Professor Noel Fitzpatrick treats an active springer spaniel called Luca for developmental elbow disease but after careful examination, he discovers that the problem is more progressive than originally thought. Noel and the team are tasked with operating on both elbows but an incident prior surgery throws a spanner into the works and the team find themselves against the clock to ensure Luca is operated on before the problem worsens.

Their Story

Mummy’s boy Luca lives with his family on a picturesque small holding in the Kent countryside. Barbara keeps dogs, horses, sheep, chickens, ducks and quails!

The Problem

Luca had been suffering from a limp since he was just a one year old puppy. He was originally treated at Fitzpatrick Referrals and had keyhole surgery to treat developmental elbow disease in his front left leg. Three years on, Luca is back in Noel’s consult room with Barbara, as the limp in his front left leg had returned. As an active dog living on a small holding, he enjoys the outdoors, is always on the move and adores swimming. The limp had become so severe that his movement was restricted and he could no longer enjoy an active lifestyle.

After examining Luca, Noel suggested that there were two possible scenarios that would explain the limp – a progressive crack in the joint, progressive erosion or both. Luca was immediately taken for a CT scan where Noel discovered that the problem was far worse than originally thought. Lucca had problems in both elbows with crevasses forming in both humerus bones. The problem had returned in the left elbow because it had never been given the opportunity to heal – unless Noel operated on both elbows to relieve the pressure on the joints, the problem would only worsen and eventually lead to fracture.

Luca was sent home ready to await his operation but during this short time, he fractured his front left leg in the garden. Barbara rushed him straight to Fitzpatrick Referrals, where the team had conduct an emergency operation on Luca’s fractured elbow.


The team at Fitzpatrick Referrals had to conduct an emergency operation on Luca’s elbow – placing a 4.5mm titanium screw through the fracture to stabilise it. Unfortunately this would make osteoarthritis very likely because the fracture was in the joint.

Six weeks after this surgery, Luca returned to see Noel who advised on the plan for his other affected elbow and any treatment that could be undertaken to reduce the impact on his healing left elbow. Noel made it clear that it was crucial the right elbow had to be operated on immediately, to avoid the risk of another fracture and to minimise the potential for osteoarthritis.

Luca was taken straight into surgery where Noel used an arthroscope to investigate the elbows. He initially checked to see if anything could be done to improve the outlook for the left elbow, as he was concerned about the surface of the ulna bone rubbing against the humeral bone. Noel decided to cut the ulna bone to change the angle of force on the affected part of the joint.

The next step involved treating Luca’s right elbow – as originally planned. To prevent the crevasse from total fracture, Noel cut the tendon that pulls the ulna bone against the humerus bone to relieve pressure on the joint. The next part of the operation involved placing a custom screw into the joint to hold the crevasse together. As it was a very tricky procedure, Noel used a 3D printed guide made from the CT scan of Luca’s elbow to navigate the screw in. Once the screw was placed over the fissure a carrier gel with bone morphogenic protein suspended in it was injected through a hole in the centre of the screw to stimulate bone growth.

Both operations went smoothly and Luca was reunited with his family just four days after the surgery – cage rest was needed. Unfortunately, Luca suffered a painful incident whilst he was out of his cage and Barbara returned to see Noel to check this incident hadn’t caused any further damage. CT scans showed that thankfully the healing was still progressing and Noel made it very clear that Luca needed to stick to his cage for rest recovery.

Noel’s given our dog another 8 years of active life and that’s immeasurable


After some much needed rest and healing, Luca was back in the fields with his family. He was even allowed to swim during the healing process and Barbara was thrilled to see how quickly Luca was back on his feet. He was back to his youthful ways and was finally free to live a pain-free life.