Danielski, Alan (2023) An innovative approach to humeral intracondylar fissure disease in Spaniel breed dogs. [Tesi di dottorato]

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Abstract

In the first part of this research project, we described the arthroscopic findings of dogs afflicted with humeral intracondylar fissure (HIF), and we compared them with the articular status of unaffected canine joints (as revealed by preoperative CT scans). In all 21 elbows (14 dogs) with HIF, a focal cartilage lesion was observed on the caudal aspect of the humeral condyle. The severity of these lesions ranged from simple indentations into the articular surface to full-thickness erosions. These cartilage lesions were suspected to arise from humero-anconeal incongruity, defined as the 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. Conversely, none of the 31 elbows (across 20 dogs) without HIF exhibited such cartilage lesions or indications of humero-anconeal incongruity. The subsequent phase of this study aimed at addressing humero-anconeal incongruity as a treatment for HIF in Spaniel breed dogs. An oblique proximal ulnar osteotomy (PUO), considered the most suitable technique for rectifying humero-anconeal incongruity, was performed in 51 antebrachii of 35 Spaniel dogs. The evaluation of HIF healing encompassed both subjective and objective assessments based on preoperative and long-term follow-up CT imaging. Objective evaluation involved measuring bone density in Hounsfield units (HU) within a rectangular region of interest (ROI) covering the entire hypo-attenuated humeral fissure. The study recorded major and minor complications. A total of 24 partial and 27 complete HIFs were diagnosed, with the follow-up CT scan conducted at a median of 18.5 months (range 10-49 months). Subjective assessment affirmed partial or complete healing of the HIF in 41 elbows (80.3%). Objectively, a significant difference in mean HU of the HIF’s ROI was observed between preoperative (HU 640) and final follow-up CT images (HU 835) (p=0.001). Younger dogs (<14 months) exhibited the highest increase in HU of the HIF’s ROI. Notably, major complications occurred in 5 dogs (6 limbs), with 4 associated with the lack of fissure healing (7.8%). In conclusion, this study advocates that oblique proximal ulnar osteotomy leads to partial or complete healing of HIF, alleviating pain in the majority of dogs. This innovative approach may help reduce the notoriously high complication rate traditionally associated with the use of a transcondylar screw.

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