Front Matter

Chapter 12 Disorders of the Canine Thoracic Limb: Diagnosis and Treatment 311

dogs of any size (even as small as 5 lbs (2.25 kg))
are candidates for treatment.
At the completion of the arthroscopic
procedure and while still under anesthesia,
an intra‐articular injection of hyaluronic acid
as a synovial fluid replacement or postsurgi­
cal lavage is recommended. This allows for
restoration of the joint to a more normal
physiological state (Mathies, 2006; Hempfling,
2007). Biological therapies (PRP and stem cell
therapy) could also be considered as a post‐
arthroscopic treatment to decrease inflamma­
tion and aid in tissue healing (Guercio et al.,
2012; Zhu et  al., 2013; Beitzel et al., 2015;
Kilincoglu et al., 2015).
When significant (>4 mm) radioulnar incon­
gruity is detected arthroscopically, an ulnar
osteotomy may be performed to facilitate the
development of congruency (Fitzpatrick &
Yeadon, 2009). Some surgeons have advocated
for performing a subtotal coronoidectomy
(SCO) (Fitzpatrick & Yeadon, 2009). The biceps
ulnar release procedure (BURP), in which the
insertion of the biceps brachii on the medial
ulna is transected, has been suggested as a
method of decreasing excessive rotational stress
on the medial coronoid process (Fitzpatrick &
Yeadon, 2009). Long‐term results of SCO and
BURP are not yet available.

Despite surgical intervention, patients with

FCP will develop degenerative joint disease/

osteoarthritis of the medial compartment of the

elbow (Fitzpatrick & Yeadon, 2009; Fitzpatrick

et al., 2009c; Burton et al., 2011). Surgical tech­

niques continue to be investigated as means of

long‐term treatment of medial compartment

diseases. Sliding humeral osteotomy involves a

transverse osteotomy of the humeral diaphysis

with the distal humerus translated medially

and stabilized with a plate. The aim of this

procedure is to transfer biomechanical load

from the medial to lateral compartment.

Preliminary clinical results show promising

short‐term outcomes (Fitzpatrick et al., 2009c).

Total elbow joint replacement has been inves­

tigated for many years. There has been difficulty

in designing the optimal implant system, and

significant morbidity has been reported in initial

studies (Conzemius, 2009). One study showed

that good long‐term outcomes are possible

with  a nonconstrained total elbow replacement

(Conzemius, 2009). Clinical outcomes associated

with initial use of partial joint replacement

(Canine Unicompartmental Elbow, CUE®) is in

clinical trials and long‐term results have been

reported (Cook et al., 2015).

Traumatic fragmented medial coronoid

process

Traumatic fragmented medial coronoid process

(TFCP) appears to occur commonly in perfor­

mance, working, and active dogs with no limi­

tations of age, size, or breed.

Cause

There is no definitive etiology for TFCP,

although three theories exist. The first sug­

gests that increased repetitive load arises from

the force generated by contraction of the

biceps/brachialis muscle complex. This force

rotates the medial coronoid into the radius. It

is theorized that, as a result of this repetitive

loading, microcracks develop, disturbing the

mechanical properties of the bone (fatigue

microdamage). If proper healing does not take

place, fatigue fractures of the subchondral tra­

becular bone eventually occur (Danielson et al.,

2006). Further, loss of osteocytes, indicated by

Figure 12.20 Arthroscopic image of a traumatic
fragmented medial coronoid process (arrow), showing
removal of the fragment with a grasper.