Master Student: Gert Jarn Pedersen
Specialisation: Surgery
Project: Minireview: Ulnar osteotomy in dogs with premature growth line disturbances in distal ulna, when and how?


This systematic review evaluates the different types of ulnar osteotomy in canine patients with antebrachial asynchronous growth. Complications associated with the procedure and the optimal time frame of performing the surgery are also included. This analysis utilizes a nonrandomized study selection that reviews relevant articles from the past 38 years.


The relevant articles were found using a highly sensitive computerized search method performed in PubMed and Ovid Medline. Included in the non-randomized studies were patients with antebrachial asynchronous growth (AAG) in the distal ulna, that have had ulnar osteotomy performed within the time frame 1978 – 2014. The inclusion criteria for this paper is such that articles are available in full text, limited to studies including more than 8 cases, and written in Danish, Swedish, Norwegian or English language. Of the 478 articles identified using the search strategy there were 26 that met the inclusion criteria. Of these 26 cases there were 14 studies that scored 50% or more on methodological quality assessment, 4 were case control studies and 5 were case series studies. Of the 14 studies 5 were prospective studies, 4 were retrospective studies, 2 were in vitro studies, 1 ex vivo study and 2 were experimental studies. Studies that fulfilled these criteria were assessed for methodological quality, using the critical appraisal of observational studies developed by the methodological index for non-randomized studies (MINORS) instrument.

The study characteristics and data on the intervention, follow-up, outcome measures and complications were extracted.


Pooling of the studies that conform with the inclusion criteria resulted in 310 ulnar osteotomies: 186 cases having distal ulnar osteotomies (DUO), 43 proximal ulnar osteotomies (PUO), 48 dynamic proximal ulnar osteotomies (dynamic PUO) and 33 bioblique dynamic proximal ulnar osteotomies (biobligue dynamic PUO).

Immature AAG patients with slight angular malformations may be treated with a partiel DUO. There is no evidence that the method can be used for adult patients and only a slight non-significant trend toward a beneficial response if the method is combined with transsection of the antebrachial interosseous ligament. In AAG patients that exhibit elbow incongruity and mild angular malformation the PUO / bioblique dynamic PUO can be used alone or in combination with distal correction osteotomy, both in adults as well as juvenile patients. There is a increased risk factor for complications as well as a greater morbidity in dynamic PUO / bioblique dynamic PUO as compared with DUO method. There is no indication that the bioblique PUO results are better than the dynamic PUO results. There is a non-significant trend that suggests that ulnar osteotomy should be performed as early as possible, before the development of severe angular malformations, osteoarthrosis (OA) and elbow incongruity (EI).


AAG patients with relatively severe angular malformations should be treated with corrective osteotomy at CORA point (center of rotation and angulation).

Immature AAV patients with slight angular malformations and possibly EI can be treated with a partial DUO, dynamic PUO or bioblique dynamic PUO . Adult AAV patients with mild angular malformations and EI can be treated with dynamic PUO or bioblique dynamic PUO.

As a result of the high incidence of complications, as well as greater morbidity in dynamic PUO /bioblique dynamic PUO should partial DUO be preferred when possible. Partial DUO should be made as early as possible in immature patients.

However, the low quality of evidence precludes solid clinical conclusions in this review.