Humeral Intracondylar Fissure Research Articles

A humeral intracondylar fissure elevates maximum principal bone strain in the humeral condyle and lateral epicondylar crest in French Bulldogs.

To investigate whether a humeral intracondylar fissure (HIF) alters bone strain in the French Bulldog humerus, we developed a quantitative CT-based 3-D finite element (FE) model for virtual mechanical testing. We hypothesized that higher strains would be seen in the intracondylar region and lateral epicondylar crest if there was a HIF. Patient CT scans from 3 (n = 3) French Bulldogs were selected. Dog 1 had a closed distal physis and no HIF. Dog 2 had an open distal humeral physis but no HIF. Dog 3 had an open distal physis and a HIF. A 3-D FE model was built for FE analysis, and pressure was applied to the humerus over the region that contacts the radial head. The maximum principal bone strain patterns differed in each of the models. A path of strain concentration mimicking the typical pattern of a lateral condylar fracture was only found in dog 3. Maximum principal strain exceeded 1% in parts of the lateral epicondylar crest in all 3 dogs. We developed a patient-specific, quantitative CT-based 3-D FE model for virtual mechanical testing. We accepted our hypothesis. Strain concentration occurred in the intracondylar region and along the lateral epicondylar crest only when a HIF was present. The presence of a HIF in French Bulldogs elevates maximum principal bone strain in this region and alters its path in an FE model, which suggests an increased risk of a lateral humeral condylar fracture.

Computed tomographic re-evaluation of skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissure: 12 cases (2018-2022).

The objective of this study was to present the follow-up findings obtained through computed tomography in skeletally immature French bulldogs previously diagnosed with humeral intracondylar fissures. Medical records from a surgical referral centre between January 2018 and September 2022 were evaluated for all dogs with a humeral condylar fracture where preoperative CT of both humeri was performed. French bulldogs between the age of 12 weeks and 12 months were identified and evaluated for the presence of contralateral humeral intracondylar fissure. The dogs with follow-up CT were evaluated for humeral intracondylar fissure resolution. A total of 137 humeral condylar fractures were operated on within the study period, 58 of which were in French bulldogs. Twenty-seven French bulldogs had a contralateral humeral intracondylar fissure with 12 dogs matching the inclusion criteria. Follow-up CT demonstrated resolution of the humeral intracondylar fissure in 11 (91.7%) of 12 cases. Contralateral humeral intracondylar fissures are common in skeletally immature French bulldogs sustaining humeral condylar fractures and the majority of these fissures tend to fuse within the follow-up period. Due to the potential for breed variation in ossification of the humeral condyle, follow-up CT may be warranted in skeletally immature French bulldogs before considering prophylactic transcondylar screw placement.

Long-Term Outcome and Complications after Transcondylar Screw Placement for Canine Humeral Intracondylar Fissure.

The aim of this study was to report postoperative complications and long-term outcomes following transcondylar screw placement for humeral intracondylar fissure (HIF). It was a retrospective single-centre case series. Medical records (2018-2022) were reviewed for dogs with HIF treated with transcondylar screw placement. Data collected included signalment, concurrent orthopaedic disease, partial or complete HIF, surgeon, surgical approach, surgical technique and implant type, transcondylar screw angulation, postoperative complications and outcomes. Long-term outcome was assessed with owner questionnaire, orthopaedic examination and follow-up radiography. Statistical analysis was performed to identify risk factors predisposing to a complication or a poor outcome. Forty-seven dogs (57 elbows) met the inclusion criteria; long-term follow-up was available in 41 dogs (50 elbows). Minor and major medical complications were noted in seven and three elbows respectively. The total complication rate was 17.5%. Increasing age was significantly associated with a reduced risk of postoperative complications (p = 0.0051). No other risk factors were identified. A postoperative complication was not associated with a less than full outcome (p = 0.5698). Transcondylar screw placement for HIF is associated with a low complication rate and good outcome.

Healing of Humeral Intracondylar Fissure Following Distal Ulnar Ostectomy to Treat Concurrent Elbow Joint Incongruity in a Dog

AbstractA 22-week-old female Labrador retriever presented with intermittent bilateral forelimb lameness. Computed tomography (CT) study interpretation revealed bilateral humeral intracondylar fissures (HIF) surrounded by sclerotic epiphyseal bone. Other changes included bilateral distal ulna retained cartilage core, secondary negative radioulnar incongruity (RUI), and medial coronoid process disease. The patient underwent bilateral dynamic distal ulnar ostectomies (DUO) in an attempt to address the elbow incongruity. Follow-up CT studies were performed at 2, 4, and 10 months postoperatively, which showed a bilateral improvement of elbow congruence and complete healing of HIF on the left side. The degree of congruence correction in the right elbow was possibly suboptimal, and following an initial improvement, a transcondylar screw was placed due to HIF progression.

Influence of oblique proximal ulnar osteotomy on humeral intracondylar fissures in 35 spaniel breed dogs.

To investigate the effects of oblique proximal ulnar osteotomy (PUO) on the healing of humeral intracondylar fissure (HIF) in spaniel breed dogs. Clinical retrospective study. A total of 51 elbows from 35 spaniel dogs. An oblique PUO was performed in dogs diagnosed with HIF. The degree of healing of HIF was subjectively and objectively assessed on preoperative and long-term follow-up CT imaging. Objective assessment was performed by measuring the bone density in Hounsfield units (HU) of a rectangular region of interest (ROI) encompassing the entire hypoattenuated humeral fissure. Major and minor complications were recorded. A total of 24 partial and 27 complete HIFs were diagnosed. The follow-up CT scan was performed at a median 18.5 months (range 10-49 months). Subjective assessment confirmed partial or complete healing of the HIF in 41 elbows (80.3%). Objective assessment confirmed a difference in mean HU of the HIF's ROI between preoperative (HU 640) and last follow-up CT images (HU 835) (p = .001). Young dogs (<14 months) had the highest increase in HU of the HIF's ROI. Major complications occurred in five dogs (6 limbs) of which four were related to the lack of healing of the fissure (7.8%). Oblique PUO resulted in partial or complete healing of HIF and pain resolution in the majority of dogs. This study introduces an innovative approach to achieve healing of the HIF in the dog, which may help reduce the high complication rate traditionally associated with the use of transcondylar screws.

Correlation between the Insertion Side of a Transcondylar Screw for the Surgical Management of Humeral Intracondylar Fissures in Dogs and the Incidence of Postoperative Surgical Site Infection.

An increased rate of surgical site infection (SSI) following treatment of canine humeral intracondylar fissure (HIF) with a lateromedially (LM) placed transcondylar screw (TCS) compared with a mediolateral (ML) TCS has been previously postulated. We hypothesized that the direction of insertion of the TCS would not affect the incidence of postoperative SSI. It was single-centre retrospective study. Dogs with HIF confirmed by computerized tomography, treated by TCS placement (between 2008 and 2019) and with a minimum follow-up of 12 weeks, were included. The following data were recorded: signalment, presenting clinical signs, direction of placement and size of the utilized TCS, surgical and anaesthetic times, concurrent surgical procedures, presence of concomitant elbow pathology, perioperative and postoperative antibiotic usage and postoperative complications. Recorded data were analysed with a multinomial logistic regression model with a p-value less than or equal to 0.05. Thirty-five dogs (46 elbows) met the inclusion criteria. Median clinical follow-up interval was 52 weeks. Seven of thirty-one elbows with a ML TCS, and 4/15 elbows with a LM TCS developed SSI. Four of nine dogs that underwent bilateral single-surgery TCS placement developed SSI unilaterally. No significant difference was shown in short-term SSI occurrence between the ML and the LM direction of placement of the TCS.

Spontaneous Resolution of a Humeral Intracondylar Fissure in a Skeletally Immature French Bulldog

AbstractA 4-month-old male entire French bulldog was presented for the investigation of acute left thoracic limb lameness. Computed tomography (CT) revealed a right-sided humeral intracondylar fissure (HIF) and a left-sided medial humeral condylar fracture which was managed by open reduction and internal fixation. Follow-up CT at 36 days after surgery revealed healing of the condylar fracture and partial resolution of the HIF, which was radiographically unapparent on further CT images 105 days thereafter (at 220 days of life). To the best of the authors' knowledge, this is the first reported case of spontaneous resolution of a HIF beyond the normal age of reported humeral condyle ossification center closure.

Design and topographic evaluation of a canine humeral anatomic plating system (CHAPS) for humeral condylar fracture repair in spaniels.

To design a precontoured plating system for humeral condylar fracture repair in spaniels with humeral intracondylar fissure (HIF) and quantify accuracy of fit of the system on 3D printed bone models. Experimental on 3D printed models. The plating system was based on morphometric data obtained from CT. Plates were applied to models and impression material was measured under the plates at points of interest to define plate bone gap (PBG). Data on locking screw interference on plate application were also obtained. Eleven elbows models were plated. Statistical analysis to assess for any difference in PBG measurements between left and right humuri revealed two loci (3 and 17) under the lateral plate and two loci (3 and 17) under the medial plate. On cumulate portion analysis, 67% of lateral plate loci and 80% of medial plate loci had a PBG of ≤2 mm respectively. An incidence of 2.1% (3/143) screw interference occurred. Design of a contoured plating system for application to humeral models from spaniels with HIF and its application with objective measurement of PBG is described. The majority of the loci measured under both lateral and medial plates had a BPG of ≤2 mm and the incidence of locking screw interference on plate application was low. This novel system may have application for the stabilization of humeral condylar fractures in spaniels avoiding the need for plate contouring and minimizing the incidence of locking screw interference.

Medial epicondylar fissure fracture as a complication of transcondylar screw placement for the treatment of humeral intracondylar fissure.

To report the incidence of medial epicondylar fissure fracture (MEFF) after medial-to-lateral transcondylar screw placement in dogs with humeral intracondylar fissure (HIF) and to identify risk factors for MEFF. Retrospective study. Seventy-four client-owned dogs (88 elbows). Medical records of dogs surgically treated for HIF, and postoperative imaging studies were reviewed for demographics, fracture characteristics, and repair techniques. The width of the transcondylar screw was expressed relative to the height of the condyle. Screw angle and degree of countersinking were recorded. Information from case records and follow-up radiographs were used to identify complications. Medial epicondylar fissure fracture was identified in 10 elbows (11.4%) following medial-to-lateral transcondylar screw placement: 4 cases were detected intraoperatively, 2 on immediate postoperative radiographs, 1 during routine radiographic follow up, and 3 when radiographs were reviewed for this study. A larger relative screw size was found to increase the risk of MEFF (P=.004, OR=1.5). Fifteen additional complications were identified in 13/80 elbows at a median of 6 weeks postoperatively (range 1-56 weeks). Screw loosening was the most frequent complication (n=9) and was the only complication in dogs with MEFF (n=3); MEFF tended to increase the risk of perioperative screw loosening (P=.06). Medial epicondylar fissure fracture occurred in 10/88 elbows treated for HIF and was more common in elbows treated with a larger screw size relative to the height of the condyle. Placing transcondylar screws with a diameter inferior to 41% of the height of the condyle is recommended to avoid MEFF. Medial epicondylar fissure fracture appears to have a low clinical significance in the perioperative period, although its effect on long-term outcome remains unknown.

Humeral intracondylar fissure in a boxer breed dog

AbstractA 6‐year‐old, male, boxer breed dog presented with a 1‐month history of severe, gradually progressive right thoracic limb lameness without history of trauma. Previous medication included oclacitinib for management of atopic skin disease. The dog was diagnosed with humeral intracondylar fissure (HIF) on computed tomography. Therefore, HIF should be considered as a differential diagnosis for thoracic limb lameness in this breed. Surgical stabilisation of HIF with a 4.5 mm titanium transcondylar screw placed from medial to lateral resulted in resolution of visible lameness.

Ulnar neuropathy: A postoperative complication following placement of a humeral transcondylar screw in a dog

AbstractA 4‐year‐old neutered male English springer spaniel was examined because of postoperative allodynia and non‐weight bearing right thoracic limb lameness following bilateral humeral transcondylar screw placement to manage humeral intracondylar fissure. Clinical examination demonstrated signs attributable to ulnar neuropathy. Ulnar nerve block resulted in temporary resolution of clinical signs and confirmed the diagnosis. Multi‐modal analgesia resulted in the resolution of clinical signs with all medication withdrawn by 3 months postoperatively. No recurrence was reported at a 6‐month follow‐up. To our knowledge, this is the first documented report of ulnar neuropathy following humeral transcondylar screw placement in a dog.

Humero-anconeal elbow incongruity in spaniel breed dogs with humeral intracondylar fissure: Arthroscopic findings.

ObjectiveTo report arthroscopic findings in dogs with humeral intracondylar fissure (HIF) and compare these findings in joints of dogs not affected by HIF on preoperative CT images.Study designControlled clinical study.AnimalsDogs with HIF (14 dogs, 21 elbows) and dogs without HIF (20 dogs, 31 elbows).MethodsA caudo‐medial arthroscope portal was used to inspect all elbow joints. Arthroscopic features of 21 joints of dogs with HIF were compared with 31 control elbows of HIF‐ negative dogs.ResultsAll elbows with HIF showed a focal cartilage lesion on the caudal aspect of the humeral condyle. The lesions ranged from a simple indentation into the articular surface to a full thickness cartilage erosion. Humero‐anconeal incongruity was identified in all elbows with HIF as absence of joint space at the point of contact between the tip of the anconeal process and the cartilage lesion, with a wider joint space distally within the ulnar trochlear notch. None of the elbows without HIF showed the cartilage lesion or evidence of humero‐anconeal incongruity.ConclusionUse of a novel arthroscope portal allowed description of a previously unreported cartilage lesion on the caudal humeral condyle of dogs with HIF. The lesion was found in all dogs with HIF but in no dogs without HIF.Clinical significanceHumero‐anconeal incongruity and an associated cartilage lesion appear to be present in dogs with HIF. We propose that this lesion may be associated with humero‐anconeal incongruity. This may be considered as a possible future therapeutic target for HIF.

Repair of Fractures of the Lateral Aspect of the Humeral Condyle in Skeletally Mature Dogs with Locking and Non-Locking Plates

The aim of this study was to report the functional outcome and complications following transcondylar screw and epicondylar plate fixation of skeletally mature dogs with fractures of the lateral aspect of the humeral condyle using a string of pearls, limited contact dynamic compression plate (LC-DCP) or locking compression plate (LCP). This study was a retrospective review of clinical records, radiographic images and canine brief pain inventory evaluation with a supplementary non-validated questionnaire. Thirty-one fractures in 29 dogs were included. The majority of dogs were Spaniels (23/29). Thirty fractures had evidence of humeral intracondylar fissure. Sixteen fractures had string of pearls, eight LCP and seven LC-DCP. There were two minor complications and three major complications. Perioperative (median: 6 weeks, range: 6-12) outcome was considered fully functional for 24 fractures and acceptable for 6 fractures. One dog had an unacceptable outcome due to the failure of an LCP that healed following revision surgery. Fractures with radiographic follow-up had a persistent visible intracondylar fracture line in 20/26. Twenty-six of twenty-seven owners perceived an excellent outcome (median: 135 weeks, range: 25-246). Repair of fractures of the lateral aspect of the humeral condyle with a transcondylar screw and epicondylar plate has a good perioperative, mid- and long-term outcome with 10% major complication rate, despite incomplete or non-union of the intracondylar fracture in 20/26 elbows.

Accuracy of medial-to-lateral transcondylar screw placement using an aiming device and preoperative computer tomography planning for the treatment of humeral intracondylar fissure.

To determine the accuracy of transcondylar screws placed from medial-to-lateral using preoperative planning on computed tomography (CT) and an aiming device in elbows with humeral intracondylar fissures (HIFs). Retrospective case series. Twenty-five client-owned dogs with HIF. A 4.5-mm transcondylar screw was placed in 34 elbows with HIF. humeral condylar diameter (HCD) was measured at the humeral condylar isthmus on CT. Entry and exit points were planned at 0.3 × HCD cranial and 0.2 × HCD distal to the medial epicondyle and 0.3 × HCD cranial and 0.3 × HCD distal to the lateral epicondyle. An aiming device was used to guide drilling from the medial entry point to the lateral exit point. The difference between planned and actual screw entry and exit points, and the angular deviation of the actual screw axis from the planned screw axis, was assessed on the postoperative CT scans. Thirty-three out of 34 screws were completely within the humeral condyle. Thirteen out of 34 screws were placed less than 2 mm from planned entry and exit points in both the transverse and the frontal plane. The axis of the screw deviated by a mean of 3.2° (transverse plane) and 3.5° (frontal plane) from the planned axis. Humeral transcondylar screws placed with the technique tested here were entirely within the humeral condyle in 33 out of 34 elbows. Use of CT planning and an aiming device allows accurate placement of transcondylar screws from medial-to-lateral in dogs with HIF.

Outcomes, complications and risk factors following fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure.

To describe the surgical technique and complications for fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure in dogs. A retrospective review was undertaken of cases from two hospitals where identical surgical technique was employed. Factors were analysed for any association with postoperative complications. Sixty-two dogs (82 elbows) were reviewed for which the postoperative complication rate was 45%; a total of 15% of cases required revision surgery. Complications were more likely in cases operated on earlier in the case series and with increasing dog bodyweight. Both increasing surgical time and being a neutered female were protective against postoperative complications. Fluoroscopically guided transcondylar screw placement for humeral intracondylar fissure is associated with a high postoperative complication rate (45%) with 15% of cases requiring revision surgery.

A humeral intracondylar repair system for the management of humeral intracondylar fissure and humeral condylar fracture.

To report complications, clinical outcomes and CT-imaging outcomes of a surgical system designed for the management of humeral intracondylar fissures and humeral condylar fractures. Retrospective review of fracture healing from medical records, direct owner contact and an online data-submission service. Follow-up included CT scans and a calculated "bone-opacity continuity index" to quantify bone healing. There was one major surgical complication and one major medical complication out of 34 fissure cases, and two major surgical and one major medical complication out of 14 fractures. Follow-up times ranged from 29 to 1268 days. All cases with CT follow-up had some continuity of bone opacity across the condyle. In the cases included in this study, this repair system was associated with low complication rates and favourable healing rates, particularly for humeral intracondylar fissure.

Long-term outcome following management of canine humeral intracondylar fissure using a medial approach and a cannulated drill system.

This study evaluated the feasibility, complications and long-term outcomes of using a cannulated drill system combined with intraoperative imaging to place a transcondylar screw for the management of canine humeral intracondylar fissure. Thirteen dogs were enrolled, with one dog undergoing staged bilateral surgery. No intraoperative complications occurred. Five minor (36%) and three major (21%) postoperative complications occurred, giving an overall complication rate of 57%. None of the screws placed penetrated the articular surface. The mean duration of surgery was 28 min (SD ±3.5) for dogs that developed a major complication versus 46 min (SD ±18.1) for those that did not (p=0.015). The duration of preoperative lameness was significantly shorter for cases which suffered a major complication (2 days; SD ±2.8) than those that did not (34 days; SD ±31.7, p=0.008). None of the variables assessed were significantly associated with minor complications. Median time from surgery to last follow-up was 5.8 years (range 3.5-8.5 years). Median Liverpool Osteoarthritis in Dogs questionnaire score at the final point of follow-up was 16 (range 7-27). A significant number of patients were found to require analgesia at long-term follow-up.

Use of an extended CT scale reconstruction to diagnose metal implant failure in a canine elbow.

A Cocker Spaniel presented for recurrence of right forelimb lameness 33 months following transcondylar screw placement for a humeral intracondylar fissure. Elbow radiographs showed no evidence of implant-related complications. Standard CT scale reconstruction images failed to demonstrate implant failure. Extended CT scale reconstruction images revealed a fracture through the mid-portion of the screw. Revision surgery confirmed the implant failure; the screw was replaced and the lameness subsequently resolved. Extended CT scale reconstruction images allow detailed assessment of metal implants and should be considered when implant failure is suspected.

Accuracy of three-dimensional printed patient-specific drill guides for treatment of canine humeral intracondylar fissure.

To determine the accuracy of three-dimensional printed patient-specific drill guides (3D-PDG) as treatment of humeral intracondylar fissures (HIF) in dogs. Retrospective consecutive case series. Client-owned dogs with HIF treated with a 5-mm transcondylar screw (TCS) placed from medial to lateral with a 3D-PDG. The proposed TCS entry point and trajectory were planned using computed tomography (CT) data and computer-aided design software (CAD), and a 3D-PDG was produced. During surgery the 3D-PDG was used to drill the pilot hole from medial to lateral; the guide was then removed, the pilot hole was overdrilled, and a 5-mm TCS was placed. Postoperative CT data were imported into CAD software, and the entry points, exit points, and trajectories were compared between the planned and actual screw locations. Sixteen elbows from 11 dogs were included. Mean (SD) entry point translation was 1.3 mm (0.64), with all screws entering cranial to the proposed location. Mean maximum screw angulation was 5.2° (2.10°), with most screws directed caudodistal to the desired trajectory. Mean (SD) exit point translation was 1.8 mm (0.89) from the planned location. There was no intra-articular screw placement. Use of a 3D-PDG permitted accurate placement of a mediolateral 5-mm locking TCS within the humeral condyle. Three-dimensional printed patient-specific drill guides should be considered as accurate and consistent for placing TCS for treatment of HIF in dogs.

Repair of Y-T Humeral Condyle Fractures with Locking Compression Plate Fixation.

The aim of this study was to describe the use of locking compression plates (LCP) in Y-T humeral condyle fractures and to evaluate their clinical outcome. This study involved a retrospective review, including clinical, radiographical and canine brief pain inventory outcome evaluation. Eighteen consecutive dogs met the inclusion criteria, and 15/18 were considered to have humeral intracondylar fissure. Twelve of 18 dogs had simple fractures, and the remaining six had comminuted fractures. Postoperative radiographs revealed accurate intracondylar reconstruction (articular step defect [ASD] < 1 mm) in 17/18 of patients. Short-term outcome was considered fully functional in 9/13 and acceptable in 3/13 patients. Complications were diagnosed in 2/13; infection in one with resolution after antibiotic treatment, and one case of implant failure. Nine of 18 owners provided postoperative questionnaire responses (median 25; range: 14-52 months) and 8/9 clients perceived the treatment to have resulted in an excellent overall outcome. Repair of Y-T humeral fractures with LCP allowed for hybrid fixation and monocortical screw placement in distal fracture fragments. There was no significant ASD at the intracondylar fracture line in most cases. ASD using combined medial and lateral approaches depends upon the accuracy of supracondylar reduction, particularly on the side that is reduced and stabilized first, and the use of locking screws may have been influential in minimizing primary loss of reduction, potentially maintaining the initial fragment reduction.