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31

Burton NJ, Dobney JA, Owen MR, Colborne GR. Joint angle, moment and power compensations in dogs with fragmented medial coronoid process. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):110–8.

- 7 dogs with FCP and inverse dynamic analysis
- FCP side compared with contralateral side (no normals)
- “In conclusion, joint angular excursions, moments and powers were all diminished in the affected forelimb, but their overall patterns were largely conserved”
- especially in propulsive phase of stance

32

Proks P, Necas A, Stehlik L, Srnec R, Griffon DJ. Quantification of humeroulnar incongruity in labrador retrievers with and without medial coronoid disease. Vet Surg. 2011 Dec;40(8):981–6.

- “Subluxation index” (SI) proposed for humeroulnar incongruity
- SI = d/r (of trochlear circle)
- on 135 extended lateral radiographs
- significant difference between the SI of Labs with coronoid disease (18.5%) vs normal labs (1.7%)

33

Proks P, Necas A, Stehlik L, Srnec R, Griffon DJ. Quantification of humeroulnar incongruity in labrador retrievers with and without medial coronoid disease. Vet Surg. 2011 Dec;40(8):981–6.

- “Subluxation index” (SI) proposed for humeroulnar incongruity
- SI = d/r (of trochlear circle)
- on 135 extended lateral radiographs
- significant difference between the SI of Labs with coronoid disease (18.5%) vs normal labs (1.7%)

34

Böttcher P, Werner H, Ludewig E, Grevel V, Oechtering G. Visual estimation of radioulnar incongruence in dogs using three-dimensional image rendering: an in vitro study based on computed tomographic imaging. Vet Surg. 2009 Feb 1;38(2):161–8.

- -2, -1, 0, +1, +2 RU incongruence model. After 3D reconstruction congruence was estimated subjectively
- sensitivity 86%, specificity 77%

35

Böttcher P, Werner H, Ludewig E, Grevel V, Oechtering G. Visual estimation of radioulnar incongruence in dogs using three-dimensional image rendering: an in vitro study based on computed tomographic imaging. Vet Surg. 2009 Feb 1;38(2):161–8.

- -2, -1, 0, +1, +2 RU incongruence model. After 3D reconstruction congruence was estimated subjectively
- sensitivity 86%, specificity 77%

36

House MR, Marino DJ, Lesser ML. Effect of limb position on elbow congruity with CT evaluation. Vet Surg. 2009 Feb 1;38(2):154–60.

pronation/supination affects elbow congruity measurements on CT

37

House MR, Marino DJ, Lesser ML. Effect of limb position on elbow congruity with CT evaluation. Vet Surg. 2009 Feb 1;38(2):154–60.

pronation/supination affects elbow congruity measurements on CT

38

Werner H, Winkels P, Grevel V, Oechtering G, Böttcher P. Sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence in dogs. An in vitro study. Vet Comp Orthop Traumatol. 2009 Jan 1;22(6):437–41.

- arthroscopy (1.9mm, elbow fixed at 145, no pronation/supination)
- was 98% sensitive and 89% specific for detecting RU inconcruity (+2, +1, 0, -1, -2mm)

39

Werner H, Winkels P, Grevel V, Oechtering G, Böttcher P. Sensitivity and specificity of arthroscopic estimation of positive and negative radio-ulnar incongruence in dogs. An in vitro study. Vet Comp Orthop Traumatol. 2009 Jan 1;22(6):437–41.

- arthroscopy (1.9mm, elbow fixed at 145, no pronation/supination)
- was 98% sensitive and 89% specific for detecting RU inconcruity (+2, +1, 0, -1, -2mm)

40

Might KR, Hanzlik KA, Case JB, Duncan CG, Egger EL, Rooney MB, et al. In vitro comparison of proximal ulnar osteotomy and distal ulnar osteotomy with release of the interosseous ligament in a canine model. Vet Surg. 2011 May;40(3):321–6.

- A distal ulnar osteotomy with an interosseus ligament release is equivalent to a proximal ulnar osteot
- the change in radioulnar incongruence (about 6mm) is not as much as the osteotomy gap (4.5 mm)
- the distal osteotomy without an interosseus lig release does not allow radioulnar sliding

41

Might KR, Hanzlik KA, Case JB, Duncan CG, Egger EL, Rooney MB, et al. In vitro comparison of proximal ulnar osteotomy and distal ulnar osteotomy with release of the interosseous ligament in a canine model. Vet Surg. 2011 May;40(3):321–6.

- A distal ulnar osteotomy with an interosseus ligament release is equivalent to a proximal ulnar osteot
- the change in radioulnar incongruence (about 6mm) is not as much as the osteotomy gap (4.5 mm)
- the distal osteotomy without an interosseus lig release does not allow radioulnar sliding

42

Kranz ST, Lesser AS. Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease. Vet Comp Orthop Traumatol. 2011;24(5):383–8.

- proximal ulnar osteotomy (2.5 cm distal to joint) allowed more ulnar movement than
- mid-diaphyseal ulnar osteotomy (i.e. distal ulnar osteotomy)
- radiographic ulnar movement peaked around 2 weeks after surgery

43

Kranz ST, Lesser AS. Radiographic evaluation of osteotomized ulnar segments following arthroscopic treatment for canine medial coronoid disease. Vet Comp Orthop Traumatol. 2011;24(5):383–8.

- proximal ulnar osteotomy (2.5 cm distal to joint) allowed more ulnar movement than
- mid-diaphyseal ulnar osteotomy (i.e. distal ulnar osteotomy)
- radiographic ulnar movement peaked around 2 weeks after surgery

44

Gutbrod A, Guerrero TG. Effect of external rotational humeral osteotomy on the contact mechanics of the canine elbow joint. Vet Surg. 2012 Oct;41(7):845–52.

- 15 external rotation humeral osteotomy shifted PCP from ulna to radius – shifted it 38% laterally
- decreased the ulnar pressure from 59% to 27%

45

Gutbrod A, Guerrero TG. Effect of external rotational humeral osteotomy on the contact mechanics of the canine elbow joint. Vet Surg. 2012 Oct;41(7):845–52.

- 15 external rotation humeral osteotomy shifted PCP from ulna to radius – shifted it 38% laterally
- decreased the ulnar pressure from 59% to 27%

46

Fitzpatrick N, Yeadon R, Smith T, Schulz K. Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg. 2009 Feb 1;38(2):261–78.

- many dogs had concurrent SCO. 6.5 month follow-up
- Generation 1 – 17.2% major complications
- Generation 2 – 22.2% major complications
- Generation 3 – 4.8% major complications (i.e. 1 of 21 dogs)
- the 2.7 plate was adjusted to accept 3.5 mm locking screws for holes 3 & 4
- the 3.5 plate was left the same, but 4.0 mm locking screws were developed for holes 3&4
- plates are 316L SS, 2.7 plate has 7.5 mm slide, 3.5 plate has 10mm slide (standard) or 7.5 mm (reduced)
- plates have Combi-holes. They are 8 hole plates
- screws broke at 4, then 3, then 2. Never in distal fragment
- try to maintain 33% overlap between cortexes
- plate is placed in buttress. Medial plate, medial slide
- “drill-guide-slide” technique

47

Fitzpatrick N, Yeadon R, Smith T, Schulz K. Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow. Vet Surg. 2009 Feb 1;38(2):261–78.

- many dogs had concurrent SCO. 6.5 month follow-up
- Generation 1 – 17.2% major complications
- Generation 2 – 22.2% major complications
- Generation 3 – 4.8% major complications (i.e. 1 of 21 dogs)
- the 2.7 plate was adjusted to accept 3.5 mm locking screws for holes 3 & 4
- the 3.5 plate was left the same, but 4.0 mm locking screws were developed for holes 3&4
- plates are 316L SS, 2.7 plate has 7.5 mm slide, 3.5 plate has 10mm slide (standard) or 7.5 mm (reduced)
- plates have Combi-holes. They are 8 hole plates
- screws broke at 4, then 3, then 2. Never in distal fragment
- try to maintain 33% overlap between cortexes
- plate is placed in buttress. Medial plate, medial slide
- “drill-guide-slide” technique

48

Mason DR, Schulz KS, Fujita Y, Kass PH, Stover SM. Measurement of humeroradial and humeroulnar transarticular joint forces in the canine elbow joint after humeral wedge and humeral slide osteotomies. Vet Surg. 2008 Jan 1;37(1):63–70.

- 4 mm slide -> 25% reduction in ulna pressure
- 8 mm slide -> 28% reduction in ulna pressure
- wedge (10 or 20) -> no statistically significant reduction in ulnar pressure
- ulna pressure approximately equaled radial pressure before procedures

49

Mason DR, Schulz KS, Fujita Y, Kass PH, Stover SM. Measurement of humeroradial and humeroulnar transarticular joint forces in the canine elbow joint after humeral wedge and humeral slide osteotomies. Vet Surg. 2008 Jan 1;37(1):63–70.

- 4 mm slide -> 25% reduction in ulna pressure
- 8 mm slide -> 28% reduction in ulna pressure
- wedge (10 or 20) -> no statistically significant reduction in ulnar pressure
- ulna pressure approximately equaled radial pressure before procedures

50

Jardel N, Crevier-Denoix N, Moissonnier P, Viateau V. Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy. Vet Comp Orthop Traumatol. 2010;23(2):75–80.

- arthroscope portal is 1-7 mm cranial to the ulnar nerve
- instrument portal is 13-30 mm caudal to the median nerve

51

Jardel N, Crevier-Denoix N, Moissonnier P, Viateau V. Anatomical and safety considerations in establishing portals used for canine elbow arthroscopy. Vet Comp Orthop Traumatol. 2010;23(2):75–80.

- arthroscope portal is 1-7 mm cranial to the ulnar nerve
- instrument portal is 13-30 mm caudal to the median nerve

52

Conzemius M. Nonconstrained elbow replacement in dogs. Vet Surg. 2009 Feb 1;38(2):279–84.

- the continuing story of total elbow development
- currently reported success rate = 80% (i.e. 20% major complications – require revision)
- feature of most recent generation = hybrid cemented and ingrowth humeral component
- the sides of the humeral condylar component have porous surfaces for bony ingrowth

53

Conzemius M. Nonconstrained elbow replacement in dogs. Vet Surg. 2009 Feb 1;38(2):279–84.

- the continuing story of total elbow development
- currently reported success rate = 80% (i.e. 20% major complications – require revision)
- feature of most recent generation = hybrid cemented and ingrowth humeral component
- the sides of the humeral condylar component have porous surfaces for bony ingrowth

54

Burton NJ, Owen MR, Colborne GR, Toscano MJ. Can owners and clinicians assess outcome in dogs with fragmented medial coronoid process? Vet Comp Orthop Traumatol. 2009 Jan 1;22(3):183–9.

- 9 dogs with unilateral FCP. Kinematic gait analysis over 1 year
- against TSMR as gold standard (symmetry index), owner and surgeon VAS scales of gait are not reliable
- owners tend to underestimate lameness over long term – more than 4 weeks post op

55

Burton NJ, Owen MR, Colborne GR, Toscano MJ. Can owners and clinicians assess outcome in dogs with fragmented medial coronoid process? Vet Comp Orthop Traumatol. 2009 Jan 1;22(3):183–9.

- 9 dogs with unilateral FCP. Kinematic gait analysis over 1 year
- against TSMR as gold standard (symmetry index), owner and surgeon VAS scales of gait are not reliable
- owners tend to underestimate lameness over long term – more than 4 weeks post op

56

Van Vynckt D, Verhoeven G, Saunders J, Polis I, Samoy Y, Verschooten F, et al. Diagnostic intra-articular anaesthesia of the elbow in dogs with medial coronoid disease. Vet Comp Orthop Traumatol. 2012 Jul 12;25(4):307–13.

- 90 dogs with unilateral lameness & MCD and clinicians weren’t sure about the dx before they did CT
- mepivacaine 1.5 mg/kg IA into elbow joint
- most dogs lameness improved – 13% false negatives
- (no negative control group)

57

Van Vynckt D, Verhoeven G, Saunders J, Polis I, Samoy Y, Verschooten F, et al. Diagnostic intra-articular anaesthesia of the elbow in dogs with medial coronoid disease. Vet Comp Orthop Traumatol. 2012 Jul 12;25(4):307–13.

- 90 dogs with unilateral lameness & MCD and clinicians weren’t sure about the dx before they did CT
- mepivacaine 1.5 mg/kg IA into elbow joint
- most dogs lameness improved – 13% false negatives
- (no negative control group)

58

Evans RB, Gordon-Evans WJ, Conzemius MG. Comparison of three methods for the management of fragmented medial coronoid process in the dog. A systematic review and meta-analysis. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):106–9.

- arthroscopy is superior to arthrotomy and medical management for FCP, based on the data at the time
- medial arthrotomy is not superior to medical management

59

Burton NJ, Dobney JA, Owen MR, Colborne GR. Joint angle, moment and power compensations in dogs with fragmented medial coronoid process. Vet Comp Orthop Traumatol. 2008 Jan 1;21(2):110–8.

- 7 dogs with FCP and inverse dynamic analysis
- FCP side compared with contralateral side (no normals)
- “In conclusion, joint angular excursions, moments and powers were all diminished in the affected forelimb, but their overall patterns were largely conserved”
- especially in propulsive phase of stance

60

Proks P, Necas A, Stehlik L, Srnec R, Griffon DJ. Quantification of humeroulnar incongruity in labrador retrievers with and without medial coronoid disease. Vet Surg. 2011 Dec;40(8):981–6.

- “Subluxation index” (SI) proposed for humeroulnar incongruity
- SI = d/r (of trochlear circle)
- on 135 extended lateral radiographs
- significant difference between the SI of Labs with coronoid disease (18.5%) vs normal labs (1.7%)