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66 Angular Limb Deformities

PROGNOSIS & OUTCOME • Anesthetists should be familiar and comfort- Technician Tips
able with anesthetic drugs, procedures, Careful observation of patients during and
VetBooks.ir • Most carry a good prognosis for full recovery • Death associated with anesthesia frequently complications.
equipment, and monitoring devices.
• Depends on the severity and duration of the
immediately after anesthesia can avert
complication.
occurs in the postoperative period. Patient
monitoring should continue throughout
if rapidly recognized and addressed.
recovery. SUGGESTED READING
Matthews N, et al: Factors associated with anesthetic-
PEARLS & CONSIDERATIONS related death in dogs and cats in primary care
Prevention veterinary hospitals. JAVMA 250:655-665, 2017.
Comments • Anesthetic plans catered to individual patients
• Most anesthetic complications are easily in consideration of signalment, coexisting AUTHOR: Rachel A. Reed, DVM, DACVAA
EDITOR: Benjamin M. Brainard, VMD, DACVAA,
prevented by diligent monitoring and disease, and procedure. DACVECC
anesthetic checklists to ensure correct pro- • Maintenance of high quality, correctly
cedures and machine function. functioning anesthetic equipment.

Angular Limb Deformities Bonus Material Client Education
Sheet
Online

BASIC INFORMATION deformity of the radius as it continues to additional aims are to restore unrestricted
grow. Elbow and carpal incongruities can growth of affected bones and prevent joint
Definition also occur. incongruities from developing.
Abnormal growth of a limb due to premature • Asymmetrical closure of the distal radial
closure of a physis (growth plate). Most com- physis can cause an angular deformity similar Acute General Treatment
monly occurs in the forelimb, with radial or to closure of the ulnar physis. • Ulnar ostectomy: used in an immature dog
ulnar physeal closures. Rarely affects the • Symmetrical closure of either radial physis with premature closure of the ulnar physis
hindlimb, with premature closure of a tibial often leads to radial shortening and elbow to restore radial growth potential
physis. incongruity but no angular deformity. ○ A fat graft placed in the ostectomy prevents
premature bone union.
Synonyms DIAGNOSIS • Distraction osteogenesis (by circular external
Premature closure of radial, ulnar, or tibial fixation): used for treating premature closure
physis; radius curvus; carpus valgus Diagnostic Overview of the distal radius
Premature closure of a physis is suspected in ○ This allows for limb lengthening and
Epidemiology a young dog with a shortened or angularly correction of angular deformities.
SPECIES, AGE, SEX deformed limb and confirmed on radiographs • Corrective radial wedge or dome osteotomy
Primarily young dogs (<1 year old); uncommon when compared to the normal limb. (stabilized with a T-plate, circular or linear
in cats external fixation, in combination with an
Differential Diagnosis ulnar osteotomy or ostectomy): performed
RISK FACTORS • Malunion of a fracture in mature dogs for acute correction of angular
• Trauma to limb and physis • Ligamentous or tendinous damage at the and rotational deformities and to restore joint
• Some chondrodystrophic breeds may be elbow or carpus congruity
predisposed. • Retained cartilaginous core of the ulna • Proximal ulnar osteotomy: permits correction
of elbow incongruities
Clinical Presentation Initial Database
HISTORY, CHIEF COMPLAINT • CBC and serum chemistry panel: no Chronic Treatment
• Trauma to the limb 3-4 weeks before abnormal findings expected • In the postoperative period, a soft, padded
deformity begins • Mediolateral and craniocaudal elbow-to- bandage or metasplint may be placed to
• Often, dog is presented when the limb begins carpus radiographs of the affected and protect the limb. The bandage or splint is
to appear deformed. contralateral limb to assess location and often applied for 2-4 weeks.
degree of deformation • Physical rehabilitation to reduce risk of
PHYSICAL EXAM FINDINGS complications
• Lameness of affected limb, with pain on Advanced or Confirmatory Testing
palpation of carpus or elbow • CT is helpful for further defining the limb
• The limb may appear shortened or have an deformation and joint congruency. Behavior/Exercise
angular deviation. • CT images can be used to produce three- Exercise restriction for at least 6 weeks until
dimensional, life-sized, stereolithographic radiographs confirm bone healing
Etiology and Pathophysiology models for surgical planning.
• Premature closure of the distal ulnar physis
is the most common physeal injury, likely TREATMENT Possible Complications
due to the conical shape of this physis in • External fixation may have premature
dogs. Treatment Overview loosening of the fixation pins or pin tract
○ Because of the paired bone system, ces- Surgical treatment aims to restore joint congru- infection.
sation of growth in the ulna causes cranial ity, normalize limb length, and correct angular • Inappropriate amount of surgical correction
bowing, external rotation, and valgus and rotational deformities. In immature dogs, may result in persistent valgus.

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