Humeral Intracondylar Fissure

What have we learned over the past 25 years?
Long before HIF was identified, it was recognized that spaniel breeds were more likely to suffer humeral condylar fractures than other breeds, and often during normal activity and without significant trauma. In 1994 Marcellin-Little & others described a mid-sagittal fissure in the humeral condyle of spaniels1. They coined the term ‘incomplete ossification of the humeral condyle (IOHC)’ on the assumption that the fissure represented a developmental failure of the two secondary centres of ossification of the humeral condyle to fuse.

With greater awareness of IOHC/HIF surgeons started to treat these cases. Some, but not all, dogs with an intracondylar fissure are lame. Stabilization of the humeral condyle with a transcondylar screw was therefore used to address lameness/elbow pain, but was also used to mitigate the risk of complete fracture of the humeral condyle. Initial reports of small case series indicated that reasonable results could be achieved with transcondylar screw fixation, with around 75% of lame dogs being free of lameness 2,3. Surgeons started to become aware however that placing a screw across the humeral condyle could lead to serious complications and anecdotally these complications were much more frequent than would be expected for similar surgeries. In 2011 Hattersley and others published a multi-centre study confirming this finding 4. In that study, a 60% overall complication rate and a 30% infection rate were reported. Factors predisposing to infection were increased body weight and placing the transcondylar screw as a positional screw rather than as a lag screw.  [...]