Front Matter

316 Canine Sports Medicine and Rehabilitation

(de  Bakker et al., 2011; Hattersley et al., 2011).
IOHC occurs bilaterally in approximately 90%
of dogs and male dogs are most commonly
affected (de Bakker et al., 2011; Hattersley et al.,
2011). Concurrent FCP has been reported in
25–56% of Spaniels with IOHC (de Bakker et al.,
2011). IOHC can be diagnosed on plain radi­
ographs using a 15‐degree craniomedial/
caudolateral view; however, CT has been
shown to be more sensitive and specific (Farrell
et al., 2011). The condition is most commonly
diagnosed when a patient presents for a lateral
humeral condylar fracture following minimal
trauma, although a history of lameness prior to
fracture is not uncommon (Hattersley et al., 2011).
It is reasonable to recommend prophylactic
screening of predisposed breeds after 6 months of
age, particularly those that will be participating in
sporting events. If IOHC is diagnosed prior to
humeral condylar fracture, a lag screw can be
placed across the condyles to help prevent future
fracture, although this procedure may be associ­
ated with significant morbidity (Hattersley et al.,
2011). Furthermore, it is important that these ani­
mals are removed from the breeding pool and
care be taken to avoid high‐impact activities.

Radius curvus

Proper development and alignment of the tho­

racic limb and elbow require that the radius

and ulna grow at a synchronous rate. The distal

physis of the radius is responsible for 60–70% of

the bone’s overall length, whereas the distal

ulnar physis is responsible for 85% of the ulna’s

length (Carrig, 1975). The conical shape of the

distal ulnar physis makes it susceptible to type

V Salter–Harris fractures following minimal

trauma (Fox, 1984). Hypertrophic osteodystro­

phy and a retained cartilaginous core can also

lead to premature closure of this physis (Fox,

1984). When distal ulnar growth is arrested

during the critical period of growth (<8 months

of age), valgus limb deformity or radius curvus

occurs (Carrig, 1975; Fox, 1984) (Figure 12.23).

The primary mechanism for the resulting

deformity is the constrained or bow‐string

effect of the ulna on the radius as it continues to

grow. This leads to cranial and medial bowing

of the radius, hyperextension and subluxation

of the carpus, and external rotation of the foot

(Fox, 1984). The most clinically significant effect

of this deformity is the development of elbow

Elbow osteoarthritis

(OA) intra-articular

treatments

Mild OA

& synovitis

Platelet-rich

plasma injection

[single injection]

Hyaluronic

acid (HA) injection

[I x per week for 3

weeks total]

No response

to treatment

No response

to treatment

Single cortisone

injection [if PRP/HA

not available]

Platelet-rich

plasma injection

[ Ix per week for 2

weeks total]

Cortisone injection

[booster in 3–4

weeks if PRP/HA

not available]

Stem cell

therapy -

PRP combination

[booster in 9–12

months if

needed]

Platelet-rich

plasma injection

[I x per week for 2–3

weeks total]

Moderate OA Severe OA

Figure 12.22 Elbow osteoarthritis intra‐articular treatment algorithm.