Case Report
Fracture of the anconeal process in
two cats
N. Medl; K. Hurter
Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
Keywords
Cat, fracture, anconeal process, elbow
Summary
Two adult domestic Shorthair cats were
presented with acute forelimb lameness. In
one case, there was a history of trauma. A
fracture of the anconeal process was diag-
nosed on the flexed mediolateral radio-
graphs of the elbow in both cats. The fracture
was accompanied by a bony avulsion of the
tricipital tendon in one animal. Both cats
underwent surgical removal of the fractured
anconeal process. Follow-up radiographic
evaluation was available for one cat six
months after treatment; radiographs
showed evidence of osteoarthritis. The long-
term clinical outcome, based on owner tele-
phone follow-up conducted four and nine
years postoperatively, was considered to be
satisfactory.
Correspondence to:
Dr. Nikola Medl, ((Author: Titles?))
Clinic for Small Animal Surgery
Vetsuisse Faculty, University of Zurich
Winterthurerstrasse 260
8057 Zurich
Switzerland
Phone: +41 44 635 8861
Fax: ((AUTHOR: Is there a fax number))
E-mail: nmedl@vetclinics.uzh.ch
Vet Comp Orthop Traumatol 2010; 23:
doi:10.3415/VCOT-09-07-0078
Received: July 25, 2009
Accepted: November 26, 2009
Pre-published on: February 11, 2010
Introduction
Radial and ulnar fractures represent 17.3%
of all reported fractures in cats and dogs
(1). However, fractures limited exclusively
to one of these two bones are rarely ob-
served and tend to be confined to the proxi-
mal third. In the ulna, these include intra-
and extra-articular fractures of the olecra-
non, proximal diaphyseal fractures and
Monteggia fractures (2). An isolated frac-
ture of the anconeal process has previously
been mentioned in one cat, yet more de-
tailed information and discussion regard-
ing aetiology, diagnosis and treatment op-
tions were not given (3). In dogs, three cases
have been reported, two of which were
Boxers and one was a German shepherd
(46). In two of these cases, the fractured
anconeal process was thought to be a sequel
to an un-united anconeal process, where
the secondary ossification centre of the an-
coneal process failed to fuse with the ulna
(4, 6). The un-united anconeal process is
well known in German Shepherds with an
incidence rate of up to 30% (7). More re-
cently, a remarkable decrease to in the inci-
dence of this disease to 1.1% was reported
in a population of German Shepherd dogs
investigated in France, but these results
have some limitation as the examined dogs
were pre-screened (8). This disease has not
been reported in Boxer dogs or in cats.
The aim of this report is to describe and
discuss the clinical presentation, diagnosis
and treatment of anconeal process frac-
tures in the cat. Outcome evaluated was
based on radiographic and owner tele-
phone follow-up.
the joint capsule. Inspection of the anco-
Case history
Case 1
A five-year-old, spayed female, domestic
Shorthair cat was presented with an acute
onset of right forelimb lameness of two
days duration. The owner was unaware of
any antecedent trauma.
A weight-bearing right forelimb lame-
ness, grade 2 out of 5, was noted on clinical
examination. Pain was elicited on full ex-
tension of the right elbow, but flexion was
only minimally painful. There was no dis-
Schattauer 2010 1
cernable soft tissue swelling. The re-
mainder of the clinical examination and
routine haematology were unremarkable.
A flexed mediolateral radiograph of the
right elbow revealed a triangular-shaped
mineral opacity craniodorsal to the anco-
neus (Fig. 1); this fragment was aligned
with the anconeus but separated from it by
a radiolucent line. A second ovoid mineral
opacity was evident cranial to the humerus,
which was interpreted as being an osteo-
chondroma or a sesamoid bone within the
tendon of origin of the supinator muscle.
The presence of a similar, smooth-shaped
fragment of bone on the radiographs of the
contra-lateral elbow is supportive of a diag-
nosis of sesamoid bone. A craniocaudal
radiograph of the right elbow did not reveal
any abnormalities.
General anaesthesia was induced intra-
venously (IV) with ketaminea (10 mg/kg
IV) and midazolamb (0.1 mg/kg IV) and
maintained with isofluranec. Perioperative
analgesia was provided by a local infil-
tration of the brachial plexus using bupiva-
cained 0.5% (2 mg/kg). Cefazoline (22 mg/
kg IV) was administered as a perioperative
antibiotic.
A standard caudolateral approach to the
elbow was performed, as described by
Piermattei and Johnson (10). Small osteo-
phytes were present at the insertion site of
neal process revealed a 2 mm bony frag-
ment at the tip. The fragment was excised
and the joint was copiously lavaged and
closed in a standard manner. The removed
fragment was submitted for histopath-
ological examination, which confirmed the
a
Narketan: Vtoquinol AG, Ittingen/Bern, Switzer-
land
b Dormicum: Roche Pharma AG, Reinach, Switzer-
land
c IsoFlo: Abbot AG, Baar, Switzerland
d
Carbostesin: AstraZeneca, Zug, Switzerland
e Kefzol: Teva Pharma AG, Aesch, Switzerland
Vet Comp Orthop Traumatol 2/2010
2 N. Medl, K. Hurter: Fracture of the anconeal process in two cats
Fig. 1 Preoperative mediolateral of the injured
right elbow (case 1) showing a triangular fracture
of the anconeal process.
a)
Fig. 2 Preoperative radiographs of the left elbow (case 2) showing fracture of the anconeal process
and a bony avulsion of the tricipital tendon in the mediolateral flexed view (A). The fracture of the an-
coneal process was not visible in the craniocaudal view (B).
Vet Comp Orthop Traumatol 2/2010
diagnosis of an acute fracture of the AP. Fi-
brous exudation with proliferation of fi-
broblasts and osteoblasts with osteoid-
formation were evident.
The cat was discharged the next day and
exercise restriction was advised for four
weeks. Postoperative analgesia consisted of
buprenorphinef (0.015 mg/kg IV/PO q6h)
for two days and a single administration of
meloxicamg at 0.2 mg /kg IV. After dis-
charge the dose of buprenorphin was con-
tinued orally every six hours for another
day by the owner, a student of veterinary
medicine.
At follow-up examinations, one and six
months after surgery, neither lameness nor
reduced range-of-motion of the joint was
evident. Radiographs taken four weeks
postoperatively showed minimal osteoar-
thritic changes at the tip of the anconeal
process. Six months after surgery, moderate
osteoarthritis was evident radiographically.
At telephone follow-up performed four
f
Temgesic: Essex Pharma GmbH, Luzern, Switzer-
land
g Metacam: Boehringer-Ingelheim GmbH, Basel ,
Switzerland
b)
years post-operatively, the owner reported
normal weight bearing and jumping.
Case 2
A three-year-old, spayed female, domestic
Shorthair cat was presented for acute lame-
ness following a fall from a height. The
medical record from this case was incom-
plete and initial physical examination find-
ings and haematology were not found.
Radiographic examination of the chest
revealed a mild pneumothorax and cloudy
shadowing of the peripheral parts of all
lung lobes, consistent with pulmonary con-
tusions. Abdominal radiographs were un-
remarkable. The flexed mediolateral radio-
graph of the left elbow revealed a fracture of
the anconeal process close to the base of the
process, as well as a suspected bony avul-
sion of the tricipital tendon at its insertion
on the olecranon (Fig. 2a). The fractured
anconeal process was not visible on the
craniocaudal radiographic view (Fig.
2b).
Surgical excision of the fractured anco-
neal process was performed through a stan-
dard caudal approach after induction of
general anaesthesia, as described in the first
case. The tricipital tendon was sutured and
anchored to the olecranon tuberosity
through a bone tunnel (Fig. 3). A de-
scription of the exact suture technique used
for tendon repair was not found in the
medical records. Postoperative radiographs
confirmed complete removal of the anco-
neal fragment and sufficient apposition of
the avulsed bony fragment with the olecra-
non. Stabilisation of the forelimb after sur-
gery was provided by a spica splint for two
weeks. Information on postoperative anal-
gesia was not available due to incomplete
data. Healing and clinical performance
were noted as satisfactory at bandage
changes. Two weeks postoperatively, left
hindlimb lameness due to a caudodorsal
coxofemoral luxation of unknown cause
was diagnosed. As acetabular damage of the
cranio- and caudodorsal rim of the acet-
abulum together with loose bony frag-
ments were present, a femoral head and
neck excision was performed. Healing
without any apparent complications was
reported.
Schattauer 2010

Further clinical and radiographic fol-
low-up examinations were not performed
because the owner had moved to a foreign
country. Owner-based telephone follow-
up revealed normal weight bearing without
lameness or impaired ability to jump nine
years postoperatively.
Discussion
Fracture of the anconeal process has been
previously mentioned in one cat, but a
more detailed description is not available
(3). In dogs, major or minor trauma is re-
ported as causes of anconeal fractures
(46). One of the dogs previously reported
was hit by a car; the other two dogs were
suspected to have sustained minor trauma
(46). In these dogs, an underlying con-
dition consistent with an un-united anco-
neal process could not be excluded al-
though signs of chronic degenerative joint
disease were not evident on radiographs.
Unlike the German Shepherd, a secondary
centre of ossification of the anconeal pro-
cess is not reported in the Boxer dog, and
information on the nature of maturation of
the anconeal process is not available for the
cat. In one of the two cats presented herein,
the anconeal process fracture was caused by
a fall that additionally resulted in an avul-
sion of the tricipital tendon. The extreme
loading of the cubital joint during landing
and the flexion accompanied by rotation
within the joint are suspected to have
caused the fracture of the anconeal process.
Trauma is considered very likely in the
other case, in which histopathology con-
firmed an acute fracture of the anconeal
process. Fracture of the anconeal process is
also known to occur in swine. Histopath-
ological examination carried out on the
elbow joints of five pigs revealed findings
that were similar to those in case one, in ad-
dition to formation of hyaline- and fibroc-
artilage as well as a buttress callus (11).
Underlying causes proposed for the por-
cine anconeal process fractures were acute
traumatic incidents, repetitive traumas and
osteochondrosis of the elbow joint. Con-
sidering the available data, we believe that
trauma is necessary to fracture the anco-
neal process in cats, however further inves-
tigation of the maturation process of the fe-
Schattauer 2010
N. Medl, K. Hurter: Fracture of the anconeal process in two cats
anconeal processes, have a better clinical
of the fractured fragment was performed in
Fig. 3 Postoperative radiographs of the left
elbow (case 2) in mediolateral flexed position
after removal of the anconeal fragment and fix-
ation of the tricipital tendon to the olecranon
tuberosity through a bone tunnel.
line anconeal process would be interesting.
The diagnosis of anconeal process frac-
ture can be made following physical and
radiographic examination. The injured
elbow may be painful on palpation and soft
tissue swelling may be present. In the first
case described herein, extension of the
elbow was most likely extremely painful, al-
though flexion did not elicit signs of pain.
Crepitus, joint effusion and soft tissue
swelling were not evident. These findings
were consistent with those previously de-
scribed in dogs. Additional findings in dogs
were signs of pain on rotation of the ante-
brachium, crepitation, joint filling and soft
tissue swelling (4, 5). Assuming trauma to
be the most common cause of anconeal
process fractures, careful physical examin-
ation to look for other trauma-related in-
juries is prudent. Given that superimposi-
tion of the humeral condyles may obscure a
direct view of the anconeal process in stan-
dard mediolateral radiographs, a radio-
graphic diagnosis in cats is best made using
a flexed mediolateral view as reported in
3
dogs (12). If injury is confined to the anco-
neal process, the fracture is not visible on
craniocaudal views, as was the case in these
two cats.
Treatment options in dogs with an un-
united anconeal process include fragment
excision, lag-screw fixation, proximal ulnar
osteotomy and a combination of the latter
(13). Conservative management as well as
excision of an un-united anconeal process,
result in progressive lameness and osteoar-
thritis, so these treatments are not recom-
mended (14). Nevertheless there is little
evidence available that other surgical meth-
ods, such as the repair of anconeal process
fractures or internal fixation of un-united
outcome and that radiographic signs of os-
teoarthritis have to be expected. Removal
both Boxers with anconeal process frac-
tures (4, 5). Lag screw fixation, which is
feasible for larger fragments, was perform-
ed in the German Shepherd (6). Consider-
ing the small size of the fracture fragments
seen in both of our cases, fixation was not
attempted and excision was performed.
Conservative treatment was not considered
because, as proven for the dog, the frag-
ment would continuously act as joint
mouse, causing persistent joint inflam-
mation, which leads to osteoarthritis, pain
and a poor functional outcome.
Radiographic changes consistent with
osteoarthritis are likely to develop despite
surgical therapy, as was seen in the first case
with a six-month radiographic follow-up
and is likely for the second cat. The assess-
ment of clinical outcome in our cases is li-
mited to owner evaluation, in which both
reported normal weight bearing, jumping
and limb function. Despite the limited fol-
low-up evaluation, the outcome in these
two cases suggest that surgical excision of a
fractured anconeal process in the cat might
be appropriate in other cases.
References
1. Phillips IR. A survey of bone fractures in the dog
and the cat. J Small Anim Pract 1979; 20: 661671.
2. Piermattei DL, Flo GL, DeCamp CE. Fractures of
the Radius and Ulna. In: Handbook of Small Ani-
mal Orthopedics and Fracture Repair, 4th ed.
Brinker WO, Piermattei DL, Flo GL (eds). Philad-
Vet Comp Orthop Traumatol 2/2010
4 N. Medl, K. Hurter: Fracture of the anconeal process in two cats
elphia: W.B. Saunders Company 2006; 359381.
3. Voss K, Langley-Hobbs SJ, Montavon PM. Fractures
of the elbow joint. In: Feline Orthopedic Surgery
and Musculoskeletal Disease. Montavon PM, Voss
K, Langley-Hobbs SJ. (eds). Philadelphia: W.B.
Saunders Company 2009; 366.
4. Flegel T, Kehnscherper G. Unusual case of a frac-
tured anconeal process in a Boxer. Vet Comp Or-
thop Traumatol 1997; 10: 192193.
5. Thrupp J, Wong W, Charles J. Primary anconeal
fracture in a boxer. Aust Vet J 2001; 79: 611612.
6. McCartney WT. Another manifestation of unu-
nited anconeal process in the German Shepherd
Dog?. Vet Comp Orthop Traumatol 1993; 6:
613614.
Vet Comp Orthop Traumatol 2/2010
7. Corley EA, Carlson WD. Radiographic, genetic and
pathologic aspects of elbow dysplasia. J Am Vet Med
Assoc 1965; 147: 1651.
8. Remy D, Neuhart L, Fau D, et al. Canine elbow dys-
plasia and primary lesions in German Shepherd
dogs in France. J Small Anim Pract 2004; 45:
244248.
9. Wood AK, McCarthy PH, Martin IC. Anatomic and
radiographic appearance of a sesamoid bone in the
tendon of origin of the supinator muscle of the cat.
Am J Vet Res 1995; 56: 736738.
10. Piermattei DL, Johnson KA. Approach to the Lat-
eral Humeroulnar Part of the Elbow Joint. In: An
Atlas of Surgical Approaches to the bones and joints
of the dog and cat, 4th ed. Piermattei DL, Johnson
KA (eds.). Philadelphia: W. B. Saunders Company
2004; 186189.
11. Kincaid SA, Lidvall ER. Observations of fracture of
the anconeal process of the ulna of swine. Am J Vet
Res 1985; 46: 12941296.
12. Cook CR, Cook JL. Diagnostic imaging of canine
elbow dysplasia: A review. Vet Surg 2009; 38:
144153.
13. Samoy Y, Van Ryssen B, Gielen I, et al. Review of the
literature elbow incongruity in the dog. Vet Comp
Orthop Traumatol 2006; 19: 18.
14. Parrisius A. Processus anconeus isolatus: Behand-
lung und Ergebnisse in den Jahren 19751983. Chi-
rurgische Tierklinik der Tierrztlichen Fakultt der
Universitt Mnchen. 1985. ((AUTHOR: IS THIS A
THESIS??))
Schattauer 2010