Assessment of normal radial joint orientation angles in nonchondrodystrophic small-breed dogs

Kathryn L. Duncan Southpaws Specialty Surgery for Animals, Moorabbin, Australia

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 DVM, MANZCVS
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Benjamin A. Mielke Hamilton Specialist Referrals, High Wycombe, UK

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Andrew Phillips Anderson Moores Veterinary Specialists, Hampshire, UK

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Matthew Pead Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK

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Richard Meeson Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK

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Benjamin M. Kaye Southpaws Specialty Surgery for Animals, Moorabbin, Australia

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Abstract

OBJECTIVE

To establish reference intervals for radial joint orientation angles in the frontal and sagittal planes in small-breed dogs and to compare them to those previously reported for medium- and large-breed dogs.

ANIMALS

Antebrachii of 30 skeletally mature, nonchondrodystrophic small-breed dogs were evaluated radiographically.

PROCEDURES

Orthogonal radiographs were retrospectively assessed to determine the anatomic medial proximal radial angle, anatomic lateral distal radial angle, anatomic cranial proximal radial angle (aCrPRA), and anatomic caudal distal radial angle (aCdDRA). The frontal plane angle, θ angle, and procurvatum were also calculated. The radial joint orientation angles determined were compared to those previously reported for medium- and large-breed dogs via a 1-sample t test.

RESULTS

Mean and SD values for anatomic medial proximal radial angle, anatomic lateral distal radial angle, aCrPRA, and aCdDRA were 80.86 ± 2.86°, 85.60 ± 1.74°, 87.99 ± 2.79°, and 83.08 ± 3.14°, respectively. The mean and SDs for frontal plane angle, θ angle, and procurvatum were 4.75 ± 2.46°, 11.88 ± 1.76°, and 16.79 ± 4.13°, respectively. aCrPRA and aCdDRA were significantly different when compared to previously reported radial joint angles for medium- and large-breed dogs.

CLINICAL RELEVANCE

Reference intervals for small-breed dog radial joint orientation angles were reported. Significant differences were identified for some joint orientation angles when compared to medium- and large-breed dogs. This small-breed reference interval reported can be utilized in planning of radial angular limb deformity corrective surgery, particularly when dogs are bilaterally affected.

Abstract

OBJECTIVE

To establish reference intervals for radial joint orientation angles in the frontal and sagittal planes in small-breed dogs and to compare them to those previously reported for medium- and large-breed dogs.

ANIMALS

Antebrachii of 30 skeletally mature, nonchondrodystrophic small-breed dogs were evaluated radiographically.

PROCEDURES

Orthogonal radiographs were retrospectively assessed to determine the anatomic medial proximal radial angle, anatomic lateral distal radial angle, anatomic cranial proximal radial angle (aCrPRA), and anatomic caudal distal radial angle (aCdDRA). The frontal plane angle, θ angle, and procurvatum were also calculated. The radial joint orientation angles determined were compared to those previously reported for medium- and large-breed dogs via a 1-sample t test.

RESULTS

Mean and SD values for anatomic medial proximal radial angle, anatomic lateral distal radial angle, aCrPRA, and aCdDRA were 80.86 ± 2.86°, 85.60 ± 1.74°, 87.99 ± 2.79°, and 83.08 ± 3.14°, respectively. The mean and SDs for frontal plane angle, θ angle, and procurvatum were 4.75 ± 2.46°, 11.88 ± 1.76°, and 16.79 ± 4.13°, respectively. aCrPRA and aCdDRA were significantly different when compared to previously reported radial joint angles for medium- and large-breed dogs.

CLINICAL RELEVANCE

Reference intervals for small-breed dog radial joint orientation angles were reported. Significant differences were identified for some joint orientation angles when compared to medium- and large-breed dogs. This small-breed reference interval reported can be utilized in planning of radial angular limb deformity corrective surgery, particularly when dogs are bilaterally affected.

Introduction

The canine antebrachium is composed of the radius and ulna—a paired bone system—and, as such, any growth disturbance affecting the radius or ulna can trigger asynchronous growth between these bones, with resultant antebrachial angular deformities.1 Antebrachial deformities are most commonly the result of premature closure of the distal ulnar physis13; however, symmetric and asymmetric closure of the distal radial physis is also reported.4 Trauma is considered the most common cause of premature closure of the distal ulnar physis,5,6 but developmental etiologies such as retained cartilaginous cores within the physis may also be responsible.7 In dogs, the distal ulnar physis is conical in shape. This conformation results in laterally directed shear forces being transformed into compression forces, predisposing the physis to compressive injury (Salter-Harris type V).1,8 Premature closure of the distal ulnar physis can be particularly significant, as all longitudinal growth of the ulna distal to the elbow joint arises from the distal physis. This premature closure not only results in a shortened length of ulna but also constrains the longitudinal growth of the radius, resulting in changes to its angular alignment, typically documented as radial procurvatum, external rotation of the radius, and carpal valgus deformities.1,9,10 Other causes of antebrachial angular limb deformities include nutritional deficiencies, metabolic disorders, and fracture malunions.11 Resultant angular changes can be associated with development of osteoarthritis in the carpus and elbow, presenting as lameness and pain in affected dogs.8,10 It has been proposed that asynchronous longitudinal growth of the radius and ulna creates incongruence of the elbow joint, with altered joint contact locations and smaller contact areas, thus predisposing to overloading of cartilage and secondary osteoarthritis.12,13

Radiography is frequently used to investigate the extent and nature of antebrachial angular limb deformities.10,14,15 The center of rotation of angulation methodology is applied to radiographs to determine the nature of malalignment and aids in the planning of corrective surgery and assessing resultant alignment following correction. Corrective surgery aims to improve bone alignment in the frontal and sagittal planes, which is quantified by the proximal and distal radial joint orientation angles, as well as correction of torsional deformities, if present.10,14 Radiography is limited in its ability to detect and quantify torsional deformities, which, when present, can reduce accuracy of frontal and sagittal plane measurements.1518 By comparison, CT is readily able to detect such torsional abnormalities and more accurately determine deformities in the frontal and sagittal planes; however, it has more limited accessibility and is associated with increased costs.14,15,19 In dogs that are affected unilaterally, the joint orientation angles of the unaffected contralateral limb can be used as a target for surgical correction. However, in dogs that are bilaterally affected, a reference interval for normal joint orientation angles is necessary to guide accurate correction.

A normal range of antebrachial joint angles has previously been described for Labrador Retrievers and similar-sized non-Labrador breeds20 and has also been described for specific breeds of chondrodystrophic dogs.21 The objective of this study was to calculate the proximal and distal radial joint orientation angles in the frontal and sagittal planes to establish reference intervals specifically for nonchondrodystrophic small-breed dogs. The secondary objective was to compare the mean radial joint orientation angles found for small-breed dogs to those previously reported for medium- and large-breed dogs by Fasanella et al20 and Fox et al.10 The null hypothesis was that the radial joint orientation angles would not be significantly different from those previously reported for larger dogs.

Materials and Methods

Data collection

The electronic records from a single referral center were reviewed retrospectively for cases between 2011 and 2019. Small-breed, skeletally mature, nonchondrodystrophic dogs that presented for an antebrachial fracture and had orthogonal radiographs of the contralateral antebrachium were evaluated. Small breed was defined as a weight of < 15 kg. Skeletally mature was defined as the absence of radiographically open physes. Dogs were eligible for inclusion if the nonfractured limb was considered normal on orthopedic examination and in radiographic appearance. The craniocaudal and mediolateral radiographic projections of the nonfractured antebrachium were required to include both the elbow and carpus in a single projection. For the radiographs to be considered acceptably positioned, the frontal plane projection required superimposition of the anconeal process and olecranon, while the sagittal plane projection required the medial and lateral humeral condyles to be concentrically positioned. Dogs without orthogonal or appropriately positioned radiographs were excluded.

Radiographic measurement

Radial joint orientation lines and anatomic axes were determined in both the frontal and sagittal planes by use of previously described methods.10 Resultant joint orientation angles were then recorded by measuring the intersecting angles of the joint orientation line and anatomic axis by use of an open-source DICOM image viewer (Horos Project). Joint orientation angles measured included the anatomic medial proximal radial angle (aMPRA) and the anatomic lateral distal radial angle (aLDRA) in the frontal plane and the anatomic cranial proximal radial angle (aCrPRA) and anatomic caudal distal radial angle (aCdDRA) in the sagittal plane. The angle of frontal plane alignment was recorded as the difference between the aMPRA and the aLDRA. In the sagittal plane, the θ angle was measured as the angular intersection of the segmental radial axes and total radial procurvatum was calculated as θ angle + (90 – [180 – aCrPRA]) + (90 – aCdDRA).

Statistical analysis

The mean with SD and 95% CI were calculated for each joint reference angle. A 1-sample t test was utilized to compare the mean small-breed dog radial joint reference angles to previously published mean reference angles in Labrador Retrievers and similar-sized non-Labrador breeds,20 as well as a previously published reference angle for nonchondrodystrophic medium- to large-breed dogs.10 Where the anatomic caudal proximal radial angle had previously been reported in the sagittal plane,20 aCrPRA was calculated for comparison as 180° – anatomic caudal proximal radial joint angle. Statistical significance was set at P < .05.

Results

Thirty dogs met the inclusion criteria, of which 15 were male and 15 were female. The mean age was 2 years (range, 6 months to 8.7 years) and mean body weight was 5.7 kg (range, 2.1 to 12.5 kg). Breeds included Italian Greyhound (n = 5 dogs), Miniature Schnauzer (5), Pomeranian (4), mixed-breed dog (3), Poodle cross (3), Papillon (2), Poodle (2), Whippet (2), Border Terrier (1), Chihuahua (1), Cocker Spaniel (1), and Yorkshire Terrier (1).

The mean and SD values for aMPRA, aLDRA, aCrPRA, and aCdDRA were 80.86 ± 2.86°, 85.60 ± 1.74°, 87.99 ± 2.79°, and 83.08 ± 3.14°, respectively (Table 1). The mean and SD frontal plane angle, θ angle, and procurvatum angles were 4.75 ± 2.46°, 11.88 ± 1.76°, and 16.79 ± 4.13°, respectively.

Table 1

Radial joint reference angle data for 30 small-breed dogs.

Radial joint angle Mean ± SD (°) 95% CI (°)
aMPRA 80.86 ± 2.86 79.83–81.88
aLDRA 85.60 ± 1.74 84.98–86.22
FPA 4.75 ± 2.46 3.87–5.63
aCrPRA 87.99 ± 2.79 86.99–88.99
aCdDRA 83.08 ± 3.14 81.95–84.20
θ angle 11.88 ± 1.76 11.25–12.51
Procurvatum 16.79 ± 4.13 15.32–18.27

aCdDRA = Anatomic caudal distal radial angle. aCrPRA = Anatomic cranial proximal radial angle. aLDRA = Anatomic lateral distal radial angle. aMPRA = Anatomic medial proximal radial angle. FPA = Frontal plane alignment.

Results of 1-sample t test comparisons between the mean radial joint angles for small-breed dogs and those previously published medium- and large-breed dog angles revealed the aMPRA was significantly different when compared to the mean reported for Labradors20 and other medium- to large-breed dogs10 (Table 2). The aLDRA was significantly different when compared to similar-sized non-Labrador breeds.20 The aCrPRA and aCdDRA were significantly different when compared to Labradors, similar-sized non-Labrador breeds, and other medium- to large-breed dogs.10,20

Table 2

Comparison of small-breed dog radial joint reference angles to previously published radial joint reference angles.

Joint angle Small-breed mean (°) ± SD Previously published joint reference angle (°), compared with small-breed dogs (1-sample t test [P value]) Previously published breed and source
aMPRA 80.86 ± 2.86 82.5 (P < .02)* Normal Labradors20
81.11 (P > .2) Normal similar sized non-Labradors20
85.3 (P < .001)* Medium- to large-breed dogs10
aLDRA 85.60 ± 1.74 86 (P > .2) Normal Labradors20
87.77 (P < .001)* Normal similar sized non-Labradors20
86.7 (0.1 < P < .2) Medium- to large-breed dogs10
aCrPRA 87.99 ± 2.79 92.92 (P < .001)* Normal Labradors20,a
92 (P < .001)* Normal similar sized non-Labradors20,a
90.5 (0.02 < P < .05)* Medium- to large-breed dogs10
aCdDRA 83.08 ± 3.14 76.92 (P < .001)* Normal Labradors20
78.3 (P < .001)* Medium- to large-breed dogs10

aCdDRA = Anatomic caudal distal radial angle. aCrPRA = Anatomic cranial proximal radial angle. aLDRA = Anatomic lateral distal radial angle. aMPRA = Anatomic medial proximal radial angle.

aWhen anatomic caudal proximal radial angle was previously reported, aCrPRA was calculated as 180° – anatomic caudal proximal radial angle.

*Difference is statistically significant.

Statistical significance set at P < .05.

Discussion

This study established a normal reference interval for the radial joint orientation angles in the frontal and sagittal planes for small-breed dogs, which can be used as a reference when surgically correcting bilateral antebrachial angular limb deformities. Previously published data for radial joint angles in dogs has focused on medium to large breeds of dogs and breed-specific data for chondrodystrophic breeds.10,20,21

When compared to the previously published mean radial joint orientation angles for Labradors and similar-sized non-Labrador dogs reported by Fasanella et al20 and a mixed population of medium- to large-breed dogs previously published by Fox et al,10 significant differences were identified in the small-breed dogs reported in this study. In the frontal plane, there was a trend for aMPRA and aLDRA to be significantly lower when compared to some but not all previously reported data sets. The mean frontal plane alignment in small-breed dogs remained within the range previously reported for medium- to large-breed dogs.10

In the sagittal plane, the mean aCrPRA and aCdPRA were both significantly different when compared to the means reported by Fasanella et al20 and Fox et al,10 with the aCrPRA being consistently lower and the aCdDRA being consistently higher in small-breed dogs. A trend toward higher aCrPRA and lower aCdDRA would suggest that small-breed dogs may have a higher degree of procurvatum comparted to their medium- to larger-breed counterparts; however, the procurvatum angle reported in this study remained within the range previously described for medium- and large-breed dogs of 8° to 35°, which may be due to the wide range of procurvatum described.10

Chondrodystrophic breeds were not included in the present study due to conflicting reports as to whether there are significant differences in radial joint orientation angles between chondrodystrophic and nonchondrodystrophic dogs.14,21 Breed-specific differences were previously documented to be statistically significant in a population of chondrodystrophic dogs,21 and it is possible that there may similarly be breed-specific differences in nonchondrodystrophic dog breeds. This was not assessed in this study due to small sample sizes of specific dog breeds; however, further investigation may be worthwhile.

Potential limitations of this study included the inclusion criteria for normal antebrachii. Although radiographic positioning was considered appropriate, the retrospective nature of the study prevented standardized radiographic positioning such as the elbow rotational position20 for each individual dog. While dogs with inappropriately positioned antebrachial radiographs were excluded, it is possible that torsional deformities in the axial plane could have been present, which has been found to impair accurate assessment of alignment in other planes.17,18

In conclusion, this study has reported reference radial joint orientation angles for nonchondrodystrophic small-breed dogs. The data reported can be utilized when planning for correction of antebrachial angular limb deformities, with particular relevance to bilaterally affected dogs. Their radial joint orientation angles appear to be significantly different in the sagittal plane to those previously reported in medium- and large-breed dogs.

Acknowledgments

The authors declare that there were no conflicts of interest related to this report.

References

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    Newton CD, Nunamaker DM, Dickinson CR. Surgical management of radial physeal growth disturbance in dogs. J Am Vet Med Assoc. 1975;167(11):10111018.

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    Morgan PW, Miller CW. Osteotomy for correction of premature growth plate closure in 24 dogs. Vet Comp Orthop Traumatol. 1994;7(3):129135.

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    Johnson KA. Retardation of endochondral ossification at the distal ulnar growth plate in dogs. Aust Vet J. 1981;57(10):474478.

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    Preston CA, Schulz KS, Taylor KT, Kass PH, Hagan CE, Stover SM. In vitro experimental study of the effect of radial shortening and ulnar ostectomy on contact patterns in the elbow joint of dogs. Am J Vet Res. 2001;62(10):15481556.

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    Wind AP. Elbow incongruity and developmental elbow diseases in the dog: part I. J Am Anim Hosp Assoc. 1986;22:711724.

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    Knapp JL, Tomlinson JL, Fox DB. Classification of angular limb deformities affecting the canine radius and ulna using the center of rotation of angulation method. Vet Surg. 2016;45(3):295302.

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    Dismukes DI, Fox DB, Tomlinson JL, Essman SC. Use of radiographic measures and three-dimensional computed tomographic imaging in surgical correction of an antebrachial deformity in a dog. J Am Vet Med Assoc. 2008;232(1):6873.

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    • Export Citation
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    Quinn MK, Ehrhart N, Johnson AL, Schaeffer DJ. Realignment of the radius in canine antebrachial growth deformities treated with corrective osteotomy and bilateral (type II) external fixation. Vet Surg. 2000;29(6):558563.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Cooley K, Kroner K, Muir P, Hetzel SJ, Bleedorn JA. Assessment of overall thoracic limb axial alignment in dogs with antebrachial deformity. Vet Surg. 2018;47(8):10741079. doi:10.1111/vsu.12962

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Piras LA, Peirone B, Fox D. Effects of antebrachial torsion on the measurement of angulation in the frontal plane: a cadaveric radiographic analysis. Vet Comp Orthop Traumatol. 2012;25(2):8994.

    • Search Google Scholar
    • Export Citation
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    Kowaleski MP. CT imaging for deformity correction planning – more accurate and faster than radiographs. Abstract in: Proceedings of the 4th World Veterinary Orthopaedic Congress. Veterinary Orthopedic Society; 2014:153.

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    • Export Citation
  • 20.

    Fasanella FJ, Tomlinson JL, Welihozkiy A, Fox DB. Radiographic measurements of the axes and joint angles of the canine radius and ulna. Abstract in: Proceedings of the Veterinary Orthopedic Society 37th Annual Conference. Veterinary Orthopedic Society; 2010:A11.

    • Search Google Scholar
    • Export Citation
  • 21.

    Kwon M, Kwon D, Lee J, Lee K, Yoon H. Evaluation of the radial procurvatum using the center of rotation of angulation methodology in chondrodystrophic dogs. Front Vet Sci. 2022;8:774993. doi:10.3389/fvets.2021.774993

    • Search Google Scholar
    • Export Citation
  • 1.

    Carrig CB. Growth abnormalities of the canine radius and ulna. Vet Clin North Am Small Anim Pract. 1983;13(1):91115.

  • 2.

    O'Brien TR, Morgan JP, Suter PF. Epiphyseal plate injury in the dog: a radiographic study of growth disturbance in the forelimb. J Small Anim Pract. 1971;12(1):1936.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ramadan RO, Vaughan LC. Premature closure of the distal ulnar growth plate in dogs—a review of 58 cases. J Small Anim Pract. 1978;19(11):647667.

  • 4.

    Newton CD, Nunamaker DM, Dickinson CR. Surgical management of radial physeal growth disturbance in dogs. J Am Vet Med Assoc. 1975;167(11):10111018.

  • 5.

    Shields Henney LH, Gambardella PC. Premature closure of the ulnar physis in the dog: a retrospective clinical study. J Am Anim Hosp Assoc. 1989;25(5):573581.

    • Search Google Scholar
    • Export Citation
  • 6.

    Morgan PW, Miller CW. Osteotomy for correction of premature growth plate closure in 24 dogs. Vet Comp Orthop Traumatol. 1994;7(3):129135.

    • Search Google Scholar
    • Export Citation
  • 7.

    Johnson KA. Retardation of endochondral ossification at the distal ulnar growth plate in dogs. Aust Vet J. 1981;57(10):474478.

  • 8.

    Balfour RJ, Boudrieau RJ, Gores BR. T-plate fixation of distal radial closing wedge osteotomies for treatment of angular limb deformities in 18 dogs. Vet Surg. 2000;29(3):207217.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Fox SM. Premature closure of the distal radial and ulnar physes in the dog. I. Pathogenesis and diagnosis. Compend Contin Educ Pract Vet. 1984;6(2):128144.

    • Search Google Scholar
    • Export Citation
  • 10.

    Fox DB, Tomlinson JL, Cook JL, Breshears LM. Principles of uniapical and biapical radial deformity correction using dome osteotomies and the center of rotation of angulation methodology in dogs. Vet Surg. 2006;35(1):6777.

    • Search Google Scholar
    • Export Citation
  • 11.

    von Pfeil DJ, DeCamp CE, Abood SK. The epiphyseal plate: nutritional and hormonal influences; hereditary and other disorders. Compend Contin Educ Vet. 2009;31(8):E1E14.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Preston CA, Schulz KS, Taylor KT, Kass PH, Hagan CE, Stover SM. In vitro experimental study of the effect of radial shortening and ulnar ostectomy on contact patterns in the elbow joint of dogs. Am J Vet Res. 2001;62(10):15481556.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Wind AP. Elbow incongruity and developmental elbow diseases in the dog: part I. J Am Anim Hosp Assoc. 1986;22:711724.

  • 14.

    Knapp JL, Tomlinson JL, Fox DB. Classification of angular limb deformities affecting the canine radius and ulna using the center of rotation of angulation method. Vet Surg. 2016;45(3):295302.

    • Search Google Scholar
    • Export Citation
  • 15.

    Dismukes DI, Fox DB, Tomlinson JL, Essman SC. Use of radiographic measures and three-dimensional computed tomographic imaging in surgical correction of an antebrachial deformity in a dog. J Am Vet Med Assoc. 2008;232(1):6873.

    • Search Google Scholar
    • Export Citation
  • 16.

    Quinn MK, Ehrhart N, Johnson AL, Schaeffer DJ. Realignment of the radius in canine antebrachial growth deformities treated with corrective osteotomy and bilateral (type II) external fixation. Vet Surg. 2000;29(6):558563.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Cooley K, Kroner K, Muir P, Hetzel SJ, Bleedorn JA. Assessment of overall thoracic limb axial alignment in dogs with antebrachial deformity. Vet Surg. 2018;47(8):10741079. doi:10.1111/vsu.12962

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Piras LA, Peirone B, Fox D. Effects of antebrachial torsion on the measurement of angulation in the frontal plane: a cadaveric radiographic analysis. Vet Comp Orthop Traumatol. 2012;25(2):8994.

    • Search Google Scholar
    • Export Citation
  • 19.

    Kowaleski MP. CT imaging for deformity correction planning – more accurate and faster than radiographs. Abstract in: Proceedings of the 4th World Veterinary Orthopaedic Congress. Veterinary Orthopedic Society; 2014:153.

    • Search Google Scholar
    • Export Citation
  • 20.

    Fasanella FJ, Tomlinson JL, Welihozkiy A, Fox DB. Radiographic measurements of the axes and joint angles of the canine radius and ulna. Abstract in: Proceedings of the Veterinary Orthopedic Society 37th Annual Conference. Veterinary Orthopedic Society; 2010:A11.

    • Search Google Scholar
    • Export Citation
  • 21.

    Kwon M, Kwon D, Lee J, Lee K, Yoon H. Evaluation of the radial procurvatum using the center of rotation of angulation methodology in chondrodystrophic dogs. Front Vet Sci. 2022;8:774993. doi:10.3389/fvets.2021.774993

    • Search Google Scholar
    • Export Citation

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