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Incomplete ossification of the humeral condyle (IOHC) / Humeral intracondylar fissure (HIF)
Synonym(s): Incomplete fracture of the elbow joint
Introduction
- Abnormal development of humeral condyle that does not fully ossify and has a cartilaginous plane separating medial and lateral aspects.
- Cartilaginous plane predisposes dogs to humeral condylar fracture occurring during normal activity.
- Disease appears to have a genetic component with a recessive mode of inheritance.
- Pathogenic mechanism of disease unknown but presence of disease may be associated with presence of fragmentation of medial coronoid process, a form of elbow dysplasia.
- Humeral intracondylar fissure develops in older dogs who had no signs of IOHC, ie a de novo fissure. Thought to be a non healing stress fracture.
Presenting signs
- Acute - non-weight-bearing lameness Lameness: forelimb - investigation usually associated with exercise.
- Chronic - insidious or intermittent lameness varying from subtle to pronounced.
- Pain on extension or external rotation of elbow.
- Mild swelling of affected elbow.
- Elbow lameness which is responsive to NSAID therapy.
- Sudden fracture with minimal trauma.
Geographic incidence
- Reported in Europe and North America.
Age predisposition
- Mean age of presentation is 6 years (6 months - 12 years). Skeletally mature dogs present with HIF.
- In puppies, presence of IOHC may be difficult to differentiate from condylar fracture secondary to trauma.
- Overall, disease is unusual.
Breed/Species predisposition
- Breed Incidence: IOHC affects dogs from multiple breeds, including:
- Spaniel breeds - American Cocker Spaniels American Cocker Spaniel , Brittanys Brittany , Boykin Spaniels, Springer Spaniels Spaniel: Welsh Springer English Springer Spaniel , Cavalier King Charles Spaniels Cavalier King Charles Spaniel , Clumber Spaniels Clumber Spaniel , Rottweilers Rottweiler , Labrador Retrievers Retriever: Labrador , German Shepherd dogs German Shepherd Dog , English Mastiffs Mastiff , miniature Pinschers Miniature Pinscher , and mixed-breed dogs.
Public health considerations
- None.
Cost considerations
- Treatment of humeral condylar fractures secondary to IOHC is complex and expensive because it often requires use of bone screws and bone plates.
Special risks
- None.
Pathogenesis
Etiology
- Etiology unknown.
- Appears to have a genetic component with a recessive mode of inheritance. May be associated with elbow dysplasia Elbow: dysplasia - significant proportion of dogs with IOHC also have fragmentation or chondromalacia of medial coronoid process Elbow: medial coronoid process disease (MCPD).
- Humeral fractures that occur in dogs with IOHC generally result from normal activity (running, climbing or going down stairs).
- HIF - thought to be stress or fatigue fracture due to abnormal loads or compromised bone health.
Predisposing factors
General- One study found that being overweight Body condition scores predisposed Cocker Spaniels American Cocker Spaniel to humeral condylar fracture secondary to IOHC but another study did not confirm it.
Specific
- None.
Pathophysiology
- Unknown pathogenic mechanism.
- In normal dogs, medial and lateral aspect of humeral condyle are separated by a cartilaginous zone that disappears by 4 months of age. In dogs with IOHC cartilaginous zone appears to persist.
- Most affected dogs have IOHC on both elbow joints (1 in 5 dogs with IOHC will have bilateral humeral condylar fractures).
Timecourse
- Dogs with IOHC have an abnormal humeral condyle and slowly develop degenerative joint disease in affected elbow joints; may not fracture elbow joints until adult.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Walton M B, Crystal E & Morrison S et al (2020) A humeral intracondylar repair system for the management of humeral intracondylar fissure and humeral condylar fracture. JSAP 61(12) 757-765 PubMed.
- Robin D & Marcellin-Little D J (2001) Incomplete ossification of the humeral condyle in two Labrador retrievers. JSAP 42 (5), 231-234 PubMed.
- Rovesti G L, Flückiger M, Margini A et al (1998) Fragmented coronoid process and incomplete ossification of the humeral condyle in a Rottweiler. Vet Surg 27 (4), 354-357 PubMed.
- Marcellin-Little D J, Roe S C & DeYoung D J (1996) What is your diagnosis? Faint vertical condylar radiolucency, secondary to incomplete ossification of the humeral condyle. J Am Vet Med Assoc 209 (4), 727-728 PubMed.
- Marcellin-Little D J, DeYoung D J, Ferris K K et al (1994) Incomplete ossification of the humeral condyle in spaniels. Vet Surg 23 (6), 475-487 PubMed.
Other sources of information
- Humeral Intracondylar Repair System (HIRS): Surgery Demonstration. Ben Walton: www.youtube.com/watch?v=nMhBNBPadXs
- Marcellin-Little D J (1999) Incomplete Ossification of the humeral condyle in dogs. In: Kirk's Current Veterinary Therapy XIII. Ed J D Bonagura. W B Saunders Company, Philadelphia, pp 1000-1004.