Page 229 - Canine Lameness

14.4 ­AnNrmallal iirirnmarNA Nidatld Hrlomal NAnmyall 201

the goal) and stabilizing them with internal fixation utilizing a transcondylar lag screw in
combination with pins or a plate (Perry et al. 2015). Medial humeral condylar fractures are observed
less commonly but the diagnostic and treatment approaches are similar. If condylar fractures are
observed in older animals, consideration should be given to incomplete ossification of the humeral
condyle (IOHC) as an underlying disease. Less commonly observed fractures of the elbow region
include Salter-Harris Type I fractures of the distal humerus and proximal radius, intercondylar
(also described as T-Y fracture) and supracondylar fractures, as well as proximal ulna fractures
with luxation of the radial head (i.e. Monteggia fracture).

14.3.1 Signalment and History
As for any fracture, trauma is the main cause which can happen to dogs of any age/signalment.
However, fractures of the elbow region are frequently seen in immature dogs. In these patients,
lateral humeral condylar fractures are most common because of the smaller-sized lateral (vs.
medial) supracondylar crest (Figure 14.2). These fractures occur frequently in smaller breeds (with
the French Bulldog being predisposed) and often occur with minor trauma. The peak age has been
reported to be four months (Perry et al. 2015).

14.3.2 Physical Exam
Because of the acute nature of the injury, physical exam findings usually show severe pain upon ELBOW REGION
elbow ROM. However, pain may present as less severe in stoic animals or when fractures are
minimally displaced.

14.3.3 Diagnostics
Diagnosis of these fractures is readily accomplished with orthogonal radiographs, although the
diagnosis can be missed if only a lateral view is taken (Figure 14.3).

14.4 Incomplete Ossification of the Humeral Condyle

IOHC is defined as failure of ossification of the lateral and medial aspects of the humeral condyle.
This ossification should be completed during the first three months of growth, while the distal
humeral physis (which is located proximally to the ossification centers) continues to grow until
five to eight months. A lack of fusion of the medial and lateral condyles results in a fibrous band
connecting the two parts of the condyle which creates a weak area predisposing for development
of condylar fractures.
Recently, Farrell and others (2011) have reported that dogs may also suffer from a condition
termed “progressive humeral intracondylar fissure (HIF).” The condition is very similar to IOHC;
however, animals develop the separation of the condyles after normal ossification has occurred,
thus indicating a fatigue fracture due to cyclic loading rather than a failure of fusion during devel-
opment (Farrell et al. 2011). Because of the uncertainty about the difference in etiology, some
authors use the term HIF to encompass both conditions, IOHC and stress fractures of the humeral
condyle (Moores and Moores 2017).
Treatment of condylar fractures due to IOCH/HIF requires open reduction and surgical fixation
like that used for traumatic condylar fractures. Ideally IOHC/HIF is identified prior to the patient