Bilateral elbow surgery tied to higher complication rates in dogs: full analysis

VERSION 2 — FULL ANALYSIS

A new Journal of Small Animal Practice study is sharpening the risk-benefit debate around bilateral elbow surgery in dogs with humeral intracondylar fissures and humeral condylar fractures. In a retrospective review of 75 dogs, bilateral simultaneous procedures were linked to significantly higher postoperative complication rates than unilateral surgery, with the reported risk rising as high as 2.22 times that seen in unilateral cases. The authors’ practical takeaway, based on the abstracted findings, is that delaying surgery on a prophylactic contralateral limb until clinical signs develop may reduce complications.

That conclusion matters because humeral intracondylar fissure, historically discussed alongside incomplete ossification of the humeral condyle, has long been a challenging problem in small animal orthopedics. These lesions can cause subtle forelimb lameness, or remain occult until a complete humeral condylar fracture occurs. The condition has been described particularly in spaniel breeds, while French bulldogs have also emerged as an important high-risk population for condylar fractures and contralateral fissures. Reviews and referral-center guidance have consistently noted that surgery can improve stability and reduce fracture risk, but not without a relatively high rate of postoperative complications compared with many other orthopedic procedures. (veterinary-practice.com)

The new study fits into that broader literature rather than standing alone. Earlier reports have documented substantial complication burdens after humeral condylar fracture repair and humeral intracondylar fissure stabilization, with risk influenced by factors such as surgical duration, residual fracture gap, implant choice, and screw orientation. One older study found the odds of a complication doubled for every additional 30 minutes of surgical time in lateral humeral condylar fracture repair. Another more recent report on transcondylar screw placement for humeral intracondylar fissure described overall complication rates high enough to keep prophylactic surgery controversial, even when long-term function was often acceptable. (pubmed.ncbi.nlm.nih.gov)

Breed-specific evidence has complicated the picture further. In French bulldogs, a recent retrospective single-centre series of 42 dogs with 43 unicondylar humeral fractures compared screw/plate with screw/pin epicondylar fixation and found no evidence that either method was superior. Most fractures were lateral (86%), perioperative follow-up showed 10% minor and 10% major I complications overall, and perioperative function was acceptable in 80% of dogs; long-term owner-reported osteoarthritis scores were mild. In other words, for unilateral fractures in this breed, both fixation strategies appear clinically workable, which shifts some of the decision-making emphasis away from construct choice and toward timing, patient selection, and whether a second elbow should be addressed at the same sitting. (pubmed.ncbi.nlm.nih.gov)

That nuance is useful because other French bulldog studies have raised concerns about specific constructs in specific settings. Prior work has suggested that fixation with a transcondylar screw plus K-wire(s) may be associated with increased risk of major complications and screw migration, while separate research in the breed has highlighted how often contralateral humeral intracondylar fissures are present when a dog presents with a humeral condylar fracture. Together, those findings help explain why surgeons are often tempted to intervene early on both sides—but also why the bilateral-surgery paper matters: it suggests that even if more than one fixation method is reasonable for a unilateral fracture, doing both elbows at once may still increase overall postoperative risk. (pubmed.ncbi.nlm.nih.gov)

Published commentary and educational reviews echo that the central clinical tension is prevention versus added surgical risk. Referral resources aimed at clinicians and pet parents note that bilateral imaging is often warranted because contralateral disease is common, but they also acknowledge that prophylactic fixation has historically carried a meaningful complication rate, including infection and implant-related problems. That makes the new bilateral-surgery paper especially relevant: it suggests the risk may not just be the procedure itself, but the decision to do both sides in one setting. (ndsr.co.uk)

Why it matters: For veterinary professionals, this study may influence case planning more than implant selection. In practice, the key question is often not whether a fissure exists, but whether an asymptomatic contralateral fissure should be stabilized immediately, staged later, or monitored. The newer French bulldog fixation data reinforce that point: if plate- and pin-based epicondylar fixation can deliver similar outcomes in unilateral cases, then the harder and potentially more consequential choice may be whether to operate on one limb or both. If bilateral simultaneous surgery truly raises complication risk by more than twofold, that could support a more conservative approach for some dogs, particularly when the second limb is prophylactic rather than painful or fractured. It also has implications for client communication with pet parents, including discussions about anesthesia time, recovery burden, revision risk, cost, and the possibility that treating the clinically affected side first may offer a safer path in selected cases. (pubmed.ncbi.nlm.nih.gov)

The study also underscores the need for sharper risk stratification. Not every contralateral fissure progresses, and newer reports suggest outcomes can vary widely depending on technique, patient selection, and follow-up period. Some recent data on transcondylar screw placement have reported lower complication rates than older series, which may reflect technical evolution or narrower case selection. At the same time, the French bulldog unicondylar fracture series is a reminder that acceptable function and mild long-term owner-reported osteoarthritis scores are achievable even when different fixation constructs are used. That means the bilateral-surgery signal should probably be interpreted as a planning warning, not a blanket argument against prophylactic treatment. (pubmed.ncbi.nlm.nih.gov)

What to watch: The next step is likely more granular work on which dogs actually benefit from staged prophylactic fixation, which can be monitored safely, and whether breed, fissure characteristics on CT, implant choice, or total surgical time can predict complication risk well enough to guide individualized decisions. In French bulldogs especially, future studies may help clarify how much of outcome variation is driven by fixation method versus the broader surgical strategy of unilateral, staged bilateral, or simultaneous bilateral management. (pubmed.ncbi.nlm.nih.gov)