498 © Schattauer 2012
Computed tomography of ununited
anconeal process in the dog
E. G. Gasch1; J. J. Labruyère2; J. F. Bardet1
1Clinique Vétérinaire du Dr. Bardet, Neuilly-sur-Seine, France; 2VetCTSpecialists Ltd., St John’s Innovation Center,
Cambridge, England
Keywords
Computed tomography, ununited anconeal
process, canine, elbow dysplasia
Summary
Objective: The purpose of this study was to
describe computed tomography (CT) features
of the ununited anconeal process and relate
them with the following elbow dysplasia
signs: medial coronoid disease, medial hum-
eral condyle changes, osteoarthritis (OA), and
radioulnar incongruence.
Methods: Computed tomographic images of
dogs older than six months with an ununited
anconeal process were evaluated (n = 13).
Ununited anconeal process features were de-
scribed as being complete or incomplete, and
the degree of displacement, volume, and pres-
ence of cysts and sclerosis were also evalu-
ated. Medial coronoid disease was defined as
an irregular medial coronoid process shape,
presence of sclerosis and fragmentation.
Medial humeral condyle changes were de-
fined as subchondral bone flattening, lucen-
cies, and sclerosis. Osteoarthritis was graded
depending on the osteophytes size. Radio-
ulnar incongruence was measured on a sagit-
tal view at the base of the medial coronoid
process.
Results: Eleven elbows had a complete and
two had an incomplete ununited anconeal
Correspondence to:
Dr. Esteban Gonzalez Gasch
Clinique Vétérinaire du Dr. Bardet
32, rue Pierret
92200 Neuilly-sur-Seine
France
Phone: +33 146 410 593
Fax: +33 140 883 267
Email: estevegg@hotmail.com
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Original Research
process. All ununited anconeal processes had Introduction
cystic and sclerotic lesions. Seven ununited
The ununited anconeal process is character-
anconeal processes were displaced and six
ized by failure of the anconeal process to fuse
were non-displaced. Mean ununited anconeal
with the proximal ulnar metaphysis in young
process volume was 1.35 cm3 (0.61 cm3 –
growing dogs. This condition is often bilat-
2.08 cm3). Twelve elbows had signs of medial
eral, and it can lead to instability, displace-
coronoid disease (4 of them with a frag-
ment of the anconeal process, and secondary
mented medial coronoid process), and one
osteoarthritis (OA) (1–4). An ununited an-
elbow did not show any evidence of medial
coneal process forms part of the group of
coronoid disease. Ten elbows had medial
elbow disorders that are collectively referred
humeral condyle changes. One elbow had
to as elbow dysplasia. This term combines the
grade 1 OA, seven elbows had grade 2, and
ununited anconeal process, fragmented
five elbows grade 3. All elbows had radioulnar
medial coronoid process, elbow incongruity,
incongruence: three elbows had a negative
and osteochondrosis dissecans of the medial
and 10 elbows had a positive radioulnar in-
part of the humeral condyle (5–13).
congruence. Mean radioulnar incongruence
Ununited anconeal process has been de-
was 1.49 mm (0.63 mm – 2.61 mm). Com-
scribed in various breeds of dogs (14–19).
puted tomographic findings were similar in
Depending on the breed, the ossification
the majority of the elbows studied: complete
centre of the anconeal process mineralizes
ununited anconeal processes with signs of
between 10 and 16 weeks of age, with com-
medial coronoid disease, positive radioulnar
plete fusion to the ulna by 20 weeks of age (2,
incongruence, high grade of OA, sclerotic
3). A definitive diagnosis of ununited anco-
medial humeral condyle changes, and large
neal process can be made if the anconeal
ununited anconeal process volumes.
process is not united after 24 weeks of age
Clinical significance: Incomplete small
(20). However, it has been suggested that the
ununited anconeal process volumes could be
radiographic appearances of an ununited
associated with a lower incidence of medial
anconeal process and the normal secondary
coronoid disease or medial humeral condyle
centre of ossification are different, and that
changes. We recommend performing preoper-
the presence of a separate anconeal fragment
ative CT of elbows with an ununited anconeal
consistent with an ununited anconeal pro-
process to evaluate concurrent lesions.
cess can be considered pathologic even if the
dog is younger than 24 weeks of age (20).
The exact aetiology of an ununited an-
coneal process is not completely clear.
Traumatic, metabolic and genetic factors
have been incriminated as causes of unu-
nited anconeal process (1, 17, 19). Hayes
Vet Comp Orthop Traumatol 2012; 25: 498–505 observed that repeated growth plate trau-
doi:10.3415/VCOT-11-10-0138
Received: October 4, 2011
ma associated with rapid or prolonged
Accepted: June 13, 2012 periods of growth in heavy-breed dogs
Pre-published online: July 25, 2012 might be implicated (21). Olsson hypo-
thesized that failure of the anconeal process
to unite with the ulna was due to failed en-
dochondral ossification (14). Wind sug-
gested that underdevelopment of the

trochlear notch of the ulna could result in
increased loading at the anconeal process
and the medial coronoid process (22). She
suggested that the radius of curvature of
the ulnar trochlear notch was smaller than
the radius of curvature of the humeral con-
dyle, resulting in the trochlear notch being
too small to accommodate the humeral
condyle, thus increasing the load on the an-
coneal and coronoid processes. On the
other hand, Sjöstrom stated that an unu-
nited anconeal process could be caused by
incongruous growth between the radius
and the ulna, with proximal displacement
of the radial head and subsequent pressure
on the anconeal process (23).
An ununited anconeal process is diag-
nosed on a flexed mediolateral radio-
graphic projection and it appears radio-
graphically as a discrete or irregular radio-
lucent line between the anconeal process
and proximal ulna (2–4, 11, 13, 24, 25). In
young growing dogs, if the elbow is not
flexed, the physis of the medial humeral
epicondyle is superimposed over the anco-
neal process and can mimic an ununited
anconeal process (13, 24). Other projec-
tions of both elbows should be included in
the radiographic examination to detect
concurrent elbow dysplasia lesions. The
radiographic diagnosis of these lesions is
often ambiguous, even with the use of sev-
eral different views. In most cases, a pre-
sumptive diagnosis is made based on find-
ings of secondary osteophytic changes (26).
Computed tomography (CT) is useful
for identifying elbow dysplasia lesions that
are not clearly defined on radiographs.
Computed tomography provides detailed
images of the medial coronoid process,
radial incisure, anconeal process, ulnar
trochlear notch, the humeral condyle, joint
congruity, and OA (13, 27–29). Computed
tomography produces cross-sectional im-
ages, thus eliminating the problems of
superimposition associated with radiogra-
phy. Computed tomography and arth-
roscopy are considered as the methods of
choice for the diagnosis of most elbow dys-
plasia disorders (6). An ununited anconeal
process is usually identified with ease on
radiographs, and the diagnosis does not
require advanced cross sectional imaging
techniques. The ununited anconeal process
has been previously studied using CT, but
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E. G. Gasch et al.: Computed tomography of ununited anconeal process in the dog
Fig. 1 Case 5, right elbow: Incomplete unu-
nited anconeal process (sagittal plane). Note the
two zones of the anconeal process: the united (ar-
rowheads) and ununited zone (arrows). R: radius;
U: ulna; H: humerus.
Fig. 2 Case 3: Ununited anconeal process
three-dimensional volume. Note the blue re-
formatted three-dimensional ununited anconeal
process.
to the authors’ knowledge, there are no case
series descriptions of the ununited anco-
neal process using CT in the dog (11, 18).
The aims of this study were: 1) to describe
the computed tomography features of the
ununited anconeal process; 2) to assess the
incidence of associated elbow dysplasia
lesions (fragmented medial coronoid pro-
cess, osteochondrosis dissecans, and elbow
incongruity); and 3) to correlate the CT
features of an ununited anconeal process
with the presence of associated disorders.
Materials and methods
We conducted a retrospective review of the
medical records of canine patients under-
499
going CT examination of both elbow joints
for elbow lameness between January 2000
and August 2010. Dogs over six months of
age with a complete clinical and ortho-
paedic history and with radiographic and
CT signs of an ununited anconeal process
were included.
All of the dogs underwent a thorough
physical and orthopaedic examination.
When lameness or pain was elicited in one or
both elbows, three routine radiographic pro-
jections were performed in both elbows (ex-
tended mediolateral, flexed mediolateral, and
craniocaudal projections). Computed to-
mography scans were performed with a third
generation scannera with dogs under general
anaesthesia. All of the dogs were placed in
dorsal recumbency with both thoracic limbs
extended symmetrically cranially. Contigu-
ous transverse 1 mm thick images were ob-
tained from the proximal aspect of the olecra-
non to 1 cm distal to the elbow joint and par-
allel with the humeroradial joint space, using
a bone reconstruction algorithm.
Individual images were reviewed using a
bone setting (window width = 3500 HU;
window level = 500 HU). Transverse im-
ages of the elbow joint were reformatted in
dorsal and sagittal planes for evaluation of
ununited anconeal process features. The
presence or absence of associated lesions
(fragmented medial coronoid process, os-
teochondrosis dissecans of the medial
humeral condyle and elbow incongruity)
was recorded.
Ununited anconeal process
features
United anconeal process features were de-
scribed as a complete ununited anconeal
process if the fracture line extended across
both cortices in the sagittal plane, and an
incomplete ununited anconeal process if
the fracture line involved only one cortex in
the same plane (씰Fig. 1). When an unu-
nited anconeal process was complete, the
degree of displacement was evaluated ac-
cording to the anatomic position of the
fragment relative to the olecranon in the
transverse and sagittal planes.
a
CTe ProSpeed Scanner: General Electrics Medical
Systems, Milwaukee, WI, USA
Vet Comp Orthop Traumatol 6/2012
500 E. G. Gasch et al.: Computed tomography of ununited anconeal process in the dog

Table 1 Medial coronoid disease

Computed tomography scoring system for elbow arthritis
Osteoarthritis grade Characteristics
Grade 0: Normal No computed tomography evidence of
osteophytes in the joint.
Grade 1: Mild Computed tomography evidence of osteophytes
(thickness <2 mm) found anywhere in the joint
Grade 2: Moderate Computed tomography evidence of osteophytes
(thickness 2 - 5 mm) found anywhere in the joint.
Grade 3: Severe Computed tomography evidence of osteophytes
(thickness >5 mm) found anywhere in the joint.
Computed to-
mography scoring Medial coronoid disease was present when
system of elbow one or more of the following abnormalities
arthritis.
were observed on the CT in three different
planes: irregular or abnormal medial cor-
onoid process shape, sclerosis, fissures, lu-
cencies (cystic lesions), and fragmentation
of the medial coronoid process (13, 27).
Osteoarthritis

The degree of elbow OA was evaluated on

Fig. 3 Case 5, right elbow: Transverse section
of the radioulnar joint. The base of the medial coron-
oid was the reference point where the sagittal plane
was reformatted to measure radioulnar incon-
gruence, after Kramer (30). R: radius; U: ulna.
Using standard image viewer softwareb,
a three-dimensional image of the fragment
was created by manually drawing regions of
interest across the transverse plane in con-
tiguous slices. The three-dimensional vol-
ume was displayed in a three-dimensional
shaded surface, and the result of the calcu-
lated volume was recorded in cm3 (씰Fig.
2). In order to detect correlations between
the ununited anconeal process volume and
the associated lesions, the ununited anco-
neal process volume was classified into one
of three categories: <1 cm3, between 1 and 2
cm3, and >2 cm3. The presence of signs of an
ununited anconeal process, cystic lesions,
fissures, and sclerosis were also recorded.
b Viewer Software, OsiriX, v3.7.3 32-bit: DICOM,
Bernex, Switzerland
CT images and scored according to the
thickness of the largest osteophytes found
anywhere in the joint (5) (씰Table 1). The
examined regions were the ununited anco-
neal process, the medial and lateral hum-
eral epicondyle, the medial and lateral
humeral condyle, the supratrochlear for-
amen, the radial head, the medial and lat-
eral coronoid process, and the ulnar troch-
lear and radial incisure.
Medial humeral condyle changes
Medial humeral condyle changes were sus-
pected when one or more of the following
abnormalities were observed on CT: sub-
chondral bone flattening or lucencies and
sclerosis in the transverse and reformatted
sagittal and dorsal views (27).

Radioulnar incongruence

Radioulnar incongruence was measured at

Fig. 4 Case 1, right elbow: Positive radio-
ulnar incongruence (RUI: +2.61 mm; sagittal
plane). Note the ellipse adjusted to the ulnar
trochlear incisure and the two lines. The top line
outlines the ventral edge of the ulnar notch and
the bottom line outlines the caudo-proximal
border of the radial head. R: radius; U: ulna;
H: humerus; UAP: ununited anconeal process.
Fig. 5 Case 2, right elbow: Negative radio-
ulnar incongruence (RUI: –2.25 mm; sagittal
plane). Note the ellipse adjusted to the ulnar
trochlear incisure and the two lines. The top line
outlines the caudo-proximal border of the radial
head and the bottom line outlines the ventral
edge of the ulnar notch. R: radius; U: ulna;
H: humerus; UAP: ununited anconeal process.
the base of the medial coronoid process at
the junction with the trochlear notch (cau-
dal ulnar incisure) using the system de-
scribed by Kramer (30). Transverse images
of the radioulnar joint at the medial coron-
oid process were reformatted in a sagittal
plane (씰Fig. 3).
Radioulnar incongruence was defined
as the distance between the subchondral
bone surfaces of the radioulnar joint at the
caudal ulnar incisure. On the sagittal plane
image, the most caudo-proximal border of
the radial head and the most ventral edge of
the ulnar notch were marked with a single
line. The ulnar notch was delineated with
an elliptical graphic to improve the accu-

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 E. G. Gasch et al.: Computed tomography of ununited anconeal process in the dog 501

racy of line placement (30). Positive radio- Table 2 Patient characteristics.

ulnar incongruence was defined as dis-
Breed Sex Age (months) Weight (kg) UAP Elbow
placement of the ulna proximal to the
radius (씰Fig. 4). Negative radioulnar in- Dogue de Bordeaux Male 6 35.7 Right + left
congruence was defined as displacement of Cane Corso Male 9 41.3 Left
the ulna distal to the radius (씰Fig. 5).
German Shepherd dog Male 96 41.5 Right + left
Cane Corso Male 33 45.3 Right + left
Results Basset Hound Female 11 25.3 Right
German Shepherd dog Male 124 43.1 Right
Nine dogs fulfilled the inclusion criteria,
with a total of 13 elbows with an ununited Rhodesian Ridgeback Male 78 62.4 Right + left
anconeal process. The breeds of the dogs Saint Bernard Female 6 42.4 Right
are listed in 씰Table 2. The mean age was
German Shepherd dog Male 11 38.6 Right
41 months (range: 6–124 months). The
mean weight was 41.7 kg (range: 25.3– Key: UAP = Ununited anconeal process.
62.4 kg). Four of the nine dogs had a bilat-
eral ununited anconeal process and five
had an unilateral ununited anconeal pro- four had a fragmented medial coronoid cm3 had medial coronoid disease, and one
cess (씰Table 2). process (씰Fig. 6). Eight elbows did not elbow did not have any signs of medial cor-
have a fragmented medial coronoid pro- onoid disease. All ten elbows with an un-
cess, but there were signs of medial coron- united anconeal process volume of more
Description of the ununited oid disease (medial coronoid sclerosis, ir- than 1 cm3 had signs of medial coronoid
anconeal process features regular medial coronoid process, fissures disease, four of which had a fragmented
and lucencies [씰Fig.7]). medial coronoid process.
Two elbows had an incomplete ununited All elbows with a complete ununited an-
anconeal process (씰Fig. 1). The remaining coneal process had signs of medial coro- Association with osteoarthritis
eleven elbows had a complete ununited an- noid disease, four of which had a frag-
coneal process. Seven of the thirteen af- mented medial coronoid process. Of the All of the elbows had some degree of OA.
fected elbows had some degree of displace- two incomplete ununited anconeal process One elbow was grade 1, seven elbows were
ment of the ununited fragment. Four were elbows, one elbow had medial coronoid grade 2, and five elbows were grade 3. The
displaced medially in the transverse plane disease (without fragmented medial coro- most common sites with osteophytes were
and three were displaced cranially in the sa- noid process), and the other was the only the medial and lateral coronoid processes,
gittal plane. All cases of ununited anconeal one without any signs of medial coronoid the radial head, the supra-trochlear for-
process had signs of cysts, sclerosis, or both. disease. amen, the medial humeral condyle, and the
The mean ununited anconeal process All seven displaced ununited anconeal epicondyle.
volume was 1.35 cm3 (range: 0.61 cm3–2.08 processes showed some medial coronoid
cm3). Three out of 13 elbows had an un- disease, three of which had a fragmented Association with medial humeral
united anconeal process volume less than medial coronoid process. Five out of six condyle changes
1 cm3. Nine elbows had an ununited anco- non-displaced ununited anconeal pro-
neal process volume between 1 and 2 cm3, cesses presented with medial coronoid Ten elbows showed signs of medial hum-
and one had an ununited anconeal process disease signs. One of them did not show eral condyle changes. Subchondral bone
volume greater than 2 cm3 (씰Table 3). any signs of medial coronoid disease. sclerosis was observed in nine out of 10 af-
Two of the three elbows with an un- fected elbows. In four elbows, medial hum-
united anconeal process volume less than 1 eral condyle flattening, lucencies or both
Ununited anconeal process with
other disorders of elbow dysplasia
Table 3 Summary of the ununited anconeal process features.
Association with medial coronoid
Complete Mean UAP UAP volume UAP Sclerosis,
disease
UAP volume (cm3) (cm3) displacement cyst lesions,
or both
Only one elbow did not have any signs of UAP features 11 elbows 1.35 <1 1-2 >2 7 elbows 13 elbows
medial coronoid disease (씰Fig. 3). The re- (13 elbows) (0.61 - 2.08)
maining twelve elbows had signs of medial 3 9 1
coronoid disease. Of these twelve elbows, Key: UAP = ununited anconeal process.

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502 E. G. Gasch et al.: Computed tomography of ununited anconeal process in the dog
Fig. 6 Case 3, right elbow: Fragmented medi-
al coronoid process (FMCP; white arrow, trans-
verse plane). Note the sclerotic subchondral bone
adjacent to the FMCP (arrow head). R: radius;
U: ulna.
were also noted (씰Fig. 8). There were not
any detached mineralized osteochondrosis
dissecans lesions in any of the elbows.
Nine of the eleven elbows with a com-
plete, ununited anconeal process had medi-
al humeral condyle changes. One of the two
elbows with an incomplete ununited anco-
neal process had a normal medial humeral
condyle.
Six of the seven elbows with a displaced
ununited anconeal process had medial
humeral condyle changes, whereas only
four out of six elbows with non-displaced
ununited anconeal process had medial
humeral condyle changes.
One of the three elbows with an un-
united anconeal process volume less than 1
cm3 had medial humeral condyle changes.
Eight of the nine elbows with an ununited
anconeal process volume between 1 and 2
cm3 had medial humeral condyle changes.
The elbow with an ununited anconeal pro-
cess volume greater than 2 cm3 had a medi-
al humeral condyle change.
Association with radioulnar
incongruence
All 13 affected elbows had varying degrees
of radioulnar incongruence. Three elbows
had a negative incongruence and the re-
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Fig. 7 Case 6, right elbow: Medial coronoid
disease (transverse plane). Note the irregular,
blunt shape of the medial coronoid process with
sclerosis (arrow) and the large osteophyte adjac-
ent to the medial coronoid process (arrow heads).
R: radius; U: ulna.
mainder had positive incongruence. Mean
radioulnar incongruence was 1.49 mm
(range: 0.63 mm – 2.61 mm).
Nine of the eleven complete ununited
anconeal process elbows had positive
radioulnar incongruence, and the other
two complete ununited anconeal process
elbows had negative radioulnar incon-
gruence. One of the two incomplete un-
united anconeal process elbows had a posi-
tive radioulnar incongruence and the other
had a negative radioulnar incongruence.
All seven displaced elbows had a positive
radioulnar incongruence. Of the six non-
displaced elbows, three had a positive radio-
ulnar incongruence, and the other three had
a negative radioulnar incongruence.
Two of the three elbows with an unu-
nited anconeal process volume less than 1
cm3 had a positive radioulnar incon-
gruence, the third had a negative radio-
ulnar incongruence. Six of the nine elbows
with an ununited anconeal process volume
of 1–2 cm3 had a positive radioulnar incon-
gruence and the remaining three elbows
had a negative radioulnar incongruence.
The elbow with an ununited anconeal pro-
cess volume greater than 2 cm3 had a posi-
tive radioulnar incongruence.
Age influence
In order to find some possible association
between the age of the dogs and the chro-
Fig. 8 Case 6, right elbow: Flattening and
sclerosis of the medial humeral condyle (arrow
heads; coronal plane). Note the large osteophyte
on the medial coronoid process (arrow). R: radius;
U: ulna; H: humerus.
nicity of the associated lesions, the popu-
lation was divided in two groups: dogs
older than one year and dogs younger than
one year at the time of the CT scan. Six of
the thirteen elbows with an ununited anco-
neal process were in five dogs younger than
12 months (mean age: 8.6 months; range: 6
months –11 months). The remaining seven
elbows were in four dogs older than 12
months (mean age of 82.8 months; range:
33 months-124 months).
Two elbows in two eleven-month-old
dogs were those that had an incomplete
ununited anconeal process. The rest of the
11 elbows (either in the young or old
group) had a complete ununited anconeal
process.
Only one of the six elbows in the young
dogs had an ununited anconeal process dis-
placement. Six of the seven elbows in the
old dogs had an ununited anconeal process
displacement.
The mean ununited anconeal process
volume in the young dogs was 1.02 cm3
(range: 0.61 cm3–1.5 cm3). Three elbows
had a volume less than 1 cm3 and three el-
bows had a volume between 1 and 2 cm3.
The mean ununited anconeal process vol-
ume in the old dogs was 1.64 cm3 (range:
1.39 cm3–2.08 cm3). Six elbows had a vol-
ume between 1 and 2 cm3 and one elbow
had a volume greater than 2 cm3.
Three of the six elbows in young dogs
had grade 2 OA. Two elbows were grade 3,
© Schattauer 2012
 E. G. Gasch et al.: Computed tomography of ununited anconeal process in the dog 503

Table 4 Summary of the ununited anconeal processes and associated lesions.

Complete or UAP UAP volume OA elbow grade MCD RUI Medial

incomplete UAP displacement (cm3) (mm) humeral changes
1 R: Complete R: Yes (medial) R: 0.85 R: Grade 2 R: MCD R: 2.61 R: Yes
L: Complete L: No L: 0.77 L: Grade 1 L: MCD L: 1.83 L: No
2 Complete No 1.13 Grade 3 MCD 1 Yes
3 R: Complete R: No R: 1.39 R: Grade 2 R: FMCP R: -1.09 R: Yes
L: Complete L: Yes (medial) L: 1.57 L: Grade 3 L: FMCP L: 1.19 L: No
4 R: Complete R: Yes (cranial) R: 1.62 R: Grade 2 R: FMCP R: 1.59 R: Yes
L: Complete L: Yes (cranial) L: 1.83 L: Grade 3 L: FMCP L: 0.63 L: Yes
5 Incomplete No 0.61 Grade 2 No -2.25 No
6 Complete Yes (medial) 2.08 Grade 3 MCD 2.22 Yes
7 R: Complete R: Yes (medial) R: 1.52 R: Grade 2 R: MCD R: 1.14 R: Yes
L: Complete L: Yes (Cranial) L: 1.48 L: Grade 2 L: MCD L: 1.24 L: Yes
8 Complete No 1.50 Grade 2 MCD -1.06 Yes
9 Incomplete No 1.23 Grade 3 MCD 1.5 Yes
Key: UAP = ununited anconeal process; OA = osteoarthritis; MCD = medial coronoid disease (without FMCP); FMCP = fragmented medial coronoid
process; RUI = radioulnar incongruence; R = right elbow; L = left elbow.

and one elbow was grade 1. Four of the
seven elbows in old dogs had a grade 2. The
remaining three elbows in old dogs were
grade 3 for OA.
The only elbow that did not have any
medial coronoid disease was found in an
11-month-old dog. The rest of the elbows
had some sign of medial coronoid disease
(including a fragmented medial coronoid
process observed in four elbows in two of
the old dogs).
The mean radioulnar incongruence in
the young dogs was 1.7 mm (range: 1
mm-2.61 mm). Four of the six elbows had a
positive radioulnar incongruence and the
other two elbows had a negative radioulnar
incongruence. Mean radioulnar incon-
gruence in the old dogs was 1.3 mm (range:
0.63 mm – 2.22 mm). Six of the seven
elbows had a positive radioulnar incon-
gruence and only one elbow had a negative
radioulnar incongruence.
Four of the six elbows in the young dogs
had signs of medial humeral condyle
changes. Three of these elbows showed
sclerosis of the medial humeral condyle
and one showed evidence of medial hum-
eral condyle lucencies. Six of the seven el-
bows in the old dogs had signs of medial
humeral condyle changes. All of them
showed signs of medial humeral condyle
sclerosis and four out of six elbows showed
some type of medial humeral condyle flat-
tening.
Discussion
An ununited anconeal process is normally
observed on a CT scan as a complete radio-
lucent line separating the anconeal process
from the ulna, but in this study we observed
two elbows with incomplete fusion of the
anconeal process (씰Fig. 1) (13, 27). Com-
puted tomography helped to determine the
exact length of the nonunion. This can be
especially relevant because we found that a
complete ununited anconeal process was
often associated with signs of medial cor-
onoid disease and medial humeral condyle
changes. Moreover, if radiographs suggest
an incomplete fusion, a CT examination
may be a useful additional tool to help plan
a surgical procedure, such as lag screw fix-
ation with proximal ulnar osteotomy
in immature animals. Computed to-
mography may be helpful for case selection
when deciding between lag screw fixation
or fragment removal.
Associated elbow abnormalities are pres-
ent irrespective of the degree of displace-
ment of the ununited anconeal process frag-
ment. Our findings showed that both dis-
placed and non-displaced ununited anco-
neal processes had signs of medial coronoid
disease and medial humeral condyle
changes. Nevertheless, the artificial posi-
tioning of the elbows during the CT scan
(elbows extended, pulled cranially, and non
weight-bearing) could alter the normal posi-
tion of the ununited anconeal process with-
in the joint, giving a misleading view of un-
united anconeal process displacement.
The majority of ununited anconeal pro-
cess volumes were over 1 cm3 and had as-
sociated lesions while the three elbows with
small ununited anconeal process volumes
had fewer associated lesions. A large un-
united anconeal process volume may dis-
rupt normal elbow loading more than a
small ununited anconeal process volume,
inducing an abnormal stance and increas-
ing the prevalence of associated lesions.
Furthermore, the ununited anconeal pro-
cess volumes were smaller in the young
dogs than in the old dogs. Bone remodell-
ing associated with OA may have falsely in-
creased ununited anconeal process vol-
umes. The presence of associated lesions,
such as medial humeral condyle changes or
medial coronoid disease, could be affected
by the age of the animals, as it could be ex-
pected that the younger the age of the ani-

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504 E. G. Gasch et al.: Computed tomography of ununited anconeal process in the dog
mal, then the lesser the probability to devel-
op an associated lesion.
The occurrence of an ununited anconeal
process and a fragmented medial coronoid
process within the same joint has been well
documented (12, 16). Computed to-
mography provides complete imaging of
the articular subchondral bone, but not of
the articular cartilage. Fragmentation of
the medial coronoid process is not detected
with CT when fragments are purely carti-
laginous. However, subchondral bone
changes associated with a fragmented
medial coronoid process and with osteo-
chondrosis, including sclerosis, fissures,
cysts, and fragmentation, are detectable on
CT images. The CT appearance of a frag-
mented medial coronoid process can be
highly variable. Imaging planes and im-
aging windows and levels can contribute to
variability (31). In our study, although we
only found a fragmented medial coronoid
process in four elbows, eight other elbows
had a blunted or irregularly shaped medial
coronoid process with some associated
sclerotic or cystic lesions. Therefore, 12 of
the 13 elbows had signs of medial coronoid
disease. A preoperative diagnosis of un-
united anconeal process is easily made on a
flexed mediolateral radiograph. However,
these results indicate the importance of an
elbow CT scan to investigate concurrent
medial coronoid lesions with or without
fragmentation, especially in older animals
which may have a higher probability to de-
velop secondary lesions related to the chro-
nicity of the lesions.
We did not observe any detached min-
eralized fragments typical of osteochon-
drosis dissecans of the medial humeral
condyle. Subchondral sclerosis of the
medial humeral condyle was the most com-
mon observation (9 out of 10 affected el-
bows). Lucency and sclerosis of the hum-
eral condyle is indicative of either primary
osteochondrosis or a ‘kissing lesion’ oppo-
site the coronoid process (11). Sclerosis of
the medial humeral condyle may be a re-
sponse to altered weight-bearing, or a de-
generative process associated with abnor-
malities of the overlying cartilage (11). Flat-
tening of the medial humeral condyle was
only observed in the old dogs group, indi-
cating that this type of lesion could be ob-
served in more chronic cases.
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All elbows affected by an ununited anco-
neal process had osteophytes at different
places. We observed lesser OA grades in the
young dogs group and higher OA grades in
the old dogs group, as can be expected
given the direct proportionality between
the grade of OA and the chronicity of the
lesions.
Elbow joint incongruity has been in-
criminated as a common denominator of
fragmented medial coronoid process, os-
teochondrosis dissecans of the medial
humeral condyle, and the ununited anco-
neal process (11, 22). In our study, all af-
fected elbows had mild radioulnar incon-
gruence, and only three elbows had a radio-
ulnar incongruence greater than 2 mm. It
seems unlikely that this mild degree of in-
congruity in non weight-bearing CT el-
bows could be the cause of an ununited an-
coneal process and its associated lesions.
Preston proposed that some geometric in-
congruity in normal joints serves to opti-
mize stress distribution during loading, re-
flecting some kind of physiologic incon-
gruity, as demonstrated in human elbows
(32, 33). Radioulnar incongruence and a
true ununited anconeal process may be a
dynamic phenomenon that only exists in
diseased dogs during the weight-bearing
phase of the stride (30).
Ten of the 13 elbows in our study had a
positive radioulnar incongruence. This
contradicts Sjöström’s hypothesis that the
ununited anconeal process is caused by in-
congruous radioulnar growth, which dis-
places the radial head proximally so that it
interferes with the anconeal process (23).
In Sjöström’s study, a negative radioulnar
incongruence was found in all elbows with
an ununited anconeal process. This dis-
crepancy could be due to the different
methods used to measure the incongruity
(radiography versus CT), and the use of
different measurement points. Mason
stated that radiography was not sensitive
enough to evaluate elbow incongruity be-
cause of the superimposition of other
structures and the influence of positioning
(7). The shape of the trochlear notch is also
affected by positioning (34). Furthermore,
the population of dogs studied by Sjöström
was predominantly young immature dogs
(younger than 6-months-old), whereas in
our case population we only found two
dogs of this age. Age could be an important
factor of bias, as chronic lesions with severe
OA or fibrosis could alter the position of
radioulnar joint.
The CT assessment of radioulnar incon-
gruence is also affected by positioning (6, 8,
34). Gemmill observed that reconstructed
CT images provide an accurate measure-
ment of joint spaces in dysplastic elbows at
the apex of the coronoid process (9, 35). We
used the base coronoid reconstruction
plane because it showed a significant differ-
ence between normal and abnormal el-
bows, and because of its simplicity (30).
However other authors consider the mid-
coronoid oblique plane to be the most re-
liable reconstruction plane (36). Wagner
reported that arthroscopic evaluation of
experimental radioulnar incongruence had
a higher specificity and reproducibility
than radiography or CT, as radioulnar in-
congruence may be caused by differences in
subchondral bone and cartilage thickness
(6). Moreover, Böttcher stated that three-
dimensional CT measurement of radio-
ulnar incongruence in vitro is a repeatable,
precise and reliable method in unaffected
elbows (37). Three-dimensional measure-
ment of radioulnar incongruence could be
a more accurate method than two-dimen-
sional CT measurement of radioulnar in-
congruence, as the latter could be in-
fluenced by limb position, as observed by
House (8).
Study limitations
The limited number of cases in this retro-
spective study prevents a statistical analysis
of the ununited anconeal process and its as-
sociated lesions. However, the main objec-
tive of this study was purely descriptive.
Limitations include the subjectivity of geo-
metric measurements of incongruence and
therefore, the difficulty to obtain reliable
and repeatable measurements of CT im-
ages, CT resolution, the inability to visual-
ize cartilage on CT, the non weight-bearing
nature of the CT procedure, and above all
the small sample population.
Finally, there is a bias in the cases that
underwent CT scan at our hospital. The op-
tion to have advanced imaging was norm-
ally recommended for dogs suffering from
© Schattauer 2012

ununited anconeal process or other elbow
dysplasia disorders in order to detect con-
current lesions associated with an ununited
anconeal process. A large population of
owners however refused CT scan evalu-
ation before surgery because of financial
constraints.
Conclusions
The ununited anconeal process is easily
diagnosed on plain flexed elbow radio-
graphs, however CT enables early and
straightforward recognition of concurrent
elbow dysplasia lesions (medial coronoid
disease, medial humeral condyle changes,
and radioulnar incongruence).
The majority of elbows with an ununited
anconeal process had similar CT features:
complete ununited anconeal processes are
associated with medial coronoid disease, a
positive radioulnar incongruence, high
grade OA, sclerotic medial humeral condyle,
and large ununited anconeal process vol-
umes. Nevertheless, some of the associated
lesions observed in this study (OA, medial
humeral condyles changes and medial cor-
onoid disease) may be related to degener-
ative changes secondary to the instability
and inflammation caused by the ununited
anconeal process, as these lesions are ob-
served more frequently in older dogs. Dogs
with an incomplete, small volume, ununited
anconeal process had minimal medial cor-
onoid disease or medial humeral condyle
changes; this could be the result of a more
stable and less chronic ununited anconeal
process. In our study, 30% of dogs with an
ununited anconeal process had concurrent
fragmented medial coronoid process.
Therefore, it might be advisable to perform
preoperative elbow CT in these patients to
evaluate the presence of concurrent lesions.
Further studies with larger populations are
required to determine whether our results
are statistically significant.
Conflict of interest
None declared.
© Schattauer 2012
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E. G. Gasch et al.: Computed tomography of ununited anconeal process in the dog 505
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Vet Comp Orthop Traumatol 6/2012