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Use of radiographic measures and three-dimensional computed tomographic imaging in surgical correction of an antebrachial deformity in a dog

David I. Dismukes DVM1, Derek B. Fox DVM, PhD, DACVS2, James L. Tomlinson DVM, MVSc, DACVS3, and Stephanie C. Essman DVM, MS, DACVR4
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  • 1 Comparative Orthopaedic Laboratory, Veterinary Medical Teaching Hospital, University of Missouri, Columbia, MO 65211.
  • | 2 Comparative Orthopaedic Laboratory, Veterinary Medical Teaching Hospital, University of Missouri, Columbia, MO 65211.
  • | 3 Comparative Orthopaedic Laboratory, Veterinary Medical Teaching Hospital, University of Missouri, Columbia, MO 65211.
  • | 4 Comparative Orthopaedic Laboratory, Veterinary Medical Teaching Hospital, University of Missouri, Columbia, MO 65211.

Abstract

Case Description—A 1-year-old 7.4-kg (16.3-lb) castrated male mixed-breed dog was evaluated because of intermittent lameness and an antebrachial angular limb deformity.

Clinical Findings—The left forelimb had gross antebrachial external rotation (approx 90°) and marked procurvatum. Radiography revealed a severe partially compensated biapical antebrachial angular limb deformity. Measurements of medial proximal radial angle (MPRA) and lateral distal radial angle (LDRA) were obtained from orthogonal radiographs of the proximal and distal segments of the radius, respectively. Elbow joint-to-carpus translation was quantified. Deformities were localized and quantified by the center of rotation of angulation (CORA) method. Computed tomographic 3-dimensional image reconstructions of the antebrachium and carpus were completed to create 3 life-size stereolithographic models.

Treatment and Outcome—2 closing wedge radial osteotomies were performed at the level of the CORAs and stabilized with bone plates and screws.

Results—Frontal and sagittal plane alignments were corrected to 8° and 15°, respectively (reference limits, 0° to 8° and 8° to 35°, respectively). The MPRA was corrected from 55° to 68°, and LDRA was corrected from 32° to 76° (values considered normal are approx 85° and 87°, respectively). Elbow joint-to-carpus translation was improved by 42.5%. After 8 weeks, radiography revealed bone union. Owners considered the outcome acceptable, on the basis of limb appearance and lack of lameness at 1 year after surgery.

Conclusions and Clinical Relevance—A segmental radiographic planning technique combined with the CORA method, computed tomography, and stereolithography may be useful in the characterization of and planning corrective surgery for forelimb deformities in dogs.

Abstract

Case Description—A 1-year-old 7.4-kg (16.3-lb) castrated male mixed-breed dog was evaluated because of intermittent lameness and an antebrachial angular limb deformity.

Clinical Findings—The left forelimb had gross antebrachial external rotation (approx 90°) and marked procurvatum. Radiography revealed a severe partially compensated biapical antebrachial angular limb deformity. Measurements of medial proximal radial angle (MPRA) and lateral distal radial angle (LDRA) were obtained from orthogonal radiographs of the proximal and distal segments of the radius, respectively. Elbow joint-to-carpus translation was quantified. Deformities were localized and quantified by the center of rotation of angulation (CORA) method. Computed tomographic 3-dimensional image reconstructions of the antebrachium and carpus were completed to create 3 life-size stereolithographic models.

Treatment and Outcome—2 closing wedge radial osteotomies were performed at the level of the CORAs and stabilized with bone plates and screws.

Results—Frontal and sagittal plane alignments were corrected to 8° and 15°, respectively (reference limits, 0° to 8° and 8° to 35°, respectively). The MPRA was corrected from 55° to 68°, and LDRA was corrected from 32° to 76° (values considered normal are approx 85° and 87°, respectively). Elbow joint-to-carpus translation was improved by 42.5%. After 8 weeks, radiography revealed bone union. Owners considered the outcome acceptable, on the basis of limb appearance and lack of lameness at 1 year after surgery.

Conclusions and Clinical Relevance—A segmental radiographic planning technique combined with the CORA method, computed tomography, and stereolithography may be useful in the characterization of and planning corrective surgery for forelimb deformities in dogs.

Contributor Notes

Presented as a poster at the 2007 American College of Veterinary Surgeons Veterinary Symposium.

The authors thank Kim Collins for technical assistance and ProtoMED, Westminster, Colo, for production of stereolithographic models.

Address correspondence to Dr. Dismukes.