Isolated Proces Anconaeus (IPA)The proces anconaeus has a separate ossification nucleus in the German Shepherd, Bernese Mountain Dog, Mastiff neapolitana, Bloodhound, and Great Dane breeds, from which the isolated proces anconaeus (IPA) develops in the absence of union with the ulnametaphysis. The disease occurs most frequently in the German shepherd dog, other predisposed breeds are affected much less frequently.
Medical history and clinical symptoms
First symptoms appear between the age of 4. and 12. month as supporting leg lameness, which worsens with weight-bearing and after resting. Early developing osteoarthritis leads to intermittent lameness in the early stages, which becomes permanent as the degenerative disease of the joint progresses. IPA occurs very frequently (up to 50%) bilaterally. These dogs are less conspicuous by lameness, but rather by stiff gait and strong reluctance to move. Affected animals often show a relieving posture. Adduct the joint in stance with simultaneous external rotation of the paw. As the limb is spared, significant muscle atrophy often develops. The longer the disease persists, the more pronounced are the secondary changes.
Diagnostics and differential diagnostics
After the clinical examination, a radiographic examination of the elbow joint should be performed to confirm the diagnosis.
Bernese mountain dog, male, 6 months: elbow in bent position. The isolated proces anconaeus is presented without superimposition.
If IPA is diagnosed before the end of the ossification phase (in German Shepherds up to the age of 4 months), it is necessary to perform a clinical examination. month, maximum until 6. month), lag screw fixation with concomitant ulna osteotomy is considered the method of choice. If the ossification phase is clearly exceeded, the IPA must be removed if it is not firmly fused with connective tie. So far, it has not been definitively clarified what influence the removal of the loose proces anconaeus has on joint stability and the further progression of osteoarthritis. Increased negative impact (instability, osteoarthritis) is questionable if the IPA was already isolated or only loosely connected to the olecranon before surgery.
The prognosis of IPA is good to poor, depending on existing secondary changes and the treatment carried out. Dogs with connective tie tight IPA as well as patients with early fixation and ulna osteotomy have a good prognosis. In all other forms, the prognosis for permanent freedom from lameness is cautious to rather poor. Especially with conservative treatment of a loose IPA is with high grade arthrosis. Degenerative joint disease with corresponding clinical symptoms to be expected.
Bernese mountain dog, 6 months: traction screw fixation with cortical screw and Kirschner drill wire.
Dr. Oliver Lautersack
Dr. Oliver Lautersack is a specialist veterinarian for small animal surgery.
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