Ununited Anconeal Process (UAP) by Cheryl May

NOTE: I would like to personally thank Cheryl May for allowing me to put this information on the GSD web site for everyone to see.  Informational links are below which you can click on to get to Cheryl's site if you are interested in checking this out further. We also thank Cheryl for the update on Lacy's condition.  Thank you Cheryl :-)  webmaster

UPDATE 10/14/99


I developed my web page to help others locate information on Ununited Anconeal Process, a form of elbow dysplasia. Your decisions for treatment may be different from mine. I am not a veterinarian and you should consult a veterinarian or orthopedic surgeon for more details and assistance. This page is not intended to offer advice, but merely to relate how my husband and I dealt with our dog's specific problem. Sometimes I think it is helpful to know that others have experienced similar problems and to learn what they decided, whether it agrees with your own choice or not.

For activities to do with your recuperating dog, click here. And if you have additional ideas for the activities page, please send me e-mail and I may add your suggestions.

Diagnosis

My German shepherd puppy Lacy, became lame three times following play over a five week period. Since I was planning to have preliminary radiographs done for OFA anyway, I made an apppointment to have these done to see if she had a problem. She did. Lacy was diagnosed with Ununited Anconeal Process at 24 weeks of age.

UAP occurs most commonly in large male German shepherds. Twice as many males are affected as females. About a fourth of affected dogs have the problem in both elbows. Lacy is a small female who had the condition in both elbows. The condition has also been reported in other large breeds including the Saint Bernard, Great Dane, Labrador retriever, Irish wolfound and others, and in Basset hounds, French bulldogs and dachsunds.

Causes

The problem is thought to be polygenic, that is, caused by a number of elements which could include an inherited developmental anomaly, a metabolic defect, a genetic disturbance of normal growth-stimulating hormone, environment, nutritional deficiencies, etc. I personally spent a lot of time worrying about what I might have done wrong that caused this to happen to Lacy. After extensive research, conversations with several veterinarians, and careful analysis of her lifestyle, feeding, etc., I've come to the conclusion that it was an unfortunate quirk of fate and not something that her breeder, or I, could have prevented. Both Lacy's parents have normal elbows certified by OFA. To my knowledge, she is the only puppy in her litter affected. Although it is not necessarily a genetic problem, it is my personal choice to have Lacy spayed.

Some researchers identify the problem as an incongrous growth between the radius and the ulna, causing extra pressure on the anconeal process that prevents it from uniting. This is the theory behind the newest surgical treatment, ulnar osteotomy, in which the surgeon cuts out a small piece of the ulna to relieve pressure on the anconeal process, allowing it to unite. This surgery has been studied and reported in journals by Swedish researchers.

Treatment Options

After identifying the problem, the difficult decision is answering the question, "What to do?"

My training buddy and friend, Jeanne Saddler, did an extensive literature search through the veterinary journals to help my husband and me make an informed decision. The options were to do nothing and relieve pain through medication, or to opt for surgery. Because Lacy was young at the time of diagnosis, and because our plans for her were to participate in obedience and agility, we opted for a surgical solution, hoping to salvage her performance career. If we had chosen to do nothing, it is my understanding that she would have developed severe pain over the next two years.

Lacy's surgery was performed July 27, 1999, by Dr. James K. Roush, head of surgery at Kansas State University's Veterinary Medical Teaching Hospital, and his surgical team. They performed an ulnar osteotomy on each of Lacy's front legs.

Surgical treatments These were the options open to us:
* Excision of loose anconeal. This is the traditional surgery. Unfortunately, removal of part of the elbow joint, which occurs in this surgery, makes the elbow less stable. It does, however, relieve pain. If we had chosen this option, it would be less likely that Lacy could participate in agility, but could probably do obedience, even at advanced levels.
* Lag-screw re-attachment. In this surgery, a lag-screw is inserted through the anconeal process, pushing the ununited parts together. The goal is to have the bones grow together. I was unable to locate research articles demonstrating success with this method.
* Ulnar osteotomy. This is the method we selected for Lacy. It involves cutting a 2 to 4 mm horizontal slice of bone from the ulna, and inserting a fat graft between the bones so the bone doesn't grow back together too quickly. This gives the anconeal process an opportunity to unite. For Lacy, X-rays in late August will tell us whether this surgery worked. If it does, her anconeal process should be as strong as if they had developed normally in the first place. If the initial surgery is not successful, she can still have the traditional surgery later.

The journal articles I found most helpful were:
* "Ununited Anconeal Process in the Dog" by Lennart Sjostrom, DVM, in Vol. 28, Number 1, January 1998 Veterinary Clinics of North America: Small Animal Practice.
* "Ununited Anconeal Process in the Dog. Pathogenesis and Treatment by Osteotomy of the Ulna" by Lennart Sjostrom, DVM, H. Kasstrom, and M. Kallberg, in the Journal of Vet. Comp. Orthop. Trauma 1995, Volume 8, pages 170-176.

UPDATE

Lacy had her X-rays yesterday and there was no progress with the anconeal process uniting. The
orthopedic surgeon said that normally he'd recommend the traditional surgery, but since she is showing very little arthritic changes, and the AP is firmly attached, even though it's not united, he's in favor of NO surgery at this time. Surgeons in South Africa, operating on another GSD Lacy's age, told an Internet contact of mine that it didn't matter if the AP never unites, because the surgery was done to correct the incongruity in the bone growth between the radius and the ulna. Uniting would be ideal, but not critical. The SA doctors say the problem is fixed because of the surgery, no matter what else happens. I told Lacy's orthopedic surgeon about the South African vets opinion, and I think it affected his recommendation to go with no additional surgery at this time.

If, in future years, the AP piece comes loose, or she limps for some reason, we could always do the
traditional surgery then. Her movement is normal for a GSD puppy her age. She isn't in pain. Of course I'll always have some concerns when working her and I'll probably be a little over-protective. :-)

I'm hoping that Chris Zink will be able to give me some good guidelines. She said she will advise me on what she thinks Lacy should be able to do, and how to tell when she has had enough. She had me send in Lacy's hip X-rays to OFA, and I'm doing a video with specific directions from Chris on what she wants to see on the video. I'll send the video and her elbow X-rays to Chris, and after OFA checks in, we'll get the consult. I'm looking forward to it.

The orthopedic surgeon said Lacy is free to do whatever GSD puppies do. :-) No big jumping - which I wouldn't have done anyway until she's a year old - but she's fine for 8-12" he said. His concern wasn't for the elbows, but for the cut he took out of the ulna. It is growing back together, but isn't completely healed. He didn't want me taking her out and sending her over 24" jumps - of course she doesn't understand how to do that anyway - she doesn't know how to jump on the bed even! Now that she has been cleared for more exercise, I am going to get back to teaching her the Chris Zink jumping program from her book, "Jumping from A to Z."

Useful links
Things to do with your recuperating dog!

Reprinted with the permission of the author Copyright © Cheryl May