Disturbances of growth and bone development

Gareth Arthurs; Sorrel Langley-Hobbs

doi:10.22233/9781910443286.8

British Small Animal Veterinary Association , 106 (2018); https://doi.org/10.22233/9781910443286.8

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Disturbances of growth and bone development

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Authors: Gareth Arthurs and Sorrel Langley-Hobbs
From: BSAVA Manual of Canine and Feline Musculoskeletal Disorders
Item: Chapter 8, pp 106 - 131
DOI: 10.22233/9781910443286.8
Copyright: © 2018 British Small Animal Veterinary Association
Publication Date: November 2018

Abstract

Problems affecting bone growth and development are caused by abnormalities of cartilage formation, cartilage transformation, or bone formation. This chapter covers angular limb deformities and bone dysplasias in depth. Operative Techniques: Distal ulnar osteotomy/segmental ostectomy; Radial and ulnar corrective osteotomies; Dynamic lengthening of the radius using an external skeletal fixator; Tibial osteotomy for tarsal varus or valgus.

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Figures

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8.3

Example of CORA calculation for frontal plane antebrachial angular limb deformity; two centres of rotation angulation deformities are identified and illustrated. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.3 Example of CORA calculation for frontal plane antebrachial angular limb deformity; two centres of rotation angulation deformities are identified and illustrated. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.4

Osteotomies and ostectomies. (a) Transverse osteotomy. (b) Opening wedge osteotomy. (c) Closing wedge after cuneiform osteotomy. (d) Oblique osteotomy. (e) Segmental osteotomy. (f) Dome osteotomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.4 Osteotomies and ostectomies. (a) Transverse osteotomy. (b) Opening wedge osteotomy. (c) Closing wedge after cuneiform osteotomy. (d) Oblique osteotomy. (e) Segmental osteotomy. (f) Dome osteotomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.6

The importance of preoperative planning. (a) An osteotomy performed at the level of maximal deformity results in a very small epiphyseal fragment in the distal tibia. (b) A small epiphyseal fragment can be difficult to stabilize adequately. (c) Making the cut proximal to the level of maximal deformity results in a larger piece of bone that is easier to stabilize. (d) When reduced, the bone in (c) will not be straight; however, this is not usually a problem as long as the joints are parallel. (e–f) Making the cut too far from the point of maximal deformity will cause a significant deformity of the bone once reduced. (g–h) Centring a dome osteotomy away from the point of deformity will correct the angular limb deformity but induce a translational deformity. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.6 The importance of preoperative planning. (a) An osteotomy performed at the level of maximal deformity results in a very small epiphyseal fragment in the distal tibia. (b) A small epiphyseal fragment can be difficult to stabilize adequately. (c) Making the cut proximal to the level of maximal deformity results in a larger piece of bone that is easier to stabilize. (d) When reduced, the bone in (c) will not be straight; however, this is not usually a problem as long as the joints are parallel. (e–f) Making the cut too far from the point of maximal deformity will cause a significant deformity of the bone once reduced. (g–h) Centring a dome osteotomy away from the point of deformity will correct the angular limb deformity but induce a translational deformity. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.7

(a) A 6-month-old Irish Wolfhound with bilateral carpal valgus secondary to metaphyseal osteopathy. (b) Mediolateral radiograph of the antebrachium of a 7-month-old Irish Wolfhound with radius curvus and a retained cartilaginous core in the distal ulna. © 2018 British Small Animal Veterinary Association

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8.7 (a) A 6-month-old Irish Wolfhound with bilateral carpal valgus secondary to metaphyseal osteopathy. (b) Mediolateral radiograph of the antebrachium of a 7-month-old Irish Wolfhound with radius curvus and a retained cartilaginous core in the distal ulna.

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8.8

Changes associated with retarded growth of the distal ulnar growth plate (radius curvus). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.8 Changes associated with retarded growth of the distal ulnar growth plate (radius curvus). Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.9

(a) Mediolateral view of the thoracic limb of a Great Dane with carpal valgus, showing premature closure of the distal ulnar growth plate and radius curvus but no elbow joint subluxation. (b) Mediolateral view of the thoracic limb of a Bassett Hound with carpal valgus, showing premature closure of the distal ulnar growth plate, radius curvus and humeroulnar subluxation. The dog also had panosteitis. © 2018 British Small Animal Veterinary Association

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8.9 (a) Mediolateral view of the thoracic limb of a Great Dane with carpal valgus, showing premature closure of the distal ulnar growth plate and radius curvus but no elbow joint subluxation. (b) Mediolateral view of the thoracic limb of a Bassett Hound with carpal valgus, showing premature closure of the distal ulnar growth plate, radius curvus and humeroulnar subluxation. The dog also had panosteitis.

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8.11

(a) Craniocaudal and (b) mediolateral views of a 9-month-old Cavalier King Charles Spaniel with premature closure of the distal radial growth plate. The radius has lost its normal cranial bowing, there is a marked humeroradial subluxation and secondary humeroulnar subluxation. There is no significant angular deformity. © 2018 British Small Animal Veterinary Association

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8.11 (a) Craniocaudal and (b) mediolateral views of a 9-month-old Cavalier King Charles Spaniel with premature closure of the distal radial growth plate. The radius has lost its normal cranial bowing, there is a marked humeroradial subluxation and secondary humeroulnar subluxation. There is no significant angular deformity.

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8.12

(a) Mediolateral and (b) craniocaudal views of a 5-month-old crossbreed dog with partial closure of the caudolateral aspect of the distal radial growth plate, combined with an abnormal appearance of the distal ulnar growth plate probably associated with delayed growth. There is humeroradial and humeroulnar subluxation. The radius has lost its normal cranial bow and has a straight appearance. There is a carpal valgoid deformity induced by the partial growth plate closure. © 2018 British Small Animal Veterinary Association

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8.12 (a) Mediolateral and (b) craniocaudal views of a 5-month-old crossbreed dog with partial closure of the caudolateral aspect of the distal radial growth plate, combined with an abnormal appearance of the distal ulnar growth plate probably associated with delayed growth. There is humeroradial and humeroulnar subluxation. The radius has lost its normal cranial bow and has a straight appearance. There is a carpal valgoid deformity induced by the partial growth plate closure.

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8.13

Imaging changes seen with premature closure of the distal radial physis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.13 Imaging changes seen with premature closure of the distal radial physis. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.14

Synostosis (arrowed) between the radius and ulna in a 6-month-old Pointer after a mid-diaphyseal fracture was stabilized with external skeletal fixation. Continued growth of the proximal radial growth plate in this immature dog could result in humeroulnar subluxation. © 2018 British Small Animal Veterinary Association

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8.14 Synostosis (arrowed) between the radius and ulna in a 6-month-old Pointer after a mid-diaphyseal fracture was stabilized with external skeletal fixation. Continued growth of the proximal radial growth plate in this immature dog could result in humeroulnar subluxation.

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8.15

(a) An adult Dachshund with marked bilateral pes varus and (b) a 3D volume rendered image from the same dog illustrating the severity of the deformity. (Courtesy of Gordon Brown) © 2018 British Small Animal Veterinary Association

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8.15 (a) An adult Dachshund with marked bilateral pes varus and (b) a 3D volume rendered image from the same dog illustrating the severity of the deformity. (Courtesy of Gordon Brown)

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8.16

Radiograph of a Shetland Sheepdog with a valgoid deformity of the tibia. The deformity developed subsequent to premature closure of the distal fibular growth plate, either alone or combined with partial closure of the lateral aspect of the distal tibial growth plate. © 2018 British Small Animal Veterinary Association

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8.16 Radiograph of a Shetland Sheepdog with a valgoid deformity of the tibia. The deformity developed subsequent to premature closure of the distal fibular growth plate, either alone or combined with partial closure of the lateral aspect of the distal tibial growth plate.

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8.17

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8.17 Lateral radiograph of the stifle of a kitten with genu recurvatum. (Courtesy of Matthew Pead)

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8.19

Osteochondrodysplastic dwarfism in a crossbreed dog. The dog has marked curvature of the antebrachium with cubital varus, carpal valgus and external rotation of the foot. The pelvic limbs are relatively straight. © 2018 British Small Animal Veterinary Association

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8.19 Osteochondrodysplastic dwarfism in a crossbreed dog. The dog has marked curvature of the antebrachium with cubital varus, carpal valgus and external rotation of the foot. The pelvic limbs are relatively straight.

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8.20

(a) CT 3D volume rendered image showing a caudally directed osteochondroma of the distal radius in a 1-year-old Deerhound with lameness due to impingement of the flexor tendons. (b) An intraoperative image showing removal of the lesion in the same dog. (Courtesy of Gordon Brown) © 2018 British Small Animal Veterinary Association

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8.20 (a) CT 3D volume rendered image showing a caudally directed osteochondroma of the distal radius in a 1-year-old Deerhound with lameness due to impingement of the flexor tendons. (b) An intraoperative image showing removal of the lesion in the same dog. (Courtesy of Gordon Brown)

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8.21

Radiograph of the elbow of a Burmese cat with an osteochondroma. The cat was sound for 6 months after local excision; however, the lesion recurred and a sarcoma developed. Amputation was curative. © 2018 British Small Animal Veterinary Association

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8.21 Radiograph of the elbow of a Burmese cat with an osteochondroma. The cat was sound for 6 months after local excision; however, the lesion recurred and a sarcoma developed. Amputation was curative.

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8.22

Osteogenesis imperfecta in an 11-month-old cat that presented with a tibial fracture. Radiographs showed (a) the presence of healed fractures in the same bone (and in the opposite tibia). (b) The cat suffered spontaneous bilateral humeral fractures while being caged during hospitalization. Bone density in this cat was not grossly reduced radiographically. © 2018 British Small Animal Veterinary Association

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8.22 Osteogenesis imperfecta in an 11-month-old cat that presented with a tibial fracture. Radiographs showed (a) the presence of healed fractures in the same bone (and in the opposite tibia). (b) The cat suffered spontaneous bilateral humeral fractures while being caged during hospitalization. Bone density in this cat was not grossly reduced radiographically.

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8.23

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8.23 Osteopetrosis. This 1-year-old entire male Bulldog presented because of lameness secondary to hip dysplasia. (Courtesy of George Papadopoulos)

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8.24

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8.24 Partial fusion of the fifth and sixth lumbar vertebrae. Block vertebrae are examples of axial dysostoses and are often incidental findings.

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8.25

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8.25 Ectrodactyly in a dog with associated elbow deformity and luxation. (Courtesy of John Innes)

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8.26

Cervical spine, skull and shoulder of a cat with mucopolysaccharidosis. There is vertebral fusion, with widened intervertebral disc spaces and abnormally shaped vertebral bodies. The shoulder joint shows irregular bone proliferation on the humeral head. © 2018 British Small Animal Veterinary Association

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8.26 Cervical spine, skull and shoulder of a cat with mucopolysaccharidosis. There is vertebral fusion, with widened intervertebral disc spaces and abnormally shaped vertebral bodies. The shoulder joint shows irregular bone proliferation on the humeral head.

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8.27

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8.27 A 6-month-old German Shepherd Dog with pituitary dwarfism. The dog is a proportionate dwarf with a retained puppy coat and ‘rat tail’.

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8.28

(a) Positioning and site of surgical incision. (b) Hohmann retractors are used to retract muscles prior to cutting the ulna. (c) When performing a segmental ulnar ostectomy, the length of ulna resected should be approximately 1.5 times the diameter of the bone. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.28 (a) Positioning and site of surgical incision. (b) Hohmann retractors are used to retract muscles prior to cutting the ulna. (c) When performing a segmental ulnar ostectomy, the length of ulna resected should be approximately 1.5 times the diameter of the bone. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.29

(a) Illustration of segmental distal ulnar ostectomy and (b) radiograph of procedure performed to address short ulna syndrome with elbow incongruence. (b, courtesy of Dr. Catharina Arthurs) © 2018 British Small Animal Veterinary Association

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8.29 (a) Illustration of segmental distal ulnar ostectomy and (b) radiograph of procedure performed to address short ulna syndrome with elbow incongruence. (b, courtesy of Dr. Catharina Arthurs)

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8.30

The lining technique for calculating the point of maximal deformity and the size of the cuneiform (wedge) ostectomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.30 The lining technique for calculating the point of maximal deformity and the size of the cuneiform (wedge) ostectomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.31

The bisection technique for calculating the point of maximal deformity and the size of the cuneiform (wedge) ostectomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.31 The bisection technique for calculating the point of maximal deformity and the size of the cuneiform (wedge) ostectomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.32

A bilateral (type II) ESF has been used to stabilize the antebrachium after a corrective closing wedge ostectomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.32 A bilateral (type II) ESF has been used to stabilize the antebrachium after a corrective closing wedge ostectomy. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.33

(a–b) Immediate postoperative radiographs following corrective radial and ulnar ostectomies showing cranial and medial radial plates, with a K-wire used for intraoperative stabilization. © 2018 British Small Animal Veterinary Association

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8.33 (a–b) Immediate postoperative radiographs following corrective radial and ulnar ostectomies showing cranial and medial radial plates, with a K-wire used for intraoperative stabilization.

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8.34

(a) Border Collie with carpal valgus subsequent to a distal radial fracture and a Salter–Harris type V closure of the distal ulnar growth plate. (b) A bilateral ESF has been applied after a closing wedge ostectomy to correct the carpal valgus. The ostectomy was performed more proximally than the true point of maximal deformity, to give a large enough distal piece of the bone to stabilize. This has resulted in a slight bow to the antebrachium; however, the foot and humerus are in line and the elbow and carpal joints are parallel, so the antebrachial deformity should not cause a problem. © 2018 British Small Animal Veterinary Association

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8.34 (a) Border Collie with carpal valgus subsequent to a distal radial fracture and a Salter–Harris type V closure of the distal ulnar growth plate. (b) A bilateral ESF has been applied after a closing wedge ostectomy to correct the carpal valgus. The ostectomy was performed more proximally than the true point of maximal deformity, to give a large enough distal piece of the bone to stabilize. This has resulted in a slight bow to the antebrachium; however, the foot and humerus are in line and the elbow and carpal joints are parallel, so the antebrachial deformity should not cause a problem.

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8.35

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8.35 An intraoperative view of the radius being exposed prior to osteotomy.

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8.36

Diagrams showing a type IIB ESF applied to the radius to achieve radial lengthening. Note the distraction of the proximal radial segment, lengthening of the radial osteotomy gap, and proximal translation of the radial head to a more normal position relative to the ulnar trochlea. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.36 Diagrams showing a type IIB ESF applied to the radius to achieve radial lengthening. Note the distraction of the proximal radial segment, lengthening of the radial osteotomy gap, and proximal translation of the radial head to a more normal position relative to the ulnar trochlea. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.37

Correction of short radius with a mid-radial osteotomy and dynamic lengthening using a circular ESF. (a) Immediately postoperatively: note the radial osteotomy, radiohumeral and humeroulnar incongruence, and circular ESF in place. (b) Three weeks postoperatively: note the distracted radial gap with early mineralization and improved radiohumeral congruency. (c) Seven weeks postoperatively: note the improved radiohumeral congruency and mature bridging of the radial osteotomy; the circular ESF was removed at this point. © 2018 British Small Animal Veterinary Association

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8.37 Correction of short radius with a mid-radial osteotomy and dynamic lengthening using a circular ESF. (a) Immediately postoperatively: note the radial osteotomy, radiohumeral and humeroulnar incongruence, and circular ESF in place. (b) Three weeks postoperatively: note the distracted radial gap with early mineralization and improved radiohumeral congruency. (c) Seven weeks postoperatively: note the improved radiohumeral congruency and mature bridging of the radial osteotomy; the circular ESF was removed at this point.

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8.38

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8.38 Application of the lining method for determining the point of maximal deformity and size of wedge required in order to straighten the tibia.

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8.39

Application of the bisection technique for determining the point of maximal deformity and size of wedge required in order to straighten the tibia. Dots indicate the midpoint of the tibia and tarsus, and the dotted line connects these bisection points to define the long axis of the tibia and tarsus respectively. © 2018 British Small Animal Veterinary Association

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8.39 Application of the bisection technique for determining the point of maximal deformity and size of wedge required in order to straighten the tibia. Dots indicate the midpoint of the tibia and tarsus, and the dotted line connects these bisection points to define the long axis of the tibia and tarsus respectively.

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8.40

A bilateral ESF has been applied with three half pins medially after closing wedge ostectomy for tarsal valgus correction. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. © 2018 British Small Animal Veterinary Association

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8.40 A bilateral ESF has been applied with three half pins medially after closing wedge ostectomy for tarsal valgus correction. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.

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8.41

Opening wedge osteotomy for pes varus in a Dachschund. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Modified from Johnson et al., 1989 , with permission) © 2018 British Small Animal Veterinary Association

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8.41 Opening wedge osteotomy for pes varus in a Dachschund. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission. (Modified from Johnson et al., 1989 , with permission)