Dynamic Proximal Ulnar Osteotomy Research Articles

Clinical and Radiographic Evaluation of Short- and Long-Term Outcomes of Different Treatments Adopted for Elbow Medial Compartment Disease in Dogs.

Medial compartment disease is a common occurrence in dogs affected by elbow dysplasia. Despite many treatments suggested in the literature, only few studies reported comparative outcomes in the short and long term. The aim of this study is to report and compare short- and long-term clinical and radiographic outcomes of dogs treated for medial compartment disease (MCD) by distal dynamic ulnar ostectomy (DUO), bi-oblique dynamic proximal ulnar osteotomy (BODPUO) and conservative management (CM). From 2016 to 2018, all medium to large dogs, aged between 5 and 12 months, affected by uni/bilateral MCD and treated by DUO, BODPUO or CM, were enrolled in this study and followed up for 24 months. Orthopedic and radiographic examinations were performed at T0, T2, T12 and T24 months after treatment. Lameness score, elbow arthralgia, elbow range of motion (ROM), osteoarthritis (OA) score and percentage of ulnar subtrochlear sclerosis (%STS) were evaluated at each time point. According to the treatment performed, dogs were divided into three groups: DUO, BODPUO and CM. Forty-five elbows from twenty-six dogs, treated with DUO (n = 17), BODPUO (n = 17) or CM (n = 11), were prospectively enrolled in the study. The patients enrolled in the CM group were older and showed more severe radiographic signs of OA, compared to those enrolled in the other two groups. Lameness and arthralgia scores (p < 10−4) were significantly decreased in patients that underwent surgical treatment and increased in patients managed conservatively (lameness p < 10−4, arthralgia p = 0.3068), at T12 and T24. OA score (p < 0.0040) and ROM (DUO, CM p < 10−4; BODPUO p = 0.0740) worsened in every study group, but %STS decreased in DUO (p = 0.0108), increased in the CM group (p = 0.0025) and remained unchanged in the BODPUO group (p = 0.2740). This study supports the clinical efficacy of DUO and BODPUO in reducing lameness, arthralgia and progression of %STS. Early diagnosis and surgical attention in patients affected by MCD can improve the short- and long-term outcome and reduce the progression of secondary changes.

Three-Dimensional Joint Kinematics in a Canine Elbow Joint with Medial Coronoid Disease before and after Bi-Oblique Dynamic Proximal Ulnar Osteotomy

Abstract Objective The aim of this study was to report the humeroulnar joint kinematics in a dog with medial coronoid process disease (MCPD) before and after dynamic proximal ulnar osteotomy (DPUO). Study Design A 15-month-old female Labrador Retriever with advanced MCPD was treated by DPUO and fragment removal. Bi-planar fluoroscopic kinematography of the affected joint was performed before and 12 weeks after DPUO along with computed tomography. Static axial radioulnar incongruence (sRUI), dynamic relative proximodistal radioulnar motion (dynamic RUI), axial humeroulnar rotation, as well as humeroulnar joint contact at the medial coronoid process (MCP) were calculated. Results Static axial radioulnar incongruence was reduced from 2.3 to 1.5 mm after DPUO but dynamic RUI remained unchanged (0.2 vs. 0.3 mm). Mean humeroulnar rotational amplitude increased from 2.6° (standard deviation 0.4) to 4.5° (standard deviation 2.0). Joint contact area at the MCP became substantially increased as well as broadly distributed among the MCP following DPUO (52.5 vs. 63.0%; p = 0.0012). Conclusion Dynamic proximal ulnar osteotomy failed to restore the radioulnar congruence and increased the humeroulnar rotational instability. No effect was observed on dynamic RUI. Nevertheless, joint contact area at the MCP was increased and became more homogeneously distributed, which might explain the beneficial effect of clinical outcome in this case.

Bi-Oblique Dynamic Proximal Ulnar Osteotomy: Surgical Technique and Clinical Outcome in 86 Dogs.

To describe the technique of bi-oblique dynamic proximal ulnar osteotomy (BODPUO) and report the clinical outcome in a series of dog with medial compartment disease and other developmental elbow diseases. Retrospective case series. Dogs (n=86; 120 elbows) treated for elbow disease with BODPUO. Medical records and diagnostic images were reviewed. Type and frequency of complications and treatment required were recorded. Force plate data were reported in dogs for which data had been recorded preoperatively and at follow-up. Mean (standard deviation) final follow-up was 23.4 (35.6) weeks. There were minor complications in 15 elbows (12%, 14 dogs). There were no major complications. The caudo-cranial and latero-medial mean osteotomy angles were 55° (7°) and 48° (10°), respectively. The most caudo-proximal point of the osteotomy was located at a mean of 39% (5%) of the total ulnar length from the olecranon. Sixty of 68 elbows (88%) were considered healed by 4 months postoperative based on radiographs. Subjective lameness scores were significantly decreased by final follow-up for all dogs. For dogs treated with BODPUO alone for medial compartment disease, peak vertical force was significantly higher at 6 months postoperative. Dogs with medial compartment disease undergoing BODPUO showed clinical improvement in the 6 month follow-up. No complications required surgical intervention.

Bi‐Oblique Dynamic Proximal Ulnar Osteotomy in Dogs: Reconstructed Computed Tomographic Assessment of Radioulnar Congruence over 12 weeks

To evaluate radioulnar joint modification using computed tomography (CT) after bi-oblique dynamic proximal ulnar osteotomy (BODPUO). Clinical study. Dogs (n = 18, 26 elbows) with elbow incongruence treated by a single surgeon with BODPUO. Radioulnar space measurements were performed on transverse, frontal, and sagittal CT projections preoperatively and after radiographically determined osteotomy healing. Three transverse plane measurements were statistically different than preoperatively at 12 weeks after the surgery demonstrating divergence of the lateral coronoid region of the radial incisure of the ulna from the radial head. None of the other measurements within the elbow were statistically different, but measurements of the radioulnar space at the level of the osteotomy site documented a statistically significant caudal tipping of the distal extent of the proximal ulnar segment. CT measurements documented a significant increase in radioulnar joint space at the mid-coronoid level, at the level of the base of the medial coronoid process, and at the level of the lateral coronoid process. This corresponds to cranially directed rotation of the medial coronoid process around the proximal radial epiphysis. A tendency for cranial tilting of the medial coronoid process was observed, which was confirmed by statistically significant caudal tipping of the distal extent of the proximal ulnar segment.

Estimation of Joint Incongruence in Dysplastic Canine Elbows Before and After Dynamic Proximal Ulnar Osteotomy

To characterize joint incongruence in dysplastic canine elbows before and after dynamic proximal ulnar osteotomy (DPUO). Clinical, prospective study. Dogs (n = 10; 12 elbows) with ≥ 2 mm radioulnar incongruence (RUI), FCP, and/or OCD. Computed tomography in a nonload bearing position was used to generate in silico 3D models of the elbow joint before DPUO, and this was repeated after DPUO union (median 3 months postoperatively). On these models, RUI, humeroradial and humeroulnar subchondral joint space width (SJSW) as well as alignment of the proximal ulnar segment were investigated. RUI at the medial coronoid process (MCP) decreased (P = .001), while it increased at the lateral coronoid process (P = .0005), and remained unchanged at the level of the trochlear ridge (P = .25). SJSW at the MCP increased (P = .001), changing from focal joint space collapse preoperatively to a more homogeneous pattern of moderate SJSW at follow-up. The proximal ulnar segment rotated in all 3 planes with caudal tipping at the level of the osteotomy and varus deformity, while no axial translation could be noted. DPUO results in reduction of RUI and amelioration of focal contact area at the MCP. This effect is the result of a complex three-dimensional rotation of the proximal ulnar segment, rather than axial shift.

Dynamic Proximal Ulnar Osteotomy for the Treatment of Ununited Anconeal Process in 17 Dogs

SummaryA prospective study was made of 17 dogs with ununited anconeal process treated by osteotomy of the proximal ulna. The effect of the surgery on lameness was evaluated subjectively and the elbows were assessed radiographically for evidence of anconeal fusion and healing of the osteotomy. Whilst clinical outcome was generally good and complications infrequent, relatively few cases achieved anconeal fusion. These results do not compare well with the results of a previous study but this disparity may be due in part to differences in patient population and radiographic evaluation.Further work is required to establish how best to achieve predictable anconeal fusion.Proximal ulnar osteotomy was used to treat 17 dogs with ununited anconeal process. Clinical results were good but anconeal fusion was not achieved consistently. Further work is needed to determine how best to achieve predictable anconeal fusion.

Treatment of Humeroulnar Subluxation with a Dynamic Proximal Ulnar Osteotomy A Review of 13 Cases

Humeroulnar subluxation was treated surgically in 13 dogs with 18 affected elbows using a proximal osteotomy of the ulna that allowed the ulna to elongate dynamically. Distal humeroulnar subluxation was secondary to premature closure of the distal ulnar physis in 16 elbows. One distal subluxation was secondary to a radioulnar synostosis, and one proximal subluxation developed after premature closure of the distal radial physis. The mean follow-up time was 22 months. Twenty-eight percent of the elbows were judged to have excellent results, 22% good results, 50% fair results, and none was judged to have a poor outcome. The presenting lameness grade and the severity of preoperative and postoperative humeroulnar subluxation had significant correlations with the prognosis. Associated orthopedic abnormalities and complications of concurrent surgical procedures affected the outcome in several dogs. Overall, the dynamic proximal ulnar osteotomy was a simple and effective technique for the treatment of uncomplicated humeroulnar subluxation.