CASE REPORTS

Incomplete ossification of the humeral

condyle in two Labrador retrievers

Incomplete ossification of the humeral condyle (IOHC) was identified Marcellin-Little 1999). I O H C has been
reported in specific breeds: cocker spaniels,
in two Labrador retrievers using computed tomography. Both dogs Brittany spaniels, springer spaniels,
were non-weightbearingon the affected forelimbs. The dogs Cavalier King Charles spaniels and clumber
spaniels, as well as in a pug and a rottweiler
were treated by means of a bone screw placed across the (Marcellin-Little and others 1996, Rovesti
humeral condyle. IOHC was originally reported in spaniel and and others 1998, Cook and others 1999,
Marcellin-Little 1999). These dogs were
chondrodystrophic breeds. The pathogenesis of the condition from chondrodystrophic breeds. It has also
remains unknown, but may be related to impaired antebrachlal been described in a Labrador retriever pup
with chondrodysplastic dwarfism (Cook
bone growth, similarly to the pathogenesesof elbow dysplasia and Jordan 1997, Marcellin-Little 1997).
and radius curvus. The chondrodystrophy or chondrodys-
plasia present in these dogs with IOHC
may have been a predisposing factor in the
pathogenesis of the condition because the
D. ROBlNt AND
INTRODUCTION ossification of long bones is impaired in
D. J. MARCELLIN-LlllLE*t
chondrodystrophy or chondrodysplasia
~~ ~

Journal of Small Animal Practice (2001)

Incomplete ossification of the hurneral
42,231-234 condyle (IOHC) is an uncommon cause
of forelimb lameness in dogs (Marcellin-
Little and others 1994). Affected dogs are
predisposed to humeral condylar fractures
(Marcellin-Little and others 1994,
(Terpin and Roach 1981, Sande and
Bingel 1983). The present report, how-
ever, describes two Labrador retrievers
with IOHC. This is, to the authors’
knowledge, the first report of IOHC in
phenotypically normal dogs with respect
to chondrodystrophy or chondrodysplasia.

CASE HISTORIES

* Clinique Veterinaire Beaulieu,
Poitiers, France
TDepartment of Clinical Sciences,
College of Veterinary Medicine,
North Carolina State University,
4700 Hillsborough Street,
Raleigh, NC 27606, USA
Correspondence to
D. J. Marcellin-Little at
the USA address
FIG 1. Cranlocaudalradiograph of the elbow of an
isweek-old Labrador retriever with Incomplete
ossificationof the humeral condyle. A radlolucent
line Is visible across the humeral condyle
Case 1
An 18-week-old yellow female Labrador
retriever was referred to the Clinique
Vktkrinaire Beaulieu in Poitiers, France,
with a weightbearing lameness of the right
forelimb of two weeks’ duration. No his-
tory of trauma was present and the dog
had been fed a commercial large-breed dog
food. The owner reported that the lame-
ness was more severe after rest. No treat-
ment had been given up to the time of
presentation.
O n presentation, the dog was not found
to be lame. No joint effusion or crepitus
was found in the joints of the forelimb,
although a pain response was present on
flexion of the right elbow.
Radiographs of both elbows were
obtained under sedation. O n the cranio-
caudal view of the right elbow, a 2 mm
wide radiolucent line was present in the
humeral condyle, which was directed in a

JOURNAL OF SMA1.L ANIMAL PRACTICE VOL 42 MAY 2001 23 1

-

proximal to distal direction (Fig 1). This
line was highly suggestive of IOHC. Mild
sclerosis of the ulnar trochlear notch was
present on the mediolateral projection of
the right elbow. Degenerative joint disease
(DJD) of the elbow was not identified.
Abnormalities were not identified in the
left elbow.
Because of the risk of secondary condy-
lar fracture (Marcellin-Little 1999), a 3.5
mm fully threaded cortical bone screw was
placed in lag fashion across the humeral
condyle, using a minimal lateral approach
to the humeral condyle with the dog under
general anaesthesia.
A mild weightbearing lameness was
present for four days after surgery. After
10 days, a small subcutaneous seroma
developed ac the lateral aspect of the right
elbow. This was treated by aspiration.
The dog was re-evaluated one month
after surgery. Neither lameness nor a pain
response on palpation ofthe forelimb were
identified. The distal portion of the radio-
lucent line was still visible across the
humeral condyle on a craniocaudal radio-
graph of the right elbow.
At further evaluation of the dog four
months after surgery, the animal was clini-
cally sound and the condylar radiolucent
line was not visible on a craniocaudal
radiograph of the right elbow.
232
O n mediolateral radiographs, the right
(affected side) radius and ulna measured
17.4 and 20.3 cm compared with 17.3 and
20.1 cm for the left radius and ulna. A
computed tomography (CT) scan of the
right elbow was made. A radiolucent line
was still visible across the humeral condyle
and the bone adjacent to the radiolucency
was sclerotic. DJD was not present in the
elbow. Seven months after surgery, the
owner reported that the dog was free of
lameness.
Dog 2
A 6.5-month-old chocolate male Labrador
retriever was referred to the veterinary
teaching hospital at North Carolina State
University with a non-progressive weight-
bearing lameness of the left forelimb of
eight weeks' duration. The owner reported
that the dog would flex its carpus and
elbow under its chest when lying down.
Before admission, the dog had been treated
with 1.8 mg/kg carprofen (Rimadyl;
Pfizer) given orally, twice daily, for seven
days. The lameness had not improved after
the administration of the drug.
O n presentation, a mild weightbearing
lameness became visible after two
minutes of exercise. The dog shifted
weight from left to right when standing or
sitting (Fig 2A) and flexed its carpus and
J O U R N A L OF SMALL ANIMAL. PRACTICF
FIG 2. Labrador
retriever with
incomplete
ossification of the
left humerai condyle.
When standing (A),
the dog shifts weight
away from its
affected side (white
h e ) . When lying
down (B), the dog
flexes the elbow and
carpus of the affected
forelimb (white line)
elbow under its chest when lying down
(Fig 2B).
O n palpation, mild muscle atrophy was
present on the left antebrachium, with a
decrease in limb circumference of 1.5 cm
below the elbow and 0.5 cm above the car-
pus. A pain response was present on flex-
ion and extension of the left elbow. The
range of motion of the left elbow was 25 to
155" compared with 25 to 165" for the
right elbow. A positive Ortolani sign was
present in both coxofemoral joints.
O n radiography of the left elbow, faint
radiolucency was observed in the humeral
condyle. Fragmentation of the medial
coronoid process (FCP) and osteochon-
drosis (OCD) of the medial aspect of the
humeral condyle were suspected (Fig 3A).
DJD was not visible.
On a CT scan of the left elbow, IOHC
was confirmed and condylar sclerosis was
found to be present next to the radiolucent
area (Fig 3B). A mild distal humeroradial
subluxation was also visible on two-dimen-
sional reconstruction of the elbow. FCP
and O C D were not, however, apparent.
O n mediolateral radiographs, the left
(affected side) radius and ulna measured
17.7 and 21.3 cm compared with 17.2
and 21.0 for the right radius and ulna.
Abnormalities were not visible on radio-
graphs and a CT scan of the right elbow.
VOL. 4 2 MAY 2001

FIG 3. Cranlocaudal radiograph (A) of the elbow
of the dog in Fig 2. A radlolucent area is faintly
visible across the humeral condyle. IOHC Is
confirmed on a CT scan (B). The bone adjacent
to the area of incomplete ossification Is sclerotic
A 4.5 mm fully threaded cortical bone
screw was placed in neutral fashion across
the humeral condyle using a minimal lateral
approach to the condyle with the dog under
general anaesthesia. A seroma developed
over the surgical site. The fluid present
was aspirated by the referring veterinarian
and evaluated cytologically to rule out
infection. The seroma was left untreated
thereafter and resolved after two months.
The left elbow was radiographed four
weeks after surgery. Radiographic changes
were not evident, in contrast to the radio-
graphs obtained immediately after surgery.
When contacted five months later, the
owner reported that the dog had a normal
activity level and that no lameness was
apparent after surgery. It was also
confirmed that the dog had not assumed
its abnormal lying position, with its left
paw under its chest, since the surgery.
This report documents the presence of
I O H C in two Labrador retrievers. It is
suspected that the condition may have
a genetic basis with a recessive mode of
inheritance (Marcellin-Little and others
1994), although its pathogenesis is
unknown. However, fragmentation of the
FCP has often been found to coexist with
JOURNAL OF SMALL ANIMAL PRACTICE VOL 42 MA
I O H C and, in a previous report, three of
14 non-fractured condyles with the condi-
tion had a displaced FCP (Marcellin-Little
and others 1994). This suggests that the
pathogeneses of I O H C and FCP may be
1inked.
The pathogenesis of FCP is not fully
understood, although most authors specu-
late that it results from abnormal growth of
the proximal portion of the ulna or asyn-
chronous growth of the radius in relation
to the ulna, resulting in incongruity of the
elbow (Wind 1986, Collins and others
1999).
The radii of the affected forelimbs in
the two dogs in the present report were
1 mm (0.6 per cent) and 5 mm (2.9 per
cent) longer than the respective contra-
lateral, non-affected radius. Because radi-
ography has limited precision in the
measurement of bone length, this relative
increase in radial length in the limbs with
I O H C could be artefactual. Alternatively,
it could represent excessive radial growth
in these limbs. Assuming excessive radial
growth in limbs with I O H C , this could
occur coincidentally to, or be a factor
in, the pathogenesis of the condition.
A relatively long radius could lead to
abnormal stresses being placed on the
humeral condyle during ossification, thereby
interfering with normal development.
The coexistence of impaired ante-
brachial growth and I O H C has been previ-
ously noted. Four of 24 cocker spaniels
with I O H C had radius curvus (Marcellin-
Little and others 1994). Furthermore, all
dogs with I O H C in previous reports were
chondrodystrophic or chondrodysplastic
and, therefore, had a potentially abnormal
antebrachial growth. The relationship of
radial and ulnar length with respect to
IOHC could be further investigated in
static mode by measuring the relative size
3f each bone in affected and contralateral,
non-affected limbs from a larger group of
dogs with unilateral IOHC. This relation-
ship could also be evaluated dynamically
by monitoring radial and ulnar growth in
dogs with and without I O H C using bipla-
nar radiography or CT (Conzemius and
00 1
others 1994). These studies could also help
to confirm the pathogenesis of FCI?
The dogs in the present report exhib-
ited mild clinical signs. Lameness was mild
and intermittent and was unresponsive to
anti-inflammatory therapy. Subtle postural
changes were also present in response to
pain originating from the elbow (Fig 2).
O n palpation, a pain response was identi-
fied only on extreme flexion and extension
of the elbow.
I O H C should be considered as the
potential cause of forelimb lameness when
other developmental orthopaedic diseases
have been ruled out. However, in dogs with-
out humeral condylar fracture, IOHC may
be difficult to confirm because the radio-
lucent line present in the humeral condyle
may only be imaged on craniocaudal radio-
graphs when the radiographic beam is par-
allel to the zone of incomplete ossification.
A 15" craniomedial to caudolateral oblique
radiographic projection is recommended.
This view may be obtained by making a
craniocaudal radiograph of the elbow with
the antebrachium externally rotated. With
proper positioning, the ulna should be
centred over the humeral condyle. IOHC
may also be confirmed using CT.
The treatment of IOHC, before any
occurrence of humeral condylar fracture,
has included the placement of a bone
screw across the humeral condyle, since it
has been reported by one of the present
authors that 43 per cent of dogs with
IOHC fracture their humeral condyle
between 11 days and 18 months after
diagnosis (Marcellin-Little 1999). The
screw should have a large diameter shaft to
avoid bending (or rupture) of the implant
a t the site of incomplete ossification (Muir
and others 1995, Marcellin-Little 1996).
[n a previous study, a Brittany spaniel
was implanted with a partially threaded
4.0 m m screw (1.9 mm diameter
ihaft)(Marcellin-Little and others 1996)
and, six years later, the dog fractured the
ateral portion of its humeral condyle after
:he screw bent. In a later study, the authors
>laced 10 fully threaded bone screws (2.4
)r 3.1 mm diameter shafts) across 10 non-
233
fractured condyles with I O H C (Marcellin-
Little 1999). To the authors’ knowledge,
none of these dogs has fractured their
humeral condyle (Marcellin-Little 1999).
It appears that bone healing across
condyles with I O H C does not occur after
transcondylar screw placement (Rovesti
and others 1998, Marcellin-Little 1999).
This was confirmed for one dog in the
present report from a CT scan obtained
four months after screw placement. The
bone screws placed appear to act solely as a
buttress.
Acknowledgements
This study was funded in part by the
Orthopedic Research Fund, College of
Veterinary Medicine, North Carolina State
University.
References
COLLINS. K. E., CROSS, A. R., LEWIS,D. D.. ZAPATA, J. &
RAPOFF, R. (1999) A comparison of the radius of cur-
vature of the ulnar trochlear notch of Rottweilers and
Greyhounds using three dimensional digitization
(Abstract). Veterinary Surgery 28, 389
CONZEMIUS,M. G.,SMITH,G. K.. BRIGTON, C. T., MARION, M.
J. & GREGOR, T. P. (1994) Analysis of physeal growth
in dogs, using biplanar radiography. American Jour-
nal of Veterinary Research 55. 22-27
COOK, J. L. &JORDAN, R. C. (1997) What is your diagno-
sis? Journal of the American Veterinary Medical
Association 210, 329-330
COOK, J. L., TOMLINSON, J. L. & REED, A. L. (1999)
Fluoroscopically guided closed reduction and inter-
nal fixation of fractures of the lateral portion of the
humeral condyle: prospective clinical study of the
technique and results in 10 dogs. Veterinary Surgery
28,315321
MARCELLIN-LITTLE. D. J. (1996) Letter to the Editor.
Veterinary and Comparative Orthopaedics and
Traumatology 9, 72
MARCELLIN-LITTLE, D. J. (1997) Letter to the Editor.
Another consideration for radiographic diagnosis.
Journal of the American Veterinary Medical Associ-
ation 210, 1264
MARCELLIN-LITTLE, D. J. (1999) Incomplete ossification
of the humeral condyle in dogs. In: Kirk’s Current
Veterinary Therapy XIII. Ed J. D. Bonagura.
W. B. Saunders, Philadelphia. pp 1000-1004
MARCELLIN-LITTLE, D. J., DEYOUNG, D. J.. FERRIS,
K. K. &
BERRY, C. M. (1994) Incomplete ossification of the
humeral condyle in spaniels. Veterinary Surgery23,
475-487
MARCELLIN-LITTLE, D. J., ROE, S. C. & DEYOUNG, D. J.
(1996) What is your diagnosis? Journal of the Amer-
ican Veterinary Medical Association 209, 727-728
MUIR.P.. JOHNSON,K. A. & MARKEL, M. D. (1995) Area
moments of inertia for comparison of implant cross-
sectional geometry and bending stiffness. Veterinary
and Comparative Orthopaedics and Traumatology8,
146-152
ROVESTI,G. L., FLUCKIGER, M., MARGINA. A. & MARCELLIN-
LITTLE,D. J. (1998) Fragmented coronoid process
and incomplete ossification of the humeral condyle
in a Rottweiler. Veterinary Surgery 27, 354-357
SANDE.R. D. & BINGEL,S.A. (1983) Animal models of
dwarfism. Veterinary Clinics of North America: Small
Animal Practice 13, 7 1 8 9
TERPIN. T. & ROACH, M. R. (1981) Chondrodysplasia in
the Alaskan malamute: involvement of arteries, as
well as bone and blood. American Journal of Veteri-
nary Research42, 1865-1873
WIND, A. P. (1986) Elbow incongruity and developmen-
tal elbow diseases in the dog: part II. Journal ofthe
American Animal Hospital Association 22, 725730

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