Humeral Condyle Fractures Research Articles

Clinical and Radiographic Evaluation of the Operative Treatment of Lateral Humeral Condylar Fracture in Children at Shafa Hospital, Tehran, Iran

Clinical and Radiographic Evaluation of the Operative Treatment of Lateral Humeral Condylar Fracture in Children at Shafa Hospital, Tehran, Iran

Closed reduction of humeral condylar fracture and elbow luxation in a dog

ABSTRACT Fractures of the distal humerus that involving the condyles often requires extensive surgical approach for treatment, leading to a prolonged recovery time. In a West Highland White Terrier dog two years old, with a fracture of the lateral humeral condyle portion and elbow luxation, was performed a closed technique for luxation reduction, fracture reduction was performed by digital pressure and percutaneous osteosynthesis by introduction of a Kirschner wire of 2 mm diameter, accompanied by Robert-Jones bandage modified for 6 weeks. Limb function was recovered in the immediate postoperative, the wire was removed six weeks after, non-was observed postoperative complications, and full functional recovery of the limb was clinically evident. This suggests that this technique could be an option in cases of condylar fractures in small-sized dogs.

Clinical application and effective analysis for total elbow arthroplasty

Objective To explore the clinical efficacy of total elbow arthroplasty for elderly comminuted fractures of the distal humerus and elbow rheumatoid arthritis. Methods Thirteen patients including 9 cases of distal humeral comminuted fracture and 4 cases of elbow rheumatic arthritis were retrospectively analyzed, and they were treated by semiconstrained prosthesis from April 2006 to June 2012. There were 3 males and 10 females, among them, 1 case was 50 years old, and 12 cases were more than 60 years old. According to AO classification system, there were 3 cases of type C2, 6 cases of type C3. Eight operations were done in one stage, and 1 case of open fracture (Gustilo-Anderson type Ⅰ) was treated in two-stage. 4 cases elbow rheumatic arthritis had average duration for 7.8 years, and there were 1 patient with stage Ⅲ, 2 patients with stage Ⅳ, and 1 case with stage Ⅴ, according to Mayo classification. They all used the hinge-semiconstrained prosthesis, and fixed by bone cement. Results Surgerytime was from 120 min to 180 min (150 min in average). Total blood loss was from 250 ml to 550 ml (400 ml in average). The days of hospitalization were 16 to 55 (30.2 days in average). All cases were followed up for 15 to 82 months (39.5 months in average). Operative incision of 12 cases were primary healing, 1 case of elbow rheumatic arthritis got local acute infection, and microbiology examination for enterobacter cloacae. After second stage operation for debridement and continuous irrigation drainage for 4 weeks, combined with sensitive antibiotics, the wound was healed. Meanwhile, this case's humeral condyle fractures occurred when osteotmy intraoperative, and was fixed with Kirschner wire tension band, and the fracture had healed after 4 months. There were no complications such as prosthesis loosening and dislocation. The prosthesis positions were good in radiography. 7 cases showed lucent lesions in bone-cement interface. The elbow functions were graded by the system of Mayo. 3 cases were in excellent, 8 cases were good, 2 cases were fair, and there were no poor cases. The excellent and good rate was 84.6% (11/13). Conclusion Total elbow arthroplasty is an effective method for treating of the distal humeral comminuted fractures as well as elbow rheumatic arthritis in aged patients. However, the indications must be restrictedly controlled, and follow the manipulative techniques of operation. And there were higher complication rate for elbow rheumatic arthritis in intraoperation and postoperation. Key words: Aged; Humeral fractures; Arthritis, rheumatoid; Arthroplasty, replacement, elbow

Kirschner wire infections in pediatric orthopaedic surgery.

Few studies have described the presentation, bacteriology, risk factors, and complications of Kirschner wire infections in pediatrics. The purpose of this study is to describe these factors to better understand, prevent, and treat infectious complications of smooth wires. A retrospective review was performed to identify all patients (birth to 16 y) who were hospitalized for Kirschner wire infection from 1995 to 2012. Presentation, hospital course, bacteriology, outcomes, and complications were recorded. A management algorithm was developed from the experience. Kirschner wire infections were present in 12 patients: 5 supracondylar fractures, 3 lateral humeral condylar fractures, a distal tibia physeal fracture, a great toe open fracture, a distal radius fracture, and an elective osteotomy for hallux valgus. The patients presented with cellulitis in 3 cases, soft-tissue abscess in 4 cases, osteomyelitis in 4 cases, and 1 case of toxic shock syndrome. A history of missed appointments or wet dressing was present in 60% of cases. Reoperation was required in 5 patients with abscess, septic arthritis, or osteomyelitis. Methicillin-sensitive Staphylococcus aureus (MSSA) was the most common pathogen followed by Pseudomonas aeruginosa. Methicillin-resistant S. aureus was not seen. Complications were present in 5 patients and included: loss of range of motion, joint destruction, wound breakdown, catheter migration, and toxic shock syndrome. Infected Kirschner wires are rare and may be maintained in a nonunited bone if the infection is superficial. Infections in this series commonly had a history of missed appointments and wet dressings, which suggests that improved postoperative education may reduce the risk. Osteomyelitis was often preceded by pin-site drainage and failed oral antibiotic therapy. MSSA and Pseudomonas were most commonly cultured and should be considered when empiric antibiotic therapy is necessary. Prognostic level IV.

Treatment of the lateral humeral condylar fractures in children

Treatment of the lateral humeral condylar fractures in children

Surgical repair of humeral condylar fractures in New Zealand working farm dogs – long-term outcome and owner satisfaction

AIM: To report the long-term outcome, return to work and owner satisfaction, for working farm dogs in New Zealand following surgical repair of humeral condylar fractures.METHODS: A retrospective study of working dogs that had undergone surgical repair of one or more condylar fractures of the humerus was undertaken by searching the medical records of two referral veterinary clinics. The inclusion criteria were working dogs that had undergone open surgical reduction and internal fixation of a fracture of one or both humeral condyles. The ability of the dog to work after surgery, persistence of lameness and the owners' degree of satisfaction with the outcome were assessed from answers to a questionnaire.RESULTS: Sixteen dogs met the inclusion criteria and had owner questionnaires completed at a median follow-up interval of 54 (min 3, max 121) months. Fifteen were working farm dogs (13 Heading dogs, including Border Collies, and two New Zealand Huntaways) and one dog was a cross-breed used for pig hunting. Four dogs had two fractures on separate occasions, of which three underwent surgery on both elbows at a median interval of 19 months. Of the 20 humeral fractures, 10 were lateral condylar, one was a medial condylar fracture and nine were dicondylar fractures. Of the 16 repairs with follow-up data, seven (44%) dogs could perform all expected duties following surgical repair, whilst a further eight (50%) could perform most duties although some allowances had to be made for some limitation of their performance. Of the 15 owners responding, 13 (87%) were satisfied or very satisfied with the outcome of surgery and felt the surgery was worth the expense. Post-operative complications requiring a second surgery occurred in 7/20 (35%) dogs, and all six dogs that received appropriate surgical revision returned to work.CONCLUSIONS: In this small case series, surgical repair of humeral condylar fractures in working dogs had a good prognosis with 15/16 of treated dogs returning to full or substantial levels of work.CLINICAL RELEVANCE: These data provide veterinarians with relevant information regarding the outcome and prognosis of surgery for clients whose working dogs have fractured a humeral condyle.

Open reduction and Kirschner wire fixation for treatment of humeral lateral condylar fractures in children

Objective To investigate the early diagnosis and treatment strategies of lateral condylar fractures of humerus in children.Methods From July 2010 to July 2012,15 patients with humeral lateral condyle fractures were treated with open reduction and internal fixation with Kirschner wires in our hospital.The treatment outcomes were assessed using Flynn functional criteria and radiographical assessment of osteoarthritis or heterotopic ossification around the elbow.Results All the patients were follow-up for a mean time of 18.5 months (range,13 to 27 months).Bony healing was achieved in all the patients,within an average of 2.0 months (range,1.4 to 2.7 months).No nonunion and delayed union were observed in X-ray films.According to Flynn criteria,the results were excellent in 13 cases and good in 2 cases.Conclusion Displaced humerus lateral condyle fracture is easy to be misdiagnosed or missed because ossification occurs late in children.The fracture therefore doesn't show on X-rays.Early diagnosis is important in order to reduce various deformities and complications.Open reduction and crossed Kirschner wire fixation can lead to satisfactory reduction and firm fixation with fewer complications.At present it is an ideal method for treatment of lateral condylar fracture of humerus in children. Key words: Child; Humerus fractures; Early diagnosis; Lateral condyle

Effect of Fixation Method on Postoperative Complication Rates After Surgical Stabilization of Lateral Humeral Condylar Fractures in Dogs

To assess the impact of stabilization method on the complication rate after lateral humeral condylar fracture (LHCF) repair. Retrospective multicenter clinical cohort study. Dogs (n = 151) with LHCF. Medical records (2004-2012) were reviewed for dogs that had surgical repair of LHCF. Data retrieved included signalment, cause of fracture, evidence of incomplete ossification of the humeral condyle, occurrence of postoperative complications, presence of supracondylar comminution preoperatively, and persistence of an intracondylar fissure postoperatively. Outcome was assessed based on the most recent data available and graded as excellent, good, fair, or poor. LHCF (n = 135) were evaluated in 132 dogs; 61 fractures were stabilized using a transcondylar screw and supracondylar K-wire, 13 using a transcondylar screw and supracondylar screw, and 61 using a transcondylar screw and lateral epicondylar plate. Major complications were significantly (P = .01) more common after stabilization using a transcondylar screw and supracondylar K-wire (28%) than in dogs where a supracondylar screw or lateral epicondylar plate were used (11%). Cases that had postoperative complications were significantly (P = .02) more likely to have a poor outcome. LHCF stabilized using a transcondylar screw and supracondylar K-wire are more likely to have major complications resulting in a poorer outcome than cases stabilized using a supracondylar screw or lateral epicondylar plate.

Clinical assessment of a shaft screw for stabilization of the humeral condyle in dogs

To report the use of a 4.5 mm shaft screw for the management of humeral condylar fractures (HCF) and incomplete ossification of the humeral condyle (IOHC) in dogs, and to assess risk factors for complications. Dogs with HCF or IOHC that were managed with a 4.5 mm shaft screw with a minimum follow-up of six months from surgery were included. Data from the case records were used to identify risk factors for complications. Long-term follow-up was provided by an owner questionnaire and veterinary re-examination. Forty-three elbows were treated in 40 dogs (14 IOHC, 29 HCF). Minor complications were seen in four cases (9%) and major complications in 10 cases (23%). There were no statistically significant risk factors for major complication. Infection resulted in shaft screw removal from three IOHC cases. Four of eight IOHC cases that had a lateral approach had a major complication compared with zero out of six dogs that had a medial approach, but this difference was not significant (p = 0.085). Nine of 12 IOHC cases and 20/23 HCF cases had excellent or good limb use at the time of long-term follow-up (median of 106 weeks, range 26-227 weeks). All fractures healed but IOHC fissure healing was inconsistent. Fatigue failure of shaft screws was not seen. The use of shaft screws for the management of IOHC and HCF is associated with a relatively low rate of complications (compared to previous reports) and a good long-term outcome.

Clinical outcomes of external fixator combined with K-wire fixation for treatment of old type C humeral intercondylar fractures

Objective To explore the effective treatment method of old humeral intercondylar fractures.Methods From January 2005 to January 2010,13 cases of old type C humeral intercondylar fractures were treated.The injury to surgery intervals were 3 to 5 weeks.A hinged elbow external fixator and Kirschner wire were used for fixation after open reduction.Results All the patients had 11 to 24 months (mean,15 months) follow-up after the surgery.Fracture healing time ranged from 4 to 7 months,with an average of 5 months.The average range of motion of the elbow joint was (19.4 ± 6.5) ° of extension,(90.0 ± 10.3)° of flexion,(50.0 ±6.0)° of forearm pronation,and (65.0 ± 6.0)° of forearm supination.HSS elbow score increased from preoperative(30.4 ± 8.6) points to postoperative (75.7 ± 8.3) points,the difference being statistically significant (P ＜ 0.01).The results were rated excellent in 5 cases,good in 4 cases,fair in 3 cases and poor in 1 case.Conclusion The application of a hinged external fixator in open reduction and internal fixation of old type C humeral condylar fractures can assist early functional exercise of the elbow.It is conducive to the recovery of elbow function and can be an effective treatment. Key words: Humeral fractures; Fracture fixation,internal; External fixators

Biomechanical Comparison of 4.0‐mm Short‐Threaded Cannulated Screws and 4.0‐mm Short‐Threaded Cancellous Screws in a Canine Humeral Condylar Fracture Model

To compare biomechanical properties of a humeral condylar fracture model stabilized either with a 4.0-mm short-threaded cancellous screw (CCS) or with a 4.0-mm short-threaded cannulated screw (CNS). In vitro biomechanical study. Bilateral cadaveric canine humeri (n = 20). Fractures of the lateral portion of the humeral condyle were simulated by standardized osteotomies; 10 condyles were each stabilized with CCS and 10 with CNS. Axial compression load was applied to each specimen until failure and force-displacement curves generated. Testing data for each construct were determined and compared using either a Student's paired t-test (quantitative data) or a χ(2) test (qualitative data) with statistical significance set at P < .05. Yield load (elastic limit), ultimate load at failure, and displacements at loads corresponding to walk and trot were determined from each curve. Mean ± SD ultimate load at failure was significantly higher (P = .01) for CCS constructs (1261 ± 261 N) than for CNS constructs (1078 ± 231 N). Yield loads were not significantly different (P = .10) between construct types, and exceeded all expected loads supported by the humeral condyle at walk. The risk of having a yield load below the expected physiologic load at trot was not statistically higher with a CNS construct compared with a CCS construct (P = .26). Humeral condylar fracture repaired either by a 4.0-mm cannulated screw or a 4.0-mm cancellous screw have comparable stability in this condylar fracture model.

Management of neglected lateral condyle fractures of humerus in children: A retrospective study

Background:Late presentation of humeral lateral condylar fracture in children is a surgical dilemma. Osteosynthesis of the fracture fragment or correction of elbow deformity with osteotomies and ulnar nerve transposition or sometimes both procedures combined is a controversial topic. We retrospectively evaluated open reduction and fixation cases in late presentation of lateral humeral condyle fracture in pediatric cases with regards to union and functional results.Materials and Methods:Twenty two pediatric (≤12 years) patients with fractures of lateral condyle presenting 4 weeks or more post injury between the study period of 2006 and 2010 were included. Multiple K-wires / with or without screws along with bone grafting were used. At final evaluation, union (radiologically) and elbow function (Liverpool Elbow Score, LES) was assessed.Results:There were 19 boys and 3 girls. Followup averaged 33 months. Pain (n=9), swelling (n=6), restriction of elbow motion (n=6), prominence of lateral condylar region (n=4), valgus deformity (n=4) were the main presenting symptoms. Ulnar nerve function was normal in all patients. There were nine Milch type I and 13 type II fractures. Union occurred in 20 cases. One case had malunion and in another case there was resorption of condyle following postoperative infection and avascular necrosis. Prominent lateral condyles (4/12), fish tail appearance (n=7), premature epiphyseal closure (n=2) were other observations. LES averaged 8.12 (range, 6.66-9.54) at final followup.Conclusions:There is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt. Our study showed poor correlation between patient's age, duration of late presentation or Milch type I or II and final elbow function as determined by LES.

Treatment of bone nonunion and bone defects associated with unsuccessful humeral condylar fracture repair with autogenous iliac bone reconstruction

Our preliminary study retrospectively assessed outcomes after the use of autogenous iliac bone grafts combined with internal fixation to repair refractory bone nonunions and bone defects associated with supracondylar or intracondylar humeral fractures, or both. We identified 22 patients (14 men and 8 women) with a mean age of 33.8 years (range, 17-60 years) with bone nonunion and severe bone defects associated with supracondylar or intercondylar humerus fractures, or both. The humeral condyle in each patient was anatomically reconstructed using autologous iliac bone grafts and internal fixation. Active functional exercise was initiated 3 to 4 weeks after surgery. The following variables were assessed: preoperative and postoperative elbow range of motion, Mayo Elbow Performance Score (MEPS), and postoperative complications. Mean follow-up was 38.6 months. Mean duration until bone union was 5.6 months. Preoperatively, 16 patients had a fair or poor MEPS (<75). At final follow-up MEPS was excellent (>90) in 8, good (75-90) in 9, fair (60-74) in 4, and poor (<60) in 1 patient. Postoperative heterotopic ossification anterior to the elbow joint occurred in 2 patients. Our preliminary results suggest that anatomic reconstruction of the humeral condyle using autogenous iliac bone grafting with internal fixation can improve elbow joint function in patients with bone nonunion and bone defects associated with supracondylar or intracondylar humeral fractures, or both. Larger scale studies are warranted to confirm our findings and compare the efficacy of this vs other surgical approaches.

Medial condyle fracture of the distal humerus in an adolescent with pre-existing fishtail deformity. A case report

Medial condyle fractures of the humerus are rare in any age group. We report a unique case of a humeral medial condyle fracture in a 15-year-old boy with posttraumatic fishtail deformity. The fracture line extended up from the top of the sharp trochlear wedge to the incomplete medial supracondylar cortical aperture. The appearance of the upward displacement and computed tomography imaging with three-dimensional reconstruction at the two different elbow positions suggested that an edge of the semilunar notch of the olecranon acted as a wedge to break and split the trochlea directly. This is the first visualized case of a wedge type injury and may provide evidence that humeral medial condyle fractures can be produced by the wedge force besides the valgus avulsion one.

Recovery of Elbow Motion Following Pediatric Lateral Condylar Fractures of the Humerus

Temporary elbow stiffness is often seen after a lateral condylar fracture of the distal end of the humerus in children. There are scant scientific data available to assess the expected time frame for return of elbow motion after these injuries. The purpose of this study is to provide a prospective, longitudinal evaluation of elbow motion in a large group of pediatric patients undergoing treatment for a lateral condylar fracture of the distal end of the humerus. We prospectively evaluated 141 patients with lateral humeral condylar fractures at a mean age of 5.2 years and with a mean follow-up of twenty-nine weeks. The patients were treated with cast immobilization, percutaneous pinning, or open reduction and internal fixation on the basis of the initial displacement. Elbow motion was followed longitudinally at clinic visits. Relative arc of motion was calculated as a percentage of the motion of the normal, contralateral elbow. The mean relative arc of motion at the time of cast removal was 44%, reaching 84% by week 12. By weeks 18, 24, 36, and 48, the relative arc of motion reached 87%, 90%, 93%, and 97%, respectively. Compared with fractures treated without surgery, those treated surgically had a significantly lower absolute arc of motion from the time of cast removal (p = 0.018) and up to eighteen weeks after the injury (p < 0.001); however, no significant difference was observed at eighteen weeks or beyond. For patients treated surgically, no significant difference in relative arc of motion was observed between the patients with closed or open reductions. The age of the patient (hazard ratio = 0.87, p = 0.008), length of immobilization (hazard ratio = 0.79, p = 0.03), and severity of the fracture (hazard ratio = 0.40, p < 0.0001) were independent predictors of recovery of elbow motion after a lateral humeral condylar fracture in children. An initial rapid recovery in elbow motion can be expected after a lateral humeral condylar fracture in a child, with progressive improvements for up to one year after the injury. This recovery is slower if the patient is older, has a longer period of immobilization, and has a more severe injury.

Nonunion of Lateral Humeral Condylar Fracture in A Child with Cubitus Varus

Patients with cubitus varus deformity secondary to malunited supracondylar fracture are at risk for lateral humeral condylar (LHC) fracture. This report describes a child presenting with preexisting malunion of supracondylar fracture presenting along with nonunion of a LHC fracture following a recent injury. The patient underwent resection osteotomy of the metaphyseal proximal fragment of the fracture surface, reduction of the displaced LHC fragment and screw fixation. This procedure corrected the cubitus varus and treated the nonunion of the lateral condyle thus avoiding a supracondylar osteotomy procedure. Treatment resulted in solid union, good range of motion and no avascular necrosis.

Prevalence of incomplete ossification of the humeral condyle in the limb opposite humeral condylar fracture: 14 dogs

The objectives of this study were to determine the frequency of incomplete ossification of the contralateral humeral condyle (IOHC) in mature dogs with unilateral, atraumatic humeral condylar fracture (HCF), and to determine the sensitivity of radiographs as a diagnostic tool for IOHC. Computed tomography and radiographs were obtained for both elbows of 14 dogs with unilateral HCF. The images were evaluated by two boarded radiologists and the prevalence of IOHC in the limb contralateral to the HCF was identified. Sensitivity and specificity of the radiographic diagnosis of IOHC were determined. Incomplete ossification of the humeral condyle was present in six of 14 dogs, however IOHC was incomplete in three of the six affected dogs. Plain radiographs had a sensitivity of 0.83 (CI 95%: 0.36 to 0.99) and specificity of 1 (CI 95%: 0.60 to1). The Kappa coefficient between radiologists for radiographic examination was 0.714. Of the Spaniel breeds, four out of eight had IOHC in the limb contralateral to the HCF. Computed tomography evaluation is more sensitive than radiographs for diagnosis of IOHC, particularly when assessing partial or incomplete IOHC. However, sensitivity of radiographic diagnosis is good and should be adequate in most cases. Clinical suspicion of IOHC in the contralateral limb to the unilateral HCF should be present; however overall frequency may not be as high as previously reported.

Twenty-degree-tilt radiography for evaluation of lateral humeral condylar fracture in children

To investigate the efficacy of '20 degrees -tilt anteroposterior (A-P) radiography' in the assessment of lateral condylar fractures of the distal humerus. Eighteen children with lateral humeral condylar fractures were studied. Every child underwent conventional A-P and lateral radiography, and six children underwent multi-detector computed tomography (MDCT). For the investigation of 20 degrees -tilt radiography, ten children with lateral humeral condylar fractures had conventional and 20 degrees -tilt A-P and lateral radiography both preoperatively and postoperatively. Fragment dislocation was measured at the lateral and medial margins of the fracture on both the conventional A-P and 20 degrees -tilt A-P radiographs. The lateral condylar fragment was triangular and was most prominent posteriorly. The fracture line was typically tilted approximately 20 degrees to a reference line perpendicular to the long axis of the humerus in the lateral view. The extent of dislocation at the lateral and medial margins of the fracture site by 20 degrees -tilt A-P radiography (9.3 +/- 3.6 mm and 5.6 +/- 2.5 mm) was significantly wider than that measured by the conventional method (6.8 +/- 4.1 mm and 2.0 +/- 1.5 mm ), which may influence treatment. Twenty-degree-tilt A-P radiography may more precisely demonstrate fragment dislocation than standard radiographs and may influence patient treatment.

Comparion of 6 functional tests for postoperative elbow function evaluation

Objective Several elbow function scores are used in research, but there is no universally adopted standard. In this study 6 elbow out,me scales were compared to provide basis for selection of postoperative elbow functional evaluation criteria. Methods Thirty-one patients who underwent elbow surgery for humeral condyle fractures or supracondyle fractures from January 2004 to August 2006 were involved in the study. Postoperatively their elbow function was evaluated using 6 widely applied elbow scores, clinical examinafions, and radiographic examinations. Pearson correlations were calculated between the total scores of the 6 instruments, between the components of the scales, and with age. Regression equations were calculated between scales. Results There was no obvious relationship between the total scores. However the relationship between components of different score systems was tight. There was a negative correlation between age and function and between function and pain. The age factor had a high negative correlation score with every score system. Conclusion Mayo score, HSS2 score particularly emphasize on patients's ubjective assessment. Modified An and Morrey score and HSS score emphasize more on objective examination. Modified Breberg and Money score and de Boer YA score were relatively balanced for both subjective and objective assessment. We recommend HSS score as the first choice for clinician based outcomes and recommend HSS2 score to evaluate patient reported outcomes. Key words: Elbow joint; Treatment outcomes; Function; Assessment

Computed Tomographic Features of Incomplete Ossification of the Canine Humeral Condyle

To describe computed tomographic (CT) features of canine elbows with incomplete ossification of the humeral condyle (IOHC) and investigate co-existing incongruence in the elbow joint. Case control study. Dogs with IOHC (n=20; 38 elbows) and 25 normal elbows. Elbows with IOHC and normal elbows were assessed by CT. Standardized dorsal and sagittal reconstructions were created at 3 levels using image analysis software to obtain single measurements of the humero-radial and humero-ulnar joint spaces. On dorsal plane reconstructions, joint space measurements were obtained at the center point of the humero-radial and humero-ulnar articulations. Joint incongruity was defined as the difference between the humero-radial and the humero-ulnar joint spaces. Nineteen dogs (95%), all Spaniel breeds, had either bilateral IOHC demonstrable as a saw-toothed intercondylar complete or incomplete hypoattenuating defect with hyperattenuating margins, or IOHC with contralateral humeral condylar fracture (HCF). Joint incongruity values for IOHC were compared with those of normal elbows. Significant differences were noted at the levels of the medial coronoid apex (P<.0001) and base (P<.004) indicative of humero-ulnar incongruence. Evidence of medial coronoid disease in 10 elbows (26%) and degenerative joint disease in 30 elbows (79%) was also found. Presence of elbow incongruence may be an underlying factor in failure of ossification centers to fuse leading to IOHC. IOHC is clearly defined by CT, and it should be considered in larger Spaniel breeds, with a chronic forelimb lameness or HCF.