To Cut or Not to Cut: Elbow Incongruity in a Newly Adopted Dog
Signalment: 6-month-old spayed crossbreed dog
History: The patient was adopted from a shelter, and the new owner noticed limping on the right thoracic limb at adoption.
Physical examination: Grade 3 of 4 lameness right thoracic limb; moderate elbow pain on right thoracic limb extension.
Related Article: Orthopedic Examination of the Forelimb in the Dog
Radiographs:
Lateral views of the left (Figure 1A) and right (Figure 1B) radius/ulna show the left limb with normal, open physes in the distal radius and ulna, as well as the presence of an IV catheter.
The distal right radial physis is closed (white arrowhead) and large gaps are present (white arrow) between the:
(1) right humeral condyle and radial head, and
(2) coronoid process of the ulna and radial head
Figure 1. Lateral views of the left (1A) and right (1B) radius/ulna.
Related Article: Elbow Pain in a Young English Bulldog
Radiographic Diagnosis:
1. Normal left radius and ulna2. Premature closure of the right distal radial physis with secondary severe elbow incongruity
Should this dog go to surgery?
Outcome: A right radial lengthening was performed, incorporating a cortical graft obtained via ulnar ostectomy. Patient lameness and elbow pain completely resolved within 3 months postoperatively.
Figure 2. Immediate postoperative lateral view (2A) with prematurely closed right radial physis of the right radius and ulna (arrowhead) and humero-ulnar incongruity (arrow). Lateral view (2B) shows the right radius and ulna 2 years after surgery, demonstrating greatly reduced incongruity and complete healing of the radius and ulna.