.
  PubMedGoogle Scholar
• 33 Vezzoni A, Pisani G, Corbari A. et al. Surgical therapy of elbow dysplasia: technique and follow up (preliminary report). In: Proceedings of the 13th Annual Meeting of the International Elbow Working Group. 2002. October 2 Granada, Spain: pg. 18-24.
  Google Scholar
• 34 Wind AP, Packard ME. Elbow incongruity and developmental elbow diseases in the dog: Part II. J Am Anim Hosp Assoc 1986; 22: 725-730.
  PubMedGoogle Scholar
• 35 Ubbink GJ, Hazewinkel HA, van de BJ. et al. Familial clustering and risk analysis for fragmented coronoid process and elbow joint incongruity in Bernese Mountain Dogs in The Netherlands. Am J Vet Res 1999; 60: 1082-1087.
  PubMedGoogle Scholar
• 36 Bernese Mountain Dog Club of America. 2005 BMDCA Health Survey. Summary of Data [document on the internet]. [Cited on 2007 July 25]. Available from: http://www.bmdca.org/health/pdf/2005_Health_Survey.pdf
  PubMedGoogle Scholar
• 37 Berzon JL, Quick CB. Fragmented coronoid process: Anatomical, clinical and radiographic considerations with case analyses. J Am Anim Hosp Assoc 2006; 16: 241-251.
  PubMedGoogle Scholar
• 38 Grondalen J. Arthrosis in the elbow joint of young rapidly growing dogs. III. Ununited medical coronoid process of the ulna and osteochondritis dissecans of the humeral condyle. Surgical procedure for correction and postoperative investigation. Nord Vet Med 1979; 31: 520-527.
  PubMedGoogle Scholar
• 39 Groves RM. Chapter 8.5: Interviewer Effects in Centralised Telephone Surveys. In: Survey Errors and Survey Costs. New York: John Wiley Sons, Inc.; 1989. pg. 365-373.
  Google Scholar
• 40 de Leeuw ED, van der Zouwen J. Chapter 18: Data quality in telephone and face to face surveys. A comparative meta-analysis. In: Groves RM, Biemer PP, Lyberg LE. editors. Telephone Survey Methodology. New York: John Wiley Sons, Inc.; 2001. pg. 283-299.
  Google Scholar
• 41 Theyse LFH, Hazewinkel HAW, van den Brom WE. Force plate analysis before and after surgical treatment of unilateral 135 fragmented coronoid process. Vet Comp Orthop Traumatol 2000; 13: 135-140.
  Article in Thieme ConnectPubMedGoogle Scholar
• 42 Böttcher P, Rey J, Oechtering G. editors. In vivo motion analysis 3D. In: Proceedings of the 20th Annual Scientific ECVS Meeting [CD ROM]. 2011. July 7-9 Ghent, Belgium.:
  Google Scholar
• 43 Tobias TA, Miabayashi T, Olmstead ML. et al. Surgical removal of fragmented medial coronoid process in the dog: comparative effects of surgical approach and age at time of surgery. J Am Anim Hosp Assoc 1994; 30: 360-368.
  PubMedGoogle Scholar
• 44 Vermote KA, Bergenhuyzen AL, Gielen I. et al. Elbow lameness in dogs of six years and older. Vet Comp Orthop Traumatol 2010; 23: 43-50.
  Article in Thieme ConnectPubMedGoogle Scholar
• 45 Olsson NC, Brinker WO, Carrig CB. et al. Asynchronous growth of the canine radius and ulna: Surgical correction following experimental premature closure of the distal radial physis. Vet Surg 1981; 125-131.
  PubMedGoogle Scholar
• 46 Gordon WJ, Conzemius MG, Riedesel E. et al. The relationship between limb function and radiographic osteoarthrosis in dogs with stifle osteoarthrosis. Vet Surg 2003; 32: 451-454.
  CrossrefPubMedGoogle Scholar
• 47 Budsberg SC. Outcome assessment in clinical trials involving medical management of osteoarthritis in small animals. Vet Clin North Am Small Anim Pract 1997; 27: 815-823.
  CrossrefPubMedGoogle Scholar
• 48 Cobb S, Merchant WR, Rubin T. The relation of symptoms to osteoarthritis. J Chronic Dis 1957; 5: 197-204.
  CrossrefPubMedGoogle Scholar
• 49 Sabiston CP, Adams ME, Li DK. Magnetic resonance imaging of osteoarthritis: correlation with gross pathology using an experimental model. J Orthop Res 1987; 5: 164-172.
  CrossrefPubMedGoogle Scholar
• 50 Schulz K, Mason DR, Holsworth IG. et al. Current research in the pathophysiology of elbow dysplasia. In: Proceedings of the 1st World Orthopaedic Veterinary Congress. 2002. September 5-8 Munich, Germany: pg. 179.
  Google Scholar
• 51 Fitzpatrick N. Subtotal coronoid ostectomy: indications and outcome. In: Proceedings of the 2011 American College of Veterinary Surgeons Veterinary Symposium. 2011. November 3-5 Chicago, Illinois, USA: pg. 113.
  Google Scholar