Effect of proximal abducting ulnar osteotomy (PAUL) on frontal plane thoracic limb alignment: An ex vivo canine study

Abstract

Objective: To determine the effect of proximal abducting ulnar osteotomy (PAUL) on frontal plane thoracic limb alignment in standing and recumbent positions. Study design: Ex vivo cadaveric study. Sample population: Canine thoracic limbs (n = 15 limb pairs). Methods: Limbs were acquired from healthy Labrador retrievers that had been euthanized for reasons unrelated to this study. A limb press was used to obtain standing and recumbent caudocranial radiographs before and after PAUL. Foot lateralization and rotation were directly measured in standing position. Mechanical joint angles were determined using full limb radiographic montages and the center of rotation of angulation (CORA) method for pre-PAUL (Pre), 2-mm PAUL (PAUL2), and 3-mm PAUL (PAUL3). Data are reported as mean ± SD and 95% CI. Mixed linear modeling was used to identify differences in limb alignment values and foot position, with significance established at P ≤ .004. Results: There were differences in five of 12 limb alignment values pre-PAUL and post-PAUL in standing and recumbent positions. In the standing position, there was an increase in mechanical medial proximal radioulnar angle (Pre,

Effect of Medial Opening Wedge and External Rotational Humeral Osteotomies on Medial Elbow Compartment Pressure: An Ex Vivo Study

“…8 The proximal abducting ulnar osteotomy (PAUL; KYON, Switzerland) reduced contact pressure in the medial compartment of experimentally induced incongruent elbows but did not reduce contact pressure of congruent elbows, and translated the thoracic limb mechanical axis laterally at the level of the elbow joint in ex vivo studies. 28,29 Coghill and colleagues, however, reported no difference in canine brief pain index scores or long-term nonsteroidal anti-inflammatory drug use between dogs treated with arthroscopy alone, compared to dogs treated with arthroscopy and PAUL, and the major and total complication rates for the PAUL procedure have recently been reported to be 18 and 26%, respectively, raising concern regarding the safety of this technique. 30,31 Furthermore, the antebrachium is a twobone segment, and the impact PAUL has on radioulnar congruency is not clear.…”

Proximal Abduction Ulnar Osteotomy (PAUL): Short- and Long-Term Evaluation in Dogs Presenting Medial Compartment Disease

“…Today, several surgical techniques have been described whose purpose is based on modifying the anomalous distribution of joint loads; the most common load-shifting modifying osteotomy techniques are bioblique dynamic proximal ulnar osteotomy (BODPUO), sliding humeral osteotomy (SHO), and proximal abduction ulnar osteotomy (PAUL) [ 3 , 4 , 7 , 15 , 16 , 17 ]. The latter is one of the newest techniques, which was described by Ingo Pfeil who theorized that proximal osteotomy of the ulna fixed by a special plate would shift, abduct, and rotate the ulna, which would lead to lateralization of the paw, thus, unloading the medial compartment [ 3 , 16 , 18 , 19 , 20 ]. According to the current literature, this procedure seems to present favorable results in the short-term [ 18 ].…”

“…According to the current literature, this procedure seems to present favorable results in the short-term [ 18 ]. However, there are few studies that demonstrate the effectiveness of the treatment, and most of them are ex vivo studies [ 19 , 21 ]. A recent study describes the mid to long-term outcomes of arthroscopy and PAUL compared to arthroscopy alone; however, it is a retrospective study [ 22 ].…”