Fragmented Medial Coronoid Process and Medial Compartment Disease
Fragmented Medial Coronoid Removal
Fragmented coronoid process is a subset of elbow dysplasia that affects large and giant breed dogs, particularly Retrievers, Rottweilers, Mastiffs, Bernese Mountain dogs, and German Shepherd dogs. Mal-alignment and overloading of the medial (innermost aspect of the joint) compartment are believed to be key in this pathology. Loading or abnormal weight bearing on the medial compartment leads to concurrent cartilage erosions (often full thickness) and possible fragmentation of the medial coronoid. Cartilage erosions involving the medial aspects of the elbow joint are now termed Medial Compartment Disease.
Diagnosis of fragmented coronoid process and medial compartment disease can be challenging. Radiographs are helpful but not definitive. In our opinion, arthroscopy is the ideal modality for the diagnosis of fragmented coronoid process because it allows accurate diagnosis and treatment of the fragment, as well as cartilage assessment. Traditional open surgery to diagnose fragmented coronoid is antiquated. First and foremost, the surgical approach to the elbow joint that affords the surgeon a thorough inspection is invasive and has moderate post-operative morbidity. Secondly, the arthroscopic visualization of key structures is far superior to an invasive surgical approach.
With newer, more effective and less invasive surgical treatments for fragmented medial coronoid process and medial compartment disease, we believe non-surgical management is inappropriate for most patients, especially those with years to live and develop OA (Osteoarthritis). We have treated nearly 30 dogs with elbow disease using regenerative stem cells at Colorado Canine Orthopedics and our results have been somewhat disappointing. Treatment of fragmented coronoid process in mild cases involves arthroscopic removal of the fragmented bone and cartilage. Arthroscopy is fast, effective, and minimally invasive. Arthroscopic treatment takes between 15 and 30 minutes per elbow and many dogs can be treated on an out patient basis. In mild cases the prognosis for return to normal activity is good. Most dogs return to normal activity within a few weeks to two months with little or no lameness.
In moderate cases, a fragment is present, the remaining coronoid process is abnormal and some cartilage loss has occurred both on the medial humeral condlye and the non-fragmented portion of the remaining medial coronoid. In these situations the fragment is removed and a partial coronoidectomy is performed arthroscopically. An ulnar osteotomy may also be performed in moderate cases. The prognosis for moderate cases of fragmented coronoid process is less certain. If the aforementioned treatments are performed and the cartilage is in fair condition, many dogs have no or minimal lameness and the progression of arthritis is slow.