Incomplete Ossification Of The Humeral Condyle Research Articles

A Case of a Yorkshire Terrier with Medial Condylar Fracture of the Humerus Caused by Incomplete Ossification of the Humeral Condyle

A Case of a Yorkshire Terrier with Medial Condylar Fracture of the Humerus Caused by Incomplete Ossification of the Humeral Condyle

Effect of Induced Incomplete Ossification of the Humeral Condyle on Ex Vivo Humeral Condylar Biomechanics.

The aim of this study was to investigate the effects of an induced incomplete ossification of the humeral condyle (IOHC) lesion on ex vivo canine humeral condylar biomechanics. Nine paired cadaveric elbows were collected from mature dogs weighing between 20 and 25 kg. Left and right limbs were randomized to IOHC or normal groups. Limbs were prepared for mechanical testing; ligaments were preserved and an IOHC lesion was created. Elbows were potted, positioned into a biomaterials testing system at an angle of 135 degrees and axially loaded to failure at a rate of 30 mm/minute. Induced IOHC lesions reduced peak load (p = 0.02) when compared with an intact humerus. There was no difference between stiffness (p = 0.36) of intact humeri or humeri with an induced IOHC lesion. An induced IOHC lesion increased (p = 0.012) the probability of intracondylar fracture under load. Cadaveric humeri are weakened by the creation of an intracondylar osteotomy and fractures secondary to induced IOHC are similar to spontaneous humeral condylar fractures. These findings support the hypothesis that naturally occurring IOHC weakens the humeral condyle and may predispose to humeral condylar fracture.

Computed tomographic findings in three Pinschers affected by incomplete ossification of the humeral condyle

Incomplete ossification of the humeral condyle is a cause of forelimb lameness in dogs. Affected dogs are predisposed to humeral condylar fractures. Incomplete ossification of the humeral condyle has been reported in breeds such as Spaniel, Rottweiler, Labrador and Pug. Diagnosis is made by a radiographic or computed tomographic study of the elbow, while treatment includes the placement of a bone screw across the humeral condyle. This paper discusses the computed tomography findings of incomplete ossification of the humeral condyle in three Pinschers.

The natural history of humeral intracondylar fissure: an observational study of 30 dogs.

To determine the risk of condylar fracture, or of needing to have a transcondylar screw placed, and to identify risk factors in a cohort of dogs with humeral intracondylar fissure (also known as incomplete ossification of the humeral condyle) that was initially managed non-surgically. A retrospective owner survey of dogs diagnosed with humeral intracondylar fissure as an incidental finding and managed non-surgically with a minimum of two years follow-up. Body weight, age, estimated fissure size, gender and contralateral fracture at the time of diagnosis were evaluated as potential risk factors for the development of a humeral condylar fracture or for having a transcondylar screw placed. Data were available for 30 dogs (34 elbows). Six humeral condyles with a mean fissure size of 50% fractured at a mean of 14 months after diagnosis. A transcondylar screw was placed across two humeral condyles with fissure sizes of 60 and 100% at 11 and 17 months. No risk factors were identified for fracture/screw placement. For those cases that did not fracture or have a screw placed mean fissure size was 52% and mean follow-up time was 56 months (range 29 to 79 months). Eighteen percent of cases progressed to fracture and 24% in total required surgery. This information allows clinicians and owners to make an informed decision regarding surgery when faced with a dog with humeral intracondylar fissure identified as an incidental finding.

Incomplete ossification of the humeral condyle (IOHC) in a three-year-old German shepherd

An unusual case of forelimb lameness in a three-year-old German Shepherd has been described. An incomplete ossification of the humeral condyle (IOHC) in both elbows has been diagnosed, which is a rare condition in this breed. The original radiographs and clinical examination were inconclusive. The diagnosis was established after scintigraphy proving elbow involvement and followed by a CT examination of both elbows. An arthroscopic examination showed a cleft in the articular cartilage between both humeral condyles. Because of the absence of lameness at the moment of admittance, initially conservative treatment was performed, which consisted of rest and avoiding trauma. The dog remained lameness-free during one year, whereafter he showed severe lameness in the left front leg. Although a second CT examination showed some progress of the lesions, it was decided to treat the left elbow with forage and physiotherapy consisting of laser treatment and therapeutic ultrasound. The dog responded favourably to the therapy and remains free of lameness to date. The optimal treatment of this disease remains debatable but the results of the treatment of this patient suggest that forage combined with physiotherapy could offer a justifiable option.

Percutaneous Screw Fixation of Incomplete Ossification of the Humeral Condyle in Three Dogs (Four Elbows).

Transcondylar screw fixation was performed using a minimally invasive percutaneous technique on three dogs (four elbows) diagnosed with incomplete ossification of the humeral condyle. The technique was performed using an aiming device in all four elbow joints and assisted by intraoperative fluoroscopy in one. All screws were successfully placed on first attempt and no elbow joint required repositioning of the transcondylar screw. On immediate postoperative radiographs, median transcondylar screw angulation was 2.9° and median percentage of screw eccentricity relative to the theoretical center of the humeral condyle was 14%. No short-term postoperative complications (<1 mo) were observed. The surgical technique described is a feasible option for surgical management of incomplete ossification of the humeral condyle in dogs that allowed accurate transcondylar screw placement and orientation.

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.

Incomplete ossificatie van de humeruscondyl bij een jonge bordeauxdog

In deze casus wordt een incomplete ossificatie van de humeruscondyl beschreven bij een bordeauxdog van acht maanden oud. Als pup was de hond al intermitterend mank aan de rechtervoorpoot. Omwille van het ras en de klinische en radiografische bevindingen werd in de eerste plaats aan elleboogdysplasie gedacht. Echter, aan de hand van het computertomografisch onderzoek werd een incomplete ossificatie van de humeruscondyl vastgesteld. Deze aandoening komt minder vaak voor dan elleboogdysplasie en veroorzaakt niet altijd manken. De hond werd conservatief behandeld vanwege de milde klinische klachten waarna het manken spontaan verdween. Het bijzondere aan deze casus is in de eerste plaats het signalement en de anamnese. Incomplete ossificatie komt vooral voor bij spaniëls en veroorzaakt bij pups meestal geen manken. Bovendien is het spontane herstel van deze hond atypisch. Vaak veroorzaakt de aandoening persisterend manken en soms evolueert een incomplete ossficatie naar een atraumatische humerale condylfractuur.

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.

MAGNETIC RESONANCE IMAGING FEATURES OF CANINE INCOMPLETE HUMERAL CONDYLE OSSIFICATION

Incomplete ossification of the humeral condyle (IOHC) is characterized by an intracondylar fissure located where the intercondylar physis is present in growing dogs. Its radiologic and computed tomographic features have been described but the magnetic resonance (MR) features have not been characterized. Our purpose was to further describe the range of MRappearances of IOHC, to assess the diagnostic capability of MRrelative to radiology, and to determine whether MRis able to identify the disease before a fissure forms. Thirty-eight elbow MRscans and radiographs, when available, were reviewed and divided into three groups. In Group 1 (affected elbows, n = 22), there was an intracondylar defect on MRwith variable appearance; the defect was not visible radiographically in 32% of the elbows. The main difference between Group 2 (nonaffected elbows, n = 6) and Group 3 (contralaterals to IOHC or to condylar fracture, without fissure, n = 10) was the appearance of the humeral condyle in short tau inversion recovery (STIR) sequences: all elbows in Group 2 had a homogeneous humeral condyle, whereas all but one in Group 3 were heterogeneous. One dog in Group 3 developed a complete condylar fissure 7 months after the first examination, when no evidence of an intracondylar defect had been detected. The MRappearance of IOHC is variable and a heterogeneous humeral condyle in STIR images without a clear defect may warn of the possibility for the subsequent development of a condylar fissure.

Prevalence of incomplete ossification of the humeral condyle and other abnormalities of the elbow in English Springer Spaniels

To determine the prevalence of incomplete ossification of the humeral condyle (IOHC) and other osseous abnormalities of the elbow in English Springer Spaniels with no history of lameness. Prospective observational study of English Springer Spaniels with no recent history of lameness. Computed tomography scans of both elbows were obtained from dogs older than six months of age which were anaesthetized or sedated for reasons unrelated to this study. Computed tomography scans were reviewed for the presence of IOHC and other abnormalities of the elbow. Radioulnar incongruity (RUI) measurements from normal elbows were compared to elbows with IOHC and elbows with medial coronoid process (MCP) abnormalities. Computed tomography scans from 50 dogs (100 elbows) were reviewed. The prevalence of IOHC was 14% (8 elbows in 7 dogs). All condylar fissures were incomplete with a mean length of 2.6 mm. Fifty percent of the dogs (44% of elbows) had abnormalities of the medial coronoid process and 60% of the elbows had periarticular osteophytes. Group RUI meansurements for IOHC and MCP were not significantly different from normal elbows. Small IOHC fissures, periarticular osteophytes and MCP abnormalities may be identified in English Springer Spaniels without forelimb lameness. Abnormalities of the MCP are more common than IOHC.

Computed Tomographic Documentation of the Natural Progression of Humeral Intracondylar Fissure in a Cocker Spaniel

To report the computed tomographic (CT) documentation of humeral intracondylar fissure (HIF) developing after complete ossification of the humeral condyle (HC). Clinical report. Male 3 year old working (English) Cocker Spaniel. Sequential CT screening (659-day interval between analyses). A sagittal hypodense fissure typical of incomplete ossification of the humeral condyle (IOHC) was identified ≈ 22 months after screening CT examination documented a normal elbow joint. Even in dogs with clinical features typical of the condition most commonly termed IOHC, fissure formation and propagation can occur after ossification is complete.

Postoperative Complications after Surgical Management of Incomplete Ossification of the Humeral Condyle in Dogs

To describe incidence and type of postoperative complications in the surgical management of incomplete ossification of the humeral condyle (IOHC) and identify any risk factors associated with development of these complications. Case series. Clinical records of dogs (n=57) that had prophylactic transcondylar screw insertion for treatment of IOHC (79 elbows) at 6 UK referral centers were reviewed. Signalment, presentation, surgical management, postoperative care, and complications were recorded. Postoperative complications were divided into seroma, surgical site infections (SSI) and implant complications. Spaniel breeds and entire males were overrepresented. The overall complication rate was 59.5%. Seroma (n=25) and SSI (24) were the most commonly encountered complications. Implant failure occurred in 2 dogs. Labrador retrievers were at greater risk of developing a postoperative complication than other breeds (P=.03). Increasing bodyweight was a significant risk factor for development of a SSI (P=.03). Placement of the transcondylar screw in lag fashion rather than as a positional screw reduced the incidence of postoperative SSI (P=.007). Surgical management of IOHC is associated with a high rate of postoperative complications. Placement of the transcondylar screw in lag fashion may limit postoperative complications and warrants further consideration.

Propagation of a partial incomplete ossification of the humeral condyle in an American cocker spaniel

A hypoattenuating lesion in the left humeral condyle of an American cocker spaniel consistent with partial incomplete ossification of the humeral condyle was observed on computed tomography. Left forelimb lameness developed over the following three weeks at which time repeat computed tomography examination confirmed propagation of the lesion. Lameness resolved following placement of a transcondylar positional screw, suggesting that lameness was secondary to condylar instability. To the authors' knowledge this is the first report of propagation of an intracondylar lesion in a dog.

Deformity secondary to bilateral incomplete ossification of the humeral condyle in a German Shorthaired Pointer dog

A five-month-old male, German Shorthaired Pointer dog was presented for severe, bilateral, thoracic-limb-lameness, with elbow swelling, pain, and crepitus. Radiography and computed tomography confirmed bilateral incomplete ossification of the humeral condyles (IOHC), with a non-displaced incomplete fracture of the left medial epicondylar crest and condylar deformity, characterised by enlargement of the trochleas with extension of the disto-medial aspect of the bone below the normal elbow joint level, and a deformed proximo-medial aspect of the ulna and radius. Transcondylar lag screws were placed bilaterally in an attempt to prevent fracture. Microscopic examination of biopsies, harvested from both humeral condyles, was supportive of IOHC. Six years after surgery, radiographs showed severe osteoarthritis and it appeared that fusion of the humeral condyles had not occurred. The dog followed an active life style until 10 years after surgery when the elbows showed almost no observable range-of-motion. However, discomfort was evident only after heavy exercise. Incomplete ossification of the humeral condyles may be associated with osteoarthritis, risk for non-union, implant failure, or secondary condylar fracture. This dog maintained good limb function despite these concerns, and despite bilateral humeral condylar deformity as well as development of severe osteoarthritis. This is the first report of a German Shorthaired Pointer dog with IOHC and the first histological description supportive of this condition in a five-month-old dog.

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.

Magnetic resonance imaging diagnosis: incomplete ossification of the humeral condyle in a German shepherd dog

Clinical signs, radiological, arthroscopic findings and magnetic resonance imaging features of a male German shepherd dog with incomplete ossification of the humeral condyle are described. The dog showed recurrent left forelimb lameness and pain on elbow palpation. In routine radiographs, the lesion was obscured. In oblique radiographs, a radiolucent line was detected, and magnetic resonance imaging clearly demonstrated a defect in the humeral condyle. However, arthroscopy showed no changes or discontinuity of the humeral cartilage. Incomplete ossification of the humeral condyle may be underrepresented in conventional, routine studies because if there is concurrent additional elbow pathology (for example fragmented coronoid process), treatment may lead to clinical improvement and further diagnostic techniques may not be performed. The benefit of magnetic resonance imaging in this case is demonstrated.

Treatment of Incomplete Ossification of the Humeral Condyle with Autogenous Bone Grafting Techniques

To report clinical experience with autogenous bone grafting, with and without metallic implants, for treatment of lameness attributed to incomplete ossification of the humeral condyle (IOHC). Case series. Dogs (n=8; 9 elbows) with IOHC. A transcondylar humeral bone core was removed and the resultant socket grafted using autogenous bone harvested as either free cancellous bone or a corticocancellous dowel using an osteochondral autograph transfer system. In 8 elbows, additional support for the humeral condyle was provided with metallic implants. Postoperative outcome was assessed by clinical, radiographic, computed tomographic (CT) and owner questionnaire examinations in the short and medium term. Eight dogs (9 elbows) were treated surgically for IOHC. Graft types were free cancellous graft (n=2) or corticocancellous dowel (7). Condylar augmentation was performed using epicondylar cross pins (1); transcondylar Acutrak (AT) screw and epicondylar cortical screw (1); and a single transcondylar AT screw (7). Lameness resolved in 1-12 weeks. Bone bridging was documented in 7 of 8 elbows assessed by CT examination. Owner questionnaires (6 dogs) assessing daily functions were available for 7 of 9 elbows (follow-up, 6-45 months). Relevant follow-up function scores were significantly improved compared with preoperative values. One dog was intermittently lame and was administered nonsteroidal antiinflammatory medication. Use of autogenous bone grafting techniques leads to resolution of lameness attributed to IOHC. Augmentation of grafts with implants like the AT screw is recommended. Autogenous bone grafting techniques represent a viable alternative or adjunct to existing techniques for clinical management of IOHC in the dog.

Failure Mode of Transcondylar Screws Used for Treatment of Incomplete Ossification of the Humeral Condyle in 5 Dogs

To investigate the mode of failure of transcondylar screws retrieved from dogs previously treated for incomplete ossification of the humeral condyle (IOHC). Metallurgical study. Broken screws (n=5) from dogs with IOHC. Broken transcondylar bone screws were retrieved from dogs that had apparently successful surgery for IOHC. Screws were measured and examined using scanning electron microscopy (SEM) and energy-dispersive analysis by X-rays (EDX). EDX confirmed that screws were made from 316L stainless steel and there was no evidence of significant corrosion or manufacturing faults that might have contributed to implant failure. SEM of the fractured surface of screws revealed a similar and complex pattern of fatigue failure characterized by multidirectional fatigue cracks and the presence of several initiation sites. All screws had signs of fatigue failure because of multidirectional forces of variable magnitude. Intercondylar instability is a feature of IOHC that persists despite placement of a transcondylar screw. The pathogenesis of IOHC involves chronic intercondylar instability and its treatment using even relatively large transcondylar screws has a risk of late implant failure.

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.