PAUL – Proximal Abducting Ulnar Osteotomy

Overview

The ALPS^® PAUL-I and ALPS^® PAUL-II plates impose a corrective limb alignment aimed at unloading the medial compartment of companion animals with medial compartment disease of the elbow.
PAUL is a novel new palliative technique showing particular benefit in younger patients treated prior to the advanced stages of osteoarthritis. The first generation ALPS^® PAUL-I plate was invented and developed by KYON in collaboration with Dr. Ingo Pfeil in 2007.

ALPS^® PAUL-I is the first generation PAUL plate based on ALPS^® Technology.
ALPS^® PAUL-II is a second generation PAUL plate. It is part of the ALPS^® Product Range and thus combines the biological benefits of ALPS^® Technology and the economical benefits of KYON Locking Screws KLS™.

• The implants offer strength and construct stability while minimizing damage of the vascular supply through ALPS^® Technology.
• Clinically proven. More than 5,000 patietns have been treated with ALPS^® PAUL-I and ALPS^® PAUL-II¹.
• Requires minimal instrumentation, consisting of drill bits, drill stops, drill sleeves and screwdriver inserts.

Biological principles of ALPS® Technology:

• Accelerated healing through minimal contact between plate and bone
  
• Use of monocortical locking screws prevents unnecessary damage of healthy bone and preserves vascular supply
• Superior biocompatibility and strength from Titanium

¹ Status April 2020

Principles

The PAUL technique was developed on the basis of multiple observations and biomechanical analyses of the canine elbow joint.

• A consequence of medial compartment disease, a subset of elbow dysplasia, is medial collapse of the contact mechanics of the elbow joint.
• Medial collapse overloads the medial compartment, exacerbating existing lameness and joint pain.
• A slight abduction, by four to six degrees, of the ulna results in an unloading of the medial compartment, alleviating pain.

Procedure

The PAUL involves an osteotomy of the proximal portion of the ulna. A specially designed ALPS PAUL plate is fixed to impose a corrective limb alignment, aimed at unloading the medial compartment. This new alignment unloads the medial compartment, alleviating lameness, stiffness, and joint pain.

Publications

Amadio A, Corriveau K, Norby B, Stephenson T, Sauders W
Effect of proximal abducting ulnar osteotomy (PAUL) on frontal plane thoracic limb alignment: An ex vivo canine study.
Veterinary Surgery. 2020;1–12 . DOI: 10.1111/vsu.13425

Starke A, Böttcher P, Pfeil I.
[Comparative radiologic examination of the canine elbow with and without elbow dysplasia under standardized load].
[Article in German] Tierarztl Prax Ausg K Kleintiere Heimtiere. 2014;42(3):141-50.

Starke A, Böttcher P, Pfeil I.
[Radiologic quantification of the elbow conformation with a new method for acquiring standardized x-rays under load. Reference values for medium sized and large dogs without dysplasia of the elbow joint].
[Article in German] Tierarztl Prax Ausg K Kleintiere Heimtiere. 2013;41(3):145-54.
¹Tierärztliche Klinik Dresdner Heide, Dresden. nestarkenachricht@msn.com

Fitzpatrick N¹, Yeadon R, Smith T, Schulz K.
Techniques of application and initial clinical experience with sliding humeral osteotomy for treatment of medial compartment disease of the canine elbow.
Vet Surg. 2009 Feb;38(2):261-78. doi: 10.1111/j.1532-950X.2008.00493.x.
¹Fitzpatrick Referrals, Eashing, UK. noelF@fitzpatrickreferrals.co.uk

Mason DR¹, Schulz KS, Fujita Y, Kass PH, Stover SM.
Measurement of humeroradial and humeroulnar transarticular joint forces in the canine elbow joint after humeral wedge and humeral slide osteotomies.
Vet Surg. 2008 Jan;37(1):63-70. doi: 10.1111/j.1532-950X.2007.00349.x.
¹JD Wheat Veterinary Orthopedic Research Laboratory, School of Veterinary Medicine, University of California-Davis, Davis, CA, USA.

Mason DR¹, Schulz KS, Fujita Y, Kass PH, Stover SM.
In vitro force mapping of normal canine humeroradial and humeroulnar joints.
Am J Vet Res. 2005 Jan;66(1):132-5.
¹Department of Clinical Sciences, Iowa State University, Ames, IA 50011, USA.

Fujita Y¹, Schulz KS, Mason DR, Kass PH, Stover SM.
Effect of humeral osteotomy on joint surface contact in canine elbow joints.
Am J Vet Res. 2003 Apr;64(4):506-11.
¹Department of Surgical and Radiological Science, School of Veterinary Medicine, University of California, Davis, CA 95616, USA.

Technical Specifications

Are you looking for sizes, item numbers or required instruments or screws? Please download our catalog.

Courses

KYON offers PAUL courses so veterinary surgeons can perform the PAUL independently and incorporate the procedure into your clinical services.

Available PAUL Courses

PAUL – Course