3D-planned correction of a forelimb angular limb deformity

Patient Overview

Oscar, a young neutered male small crossbreed, was seen for investigation of intermittent forelimb lameness that had not resolved with rest and anti-inflammatory medication.

His lameness was initially sporadic, but his owners had noticed stiffness and episodes where he would briefly lift the affected forelimb. Although Oscar was otherwise bright and well, the persistence of his signs raised concern that there may be an underlying orthopaedic cause rather than a simple soft tissue strain.

Initial presentation

On clinical assessment, Oscar’s lameness was subtle and intermittent, which is not uncommon in young dogs with conformational or developmental limb problems. Examination identified discomfort associated with the left elbow and carpus, together with mild carpal valgus.

Carpal valgus describes outward deviation of the lower limb at the wrist. In some patients this can reflect a deeper angular limb deformity, where the bones of the forelimb grow or rotate in a way that affects joint alignment. Because these cases can be difficult to fully understand from examination alone, advanced imaging was recommended to guide the next stage of decision-making.

Diagnostic assessment and planning

Oscar underwent CT assessment of the thoracic limb under sedation. CT is particularly helpful in angular limb deformity cases because it allows three-dimensional assessment of the limb, rather than relying only on standard two-dimensional radiographs.

The CT assessment identified abnormalities affecting the left radius and ulna, with bowing, mild radial subluxation and elbow incongruity. Elbow incongruity means that the joint surfaces do not meet as evenly as they should, which can contribute to discomfort and abnormal loading through the limb.

Joint taps were also performed from selected joints and were normal, helping to support a mechanical or conformational cause for Oscar’s signs rather than a primary inflammatory joint problem.

Following review of the CT, Oscar’s case was submitted for specialist 3D planning. Patient-specific 3D surgical guides were created to help plan the correction. These guides are designed from the individual patient’s CT scan and allow the planned bone cut and rotational correction to be transferred accurately into theatre.

Before surgery, Oscar’s owners were talked through the findings and the surgical plan. CAD images were used to help explain the proposed correction visually, which was particularly helpful in a case where the issue was not simply a visible bend in the leg, but a rotational angular deformity affecting overall limb alignment.

Surgery

Oscar underwent corrective surgery for his left forelimb angular limb deformity.

The aim of surgery was to improve alignment through the forearm, carpus and elbow by correcting the rotational component of the deformity. A patient-specific cutting guide was used to perform the planned bone correction, followed by a reduction guide to help position the limb in the corrected alignment. The correction was stabilised using two orthogonally placed locking plates. Post-operative imaging confirmed improved axial alignment of the paw, with the elbow and carpus appearing better aligned following correction.

Rather than focusing on implant detail alone, the key part of this procedure was the planning process: CT-based assessment, 3D modelling, patient-specific guides, careful execution in theatre, and immediate imaging to confirm the correction achieved.

Recovery and post-operative support

Oscar recovered well from his anaesthetic and was discharged with a structured post-operative plan.

Sedation support was also provided to help Oscar remain settled during the early rest period, which is often an important practical part of recovery in young, active dogs.

Oscar returned for a nurse-led recovery check, where his bandage was removed and the limb was assessed. He continued with strict rest and planned follow-up, including further wound assessment and scheduled post-operative radiographs.

Discussion

This case highlights several important points for referring vets.

Firstly, intermittent or subtle forelimb lameness in a young dog can still represent a significant underlying orthopaedic problem. Oscar’s signs were not dramatic in the consulting room, but his history, carpal alignment and elbow discomfort justified further investigation.

Secondly, CT was central to understanding the case. Angular limb deformities may involve angulation, rotation, joint incongruity, or a combination of these. CT allowed the limb to be assessed in three dimensions and gave the information needed for accurate planning.

Thirdly, patient-specific 3D printed guides can be very useful where rotational correction is required. These cases are technically demanding because the aim is not simply to straighten the limb, but to restore more appropriate alignment through several connected joints. The guides helped translate the planned correction into surgery in a controlled and repeatable way.

Finally, owner communication was an important part of the case. Oscar’s owners were supported through the diagnostic process, estimate and insurance planning, surgical explanation, discharge, and recovery. For referring vets, this continuity helps ensure that clients feel informed and supported throughout the referral journey.

Outcome

Oscar’s early post-operative progress was encouraging. At follow-up he was reported to be doing well, with no lameness noted, and his surgical wound was healing appropriately.

Further radiographic assessment was planned to monitor bone healing and implant position as part of his ongoing recovery. 

Referral/service summary

Oscar’s case demonstrates how advanced imaging, careful surgical planning and patient-specific 3D printed guides can support the management of complex forelimb deformities. At East Kent Veterinary Referrals, our orthopaedic service is designed to provide practical, collaborative support for vets across the Canterbury and wider Kent area, managing challenging lameness cases, while keeping clients informed and reassured throughout.

If you have a patient with persistent forelimb lameness, suspected angular limb deformity, carpal valgus, elbow incongruity, or a case where CT assessment may help guide decision-making, our team would be happy to discuss the case and advise on referral options.