Complications after proximal abducting ulnar osteotomy and prognostic factors in 66 dogs

Alan Danielski, Alexander Krekis, Russell Yeadon, Miguel Angel Solano, Tim Parkin, Aldo Vezzoni, Ingo Pfeil
Vet Surg. 2021 Aug 9. doi: 10.1111/vsu.13697.

Objective: To report complications and prognostic factors in dogs undergoing proximal abducting ulnar osteotomy (PAUL). To evaluate the ability to predict complications on the basis of post-operative radiographic examination.

Study design: Retrospective cohort study.

Animals: Sixty-six dogs.

Methods: Medical records of dogs treated with PAUL between 2014 and 2019 were reviewed for demographics, intraoperative findings, and post-operative complications. Post-operative radiographs were reviewed by two masked expert orthopedic surgeons, who were asked to predict the likelihood of major mechanical complications. The prognostic value of variables was tested with univariate and multivariable logistic regression. Inter-investigator agreement to predict complications was evaluated with two-by-two tables and kappa coefficient.

Results: Seventy-four PAULs in 66 dogs were included. Duration of follow-up ranged from 12 to 75 months (median: 53 months). Post-operative complications were documented in 19/74 limbs (16 dogs), including major complications in 13 limbs. These complications consisted mainly of non-union (six limbs), implant failure (two limbs), and infection (two limbs) requiring revision surgery in nine limbs. Body weight was the only variable associated with an increased risk of post-operative complications (p = .04). Agreement between expert predictions was low (respectively k = -0.08 and k = 0.11).

Conclusion: Major complications were reported in one fourth of limbs treated with PAUL and were more likely as body weight increased. Suboptimal plate and screw placement or osteotomy reduction on post-operative radiographs were poorly predictive of complications.

Clinical significance: Complications are fairly common after PAUL, particularly in heavier dogs, and post-operative radiographic examination seems unreliable to predict those.