Vol. 19, No.
3 March 1997
Continuing Education Article
Refereed Peer Review
FOCAL POINT
★Without appropriate treatment,
ununited anconeal process
will progress to debilitating
osteoarthritis.
KEY FACTS
■ Ununited anconeal process is
most commonly diagnosed in
male German shepherds around
5.5 months of age and is
probably hereditary.
■ The disease cannot be diagnosed
radiographically until the dog is
20 weeks old, after which time
the normal anconeal process
should have fused with the ulna.
■ The pathogenesis remains
controversial but probably
involves incongruous growth of
the radius and ulna.
■ Surgical treatment options
include excision, lag-screw
fixation, and ulnar osteotomy.
■ Some lameness may persist
despite surgical therapy.
Ununited Anconeal
Process of the
Canine Elbow
University of Georgia
Alan R. Cross, DVM
Jonathan N. Chambers, DVM
U
nunited anconeal process (UAP) is a developmental orthopedic disease
in which the anconeal process of the ulna fails to form an osseous
union with the ulna by the time a dog is 20 weeks old.1 The clinical
and radiographic appearance of this disease was first reported in 1956; Stiern
reported its occurrence in three genetically related German shepherds and
called it patella cubiti, after a somewhat similar human disease.2 The disease
probably existed long before those cases were reported. The condition was an
incidental finding in the skeleton of a dog in a museum display; the dog had
died in 1936.3
The term ununited anconeal process was first applied to the condition in 1959
by Cawley et al.4 They reported 11 cases that had occurred in German shep-
herds and identified the radiographically evident bone fragment as the an-
coneal process rather than mineralization of the triceps tendon, as seen in cases
of patella cubiti. Since then, much work has been done in an attempt to eluci-
date the pathogenesis of this disease and determine the optimum method of
treatment.
ANATOMY
The cubital joint consists of the humeroulnar joint, the humeroradial joint,
and the proximal radioulnar joint. All of these joints share a single joint cap-
sule. The humeroradial joint is formed by articulation of the laterally situated
capitulum of the humeral condyle with the head of the radius. It is responsible
for most of the weight-bearing function of the elbow. The humeroulnar joint is
formed by articulation of the humeral condyle with the trochlear or semilunar
notch of the ulna. It is responsible for stabilizing and restricting motion in the
sagittal plane.5
The semilunar notch of the ulna is bounded proximally by the anconeal pro-
cess and distally by the medial and lateral coronoid processes. The anconeal
process is a slightly hooked articular eminence that fits into the olecranon fossa
of the humerus when the elbow is extended.6 Thus, the anconeal process is
Small Animal The Compendium March 1997

thought to contribute medi- A genetic component of

al and lateral stability to the UAP was suspected because
elbow during extension. 7 the initial reported cases of
There are no ligamentous the disease were exclusively
attachments to the anconeal in German shepherds and
process6 (Figure 1). related dogs. 1,2,4,8,10,12–14 A
subsequent genetic study of
PATHOGENESIS 187 offspring from con-
The anconeal process aris- trolled matings suggested
es from one of four centers that the trait was caused by
of ulnar ossification—the the presence of three domi-
other three being the proxi- nant genes in German shep-
mal epiphyseal, distal epi- herds.14 The authors of that
1
physeal, and diaphyseal. study postulated that the in-
The anconeal ossification cidence of UAP was as high
center does not appear ra- as 30% in the general popu-
diographically until about lation of German shep-
the 85th day after birth.1,8–10 herds.14
Although Cawley suspect- These results have been
ed that the anconeal process disputed by some re-
had a separate ossification searchers 16 and should be
4
center, this suspicion was interpreted cautiously be-
not confirmed in the initial cause the study was of el-
studies of bone ossification bow dysplasia—not limited
centers because they were to UAP. Metabolic defects,
not carried out in dogs older nutritional deficiencies, hor-
Figure 1—Lateral view of the left proximal ulna.
than 65 days.11,12 The imma- monal effects, trauma, and
ture appearance of the pro- acquired diseases have been
cess was recognized early in suggested as potential causes
the study of UAP pathogenesis, but it was initially of UAP,15,16 but none of these have been proven to be
thought by some to be abnormal and a precursor to involved in the development of UAP in dogs.
UAP.8,9 Unfortunately, anconeal processes that were Osteochondrosis has been incriminated in the patho-
probably normal were removed from dogs younger genesis of UAP. It was suggested that increased stress on
than 20 weeks.12 the anconeal process results in a trauma-induced osteo-
It was later shown that in German shepherds the pro- chondrosis-like lesion and subsequent failure of the an-
cess fuses with the olecranon by 16 to 20 weeks of coneal process to fuse to the olecranon.18,19 This theory
1,10
age. Prior to these studies, it was thought that UAPs is not consistent with the classic pathogenesis of prima-
observed in dogs younger than 20 weeks might fuse ry osteochondrosis, and such a progression has not
spontaneously.3 Although anconeal fusion has been been confirmed to occur histologically.
shown to occur in German shepherds as young as 14 or Most currently accepted theories of pathogenesis are
15 weeks, the exact age at which fusion can be expected based on developmental joint incongruity, which re-
to occur in other breeds is unknown. sults in abnormal shear stress on the anconeal process
The term elbow dysplasia has been intermittently used and subsequent failure of fusion with the ulna. Several
to describe this disease.1,8–10,13–16 As elbow dysplasia is studies have attempted to document and quantify this
not limited to UAP, three subgroups of elbow dysplasia incongruity by various means.18,20–25
15
were proposed based on the type of abnormality. This Wind20,21 evaluated elbow incongruity radiographi-
terminology has since been rejected by some because cally and grossly in seven dogs with either UAP, frag-
dysplasia merely implies malformation; not all of the mented coronoid process (FCP), or osteochondrosis
pathologic processes in the elbow have a common etiol- dissecans (OCD) and in two dogs that were related to
ogy.7,9,16,17 Use of the term elbow dysplasia as a synonym dogs with FCP. Varying patterns of incongruity were
for UAP should be avoided. Misuse of this terminology found.
also makes interpretation of earlier work difficult be- In the dogs with FCP or OCD, there was typically a
cause not all of the dogs with elbow dysplasia had UAP. radiographically increased radiohumeral joint space;

ELBOW DYSPLASIA ■ OSTEOCHONDROSIS ■ FRAGMENTED CORONOID PROCESS

The Compendium March 1997
grossly, the articular surface of the medial coronoid
process was located more proximal than the articular
surface of the radial head, thus resulting in a step defor-
mity. No step deformity was seen in the two dogs with
UAP.
Wind suggested that the incongruity resulted from
abnormal development of the trochlear notch of the
ulna, which resulted in a slightly elliptical articular sur-
face with an arc of curvature too small to encompass
the humeral trochlea.20,21 Such a malformation would
place increased stress on the medial coronoid process
and anconeal process. Areas of atrophic articular carti-
lage in the center of the trochlear notch supported this
hypothesis.
Another part of this study looked at normalized
proximal ulnar length and found it to be greater in
large-breed dogs. It was then postulated that a larger
proximal ulna was needed to accommodate a larger
trochlear notch for articulation with a heavier humerus
and that this may contribute to trochlear notch malfor-
mation. An appropriate study to measure the radii of
curvature of normal and affected elbows has not yet
been performed.
According to this theory, UAP and FCP would be ex-
pected to coexist frequently because both structures are
placed under abnormal stress. Paradoxically, however,
the combination of FCP and UAP in the same joint is
exceedingly rare. In this study, 34 of 255 dogs were sus-
pected to have concurrent FCP and UAP; both diseases
were confirmed in 5 of 6 of these dogs that underwent
surgical exploration. Others have suggested that FCP
never coexists with UAP (0/500).18
Guthrie22 measured the radiographic distance from
the olecranon to the radial head in 27 dogs with unilat-
eral UAP. The distances in the affected limbs were sig-
nificantly shorter than in the opposite normal limbs.
This was interpreted to mean that the olecranon pro-
cess was shorter, thus altering joint biomechanics suffi-
ciently that increased stress on the anconeal process
prevented fusion.
An alternative interpretation is that the radius is
longer, thus making the olecranon appear relatively
shorter; this interpretation is supported by other
work.18,24 This decreased radius-to-olecranon distance
would then place increased stress on the anconeal pro-
cess, thus potentially preventing fusion.
Sjostrom and others24 attempted to demonstrate that
UAP resulted from incongruous growth of the radius
and ulna by measuring the radiographic distance from
the radial head to the olecranon in 17 dogs with unilat-
eral UAP. They found significant proximal displace-
ment of the radius relative to the olecranon in the af-
fected limbs as compared with the opposite normal
BREED PREDISPOSITION ■ BILATERAL INVOLVEMENT ■ ONSET OF SIGNS
Small Animal
limbs in 15 cases. This finding was interpreted to show
that asynchronous growth places more stress on the an-
coneal process, thus preventing fusion.
This theory was supported
by subsequent fusion of 21 of Diagnosis and
22 UAPs after ulnar osteoto- Treatment of
my to correct the incongru-
ity.24 Fusion would not be ex- Ununited Anconeal
pected to occur if UAP was a Process
result of decreased radius of
curvature of the trochlear Diagnostic Differentials
notch; osteotomy distal to ■ Osteochondrosis
the elbow should not change dissecans (OCD)
the configuration of the ■ Fragmented coronoid
trochlear notch but could al- process (FCP)
ter the relative positions of
■ Panosteitis
the radial and ulnar joint sur-
faces at the elbow. ■ Fracture or
Further support for the subluxation
asynchronous-growth theory
comes from the observation Surgical Treatment
that UAP occurs in chon- Options
drodystrophic breeds and in ■ Anconeal excision
dogs with premature closure ■ Lag-screw attachment
of the distal ulnar physis.17 ■ Proximal ulnar
In these cases, gross elbow osteotomy
incongruity is often apparent
and presumably leads to de-
velopment of UAP.
In summary, evidence suggests that UAP results from
elbow incongruity secondary to incongruous radial and
ulnar growth. The resulting stress prevents normal fu-
sion of the ossification centers. Future work may sup-
port the hypothesis that FCP and UAP are mutually ex-
clusive diseases, both arising from incongruous radial
and ulnar growth: FCP may develop if the radial articu-
lar surface is too distal relative to the ulnar articular sur-
face, and UAP may develop if it is too proximal.18
INCIDENCE
German shepherds are most commonly affected; the
incidence in this breed is as high as 18%.21 The condi-
tion has also reportedly occurred in numerous other
large- and giant-breed dogs as well as in mixed-breed
and chondrodystrophic dogs.3,7,9,15,26 Males are reported-
ly predisposed,10,16,27 and bilateral involvement is com-
mon: 4 out of 19 (21%),10 5 out of 16 (31%),27 and 5
out of 46 (11%).22 Right and left sides are equally af-
fected.10,22,27 Onset of clinical signs typically ranges from
4 to 8 months (mean, 5.5 months). 7,10,12,13,15,17,22,27,28
However, clinical signs of UAP have been reported to
occur in animals as young as 2 and 3 months and as old
as 6 years.12,22,23 Clinical signs apparent in an animal
Small Animal The Compendium March 1997

younger than 16 weeks may A tabletop technique us-

support the hypothesis that ing detail screens with ap-
preexisting stress due to propriate collimation is
incongruity prevents fusion preferable.5 Mild sedation is
of the anconeal process. useful to allow proper posi-
Concurrent developmental tioning without undue pa-
orthopedic abnormalities tient stress. Complete radio-
(including hip dysplasia, graphic evaluation of the
panosteitis, and osteochon- elbow requires a minimum
drosis dissecans) have been of the following four views:
reported frequently, but no craniocaudal, standard and
direct association has been flexed mediolateral, and a
established.16,28 mediolateral supinated
(oblique) view.5,26
DIAGNOSIS Figure 2—Flexed lateral radiographic view of an 8-month- The mediolateral view
Clinical Signs old German shepherd with unilateral UAP. A radiolucent should be obtained with the
A gradual and progressive gap is present between the anconeal process and the olecra- patient in lateral recumben-
weight-bearing lameness is non. cy with the desired limb
the primary clinical sign of down. Pronation or supina-
UAP. The lameness is often tion of the antebrachium
intermittent and exacerbat- should be avoided, and the
ed by heavy exercise or pro- elbow should be allowed to
longed periods of inactivity. assume a normal (45° from
The lameness can usually extension) degree of flexion.
be localized to the elbow, The beam is centered over
through observing for signs the medial epicondyle of the
of pain on manipulation of humerus.5 This is followed
the joint. Secondary signs by a mediolateral view with
include palpable joint effu- the elbow placed in maxi-
sion, joint thickening, and mal flexion.
crepitus. Lateral deviation of The mediolateral oblique
the elbow and decreased view is taken with the elbow
range of motion may be ap- maximally extended and
parent.28 The ability to pal- supinated 15°.5 This view is
pate the free anconeal frag- useful in the diagnosis of
ment by applying firm FCP.
digital pressure just caudal Figure 3—Flexed lateral radiographic view of a 2.5-year-old The craniocaudal view is
to the humeral epicondyles Chesapeake Bay retriever with unilateral UAP. Os- obtained by placing the pa-
teoarthritic changes are present on the anconeal process
has been reported.4 A thor- tient in sternal recumbency
and the radial head. Subchondral sclerosis is present along
ough orthopedic examina- the trochlear notch. with the desired limb ex-
tion is essential to avoid tended. The beam is angled
overlooking bilateral UAP 10° to 20° and directed
or other developmental orthopedic diseases (See Diag- proximally to compensate for incomplete extension of
nosis and Treatment of Ununited Anconeal Process). the elbow.5
The diagnosis of UAP is usually made from the
Radiography flexed mediolateral view, which avoids superimposition
Although the radiographic signs of UAP are often of the medial humeral epicondyle and the anconeal
conspicuous, high-quality radiographs, proper tech- process. Superimposition of the physis of the medial
nique, and a complete study including four views are humeral epicondyle should not be confused with a
essential to confirm the diagnosis and rule out other or- UAP in dogs younger than 8 months.26 A radiolucent
thopedic lesions, such as osteochondrosis dissecans and line between the anconeal process and the ulna is diag-
FCP. The opposite elbow should be routinely radio- nostic of UAP in an animal older than 20 weeks.
graphed because bilateral involvement is common. Varying degrees of osteoarthritic changes will be

WEIGHT-BEARING LAMENESS ■ EXERCISE ■ FLEXED MEDIOLATERAL VIEW

The Compendium March 1997 Small Animal

present, depending on the

chronicity of the lesion (Fig-
ures 2 and 3). The presence
of osteoarthritic changes in a
joint in the absence of UAP
may support a diagnosis of
FCP or OCD. Secondary
degenerative changes are best
visualized on the mediolater-
al view and include osteo-
phyte formation on the prox-
imal rim of the anconeal
process and sclerosis of the
ulna beneath the proximal
radioulnar articulation.5

TREATMENT
Surgical therapy is the
treatment of choice for
UAP. Medical therapy alone
has been less successful, usu-
ally resulting in the rapid
progression of severe osteo-
Figure 4A arthritis—although sponta-
neous fusion has been re-
ported.17,22,24 Three surgical
treatment options have been
reported: excision, lag-screw
fixation, and proximal ulnar
osteotomy. The refinement
of existing techniques and
introduction of new surgical
therapies have met with
good initial results.24,25

Surgical Excision
Surgical excision via later-
al arthrotomy has been the
traditional treatment. Sur-
gery is generally performed
at the time of diagnosis. 26
Delaying the surgery until
the animal is 9 to 12 months
old has been proposed be-
cause of perceived accelera-
tion of osteoarthritic changes
following arthrotomy in im-
mature animals.19
Figure 4B
Figure 4—(A) The anconeal process in its normal position within the olecranon fossa. The Surgical Approach
initial lateral surgical approach is shown through the skin and deep fascia exposing the an- A skin incision is made
coneus muscle. (B) The approach is continued with retraction of the anconeus muscle and just caudal to the lateral
exposure of the anconeal process. The process is grasped with forceps and removed.
humeral epicondyle. The

OSTEOPHYTE ■ SPONTANEOUS FUSION ■ DELAY OF SURGERY

Small Animal The Compendium March 1997

deep fascia is incised along joint is required to expose

the same line over the divi- the free process, which is
sion between the long and grasped with tissue or towel
lateral heads of the triceps forceps and removed (Fig-
muscle. The heads are sepa- ure 4B). Fibrous attach-
rated by blunt dissection, ments are frequently present
avoiding the muscular and must be severed to al-
branch of the radial nerve low removal. The wound is
proximally and exposing the closed routinely. A soft sup-
anconeus muscle. The an- port wrap maintained for 2
coneus muscle is elevated to 5 days decreases the im-
from its ulnar insertion or mediate postoperative swel-
from the lateral epicondylar ling. Exercise restriction for
crest of the humerus, and 2 to 4 weeks is generally
the joint is entered through recommended.17,26,27
a capsular incision.29 As an
alternative, the incision can Surgical Reattachment
be made through the an- Surgical reattachment of
coneus muscle and into the the anconeal process was
joint space (Figure 4A).4 first described in 1970 by
Figure 5—Flexed lateral radiographic view of a 1-year-old Herron.7 The goal of reat-
Removal of the Free German shepherd, 8 weeks after lag-screw fixation. The an- tachment is to prevent the
Process coneal process is almost fused with the olecranon. The screw progression of osteoarthritis
Maximum flexion of the tip was cut flush with the caudal ulnar cortex during surgery. resulting from the instability

TABLE I
Outcome of Treatment for Ununited Anconeal Process
Number of Follow-Up Range of
Treatment Joints Time (months) Fusion Motion Lamenessa Osteoarthritis
27
Excision 19 2–40 N/A Mean of 1 excellent 1 slight
(mean, 19.5) 58% normal flexion 14 good 9 minimal
84% normal 4 poor 5 moderate
extension 4 severe
(4 progressed
after surgery)

Lag-screw 10 6–48 5 N/R N/R 1 minimal

fixation25 (4 lost (mean, 20.2) 2 mild
to radio- 5 moderate
graphic (N/R after
follow-up) surgery)

Proximal ulnar 22 4–51 21 16: within 5o 12 excellent 6 none

osteotomy24 (mean, 21) 3: reduced 10o 5 good 10 mild
1: reduced 20o 2 fair 3 moderate
(from normal 1 poor 1 severe
flexion) (N/R
preoperatively)
a
Excellent = no lameness even after heavy exercise; good = slight lameness after exercise; fair = mild, occasional lameness; poor = moder-
ate, consistent lameness; N/A = not applicable; N/R = not reported.

INCISION ■ FIBROUS ATTACHMENTS ■ SUPPORT WRAP

The Compendium March 1997
believed to result from sur-
gical excision.7,17 The tech-
nique entails a lateral ap-
proach to the elbow and
exposure of the anconeal
process.
The opposing surfaces are
abraded to encourage union.
The elbow is flexed, and a
screw is placed in lag fash-
ion through the anconeal
process and into the ulna as
perpendicular as possible to
the nonunion line. The
screw head should be coun-
tersunk beneath the articu-
lar cartilage (Figure 5). The
wound is closed routinely.7
Postoperative care is similar
to that following surgical ex-
cision.
In a modification of this
procedure, the lag screw is
inserted in the opposite di-
rection—with the head on
the caudal surface of the
ulna and the threads engag-
ing the anconeal process 30
(Figure 6). This technique
produces a smaller hole in
the anconeal process, the
screw head is not within the
joint, and screw placement
and removal are easier.30 A
further modification of this
procedure entails placement
of Kirschner wires within
the soft tissue as a visual
guide for screw placement;
another Kirschner wire is
driven parallel to the lag
screw if necessary.25
Osteotomy of the
Proximal Ulna
Osteotomy of the proxi-
mal ulna is based on the as-
sumption that joint incon-
gruity (resulting from a
radius that is too long or an
ulna that is too short) is plac-
ing stress on the anconeal
process, thereby preventing
LAG SCREW ■ INTRAMEDULLARY PIN ■ IMPLANT COMPLICATIONS
Small Animal
fusion. By allowing function-
al lengthening of the ulna,
the osteotomy relieves stress
and permits fusion.
The technique, which was
first described in 1990 by
Olsson,31 is relatively simple.
A caudolateral incision is
made directly over the proxi-
mal ulna. The deep fascia is
incised along the same line,
and the ulna is freed from
muscular attachments around
its circumference for approx-
imately 1 cm. An ostectomy
is performed 2 to 3 cm distal
to the plane of the radial
joint surface, and a 4- to 6-
mm segment of bone and at-
tached periosteum are re-
moved (Figure 7). It is
thought that oblique cuts
may result in too-rapid heal-
ing.24 Closure and postoper-
ative care are routine. An in-
Figure 6—Cranially directed lag-screw repair. The approach tramedullary pin driven
is similar to that illustrated in Figure 4. A partially threaded down the shaft of the ulna
cancellous bone screw is placed in lag fashion compressing has been used to provide sta-
the fissure line. No threads should engage the olecranon. bility, but implant complica-
tions may necessitate re-
moval of the pin (Figure 8).
PROGNOSIS
Unfortunately, no clinical
trial comparing the out-
comes of the three surgical
treatment techniques has yet
been performed. Small
prospective and retrospec-
tive studies of each treat-
ment have been reported.
Direct comparison is diffi-
cult because of variation in
methods.
One report described the
results of surgical removal in
19 elbows in 16 dogs.27 Out-
come was assessed by joint
Figure 7—Osseous landmarks for proximal ulnar osteoto- palpation, observation of
my. The caudal approach to the proximal ulna is illustrat- gait, measurement of range
ed, with elevation and retraction of the muscles surround-
of motion, and radiographic
ing the ulna. The osteotomies are performed as indicated
with an oscillating saw or obstetric wire. assessment of progression of
osteoarthritis. Follow-up
Small Animal The Compendium March 1997

ranged from 2 to 40 months Range of motion was within

(mean, 19.5 months). Fif- 5° of normal in 16 joints;
teen of the 19 elbows maximum flexion was re-
showed no signs of pain on duced by 10° in three joints
palpation but variable and by 20° in one joint.
amounts of bony and soft Radiographically, healing
tissue crepitus. Most of the of the UAP was complete in
dogs had a minor limp that 15 joints. A narrow radiolu-
was exacerbated by exercise. cent line remained in six,
After surgery, 58% of nor- but clinical results and lack
mal flexion and 84% of of secondary osteoarthritic
normal extension were re- changes suggested a func-
tained. All dogs had some tional union. Osteophytes
degree of osteoarthritis be- were nonexistent or mild in
fore surgery. The arthritis 16 joints, moderate in three
did not progress radiograph- joints, and severe in one. It
ically in most of the el- was thought that the proxi-
bows27 (Table I). mal ulna had tilted cranially
Results for 19 cases treat- in three joints24 (Table I).
ed with surgical excision Although the initial clini-
were reported based on own- cal results of the proximal
er’s response to a question- ulnar osteotomy (ostectomy)
naire. Fourteen had im- technique appear to be supe-
proved, 10 being completely rior, further work needs to
Figure 8—Flexed lateral radiographic view of the elbow in
free of lameness and 4 occa- be done before this tech-
Figure 2 immediately after ulnar osteotomy. The proximal
sionally lame. One dog had ulnar segment is slightly rotated proximally. nique can be recommended
remained intermittently in all cases. Whether this
lame, and 4 were persistently procedure would benefit an
lame. Of the 7 cases available for radiographic follow- older animal with advanced osteoarthritic changes is un-
up, all had radiographic progression of osteoarthritis.22 known. A combination of lag screw repair and proximal
Another report described the results of lag-screw fixa- ulnar osteotomy may prove beneficial if the UAP does
tion in 10 elbows in 8 dogs. Outcome was assessed ra- not fuse after osteotomy alone. Clinical experience and
diographically in 6 of the 10 elbows (4 dogs). Progres- further studies should help elucidate the most appropri-
sion of osteoarthritis and clinical lameness were not ate treatment for varying clinical presentations. Perhaps
assessed. Follow-up time ranged from 6 to 48 months. procedures that salvage the anconeal process would be
Five processes (3 dogs) had united by 2 to 3 months af- less effective if preexisting osteoarthritis is advanced.
ter surgery. No complications relative to the implants At present, no treatment option can ensure a func-
were reported25 (Table I). tionally normal joint. Some degree of osteoarthritis will
This technique has not seen widespread use largely be present and will probably progress throughout the
because of technical difficulty, implant complications, patient’s life.22,26 The clinical consequences are variable
and poor clinical results. Implant complications (specif- and difficult to predict. Prompt diagnosis and surgical
ically, screw breakage at the fissure line) have been re- intervention appear to offer the best prognosis for slow-
ported.7,30 Screw breakage is a significant complication ing the development of osteoarthritis.
because the broken screw is difficult to remove.
Another report described the results of proximal ulnar ACKNOWLEDGMENT
osteotomy in 22 elbows in 20 dogs.24 Outcome was as- The authors thank Wes Price, MS, for the illustrations.
sessed by lameness examination, measurement of range
of motion, and radiographic assessment of healing and About the Authors
osteoarthritis. Follow-up time ranged from 4 to 51 Drs. Cross and Chambers are affiliated with the Department
months, with a mean of 21 months. Twelve of 20 limbs of Small Animal Medicine, College of Veterinary Medicine,
exhibited no lameness even after heavy exercise, five had University of Georgia, Athens, Georgia. Dr. Chambers is a
intermittent lameness only after heavy exercise, two were Diplomate of the American College of Veterinary Surgeons.
intermittently lame, and one was persistently lame.

LAMENESS ■ RANGE OF MOTION ■ OSTEOARTHRITIS

Small Animal
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