Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow

Abstract

Objective To determine medium-term clinical efficacy of sliding humeral osteotomy (SHO) for treatment of lameness and elbow pain associated with clinically diagnosed elbow disease featuring cartilage eburnation of the medial elbow compartment (medial compartment disease - MCD). Study Design Case series. Animals Dogs (n=49) with severe or persistent lameness attributable to MCD. Methods Signalment, lameness history, and preoperative imaging findings were recorded. A custom, locking, stepped SHO plate was applied to the medial aspect of the humerus, stabilizing a mid-diaphyseal transverse osteotomy, medially translating the distal segment relative to the proximal segment. Three variants of technique of application were used and outcomes compared between respective patient groups. Outcome measures included lameness scoring, anatomic measures, VAS scoring of elbow pain, and owner assessment of function. Measures recorded preoperatively, 12, and 26 weeks postoperatively were compared. Results Of 59 limbs that had SHO, 39 had preoperative focal treatment of the diseased medial aspect of the coronoid process. Mean ± SD dog age was 45.5 ± 37.48 months and body weight ranged from 13.6 to 46.7 kg. Mean preoperative duration of lameness was 14.7 ± 18.50 months. Lameness improved for all limbs by 26 weeks, and resolved in 21/32 limbs. Significant improvements in postoperative elbow pain scores and most owner assessments of function were observed. Incidence of major complications requiring surgical intervention was 17.2%, 22.2%, and 4.8% for each of the 3 technique variants described. Histologic examination of 2 elbows at >12 months revealed fibrocartilage cover of medial aspect of humeral condyle. Conclusions Canine SHO with or without focal treatment of the diseased medial aspect of the coronoid process ameliorates lameness and pain associated with MCD at medium-term follow-up. Application technique is critical to minimizing morbidity. Clinical Relevance SHO is appropriate for clinical management of pain and lameness in select cases of canine MCD. © Copyright 2009 by The American College of Veterinary Surgeons.