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interrogation of diagnostic imaging and to encourage open-minded unbiased evidence-based adjudication
of outcomes of any physiotherapeutic, medical or surgical management protocol based on comparison of objectively scored elbow disease. This may help provide a starting framework upon which future developments can be structured. The algorithm should not be taken out of context and is no more than compartmentalisation of thought, opinion and experience combined with the techniques available to try to give families and clinicians some basis on which to make a decision regarding intervention for an individual dog affected by DED. The goal is to alleviate pain and optimise function for the longest possible period in clinically affected patients.
The algorithm balances the perceived in uence of mechanical, biological and clinical factors for a speci c dog being treated by the author. Due consideration
is given to the age of the patient, practical and
 nancial circumstance of the family, dietary and
medical management, intra-articular injections (both pharmaceutical and biological) and modalities of
physical therapy, but the main focus of the algorithm is classi cation of disease groups and apportionment of potential surgical intervention based on current availability of the technique, evidence for clinical application and author experience. In all cases, dogs affected by DED and operated by the author have kinetic assessment, clinical evaluation, anamnesis derived from consultation with the owner, radiography, CT scan and arthroscopic evaluation as pre-requisites for surgical intervention and decision making.
4 SCO Alone:
Coronoid disease with  ssuring or fragmentation of
any pattern but none or very limited disease of the
medial aspect of the humeral condyle and no measured incongruity. SCO for all RI and RIT fragmentation patterns because abaxial aspect of MCP is also diseased.
Diffuse medial coronoid disease Grade 1-3 with focal Grade 1 or 2 disease of the medial aspect of the humeral condyle.
6 BODPUO +/- FR or SCO:
Coronoid disease with or without fragmentation plus up to Grade 3 focal cartilage erosion of the coronoid or humerus with or without static or dynamic incongruity.
7 BODPUO + Anconeal headless compression screw:
Detached but not remodelled UAP.
8 BODPUO Alone:
HUI, HRI, RUI without coronoid fragmentation or UAP which is still  brous-attached.
9 Transcondylar 4.5 mm Ti screw, or shaft screw +/- reinforcing epicondylar plate or F2T2 screw:
Partial or complete thickness HIF.
Focal Grade 4 lesion of humerus constituting OCD.
+/- SCO for MCD
11 PAUL:
Diffuse Grade 3 or focal Grade 4 lesions of humerus opposing MCD.
12 SHO and cSHO:
Diffuse Grade 4 lesions of humerus opposing MCD in a young to middle-aged without aggressive periarticular osteophytosis or HRI. Radial head intact.
13 CUE and cMCR:
Diffuse Grade 4 or 5 lesions humerus and coronoid
+/- limited erosion of medial edge of radial head due to medial compartment collapse.
14 TER and cTER:
Global elbow arthrosis with pervasive Grade 5 lesions
of medial compartment and across humeral isthmus, obvious disease extension onto the radial head and/or aggressive periarticular osteophytosis impairing range of motion.
Surgical procedures commonly employed by the author: 1 BURP:
(a) Low grade coronoid disease +/- RI or RIT  ssuring, none or very limited disease of the medial aspect of the humeral condyle, no static incongruity and no signi cant osteophytosis, usually young.
(b) In elbows affected by synovitis and low grade super cial coronoid disease contralateral to overt coronoid pathology requiring focal arthroscopic treatment, with a view to amelioration of disease progression.
(c) Ancillary to SCO or FR in cases of RI or RIT  ssure/ fragmentation to attempt amelioration of ongoing HUC.
2 DUO:
Less than 1-year-old with low grade coronoid disease of any kind +/- static or dynamic incongruity and without disease of the medial aspect of the humeral condyle.
3 FR:
Rare in isolation. Only with T fragmentation pattern and minimal cartilage disease caudal to the fragment or on opposing medial aspect of humeral condyle.
An Urban Experience

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